- Department of Spinal Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
- Department of Neurosurgery, Russian People’s Friendship University, United Nations Educational, Scientific and Cultural Organization (UNESCO), Digital Anatomy, Moscow, Russian Federation,
- Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan,
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
Correspondence Address:
Nicola Montemurro, Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
DOI:10.25259/SNI_659_2023
Copyright: © 2023 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Renat Nurmukhametov1, Abakirov Medetbek1, Manuel Encarnacion Ramirez2, Afifa Afsar3, Salman Sharif3, Nicola Montemurro4. Factors affecting return to work following endoscopic lumbar foraminal stenosis surgery: A single-center series. 24-Nov-2023;14:408
How to cite this URL: Renat Nurmukhametov1, Abakirov Medetbek1, Manuel Encarnacion Ramirez2, Afifa Afsar3, Salman Sharif3, Nicola Montemurro4. Factors affecting return to work following endoscopic lumbar foraminal stenosis surgery: A single-center series. 24-Nov-2023;14:408. Available from: https://surgicalneurologyint.com/surgicalint-articles/12643/
Abstract
Background: This study evaluates the factors affecting the return to work of endoscopic surgery for lumbar foraminal stenosis (LFS), including symptoms, functional status, complications, and reoperation rates.
Methods: The authors’ retrospective cohort study included 100 consecutive patients (50 males and 50 females) diagnosed with LFS who underwent endoscopic surgery at Trotsky National Research Center of Surgery between January 2018 and December 2021.
Results: There were no significant differences in age and preoperative visual analog scale and Oswestry disability index scores between the male and female groups, time to return to work for different patient groups after undergoing endoscopic lumbar foraminotomy (ELF). However, patients with more severe stenosis and comorbidities may take longer to recover. Confounding factors were patient age, preoperative physical function, and job requirements.
Conclusion: This study confirms that study ELF can effectively improve symptoms associated with lumbar radiculopathy, as well as back pain, and improve patients’ quality of life. Comorbidity, smoking status, and complications prolong the time to return to work following ELF surgery compared to healthy subjects.
Keywords: Clinical outcome, Endoscopic lumbar foraminotomy, Lumbar foraminal stenosis, Pain, Spine surgery
INTRODUCTION
Lumbar foraminal stenosis (LFS) is a common spinal disorder characterized by the narrowing of the neural foramen, causing compression of the exiting nerve root. LFS causes radicular and generalized back pain. Chronic low back pain, sciatica, and motor weakness may significantly affect patients’ quality of life. The traditional surgical approach for LFS is open decompression.
In recent years, endoscopic spine surgery has emerged as a minimally invasive alternative treatment for LFS. Endoscopic spine surgery involves using a small camera and specialized instruments inserted through a tiny incision, allowing the surgeon to visualize and access the affected area without extensive tissue disruption. This technique has been shown to have several advantages compared to open surgery, including reduced blood loss, shorter hospital stays, faster recovery, and lower morbidity rates.[
Endoscopic lumbar foraminotomy (ELF), as well as minimally invasive spinal surgery (MISS), led to the same endpoint of neural decompression when starting with more severe compression.[
Return to work is an essential indicator of the success of LFS surgery. Asher et al.[
MATERIALS AND METHODS
Study population
A retrospective analysis was performed on 100 consecutive patients consisting of 50 males and 50 females who underwent ELF for LFS at the Department of Spinal Surgery, Central Clinical Hospital of the Russian Academy of Sciences, between January 2018 and December 2021. The mean age was 48.2 years for males and 51.7 years for females.
