Minimally Invasive Decompression Versus X-Stop in Lumbar Spinal Stenosis. Issue 2 (15th January 2015)

• Record Type: Journal Article
• Authors: Lønne, Greger; Johnsen, Lars Gunnar; Rossvoll, Ivar; Andresen, Hege; Storheim, Kjersti; Zwart, John Anker; Nygaard, Øystein P.
• Is Part Of: Spine. Volume 40:Issue 2(2015)
• Publication Date: 2015-01-15
• Subjects: Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000000691
• Languages: English
• ISSNs: 0362-2436

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Study Design.</title> <p>Prospective randomized controlled multicenter study.</p> </sec> <sec> <title>Objective.</title> <p>To compare the effect of X-Stop with minimally invasive decompression (MID) in patients with neurogenic intermittent claudication due to lumbar spinal stenosis.</p> </sec> <sec> <title>Summary of Background Data.</title> <p>Lumbar spinal stenosis is the most common indication for operative treatment in elderly. Laminectomy has been the "gold standard, " but MID is now widely used. Another minimally invasive surgery option is X-Stop showing good result compared with nonoperative treatment, but showing higher reoperation rate than laminectomy.</p> </sec> <sec> <title>Methods.</title> <p>We enrolled 96 patients aged 50 to 85 years, with symptoms of neurogenic intermittent claudication within 250-m walking distance and 1- or 2-level lumbar spinal stenosis, randomized to either MID or X-Stop. Primary outcome was Zurich Claudication Questionnaire in this intention-to-treat analysis. Secondary outcome was Oswestry Disability Index, EuroQol 5-dimensional questionnaire, numerical rating scale 11 for lower back pain and leg pain, and risk for secondary surgery and complications.</p> </sec> <sec> <title>Results.</title> <p>No significant differences were found in Zurich Claudication Questionnaire between the groups at any follow-ups. Both groups had a statistical and clinical significant improvement at 6 weeks and throughout the 2-year observation period. The number of patients having secondary surgery due to persistent or recurrent symptoms was significantly higher in the X-Stop group, odds ratio (95% confidence interval) = 6.5 (1.3–31.9). Complication rate was similar and low, but more severe for MID.</p> </sec> <sec> <title>Conclusion.</title> <p>Both MID and X-Stop led to significant symptom improvements. There were no significant clinical differences in effect between the methods at any of the follow-up time points. X-Stop had significant higher risk of secondary surgery. Complication was more severe for MID.</p> <p> <bold>Level of Evidence:</bold> 2</p> </sec> </abstract>