脊柱杂志

Lumbar Decompressive Laminectomy or Laminotomy for Degenerative Conditions: “ Outcome Comparison of Traditional Open versus Less Invasive Techniques ”

Abstract

Reginald Q Knight, Melissa Scribani, Nicole Krupa, Scott Grainger, Craig Goldberg, Carl Spivak and Paul Jenkins

Abstract Study design: Non-randomized chart review of elective lumbar decompression Objective: Compare patient outcome and health system economic impact associated with direct lumbar decompression. Summary of background data: Degenerative lumbar conditions refractory to non-operative measures are traditionally treated via open decompression. Less invasive techniques assisted by tubular retractors or endoscopic visualization continue to grow in popularity. Methods: 338 consecutive patients with spinal stenosis or disc herniation were treated with: Open, Tube-assisted, or Endoscope-assisted procedures based on the surgeons’ typical indications, practice pattern and procedure of choice. Cases stratified by stenosis requiring decompression without discectomy (Stenosis) or disc herniation requiring discectomy (Disc). Data collected preoperatively, one, four and ten months postoperatively. Within strata, perioperative demographics, intraoperative and postoperative complications, and functional outcomes were compared across procedure types. Outcome measures include VAS (back / leg), Oswestry and Medicare subset for Net revenue. Results: 234 Disc and 104 Stenosis cases. Stenosis patients were significantly older than Disc patients (67.0 vs. 52.3 years, p=0.0001). Disc cases: 42.7% Open, 36.8% Endoscope-assisted, 20.5% Tube-assisted. Stenosis cases: 36.5% Open, 63.5% Tube-assisted. Operative time, estimated blood loss, and length of stay were significantly greater for Open procedures both Disc and Stenosis. Disc cases fluoroscopy time was significantly greater for Endo (p<0.0001). Stenosis cases fluoroscopy time was significantly greater for Tube-assisted. Intraoperative complications occurred in 12 (3.5%) patients, 16 experienced postoperative events. A non-significant trend towards greater post-operative complication was seen in Open – stenosis group. Functional outcome improvements for ODI, VASB, and VASL were experienced regardless of case group or procedure type (p<0.0001). Medicare (n=107) revenue generated net positive regardless of case type or location. Conclusions: Functional improvement following treatment of degenerative lumbar conditions via direct decompression should be anticipated regardless of case group or procedure type. Despite their reduction in fluoroscopy, Open cases are associated with a significant increase in length of stay, operating time, estimated blood loss and potentially postoperative infections.