Clinical Outcomes Following Decompression of Central Canal and Lateral Recess Simultaneous Stenosis, with a Focus on Multilevel Stenosis: A Randomized Comparison of Microscopic Bilateral Laminotomy versus Total Laminectomy with Posterior Spinal Fusion.

BACKGROUND: In patients with simultaneous lumbar central spinal stenosis (LCSS) and lateral recess stenosis (LRS) at multiple levels, spinal decompression using microscopic bilateral laminotomy was compared to total laminectomy plus medial facetectomy and fusion (LF). METHODS: From 2017 to 2022, this trial was performed to examine 96 patients with concomitant LCS and LRS at multilevel. Of the 96 patients, 48 were allocated to the following groups: LF (group I) or microscopic bilateral laminotomy (group II). However, 76 patients completed the study. We compared the outcomes in these 2 groups. RESULTS: Microscopic bilateral laminotomy was superior in most outcome measures. Delta-visual analog scale leg pain in group II was significantly greater than in group I (mean-group I: 4.368 vs. group II: 5.368, P value = 0.001). Complication and revision rates were lower in the microscopic bilateral laminotomy than in group I, except for incidental durotomy occurrence (group II: 31.58% -group I: 7.89%, P value = 0.0190). The rate of revision surgery for group I compared with group II was 44.74% versus 13.16% (P value = 0.0047), indicating the superiority of laminotomy over LF. The mean length of hospital stay was 3.551 ± 0.6349 in group II versus 6.774 ± 1.197 in group I (P value <0.0001). Also, blood loss during surgery was significantly lower in group II (P value <0.0001). CONCLUSIONS: The findings indicate that microscopic bilateral laminotomy provides favorable clinical and radiological outcomes for individuals experiencing multilevel lumbar central canal and LRS. However, a higher frequency of durotomy may occur during microsurgical procedures.

Pedicle Screw Fixation With Cement Augmentation Versus Without in the Treatment of Spinal Stenosis Following Posterior Spinal Fusion Surgery, Superiority According to Bone Mineral Density: A Three-Arm Randomized Clinical Trial.

OBJECTIVE: To investigate whether cement augmentation has an impact on clinical and radiologic outcomes following posterior spinal fusion (PSF) in low-density bones and whether its performance is comparable to regular bone density. METHODS: Between 2017 and 2021, 114 patients with spinal canal stenosis were enrolled to undergo PSF. They were initially stratified based on their bone mineral density: T-score ≥ -1.5: Group I (n = 34), and T-score < -1.5: Group II (n = 80). Furthermore, group II was randomly subdivided: II-A (unaugmented, n = 35) and II-B (bone cement augmented, n = 45). The primary and secondary endpoints of the study were evaluated using visual analog scales (VAS) and radiologic parameters, including screw loosening, screw or rod fractures, proximal junctional kyphosis (PJK), proximal junctional vertebral fracture (PJVF), and adjacent segment disease (ASD), at 1 year postoperatively. RESULTS: All 3 groups showed improvement in VAS scores, but the most significant improvements were seen in groups I and II-B. Group II-B had lower incidence rates of ASD, PJVF, PJK, rod, and screw fracture compared to group II-A, but only screw loosening was statistically significant (P < 0.0001). Contrary, there were statistically significant differences in all variables except for ASD and screw fracture (P = 0.0576 and 0.670, respectively) when comparing groups I and II-A. In both groups I and II-A, screw loosening was the most common complication following PSF, while only 5.41% of patients in group II-B experienced it. CONCLUSIONS: The efficacy of cement augmentation in mitigating pain and screw loosening following PSF surgery in low-density bones is comparable to that of normal-density bone.