Surgical treatment and results in patients suffering from lumbar spinal steoses

Abstract

Stenosis of the lumbar spinal canal is contributing to 3-5% of all patients operated on a lumbar nerve root compression syndrome. Morphologically, a reduction of the midsagittal diameter of the spinal canal to less than 12 mm or stenoses of the lateral recessus or foramen intervertebrale have been described. In our department 37 patients with a lumbar spinal stenosis have been surgically treated between 1982 and 1987. Spinal stenosis is a disease of aged patients mostly suffering for a long history. The main symptoms are lumbar and sciatic pains, neurological deficits and a claudicatio intermittens spinalis. Neuroradiologically, the diagnosis can be confirmed by CT, myelography or MRI. These studies were demonstrating the stenosis in 69% at the level of L4/5, multiple stenoses have been found in 22% of all cases. An additional disc herniation existed in 35% of the patients. Concerning the specific complaints of the patients and their neuroradiological findings, the extent of the surgical decompression was decided on individually in each patient. We performed 22 laminectomies, 11 hemilaminectomies, in 3 cases an extended flavectomy and in one case an implantation of a dorsal column stimulation device. The postoperative follow-up period, ranging from 3 months to 3 years, demonstrated a complete recovery in 53%, a marked reduction of complaints in 44% of all cases. One patient did not respond to surgical treatment, but in the remaining cases surgical treatment led to satisfactory results.

Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis part II: Clinical experiences

“…Spondylosis affects predominantly the motion segment of L4-L5, and progressive degeneration of the facet joints as well as hypertrophy of the ligamentum flavum commonly cause chronic low back pain, neurogenic claudication and entrapment radiculopathy [3,7,9,18,20,23,[35][36][37][38].…”

“…For classification either a functional definition is used, related to the patient's symptoms and signs, or a morphometrical definition, with diameter or cross-sectional area measurements of the spinal canal. Accordingly, absolute and relative spinal stenosis is a frequently used differentiation, based on the measurement of the antero-posterior diameter (APD) [18,26,34,35]. Nevertheless, people with radiologically proven absolute spinal stenosis may be asymptomatic [4,6,9], and the antero-posterior diameter is not an adequate measurement, especially in patients with severe hypertrophy of the facet joints.…”

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

“…Younger patients had a positive straight leg raising result more often [8]. The preoperative duration of symptoms was significantly shorter in patients with disc herniation it has been observed that stenosis has been accompanied by disc hernia in 35-40% of the cases [7,10,12]. In neurological examination, Laseque test has been negative in 65% of the cases.…”

“…According to Lange et al [12] their study was demonstrating the stenosis in 69% at the level of L4/5, and multiple stenoses have been found in 22% of all cases. Halls et al [5] found, 30% had multi-level stenosis.…”

“…Lange et al achieved complete recovery in 53% of the cases. Satisfactory results from operative treatment were expected only after adequate and thorough decompression [12].…”