Percutaneous Pedicle-Lengthening Osteotomy in Minimal Invasive Spinal Surgery to Treat Degenerative Lumbar Spinal Stenosis: A Single-Center Preliminary Experience

Rosario Maugeri; Luigi Basile; Carlo Gulì; Aurelia Banco; Giovanna Giordano; Antonella Giugno; Francesca Graziano; Roberto Giuseppe Giammalva; Domenico Gerardo Iacopino

doi:10.1055/s-0038-1641148

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2018; 79(05): 365-371
DOI: 10.1055/s-0038-1641148

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Percutaneous Pedicle-Lengthening Osteotomy in Minimal Invasive Spinal Surgery to Treat Degenerative Lumbar Spinal Stenosis: A Single-Center Preliminary Experience

Rosario Maugeri

¹Department of Neurosurgery, Università Degli Studi di Palermo, Palermo, Italy

,

Luigi Basile

²Department of Experimental Biomedicine and Clinical Neurosciences, AOU Policlinico Paolo Giaccone, Palermo, Italy

,

Carlo Gulì

²Department of Experimental Biomedicine and Clinical Neurosciences, AOU Policlinico Paolo Giaccone, Palermo, Italy

,

Aurelia Banco

³Department of Radiology, Institute of Radiology, Palermo, Italy

,

Giovanna Giordano

³Department of Radiology, Institute of Radiology, Palermo, Italy

,

Antonella Giugno

²Department of Experimental Biomedicine and Clinical Neurosciences, AOU Policlinico Paolo Giaccone, Palermo, Italy

,

Francesca Graziano

²Department of Experimental Biomedicine and Clinical Neurosciences, AOU Policlinico Paolo Giaccone, Palermo, Italy

,

Roberto Giuseppe Giammalva

²Department of Experimental Biomedicine and Clinical Neurosciences, AOU Policlinico Paolo Giaccone, Palermo, Italy

,

Domenico Gerardo Iacopino

²Department of Experimental Biomedicine and Clinical Neurosciences, AOU Policlinico Paolo Giaccone, Palermo, Italy

› Author Affiliations

Abstract

Background Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal due to spinal degeneration, and its main clinical symptom is neurogenic claudication. Surgical treatment is pursued for patients who do not improve with conservative care. Patients with symptomatic LSS who also have significant medical comorbidities, although clearly in need of intervention, are unattractive candidates for traditional open lumbar decompressive procedures. Thus it is important to explore minimally invasive surgical techniques to treat select patients with LSS.

Methods This retrospective case series evaluated the clinical and radiographic outcomes of a new minimally invasive procedure to treat LSS: pedicle-lengthening osteotomy using the ALTUM system ((Innovative Surgical Designs, Inc., Bloomington, Indiana, United States). Peri- and postoperative demographic and radiographic data were collected from a clinical series of seven patients with moderate LSS who were > 60 years of age. Clinical outcome was evaluated using visual analog scale (VAS) scores and the spinal canal area on computed tomography scans.

Results Twelve months after the procedure, scoring revealed a median improvement of 3.7 on the VAS for the back and 6.3 on the VAS for the leg, compared with the preoperative baseline (p < 0.05). The postoperative central area of the lumbar canal was significantly increased, by 0.39 cm²; the right and left neural foramina were enlarged by 0.29 cm² and 0.47 cm², respectively (p < 0.05).

Conclusions In this preliminary study, the ALTUM system showed a good clinical and radiologic outcome 1 year after surgery. In an older or high-risk population, a short minimally invasive procedure may be beneficial for treating LSS.

Keywords

lumbar spinal stenosis - pedicle-lengthening osteotomy - minimal invasive spinal surgery - lumbar degenerative disease

