The Natural Course of Lumbar Spinal Stenosis

Ke, Johnsson; Rosén, Ingmar; Udén, Alf

doi:10.1097/00003086-199206000-00010

Cited by 233 publications

(94 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the absence of preexisting spinal instability, arthrodesis is unnecessary after decompression of lumbar spine for canal stenosis. No difference was found in the improvement of walking distance and relief of pain (followup more than 2 years) in patients who had decompression alone or decompression with fusion 1121–2527–29…”

Section: Discussionmentioning

confidence: 90%

“…Many workers have combined extensive laminectomy with fusion with or without instrumented stabilization 21–24. However, there is no convincing evidence to suggest that concomitant fusion has increased patients’ satisfaction 25–29. Fusion of mobile segments of the spine entails hypermobility of the adjacent unfused joints which may lead to instability (more than 3 mm of anteroposterior translation) or premature disc degeneration or stenosis of the canal.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

Tuli

Kapoor

Jain

et al. 2011

IJOO

View full text Add to dashboard Cite

Background:Iatrogenic instability following laminectomy occurs in patients with degenerative lumbar canal stenosis. Long segment fusions to obviate postoperative instability result in loss of motion of lumbar spine and predisposes to adjacent level degeneration. The best alternative would be an adequate decompressive laminectomy with a nonfusion technique of preserving the posterior ligament complex integrity. We report a retrospective analysis of multilevel lumbar canal stenosis that were operated for posterior decompression and underwent spinaplasty to preserve posterior ligament complex integrity for outcome of decompression and iatrogenic instability.Materials and Methods:610 patients of degenerative lumbar canal stenosis (n=520) and development spinal canal stenosis (n=90), with a mean age 58 years (33–85 years), underwent multilevel laminectomies and spinaplasty procedure. At followup, changes in the posture while walking, increase in the walking distance, improvement in the dysesthesia in lower limb, the motor power, capability to negotiate stairs and sphincter function were assessed. Forward excursion of vertebrae more than 4 mm in flexion–extension lateral X-ray of the spine as compared to the preoperative movements was considered as the iatrogenic instability. Clinical assessment was done in standing posture regarding active flexion–extension movement, lateral bending and rotationsResults:All patients were followed up from 3 to 10 years. None of the patients had neurological deterioration or pain or catch while movement. Walking distance improved by 5–10 times, with marked relief (70–90%) in neurogenic claudication and preoperative stooping posture, with improvement in sensation and motor power. There was no significant difference in the sagittal alignment as well as anterior translation. Two patients with concomitant scoliosis and one with cauda equine syndrome had incomplete recovery. Two patients who developed disc protrusion, underwent a second operation for a symptomatic disc prolapse.Conclusion:Spinaplasty following posterior decompression for multilevel lumbar canal stenosis is a simple operation, without any serious complications, retaining median structures, maintaining the tension band and the strength with least disturbance of kinematics, mobility, stability and lordosis of the lumbar spine.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

Tuli

Kapoor

Jain

et al. 2011

IJOO

View full text Add to dashboard Cite

show abstract

“…In a study comparing surgical and conservative treatment, Johnsson et al [15] noted that 60% of surgically treated patients improved and 25% worsened, while 30% of conservatively treated patients improved and 60% had their clinical situation unchanged. These authors found that after a follow-up of 49 months, only 15% of patients had worsened, while 70% of patients experienced no variations in clinical status and 15% of patients had an improvement: therefore, conservative treatment for lumbar stenosis can be considered a valid alternative to the surgical approach [3]. In a recent metaanalysis, Gunzburg and Szpalski [5] reported that 64% of surgically treated patients had good to excellent results.…”

Section: Discussionmentioning

confidence: 99%

“…When clinical presentation includes inferior limb numbness and paraesthesia, and if imaging and electrodiagnostic tests confirm the diagnosis, surgical management is considered the routine therapeutic choice. Nevertheless, clinical experience shows that good results can also be achieved without surgical treatment [2,3].…”

Section: Introductionmentioning

confidence: 99%

The role of JOA score as an indication for surgical or conservative treatment of symptomatic degenerative lumbar spinal stenosis

Costanzo

Cellocco

Francesco

et al. 2005

J Orthopaed Traumatol

View full text Add to dashboard Cite

The aim of this study was to evaluate the short-to medium-term results (up to 2 years) of conservative and surgical treatments of patients with symptomatic lumbar stenosis. To our knowledge, no previous study has provided strict indications for conservative or surgical treatment. We retrospectively studied 184 patients, who were divided into 3 groups according to JOA (Japanese Orthopaedic Association) score. A cutoff JOA score was arbitrarily fixed at 7. Patients with a score ≤7 (n=12; group A) underwent surgery, while patients with a score >7 (n=172) were conservatively treated. Group A included patients surgically treated within two months from diagnosis. Group B consisted of 144 patients who received conservative treatment, while group C (28 patients) represented patients who underwent surgery after a period of failed conservative treatment. The outcomes of surgical and conservative treatments were evaluated after 12 and 24 months, and were rated as satisfactory, not totally satisfactory, not satisfactory or totally unsatisfactory. Conservative treatment consisted of physical, orthotic and drug therapy, whereas surgical treatment included spinal decompression and instrumentation (if indicated), either rigidly or dynamically performed. Surgery was indicated in 22% of all patients and we obtained excellent results in 85% of them. Operative treatment provides excellent results for patients with severe clinical presentation (JOA score ≤7), while individuals with mild to moderate spinal stenosis (JOA score >7) should receive conservative treatment.

show abstract

“…Die Ansprechrate ist hier allerdings dadurch reduziert, dass durch den operativen Eingriff die intraspinale Anatomie verändert wird und durch Verklebungen und Vernarbungen epidural injizierte Lösungen teilweise nicht den gewünschten Ort erreichen [15]. Spontan kommt es hier nur bei 15% der Patienten innerhalb von 4 Jahren zur Besserung, 70% bleiben klinisch unverändert, und 15% zeigen eine Zunahme der Beschwerden [17]. Allerdings kann bei Patienten mit Claudicatio spinalis ein mehrmonatiges schmerzfreies oder -gemindertes Intervall erreicht werden, sodass in vielen Fällen eine Operation hinausgezögert oder sogar vermieden werden kann [12].…”

Section: Diskussionunclassified

Minimally invasive injection therapy for patients with radicular lumbar spine syndrome

Madl

Linhardt

Boluki

et al. 2007

Schmerz

View full text Add to dashboard Cite

show abstract

The Natural Course of Lumbar Spinal Stenosis

Cited by 233 publications

References 0 publications

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

The role of JOA score as an indication for surgical or conservative treatment of symptomatic degenerative lumbar spinal stenosis

Minimally invasive injection therapy for patients with radicular lumbar spine syndrome

Contact Info

Product

Resources

About