Lumbar Spinal Stenosis in Elderly Patients

Abstract

Over a 3-year period in our clinic, surgeons operated on 32 persons over 65 years old with lumbar spinal stenosis. This article presents the retrospective analysis of the clinical, radiological, and short-term surgical outcomes. The stenosis seen most commonly among the elderly develops focally at the intervertebral junctions as a result of a complex process of disc degeneration, facet arthropathy, ligamentum flavum hypertrophy, spondylosis, and sometimes spondylolisthesis. All patients underwent a midline decompressive laminectomy with foraminotomies at the affected levels, and discectomy was performed in persons with lumbar disc hernia. Average age was 71.15 +/- 5.09 (65-80); 50% (16) were women, and 50% (16) were men. The most frequent symptoms were pain (96.9%) and neurological claudication (90.6%). The average preoperative duration of the symptoms was 139.87 +/- 115.03 weeks. The most frequent neurological symptoms were reflex disturbances (62.5%), Lasèques's sign (SLR) (+)(53%), and motor deficit (50%). The anteroposterior diameter of the spinal canal was less than 11.5 mm in 71.9% of the cases. In 62.5% of the patients, partial recovery was observed in the short term; 68.8% of the patients underwent laminectomy. Of those, 87.5% had total and 12.5% had partial laminectomies. In addition to laminectomy, discectomy was performed in 31.3% of the patients. Total laminectomy was more likely to be performed on patients older than 65 years, because the anteroposterior diameter was more likely to be below 11.5 mm in this cohort of patients. In lumbar stenosis, surgical treatment-decompression-is an effective method. Surgery has been demonstrated to be effective even in patients over the age of 75 years.

Agreement and Correlation Between the Straight Leg Raise and Slump Tests in Subjects With Leg Pain

“…18,19 Indeed, there is controversy as to whether nerve conduction studies are useful in the identification of neural pain syndromes, at least in the upper limb. 26,27 Realtime ultrasound has been used in the investigation of neural tissue pain disorders in the upper limb [28][29][30] and sciatic nerve movement in the lower limb.…”

“…Furthermore, lumbar nerve root compression does not always result in SLR limitation. 18,19 Macrophages play a major role in the inflammatory process arising from disk herniation. Activated macrophages secrete cytokines (eg, interleukin-β, tumor necrosis factor-α [TNFα], cathepsins, collagenases, and other lytic enzymes) that have potent effects to sensitize adjacent neural tissues.…”

The analysis of the factors affecting lumbar spinal stenosis in adult patients

“…It has also been mentioned that there is no need for fusion as long as there is not preoperative instability. Decompression without fusion was recommended because of increased hospitalization, recovery time and complications associated with fusion [5,9,12,17,19].…”

Kesesuaian ukuran kanalis spinalis lumbal berdasarkan Ultrasonografi dengan MR-Myelografi pada penderita nyeri punggung bawah

“…Hulagu Kaptan dkk melaporkan pada pasien-pasien yang kanalis spinalis lumbal dengan diameter anteroposterior kurang dari 11,5 mm, dipastikan stenosis kanalis spinalis lumbal, dan laminektomi total lebih sering dilakukan. 14,15 Karena pentingnya peranan imaging dalam diagnosis nyeri punggung bawah, kami tertarik untuk meneliti kesesuaian ukuran kanalis spinalis lumbal menggunakan ultrasonografi dengan MR-myelografi lumbosakral pada penderita nyeri punggung bawah.…”