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Nils H Ulrich - One of the best experts on this subject based on the ideXlab platform.
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Decompression Surgery alone versus Decompression plus fusion in symptomatic lumbar spinal stenosis a swiss prospective multicenter cohort study with 3 years of follow up
Spine, 2017Co-Authors: Nils H Ulrich, Francois Porchet, Jakob M Burgstaller, Mazda Farshad, Giuseppe Pichierri, Maria M Wertli, Johann Steurer, Ulrike HeldAbstract:STUDY DESIGN Retrospective analysis of a prospective, multicenter cohort study. OBJECTIVE To estimate the added effect of surgical fusion as compared to Decompression Surgery alone in symptomatic lumbar spinal stenosis patients with spondylolisthesis. SUMMARY OF BACKGROUND DATA The optimal surgical management of lumbar spinal stenosis patients with spondylolisthesis remains controversial. METHODS Patients of the Lumbar Stenosis Outcome Study with confirmed DLSS and spondylolisthesis were enrolled in this study. The outcomes of this study were Spinal Stenosis Measure (SSM) symptoms (score range 1-5, best-worst) and function (1-4) over time, measured at baseline, 6, 12, 24, and 36 months follow-up. In order to quantify the effect of fusion Surgery as compared to Decompression alone and number of decompressed levels, we used mixed effects models and accounted for the repeated observations in main outcomes (SSM symptoms and SSM function) over time. In addition to individual patients' random effects, we also fitted random slopes for follow-up time points and compared these two approaches with Akaike's Information Criterion and the chi-square test. Confounders were adjusted with fixed effects for age, sex, body mass index, diabetes, Cumulative Illness Rating Scale musculoskeletal disorders, and duration of symptoms. RESULTS One hundred thirty-one patients undergoing Decompression Surgery alone (n = 85) or Decompression with fusion Surgery (n = 46) were included in this study. In the multiple mixed effects model the adjusted effect of fusion compared with Decompression alone Surgery on SSM symptoms was 0.06 (95% confidence interval: -0.16-0.27) and -0.07 (95% confidence interval: -0.25-0.10) on SSM function, respectively. CONCLUSION Among the patients with degenerative lumbar spinal stenosis and spondylolisthesis our study confirms that in the two groups, Decompression alone and Decompression with fusion, patients distinctively benefited from surgical treatment. When adjusted for confounders, fusion Surgery was not associated with a more favorable outcome in both SSM scores as compared to Decompression alone Surgery. LEVEL OF EVIDENCE 3.
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the impact of incidental durotomy on the outcome of Decompression Surgery in degenerative lumbar spinal canal stenosis analysis of the lumbar spinal outcome study lsos data a swiss prospective multi center cohort study
BMC Musculoskeletal Disorders, 2016Co-Authors: Nils H Ulrich, Francois Porchet, Jakob M Burgstaller, Mazda Farshad, Giuseppe Pichierri, Johann Steurer, Florian Brunner, Ulrike HeldAbstract:Incidental durotomy is a well-known complication during Surgery for degenerative lumbar spinal stenosis (DLSS). In this prospective multicenter cohort study including eight medical centers our aim was to assess whether incidental durotomy during first-time lumbar spinal stenosis Decompression Surgery without fusion has an impact on long-term outcome. Patients of the multi-center Lumbar Stenosis Outcome Study (LSOS) with confirmed DLSS undergoing first-time Decompression without fusion were enrolled in this study. Baseline patient characteristics and outcomes were analyzed at 6, 12, and 24 months follow-up respectively with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). A total of 167 patients met the inclusion criteria. Fifteen (9 %) of those patients had an incidental durotomy. Baseline characteristics were similar between the durotomy and no-durotomy group. All patients improved over time. In the group of durotomy patients, the median improvement in SSM symptoms scale was 1.1 points at 6 months, 1.1 points at 12 months, and 1.6 points at 24 months after baseline. For the no-durotomy group, these improvements were 0.8, 0.9, and 0.9. For SSM function the improvements were 1.0, 0.8, and 0.9 in the durotomy group, and 0.6, 0.8, and 0.8 in the no-durotomy group. None of the between-group differences were statistically significant. Incidental durotomy in patients with DLSS undergoing first-time Decompression Surgery without fusion did not have negative effect on long-term outcome and quality of life. However, only 15 patients were included in the durotomy group but these findings remained even after adjusting for observed differences in baseline characteristics.
