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Mario Ganau: laminotomy EANS2010

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Mario Ganau

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Transcript of Mario Ganau: laminotomy EANS2010

TRAINEE LECTURES 2010
ITALY
MICRODECOMPRESSIVE LAMINOTOMY FOR LUMBAR SPINAL STENOSIS
TECHNICAL NOTES AND LONG-TERM FOLLOW-UP
Mario Ganau MD, Enrico De Micheli MD
Dept of Neurosurgery, University of Verona - Italy
OVERVIEW AND PURPOSE
STUDY DESING
CLINICAL AND
RADIOLOGICAL OUTCOMES
FINAL REMARKS
That's all folks
TRADITIONAL TREATMENT
MORE TAILORED PROCEDURES
PROSPECTIVE STUDY
2004-2009
No of PATIENTS: 125
QUANTITATIVE FUNCTIONAL ASSESSMENT
ON ADMISSION
VAS
BSS
Beaujon Scoring System
RADIOGRAPHIC ASSESSMENT
CT SCAN
MRI SCAN
SHORT- AND LONG-TERM OUTCOME
STATISTICAL ANALYSIS
EANS
MAC NAB
CRITERIA
DRAWBACKS
Destruction or insufficiency of the pars interarticularis and facet joints
Prolonged retraction of paraspinal tissues
Need for concomitant or subsequent fusion (Hopp et al.)
Prolonged muscles retraction may be responsible for the high rate of perioperative pain and Failed Low Back Sindrome (Datta et al.)
WIDE LAMINECTOMY
MICRODECOMPESSIVE LAMINOTOMY
LIMITS
Elderly patients (Wang et al.)
Spondylolisthesis (Lassale et al.)
Scoliosis (Kostuik et al.)
Comorbidities: Osteoporosis (Bultink et al.), LE (Bultink et al.) and RA (Inaoka et al.)
Excision of ligamentum flavum
Undercutting of spinal laminae
Uni- or Bilateral access
Suitable for Central or Lateral LCS
Setting: Neurosurg Dept - Univ of Verona
END POINTS:

symptomatic relief
increase in spinal canal diameters
functional improvement
Limits of the present study and future perspectives:

From single center prospective study to randomized multicentric study
Microdecompressive laminotomy allows for:
immediate pain relief
rapid post-op mobilization
satisfactory long-term outcomes
Because of its advantages, including fusion avoidance, this technique should be particularly recommended, instead of more invasive ones, in patients with fragility of the spine
Factors influencing clinical
outcome at discharge:

low BSS at admission and comorbidities
Statistical (univariate and multivariate) analysis showed that:

- spondylolisthesis does not affect outcome
- scoliosis (OR= 1.2), osteoporosis (OR= 2), LE and RA (OR= 2) may reduce, but not preclude, the chances to achieve a MacNab grade I at long-term follow up
AP
IA
TP
UNILATERAL LAMINOTOMY
hypertrophy of ligamenta flava
spondylolisthesis
BILATERAL LAMINOTOMY
hypertrophy of facet joints
0% rate of spinal instability at long term radiological follow up
TRAINING COURSE - PADUA, 11 FEBRUARY 2010
Visual Analogue Scale
PATIENTS DATA:

125 patients
65%: older than 65y
29%: comorbidities (osteoporosis, LE, RA)
35%: Meyerding grade I spondylolisthesis
15%: scoliosis >20°
*p < 0.05
*p 0.00 **p 0.01
ANY ADVANTAGES
OR ANY LIMITS
IN COMORBIDITIES?
AVERAGE CROSS SECTIONAL AREA
(CALCULATED ON AXIAL MRI ACCORDING TO HAMANISHI TECHNIQUE)


PRE-OP POST-OP
48.8 mm2 148.1 mm2
INCREASE IN SPINAL CANAL DIAMETERS
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