Introduction
Materials and methods
Patient population
Magnetic resonance imaging
Treatment protocol
Outcome analyses
Risk assessment
Statistical methods
Results
Patient characteristics, preoperative symptoms, and comorbidities
Parameter | SEL | SEL+LSS | LSS | p-value |
---|---|---|---|---|
Clinical parameters | ||||
Total, n (%) | 31 (35.6) | 26 (29.9) | 30 (34.5) | |
Sex, n (%) | ||||
Male | 22 (25.3) | 21 (24.1) | 17 (19.5) | 0.6 |
Female | 9 (10.3) | 5 (5.7) | 13 (14.9) | 0.07 |
Age (yrs) | 69.2 ± 7.1 | 72.0 ± 8.9 | 68.5 ± 10.8 | 0.3 |
Body mass index (kg/m2) | 30.2 ± 5.5 | 27.5 ± 3.8 | 27.1 ± 4.8 | 0.03 |
Steroid long-term medication, n (%) | 7 (8.0) | 2 (2.3) | 0 | 0.01 |
Number of segments | 2.8 ± 1.8 | 2.4 ± 0.8 | 2.0 ± 1.1 | 0.07 |
Walking distance preoperatively (m) | 400.3 ± 636.7 | 161.3 ± 154.5 | 163.3 ± 127.3 | 0.04 |
VAS-N preoperatively | 6.2 ± 0.7 | 6.4 ± 0.8 | 6.2 ± 1.2 | 0.4 |
VAS-R preoperatively | 5.9 ± 0.6 | 6.2 ± 0.9 | 5.8 ± 1.4 | 0.3 |
Duration of stay (d) | 7.4 ± 3.0 | 8.3 ± 3.1 | 7.5 ± 2.1 | 0.4 |
Symptoms duration (mo) | 15.1 ± 23.4 | 18.2 ± 20.3 | 13.0 ± 19.0 | 0.6 |
Follow-up (mo) | 30.5 ± 16.7 | 48.7 ± 14.2 | 48.6 ± 16.8 | 0.0002 |
Surgical parameters | ||||
Surgery side, n (%) | ||||
Right | 13 (14.9) | 12 (13.8) | 18 (20.7) | 0.3 |
Left | 17 (19.5) | 12 (13.8) | 12 (13.8) | 0.5 |
Both-sided | 1 (1.1) | 2 (2.3) | 0 | 0.3 |
Previous surgery, n (%) | 11 (13.8) | 5 (9.2) | 3 (3.4) | 0.05 |
Index segment(s) | 8 (72.7) | 4 (80.0) | 2 (66.7) | 0.9 |
Other segment(s) | 3 (27.3) | 1 (20.0) | 1 (33.3) | |
Re-surgery, n (%) | 2 (2.3) | 0 | 1 (1.1) | 0.4 |
Period surgery-discharge (d) | 5.8 ± 2.2 | 6.3 ± 2.5 | 5.9 ± 2.1 | 0.7 |
Surgical time (min) | 177.6 ± 64.2 | 172.3 ± 70.8 | 168.9 ± 58.0 | 0.9 |
Bloodloss (ml) | 454.7 ± 513.2 | 372.3 ± 403.2 | 339.3 ± 335.4 | 0.5 |
SEL n = 31 (%) | SEL+LSS n = 26 (%) | LSS n = 30 (%) | p-value | |
---|---|---|---|---|
Borré classification [8], n (%) | ||||
Normal 0 | 0 | 0 | 0.99 | |
SEL I | 0 | 1 (3.8) | 0.4 | |
SEL II | 29 (93.5) | 18 (69.2) | 0.07 | |
SEL | 2 (6.5) | 7 (26.9) | 0.06 | |
Ishikawa classification [14], n (%) | ||||
Sagittal | ||||
Grade 1 | 4 (12.9) | 2 (7.7) | 0.7 | |
Grade 2 | 17 (54.8) | 19 (73.1) | 0.2 | |
Grade 3 | 10 (32.3) | 5 (16.1) | 0.4 | |
Axial | ||||
Grade 1 | 2 (6.5) | 3 (11.5) | 0.6 | |
Grade 2 | 18 (58.1) | 16 (61.5) | 0.99 | |
Grade 3 | 11 (35.4) | 7 (26.9) | 0.6 | |
Schizas classification[26], n (%) | ||||
A1 | 0 | 0 | 0.99 | |
