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  • Utility of Minimally-Invasive Single-level Spinal Fusion and Adjacent-level Laminectomy in patients with Multilevel Spinal Stenosis and Spondylolisthesis

    Final Number:

    Namath Syed Hussain MD; Mick J. Perez-Cruet MD MS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Low back pain is the second most common reason patients present to the emergency department and is the most common symptom that patients present with to spine surgeons. Many of these patients have multi-level spinal stenosis and spondylolisthesis, which is often treated with multi-level pedicle screw fixation and fusion, which can have significant morbidity. A retrospective chart review was performed to further evaluate success rates and complications associated with a more limited, minimally-invasive one-level spinal fusion and adjacent-level laminectomy in this cohort of patients.

    Methods: 20 patients (mean age of 66.7, range 52 – 77) presented to our clinic with intractable neurogenic claudication and low back pain (n = 18), radiculopathy (n = 16), difficulty walking (n = 11), and bowel/bladder dysfunction (n = 2). Patients had undergone conservative therapeutic measures, including oral pain medications (n = 10), physical therapy (n = 9), epidural steroid injections (n = 7), and chiropractic manipulation (n = 4) or a combination of these, with continued symptoms. Visual Analog scale, Short Form – 36, and Oswestry Disability Index scores were recorded preoperatively and postoperatively.

    Results: Patients underwent single-level transforaminal lumbar interbody fusion and adjacent-level laminectomy. Three patients underwent fusion at L3-4; 14 patients underwent fusion at L4-5; three patients underwent fusion at L5-S1. All patients had adjacent-level laminectomies performed concomitantly. These patients experienced excellent pain relief after surgery. Pre and Post-operative scores from the Visual Analog Scale, Short Form – 36, and Oswestry Disability index were recorded and analyzed. There was a statistically-significant (p < 0.01) improvement in all scales, except for the Mental Component of the SF-36 (p = 0.33). There were no intra-operative or postoperative complications.

    Conclusions: Minimally-invasive surgical interventions have the advantage of having decreased intra-operative and postoperative complications and morbidity. Patients with multi-level spinal stenosis and spondylolisthesis can be treated with a minimally-invasive single-level fusion and adjacent-level laminectomy with good results and potentially reduced cost.

    Patient Care: This clinical trial provides preliminary evidence for the utility of adjacent-level laminectomy when performing spinal fusion procedures, potentially reducing remote morbidity after surgery and also reducing costs.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the pathophysiology of the development of adjacent-level stenosis after spinal fusion procedures, 2) Discuss, in small groups, the utility of concomitant adjacent-level laminectomy in these patients, and 3) Identify future effective treatments for this phenomenon.


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