Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

The efficacy of a novel spinous process osteotomy technique in the management of lumbar stenosis with and without degenerative spondylolisthesis (#42)

Lauren A Barber 1 2 , Stone Sima 2 , Charmian Stewart 2 , Alisha sial 2 , Ashish Diwan 2
  1. University of New South Wales, Kogarah, NSW, Australia
  2. Spine Service, St. George Hospital, Kogarah, NSW, Australia

INTRODUCTION: As the global life expectancy continues to rise, the incidence of degenerative spinal disease has also increased1,2. Lumbar decompression is a proven treatment for the management of degenerative spinal disease3. Though back and leg pain are key symptoms of both lumbar stenosis with (+DS) and lumbar stenosis without (-DS) degenerative spondylolisthesis, they are two different pathologies with different mechanisms of disease. Nevertheless, both pathologies can be managed with lumbar decompression. However, there is a paucity of literature evaluating patient reported outcomes (PROs) after lumbar decompression between +DS and -DS. This study aims to compare patient reported outcomes between patients undergoing decompression for +DS and -DS using a novel spinous process osteotomy decompression technique, which maintains midline attachments.

 

METHODS: This is a prospective cohort study of adult patients (>18 years old) who underwent 1-3 level lumbar decompression between 2020 and 2023 using a novel spinous process osteotomy technique. This technique involves a unilateral soft tissue exposure, an osteotomy at the junction of the spinous process and the lamina, and sub-spinous process contralateral exposure. Through this approach, bilateral decompression with maintenance of all midline attachments can be achieved. All patients had a diagnosis of lumbar stenosis with or without degenerative spondylolisthesis. In addition to demographic variables, comparison between pre-operative and post-operative back and leg visual analogue scale (VAS), Oswestry disability index (ODI), and European quality of life 5 dimension (EQ5D) at baseline, 3-, 6-, and 12-months were evaluated.

 

RESULTS: 93 total patients were included with an average age of 64±17 years. 53% of the patients were male and 59% had a diagnosis of -DS. Males had a higher rate of -DS compared to +DS (OR=2.5, p<0.05), patients with +DS were older (p=0.046). The -DS group had a higher EQ5D score at baseline than the +DS group (45 vs 31, p=0.02). However, there were no other significant differences in back VAS, leg VAS, ODI, or EQ5D at any time-point when comparing patients undergoing decompression for +DS vs -DS (Figure 1).

 

DISCUSSION: Though +DS and -DS are different degenerative pathologies, both groups had similar outcomes in pain, disability, and quality of life following decompression using this novel spinous process osteotomy decompression technique. Thus, these findings suggest lumbar decompression alone can be a useful strategy in lumbar stenosis both with and without degenerative spondylolisthesis. This is particularly important given the concerns for inducing or worsening instability with decompression of degenerative spondylolisthesis. These results can not only serve as a pre-operative clinical decision-making guide, but also as a post-operative expectation management tool in patients with degenerative spinal diseases.

 

Figure 1: +DS vs -DS outcomes at baseline, 3-, 6-, and 12-months for A) back VAS, B) leg VAS, C) ODI, and D) EQ5D.

 

6555a67d753ce-Figure+1_Decompression+in+Lumbar+Stenosis.png

  1. Lee CH, Chung CK, Kim CH, Kwon JW. Health Care Burden of Spinal Diseases in the Republic of Korea: Analysis of a Nationwide Database From 2012 Through 2016. Neurospine. Mar 2018;15(1):66-76. doi:10.14245/ns.1836038.019.
  2. Lucas JW, Connor EM, Bose J. Back, Lower Limb, and Upper Limb Pain Among U.S. Adults, 2019. NCHS Data Brief. Jul 2021;(415):1-8.
  3. Gadjradj PS, Basilious M, Goldberg JL, Sommer F, Navarro-Ramirez R, Mykolajtchuk C, Ng AZ, Medary B, Hussain I, Härtl R. Decompression alone versus decompression with fusion in patients with lumbar spinal stenosis with degenerative spondylolisthesis: a systematic review and meta-analysis. Eur Spine J. Mar 2023;32(3):1054-1067. doi: 10.1007/s00586-022-07507-1.