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the impact of obesity on the outcome of Decompression Surgery in degenerative lumbar spinal canal stenosis analysis of the lumbar spinal outcome study lsos a swiss prospective multicenter cohort study
Spine, 2016Co-Authors: Jakob M Burgstaller, Francois Porchet, Mazda Farshad, Johann Steurer, Ulrike Held, Florian Brunner, Nils H UlrichAbstract:STUDY DESIGN Prospective, multicenter cohort study including 8 medical centers of the Cantons Zurich, Lucerne, and Thurgau, Switzerland. OBJECTIVE The aim of the study was to assess whether obese patients benefit after Decompression Surgery for degenerative lumbar spinal stenosis (DLSS). SUMMARY AND BACKGROUND DATA Lumbar Decompression Surgery has been shown to improve quality of life in patients with DLSS. In the existing literature, the efficacy of lumbar Decompression in the obese population remains controversial. METHODS Baseline patient characteristics and outcomes were analyzed at 6 and 12 months follow-up with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). Body mass index (BMI) was classified into 3 categories according to the WHO. Minimal clinically important differences (MCIDs) in SSM for different BMI categories were considered as main outcome. RESULTS Of the 656 patients in the Lumbar Spinal Outcome Study database as of end of October 2014, 166 patients met the inclusion criteria. Fifty (30.1%) had a BMI less than 25 (underweight and normal weight group), 72 (43.4%) had a BMI between 25 and less than 30 (preobesity group), and 44 (26.5%) patients had a BMI at least 30 (obese group). We found for the main outcome that in obese patients 36% reached MCID at 6 months, and 48% at 12 months. The estimated odds ratios for MCID in the obese group were 0.78 (0.34-1.82) at 6 months and 0.99 (0.44-2.23) at 12 months in a logistic regression model adjusting for levels of laminectomy. In the additional outcomes, SSM, NRS, FT, and RMDQ showed statistically significant mean improvements in the 6 and 12 months follow-up. CONCLUSION Obese patients can expect clinical improvement after lumbar Decompression for DLSS, but the percentage of patients with a meaningful improvement is lower than in the group of patients with underweight, normal weight, and preobese weight at 6 and 12 months.
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clinical outcome in lumbar Decompression Surgery for spinal canal stenosis in the aged population a prospective swiss multicenter cohort study
Spine, 2015Co-Authors: Nils H Ulrich, Francois Porchet, Frank Kleinstuck, Christoph M Woernle, Alexander Antoniadis, Sebastian Winklhofer, Jakob M Burgstaller, Mazda Farshad, Joachim Oberle, Kan MinAbstract:STUDY DESIGN This is a prospective, multicenter cohort study including 8 medical centers in the metropolitan area of the Canton Zurich, Switzerland. OBJECTIVES To examine whether outcome and quality of life might improve after Decompression Surgery for degenerative lumbar spinal stenosis (DLSS) even in patients older than 80 years and to compare data with a younger patient population from our own patient collective. SUMMARY AND BACKGROUND DATA Lumbar Decompression Surgery without fusion has been shown to improve quality of life in lumbar spinal canal stenosis. In the population older than 80 years, treatment recommendations for DLSS show conflicting results. METHODS Eight centers in the metropolitan area of Zurich, Switzerland agreed on the classification of DLSS, surgical principles, and follow-up protocols. Patients were followed from baseline, at 6 months, and 12 months. Baseline characteristics were analyzed with 5 different questionnaires "Spinal Stenosis Measure, Feeling Thermometer, Numeric Rating Scale, 5D-3L, and Roland and Morris Disability Questionnaire." In addition, our study population was compared with a younger control group. Furthermore, we calculated the minimal clinically important differences. RESULTS Thirty-seven patients with an average age of 82.5 ± 2.5 years reached the 12-month follow-up. Spinal Stenosis Measure scores, the Feeling Thermometer, the Numeric Rating Scale, and the Roland and Morris Disability Questionnaire showed significant improvements at the 6-month and 12-month follow-ups (P < 0.001). One EQ-5D-3Lsubgroup "anxiety/depression" showed no significant improvement (P = 0.109) at 12-month follow-up. The minimal clinically important difference for the "Symptom Severity scale" in the Spinal Stenosis Measure was achieved with improvement of 70% in the older patient population. CONCLUSION Patients 80 years or older can expect a clinically meaningful improvement after lumbar Decompression for symptomatic DLSS. Our patient population showed significant positive development in quality of life in the short- and long-term follow-ups. LEVEL OF EVIDENCE 3.
Francois Porchet - One of the best experts on this subject based on the ideXlab platform.
