Efficacy of an Outpatient Minimally Invasive Decompression Spine Surgery via Laminotomy and Foraminotomy

Presented at SMISS Annual Forum 2016
By Chip Wade
With Michael Weiss , Zolton Bereczki , Stefan Prada , Mark Flood , Reginald Davis ,

Disclosures: Chip Wade None Michael Weiss None, Zolton Bereczki None, Stefan Prada None, Mark Flood None, Reginald Davis None,

Introduction

Traditionally, lumbar stenosis is treated with an open, decompressive laminectomy with or without facetectomies. This has been a successful treatment for improvement of clinical symptoms but may unintentionally lead to cases of iatrogenic spinal instability, which may result in follow on surgical intervention for stabilization. Studies have shown that open decompressive laminectomies are effective for lumbar spinal stenosis (LSS) but may also disrupt the normal anatomical structures and function of the spine. Surgical decompression of LSS is one of the most common MISS surgery. Studies have shown significantly greater improvements in functional outcome and quality of life metrics with surgical intervention compared to conservative medical management. Recent research has shown decreased blood loss, shorter operative time, shorter hospital duration, decreased postoperative narcotic requirement, decreased rate of infection and CSF leak, and a decrease in time required for return to work as benefits of MISS approaches. 

Aims/Objectives

The current paper retrospectively examines one of the largest consecutive series of prospective outcomes of MISS Laminotomy Foraminotomy Decompression (LFD) for the treatment of LSS. 

Methods

500 consecutive primary lumbar MISS LFD patients were evaluated. Demographics were weighted more towards Medicaid age comorbities. Laryngeal mask anesthesia was used. Estimated blood loss (EBL), number of intraoperative and postoperative complications up to 30-days out (NOC), length of surgery (LOS), VAS and ODI both preoperatively and 12-months postoperatively were collected. Return to Work (RTW) was self-reported (return to full work status). 

Results

A significant decrease in VAS (p < 0.001) and ODI scores (p < 0.001) between preoperative and postoperative was observed. The average EBL was 48.48 ml and the LOS averaged at 61.17 min. There were no reported intraoperative or postoperative NOC. The average length of time to return to work for patients studied was 1.39 months from the time of their surgery. 

Conclusions

Results indicate that MISS for the treatment of LSS is associated with shorter operative times, lower complication rates, reduced return to work times, and minimal average EBL. Additionally patients who underwent MISS reported less pain and disability postoperatively than preoperatively. MISS LFD can be used to decompress the spinal canal as effectively as an open laminotomy and may prove to be beneficial in decreasing the complications and morbidity of standard treatments for lumbar stenosis. Our analysis provides evidence that MISS procedures result in fewer complications and improved patient outcomes regardless of patient demographics.