Clinical and Roentgenographic Results of Decompression for Lumbar Spinal Stenosis

McCullen, Geoffrey M.; Bernini, Philip M.; Bernstein, Steven H.; Tosteson, Tor D.

doi:10.1097/00002517-199410000-00003

Cited by 33 publications

(14 citation statements)

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“…Both pre-and postoperative instability are negative predictive factors for the long-term outcome. [29][30][31]34 Postacchini, Cinotti and Gumina 37 found an incidence of secondary instability in 63% of patients who had preoperative evidence of instability after decompression. Guigui et al 36 and Katz et al 20 reported that secondary spondylolisthesis was twice as common among patients with unsatisfactory results after lumbar decompression.…”

Section: Discussionmentioning

confidence: 98%

Surgical treatment of lumbar spinal stenosis

Jolles¹,

Porchet²,

Theumann

2001

The Journal of Bone and Joint Surgery. British volume

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W e carried out a retrospective review of 155 patients with lumbar spinal stenosis who had been treated surgically and followed up regularly: 77 were evaluated at a mean of 6.5 years (5 to 8) after surgery by two independent observers. The outcome was assessed using the scoring system of Roland and Morris, and the rating system of Prolo, Oklund and Butcher. Instability was determined according to the criteria described by White and Panjabi.A significant decrease in low back pain and disability was seen. An excellent or good outcome was noted in 79% of patients; 9% showed secondary radiological instability.Surgical decompression is a safe and efficient procedure. In the absence of preoperative radiological evidence of instability, fusion is not required. Stenosis is the commonest problem of the lumbar spine in people over the age of 65 years and surgery is required with increasing frequency. [1][2][3][4] Spinal stenosis has been defined as a narrowing of the vertebral canal and/or the foramen, to a degree that gives rise to compression of lumbosacral nerve roots or the cauda equina. 5-7The initial treatment should be conservative. The natural long-term outcome of conservative treatment, however, is often unsatisfactory. In a study of conservatively managed patients followed for four years, Johnsson, Rosen and Uden 8 noted that 77% had persistent claudication, 85%were unchanged or had deteriorated, and 63% had continual low back pain. Surgery is required after the failure of conservative care. 9,10 The procedure aims to decompress the spinal canal and the foramen while minimising the risk of secondary instability. The literature presents a variable picture after the surgical treatment of spinal stenosis with good to excellent results in 26% to 100% of patients. 4 The periods of followup have often been short and the outcome measures are usually not comparable because of the variability of the scoring systems used. We have evaluated the long-term results of surgical treatment after five years or more applying established scoring systems in order to assess the quality of life, the incidence of low back pain and the functional and socioeconomic status 11,12 of these patients.We also determined the incidence of instability after surgery and its effect on the outcome. Patients and MethodsWe carried out a retrospective review of 155 consecutive patients who had decompression for lumbar spinal stenosis (LSS) at our centre between January 1990 and December 1992.The patients assessed were undergoing primary lumbar spinal surgery, were in good general health without systemic pathology or vascular disease and had given informed consent. Patients who were participating in another simultaneous clinical study were excluded. Of the 155 patients, 22 were excluded; 15 had cardiopulmonary disorders, four had undergone previous surgery for LSS, one had rheumatoid arthritis, one had had an amputation of a lower limb, and one had bilateral osteoarthritis of the hip and was awaiting replacement surgery. Fifteen patients declined to par...

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Section: Discussionmentioning

confidence: 98%

Surgical treatment of lumbar spinal stenosis

Jolles¹,

Porchet²,

Theumann

2001

The Journal of Bone and Joint Surgery. British volume

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“…[18,39,40,51,[68][69][70] Katz and associates [39] prospectively studied 194 patients treated with decompressive laminectomy for degenerative lumbar stenosis and reported that 22% of patients were somewhat or very dissatisfied with the results of surgery 6 months postoperatively. McCullen, et al, [50] reviewing 118 patients who underwent lumbar decompression for acquired spinal stenosis, reported 50% good, 27% fair, and 23% poor outcomes with an overall reoperation rate of 9%. Furthermore, preoperative spondylolisthesis as well as progressive postoperative slippage clearly predisposed to poor outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have implicated degenerative spondylolisthesis as a poor prognostic indicator. [9,26,30,36,42,50,61,65,68,69,73] Several authors have reported less favorable outcomes in women, [9,19,27,34,50,65,68,69] younger patients, [32,64,67,73] and patients undergoing repeated lumbar surgery. [15,28,52,61,72] Patient characteristics that warrant the consideration of arthrodesis (PLIF) in addition to decompression are listed in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…[9,18,21,26,30,49,50,52] Spinal fusion, PLIF in particular, is technically more demanding to perform than decompressive surgery. Potential long-term consequences of segmental fusion, notably accelerated adjacent-level degeneration, must be further investigated and characterized.…”

Section: Discussionmentioning

confidence: 99%

“…[25,33,43,63] It is evident that decompressive lumbar surgery plays a significant role in destabilizing the spine in a subgroup of patients with stenosis. [10,28,32,50] Surgical removal of the posterior elements during decompressive laminectomy or hemilaminectomy places additional load on the disc and may accelerate degeneration. [4,30,47,51] Postoperative progressive slippage as a result of segmental instability often leads to recurrent symptomatic spinal stenosis.…”

Section: Pathological Characteristicsmentioning

confidence: 99%

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Posterior lumbar interbody fusion in the treatment of symptomatic spinal stenosis

Coric

Branch²

1997

FOC

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Lumbar spinal stenosis is often the result of advanced degeneration of motion segments of the lumbar spine. Loss of disc height, facet displacement and hypertrophy, spondylosis, and spondylolisthesis, as well as buckling of the ligamentum flavum and annulus fibrosus, all contribute to impingement on the spinal canal and intervertebral foramen in lumbar stenosis. There is a subgroup of patients with spinal stenosis in whom the spine is unstable preoperatively or becomes destabilized following decompression who would benefit from an initial fusion procedure. Posterior lumbar interbody fusion (PLIF) addresses several aspects of the multifactorial pathophysiology responsible for spinal stenosis and may arrest the degenerative changes at the fused level. Fusion, in particular PLIF, should be considered in complex cases of lumbar spinal stenosis, most notably in patients with postlaminectomy stenosis or stenosis associated with spondylolisthesis.

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Degenerative Diseases of the Spine

Gibby¹

2000

Neuroimaging

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Clinical and Roentgenographic Results of Decompression for Lumbar Spinal Stenosis

Cited by 33 publications

References 0 publications

Surgical treatment of lumbar spinal stenosis

Surgical treatment of lumbar spinal stenosis

Posterior lumbar interbody fusion in the treatment of symptomatic spinal stenosis

Degenerative Diseases of the Spine

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