Effects of Fluid Gelatin for Lumbar Spinal Stenosis Undergoing Lumbar Endoscopic Bilateral Decompression: A Prospective, Randomized Controlled Trial.
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In patients with lumbar spinal stenosis (LSS), prolonged compression of the epidural venous plexus heightens the risk of bleeding and hematoma during minimally invasive surgery. While absorbable fluid gelatin, an animal protein-based hemostatic agent, is available, its effectiveness in lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD) remains debated. Our research aims to conduct a prospective randomized controlled trial to investigate the effectiveness and safety of this hemostatic material in patients undergoing LE-ULBD for LSS. From October 2023 to July 2024, a total of 90 patients with LSS who underwent LE-ULBD were enrolled in this study. The 90 patients were randomly divided into two groups: fluid gelatin group (45 cases, using fluid gelatin) and null-fluid gelatin group (45 cases, not using fluid gelatin). Primary outcomes included the success rate of achieving hemostasis within 3 min and symptomatic postoperative epidural hematoma (SPEH). Secondary outcomes encompassed surgical time, intraoperative blood loss, perioperative blood loss, length of stay, and complications. Independent sample t tests were used to compare continuous data. Chi-squared tests and Fisher's exact probability tests were used to analyze the categorical data. The success rate of achieving hemostasis within 3 min (p < 0.05) was significantly higher in fluid gelatin group compared to that in the null-fluid gelatin group, and perioperative blood loss (p < 0.05) and surgical time (p < 0.05) were notably lower in the fluid gelatin group. However, there were no statistically significant differences between the two groups regarding intraoperative blood loss, length of stay, and complications, such as SPEH, allergy, and thrombus. In patients with LSS undergoing LE-ULBD surgery, using fluid gelatin can achieve rapid intraoperative hemostasis, shorten surgical time, and reduce perioperative blood loss without causing complications. Therefore, the conventional use of fluid gelatin in LE-ULBD surgery is an effective and safe strategy.Cite
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Study Design . A cohort series of the patients who underwent biportal endoscopic decompression (BPED) and conventional decompression for lumbar spinal stenosis were analyzed for tissue damage. Background: Posterior decompression has been the most common surgical procedure for lumbar spinal stenosis. Endoscopic decompression is a new surgical technique for spinal stenosis decompression. Subjective outcomes after the procedure, VAS and functional scores, were very satisfying but there were no reports published on the amount of tissue damage for this procedure. Objectives : To evaluate the paravertebral muscles and soft tissue destruction between two methods of spinal decompression by muscle enzyme, CRP and size of muscle destruction. Materials and Methods : Two groups of the patients, open decompression and BPED, who underwent spinal stenosis decompression were compared in postoperative outcomes such as modified Macnab criteria, VAS, CPK, and CRP. Results : The CRP and CPK level were significantly lower in BPED group than in open decompression group at 24 and 72 hours after surgery. ( p < 0.05) Size of soft tissue destructions after BPED were 35 + 18 milliliters. Conclusions : Postoperative CPK and CRP level of BPED were statistically significant lower than conventional laminectomy. Keywords : endoscope, biportal, two portal, spinal stenosis, decompression, CPK, CRP, muscle enzyme, tissue damage
Endoscope
Spinal decompression
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This study is aimed to establish accurate FE model of complete lumbar spine with complex lumbar spinal stenosis(LSS) and conduct comparasion and analysis with normal model and decompression treated model.Patients with complex LSS were selected for the collection of the CT scan data.Using special modeling system,the lumbar was meshing adaptively and auxiliary tissues were created interactively.The complete FE model of Lumbar with complex LSS as well as normal models was generated.Same boundary conditions were applied.Results showed that the active movement range of complex LSS decreased about 20%,but the decompression model increased about 40%,the model with lag screw increased about 25%,and the model with intervertebral fusion was stiffer than normal model.The stress in the decompression model increased about 70%,and the lag screw and intervertebral fusion have obvious decompression effect.The treatment of simple decompression for lumbar spine with complex LSS can release the pain,however may result in unstable and accelerated degeneration.The model with lag screw cannot provide full stability,and the model with intervertebral fusion can provide best treatment.
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The surgical methods of degenerative lumbar spinal stenosis include spinal decompression with or without instrumented or non-instrumented spinal fusion. Previous meta-analysis and systematic reviews have reported the contrast between surgical management and nonsurgical management for degenerative lumbar spinal stenosis, while no literature did among surgical managements. And it is evidenced that whether fusion should be added to spinal decompression in patients of lumbar spinal stenosis is still divisive. So our purpose is to identify whether spinal fusion with or without decompression has a better effect than decompression alone for patients with degenerative lumbar spinal stenosis.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) for reports before November 2014 and PubMed, EMBASE, GOOGLE SCHOLAR for those before December 2014. We also searched the reference lists included in studies and previous reviews. Randomized Controlled Trials and prospective or retrospective cohort studies of patients with degenerative lumbar spinal stenosis after spinal decompression with or without fusion were eligible. Abstracted outcomes from retrieved articles included clinical outcome and reoperation rate of two aspects. Both random-effects and fixed-effects models were used to calculate the end-points.We identified 23 studies with data collected from 61576 patients. The combined relative risk (RR) of clinical outcome for the spinal fusion compared with the spinal decompression was 0.91 (95% confidence interval [CI]: 0.85 to 0.98), and little evidence of heterogeneity was observed. Namely, a satisfactory clinical outcome was significantly more likely with fusion than with decompression alone. But there was a trend toward a higher reoperation rate with fusion compared with decompression alone (RR: 0.93; 95% CI: 0.88 to 0.97).This meta-analysis provides robust evidence of a better clinical outcome but a higher reoperation rate for spinal fusion compared with decompression alone.
