73% of patients reported excellent or good outcomes. 1 patient had a CSF leak without clinical symptoms . Rahman et al. retrospectively compared MEDS to www.selleckchem.com/products/GDC-0449.html the open laminectomy technique in 126 patients. Similar to the aforementioned studies, the MEDS group on average had a lower EBL, shorter operative time, and decreased hospitalization when compared to the open laminectomy group. These trends were strikingly different when MEDS was performed for 3 levels or greater of stenosis or on a previously operated patient. The EBL for a 3-level open laminectomy case was 194cc greater than a comparative MEDS and hospitalization was an additional 2.52days (average MEDS hospitalization ~ 0.75days). Overall complications of open laminectomy were 16.1% and MEDS was 7.9%.
The open laminectomy group encountered 2 durotomies, 3 CSF leaks, 3 wound infections, and one death from postoperative sepsis. The MEDS group had 1 infection and 1 CSF leak . Asgarzadie and Khoo compared 48 MEDS patients to 32 patients with open laminectomies with follow-up of four years. The average EBL for the MEDS group was 25cc and 193cc for the open laminectomy group. The preoperative ODI score in the MEDS group was 46 and 26 at 3 years. The average length of hospitalization for the MEDS group was 36 hours compared to 94 hours in the open laminectomy group. The rate of durotomies was 4% for the MEDS group . Yagi et al. performed a prospective, randomized trial comparing the traditional open laminectomy approach to MEDS for bilateral decompression of lumbar stenosis in 41 patients.
Single-level decompressions were performed, including patients with grade I spondylolisthesis without preoperative evidence of instability on dynamic X-rays. Outcomes were measured by pre- and postop imaging, VAS, JOA, cross-sectional areas of paraspinal muscles, and postoperative CPK-MM levels as a measurement of muscle destruction. Comparing the MEDS group to the open laminectomy group, the mean operative time was 71.1mins versus 63.6mins and EBL was 37cc versus 71cc, respectively. In addition, the MEDS group required decreased amounts of post-op analgesics, decreased levels of CPK-MM, decreased atrophy of paraspinal muscles, and improved functional outcome scores at the one-year follow-up. Postoperative spondylolisthesis was not present in the MEDS group but two patients in the open laminectomy group developed new spondylolisthesis.
Yagi’s group was able to demonstrate the efficacy and safety of MEDS compared to open laminectomy in a prospective, randomized trial . Pao et al. prospectively operated on 60 patients over two years with MEDS for multilevel lumbar stenosis. 13 patients had spondylolisthesis and 4 patients had scoliosis. Exclusion criteria included primary mechanical low back pain Anacetrapib or spinal instability as defined by dynamic X-rays. The mean operative time was 126.7mins and the EBL was 104.5cc.