Our Summary
This research paper is a comparison of two surgical methods used to treat lumbar spinal stenosis (LSS), a condition where the spinal canal in the lower back narrows, causing pain and discomfort. The two methods compared are full-endoscopic (FE) and microscopic (MI) lumbar decompression laminectomy, both of which aim to relieve pressure on the spinal cord or nerves.
Researchers looked at studies published between 2008 and 2020, with a total of 1,727 patients included in the analysis. The main outcomes they were interested in were measures of pain (using a visual analogue scale or VAS for leg and back pain) and disability (using the Oswestry Disability Index or ODI).
The results showed that, in the first 24 hours after surgery, patients who underwent the FE method experienced better pain control than those who underwent the MI method. This was true for both back and leg pain. The FE group also had a significantly lower score on the disability index than the MI group. After 6 months, the MI group had a lower disability score than the FE group, but after 12 months, the FE group did better again.
In simpler terms, the FE method seems to result in better pain control in the early days after surgery, both in the back and legs, and leads to shorter operation and hospital stay times. However, at 6 months post-surgery, the MI method seems to do better in terms of disability, but by 12 months, the FE method is back on top. So, the best choice of method may depend on the specific circumstances and needs of each patient.
FAQs
- What are the two surgical methods used to treat lumbar spinal stenosis (LSS)?
- According to the research, which surgical method provides better pain control in the first 24 hours after surgery?
- How do the results for disability vary between the full-endoscopic (FE) and microscopic (MI) methods at 6 months and 12 months post-surgery?
Doctor’s Tip
A helpful tip a doctor might give a patient about spinal decompression is to follow post-operative instructions carefully, including engaging in physical therapy and rehabilitation to strengthen the muscles supporting the spine and improve flexibility. This can help maintain the benefits of the surgery and prevent future issues. It is also important to maintain a healthy lifestyle, including regular exercise, a balanced diet, and avoiding smoking, as these factors can impact the success of the procedure and overall spinal health.
Suitable For
Patients who are typically recommended spinal decompression include those with lumbar spinal stenosis (LSS) who have not responded well to conservative treatments such as physical therapy, medications, and injections. Symptoms of LSS include lower back pain, leg pain, numbness, weakness, and difficulty walking or standing for long periods of time. Patients with severe symptoms that significantly impact their quality of life and daily activities may benefit from spinal decompression surgery.
It is important for patients to undergo a thorough evaluation by a spine specialist to determine if they are a good candidate for spinal decompression. Factors such as the severity of symptoms, the presence of spinal cord or nerve compression, overall health, and previous treatments should all be considered when deciding on the most appropriate treatment approach.
Overall, spinal decompression surgery is typically recommended for patients with moderate to severe symptoms of LSS that have not responded to conservative treatments. The choice between full-endoscopic and microscopic lumbar decompression laminectomy will depend on individual patient factors and preferences, as both methods have shown to be effective in relieving symptoms and improving quality of life for patients with LSS.
Timeline
Before spinal decompression surgery, a patient typically experiences symptoms such as back pain, leg pain, numbness, tingling, and weakness in the legs. They may have difficulty walking or standing for long periods of time, and their quality of life may be significantly impacted.
After spinal decompression surgery, the patient may experience immediate pain relief in the first 24 hours, especially if they undergo full-endoscopic (FE) lumbar decompression. They may also experience improved mobility and functionality as the pressure on the spinal cord or nerves is relieved. Over time, their pain levels may continue to decrease, and their overall disability may improve, leading to a better quality of life.
It is important for patients to follow their post-operative care instructions, including physical therapy and rehabilitation, to ensure the best possible outcome after spinal decompression surgery.
What to Ask Your Doctor
Some questions a patient should ask their doctor about spinal decompression include:
- What are the potential risks and complications associated with the surgical method being recommended?
- How long is the recovery period expected to be, and what kind of post-operative care will be needed?
- What are the success rates and outcomes of the surgical method compared to other treatment options?
- Will physical therapy or rehabilitation be necessary after the surgery, and if so, what does that entail?
- Are there any restrictions or limitations on activities that should be followed after the surgery?
- How long do the effects of the surgery typically last, and are additional procedures or treatments likely to be needed in the future?
- Can the doctor provide information on their experience and expertise in performing the specific surgical method being recommended?
- Are there any alternative treatments or less invasive procedures that could be considered before opting for surgery?
- What is the expected level of pain relief and improvement in function that can be achieved with the surgery?
- What is the overall prognosis for the patient’s condition in the long term, and what steps can be taken to prevent further issues in the future?
Reference
Authors: Tang S, Mok TN, He Q, Li L, Lai X, Sin TH, Deng J, Yu S, Li J, Wu H. Journal: Ann Palliat Med. 2021 Oct;10(10):10130-10146. doi: 10.21037/apm-21-198. Epub 2021 Sep 15. PMID: 34551575