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?
Far Lateral Microdiscectomy at L4-5
6%
157/2717
Anterior Lumbar Interbody Fusion at L4-5
3%
74/2717
Direct Lateral Interbody Fusion with Lateral Plate L4-5
1%
28/2717
Laminectomy with unilateral approach preserving the Spinous Process, interspinous ligaments, and supraspinous ligaments
43%
1171/2717
L4-5 Laminectomy with Instrumented Fusion
46%
1263/2717
Select Answer to see Preferred Response
The patient has L4/5 spinal stenosis without evidence of spondylolithesis and has failed nonoperative treatment. Therefore, laminectomy alone is indicated. A laminectomy can be performed either by a traditional wide resection or a unilateral approach undercutting the spinous process in order to preserve the most posterior stabilizing structures. The patient reports symptoms that are classic for neurogenic claudication secondary to lumbar spinal stenosis. Lumbar laminectomy is the mainstay of surgical management of lumbar spinal stenosis in the absence of spondylolithesis. Conservative measures, including epidural steroid injections, have shown varying efficacy. Data from the Spine Patient Outcomes Research Trial (SPORT) have shown improvement in multiple domains in the operatively managed group. While newer 8-year data shows convergence of some endpoints, the benefit of surgery is still present Lurie et al. report on the 8-year follow data for the SPORT trial. Patients with symptomatic spinal stenosis show diminishing benefits of surgery in as-treated analyses of the randomized group between 4 and 8 years, whereas outcomes in the observational group remained stable. This is the only divergence in outcomes seen so far between the randomized and observational results. This suggests that the advantage of surgery in spinal stenosis likely does diminish over time. Weinstein et al. (2010), as part of the SPORT trial, found that surgical management of symptomatic lumbar stenosis with decompressive laminectomy resulted in greater improvement in pain, function, and satisfaction as compared to nonsurgical management. These advantages were maintained at four years of follow up. Figures A-D demonstrate L4/5 disc bulge and ligamentum flavum hypertrophy contribute to a severe narrowing of the vertebral canal and effacement of the lateral recesses. Moderate narrowing of both intervertebral foramina. Figure D is a cut looking at the facets at that level, notice how there is no fluid (hyperintensity) within the joints. Figure E demonstrates flexion and extension films without instability Incorrect answers: Answer 1: A far lateral microdiscectomy would not address the vertebral canal stenosis. Answers 2: There is no evidence of instability, therefore fusion is not indicated. Answer 3: There is no evidence of instability, therefore fusion is not indicated. Answer 5: There is no evidence of instability, therefore fusion is not indicated.
1.3
(46)
Please Login to add comment