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Decompression Surgery alone versus Decompression plus fusion in symptomatic lumbar spinal stenosis a swiss prospective multicenter cohort study with 3 years of follow up
Spine, 2017Co-Authors: Nils H Ulrich, Francois Porchet, Jakob M Burgstaller, Mazda Farshad, Giuseppe Pichierri, Maria M Wertli, Johann Steurer, Ulrike HeldAbstract:STUDY DESIGN Retrospective analysis of a prospective, multicenter cohort study. OBJECTIVE To estimate the added effect of surgical fusion as compared to Decompression Surgery alone in symptomatic lumbar spinal stenosis patients with spondylolisthesis. SUMMARY OF BACKGROUND DATA The optimal surgical management of lumbar spinal stenosis patients with spondylolisthesis remains controversial. METHODS Patients of the Lumbar Stenosis Outcome Study with confirmed DLSS and spondylolisthesis were enrolled in this study. The outcomes of this study were Spinal Stenosis Measure (SSM) symptoms (score range 1-5, best-worst) and function (1-4) over time, measured at baseline, 6, 12, 24, and 36 months follow-up. In order to quantify the effect of fusion Surgery as compared to Decompression alone and number of decompressed levels, we used mixed effects models and accounted for the repeated observations in main outcomes (SSM symptoms and SSM function) over time. In addition to individual patients' random effects, we also fitted random slopes for follow-up time points and compared these two approaches with Akaike's Information Criterion and the chi-square test. Confounders were adjusted with fixed effects for age, sex, body mass index, diabetes, Cumulative Illness Rating Scale musculoskeletal disorders, and duration of symptoms. RESULTS One hundred thirty-one patients undergoing Decompression Surgery alone (n = 85) or Decompression with fusion Surgery (n = 46) were included in this study. In the multiple mixed effects model the adjusted effect of fusion compared with Decompression alone Surgery on SSM symptoms was 0.06 (95% confidence interval: -0.16-0.27) and -0.07 (95% confidence interval: -0.25-0.10) on SSM function, respectively. CONCLUSION Among the patients with degenerative lumbar spinal stenosis and spondylolisthesis our study confirms that in the two groups, Decompression alone and Decompression with fusion, patients distinctively benefited from surgical treatment. When adjusted for confounders, fusion Surgery was not associated with a more favorable outcome in both SSM scores as compared to Decompression alone Surgery. LEVEL OF EVIDENCE 3.
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the impact of incidental durotomy on the outcome of Decompression Surgery in degenerative lumbar spinal canal stenosis analysis of the lumbar spinal outcome study lsos data a swiss prospective multi center cohort study
BMC Musculoskeletal Disorders, 2016Co-Authors: Nils H Ulrich, Francois Porchet, Jakob M Burgstaller, Mazda Farshad, Giuseppe Pichierri, Johann Steurer, Florian Brunner, Ulrike HeldAbstract:Incidental durotomy is a well-known complication during Surgery for degenerative lumbar spinal stenosis (DLSS). In this prospective multicenter cohort study including eight medical centers our aim was to assess whether incidental durotomy during first-time lumbar spinal stenosis Decompression Surgery without fusion has an impact on long-term outcome. Patients of the multi-center Lumbar Stenosis Outcome Study (LSOS) with confirmed DLSS undergoing first-time Decompression without fusion were enrolled in this study. Baseline patient characteristics and outcomes were analyzed at 6, 12, and 24 months follow-up respectively with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). A total of 167 patients met the inclusion criteria. Fifteen (9 %) of those patients had an incidental durotomy. Baseline characteristics were similar between the durotomy and no-durotomy group. All patients improved over time. In the group of durotomy patients, the median improvement in SSM symptoms scale was 1.1 points at 6 months, 1.1 points at 12 months, and 1.6 points at 24 months after baseline. For the no-durotomy group, these improvements were 0.8, 0.9, and 0.9. For SSM function the improvements were 1.0, 0.8, and 0.9 in the durotomy group, and 0.6, 0.8, and 0.8 in the no-durotomy group. None of the between-group differences were statistically significant. Incidental durotomy in patients with DLSS undergoing first-time Decompression Surgery without fusion did not have negative effect on long-term outcome and quality of life. However, only 15 patients were included in the durotomy group but these findings remained even after adjusting for observed differences in baseline characteristics.
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the impact of obesity on the outcome of Decompression Surgery in degenerative lumbar spinal canal stenosis analysis of the lumbar spinal outcome study lsos a swiss prospective multicenter cohort study
Spine, 2016Co-Authors: Jakob M Burgstaller, Francois Porchet, Mazda Farshad, Johann Steurer, Ulrike Held, Florian Brunner, Nils H UlrichAbstract:STUDY DESIGN Prospective, multicenter cohort study including 8 medical centers of the Cantons Zurich, Lucerne, and Thurgau, Switzerland. OBJECTIVE The aim of the study was to assess whether obese patients benefit after Decompression Surgery for degenerative lumbar spinal stenosis (DLSS). SUMMARY AND BACKGROUND DATA Lumbar Decompression Surgery has been shown to improve quality of life in patients with DLSS. In the existing literature, the efficacy of lumbar Decompression in the obese population remains controversial. METHODS Baseline patient characteristics and outcomes were analyzed at 6 and 12 months follow-up with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). Body mass index (BMI) was classified into 3 categories according to the WHO. Minimal clinically important differences (MCIDs) in SSM for different BMI categories were considered as main outcome. RESULTS Of the 656 patients in the Lumbar Spinal Outcome Study database as of end of October 2014, 166 patients met the inclusion criteria. Fifty (30.1%) had a BMI less than 25 (underweight and normal weight group), 72 (43.4%) had a BMI between 25 and less than 30 (preobesity group), and 44 (26.5%) patients had a BMI at least 30 (obese group). We found for the main outcome that in obese patients 36% reached MCID at 6 months, and 48% at 12 months. The estimated odds ratios for MCID in the obese group were 0.78 (0.34-1.82) at 6 months and 0.99 (0.44-2.23) at 12 months in a logistic regression model adjusting for levels of laminectomy. In the additional outcomes, SSM, NRS, FT, and RMDQ showed statistically significant mean improvements in the 6 and 12 months follow-up. CONCLUSION Obese patients can expect clinical improvement after lumbar Decompression for DLSS, but the percentage of patients with a meaningful improvement is lower than in the group of patients with underweight, normal weight, and preobese weight at 6 and 12 months.