A2 | 0 | 0 | 0.99 | |
A3 | 0 | 0 | 0.99 | |
A4 | 0 | 0 | 0.99 | |
B | 0 | 3 (10.0) | 0.2 | |
C | 20 (76.9) | 13 (43.3) | 0.01 | |
D | 6 (23.1) | 14 (46.7) | 0.1 |
Parameter | SEL n = 31 (%) | SEL+LSS n = 26 (%) | LSS n = 30 (%) | p-value |
---|---|---|---|---|
Symptoms preoperatively | ||||
Paresis | 18 (20.7) | 9 (10.3) | 16 (18.4) | 0.2 |
Sensory disorder | 22 (25.3) | 16 (18.4) | 14 (16.1) | 0.1 |
Lumbar pain | 28 (32.2) | 18 (20.7) | 16 (18.4) | 0.006 |
Radicular pain | 29 (33.3) | 23 (26.4) | 26 (29.9) | 0.7 |
Bladder/sphincter disorder | 1 (1.1) | 2 (2.3) | 0 | 0.3 |
Gait disturbance | 9 (10.3) | 2 (2.3) | 0 | 0.002 |
Spasticity | 0 | 0 | 0 | 0.99 |
Claudication | 30 (34.5) | 26 (29.9) | 20 (23.0) | 0.0001 |
Symptoms at dismission | ||||
Paresis | 9 (10.3) | 5 (5.7) | 5 (5.7) | 0.5 |
Sensory disorder | 7 (8.0) | 4 (4.6) | 5 (5.7) | 0.7 |
Lumbar pain | 2 (2.3) | 2 (2.3) | 1 (1.1) | 0.8 |
Radicular pain | 4 (4.6) | 2 (2.3) | 0 | 0.1 |
Bladder/sphincter disorder | 1 (1.1) | 0 | 0 | 0.4 |
Gait disturbance | 2 (2.3) | 1 (1.1) | 0 | 0.4 |
Spasticity | 0 | 0 | 0 | 0.99 |
Claudication | 2 (2.3) | 1 (1.1) | 1 (1.1) | 0.8 |
Symptoms at last FU | ||||
Paresis | 6 (6.9) | 3 (3.4) | 3 (3.4) | 0.6 |
Sensory disorder | 6 (6.9) | 4 (4.6) | 5 (5.7) | 0.9 |
Lumbar pain | 4 (4.6) | 3 (3.4) | 1 (1.1) | 0.4 |
Radicular pain | 1 (1.1) | 2 (2.3) | 0 | 0.2 |
Bladder/sphincter disorder | 1 (1.1) | 0 | 0 | 0.4 |
Gait disturbance | 0 | 0 | 0 | 0.99 |
Spasticity | 0 | 0 | 0 | 0.99 |
Claudication | 0 | 0 | 1 (1.1) | 0.4 |
Parameter | SEL n = 31 (%) | SEL+LSS n = 26 (%) | LSS n = 30 (%) | p-value |
---|---|---|---|---|
No co-morbidity | 1 (1.1) | 2 (2.3) | 3 (3.4) | 0.6 |
Diabetes mellitus | 8 (9.2) | 6 (6.9) | 7 (8.0) | 0.9 |
Arterial hypertension | 26 (29.9) | 16 (18.4) | 18 (20.7) | 0.08 |
Nicotine abuse | 10 (11.5) | 5 (5.7 | 5 (5.7) | 0.3 |
Peripheral artery disease | 9 (10.3) | 2 (2.3) | 5 (5.7) | 0.1 |
Coronary artery disease | 15 (17.2) | 8 (9.2) | 16 (18.4) | 0.2 |
Carpal tunnel syndrome | 1 (1.1) | 0 | 0 | 0.4 |
Osteoarthritis knee | 6 (6.9) | 2 (2.3) | 5 (5.7) | 0.4 |
Osteoarthritis hip | 2 (2.3) | 2 (2.3) | 3 (3.4) | 0.9 |
Lumbar spine syndrome | 7 (8.0) | 5 (5.7) | 10 | 0.4 |
Osteoporosis | 0 | 0 | 0 | 0.99 |
Rheumatoid arthritis | 0 | 1 (1.1) | 0 | 0.4 |
Obesity | 13 (14.9) | 8 (9.2) | 9 (10.3) | 0.5 |
Alcohol abuse | 3 (3.4) | 2 (2.3) | 2 (2.3) | 0.9 |
Cancer disease | 1 (1.1) | 4 (4.6) | 4 (4.6) | 0.3 |
Spine segmentation disorder | 0 | 0 | 0 | 0.99 |
