BACKGROUND: Lumbar spinal stenosis (LSS) is traditionally treated with an open approach to decompressive laminectomy with or without facetectomies (LFD). Traditional treatments, while being commonly accepted and arguably being a successful treatment may result in unintentional iatrogenic spinal instability, which may result in follow up surgical interventions for stabilization. The concern is the impact of the treatment on the normal anatomical structures and function of the spine. Surgical decompression of LSS is one of the most common minimally invasive surgeries (MIS), resulting in significantly greater improvements in functional outcomes and quality of life metrics with surgical intervention compared to conservative medical management. The concerns of unintentional impact on normal anatomical function and its impact on postoperative axial pain are an important factor in surgical success and patient outcomes. Axial pain has been defined as pain from the nuchal to the periscapular or shoulder region. Research has yet to pinpoint the underlying mechanisms and specific surgical intervention which may be the major cause of axial pain. The current study investigates changes in axial pain following a MIS LFD between patients with high (≥60%) and low (<60%) axial pain prior to the procedure. METHODS: 500 primary lumbar MIS LFD patients were evaluated. Patients with axial pain ≥60% accounted for 247 and axial pain <60% accounted for 253. Estimated blood loss (EBL), number of intraoperative and postoperative complications up to 30-days out (NOC), length of surgery (LOS), VAS and ODI preoperatively and 12-months postoperatively were collected. RESULTS: Both cohorts experienced significant differences in VAS and ODI from preoperative to postoperative time points. The pre-to-post delta in VAS for the <60% cohort was greater than the delta in the ≥60% cohort (2.96 vs. 2.29) (p<0.05). The same was observed for the ODI when comparing deltas in the <60% and ≥60% cohorts (12.12 vs. 8.64) (p<0.05). The average EBL was 48.01 ml and the LOS averaged at 61.17 min. CONCLUSIONS: Based on the sample, patients with <60% axial pain will experience greater relief than patients with≥60% axial pain when undergoing MIS. Results also indicate that patients who underwent MIS reported less pain and disability postoperatively than preoperatively, experiencing shorter operative times, lower complication rates, and minimal average EBL.

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