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Best Abstract in Spinal Neurosurgery: Minimally invasive solutions of complicated degenerative compressive lumbar spinal lesions
EANS Academy. Aydın Y. Sep 27, 2019; 281719
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Unilateral approaches allowed;
-sufficient and safe decompression of the neural structures,
-adequate preservation of vertebral stability (reducing the need for stabilization)
-resulted in a highly significant reduction of symptoms and disability,
-improved health-related quality of life,
-decrease the length of hospital stay and thereby the treatment costs.
Background: This present study was undertaken for analysis of 1093 patients with 3025 levels of degenerative lumbar spinal stenosis with or without degenerative spondylolisthesis, one/two level disc herniation, and/or far-lateral-disc-herniation who underwent bilateral decompression via a unilateral approach between 2000 and 2017. We have conducted a study to compare the initial chief complaint, neurological status and outcome of patients.
Methods: 168(15.3%) of 1093 patients underwent operation for lumbar stenosis associated with degenerative spondylolisthesis. Decompression was performed at more than 3 levels in 336(30.7%) patients. 261(23.8%) of 1093 patients underwent concomitant discectomies at the index level. All patients were followed-up regularly at intervals of 1,6,12 months, and were followed up annually thereafter. All patients underwent MR-imaging studies one year after surgery. Routine radiological investigations including neutral, flexion/extension lateral radiographs at these time intervals were taken routinely. Spinal canal size and (neutral and dynamic) slip percentages were measured both pre- and postoperatively. For clinical evaluations, Oswestry Disability Index (ODI), and Short Form–36 (SF-36) were used.
Results: Neutral and dynamic slip percentages did not significantly change after surgery (p=0.67 and p=0.61, respectively). The spinal canal was increased to 2,1–3.6-fold (mean 2.7 ± SD 0.3-fold) the preoperative size. The ODI scores decreased significantly in both the early and late follow-up evaluations, and good or excellent results were obtained in 934 cases (85.4%). The SF-36 scores demonstrated significant improvement in the late follow-up results (p<0.001).
Conclusions: Postoperative clinical improvement and radiological findings clearly demonstrated that the unilateral approach for treating complicated degenerative lumbar spinal lesions is a safe, effective, and real minimally invasive method in terms of reducing the need for stabilization.
Keywords: minimally invasive solutions, bilateral decompression via a unilateral approach, degenerative spondylolisthesis, far lateral disc herniation; complicated degenerative lumbar spinal lesions
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