Minimally invasive decompression surgery for lumbar spinal stenosis with degenerative scoliosis: Predictive factors of radiographic and clinical outcomes.
There is ongoing controversy regarding the most appropriate surgical treatment for lumbar spinal stenosis (LSS) with concurrent degenerative lumbar scoliosis (DLS): decompression alone, decompression with limited spinal fusion, or long spinal fusion for deformity correction. The coexistence of degenerative stenosis and deformity is a common scenario; Nonetheless, selecting the appropriate surgical intervention requires thorough understanding of the patients clinical symptomatology as well as radiographic parameters. Minimally invasive (MIS) decompression surgery was performed for LSS patients with DLS. The aims of this study were (1) to investigate the clinical outcomes of MIS decompression surgery in LSS patients with DLS, and (2) to identify the predictive factors for both radiographic and clinical outcomes after MIS surgery. 438 consecutive patients were enrolled in this study. Inclusion criteria was evidence of LSS and DLS with coronal curvature measuring greater than 10°. The Japanese Orthopaedic Association (JOA) score, JOA recovery rate, low back pain (LBP), and radiographic features were evaluated preoperatively and at over 2 years postoperatively. Of the 438 patients, 122 were included in final analysis, with a mean follow-up of 2.4 years. The JOA recovery rate was 47.6%. LBP was significantly improved at final follow-up. Cobb angle was maintained for 2 years postoperatively (p = 0.159). Clinical outcomes in foraminal stenosis patients were significantly related to sex, preoperative high Cobb angle and progression of scoliosis (p = 0.008). In the severe scoliosis patients, the JOA recovery was 44%, and was significantly depended on progression of scoliosis (Cobb angle: preoperation 29.6°, 2-years follow-up 36.9°) and mismatch between the pelvic incidence (PI) and the lumbar lordosis (LL) (preoperative PI-LL 35.5 ± 21.2°) (p = 0.028). This study investigated clinical outcomes of MIS decompression surgery in LSS patients with DLS. The predictive risk factors of clinical outcomes were severe scoliosis, foramina stenosis, progressive scoliosis and large mismatch of PI-LL.
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan. Electronic address: minamide@wakayama-med.ac.jp.
Akihito
A
Minamide
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Munehito
M
Yoshida
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Hiroki
H
Iwahashi
Texas Back Institute, Dallas, TX, USA.
Andrew K
AK
Simpson
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Hiroshi
H
Yamada
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Hiroshi
H
Hashizume
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Yukihiro
Y
Nakagawa
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Hiroshi
H
Iwasaki
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Shunji
S
Tsutsui
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Ryohei
R
Kagotani
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Mayumi
M
Sonekatsu
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Takahide
T
Sasaki
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Kazunori
K
Shinto
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Tsuyoshi
T
Deguchi
D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007796:Laminectomy / Q000379:methods; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D011859:Radiography / Q000379:methods*; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013130:Spinal Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome