Interspinous process device versus standard conventional surgical decompression for lumbar spinal stenosis: Randomized controlled trial

Abstract Objective To assess whether interspinous process device implantation is more effective in the short term than conventional surgical decompression for patients with intermittent neurogenic claudication due to lumbar spinal stenosis. Design Randomized controlled trial. Setting Five neurosurgical centers (including one academic and four secondary level care centers) in the Netherlands. Participants 203 participants were referred to the Leiden-The Hague Spine Prognostic Study Group between October 2008 and September 2011; 159 participants with intermittent neurogenic claudication due to lumbar spinal stenosis at one or two levels with an indication for surgery were randomized. Interventions 80 participants received an interspinous process device and 79 participants underwent spinal bony decompression. Main outcome measures The primary outcome at short term (eight weeks) and long term (one year) follow-up was the Zurich Claudication Questionnaire score. Repeated measurements were made to compare outcomes over time. Results At eight weeks, the success rate according to the Zurich Claudication Questionnaire for the interspinous process device group (63%, 95% confidence interval 51% to 73%) was not superior to that for

Tubular discectomy versus conventional microdiscectomy for the treatment of lumbar disc herniation: long-term results of a randomised controlled trial

Item does not contain fulltex

Predictive value of MRI in decision making for disc surgery for sciatica

Analysis and support of clinical decision makin

Interspinous process device versus standard conventional surgical decompression for lumbar spinal stenosis: randomized controlled trial

Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Magnetic Resonance Imaging Interpretation in Patients with Sciatica Who Are Potential Candidates for Lumbar Disc Surgery

<p>Background: Magnetic Resonance Imaging (MRI) is considered the mainstay imaging investigation in patients suspected of lumbar disc herniations. Both imaging and clinical findings determine the final decision of surgery. The objective of this study was to assess MRI observer variation in patients with sciatica who are potential candidates for lumbar disc surgery.</p><p>Methods: Patients for this study were potential candidates (n = 395) for lumbar disc surgery who underwent MRI to assess eligibility for a randomized trial. Two neuroradiologists and one neurosurgeon independently evaluated all MRIs. A four point scale was used for both probability of disc herniation and root compression, ranging from definitely present to definitely absent. Multiple characteristics of the degenerated disc herniation were scored. For inter-agreement analysis absolute agreements and kappa coefficients were used. Kappa coefficients were categorized as poor (</p><p>Results: Excellent agreement was found on the affected disc level (kappa range 0.81-0.86) and the nerve root that most likely caused the sciatic symptoms (kappa range 0.86-0.89). Interobserver agreement was moderate to substantial for the probability of disc herniation (kappa range 0.57-0.77) and the probability of nerve root compression (kappa range 0.42-0.69). Absolute pairwise agreement among the readers ranged from 90-94% regarding the question whether the probability of disc herniation on MRI was above or below 50%. Generally, moderate agreement was observed regarding the characteristics of the symptomatic disc level and of the herniated disc.</p><p>Conclusion: The observer variation of MRI interpretation in potential candidates for lumbar disc surgery is satisfactory regarding characteristics most important in decision for surgery. However, there is considerable variation between observers in specific characteristics of the symptomatic disc level and herniated disc.</p>