Neurosurg Focus
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OBJECTIVERecently, minimally invasive unilateral laminotomy with bilateral decompression (ULBD) has been performed for lumbar stenosis using endoscopic approaches. The object of this retrospective study was to compare the clinical and radiological outcomes of three types of minimally invasive decompressive surgery: microsurgery, percutaneous uniportal endoscopic surgery, and percutaneous biportal endoscopic surgery. METHODSIn the period from March 2016 to December 2017, minimally invasive ULBD was performed using microscopy, a uniportal endoscopic approach, or a biportal endoscopic approach to treat lumbar canal stenosis. ⋯ CONCLUSIONSAlthough radiological results were different among the three groups of patients, postoperative clinical outcomes were significantly improved after each type of surgery. The percutaneous biportal or uniportal endoscopic approach offers the advantage of reduced immediate postoperative pain. A percutaneous uniportal or biportal endoscopic lumbar approach may be effective for the treatment of lumbar central stenosis and an alternative to conventional microsurgical decompression.
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OBJECTIVEPatient-reported outcome measures (PROMs) following decompression surgery for lumbar spinal stenosis (LSS) demonstrate considerable heterogeneity. Individualized prediction tools can provide valuable insights for shared decision-making. The authors aim to evaluate the feasibility of predicting short- and long-term PROMs, reoperations, and perioperative parameters by machine learning (ML) methods. ⋯ The developed ML-based model enabled prediction of extended hospital stay with an accuracy of 77% and AUC of 0.58. CONCLUSIONSPreoperative prediction of a range of clinically relevant endpoints in decompression surgery for LSS using ML is feasible, and may enable enhanced informed patient consent and personalized shared decision-making. Access to individualized preoperative predictive analytics for outcome and treatment risks may represent a further step in the evolution of surgical care for patients with LSS.
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OBJECTIVEPatient-reported outcome measures (PROMs) are standard of care for the assessment of functional impairment. Subjective outcome measures are increasingly complemented by objective ones, such as the "Timed Up and Go" (TUG) test. Currently, only a few studies report pre- and postoperative TUG test assessments in patients with lumbar spinal stenosis (LSS). ⋯ CONCLUSIONSThe TUG test is a quick and easily applicable tool that reliably measures OFI in patients with LSS. Objective tests incorporating longer walking time should be considered if OFI is suspected but fails to be proven by the TUG test, taking into account that neurogenic claudication may not clinically manifest during the brief TUG examination. Objective tests do not replace the subjective PROM-based assessment, but add valuable information to a comprehensive patient evaluation.