Resultados clínicos y radiológicos de pacientes con estenosis lumbar central operados con técnica microscópica unilateral «over the top»: signo del vacío como predictor de falla.

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Bibliographic Details
Title:	Resultados clínicos y radiológicos de pacientes con estenosis lumbar central operados con técnica microscópica unilateral «over the top»: signo del vacío como predictor de falla.
Alternate Title:	Clinical and radiological results of patients with central lumbar stenosis operated on with unilateral microscopic «over the top» technique: the void sign as a predictor of failure.
Authors:	Cullari, M. L.¹ matiaslcullari@gmail.com, Jorquera, J.¹, Gutiérrez, L.¹, De Giano, J. I.¹, Aguirre, F.¹, Aguer, S.¹, Miguens, E.¹, Lloyd, R.¹
Source:	Acta Ortopédica Mexicana. May/Jun2026, Vol. 40 Issue 3, p134-140. 7p.
Subjects:	Surgical decompression, Minimally invasive procedures, Reoperation, Diagnostic imaging, Spinal stenosis, Treatment effectiveness
Abstract (English):	Introduction: lumbar spinal stenosis is a common condition in elderly patients, which can lead to neurogenic claudication or radiculopathy. One of the current surgical techniques used for decompression is the «over the top» approach, which consists of a unilateral microscopic decompression with partial resection of the lamina, ligamentum flavum, and part of the facet joint, without causing instability. The objective was to evaluate the clinical and radiological postoperative outcomes of patients with degenerative lumbar stenosis treated with the «over the top» technique. Material and methods: a retrospective study was conducted between January 2022 and December 2023. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scales were used to assess clinical outcomes. The presence of the tomographic «vacuum sign» was evaluated, as well as imaging changes according to the Schizas classification. Postoperative complications and reoperations were also recorded. Results: a total of 56 patients were included. The preoperative lumbar VAS was 7.21 ± 1.24 [range 4-9], and at 12 months it was 3.11 ± 1.54 [range 2-8] (p < 0.00001). The preoperative ODI was 32 ± 8.02 [range 25-39]; at 12 months, it significantly improved to 14.92 ± 5.03 [range 7-26] (p < 0.00001). A statistically significant association was found between patients with preoperative pneumodisc and those who underwent reoperation (p = 0.025). No patients showed signs of postoperative instability on radiographic assessment. Conclusion: the minimally invasive «over the top» decompression technique provides good clinical outcomes in the surgical treatment of lumbar spinal stenosis. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Introducción: la estenosis espinal lumbar es una afección frecuente en pacientes de edad avanzada que puede provocar claudicación neurogénica o radiculopatía. Una de las técnicas quirúrgicas actuales para la descompresión es el abordaje «over the top», que consiste en una descompresión microscópica unilateral con resección parcial de la lámina, el ligamento amarillo y parte de la articulación facetaria, sin causar inestabilidad. El objetivo fue evaluar los resultados clínicos y radiológicos postoperatorios de pacientes con estenosis lumbar degenerativa tratados con la técnica «over the top». Material y métodos: se realizó un estudio retrospectivo entre enero de 2022 y diciembre de 2023. Se utilizaron escala visual analógica (EVA) y Oswestry Disability Index (ODI) para evaluar los resultados clínicos. Se evaluó la presencia del «signo de vacío» tomográfico, así como los cambios en las imágenes según la clasificación de Schizas. También se registraron las complicaciones postoperatorias y las reintervenciones. Resultados: se incluyó a un total de 56 pacientes. La EVA lumbar preoperatoria fue de 7.21 ± 1.24 [rango 4-9] y a los 12 meses fue de 3.11 ± 1.54 [rango 2-8] (p < 0.00001). El ODI preoperatorio fue de 32 ± 8.02 [rango 25-39]; a los 12 meses mejoró significativamente, siendo de 14.92 ± 5.03 [rango 7-26] (p < 0.00001). Se encontró una asociación estadísticamente significativa entre los pacientes con neumodisco preoperatorio y los que se sometieron a reintervención (p = 0.025). Ningún paciente mostró signos de inestabilidad postoperatoria en la evaluación radiográfica. Conclusión: la técnica de descompresión mínimamente invasiva «over the top» proporciona buenos resultados clínicos en el tratamiento quirúrgico de la estenosis espinal lumbar. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Introduction: lumbar spinal stenosis is a common condition in elderly patients, which can lead to neurogenic claudication or radiculopathy. One of the current surgical techniques used for decompression is the «over the top» approach, which consists of a unilateral microscopic decompression with partial resection of the lamina, ligamentum flavum, and part of the facet joint, without causing instability. The objective was to evaluate the clinical and radiological postoperative outcomes of patients with degenerative lumbar stenosis treated with the «over the top» technique. Material and methods: a retrospective study was conducted between January 2022 and December 2023. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scales were used to assess clinical outcomes. The presence of the tomographic «vacuum sign» was evaluated, as well as imaging changes according to the Schizas classification. Postoperative complications and reoperations were also recorded. Results: a total of 56 patients were included. The preoperative lumbar VAS was 7.21 ± 1.24 [range 4-9], and at 12 months it was 3.11 ± 1.54 [range 2-8] (p < 0.00001). The preoperative ODI was 32 ± 8.02 [range 25-39]; at 12 months, it significantly improved to 14.92 ± 5.03 [range 7-26] (p < 0.00001). A statistically significant association was found between patients with preoperative pneumodisc and those who underwent reoperation (p = 0.025). No patients showed signs of postoperative instability on radiographic assessment. Conclusion: the minimally invasive «over the top» decompression technique provides good clinical outcomes in the surgical treatment of lumbar spinal stenosis. [ABSTRACT FROM AUTHOR]
ISSN:	23064102
DOI:	10.35366/123283