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clinical outcome in lumbar Decompression Surgery for spinal canal stenosis in the aged population a prospective swiss multicenter cohort study
Spine, 2015Co-Authors: Nils H Ulrich, Francois Porchet, Frank Kleinstuck, Christoph M Woernle, Alexander Antoniadis, Sebastian Winklhofer, Jakob M Burgstaller, Mazda Farshad, Joachim Oberle, Kan MinAbstract:STUDY DESIGN This is a prospective, multicenter cohort study including 8 medical centers in the metropolitan area of the Canton Zurich, Switzerland. OBJECTIVES To examine whether outcome and quality of life might improve after Decompression Surgery for degenerative lumbar spinal stenosis (DLSS) even in patients older than 80 years and to compare data with a younger patient population from our own patient collective. SUMMARY AND BACKGROUND DATA Lumbar Decompression Surgery without fusion has been shown to improve quality of life in lumbar spinal canal stenosis. In the population older than 80 years, treatment recommendations for DLSS show conflicting results. METHODS Eight centers in the metropolitan area of Zurich, Switzerland agreed on the classification of DLSS, surgical principles, and follow-up protocols. Patients were followed from baseline, at 6 months, and 12 months. Baseline characteristics were analyzed with 5 different questionnaires "Spinal Stenosis Measure, Feeling Thermometer, Numeric Rating Scale, 5D-3L, and Roland and Morris Disability Questionnaire." In addition, our study population was compared with a younger control group. Furthermore, we calculated the minimal clinically important differences. RESULTS Thirty-seven patients with an average age of 82.5 ± 2.5 years reached the 12-month follow-up. Spinal Stenosis Measure scores, the Feeling Thermometer, the Numeric Rating Scale, and the Roland and Morris Disability Questionnaire showed significant improvements at the 6-month and 12-month follow-ups (P < 0.001). One EQ-5D-3Lsubgroup "anxiety/depression" showed no significant improvement (P = 0.109) at 12-month follow-up. The minimal clinically important difference for the "Symptom Severity scale" in the Spinal Stenosis Measure was achieved with improvement of 70% in the older patient population. CONCLUSION Patients 80 years or older can expect a clinically meaningful improvement after lumbar Decompression for symptomatic DLSS. Our patient population showed significant positive development in quality of life in the short- and long-term follow-ups. LEVEL OF EVIDENCE 3.
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the outcome of Decompression Surgery for lumbar herniated disc is influenced by the level of concomitant preoperative low back pain
European Spine Journal, 2011Co-Authors: Frank S Kleinstueck, Tamas F Fekete, Dezso Jeszenszky, Anne F Mannion, Dieter Grob, Friederike Lattig, U Mutter, Francois PorchetAbstract:Decompression Surgery is a common and generally successful treatment for lumbar disc herniation (LDH). However, clinical practice raises some concern that the presence of concomitant low back pain (LBP) may have a negative influence on the overall outcome of treatment. This prospective study sought to examine on how the relative severity of LBP influences the outcome of Decompression Surgery for LDH. The SSE Spine Tango System was used to acquire the data from 308 patients. Inclusion criteria were LDH, first-time Surgery, maximum 1 affected level, and Decompression as the only procedure. Before and 12 months after Surgery, patients completed the multidimensional Core Outcome Measures Index (COMI; includes 0–10 leg/buttock pain (LP) and LBP scales); at 12 months, global outcome was rated on a Likert scale and dichotomised into “good” and “poor” groups. In the “good” outcome group, mean baseline LP was 2.8 (SD 3.1) points higher than LBP; in the “poor” group, the corresponding value was 1.1 (SD 2.9) (p < 0.001 between groups). Significantly fewer patients with back pain as their “main problem” had a good outcome (69% good) when compared with those who reported leg/buttock pain (84% good) as the main problem (p = 0.04). In multivariate regression analyses (controlling for age, gender, co-morbidity), baseline LBP intensity was a significant predictor of the 12-month COMI score, and of the global outcome (each p < 0.05) (higher LBP, worse outcome). In conclusion, patients with more back pain showed significantly worse outcomes after Decompression Surgery for LDH. This finding fits with general clinical experience, but has rarely been quantified in the many predictor studies conducted to date. Consideration of the severity of concomitant LBP in LDH may assist in establishing realistic patient expectations before the Surgery.
Morio Matsumoto - One of the best experts on this subject based on the ideXlab platform.
