Surgery for Lumbar Spinal Stenosis

Turner, Judith A.; Ersek, Mary; Herron, Larry D.; Deyo, Richard A.

doi:10.1097/00007632-199201000-00001

Cited by 567 publications

(38 citation statements)

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“…The incidence was comparable with and even lower than the reported incidence of 18% in most series of open laminectomy for LSS [30]. However, we thought the dural tears were associated with the learning curve [23], the approach method [24], and the severity of stenosis, because most of them occurred in the early cases, unilateral laminotomy for bilateral decompression, and severe stenosis.…”

Section: Discussionsupporting

confidence: 66%

“…By the original definition of this scoring system, the success rate of MEDL was as high as 90%; good or excellent results were obtained in 80% patients. In a historical meta-analysis, the success rate was 64% only [30]. As compared with a similar study for traditional open laminectomy, in which only 56.7% patients obtained good or excellent results, the results of our series were much better [13].…”

Section: Discussionsupporting

confidence: 42%

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Degenerative Lumbar Spinal Stenosis

Chen

Spivak

2003

The Physician and Sportsmedicine

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The goal of surgical treatment for degenerative lumbar spinal stenosis (LSS) is to effectively relieve the neural structures by various decompressive techniques. Microendoscopic decompressive laminotomy (MEDL) is an attractive option because of its minimally invasive nature. The aim of prospective study was to investigate the effectiveness of MEDL by evaluating the clinical outcomes with patient-oriented scoring systems. Sixty consecutive patients receiving MEDL between December 2005 and April 2007 were enrolled. The indications of surgery were moderate to severe stenosis, persistent neurological symptoms, and failure of conservative treatment. The patients with mechanical back pain, more than grade I spondylolisthesis, or radiographic signs of instability were not included. A total of 53 patients (36 women and 17 men, mean age 62.0) were included. Forty-five patients (84.9%) were satisfied with the treatment result after a follow-up period of 15.7 months (12-24). The clinical outcomes were evaluated with the Oswestry disability index (ODI) and the Japanese Orthopedic Association (JOA) score. Of the 50 patients providing sufficient data for analysis, the ODI improved from 64.3 ± 20.0 to 16.7 ± 20.0. The JOA score improved from 9.4 ± 6.1 to 24.2 ± 6.0. The improvement rate was 73.9 ± 30.7% and 40 patients (80%) had good or excellent results. There were 11 surgical complications: dural tear in 5, wrong level operation in 2, and transient neuralgia in 4 patients. No wound-related complication was noted. Although the prevalence of pre-operative comorbidities was very high (69.8%), there was no serious medical complication. There was no post-operative instability at the operated segment as evaluated with dynamic radiographs at final follow-up. We concluded that MEDL is a safe and very effective minimally invasive technique for degenerative LSS. With an appropriate patient selection, the risk of post-operative instability is minimal.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionsupporting

confidence: 42%

Degenerative Lumbar Spinal Stenosis

Chen

Spivak

2003

The Physician and Sportsmedicine

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“…In comparison, other series have reported it with variable frequency ranging from 23 to 94% [7, 9, 10, 11, 12, 13, 20]probably reflecting differing patient selection and definition of spinal claudication. A series reporting spinal claudication in only 23% of patients also reported leg pain in 58% but did not elaborate further on its nature [7].…”

Section: Discussionmentioning

confidence: 79%

“…Most studies on the outcome of lumbar spinal stenosis have looked specifically at factors which affect the results of surgery [7, 8, 12, 23, 24, 25]. Our study did not specifically look at any particular modality of treatment but rather attempted to survey the evolution of the disease till the time of review.…”

Section: Discussionmentioning

confidence: 99%

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The Clinical Syndrome Associated with Lumbar Spinal Stenosis

Goh¹,

Khalifa

Anslow

et al. 2004

Eur Neurol

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Lumbar spinal stenosis is well defined in patho-anatomical terms but its clinical features are heterogeneous. We carried out a comprehensive retrospective review of the clinical features, radiological changes and outcome of 75 patients with radiologically diagnosed lumbar spinal stenosis in order to define its clinical spectrum. The presenting complaints were of weakness, numbness/tingling, radicular pain and neurogenic claudication in almost equal proportions. The commonest symptom was numbness or tingling of the legs. Neurogenic claudication eventually occurred in only 61%. Ninety-three per cent showed abnormalities on neurological examination, but these were generally mild with reduced ankle jerks being commonest. Imaging of the lumbar spine showed that moderate to severe central spinal stenosis correlated with complaints of weakness and abnormal motor power on clinical examination. Patients were reviewed at a mean of 4 years after diagnosis and 65% had undergone surgical decompression; this was not a prospective comparison of different treatment modalities. Overall, a third of patients felt that their symptoms had improved while a quarter felt that they had worsened. More than half had satisfactory neurological function at the time of review. Thirty-nine per cent of those treated surgically, and 25% of those managed conservatively, reported improved symptoms. A poorer functional status at review correlated with complaints of motor weakness and associated comorbid disease. Degenerative lumbar stenosis is a clinically heterogeneous neurological disorder of the lower limbs in the elderly with variable longer-term outcome. A high index of suspicion is required and neuroimaging should be obtained to confirm the diagnosis.

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