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Aims We compared decompression alone to decompression with fusion surgery for lumbar spinal stenosis, with or without degenerative spondylolisthesis (DS). The aim was to evaluate if five-year outcomes differed between the groups. The two-year results from the same trial revealed no differences. Methods The Swedish Spinal Stenosis Study was a multicentre randomized controlled trial with recruitment from September 2006 to February 2012. A total of 247 patients with one- or two-level central lumbar spinal stenosis, stratified by the presence of DS, were randomized to decompression alone or decompression with fusion. The five-year Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were the EuroQol five-dimension questionnaire (EQ-5D), visual analogue scales for back and leg pain, and patient-reported satisfaction, decreased pain, and increased walking distance. The reoperation rate was recorded. Results Five-year follow-up was completed by 213 (95%) of the eligible patients (mean age 67 years; 155 female (67%)). After five years, ODI was similar irrespective of treatment, with a mean of 25 (SD 18) for decompression alone and 28 (SD 22) for decompression with fusion (p = 0.226). Mean EQ-5D was higher for decompression alone than for fusion (0.69 (SD 0.28) vs 0.59 (SD 0.34); p = 0.027). In the no-DS subset, fewer patients reported decreased leg pain after fusion (58%) than with decompression alone (80%) (relative risk (RR) 0.71 (95% confidence interval (CI) 0.53 to 0.97). The frequency of subsequent spinal surgery was 24% for decompression with fusion and 22% for decompression alone (RR 1.1 (95% CI 0.69 to 1.8)). Conclusion Adding fusion to decompression in spinal stenosis surgery, with or without spondylolisthesis, does not improve the five-year ODI, which is consistent with our two-year report. Three secondary outcomes that did not differ at two years favoured decompression alone at five years. Our results support decompression alone as the preferred method for operating on spinal stenosis. Cite this article: Bone Joint J 2024;106-B(7):705–712.
Oswestry Disability Index
Back Pain
Spinal decompression
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Back Pain
Spinal decompression
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Retrospective analysis of a prospective, multicenter cohort study.To estimate the added effect of surgical fusion as compared to decompression surgery alone in symptomatic lumbar spinal stenosis patients with spondylolisthesis.The optimal surgical management of lumbar spinal stenosis patients with spondylolisthesis remains controversial.Patients of the Lumbar Stenosis Outcome Study with confirmed DLSS and spondylolisthesis were enrolled in this study. The outcomes of this study were Spinal Stenosis Measure (SSM) symptoms (score range 1-5, best-worst) and function (1-4) over time, measured at baseline, 6, 12, 24, and 36 months follow-up. In order to quantify the effect of fusion surgery as compared to decompression alone and number of decompressed levels, we used mixed effects models and accounted for the repeated observations in main outcomes (SSM symptoms and SSM function) over time. In addition to individual patients' random effects, we also fitted random slopes for follow-up time points and compared these two approaches with Akaike's Information Criterion and the chi-square test. Confounders were adjusted with fixed effects for age, sex, body mass index, diabetes, Cumulative Illness Rating Scale musculoskeletal disorders, and duration of symptoms.One hundred thirty-one patients undergoing decompression surgery alone (n = 85) or decompression with fusion surgery (n = 46) were included in this study. In the multiple mixed effects model the adjusted effect of fusion compared with decompression alone surgery on SSM symptoms was 0.06 (95% confidence interval: -0.16-0.27) and -0.07 (95% confidence interval: -0.25-0.10) on SSM function, respectively.Among the patients with degenerative lumbar spinal stenosis and spondylolisthesis our study confirms that in the two groups, decompression alone and decompression with fusion, patients distinctively benefited from surgical treatment. When adjusted for confounders, fusion surgery was not associated with a more favorable outcome in both SSM scores as compared to decompression alone surgery.3.
Spinal Surgery
Surgical decompression
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Lumbar spinal stenosis is one of the most common spinal disorders in elderly patients, how to choose decompression alone or decompression plus fusion is still controversial. It was reported that the rate of decompression alone for lumbar stenosis was decreased, whereas the rate of decompression plus fusion was increased recently. Two recent multicenter RCTs papers published in the same issue of N Engl J Med compare the outcomes of decompression alone or decompression plus fusion for lumbar spinal stenosis currently. We combined the results from these two studies using the Stata software, we found that the decompression plus fusion had a significantly more blood loss and longer operative time. And no significant difference was found in the parameters of length of hospital stay, SF-36 Physical Component Summary, Oswestry Disability Index, Visual analogue scales of back pain and leg pain between decompression alone group and decompression plus fusion group. Therefore, based on the current evidence, we advocate a rethink on the decompression plus fusion trend chosen by surgeons, the indications of fusion should be restricted to the lumbar stenosis patients accompanied with spinal instability or deformity.
Oswestry Disability Index
Back Pain
Spinal decompression
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Surgical decompression
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Is interspinous process device implantation more effective in the short term (eight weeks) than conventional surgical decompression for patients with intermittent neurogenic claudication due to lumbar spinal stenosis?The use of interspinous implants did not result in a better outcome than conventional decompression, but the reoperation rate was significantly higher.Bony decompression and treatment with interspinous process devices are superior to conservative and non-surgical treatment for intermittent neurogenic claudication due to lumbar spinal stenosis. Interspinous implants surgery is not superior to bony decompression, and the reoperation rate is significantly higher.
Neurogenic claudication
Intermittent claudication
Surgical decompression
Claudication
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