Outcome of unilateral versus standard open midline approach for bilateral decompression in lumbar spinal stenosis: is "over the top" really better? A Swiss prospective multicenter cohort study.

Ulrich, Nils H; Burgstaller, Jakob M; Gravestock, Isaac; Pichierri, Giuseppe; Wertli, Maria Monika; Steurer, Johann; Farshad, Mazda; , (2019). Outcome of unilateral versus standard open midline approach for bilateral decompression in lumbar spinal stenosis: is "over the top" really better? A Swiss prospective multicenter cohort study. Journal of neurosurgery - spine, 31(2), pp. 236-245. American Association of Neurological Surgeons 10.3171/2019.2.SPINE181309

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OBJECTIVEIn this retrospective analysis of a prospective multicenter cohort study, the authors assessed which surgical approach, 1) the unilateral laminotomy with bilateral spinal canal decompression (ULBD; also called "over the top") or 2) the standard open bilateral decompression (SOBD), achieves better clinical outcomes in the long-term follow-up. The optimal surgical approach (ULBD vs SOBD) to treat lumbar spinal stenosis remains controversial.METHODSThe main outcomes of this study were changes in a spinal stenosis measure (SSM) symptoms score, SSM function score, and quality of life (sum score of the 3-level version of the EQ-5D tool [EQ-5D-3L]) over time. These outcome parameters were measured at baseline and at 12-, 24-, and 36-month follow-ups. To obtain an unbiased result on the effect of ULBD compared to SOBD the authors used matching techniques relying on propensity scores. The latter were calculated based on a logistic regression model including relevant confounders. Additional outcomes of interest were raw changes in main outcomes and in the Roland and Morris Disability Questionnaire from baseline to 12, 24, and 36 months.RESULTSFor this study, 277 patients met the inclusion criteria. One hundred forty-nine patients were treated by ULBD, and 128 were treated by SOBD. After propensity score matching, 128 patients were left in each group. In the matched cohort, the mean (95% CI) estimated differences between ULBD and SOBD for change in SSM symptoms score from baseline to 12 months were -0.04 (-0.25 to 0.17), to 24 months -0.07 (-0.29 to 0.15), and to 36 months -0.04 (-0.28 to 0.21). For change in SSM function score, the estimated differences from baseline to 12 months were 0.06 (-0.08 to 0.21), to 24 months 0.08 (-0.07 to 0.22), and to 36 months 0.01 (-0.16 to 0.17). Differences in changes between groups in EQ-5D-3L sum scores were estimated to be -0.32 (-4.04 to 3.40), -0.89 (-4.76 to 2.98), and -2.71 (-7.16 to 1.74) from baseline to 12, 24, and 36 months, respectively. None of the group differences between ULBD and SOBD were statistically significant.CONCLUSIONSBoth surgical techniques, ULBD and SOBD, may provide effective treatment options for DLSS patients. The authors further determined that the patient outcome results for the technically more challenging ULBD seem not to be superior to those for the SOBD even after 3 years of follow-up.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Wertli, Maria Monika

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1547-5654

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Tobias Tritschler

Date Deposited:

25 Jun 2019 10:56

Last Modified:

18 May 2024 00:10

Publisher DOI:

10.3171/2019.2.SPINE181309

PubMed ID:

31026821

Uncontrolled Keywords:

CIRS = Cumulative Illness Rating Scale DLSS = degenerative lumbar spinal stenosis EQ-5D-3L = 3-level EQ-5D HADS = Hospital Anxiety and Depression Scale LSOS = Lumbar Stenosis Outcome Study MCID = minimal clinically important difference SMD = standardized mean difference SOBD = standard open bilateral decompression SSM = spinal stenosis measure ULBD = unilateral laminotomy with bilateral spinal canal decompression decompression degenerative lumbar spinal stenosis fusion laminectomy laminotomy lumbar fusion multicenter multilevel surgery

BORIS DOI:

10.7892/boris.130397

URI:

https://boris.unibe.ch/id/eprint/130397

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