Clinical significance of postdecompression facet joint effusion after minimally invasive decompression for degenerative lumbar spinal stenosis
Journal
Journal of Spinal Disorders and Techniques
Journal Volume
27
Journal Issue
8
Date Issued
2014
Author(s)
Abstract
Study Design: A retrospective case series study.Objective: To investigate the clinical significance of postdecompression facet effusion (PDFE) after microendoscopic decompressive laminotomy (MEDL).Summary of Background Data: The facet joint effusion noted on magnetic resonance imaging was considered as an indicator of degeneration of the facet joints and segmental instability. PDFE occurring after MEDL might imply postdecompression segmental instability. Its clinical significance has not yet been clarified.Materials and Methods: From 2005 to 2010, 165 patients with degenerative lumbar spinal stenosis (average age: 64.5, average follow-up: 25.8mo) who received MEDL were reviewed. We investigated the incidence of PDFE with preoperative and repetitive magnetic resonance imaging at 6 months postoperatively. The clinical data and treatment courses were reviewed. The treatment outcomes were evaluated with Oswestry Disability Index and Japanese Orthopedic Association scores.Results: The incidence of PDFE was 17.0% (n =28), which was significantly higher in patients receiving multilevel decompression and patients with scoliosis or spondylolisthesis. The intensity of low back pain was similar between patients with and without PDFE, but "mechanical" low back pain was only noted in patients with PDFE. Of the 28 patients with PDFE, only 9 symptomatic patients required invasive treatment (5 facet joint steroid injection, 3 revision MEDL, and 1 spinal fusion). Although the postoperative Oswestry Disability Index and Japanese Orthopedic Association scores were significantly worse these 9 patients, the final outcomes were good. Progression of spondylolisthesis was noted in 2 patients without PDFE but no patients with PDFE during the follow-up period.Conclusions: The relatively high incidence of PDFE after MEDL suggests that injury to the integrity of facet joint is inevitable during decompression of the stenosis, even using minimally invasive techniques. However, the overall stability is well preserved with very rare progression of spondylolisthesis. Most patients with PDFE are asymptomatic. The prognosis of PDFE is very good. Spinal fusion is rarely indicated. Copyright ? 2014 by Lippincott Williams & Wilkins.
Subjects
Complication; Degenerative lumbar spinal stenosis; Facet joint effusion; Incidence; Magnetic resonance imaging; Microendoscopic decompression; Minimally invasive spine surgery; Postdecompression facet effusion; Segmental instability; Treatment outcomes
SDGs
Other Subjects
steroid; adult; aged; Article; asymptomatic disease; case study; cyst; degenerative lumbar spinal stenosis; disease course; female; follow up; functional status; human; intraspinal facet cyst; Japanese Orthopaedic Association score; low back pain; lumbar spinal stenosis; major clinical study; male; medical record review; microendoscopic decompressive laminotomy; minimally invasive surgery; nuclear magnetic resonance imaging; Oswestry Disability Index; postdecompression facet effusion; postdecompression facet effusion; postoperative complication; postoperative period; preoperative evaluation; prognosis; scoliosis; spine fusion; spine instability; spondylolisthesis; treatment outcome; adverse effects; back; complication; decompression surgery; disability; endoscopy; Intervertebral Disc Degeneration; low back pain; microsurgery; middle aged; minimally invasive surgery; pathology; Postoperative Complications; retrospective study; Spinal Stenosis; zygapophyseal joint; Aged; Decompression, Surgical; Disability Evaluation; Endoscopy; Female; Humans; Intervertebral Disc Degeneration; Low Back Pain; Lumbosacral Region; Magnetic Resonance Imaging; Male; Microsurgery; Middle Aged; Minimally Invasive Surgical Procedures; Postoperative Complications; Retrospective Studies; Spinal Stenosis; Treatment Outcome; Zygapophyseal Joint
Type
journal article