Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Microdiscectomy
2%
29/1502
Bilateral laminectomies
4%
54/1502
Percutaneous posterior instrumented fusion
25/1502
Bilateral laminectomies and posterior instrumented fusion from L4-S1
37%
561/1502
Bilateral laminectomies and L4-L5 posterior instrumented fusion
54%
815/1502
Select Answer to see Preferred Response
Neurogenic claudication in the setting of lumbar stenosis with an associated spondylolisthesis or instability is best treated with decompression and fusion. Patients presenting with claudicatory symptoms should be scrutinized for neurological versus vascular causes. Identifying lower extremity pulses should be part of every physical exam. It is also important to note that the physical exam in patients with lumbar stenosis may be benign, as they are often seated during examination. For this reason, it is helpful to ambulate the patient in the office to provoke symptoms. Lastly, if instability is identified on standing or flexion/extension films, a fusion should be performed in most cases. Pearson et al. utilized the SPORT study to determine the modifiers of the treatment effect of surgery (the difference between surgical and nonoperative outcomes) for spinal stenosis patients using subgroup analysis. There were 419 patients enrolled in the surgical group and 235 in the non-surgical group. They determined that surgical treatment resulted in improved outcomes, except in smokers, compared to non-operative treatment of spinal stenosis. Chan et al. compared laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients. They looked at baseline, 3-month, and 12-month follow-up data and evaluated multiple factors, such as patient-reported outcomes (PROs), reoperations, baseline clinical characteristics, fusion, and readmission rates. They found significant improvements in PROs at 12 months in patients with and without fusions but superior Oswestry Disability Index scores in the fusion group. Fusion procedures were also associated with lower rates of reoperation. Figure A is a standing lateral XR demonstrating a degenerative spondylolisthesis at L4/L5. Figures B and C are T2 MRIs redemonstrating the slip and central and bilateral recess stenosis at the L4/L5 level. Note how the spondylolisthesis reduces when the patient is supine in the MRI scanner. This may account for dynamic symptoms only present with standing or activity. Incorrect Answers: Answer 1: A microdiscectomy is not indicated for lumbar stenosis unless the culprit is a disc herniation. Answer 2: Degenerative spondylolisthesis or spinal instability generally warrants a spinal fusion when symptomatic. Answer 3: A fusion alone will not decompress the spine. Answer 4: There is no need for a multilevel fusion; this may be warranted in a high-grade isthmic spondylolisthesis.
2.9
(19)
Please Login to add comment