Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal stenosis: radiological results from a randomized controlled trial in the NORDSTEN study.,European Spine Journal

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Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal stenosis: radiological results from a randomized controlled trial in the NORDSTEN study.
European Spine Journal ( IF 2.8 ) Pub Date : 2020-06-18 , DOI: 10.1007/s00586-020-06499-0
Erland Hermansen _{1,

2,

3} , Ivar Magne Austevoll _{2,

3} , Christian Hellum ₄ , Kjersti Storheim ₅ , Tor Åge Myklebust ₆ , Jørn Aaen _{1,

7} , Hasan Banitalebi _{8,

9} , Masoud Anvar ₁₀ , Frode Rekeland ₂ , Jens Ivar Brox ₁₁ , Eric Franssen ₁₂ , Clemens Weber _{13,

14} , Tore Solberg _{15,

16} , Knut Jørgen Haug ₁₇ , Oliver Grundnes ₁₈ , Helena Brisby _{19,

20} , Kari Indrekvam _{2,

3}

Affiliation

Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway.
Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital,, Oslo, Norway.
Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.
Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Diagnostic Imaging, Akershus University Hospital,, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Unilabs Radiology, Oslo, Norway.
Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
Department of Orthopaedics, Stavanger University Hospital, Stavanger, Norway.
Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway.
Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.
Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsö, Norway.
Institute of Clinical Medicine, The Arctic University of Norway, Tromsö, Norway.
Departement of Orthopedic Surgery, Telemark Regional Hospital, Skien, Norway.
Department of Orthopedics, Akershus University Hospital, Oslo, Norway.
Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.
Department of Orthopaedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.

Purpose

To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis.

Summary of background data

Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques.

Methods

The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm², (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B.

Results

No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm² in the UL-group, 71.9 (SD 37.1) mm² in the BL-group and 68.1 (SD 41.0) mm² in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found.

Conclusion

For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area.

Clinical trial registration

The study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083.

中文翻译：

三种不同的腰椎管狭窄症后路减压技术后，硬膜囊面积的可比增加：NORDSTEN研究中的一项随机对照试验的放射学结果。

目的

目的探讨腰椎管狭窄症手术后三种减压方法后硬膜囊区的变化。

背景数据汇总

神经根减压是腰椎管狭窄症的主要外科治疗方法。这项研究的目的是放射学研究三种常用的后路减压技术。

方法

本研究报告了NORDSTEN研究中包括的两个多中心随机试验之一的数据。在本试验中，涉及437名接受手术治疗的患者，我们报告了三种不同的中线保留后路减压技术后的放射学结果：单侧剖腹术与交叉术（UL）（n = 146），双侧剖腹术（BL）（n = 142）和棘突截骨术（SPO）（n = 149）。术前和术后三个月进行MRI检查。在最狭窄的水平评估了硬膜囊面积和Schizas等级的增加。使用了三种不同的预定义的实质性减压手术指标：（1）术后硬膜囊面积> 100 mm ²，（2）硬脑膜囊面积增加至少50％，（3）术后Schizas A级或B级。