Long-Term Outcome of Laminectomy for Spinal Stenosis in Octogenarians

Galiano, Klaus; Obwegeser, Alois Albert; Gabl, Michael; Bauer, Richard; Twerdy, K

doi:10.1097/01.brs.0000152381.20719.50

Cited by 72 publications

(53 citation statements)

References 19 publications

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“…Previously, younger age has been found to be predictive of better postoperative walking ability in a 6 months' follow-up [15]. Generally, older age has not been found to predict poor clinical outcome in long-term studies [1,10].…”

Section: Discussionmentioning

confidence: 99%

Depression is associated with poorer outcome of lumbar spinal stenosis surgery

et al. 2007

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The objective of this observational prospective study was to investigate the effect of depression on shortterm outcome after lumbar spinal stenosis (LSS) surgery. Surgery was performed on 99 patients with clinically and radiologically defined LSS, representing ordinary LSS patients treated at the secondary care level. They completed questionnaires before surgery and 3 months postoperatively. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with Oswestry disability index, Stucki Questionnaire, self-reported walking ability, visual analogue scale (VAS) and pain drawing. Preoperatively, 20% of the patients had depression. In logistic regression analyses, significant associations were seen between preoperative depression and postoperative high Oswestry disability and Stucki severity scores and high intensity of pain (VAS score). In subsequent analyses, the patients with continuous depression, measured with BDI (60% of the patients who had preoperative depression), showed fewer improvements in symptom severity, disability score, pain intensity and walking capacity than the patients who did not experience depression at any phase. In those patients who recovered from depression, according to BDI-scores (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. In the surgical treatment of LSS, we recommend that the clinical practice should include an assessment of depression.

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Section: Discussionmentioning

confidence: 99%

Depression is associated with poorer outcome of lumbar spinal stenosis surgery

et al. 2007

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“…Cirak et al 6 concluded that in cases of lumbar spinal stenosis, decompressive laminectomy and extensive foraminotomy without instrumentation have good outcomes. Galiano and coworkers 10 showed that in the long term, decompressive laminectomies in selected octogenarians resulted in decreased disability, decline of analgesic use, and increased quality of life. However, there currently seems to be much less consensus regarding the extent of decompression in patients with lumbar spinal stenosis.…”

Section: Methods Of Decompression and Outcomementioning

confidence: 99%

“…27 There are also studies that present the opposite of these findings. 10,12 Some investigations undertaken for lumbar spinal stenosis surgery have noted that comorbidity is associated with poorer postoperative symptoms, motor function, and overall satisfaction. Katz et al 14 found that greater cardiovascular, musculoskeletal, and overall comorbidities led to poorer scores in most of the outcome measurements.…”

Section: Issues Associated With Elderly Patientsmentioning

confidence: 99%

Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

Morgalla¹,

Noak²,

Merkle³

et al. 2011

SPI

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Object For the treatment of lumbar spinal stenosis, less invasive procedures, which preserve maximal bony and ligamentous structures, have been recommended to reduce associated morbidity. The authors examined the outcome after decompression of spinal stenosis in the elderly by comparing 3 different surgical approaches. Their focus was whether a unilateral microsurgical decompression provided sufficient outcomes in the elderly population. Methods The authors investigated 108 elderly patients (age ≥ 60 years) with lumbar spinal stenosis (mean age 71 years [range 60–93 years]) who underwent surgery between 2004 and June 2006 at the authors' institution. Three different modes of decompression were analyzed in this study: a unilateral partial hemilaminectomy, a hemilaminectomy, and a laminectomy. The outcome was assessed 12 months postoperatively using the Quebec Back Pain Disability Scale and the Hannover Functional Back Pain Questionnaire. Results The authors performed a unilateral partial hemilaminectomy in 53 patients (49%). Patients who underwent unilateral partial hemilaminectomies achieved favorable results of at least 80% as assessed using the Quebec Back Pain Disability Scale and Hannover Functional Back Pain Questionnaire. Hemilaminectomies were performed in 45 patients (41.7%), and laminectomies were performed in 10 patients (9.3%). However, there was no statistically significant difference between the various techniques regarding the postoperative results (p < 0.05). Conclusions Laminectomies did not show any advantage when compared with unilateral transmedian approaches. A unilateral partial hemilaminectomy combined with a transmedian decompression sufficiently treated the stenosis. This method seemed advantageous in minimizing the procedure and associated morbidity in this elderly population. Further investigations with long-term results (> 5 years) are still necessary.

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“…Among patients 80 years and older undergoing laminectomy for spinal stenosis, Galiano et al 21 noted that at 2.7 years of follow-up, there was a 54.1% improvement in ODI and a statistically significant decrease in analgesic usage.…”

Section: Clinical Outcomementioning

confidence: 99%

Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions

Drazin

Shirzadi²,

Rosner³

et al. 2011

FOC

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Object The elderly population (age > 60 years) is the fastest-growing age group in the US. Spinal deformity is a major problem affecting the elderly and, therefore, the demand for surgery for spinal deformity is becoming increasingly prevalent in elderly patients. Much of the literature on surgery for adult deformity focuses on patients who are younger than 60 years, and therefore there is limited information about the complications and outcomes of surgery in the elderly population. In this study, the authors undertook a review of the literature on spinal deformity surgery in patients older than 60 years. The authors discuss their analysis with a focus on outcomes, complications, discrepancies between individual studies, and strategies for complication avoidance. Methods A systematic review of the MEDLINE and PubMed databases was performed to identify articles published from 1950 to the present using the following key words: “adult scoliosis surgery” and “adult spine deformity surgery.” Exclusion criteria included patient age younger than 60 years. Data on major Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores, patient-reported outcomes, and complications were recorded. Results Twenty-two articles were obtained and are included in this review. The mean age was 74.2 years, and the mean follow-up period was 3 years. The mean preoperative ODI was 48.6, and the mean postoperative reduction in ODI was 24.1. The mean preoperative VAS score was 7.7 with a mean postoperative decrease of 5.2. There were 311 reported complications for 815 patients (38%) and 5 deaths for 659 patients (< 1%). Conclusions Elderly patient outcomes were inconsistent in the published studies. Overall, most elderly patients obtained favorable outcomes with low operative mortality following surgery for adult spinal deformity.

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Long-Term Outcome of Laminectomy for Spinal Stenosis in Octogenarians

Abstract: On the long-term, decompressive laminectomy in selected octogenarians results in decreased disability, decline of analgesics usage, and increased quality of life.

Cited by 72 publications

References 19 publications

Depression is associated with poorer outcome of lumbar spinal stenosis surgery

Depression is associated with poorer outcome of lumbar spinal stenosis surgery

Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions

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