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impact of lumbar hypolordosis on the incidence of symptomatic postoperative spinal epidural hematoma after Decompression Surgery for lumbar spinal canal stenosis
European Spine Journal, 2019Co-Authors: Nobuyuki Fujita, Osahiko Tsuji, Narihito Nagoshi, Mitsuru Yagi, Masaya Nakamura, Takehiro Michikawa, Satoshi Suzuki, Eijiro Okada, Takashi Tsuji, Morio MatsumotoAbstract:Purpose Potential associations between radiographic parameters and the incidence of symptomatic postoperative spinal epidural hematoma (PSEH) have not been identified. This study aimed to identify risk factors including radiographic parameters for symptomatic PSEH after posterior Decompression Surgery for lumbar spinal canal stenosis (LSS).
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impact of sagittal spinopelvic alignment on clinical outcomes after Decompression Surgery for lumbar spinal canal stenosis without coronal imbalance
Journal of Neurosurgery, 2015Co-Authors: Tomohiro Hikata, Nobuyuki Fujita, Naobumi Hosogane, Koota Watanabe, Akio Iwanami, Ken Ishii, Masaya Nakamura, Yoshiaki Toyama, Morio MatsumotoAbstract:OBJECT The object of this study was to investigate correlations between sagittal spinopelvic alignment and improvements in clinical and quality-of-life (QOL) outcomes after lumbar Decompression Surgery for lumbar spinal canal stenosis (LCS) without coronal imbalance. METHODS The authors retrospectively reviewed data from consecutive patients treated for LCS with Decompression Surgery in the period from 2009 through 2011. They examined correlations between preoperative or postoperative sagittal vertical axis (SVA) and radiological parameters, clinical outcomes, and health-related (HR)QOL scores in patients divided according to SVA. Clinical outcomes were assessed according to Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores. Health-related QOL was evaluated using the Roland-Morris Disability Questionnaire (RMDQ) and the JOA Back Pain Evaluation Questionnaire (JOABPEQ). RESULTS One hundred nine patients were eligible for inclusion in the study. Compared to patients with normal sag...
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posterior Decompression Surgery for extraforaminal entrapment of the fifth lumbar spinal nerve at the lumbosacral junction
Journal of Neurosurgery, 2010Co-Authors: Morio Matsumoto, Kota Watanabe, Ken Ishii, Masaya Nakamura, Yoshiaki Toyama, Takashi Tsuji, Hironari Takaishi, Kazuhiro ChibaAbstract:Object In this paper, the authors' goal was to elucidate the clinical features and results of Decompression Surgery for extraforaminal stenosis at the lumbosacral junction. Methods Twenty-eight patients with severe leg pain caused by extraforaminal stenosis at the lumbosacral junction (18 men and 10 women; mean age 68.2 ± 8.9 years) were treated by posterior Decompression without fusion using a microendoscope in 19 patients and a surgical microscope or loupe in 9 patients. The Decompression procedures consisted of partial resection of the sacral ala, the L-5 transverse process, and the L5–S1 facet joint along the L-5 spinal nerve. The following items were investigated: 1) preoperative neurological findings; 2) preoperative radiological findings, including plain radiographs, CT scans, selective radiculography of L-5; 3) surgical outcome as evaluated using the Japanese Orthopaedic Association scale for low-back pain (JOA score); and 4) need for revision Surgery. Results All patients presented with neurologi...
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posterior Decompression Surgery for extraforaminal entrapment of the fifth lumbar spinal nerve at the lumbosacral junction clinical article
Journal of Neurosurgery, 2010Co-Authors: Morio Matsumoto, Kota Watanabe, Ken Ishii, Masaya Nakamura, Yoshiaki Toyama, Takashi Tsuji, Hironari Takaishi, Kazuhiro ChibaAbstract:Object In this paper, the authors' goal was to elucidate the clinical features and results of Decompression Surgery for extraforaminal stenosis at the lumbosacral junction. Methods Twenty-eight patients with severe leg pain caused by extraforaminal stenosis at the lumbosacral junction (18 men and 10 women; mean age 68.2 ± 8.9 years) were treated by posterior Decompression without fusion using a microendoscope in 19 patients and a surgical microscope or loupe in 9 patients. The Decompression procedures consisted of partial resection of the sacral ala, the L-5 transverse process, and the L5–S1 facet joint along the L-5 spinal nerve. The following items were investigated: 1) preoperative neurological findings; 2) preoperative radiological findings, including plain radiographs, CT scans, selective radiculography of L-5; 3) surgical outcome as evaluated using the Japanese Orthopaedic Association scale for low-back pain (JOA score); and 4) need for revision Surgery. Results All patients presented with neurologi...
Jakob M Burgstaller - One of the best experts on this subject based on the ideXlab platform.
