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Title: Does laminectomy increase the
rate of adjacent segment disease?

          Macquarie Neurosurgery
   Evidence Based Surgery presentation
   Date: 24/5/2012


                                     EBS presentation   1
Clinical case


• 67 yo male
• Hx of previous laminectomy done elsewhere
• Presented with symptoms related to
  degeneration at the level above the
  laminectomy




                                       EBS presentation   2
Searchable question (PICO format)


•   P= patients with back pain
•   I= laminectomy
•   C= fusion
•   O= rate of ASD




                                 EBS presentation   3
EBS presentation   4
EBS presentation   5
EBS presentation   6
Search strategy




                  EBS presentation   7
EBS presentation   8
EBS presentation   9
EBS presentation   10
EBS presentation   11
Search results




                 EBS presentation   12
EBS presentation   13
Gibson JN, Waddell G: Surgery for degenerative          Level II
lumbar spondylosis: updated Cochrane Review.
Spine (Phila Pa 1976) 30:2312-2320, 2005.
Shenkin HA, Hash CJ: Spondylolisthesis after multiple   Level IV
bilateral laminectomies and facetectomies for
lumbar spondylosis: follow-up review. J Neurosurg
50:45-47, 1979.
Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH,     Level IV
LiangMH:Seven- to 10-year outcome of decompressive
surgery for degenerative lumbar spinal stenosis.
Spine (Phila Pa 1976) 21:92-98, 1996.

Malter AD,McNeneyB, Loeser JD, Deyo RA: 5-year          Level IV
reoperation
rates after different types oflumbarspine surgery.
Spine (Phila Pa 1976) 23:814-820, 1998.
Aiki H, Ohwada O, Kobayashi H, Hayakawa M,              Level IV
Kawaguchi S, Takebayashi T, Yamashita T: Adjacent
segment stenosis after lumbar fusion requiring second
operation. J Orthop Sci 10:490-495, 2005.

                                                               EBS presentation   14
Rahm MD, Hall BB: Adjacent-segment degeneration             Level IV
after lumbar fusion with instrumentation: a retrospective
study. J Spinal Disord 9:392-400, 1996.
Reoperation after decompression for lumbar spine            Level IV
stenosis. Lam


A comparison of unilateral and bilateral laminotomies for   Level IV
decompression of L4/5 stenosis. Hong




                                                                       EBS presentation   15
Discussion/Results


• There is no paper who has looked at damage
  to adjacent level facet complex for
  laminectomy alone while this data are
  available for laminectomy above a fusion
• Preoperative data on preexisting adjacent
  level disease prior to laminectomy have not
  been recorded



                                       EBS presentation   16
• Different techniques in laminectomy also
  seem to influence reoperation and adjacent
  level disease rate (i.e. splitting of the spinous
  process, undercutting of the spinous process
  with unilateral dissection, modified bilateral
  laminectomy, unilateral hemilaminectomy.




                                             EBS presentation   17
Conclusions
• There is some evidence that some of the
  reoperation for lumbar laminectomy include
  problems related to the level adjacent to this
  procedure
• There are no sufficient data in the literature to
  suggest that laminectomies could be
  responsible for ASD but there is some
  suggestions that “some” laminectomies could
  be done in a way that predisposes patient to
  the development of ASD (i.e. violation of
  neighbouring facet-ligamentous complex)
                                             EBS presentation   18
Conclusion 2


• It would be useful to record the specific
  reason for reoperation after laminectomy and
  thoroughly look at the data set to evaluate
  rate and causes for ASD after laminectomy.




                                        EBS presentation   19
Thanks!




          EBS presentation   20

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Ebs asd laminectomy may_2012

  • 1. Title: Does laminectomy increase the rate of adjacent segment disease? Macquarie Neurosurgery Evidence Based Surgery presentation Date: 24/5/2012 EBS presentation 1
  • 2. Clinical case • 67 yo male • Hx of previous laminectomy done elsewhere • Presented with symptoms related to degeneration at the level above the laminectomy EBS presentation 2
  • 3. Searchable question (PICO format) • P= patients with back pain • I= laminectomy • C= fusion • O= rate of ASD EBS presentation 3
  • 7. Search strategy EBS presentation 7
  • 12. Search results EBS presentation 12
  • 14. Gibson JN, Waddell G: Surgery for degenerative Level II lumbar spondylosis: updated Cochrane Review. Spine (Phila Pa 1976) 30:2312-2320, 2005. Shenkin HA, Hash CJ: Spondylolisthesis after multiple Level IV bilateral laminectomies and facetectomies for lumbar spondylosis: follow-up review. J Neurosurg 50:45-47, 1979. Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Level IV LiangMH:Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 21:92-98, 1996. Malter AD,McNeneyB, Loeser JD, Deyo RA: 5-year Level IV reoperation rates after different types oflumbarspine surgery. Spine (Phila Pa 1976) 23:814-820, 1998. Aiki H, Ohwada O, Kobayashi H, Hayakawa M, Level IV Kawaguchi S, Takebayashi T, Yamashita T: Adjacent segment stenosis after lumbar fusion requiring second operation. J Orthop Sci 10:490-495, 2005. EBS presentation 14
  • 15. Rahm MD, Hall BB: Adjacent-segment degeneration Level IV after lumbar fusion with instrumentation: a retrospective study. J Spinal Disord 9:392-400, 1996. Reoperation after decompression for lumbar spine Level IV stenosis. Lam A comparison of unilateral and bilateral laminotomies for Level IV decompression of L4/5 stenosis. Hong EBS presentation 15
  • 16. Discussion/Results • There is no paper who has looked at damage to adjacent level facet complex for laminectomy alone while this data are available for laminectomy above a fusion • Preoperative data on preexisting adjacent level disease prior to laminectomy have not been recorded EBS presentation 16
  • 17. • Different techniques in laminectomy also seem to influence reoperation and adjacent level disease rate (i.e. splitting of the spinous process, undercutting of the spinous process with unilateral dissection, modified bilateral laminectomy, unilateral hemilaminectomy. EBS presentation 17
  • 18. Conclusions • There is some evidence that some of the reoperation for lumbar laminectomy include problems related to the level adjacent to this procedure • There are no sufficient data in the literature to suggest that laminectomies could be responsible for ASD but there is some suggestions that “some” laminectomies could be done in a way that predisposes patient to the development of ASD (i.e. violation of neighbouring facet-ligamentous complex) EBS presentation 18
  • 19. Conclusion 2 • It would be useful to record the specific reason for reoperation after laminectomy and thoroughly look at the data set to evaluate rate and causes for ASD after laminectomy. EBS presentation 19
  • 20. Thanks! EBS presentation 20

Editor's Notes

  1. Please ensure that no identifying features are included
  2. Instability after laminectomy up to 15% Reoperation rate 15-23% Malter 18 vs 15 % reoperation rate in fused vs non fused
  3. Only 5-8% required further surgery (30-53% radiographic)