OPERATIVE TREATMENT FOR DEGENERATIVE LUMBAR SPINAL STENOSIS
Abstract
Background. Degenerative lumbar spinal stenosis (DLSS) is a common cause of low back and leg pain in the elderly. Conservative treatment seldom results in sustained improvement.
Methods. Fifty-six patients (33 women, 23 men) older than 50 years (mean 67 years, range 51 to 82 years) and with no prior low back surgery were treated from 1993 to 1999 for clinical and radiologic evidence of DLSS. The goal of this study was to describe the results of decompressive laminectomy with or without fusion in terms of reoperation, severity of back pain, leg pain and patient satisfaction. Answers to Swiss spinal stenosis questionnaires completed before surgery and one to five years afterwards were evaluated. Seven patients (12.5%) with degenerative spondylolisthesis, scoliosis and/or more radical facetectomies received fusion.
Results. Of the 56 patients in the original cohort, two were deceased and two had undergone reoperation by follow-up. Forty-eight patients answered questionnaires. Average duration of follow-up was 2.5 years. More than 70 percent of the respondents had no or only mild back or buttock pain at follow-up and more than 60 percent were able to walk more than 500 m. Added fusion reduced the incidence of low back pain and pain frequency, and increased walking distance (ANOVA).
Conclusions. Eighty-one percent of patients were satisfied with the results of surgery and 87.5% would choose to have the operation again if they had the choice. Decompressive laminectomy for DLSS yields best results if instrumented fusion is included in the procedure.
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References
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