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Decompression Surgery alone versus Decompression plus fusion in symptomatic lumbar spinal stenosis a swiss prospective multicenter cohort study with 3 years of follow up
Spine, 2017Co-Authors: Nils H Ulrich, Francois Porchet, Jakob M Burgstaller, Mazda Farshad, Giuseppe Pichierri, Maria M Wertli, Johann Steurer, Ulrike HeldAbstract:STUDY DESIGN Retrospective analysis of a prospective, multicenter cohort study. OBJECTIVE To estimate the added effect of surgical fusion as compared to Decompression Surgery alone in symptomatic lumbar spinal stenosis patients with spondylolisthesis. SUMMARY OF BACKGROUND DATA The optimal surgical management of lumbar spinal stenosis patients with spondylolisthesis remains controversial. METHODS Patients of the Lumbar Stenosis Outcome Study with confirmed DLSS and spondylolisthesis were enrolled in this study. The outcomes of this study were Spinal Stenosis Measure (SSM) symptoms (score range 1-5, best-worst) and function (1-4) over time, measured at baseline, 6, 12, 24, and 36 months follow-up. In order to quantify the effect of fusion Surgery as compared to Decompression alone and number of decompressed levels, we used mixed effects models and accounted for the repeated observations in main outcomes (SSM symptoms and SSM function) over time. In addition to individual patients' random effects, we also fitted random slopes for follow-up time points and compared these two approaches with Akaike's Information Criterion and the chi-square test. Confounders were adjusted with fixed effects for age, sex, body mass index, diabetes, Cumulative Illness Rating Scale musculoskeletal disorders, and duration of symptoms. RESULTS One hundred thirty-one patients undergoing Decompression Surgery alone (n = 85) or Decompression with fusion Surgery (n = 46) were included in this study. In the multiple mixed effects model the adjusted effect of fusion compared with Decompression alone Surgery on SSM symptoms was 0.06 (95% confidence interval: -0.16-0.27) and -0.07 (95% confidence interval: -0.25-0.10) on SSM function, respectively. CONCLUSION Among the patients with degenerative lumbar spinal stenosis and spondylolisthesis our study confirms that in the two groups, Decompression alone and Decompression with fusion, patients distinctively benefited from surgical treatment. When adjusted for confounders, fusion Surgery was not associated with a more favorable outcome in both SSM scores as compared to Decompression alone Surgery. LEVEL OF EVIDENCE 3.
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the impact of incidental durotomy on the outcome of Decompression Surgery in degenerative lumbar spinal canal stenosis analysis of the lumbar spinal outcome study lsos data a swiss prospective multi center cohort study
BMC Musculoskeletal Disorders, 2016Co-Authors: Nils H Ulrich, Francois Porchet, Jakob M Burgstaller, Mazda Farshad, Giuseppe Pichierri, Johann Steurer, Florian Brunner, Ulrike HeldAbstract:Incidental durotomy is a well-known complication during Surgery for degenerative lumbar spinal stenosis (DLSS). In this prospective multicenter cohort study including eight medical centers our aim was to assess whether incidental durotomy during first-time lumbar spinal stenosis Decompression Surgery without fusion has an impact on long-term outcome. Patients of the multi-center Lumbar Stenosis Outcome Study (LSOS) with confirmed DLSS undergoing first-time Decompression without fusion were enrolled in this study. Baseline patient characteristics and outcomes were analyzed at 6, 12, and 24 months follow-up respectively with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). A total of 167 patients met the inclusion criteria. Fifteen (9 %) of those patients had an incidental durotomy. Baseline characteristics were similar between the durotomy and no-durotomy group. All patients improved over time. In the group of durotomy patients, the median improvement in SSM symptoms scale was 1.1 points at 6 months, 1.1 points at 12 months, and 1.6 points at 24 months after baseline. For the no-durotomy group, these improvements were 0.8, 0.9, and 0.9. For SSM function the improvements were 1.0, 0.8, and 0.9 in the durotomy group, and 0.6, 0.8, and 0.8 in the no-durotomy group. None of the between-group differences were statistically significant. Incidental durotomy in patients with DLSS undergoing first-time Decompression Surgery without fusion did not have negative effect on long-term outcome and quality of life. However, only 15 patients were included in the durotomy group but these findings remained even after adjusting for observed differences in baseline characteristics.
