Factors influencing the outcome of operative treatment for lumbar spinal stenosis

Lehto, Matti; Honkanen, Petri

doi:10.1007/bf02188775

Cited by 35 publications

(38 citation statements)

References 10 publications

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“…In several studies, there appeared to be a tendency toward poorer results for smokers, but this difference was not statistically significant. 18,50,[97][98][99][100] Although the surgical results were inferior for smokers in our study, it should be emphasised that even the smokers experienced considerable pain reduction and improvement in their QoL and walking ability after decompressive surgery. Consequently, our study should not be used as an argument to encourage smokers not to undergo surgery for spinal stenosis on an individual level.…”

Section: Effect Of Smoking On Surgical Resultscontrasting

confidence: 61%

Surgery for Lumbar Spinal Stenosis

Turner

Ersek

Herron

et al. 1995

Journal of Neurosurgery

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The incidence of lumbar spinal stenosis (LSS) is steadily rising, mostly because of a noticeably older age structure. In Sweden, LSS surgery has increased continuously over the years and is presently the most common argument to undergo spine surgery. The purpose of the surgery is to decompress the neural elements in the stenotic spinal canal. To avoid instability, there has been a tradition to do the decompression with a complementary fusion, especially if degenerative spondylolisthesis is present preoperatively.The overall aims of this thesis were to evaluate which method of surgery that generally can be considered to give sufficiently good clinical results with least cost to society and risk of complications and to determine whether there is a difference in outcome between smokers and non-smokers.The Swespine Register was used to collect data on clinical outcome after LSS surgery. In two of the studies, large cohorts were observed prospectively with follow-up after 2 years. Data were analysed in a multivariate model and logistic regression. In a randomised controlled trial (RCT, the Swedish Spinal Stenosis Study), 233 patients were randomised to either decompression with fusion or decompression alone and then followed for 2 years. The consequence of preoperative degenerative spondylolisthesis on the results was analysed and a health economic evaluation performed. The three-dimensional CT technique was used in a radiologic biomechanical pilot study to evaluate the stabilising role of the segmental midline structures in LSS with preoperative degenerative spondylolisthesis by comparing laminectomy with bilateral laminotomies.Smokers, in comparison with non-smokers, showed less improvement after surgery for LSS. Decompression with fusion did not lead to better results compared with decompression alone, no matter if degenerative spondylolisthesis was present preoperatively or not; nor was decompression with fusion found to be more cost-effective than decomression alone. The instability caused by a decompression proved to be minimal and removal of the midline structures by laminectomy did not result in increased instability compared with the preservation of these structures by bilateral laminotomies.In LSS surgery, decompression without fusion should generally be the treatment of choice, regardless of whether preoperative degenerative spondylolisthesis is present or not. Special efforts should be targeted towards smoking cessation prior to surgery.

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Section: Effect Of Smoking On Surgical Resultscontrasting

confidence: 61%

Surgery for Lumbar Spinal Stenosis

Turner

Ersek

Herron

et al. 1995

Journal of Neurosurgery

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“…Several investigations have shown that the results of lumbar spine surgery are also adversely affected by cigarette-smoking, with lower rates of fusion, poorer clinical outcomes, and higher rates of postoperative infection in smokers [4][5][6][7][8][9][10][11] . Initially, it was postulated that the lower rate of consolidation of posterolateral lumbar spinal grafts among smokers was due to a lower oxygen-carrying capacity of the bloodstream 4 .…”

mentioning

confidence: 99%

Impact of Smoking on the Outcome of Anterior Cervical Arthrodesis with Interbody or Strut-Grafting

Hilibrand

Fye

Emery³

et al. 2001

The Journal of Bone and Joint Surgery-American Volume

175

106

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“…In addition, the prevalence of degenerative conditions such as spinal stenosis, arthritis of the intervertebral disc or facet joints, and spinal deformities increase as a patient ages, potentially creating a conundrum of increased rates of pathology in patients who are at higher risk for treatment. 1,2,7,8,11 Indeed, in a recent review of Medicare claims data for 2002-2007, the rate of complex fusion procedures increased from 1.3 to 19.9 per 100,000 beneficiaries.…”

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confidence: 99%

The safety profile of lumbar spinal surgery in elderly patients 85 years and older

Wang¹,

Widi²,

Levi³

2015

FOC

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OBJECT The aging of the population will require that surgeons increasingly consider operating on elderly patients. Performing surgery safely in the elderly will require an understanding of the factors that predict successful outcomes and avoid complications. METHODS Records of patients 85 years and older undergoing elective lumbar spinal surgery were retrospectively reviewed. Microdiscectomies were excluded. Preexisting medical illnesses measured using the Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) Physical Status class, age, and surgical parameters were analyzed as factors potentially predictive of complications. Ambulatory function was rated on a 4-point scale. RESULTS During the study 26 consecutive patients (mean age 87 years) with a mean ASA class of 2.6 ± 0.65 and CCI of 1.1 ± 1.27 were enrolled. The average number of levels treated was 2.17 ± 1.23, and 73% underwent fusion. The mean follow-up was 41.9 months with a minimum of 24 months, and all patients were alive at last follow-up. Average blood loss was 142 ± 184 ml, and the operative time was 183.3 ± 80.6 minutes. The mean number of levels treated was 2.17 ± 1.13 (range 1–4). Ambulatory function improved significantly by 0.59 ± 1.0 points. Five complications (19.2%) occurred in 4 patients, 2 major and 3 minor. Four complications were temporary and 1 was permanent. Patient age, blood loss, CCI score, ASA class, the number of levels treated, and fusion surgery were not statistically associated with a complication. Operative time of longer than 180 minutes (p = 0.0134) was associated with complications. CONCLUSIONS Lumbar spine surgery in patients 85 years and older can be accomplished safely if careful attention is paid to preoperative selection. Prolonged operative times are associated with a higher risk of complications.

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Factors influencing the outcome of operative treatment for lumbar spinal stenosis

Cited by 35 publications

References 10 publications

Surgery for Lumbar Spinal Stenosis

Surgery for Lumbar Spinal Stenosis

Impact of Smoking on the Outcome of Anterior Cervical Arthrodesis with Interbody or Strut-Grafting

The safety profile of lumbar spinal surgery in elderly patients 85 years and older

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