Outcome after laminectomy for lumbar spinal stenosis

Abstract

All patients who underwent decompressive lumbar laminectomy in the Washtenaw County, Michigan metropolitan area during a 7-year period were studied for the purpose of defining long-term outcome, clinical correlations, and the need for subsequent fusion. Outcome was determined by questionnaire and physical examination from a cohort of 119 patients with an average follow-up evaluation interval of 4.6 years. Patients graded their outcome as much improved (37%), somewhat improved (29%), unchanged (17%), somewhat worse (5%), and much worse (12%) compared to their condition before surgery. Poor outcome correlated with the need for additional surgery, but there were few additional significant correlations. No patient had a lumbar fusion during the study interval. The outcome after laminectomy was found to be less favorable than previously reported, based on a patient questionnaire administered to an unbiased patient population. Further randomized, controlled trials are therefore necessary to determine the efficacy of lumbar fusion as an adjunct to decompressive lumbar laminectomy.

Posterior lumbar interbody fusion in the treatment of symptomatic spinal stenosis

“…Several recent, well-designed studies underscore the need for more effective treatments and outcome measures. [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. Tuite and coworkers [68,69] reviewed 119 patients treated by decompressive lumbar laminectomy and found 66% good outcomes and 34% bad outcomes with a 15% reoperation rate. They also reported that surgical levels undergoing laminectomy were significantly more likely to develop progressive spinal deformity, including progressive spondylolisthesis, disc space angulation, and decreased disc space height.…”

“…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.…”

“…Traditionally, this has entailed a total laminectomy at the involved segment(s) with varying degrees of facetectomy and/or foraminotomy. [2,3,19,23,27,29,40,45,51,53,54,63,[68][69][70] A more limited interlaminar decompression with medial facetectomy has been advocated for lateral stenosis without a significant central component. [43,45,57,64] Decompressive surgery alone does not address the underlying degenerative process responsible for creating the stenosis and, in some circumstances, may serve to accelerate it.…”

Comparative study between functional outcome of lumbar canal stenosis treated with surgical decompression by laminectomy and unilateral partial hemi laminectomy approaches

“…Unilateral decompression by partial hemi laminectomy method of decompression is thought to avoid one side of paraspinal muscle damage and extensor weakness by preserving the attachment of paraspinal muscle less and the posterior l, ligamentous attachments of spinous processes. 7 We present the prospective randomized control study comparing the outcome of a unilateral decompression by partial hemi laminectomy and conventional midline decompression (CMD) by laminectomy in 41 patients who underwent surgery for lumbar spinal canal stenosis. 8 …”