Surgery for lumbar spinal stenosis in old people

Sanderson, P. L.; Wood, P. L. R.

doi:10.1302/0301-620x.75b3.8496206

Cited by 135 publications

(72 citation statements)

References 13 publications

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“…The ligamenta flava thicken, the facet joints hypertrophy, and a progressive disc degeneration results in a narrowing of the neural pathways. 21 Patients often present with a history of numbness, weakness, and radicular pain. Neural claudication is one of the key features, and it may be difficult to differentiate it from vascular impairment.…”

Section: Discussionmentioning

confidence: 99%

Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

Morgalla¹,

Noak²,

Merkle³

et al. 2011

SPI

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Object For the treatment of lumbar spinal stenosis, less invasive procedures, which preserve maximal bony and ligamentous structures, have been recommended to reduce associated morbidity. The authors examined the outcome after decompression of spinal stenosis in the elderly by comparing 3 different surgical approaches. Their focus was whether a unilateral microsurgical decompression provided sufficient outcomes in the elderly population. Methods The authors investigated 108 elderly patients (age ≥ 60 years) with lumbar spinal stenosis (mean age 71 years [range 60–93 years]) who underwent surgery between 2004 and June 2006 at the authors' institution. Three different modes of decompression were analyzed in this study: a unilateral partial hemilaminectomy, a hemilaminectomy, and a laminectomy. The outcome was assessed 12 months postoperatively using the Quebec Back Pain Disability Scale and the Hannover Functional Back Pain Questionnaire. Results The authors performed a unilateral partial hemilaminectomy in 53 patients (49%). Patients who underwent unilateral partial hemilaminectomies achieved favorable results of at least 80% as assessed using the Quebec Back Pain Disability Scale and Hannover Functional Back Pain Questionnaire. Hemilaminectomies were performed in 45 patients (41.7%), and laminectomies were performed in 10 patients (9.3%). However, there was no statistically significant difference between the various techniques regarding the postoperative results (p < 0.05). Conclusions Laminectomies did not show any advantage when compared with unilateral transmedian approaches. A unilateral partial hemilaminectomy combined with a transmedian decompression sufficiently treated the stenosis. This method seemed advantageous in minimizing the procedure and associated morbidity in this elderly population. Further investigations with long-term results (> 5 years) are still necessary.

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Section: Discussionmentioning

confidence: 99%

Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

Morgalla¹,

Noak²,

Merkle³

et al. 2011

SPI

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“…This figure is slightly higher than that from the studies by Yukawa et al [9] and Gelalis et al [10] which was 7.1 and 7.5 respectively. Sanderson et al [11] reported a pre-operative pain score of 6.6 while Kwon et al The higher mean pain score in this study could be due to the advanced nature of the pathology in the population due to late presentation, and/or late acceptance of surgical treatment; as many of the patients refused spinal decompression until their pain became unbearable to them.…”

Section: Discussionmentioning

confidence: 51%

“…Twelve patients (30.8%) in this study had discectomy in addition to other procedures while in another study by Postacchini et al [15], discectomy was performed in 20% of the patients. Sanderson et al [11], however, reported that none of the 31 patients in their study with degenerative spinal stenosis had discectomy. Concomitant inter-transverse process fusion with autogenous bone graft was done in 30.8% of the patients, the figure is similar to 30% noted in the study by Postacchini et al [15], in contrast however, Sanderson et al [11], submitted that none of the patients who had decompression for degenerative lumbar spinal stenosis had fusion.…”

Section: Discussionmentioning

confidence: 85%

Early Functional Outcome of Posterior Spinal Decompression for Lumbar Spinal Stenosis at a Tertiary Health Institution, South East Nigeria

