Minimally Invasive Decompression and Physiotherapy for Lumbar Spinal Stenosis in Geriatric Patients

Abstract

BackgroundLumbar spinal stenosis (LSS) is the most common indication for spine surgery among the geriatric population. Although decompressive surgery is effective, older patients do not benefit as much as younger patients, and they are frequently excluded from studies assessing postoperative physiotherapy. We sought to evaluate the long-term outcomes after surgery when a novel postoperative physiotherapy regimen was included.MethodsWe performed a retrospective review of patients with LSS greater than 70 years old who underwent lumbar decompressive surgery by the senior author over the past five years. We evaluated patients who participated in a novel postoperative physiotherapy regimen involving four phases of rehabilitation aimed at progressively independent ambulation. The visual analog scale (VAS), lower extremity motor strength, and functional independence measure (FIM) were collected preoperatively and after physiotherapy to measure outcomes.ResultsTen consecutive patients with an average age of 83 years (range: 71 – 96) met the inclusion criteria. Nine patients underwent minimally invasive laminotomies at L4-L5 and one underwent a laminotomy at L3-L4. The average follow-up time was 41.9 months. The preoperative mean VAS was 7.35, and at the end of the study, it was 1.7 (p = 0.005). Three of the four patients with preoperative motor deficits improved. The median transfer and locomotion subscores of the FIM were six preoperatively and increased to seven postoperatively. Neither of these improvements was significant.ConclusionsPatients older than 70 years undergoing decompressive surgery and a novel postoperative physiotherapy regimen experienced significant reductions in pain. Independence also increased; however, this did not reach statistical significance.

The Role of Minimally Invasive Spinal Surgical Procedures in the Elderly Patient: An Analysis of 49 Patients Between 75 and 95 Years of Age

“…The most common spinal problems that are seen in the elderly population and in which minimally invasive spinal procedures are applicable include vertebral compression fractures with acute incapacitating or later chronic back pain, spinal stenosis with neurogenic claudication, acute far lateral discs that are often seen in the upper lumbar spine, and chronic pain secondary to failed laminectomy, degenerative scoliosis, and spondylosis often in combination with diabetic or vascular neuropathy [23][24]. As the spinal surgeon, interventional pain management specialist or even interventional radiologists and especially anesthesia team become comfortable with performing procedures under local anesthesia, and as the operative time of the experienced surgeon becomes shorter, it is possible to recommend minimal invasive procedures when supported by diagnostic studies with faster return home, ambulation, post-procedure physical therapy, and less morbidity with similar outcomes [25][26].…”