Reoperation Rate After Microsurgical Uni- or Bilateral Laminotomy for Lumbar Spinal Stenosis With and Without Low-grade Spondylolisthesis
Bibliographic record
Abstract
STUDY DESIGN: Retrospective single-center cohort study. OBJECTIVE: The aim of this study was to analyze the influence of preoperative radiographic parameters on reoperation rates after microsurgical laminotomy for lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: Decompression for symptomatic LSS has shown to be effective. However, the optimal surgical strategy remains a matter of debate, especially with underlying spondylolisthesis. METHODS: Adult patients with LSS who underwent primary laminotomy without fusion between January 2012 and September 2013 at our institution were included for analysis. Disc height (in mm), facet joint (FJ) orientation (degrees), and grade of spondylolisthesis of all surgical index levels (SILs) were analyzed from preoperative magnetic resonance imaging. Patients were contacted in January 2017 by follow-up phone call (mean follow-up 49 months) regarding lumbar reoperation. RESULTS: A total of 161 patients (mean age 68.5 yrs, ±11.3) and 236 SILs were analyzed. Fifty-six patients (34.8%) had low-grade spondylolisthesis involving 60 SILs (25.4%). Twenty-four patients (14.9%) underwent reoperation involving 32 levels. Of latter, 23 SILs (9.7%) had recurrent stenosis (RS) and 9 (3.8%) had adjacent level stenosis. Five patients in total (3.1%) required secondary fusion; all had preexisting spondylolisthesis. SILs with spondylolisthesis had a significantly higher rate of RS requiring reoperation compared with SILs without spondylolisthesis [18.3% (11/60) vs. 6.8% (12/176), P = 0.013]. Disc height and FJ orientation showed no significant difference between patients with and without reoperation, or with and without spondylolisthesis. CONCLUSION: Decompression alone is reasonable for most patients with LSS and stable low-grade spondylolisthesis. The overall reoperation rate and need for secondary fusion were low in our series. However, patients with spondylolisthesis had a higher rate of reoperation for RS after laminotomy without fusion. This must be taken into account for preoperative risk-benefit analysis, tailored surgical decision making and patient counseling. LEVEL OF EVIDENCE: 4.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".