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the impact of obesity on the outcome of Decompression Surgery in degenerative lumbar spinal canal stenosis analysis of the lumbar spinal outcome study lsos a swiss prospective multicenter cohort study
Spine, 2016Co-Authors: Jakob M Burgstaller, Francois Porchet, Mazda Farshad, Johann Steurer, Ulrike Held, Florian Brunner, Nils H UlrichAbstract:STUDY DESIGN Prospective, multicenter cohort study including 8 medical centers of the Cantons Zurich, Lucerne, and Thurgau, Switzerland. OBJECTIVE The aim of the study was to assess whether obese patients benefit after Decompression Surgery for degenerative lumbar spinal stenosis (DLSS). SUMMARY AND BACKGROUND DATA Lumbar Decompression Surgery has been shown to improve quality of life in patients with DLSS. In the existing literature, the efficacy of lumbar Decompression in the obese population remains controversial. METHODS Baseline patient characteristics and outcomes were analyzed at 6 and 12 months follow-up with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). Body mass index (BMI) was classified into 3 categories according to the WHO. Minimal clinically important differences (MCIDs) in SSM for different BMI categories were considered as main outcome. RESULTS Of the 656 patients in the Lumbar Spinal Outcome Study database as of end of October 2014, 166 patients met the inclusion criteria. Fifty (30.1%) had a BMI less than 25 (underweight and normal weight group), 72 (43.4%) had a BMI between 25 and less than 30 (preobesity group), and 44 (26.5%) patients had a BMI at least 30 (obese group). We found for the main outcome that in obese patients 36% reached MCID at 6 months, and 48% at 12 months. The estimated odds ratios for MCID in the obese group were 0.78 (0.34-1.82) at 6 months and 0.99 (0.44-2.23) at 12 months in a logistic regression model adjusting for levels of laminectomy. In the additional outcomes, SSM, NRS, FT, and RMDQ showed statistically significant mean improvements in the 6 and 12 months follow-up. CONCLUSION Obese patients can expect clinical improvement after lumbar Decompression for DLSS, but the percentage of patients with a meaningful improvement is lower than in the group of patients with underweight, normal weight, and preobese weight at 6 and 12 months.
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clinical outcome in lumbar Decompression Surgery for spinal canal stenosis in the aged population a prospective swiss multicenter cohort study
Spine, 2015Co-Authors: Nils H Ulrich, Francois Porchet, Frank Kleinstuck, Christoph M Woernle, Alexander Antoniadis, Sebastian Winklhofer, Jakob M Burgstaller, Mazda Farshad, Joachim Oberle, Kan MinAbstract:STUDY DESIGN This is a prospective, multicenter cohort study including 8 medical centers in the metropolitan area of the Canton Zurich, Switzerland. OBJECTIVES To examine whether outcome and quality of life might improve after Decompression Surgery for degenerative lumbar spinal stenosis (DLSS) even in patients older than 80 years and to compare data with a younger patient population from our own patient collective. SUMMARY AND BACKGROUND DATA Lumbar Decompression Surgery without fusion has been shown to improve quality of life in lumbar spinal canal stenosis. In the population older than 80 years, treatment recommendations for DLSS show conflicting results. METHODS Eight centers in the metropolitan area of Zurich, Switzerland agreed on the classification of DLSS, surgical principles, and follow-up protocols. Patients were followed from baseline, at 6 months, and 12 months. Baseline characteristics were analyzed with 5 different questionnaires "Spinal Stenosis Measure, Feeling Thermometer, Numeric Rating Scale, 5D-3L, and Roland and Morris Disability Questionnaire." In addition, our study population was compared with a younger control group. Furthermore, we calculated the minimal clinically important differences. RESULTS Thirty-seven patients with an average age of 82.5 ± 2.5 years reached the 12-month follow-up. Spinal Stenosis Measure scores, the Feeling Thermometer, the Numeric Rating Scale, and the Roland and Morris Disability Questionnaire showed significant improvements at the 6-month and 12-month follow-ups (P < 0.001). One EQ-5D-3Lsubgroup "anxiety/depression" showed no significant improvement (P = 0.109) at 12-month follow-up. The minimal clinically important difference for the "Symptom Severity scale" in the Spinal Stenosis Measure was achieved with improvement of 70% in the older patient population. CONCLUSION Patients 80 years or older can expect a clinically meaningful improvement after lumbar Decompression for symptomatic DLSS. Our patient population showed significant positive development in quality of life in the short- and long-term follow-ups. LEVEL OF EVIDENCE 3.
Ulrike Held - One of the best experts on this subject based on the ideXlab platform.
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Decompression Surgery alone versus Decompression plus fusion in symptomatic lumbar spinal stenosis a swiss prospective multicenter cohort study with 3 years of follow up
Spine, 2017Co-Authors: Nils H Ulrich, Francois Porchet, Jakob M Burgstaller, Mazda Farshad, Giuseppe Pichierri, Maria M Wertli, Johann Steurer, Ulrike HeldAbstract:STUDY DESIGN Retrospective analysis of a prospective, multicenter cohort study. OBJECTIVE To estimate the added effect of surgical fusion as compared to Decompression Surgery alone in symptomatic lumbar spinal stenosis patients with spondylolisthesis. SUMMARY OF BACKGROUND DATA The optimal surgical management of lumbar spinal stenosis patients with spondylolisthesis remains controversial. METHODS Patients of the Lumbar Stenosis Outcome Study with confirmed DLSS and spondylolisthesis were enrolled in this study. The outcomes of this study were Spinal Stenosis Measure (SSM) symptoms (score range 1-5, best-worst) and function (1-4) over time, measured at baseline, 6, 12, 24, and 36 months follow-up. In order to quantify the effect of fusion Surgery as compared to Decompression alone and number of decompressed levels, we used mixed effects models and accounted for the repeated observations in main outcomes (SSM symptoms and SSM function) over time. In addition to individual patients' random effects, we also fitted random slopes for follow-up time points and compared these two approaches with Akaike's Information Criterion and the chi-square test. Confounders were adjusted with fixed effects for age, sex, body mass index, diabetes, Cumulative Illness Rating Scale musculoskeletal disorders, and duration of symptoms. RESULTS One hundred thirty-one patients undergoing Decompression Surgery alone (n = 85) or Decompression with fusion Surgery (n = 46) were included in this study. In the multiple mixed effects model the adjusted effect of fusion compared with Decompression alone Surgery on SSM symptoms was 0.06 (95% confidence interval: -0.16-0.27) and -0.07 (95% confidence interval: -0.25-0.10) on SSM function, respectively. CONCLUSION Among the patients with degenerative lumbar spinal stenosis and spondylolisthesis our study confirms that in the two groups, Decompression alone and Decompression with fusion, patients distinctively benefited from surgical treatment. When adjusted for confounders, fusion Surgery was not associated with a more favorable outcome in both SSM scores as compared to Decompression alone Surgery. LEVEL OF EVIDENCE 3.