Tethered cord | 0 | 0 | 0 | 0.99 |
Myelomeningocele | 0 | 0 | 0 | 0.99 |
Chiari malformation | 0 | 0 | 0 | 0.99 |
Epileptic seizures | 0 | 0 | 2 (2.3) | 0.1 |
Stroke | 0 | 2 (2.3) | 2 (2.3) | 0.3 |
Clubfoot | 0 | 0 | 0 | 0.99 |
Heart malformation | 0 | 1 (1.1) | 0 | 0.4 |
Hydrocephalus | 0 | 0 | 0 | 0.99 |
Secondary spinal tumor | 0 | 0 | 0 | 0.99 |
Outcome
Walking distance difference
Evaluation of VAS-N/-R
Evaluation of the Odom score
Odom score at dismission | ||||
Parameter | SEL n = 31 (%) | SEL+LSS n = 26 (%) | LSS n = 30 (%) | p-value |
1) Excellent | 12 (13.8) | 20 (23.0) | 20 (23.0) | 0.3 |
2) Good | 17 (19.5) | 5 (5.7) | 9 (10.3) | 0.01 |
3) Fair | 2 (2.3) | 1 (1.1) | 1 (1.1) | 0.8 |
4) Poor | 0 | 0 | 0 | 0.99 |
Odom score at FU | ||||
Parameter | SEL n = 31 (%) | SEL+LSS n = 23 (%) | LSS n = 28 (%) | p-value |
1) Excellent | 20 (24.4) | 19 (23.2) | 20 (24.4) | 0.3 |
2) Good | 10 (12.2) | 4 (4.9) | 8 (9.8) | 0.5 |
3) Fair | 1 (1.2) | 0 | 0 | 0.4 |
4) Poor | 0 | 0 | 0 | 0.99 |
Surgical morbidity and revision surgeries
Factors associated with SEL
Variable | Odds ratio | 95% CI | p-value |
---|---|---|---|
(A) Univariate analysis | |||
Sex (male vs female) | 1.1 | 0.4508 to 3.107 | 0.8 |
Symptoms preoperatively | |||
Paresis | 1.7 | 0.7116 to 4.233 | 0.2 |
Sensory disorder | 2.1 | 0.8480 to 5.602 | 0.1 |
Lumbar pain | 6.0 | 1.849 to 27.39 | 0.007 |
Radicular pain | 2.1 | 0.4632 to 14.53 | 0.4 |
Bladder/sphincter disorder | 0.9 | 0.04086 to 9.770 | 0.9 |
Gait disturbance | 11.1 | 2.594 to 76.38 | 0.0007 |
Claudication | 6.5 | 1.159 to 122.8 | 0.08 |
Co-morbidities | |||
Steroid long-term therapy | 7.9 | 0.5614 to 4.017 | 0.006 |
Diabetes mellitus | 1.1 | 0.4037 to 3.145 | 0.8 |
Arterial hypertension | 3.4 | 1.193 to 11.12 | 0.03 |
Nicotine abuse | 2.2 | 0.7877 to 6.141 | 0.1 |
Peripheral artery disease | 2.9 | 0.9500 to 8.981 | 0.06 |
Coronary artery disease | 1.2 | 0.5159 to 3.032 | 0.6 |
Osteoarthritis knee | 1.7 | 0.4935 to 5.589 | 0.4 |
Osteoarthritis hip | 0.7 | 0.09652 to 3.494 | 0.7 |
Lumbar spine syndrome | 0.8 | 0.2716 to 2.179 | 0.7 |
Obesity | 1.7 | 0.6613 to 4.149 | 0.3 |
Alcohol abuse | 1.4 | 0.2594 to 6.748 | 0.7 |
Cancer disease | 0.2 | 0.01051 to 1.170 | 0.1 |
(B) Multivariate analysis | |||
Lumbar pain | 2.7 | 0.07219 to 0.4630 | 0.008 |
Gait disturbance | 3.4 | 0.1863 to 0.7170 | 0.001 |
Steroid long-term therapy | 3.3 | 0.1903 to 0.7619 | 0.001 |
Arterial hypertension | 1.7 | -0.02849 to 0.3513 | 0.09 |