Lumbar Spinal Stenosis and Nerve Root Entrapment Syndromes

Arnoldi, Carl C.; Brodsky, Alex; Cauchoix, J; Crock, Henry Vernon; Dommisse, G. F.; Edgar, Michael; Gargano, Fredie P.; Jacobson, Robert E; Kirkaldy-Willis, W. H.; Kurihara, Akira; Ld, Andreeva; Macnab, Ian; McIvor, G. W.D.; Newman, P. H.; Paine, Kenneth W. E.; Russin, Lester A.; Sheldon, Jerome J.; Tile, Marvin; Urist, M. R.; Wilson, William E.; Wiltse, Leon L.

doi:10.1097/00003086-197603000-00002

Cited by 190 publications

(194 citation statements)

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“…However, it was only after 1954, when Verbiest [26] set out definitive clinical and pathological findings, that spinal stenosis could adequately be diagnosed [18]. Lumbar spinal stenosis has been defined as a condition involving any type of narrowing of the spinal canal, nerve root canals, or tunnels of intervertebral foramina [1]. The most common form is the degenerative lumbar spinal stenosis due to hypertrophy of the facet joint, with or without developmental changes, leading eventually to protrusions of the intervertebral discs resulting in a narrowing of the spinal canal [17].…”

Section: Introductionmentioning

confidence: 99%

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

1997

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Therapy for spinal stenosis remains difficult. The possibilities for conservative management are limited and not satisfactory in the more severe cases. Various surgical procedures are possible, such as decompression, decompression and fusion without instrumentation and decompression and fusion with instrumentation. The aim of our metaanalysis was to compare the postoperative results of these three surgical techniques in the literature and, thus, to establish a treatment of choice for degenerative lumbar spinal stenosis. Via Medline, 30 articles met the inclusion criteria for our study, leading to a total number of 1668 cases being included in the meta-analysis. The evaluation was made according to our own definition of outcomes, based on criteria most commonly used in the studies reviewed. We found that in patients suffering degenerative spinal stenosis for up to 8 years, decompression without fusion showed the best results. For a duration of symptoms of 15 years or more, decompression with instrumented fusion had the best results. Analysing all postoperative outcomes, decompression is the surgical procedure with the highest rate of success and the fewest complications, followed by decompression with instrumented fusion. In surgery for degenerative lumbar spinal stenosis, decompression and fusion without instrumentation was the least successful procedure. As patients suffering from a degenerative spinal stenosis often are elderly, operations are risky and place a strain on them. This review of the literature shows that the least invasive surgical procedure can obtain the best results if the correct diagnosis is made and if the operation is carried out within the first years of the disease.

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Section: Introductionmentioning

confidence: 99%

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

1997

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“…Classi®cation of patients (40 females, 32 males) was performed in a modi®cation of the scheme of Arnoldi 4 from 1976. Four groups were distinguished:…”

Section: Methodsmentioning

confidence: 99%

Long term follow up in lumbar spinal stenosis

1998

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In a retrospective study the charts of 72 patients who had decompressive surgery for lumbar stenosis between 1987 and 1990 were evaluated. Mean ®rst follow up was 2.5 years (range 1.5 years to 3.5 years). A second follow up was done 8 years after surgery via mail. The mean age was 59.7 years (females 63.7, males 55 years). The average interval between the onset of complaints to surgery was 6 years. Claudicatio intermittens was found in 34.7% of cases. Patients were divided into four groups according to the classi®cation by Arnoldi from 1976. Laminectomy or hemilaminectomy was performed in 73.6% of cases. In 68.1% nucleotomy was performed. In the ®rst follow up outcome of patients was good in 73.6%. Complete recovery was noted in 61.1%. 11% were not satis®ed with operative results. Old patients especially bene®tted from the operation. In the second follow up after 8 years only 62.1% of the patients mentioned that their results were unchanged, good or better than at the ®rst evaluation. The other 37.9% complained of a poorer result.

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“…Decompressive laminectomy has been widely used as an operative treatment for lumbar canal stenosis 1–5. Laminectomy including removal of spinous process, supraspinous ligament, interspinous ligament, lamina and ligamentum flavum jeopardize the integrity of posterior complex of the spine.…”

Section: Introductionmentioning

confidence: 99%

“…Long segment fusions have been done by some workers to obviate postoperative instability; however, such operations result in loss of motion of lumbar spine and predisposes the spine for adjacent level degeneration 10–13. It is important in the treatment of spinal stenoses to achieve adequate spinal decompression while maintaining the spinal stability 1. The preservation of posterior spinal elements associated with minimally invasive surgery could minimize the risk of developing de novo postoperative changes in spinal alignment and/or acceleration of facet and disc degeneration.…”

Section: Introductionmentioning

confidence: 99%

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

Tuli

Kapoor

Jain

et al. 2011

IJOO

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Background:Iatrogenic instability following laminectomy occurs in patients with degenerative lumbar canal stenosis. Long segment fusions to obviate postoperative instability result in loss of motion of lumbar spine and predisposes to adjacent level degeneration. The best alternative would be an adequate decompressive laminectomy with a nonfusion technique of preserving the posterior ligament complex integrity. We report a retrospective analysis of multilevel lumbar canal stenosis that were operated for posterior decompression and underwent spinaplasty to preserve posterior ligament complex integrity for outcome of decompression and iatrogenic instability.Materials and Methods:610 patients of degenerative lumbar canal stenosis (n=520) and development spinal canal stenosis (n=90), with a mean age 58 years (33–85 years), underwent multilevel laminectomies and spinaplasty procedure. At followup, changes in the posture while walking, increase in the walking distance, improvement in the dysesthesia in lower limb, the motor power, capability to negotiate stairs and sphincter function were assessed. Forward excursion of vertebrae more than 4 mm in flexion–extension lateral X-ray of the spine as compared to the preoperative movements was considered as the iatrogenic instability. Clinical assessment was done in standing posture regarding active flexion–extension movement, lateral bending and rotationsResults:All patients were followed up from 3 to 10 years. None of the patients had neurological deterioration or pain or catch while movement. Walking distance improved by 5–10 times, with marked relief (70–90%) in neurogenic claudication and preoperative stooping posture, with improvement in sensation and motor power. There was no significant difference in the sagittal alignment as well as anterior translation. Two patients with concomitant scoliosis and one with cauda equine syndrome had incomplete recovery. Two patients who developed disc protrusion, underwent a second operation for a symptomatic disc prolapse.Conclusion:Spinaplasty following posterior decompression for multilevel lumbar canal stenosis is a simple operation, without any serious complications, retaining median structures, maintaining the tension band and the strength with least disturbance of kinematics, mobility, stability and lordosis of the lumbar spine.

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Lumbar Spinal Stenosis and Nerve Root Entrapment Syndromes

Cited by 190 publications

References 0 publications

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

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

Long term follow up in lumbar spinal stenosis

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

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