Preoperative and Postoperative Instability in Lumbar Spinal Stenosis

Johnsson, Karl-Erik; Redlund-Johnell, Inga; Udén, Alf; Willner, Stig

doi:10.1097/00007632-198906000-00008

Cited by 178 publications

(97 citation statements)

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“…This is in agreement with the results of Jönsson (14), who also used a facet-sparing technique, but in contrast to the findings of Johnson et al (11) who after extensive laminectomies and facetectomies found post-operative slippage twice as common among patients with a poor outcome compared to those with a good outcome. Furthermore, in their study 43 % of the patients showed post-operative slippage compared to 21 % in our material.…”

Section: Discussionsupporting

confidence: 92%

“…The extensive decompression and especially the complete removal of facets might cause instability and induce further or even new symptoms. Johnsson et al (11) reported 59 % excellent or good results and 41 % unchanged or worse. They stated that "a general tendency towards more radical decompression was seen in the poor group", the radicality being studied by post-operative CT.…”

Section: Discussionmentioning

confidence: 97%

“…The rate of complications has been modest, the results varying (16) but mostly good (1,7,10,23). However, following this type of surgery, post-operative spondylolisthesis has been reported to be rather frequent (8,11,13). Therefore, a more gentle surgical procedure retaining more of the weight-bearing tissues was called for.…”

Section: Introductionmentioning

confidence: 99%

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Microsurgical decompression without laminectomy in lumbar spinal stenosis

Nyström

Weber²,

Amundsen³

2001

Upsala Journal of Medical Sciences

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Our objectives were to study a/ the clinical results of microsurgical decompression without laminectomy compared to those reported from standard decompression laminectomy in patients with central lumbar spinal stenosis, and b/ if the microsurgical technique could prevent post-operative instability and concomitant symptoms.Twenty-one patients were treated, 11 men and 10 women, aged 47-81 years. Fourteen patients had "pure" stenosis whereas 7 had additional diseases that compounded the symptoms of stenosis. Independent examiners saw the patients pre-operatively and a mean of 27 months post-operatively. Plain X-ray films were taken of 14 patients a mean of 5 years post-operatively to study possible slippage.Among the 14 patients with "pure" stenosis the results were excellent in 13 and fair in 1. Among the 7 with additional diseases the outcome was excellent in 1, fair in 1, unchanged in 3 and worse in 2. The technique did not prevent post-operative slippage, which occurred in 3 of 14 patients. However, the clinical outcome was not related to slippage.We found the microsurgical technique safe and gentle with excellent possibilities for decompression of the complete spinal canal without laminectomy. The results following this procedure were well comparable to or even better than those reported following standard decompression laminectomy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

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Microsurgical decompression without laminectomy in lumbar spinal stenosis

Nyström

Weber²,

Amundsen³

2001

Upsala Journal of Medical Sciences

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“…Some authors reported factors predisposing patients to worse outcomes as: female sex, greater severity and duration of symptoms before surgery, younger age (30-50 years), prior back surgery, compensation and ligitation issues and multilevel decompression [4,8,9,11,14,28].…”

Section: Discussionmentioning

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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“…However, the significance of lumbar fusion following posterior decompression is still controversial [1,14]. Although decompressive wide laminectomy is one of the most commonly performed operations for this disease, postoperative instability is, to some degree, unavoidable in degenerative and/ or spondylolisthetic spinal stenosis [5,8]. Some authors have reported a satisfactory outcome with laminectomy alone [2,4], whereas others have reported better results with laminectomy in conjunction with spinal fusion [3,12].…”

Section: Introductionmentioning

confidence: 99%

Expansive lumbar laminoplasty for degenerative spinal stenosis in patients below 70 years of age

et al. 1997

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We reviewed the clinical and radiological results of patients with lumbar degenerative spinal stenosis who underwent expansive laminoplasty with a mean follow-up term of 5.6 years. Twenty-seven patients underwent open-door-type expansive lumbar laminoplasty, which has both decompression and stabilization effects. Clinical results were assessed based on the score system devised by the Japanese Orthopaedic Association (JOA score). The number and causes of repeat surgery were also evaluated. Radiological changes, such as degenerative scoliosis and spondylolisthesis, were evaluated at the operated levels and at levels L1-L5. There was marked recovery of clinical symptoms assessed by pre-and postoperative JOA score. Nearly 80% of patients obtained good or excellent results. Only one patient (4%) required additional surgery, which involved discectomy at the caudal level of the laminoplasty. Radiographic evaluation revealed that postoperative changes of spondylolisthesis and scoliosis were slight both in the expanded area and the L1-L5 levels. Range of motion of the disc space angle in the expanded area showed a significant decrease postoperatively. However, pre-and postoperative radiological changes showed no significant correlation with JOA score changes and repeat surgery. In conclusion, lumbar fusion after posterior decompression in active patients with spinal stenosis offers satisfactory clinical results concomitantly with a relatively small risk of repeat surgery.

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Preoperative and Postoperative Instability in Lumbar Spinal Stenosis

Cited by 178 publications

References 0 publications

Microsurgical decompression without laminectomy in lumbar spinal stenosis

Microsurgical decompression without laminectomy in lumbar spinal stenosis

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

Expansive lumbar laminoplasty for degenerative spinal stenosis in patients below 70 years of age

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