Top

Acta Neurochirurgica

Published in:

01-03-2018 | Original Article - Spine

Decompressive surgery for lumbar spinal stenosis across the Atlantic: a comparison of preoperative MRI between matched cohorts from the US and Norway

Authors: Amandeep Bhalla, Thomas D. Cha, Clemens Weber, Ulf Nerland, Sasha Gulati, Greger Lønne

Published in: Acta Neurochirurgica | Issue 3/2018

Abstract

Background

There are no uniform guidelines regarding when to operate for Lumbar Spinal Stenosis (LSS). As we apply findings from clinical research from one population to the next, elucidating similarities or differences provides important context for the validity of extrapolating clinical outcomes. The aim of this study was to compare the morphological severity of lumbar spinal stenosis on preoperative MRI in patients undergoing decompressive surgery in Boston, USA, and Trondheim, Norway.

Methods

In this observational retrospective study, we compared morphological severity on MRI before surgical treatment between two propensity score-matched patient populations with single or two-level symptomatic LSS. We assessed the radiographic severity of LSS utilizing the Schizas classification (grade A to D).

Results

Following propensity score matching, demographics are balanced. In the Trondheim cohort, two levels decompression were present in 36.2% of the patients vs. 41.9% in Boston, (p = 0.396). There was no significant difference in grades A to D concerning central stenosis (p = 0.075). When dichotomized in mild/moderate (A/B) and severe /extreme (C/D), there were no significant differences in the rate of levels operated for high-grade stenosis (C/D), 67.6% in the Boston group compare to 78.1% in the Trondheim group (p = 0.088).

Conclusions

Trondheim, Norway, and Boston, US, have similar radiographic thresholds of LSS for offering surgery.

Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424. https://doi.org/10.1080/00273171.2011.568786 CrossRef

Bederman SS, Coyte PC, Kreder HJ, Mahomed NN, McIsaac WJ, Wright JG (2011) Whoʼs in the driverʼs seat? The influence of patient and physician enthusiasm on regional variation in degenerative lumbar spinal surgery. Spine 36:481–489. https://doi.org/10.1097/BRS.0b013e3181d25e6f CrossRefPubMed

Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259–1265. https://doi.org/10.1001/jama.2010.338 CrossRefPubMedPubMedCentral

Fritzell P, Hagg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study G (2001) 2001 Volvo Award winner in clinical studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish lumbar spine study group. Spine (Phila Pa 1976) 26:2521–2532 discussion 2532-2524CrossRef

Genevay S, Atlas SJ, Katz JN (2010) Variation in eligibility criteria from studies of radiculopathy due to a herniated disc and of neurogenic claudication due to lumbar spinal stenosis: a structured …. Spine. https://doi.org/10.1097/BRS.0b013e3181bc9454

Haig AJ, Park P, Henke PK, Yamakawa KS, Tomkins-Lane C, Valdivia J, Loar S (2013) Reliability of the clinical examination in the diagnosis of neurogenic versus vascular claudication. Spine J 13:1826–1834. https://doi.org/10.1016/j.spinee.2013.06.021 CrossRefPubMed

Kim HJ, Park JY, Kang KT, Chang BS, Lee CK, Yeom JS (2015) Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process. Eur Spine J 24:339–347. https://doi.org/10.1007/s00586-014-3441-5 CrossRefPubMed

Kovacs FM, Urrutia G, Alarcon JD (2011) Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine 36:E1335–E1351. https://doi.org/10.1097/BRS.0b013e31820c97b1 CrossRefPubMed

Lavis JN, Malter A, Anderson GM, Taylor VM, Deyo RA, Bombardier C, Axcell T, Kreuter W (1998) Trends in hospital use for mechanical neck and back problems in Ontario and the United States: discretionary care in different health care systems. Can Med Assoc J 158:29–36

10.

Lønne G, Ødegård B, Johnsen L, Solberg T, Kvistad K, Nygaard Ø (2014) MRI evaluation of lumbar spinal stenosis: is a rapid visual assessment as good as area measurement? Eur Spine J 23:1–5. https://doi.org/10.1007/s00586-014-3248-4 CrossRef

11.

Lønne G, Schoenfeld AJ, Cha TD, Nygaard ØP, Zwart JA, Solberg TK (2017) Variation in selection criteria and approaches to surgery for lumbar spinal stenosis among patients treated in Boston and Norway. Clin Neurol Neurosurg 156:77–82. https://doi.org/10.1016/j.clineuro.2017.03.008 CrossRefPubMed

12.

