Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal stenos
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ORIGINAL ARTICLE
Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal stenosis: radiological results from a randomized controlled trial in the NORDSTEN study Erland Hermansen1,2,3 · Ivar Magne Austevoll2,3 · Christian Hellum4 · Kjersti Storheim5 · Tor Åge Myklebust6 · Jørn Aaen1,7 · Hasan Banitalebi8,9 · Masoud Anvar10 · Frode Rekeland2 · Jens Ivar Brox11 · Eric Franssen12 · Clemens Weber13,20 · Tore Solberg14,15 · Knut Jørgen Haug16 · Oliver Grundnes17 · Helena Brisby18,19 · Kari Indrekvam2,3 Received: 1 February 2020 / Revised: 27 May 2020 / Accepted: 3 June 2020 © The Author(s) 2020
Abstract Purpose To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Summary of background data Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. Methods The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. Results No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) m m2 in the UL-group, 71.9 (SD 37.1) m m2 in the BL-group and 68.1 (SD 41.0) m m2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. Conclusion For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area. Clinical trial registration The study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083. Keywords Randomized controlled trial · Lumbar spinal stenosis · Posterior decompression techniques · Dural sac area · MRI and lumbar spine surgery
Introduction Lumbar spinal stenosis (LSS) is a clinical and radiological entity with symptoms predominantly in the lower extremities, including reduced walking capability, neurogenic claudication and sometimes radicular pain. Symptoms are * Erland Hermansen Erland.hermansen@helse‑bergen.no Extended author information available on the last page of the article
associated with narrowing of the spinal canal [1] due to
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