Inclusion/exclusion criteria
Inclusion criteria are patients diagnosed with LFS confirmed by clinical and radiological examination, who underwent ELF, were over 18, and had a minimum follow-up of 12 months. Exclusion criteria were previous lumbar surgery, pregnancy, history of cancer or autoimmune disorders affecting the spine, concomitant central lumbar spinal stenosis, spondylolisthesis, and deformity. All surgeries were performed by the senior author (RN). The grade of LFS was graded and recorded according to Lee et al.[
Outcome measures
The primary outcome measures were the visual analog scale (VAS) score and the Oswestry disability index (ODI) score.[
Ethical considerations
The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the Department of Spinal Surgery, Petrovsky National Research Center of Surgery, Moscow, Russia. Informed consent was obtained from all patients before surgery. Patient confidentiality was always maintained, and the data were anonymized during analysis and reporting.
Surgical technique
Under general or regional anesthesia, a small incision on the patient’s back to access the lumbar neuroforamen through the transforaminal approach. The endoscopic working cannula is inserted over sequential tubular dilators. A foraminal endoscope is used to visualize the compression pathology directly. The decompression is done with a motorized drill or Kerrison rongeurs. These endoscopic instruments are placed through the endoscope’s central working channel. The skin incision is closed with stitches or surgical glue. The patient is taken to a recovery area, where they are monitored until comfortable, able to ambulate, and void before being sent home from the recovery room.
Statistical analysis
Descriptive statistics were used to summarize the patient demographics, clinical presentation, and radiological findings. The pre-and postoperative VAS and ODI scores were analyzed with a paired T-test. Statistical analysis was performed using SPSS version 26.
RESULTS
Based on the sagittal MRI, Lee et al.[
The mean preoperative VAS score was 7.9 ± 1.5 for male and 8.1 ± 1.4 for female patients. The corresponding postoperative numbers were 2.4 ± 1.4 versus 2.6 ± 1.5, respectively. The mean preoperative ODI score for males was 58.3 ± 12.9 versus females 60.7 ± 14.6. The respective postoperative ODI scores were 19.5 ± 9.3 and 21.1 ± 10.1. There were no statistically significant differences between female and male patients between pre- and postoperative VAS and ODI numbers. However, the VAS and ODI score improvements were statistically significant (P = 0.021). Overall, surgical complications resulted in 6% of cases. There was one dural tear, postoperative hematoma, and nerve root injury. The reoperation rate in patients with LFS who underwent ELF was 4%. The mean time between first surgery and reoperation was 7.6 ± 3.4 months. The mean time to return to work following surgery was 2.5 weeks in patients without complications. In patients with complications, it was 4.3 weeks [
DISCUSSION
Surgical management of lumbar pathology has been proven to effectively improve patients’ function and allow them to return to work. However, around 25% of the surgically managed spine patients report minimal improvement in quality of life, and up to 10% experience a major complication or hospital readmission post-surgery.[
Our results corroborate findings reported by others, indicating that ELF is effective in treating LFS, with a low complication and reoperation rate. Lewandrowski[
However, patients with more severe stenosis and comorbidities may have longer recovery times. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings. This is in line with previous research that has shown that the degree of stenosis is a key predictor of surgical outcomes in patients with LFS.[
A recent clinical study [
Findings showed relatively consistently that a lower level of education, a higher level of preoperative pain, less work satisfaction, a longer duration of sick leave, higher levels of psychological complaints, and more passive avoidance coping function as predictors of an unfavorable outcome in terms of pain, disability, work capacity, or a combination of these outcome measures.[
CONCLUSION
ELF is a surgical technique for the treatment of LFS. The author’s study suggests that ELF can effectively improve symptoms associated with lumbar radiculopathy, as well as back pain, and improve patients’ quality of life. Comorbidity, smoking status, and complications prolong the time to return to work following ELF surgery compared to healthy subjects. However, more prospective and randomized studies about patients treated with ELF for LFS are needed.
Ethical approval
The author(s) declare that they have taken the ethical approval from IRB of Department of Spinal Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russia (10/21). Approval number is 10/2021.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Disclaimer
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
Acknowledgments
We thank Prof Jesus Lafuente Barza, Prof Matias Baldoncini, Dr. Ismael Peralta Baez, Dr. Medet Dosanov, and Dr Kai-Uwe Lewandrowski for their scientific support.
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