Muoghalu¹,

Nwadinigwe²,

Iyidobi³

et al. 2018

JBM

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Background: Surgical treatment of lumbar spinal stenosis by posterior spinal decompression may be indicated if non-surgical management for the symptoms of low back and lower limbs radicular pains is unsuccessful and/or in patients with persisting or worsening neurological deficits. It has been reported to be an effective treatment modality in well selected patients. This procedure is however not without possible complications which can adversely affect the outcome of treatment in the affected patients. This prospective study was therefore undertaken to evaluate the early functional outcome of posterior spinal decompression for lumbar spinal stenosis at our health institution. Method: All patients with symptomatic lumbar spinal stenosis admitted for posterior spinal decompression and who met the inclusion criteria were recruited with their written informed consent. The patients' pain severity and functional disability were assessed preoperatively with visual analogue scale (VAS) and Oswestry Disability Index (ODI). The VAS and ODI were also used to reassess the patients postoperatively, at 2 weeks, 6 weeks and 12 weeks respectively. All intraoperative and/or postoperative complications were documented and the results were analyzed. Results: The patients' mean preoperative lower back pain and leg pain VAS score was 8.26 ± 1.46 while the mean preoperative ODI was 62.4% ±13.56. The commonest combination of spinal decompressive procedure done in the patients was laminectomy + foraminotomy in 10 (25% patients). The most common decompressed spinal level was L4/L5 (89.7%); while almost equal number of patients had either one spinal level or two-spinal level decompression (43.6% and 46.1% respectively). Postoperative pain assessment showed a mean VAS of 3.79 ± 1.15, 2.55 ± 1.27 and 2.00 ± 1.41 at 2 weeks, 6 weeks and 12 weeks respectively (p = 0.000). Functional outcome assessment with ODI was 34% ± 11.79%, 24% ± 10.75% and 18.12% ± 10.61% at 2 weeks, 6 weeks and 12 weeks respectively (p = 0.000). The commonest surgical complication seen was dura tear which occurred in nine patients (23.1%). Conclusion: There was significant reduction in low back and radicular pains with consequent functional improvement in majority of the patients who had posterior spinal decompression for lumbar spinal stenosis at our health institution. There were few complications of which dura tear was the commonest.

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“…Generally, minor complications that do not prolong hospital stay make up the largest part [6,7,18,19,21,22]. The wide variation in complication rates is not only based on heterogeneity of patients, operative indications, and surgical procedures performed, but also on the varying definitions of complications per se.…”

Section: Discussionmentioning

confidence: 99%

“…However, we observed no higher rate of implant related complications in group 3 compared to group 1 and 2 ( Table 3). The probability for a reoperation appears to decrease with increasing age [8,13,21]. Outcomes described in the literature vary based on length of FU, patient selection, indications, and surgical procedures and present good to excellent results in 53-93% of cases [24].…”

Section: Discussionmentioning

confidence: 99%

Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry

et al. 2011

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Introduction Published opinions regarding the outcomes and complications in older patients have a broad spectrum and there is a disagreement whether surgery in older patients entails a higher risk. Therefore this study examines the risk of surgery for lumbar spinal stenosis relative to age in the pooled data set of the Spine Tango registry. Materials and methods Between May 2005 and February 2010 the database query resulted in 1,764 patients. The patients were subdivided into three socio-economically relevant age groups: \65 years, 65-74 years, C75 years. Frequencies for occurred surgical, general and follow-up complications were assessed. Multivariate and univariate logistic regressions were performed to reveal predictors for respective complication types. Results and discussion Our study found that age, ASA status and blood loss were significant co-varieties for the occurrence of general complications. The risk of general complications is increased in older versus younger patients. Fusion or rigid stabilization does not lead to more complications. Surgical complications as well as complication rates at follow-up showed no significant age-related variation. Physician-based outcome was good or excellent in over 80% of patients in all age groups.

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Surgery for lumbar spinal stenosis in old people

Cited by 135 publications

References 13 publications

Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

Early Functional Outcome of Posterior Spinal Decompression for Lumbar Spinal Stenosis at a Tertiary Health Institution, South East Nigeria

Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry

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