Mobbs RJ, Li J, Sivabalan P, Raley D, Rao PJ (2014) Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article. J Neurosurg Spine 21:179–186. https://doi.org/10.3171/2014.4.SPINE13420 CrossRefPubMed

13.

Nerland US, Jakola AS, Solheim O, Weber C, Rao V, Lonne G, Solberg TK, Salvesen O, Carlsen SM, Nygaard OP, Gulati S (2015) Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study. BMJ 350:h1603. https://doi.org/10.1136/bmj.h1603 CrossRefPubMedPubMedCentral

14.

Roder C, El-Kerdi A, Frigg A, Kolling C, Staub LP, Bach B, Muller U (2005) The Swiss Orthopaedic Registry. Bull Hosp Jt Dis 63:15–19PubMed

15.

Schizas C, Kulik G (2012) Decision-making in lumbar spinal stenosis; a survey on the influence of the morphology of the dural sac. J Bone Joint Surg Br 94B:98–101. https://doi.org/10.1302/0301-620X.94B1.27420 CrossRef

16.

Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G (2010) Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine 35:1919–1924. https://doi.org/10.1097/BRS.0b013e3181d359bd CrossRefPubMed

17.

Sengupta DK, Herkowitz HN (2005) Degenerative spondylolisthesis: review of current trends and controversies. Spine (Phila Pa 1976) 30:S71–S81CrossRef

18.

Sigmundsson FG, Jonsson B, Stromqvist B (2013) Impact of pain on function and health related quality of life in lumbar spinal stenosis. A register study of 14,821 patients. Spine (Phila Pa 1976) 38:E937–E945. https://doi.org/10.1097/BRS.0b013e3182955989 CrossRef

19.

Sirvanci M, Bhatia M, Ganiyusufoglu KA, Duran C, Tezer M, Ozturk C, Aydogan M, Hamzaoglu A (2008) Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J 17:679–685. https://doi.org/10.1007/s00586-008-0646-5 CrossRefPubMedPubMedCentral

20.

Steurer J, Roner S, Gnannt R, Hodler J, On behalf of the LumbSten Research Collaboration ZS (2011) Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord 12:175. https://doi.org/10.1186/1471-2474-12-175 CrossRefPubMedPubMedCentral

21.

Thome C, Zevgaridis D, Leheta O, Bazner H, Pockler-Schoniger C, Wohrle J, Schmiedek P (2005) Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3:129–141. https://doi.org/10.3171/spi.2005.3.2.0129 CrossRefPubMed

22.

Watters WC 3rd, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, Reitman CA, Shaffer WO, Summers JT, Toton JF, North American Spine S (2008) Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J 8:305–310. https://doi.org/10.1016/j.spinee.2007.10.033 CrossRefPubMed

23.

Weber C, Giannadakis C, Rao V, Jakola AS, Nerland U, Nygaard OP, Solberg TK, Gulati S, Solheim O (2016) Is there an association between radiological severity of lumbar spinal stenosis and disability, pain, or surgical outcome?: a multicenter observational study. Spine (Phila Pa 1976) 41:E78–E83. https://doi.org/10.1097/BRS.0000000000001166 CrossRef

24.

Weinstein JN, Tosteson TD, Lurie JD, Tosteson A (2010) Surgical versus non-operative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine. https://doi.org/10.1097/BRS.0b013e3181e0f04d

25.

Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H, Investigators S (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358:794–810. https://doi.org/10.1056/NEJMoa0707136 CrossRefPubMedPubMedCentral

Title: Decompressive surgery for lumbar spinal stenosis across the Atlantic: a comparison of preoperative MRI between matched cohorts from the US and Norway
Authors: Amandeep Bhalla
Thomas D. Cha
Clemens Weber
Ulf Nerland
Sasha Gulati
Greger Lønne
Publication date: 01-03-2018
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 3/2018
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-017-3460-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Decompressive surgery for lumbar spinal stenosis across the Atlantic: a comparison of preoperative MRI between matched cohorts from the US and Norway

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position

Current treatment concepts for iatrogenic ventriculitis: a nationwide survey in Germany

Non-functionalized soft alginate hydrogel promotes locomotor recovery after spinal cord injury in a rat hemimyelonectomy model

Association of decision-making in spinal surgery with specialty and emotional involvement—the Indications in Spinal Surgery (INDIANA) survey

A counterforce to diversion of cerebrospinal fluid during ventriculoperitoneal shunting: the intraperitoneal pressure. An observational study

Intramedullary ependymoma: long-term outcome after surgery