Long-term Results After Surgical or Nonsurgical Treatment in Patients With Degenerative Lumbar Spinal Stenosis

OBJECTIVE Interspinous process distraction devices (IPDs) can be implanted to treat patients with intermittent neurogenic claudication (INC) due to lumbar spinal stenosis. Short-term results provided evidence that the outcomes of IPD implantation were comparable to those of decompressive surgery, although the reoperation rate was higher in patients who received an IPD. This study focuses on the long-term results. METHODS Patients with INC and spinal stenosis at 1 or 2 levels randomly underwent either decompression or IPD implantation. Patients were blinded to the allocated treatment. The primary outcome was the Zurich Claudication Questionnaire (ZCQ) score at 5-year follow-up. Repeated measurement analysis was applied to compare outcomes over time. RESULTS In total, 159 patients were included and randomly underwent treatment: 80 patients were randomly assigned to undergo IPD implantation, and 79 underwent spinal bony decompression. At 5 years, the success rates in terms of ZCQ score were similar (68% of patients who underwent IPD implantation had a successful recovery vs 56% of those who underwent bony decompression, p = 0.422). The reoperation rate at 2 years after surgery was substantial in the IPD group (29%), but no reoperations were performed thereafter. Long-term visual analog scale score for back pain was lower in the IPD group than the bony decompression group (p = 0.02). CONCLUSIONS IPD implantation is a more expensive alternative to decompressive surgery for INC but has comparable functional outcome during follow-up. The risk of reoperation due to absence of recovery is substantial in the first 2 years after IPD implantation, but if surgery is successful this positive effect remains throughout long-term follow-up. The IPD group had less back pain during long-term follow-up, but the clinical relevance of this finding is debatable.

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Long-Term Results of Surgical Treatment of Lumbar Spinal Stenosis

Spine ◽

10.1097/00007632-199318110-00011 ◽

1993 ◽

Vol 18 (11) ◽

pp. 1471-1474 ◽

Cited By ~ 91

Author(s):

Arto Herno ◽

Olavi Airaksinen ◽

Tapani Saari

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Long Term Results ◽

Lumbar Spinal

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Long-Term Results of Surgical Treatment of Lumbar Spinal Stenosis

Spine ◽

10.1097/00007632-199309010-00011 ◽

1993 ◽

Vol 18 (11) ◽

pp. 1471-1474

Author(s):

Arto Herno ◽

Olavi Airaksinen ◽

Tapani Saari

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Long Term Results ◽

Lumbar Spinal

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LONG-TERM RESULTS OF MICROSURGICAL TREATMENT OF LUMBAR SPINAL STENOSIS BY UNILATERAL LAMINOTOMY FOR BILATERAL DECOMPRESSION

Neurosurgery ◽

10.1227/01.neu.0000245616.32226.58 ◽

2006 ◽

Vol 59 (6) ◽

pp. 1264-1270 ◽

Cited By ~ 78

Author(s):

Markus F. Oertel ◽

Yu-Mi Ryang ◽

Marcus C. Korinth ◽

Joachim M. Gilsbach ◽

Veit Rohde

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Clinical Results ◽

Reoperation Rate ◽

Long Term Results ◽

Spinal Instability ◽

Long Term Follow Up ◽

Lumbar Spinal

Abstract OBJECTIVE Laminectomy and bilateral laminotomy are the standard procedures for decompression of lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability, the technique of unilateral laminotomy for bilateral decompression (ULBD) was developed. However, limited follow-up data exist to determine the efficiency and outcome of ULBD. Therefore, the authors present their 10-year experience with ULBD and postoperative long-term results. METHODS One hundred thirty-three consecutive patients (73 men and 60 women; mean age, 63 yr) meeting clinical and radiographic criteria for LSS who underwent first-time ULBD between 1994 and 1999 entered the study. The study parameters were set to ensure a follow-up period of at least 4 years. All patients were available for short-term follow-up re-evaluation within 3 months, and 102 (77%) of the 133 patients were available for long-term examination after a mean duration of 5.6 years. The scale of Finneson and Cooper was used for evaluation of the clinical results. RESULTS One hundred thirty patients (97.7%) improved immediately after surgery. Ninety-four (92.2%) of the 102 patients available for long-term follow-up examination remained improved, and 85.3% had an excellent-to-fair operative result. The incidence of complications was 9.8%. Resurgery for complication was necessary in three patients, for restenosis in seven patients, and for spinal instability in two patients, accounting for a reoperation rate of 11.8%. CONCLUSION ULBD allows achievement of good and long-lasting operative results in patients with LSS. Postoperative deterioration, recurrences, and spinal instability are infrequent. For the authors, ULBD is the preferred technique to treat symptomatic LSS.

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