Evaluation of the clinical and demographic data of patients requiring revision after lumbar spinal stenosis surger
Evaluation of the clinical and demographic data of patients requiring revision after lumbar spinal stenosis surger
Aim: This study aimed to evaluate the clinical and demographic data of patients requiring revision surgery after lumbar spinal stenosis (LSS) surgery and to provide a guide us in choosing primary surgical options.Material and Methods: This study was conducted as a single-center, descriptive, and retrospective study. LSS patients, who were operated upon using the same implant technique between 2012 and 2017, and subsequently underwent revision surgery due to implant failure and operated by the same surgeon were included. Medical records, preoperative and postoperative two-plan radiographs, and computed tomography (CT) scans of the primary and revision surgeries of the patients were evaluated.Results: A total of 19 patients (5 males, 14 females) with a mean age of 64.16 ± 7.9 years (range: 47 to 77 years) were included in the study. Most of the patients who underwent revision surgery were over 65 years of age and had a normal body mass index (BMI). In addition, 16 patients (84.2%) who underwent revision surgery were operated without transforaminal lumbar inter-body fusion (non-TLIF). L5-S1 was the most commonly seen level for spinal stenosis revision. The mean revision time was 245.26 ± 65.1 days (range: 135 to 342).Conclusion: Debates are ongoing between transforaminal lumbar inter-body fusion (TLIF) and non-TLIF surgery. In light of the data obtained through this study, we think that TLIF cage surgery should be included in the primary surgical procedure, especially at the lumbosacral junction, where it is difficult to obtain fusion to avoid revision in patients undergoing LSS surgery.
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- 1. Tsuchiya K, Bridwell KH, Kuklo TR, et al. Minimum 5-year analysis of L5–S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine 2006;31:303-8.
- 2. Crandall DG, Revella J, Patterson J, et al. Transforaminal lumbar interbody fusion with rhBMP-2 in spinal deformity, spondylolisthesis, and degenerative disease–part 1: large series diagnosis related outcomes and complications with 2-to 9-year follow-up. Spine 2013;38:1128-36.
- 3. Pietrantonio A, Trungu S, Famà I, et al. Long-term clinical outcomes after bilateral laminotomy or total laminectomy for lumbar spinal stenosis: a single-institution experience. Neurosurgical Focus 2019;46:2.
- 4. Yuce I, Kahyaoglu O, Cavusoglu HA, et al. Long- Term Clinical Outcome and Reoperation Rate for Microsurgical Bilateral Decompression via Unilateral Approach of Lumbar Spinal Stenosis. World neurosurgery 2019;125:465-72.
- 5. Leschke JM, Chen CC. Supplementing decompression with instrumented fusion for symptomatic lumbar spinal stenosis—a critical appraisal of available randomized controlled trials. Neurosurgical Review. 2020:1-6.
- 6. Cacan MA, Ucar BY. What every spine surgeon should know about transforaminal lumbar interbody fusion surgery for herniated discs. Int Orthop 2019;43:883-9.
- 7. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 2008;358:794-810.
- 8. Miscusi M, Trungu S, Forcato S, et al. Long-term clinical outcomes and quality of life in elderly patients treated with interspinous devices for lumbar spinal stenosis. J Neurol Surg B Skull Base Part A: Cent Eur Neurosurg 2018;79:139-44.
- 9. Katz JN, Lipson SJ, Chang LC, et al. Seven-to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 1996;21:92-7.
- 10. Kovacs FM, Urrútia G, Alarcón JD. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine 2011;36:1335-51.
- 11. Atlas SJ, Keller RB, Wu YA, et al. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine 2005;30:936-43.
- 12. Malmivaara A, Slätis P, Heliövaara M, et al. Surgical or nonoperative treatment for lumbar spinal stenosis?: a randomized controlled trial. Spine 2007;32:1-8.
- 13. Chang Y, Singer DE, Wu YA, Keller RB, Atlas SJ. The effect of surgical and nonsurgical treatment on longitudinal outcomes of lumbar spinal stenosis over 10 years. J Am Geriatr Soc 2005;53:785-92.
- 14. Phan K, Mobbs RJ. Minimally invasive versus open laminectomy for lumbar stenosis: a systematic review and meta-analysis. Spine 2016;41:91-100.
- 15. Schöller K, Steingrüber T, Stein M, et al. Microsurgical unilateral laminotomy for decompression of lumbar spinal stenosis: long-term results and predictive factors. Acta neurochirurgica 2016;158:1103-13.
- 16. Oppenheimer JH, DeCastro I, McDonnell DE. Minimally invasive spine technology and minimally invasive spine surgery: a historical review. Neurosurgical focus 2009;27:9.
- 17. Badlani N, Yu E, Kreitz T, et al. Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF). Clinical Spine Surgery 2020;33:62-4.
- 18. Majidi H, Shafizad M, Niksolat F, et al. Relationship Between Magnetic Resonance Imaging Findings and Clinical Symptoms in Patients with Suspected Lumbar Spinal Canal Stenosis: a Case-control Study. Acta Inform Med 2019;27:229.