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Ebs asd laminectomy may_2012
1. Title: Does laminectomy increase the
rate of adjacent segment disease?
Macquarie Neurosurgery
Evidence Based Surgery presentation
Date: 24/5/2012
EBS presentation 1
2. Clinical case
• 67 yo male
• Hx of previous laminectomy done elsewhere
• Presented with symptoms related to
degeneration at the level above the
laminectomy
EBS presentation 2
3. Searchable question (PICO format)
• P= patients with back pain
• I= laminectomy
• C= fusion
• O= rate of ASD
EBS presentation 3
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bilateral laminectomies and facetectomies for
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reoperation
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Kawaguchi S, Takebayashi T, Yamashita T: Adjacent
segment stenosis after lumbar fusion requiring second
operation. J Orthop Sci 10:490-495, 2005.
EBS presentation 14
15. Rahm MD, Hall BB: Adjacent-segment degeneration Level IV
after lumbar fusion with instrumentation: a retrospective
study. J Spinal Disord 9:392-400, 1996.
Reoperation after decompression for lumbar spine Level IV
stenosis. Lam
A comparison of unilateral and bilateral laminotomies for Level IV
decompression of L4/5 stenosis. Hong
EBS presentation 15
16. Discussion/Results
• There is no paper who has looked at damage
to adjacent level facet complex for
laminectomy alone while this data are
available for laminectomy above a fusion
• Preoperative data on preexisting adjacent
level disease prior to laminectomy have not
been recorded
EBS presentation 16
17. • Different techniques in laminectomy also
seem to influence reoperation and adjacent
level disease rate (i.e. splitting of the spinous
process, undercutting of the spinous process
with unilateral dissection, modified bilateral
laminectomy, unilateral hemilaminectomy.
EBS presentation 17
18. Conclusions
• There is some evidence that some of the
reoperation for lumbar laminectomy include
problems related to the level adjacent to this
procedure
• There are no sufficient data in the literature to
suggest that laminectomies could be
responsible for ASD but there is some
suggestions that “some” laminectomies could
be done in a way that predisposes patient to
the development of ASD (i.e. violation of
neighbouring facet-ligamentous complex)
EBS presentation 18
19. Conclusion 2
• It would be useful to record the specific
reason for reoperation after laminectomy and
thoroughly look at the data set to evaluate
rate and causes for ASD after laminectomy.
EBS presentation 19