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Ebs asd laminectomy may_2012

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

Transcript

  • 1. Title: Does laminectomy increase therate 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
  • 4. EBS presentation 4
  • 5. EBS presentation 5
  • 6. EBS presentation 6
  • 7. Search strategy EBS presentation 7
  • 8. EBS presentation 8
  • 9. EBS presentation 9
  • 10. EBS presentation 10
  • 11. EBS presentation 11
  • 12. Search results EBS presentation 12
  • 13. EBS presentation 13
  • 14. Gibson JN, Waddell G: Surgery for degenerative Level IIlumbar spondylosis: updated Cochrane Review.Spine (Phila Pa 1976) 30:2312-2320, 2005.Shenkin HA, Hash CJ: Spondylolisthesis after multiple Level IVbilateral laminectomies and facetectomies forlumbar spondylosis: follow-up review. J Neurosurg50:45-47, 1979.Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Level IVLiangMH:Seven- to 10-year outcome of decompressivesurgery for degenerative lumbar spinal stenosis.Spine (Phila Pa 1976) 21:92-98, 1996.Malter AD,McNeneyB, Loeser JD, Deyo RA: 5-year Level IVreoperationrates after different types oflumbarspine surgery.Spine (Phila Pa 1976) 23:814-820, 1998.Aiki H, Ohwada O, Kobayashi H, Hayakawa M, Level IVKawaguchi S, Takebayashi T, Yamashita T: Adjacentsegment stenosis after lumbar fusion requiring secondoperation. J Orthop Sci 10:490-495, 2005. EBS presentation 14
  • 15. Rahm MD, Hall BB: Adjacent-segment degeneration Level IVafter lumbar fusion with instrumentation: a retrospectivestudy. J Spinal Disord 9:392-400, 1996.Reoperation after decompression for lumbar spine Level IVstenosis. LamA comparison of unilateral and bilateral laminotomies for Level IVdecompression 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