Comparison of surgical procedures for degenerative lumbar spinal stenosis: A meta-analysis of the literature from 1975 to 1995

Niggemeyer, O.; Strauß, J; Schulitz, Klaus-Peter

doi:10.1007/bf01834073

Cited by 108 publications

(50 citation statements)

References 23 publications

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“…The degree of stenosis determines the indication for mono-or bilateral hemifacetectomy, mono-or bilateral laminectomy or even laminectomy on two levels. A meta-analysis of the literature from 1975 to 1995 revealed that decompressive laminectomy is only optimal for degenerative spinal stenosis if symptoms have a duration of less than 8 years [13]. Another meta-analysis also showed that decompressive laminectomy can benefit many patients with lumbar spinal stenosis by reducing pain and increasing function [22].…”

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confidence: 99%

Influence of graded facetectomy and laminectomy on spinal biomechanics

Zander

Rohlmann

Klöckner

et al. 2003

European Spine Journal

143

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Facetectomy and laminectomy are techniques for decompressing lumbosacral spinal stenosis. Resections of posterior bony or ligamentous parts normally lead to a decrease in stability. The degree of instability depends on the extent of resection, the loading situation and the condition of the intervertebral discs. The correlation between these parameters is not well understood. In order to investigate how these parameters relate to one another, a three-dimensional, non-linear finite element model of the lumbosacral spine was created. Intersegmental rotations, intradiscal pressures, stresses, strains and forces in the facet joints were calculated while simulating an intact spine as well as different extents of resection (left and bilateral hemifacetectomy, hemilaminectomy and bilateral laminectomy, two-level laminectomy), disc conditions (intact and degenerated) and loading situations (pure moment loads, standing and forward bending). The results of the modelling showed that a unilateral hemifacetectomy increases intersegmental rotation for the loading situation of axial rotation. Expanding the resection to bilateral hemifacetectomy increases intersegmental rotation even more, while further resection up to a bilateral laminectomy has only a minor additional effect. Hemilaminectomy and laminectomy only differ in their effect for ventriflexion and muscle-supported forward bending. Two-level laminectomy increases the intersegmental rotation only for standing. Degenerated discs result in smaller intersegmental rotations and higher disc stresses at the respective levels. Decompression procedures affect the examined biomechanical parameters less markedly in degenerated than in intact discs. Resection of posterior bony or ligamentous elements has a stronger influence on the amount than on the distribution of stresses and deformations in a disc. It has only a minor effect on the biomechanical behaviour of the adjacent region. Spinal stability is decreased after a laminectomy for forward bending, and after a two-level laminectomy for standing. For axial rotation, spinal stability is decreased even after a hemifacetectomy. Patients should therefore avoid excessive axial rotation after such a treatment.

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mentioning

confidence: 99%

Influence of graded facetectomy and laminectomy on spinal biomechanics

Zander

Rohlmann

Klöckner

et al. 2003

European Spine Journal

143

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“…In all but the most moderate of cases, the problem is difficult to treat without recourse to surgery [5-7, 20, 25], due to the largely mechanical (structural) nature of the disorder [57]. Nonetheless, the success rates of surgery are not particularly impressive: systematic reviews of the long-term outcome report an average success rate of between 45 and 72%, depending on the criterion by which 'success' is judged (ability to work, neurologic symptoms, leg/back pain) [16,43,58].…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine