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the impact of incidental durotomy on the outcome of Decompression Surgery in degenerative lumbar spinal canal stenosis analysis of the lumbar spinal outcome study lsos data a swiss prospective multi center cohort study
BMC Musculoskeletal Disorders, 2016Co-Authors: Nils H Ulrich, Francois Porchet, Jakob M Burgstaller, Mazda Farshad, Giuseppe Pichierri, Johann Steurer, Florian Brunner, Ulrike HeldAbstract:Incidental durotomy is a well-known complication during Surgery for degenerative lumbar spinal stenosis (DLSS). In this prospective multicenter cohort study including eight medical centers our aim was to assess whether incidental durotomy during first-time lumbar spinal stenosis Decompression Surgery without fusion has an impact on long-term outcome. Patients of the multi-center Lumbar Stenosis Outcome Study (LSOS) with confirmed DLSS undergoing first-time Decompression without fusion were enrolled in this study. Baseline patient characteristics and outcomes were analyzed at 6, 12, and 24 months follow-up respectively with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). A total of 167 patients met the inclusion criteria. Fifteen (9 %) of those patients had an incidental durotomy. Baseline characteristics were similar between the durotomy and no-durotomy group. All patients improved over time. In the group of durotomy patients, the median improvement in SSM symptoms scale was 1.1 points at 6 months, 1.1 points at 12 months, and 1.6 points at 24 months after baseline. For the no-durotomy group, these improvements were 0.8, 0.9, and 0.9. For SSM function the improvements were 1.0, 0.8, and 0.9 in the durotomy group, and 0.6, 0.8, and 0.8 in the no-durotomy group. None of the between-group differences were statistically significant. Incidental durotomy in patients with DLSS undergoing first-time Decompression Surgery without fusion did not have negative effect on long-term outcome and quality of life. However, only 15 patients were included in the durotomy group but these findings remained even after adjusting for observed differences in baseline characteristics.
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the impact of obesity on the outcome of Decompression Surgery in degenerative lumbar spinal canal stenosis analysis of the lumbar spinal outcome study lsos a swiss prospective multicenter cohort study
Spine, 2016Co-Authors: Jakob M Burgstaller, Francois Porchet, Mazda Farshad, Johann Steurer, Ulrike Held, Florian Brunner, Nils H UlrichAbstract:STUDY DESIGN Prospective, multicenter cohort study including 8 medical centers of the Cantons Zurich, Lucerne, and Thurgau, Switzerland. OBJECTIVE The aim of the study was to assess whether obese patients benefit after Decompression Surgery for degenerative lumbar spinal stenosis (DLSS). SUMMARY AND BACKGROUND DATA Lumbar Decompression Surgery has been shown to improve quality of life in patients with DLSS. In the existing literature, the efficacy of lumbar Decompression in the obese population remains controversial. METHODS Baseline patient characteristics and outcomes were analyzed at 6 and 12 months follow-up with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). Body mass index (BMI) was classified into 3 categories according to the WHO. Minimal clinically important differences (MCIDs) in SSM for different BMI categories were considered as main outcome. RESULTS Of the 656 patients in the Lumbar Spinal Outcome Study database as of end of October 2014, 166 patients met the inclusion criteria. Fifty (30.1%) had a BMI less than 25 (underweight and normal weight group), 72 (43.4%) had a BMI between 25 and less than 30 (preobesity group), and 44 (26.5%) patients had a BMI at least 30 (obese group). We found for the main outcome that in obese patients 36% reached MCID at 6 months, and 48% at 12 months. The estimated odds ratios for MCID in the obese group were 0.78 (0.34-1.82) at 6 months and 0.99 (0.44-2.23) at 12 months in a logistic regression model adjusting for levels of laminectomy. In the additional outcomes, SSM, NRS, FT, and RMDQ showed statistically significant mean improvements in the 6 and 12 months follow-up. CONCLUSION Obese patients can expect clinical improvement after lumbar Decompression for DLSS, but the percentage of patients with a meaningful improvement is lower than in the group of patients with underweight, normal weight, and preobese weight at 6 and 12 months.