Full Text

References

References
1 Richter A, Schütz C, Hauck M, Halm H. Does an interspinous device (Coflex) improve the outcome of decompressive surgery in lumbar spinal stenosis? One-year follow up of a prospective case control study of 60 patients. Eur Spine J 2010; 19 (02) 283-289
2 Gunzburg R, Keller TS, Szpalski M, Vandeputte K, Spratt KF. Clinical and psychofunctional measures of conservative decompression surgery for lumbar spinal stenosis: a prospective cohort study. Eur Spine J 2003; 12 (02) 197-204
3 Mobbs RJ, Li J, Sivabalan P, Raley D, Rao PJ. Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article. J Neurosurg Spine 2014; 21 (02) 179-186
4 Resnick DK, Watters III WC, Mummaneni PV. , et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: lumbar fusion for stenosis without spondylolisthesis. J Neurosurg Spine 2014; 21 (01) 62-66
5 Thomé C, Zevgaridis D, Leheta O. , et al. Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 2005; 3 (02) 129-141
6 Jalil Y, Carvalho C, Becker R. Long-term clinical and radiological postoperative outcomes after an interspinous microdecompression of degenerative lumbar spinal stenosis. Spine 2014; 39 (05) 368-373
7 Schöller K, Steingrüber T, Stein M. , et al. Microsurgical unilateral laminotomy for decompression of lumbar spinal stenosis: long-term results and predictive factors. Acta Neurochir (Wien) 2016; 158 (06) 1103-1113
8 Tye EY, Anderson JT, Haas AR. , et al. Decompression versus decompression and fusion for degenerative lumbar stenosis in a workers' compensation setting. Spine 2017; 42 (13) 1017-1023
9 Chopko BW. A novel method for treatment of lumbar spinal stenosis in high-risk surgical candidates: pilot study experience with percutaneous remodeling of ligamentum flavum and lamina. J Neurosurg Spine 2011; 14 (01) 46-50
10 Galarza M, Fabrizi AP, Maina R, Gazzeri R, Martínez-Lage JF. Degenerative lumbar spinal stenosis with neurogenic intermittent claudication and treatment with the Aperius PercLID System: a preliminary report. Neurosurg Focus 2010; 28 (06) E3
11 Rosen DS, O'Toole JE, Eichholz KM. , et al. Minimally invasive lumbar spinal decompression in the elderly: outcomes of 50 patients aged 75 years and older. Neurosurgery 2007; 60 (03) 503-509 ; discussion 509–510
12 Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br 1954; 36-B (02) 230-237
13 Maugeri R, Graziano F, Giugno A, Iacopino DG. A new concept to treat lumbar spine stenosis in a mini invasive way. J Neurosurg Sci 2017; 61 (03) 347-348
14 Mlyavykh S, Ludwig SC, Mobasser JP, Kepler CK, Anderson DG. Twelve-month results of a clinical pilot study utilizing pedicle-lengthening osteotomy for the treatment of lumbar spinal stenosis. J Neurosurg Spine 2013; 18 (04) 347-355
15 Kiapour A, Anderson DG, Spenciner DB, Ferrara L, Goel VK. Kinematic effects of a pedicle-lengthening osteotomy for the treatment of lumbar spinal stenosis. J Neurosurg Spine 2012; 17 (04) 314-320
16 Lauryssen C. Appropriate selection of patients with lumbar spinal stenosis for interspinous process decompression with the X STOP device. Neurosurg Focus 2007; 22 (01) E5
17 Lauryssen C. Technical advances in minimally invasive surgery: direct decompression for lumbar spinal stenosis. Spine 2010; 35 (26, Suppl) S287-S293
18 Airaksinen O, Herno A, Saari T. Surgical treatment of lumbar spinal stenosis: patients' postoperative disability and working capacity. Eur Spine J 1994; 3 (05) 261-264
19 Alimi M, Hofstetter CP, Pyo SY, Paulo D, Härtl R. Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates. J Neurosurg Spine 2015; 22 (04) 339-352
20 Deyo RA, Martin BI, Kreuter W, Jarvik JG, Angier H, Mirza SK. Revision surgery following operations for lumbar stenosis. J Bone Joint Surg Am 2011; 93 (21) 1979-1986
21 Jansson KA, Németh G, Granath F, Blomqvist P. Spinal stenosis re-operation rate in Sweden is 11% at 10 years—a national analysis of 9,664 operations. Eur Spine J 2005; 14 (07) 659-663
22 Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. 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 (08) 936-943
23 Aizawa T, Ozawa H, Kusakabe T. , et al. Reoperation rates after fenestration for lumbar spinal canal stenosis: a 20-year period survival function method analysis. Eur Spine J 2015; 24 (02) 381-387
24 Kim CH, Chung CK, Park CS. , et al. Reoperation rate after surgery for lumbar spinal stenosis without spondylolisthesis: a nationwide cohort study. Spine J 2013; 13 (10) 1230-1237
25 Ghogawala Z, Dziura J, Butler WE. , et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 2016; 374 (15) 1424-1434
26 Försth P, Ólafsson G, Carlsson T. , et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 2016; 374 (15) 1413-1423
27 Ghogawala Z, Resnick DK, Glassman SD, Dziura J, Shaffrey CI, Mummaneni PV. Randomized controlled trials for degenerative lumbar spondylolisthesis: which patients benefit from lumbar fusion?. J Neurosurg Spine 2017; 26 (02) 260-266
28 Banczerowski P, Lipóth L, Veres R. Bilateral “over the top” decompression through unilateral laminotomy for lumbar and thoracic spinal canal stenosis [in Hungarian]. Ideggyogy Sz 2007; 60 (11-12): 467-473
29 Härtl R, Korge A. Minimally Invasive Spine Surgery: Techniques, Evidence, and Controversies. Davos-Platz, Switzerland: AO Spine; 2012
30 Marcus JD, James AR, Härtl R. Minimally invasive surgical treatment options for lumbar disc herniations and stenosis. Semin Spine Surg 2011; 23 (01) 20-26
31 Costa F, Sassi M, Cardia A. , et al. Degenerative lumbar spinal stenosis: analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression. J Neurosurg Spine 2007; 7 (06) 579-586
32 Anderson PA, Tribus CB, Kitchel SH. Treatment of neurogenic claudication by interspinous decompression: application of the X STOP device in patients with lumbar degenerative spondylolisthesis. J Neurosurg Spine 2006; 4 (06) 463-471