et al. 2007

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Spinal decompression is the most common type of spinal surgery carried out in the older patient, and is being performed with increasing frequency. Physiotherapy (rehabilitation) is often prescribed after surgery, although its benefits compared with no formal rehabilitation have yet to be demonstrated in randomised control trials. The aim of this randomised controlled trial was to examine the effects on outcome up to 2 years after spinal decompression surgery of two types of postoperative physiotherapy compared with no postoperative therapy (self-management). Hundred and fifty-nine patients (100 men, 59 women; 65 ± 11 years) undergoing decompression surgery for spinal stenosis/herniated disc were randomised to one of the following programmes beginning 2 months post-op: recommended to ''keep active'' (CONTROL; n = 54); physiotherapy, spine stabilisation exercises (PT-StabEx; n = 56); physiotherapy, mixed techniques (PT-Mixed; n = 49). Both PT programmes involved 2 · 30 min sessions/week for up to 12 weeks, with home exercises. Pain intensity (0-10 graphic rating scale, for back and leg pain separately) and self-rated disability (Roland Morris) were assessed before surgery, before and after the rehabilitation phase (approx. 2 and 5 months post-op), and at 12 and 24 months after the operation. 'Intention to treat' analyses were used. At 24 months, 151 patients returned questionnaires (effective return rate, excluding 4 deaths, 97%).Significant reductions in leg and back pain and self-rated disability were recorded after surgery (P < 0.05). Pain showed no further changes in any group up to 24 months later, whereas disability declined further during the ''rehabilitation'' phase (P < 0.05) then stabilised, but with no significant group differences. 12 weeks of post-operative physiotherapy did not influence the course of change in pain or disability up to 24 months after decompression surgery. Advising patients to keep active by carrying out the type of physical activities that they most enjoy appears to be just as good as administering a supervised rehabilitation program, and at no cost to the health-care provider.

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“…The outcome of those studies favours surgical over conservative treatment [2,16]. The most widely used surgical techniques are all based on the principles of decompression alone or decompression and fusion, with or without instrumentation [8,11,21,24].…”

Section: Introductionmentioning

confidence: 99%

Decompressive surgery for degenerative lumbar spinal stenosis: long-term results

Gelalis

Stafilas

Korompilias

et al. 2005

International Orthopaedics (SICO

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We report the outcome of 50 patients with degenerative lumbar spinal stenosis who were treated surgically by spinal decompression between 1984 and 1995. Their mean age at the time of surgery was 59.9 (45-77) years and the mean follow-up was 11.6 (6.1-17.2) years. Five patients had a concomitant spinal fusion. The preoperative data were collected retrospectively from the patients' charts. The follow-up data were obtained from a clinical examination and questionnaire including overall pain, ability to work, walking ability, use of analgesics and satisfaction with surgery. The outcome was rated as excellent in 23 patients, good in 13 patients, fair in 9 patients and poor in 5 patients. Patients with concomitant fusion had good to excellent results and were more satisfied, whereas patients with long-standing preoperative symptoms had poor to fair result and were less satisfied.Résumé Nous rapportons le résultat de 50 malades avec une sténose lombaire dégénérative qui a été traité chirurgicalement par décompression vertébrale entre 1984 et 1995. L'âge moyen à la chirurgie était 59,9 (45-77) ans et le suivi moyen était 11,6 (6.1-17.2) années. Cinq malades avaient une fusion vertébrale concomitante. Les données préopératoires ont été rassemblées rétrospectivement. Les données du suivi ont été obtenues par un examen clinique et un questionnaire qui inclut les douleurs , la capacité de travailler, la capacité de marcher, l'usage d'analgésiques et la satisfaction de la chirurgie. Le résultat a été estimé comme excellent pour 23 malades, bon pour 13 malades, juste pour 9 et mauvais pour 5 malades. Les patients avec une fusion concomitante avaient des résultats bons ou excellents et étaient plus satisfaits alors que ceux avec symptômes préopératoires anciens avaient des résultats moyens ou mauvais et étaient moins satisfaits.

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Comparison of surgical procedures for degenerative lumbar spinal stenosis: A meta-analysis of the literature from 1975 to 1995

Cited by 108 publications

References 23 publications

Influence of graded facetectomy and laminectomy on spinal biomechanics

Influence of graded facetectomy and laminectomy on spinal biomechanics

A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine

Decompressive surgery for degenerative lumbar spinal stenosis: long-term results

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