Familial lumbar spinal stenosis with acute disc herniations

✓ The case histories are reported of four brothers with lumbosciatic syndrome due to acute disc herniations, and associated spinal stenosis. Hereditary factors, although not hitherto reported, may be implicated for these spinal lesions, as the parents had also undergone spinal operations previously.

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Surgical treatment of lumbar spinal stenosis in patients older than 75 years of age

Journal of Neurosurgery Spine ◽

10.3171/spi.1999.91.2.0181 ◽

1999 ◽

Vol 91 (2) ◽

pp. 181-185 ◽

Cited By ~ 14

Author(s):

Todd W. Vitaz ◽

George H. Raque ◽

Christopher B. Shields ◽

Steven D. Glassman

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Intraoperative Complication ◽

Content Type ◽

Fusion Procedure ◽

Lumbar Decompression ◽

Preoperative Selection ◽

Lumbar Spinal ◽

Fine Print

Object. The purpose of this study was to evaluate the safety and efficacy of the surgical treatment of lumbar spinal stenosis in patients older than 75 years of age. Methods. The authors reviewed the records of 65 patients with lumbar spinal stenosis who were at least 75 years of age at the time of surgery, which was performed between November 1990 and May 1996. The 65 patients (43 women, 22 men; average age 78 years) underwent a total of 71 operations (one patient underwent three, and four patients underwent two). Fifteen patients (21%) underwent isolated lumbar decompression, and 56 patients (79%) underwent decompression in conjunction with posterior spinal fusion. There was an average of 1.7 levels decompressed per isolated lumbar decompression and 2.6 levels per decompression and fusion procedure. Seven patients (10%) experienced one or more serious postoperative complication, which included wound infection, septicemia, small bowel obstruction, stroke, myocardial infarction, gastrointestinal bleeding, and pulmonary embolus. In addition there was one intraoperative complication (hypotension [1%]) that required modification of the planned surgical procedure. No deaths were documented in the perioperative period. Conclusions. With appropriate preoperative selection and evaluation, careful intraoperative monitoring, and attentive perioperative care, the surgical treatment of elderly patients with lumbar spinal stenosis can effect significant improvement with acceptable levels of morbidity and mortality.

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Lumbar spinal stenosis: postoperative results in terms of preoperative posture-related pain

Journal of Neurosurgery ◽

10.3171/jns.1990.72.1.0071 ◽

1990 ◽

Vol 72 (1) ◽

pp. 71-74 ◽

Cited By ~ 48

Author(s):

Jeremy C. Ganz

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Selection Criteria ◽

Decompressive Surgery ◽

Leg Pain ◽

Postoperative Result ◽

Content Type ◽

Lumbar Spinal ◽

Exacerbation Of Symptoms ◽

Fine Print

✓ Thirty-three consecutive patients with lumbar spinal stenosis were treated with decompressive surgery aimed at relieving pain. The selection criteria for surgery included marked symptoms and lumbar spinal stenosis demonstrated by myelography. Preoperatively, only 15 patients had claudication; however, 23 experienced relief or exacerbation of symptoms related to changes in posture. A good postoperative result was obtained in 82% of the entire series, but in only 50% of patients whose symptoms were not affected by posture. Of those whose symptoms did have a postural component, a good result was obtained in 96%. The relief of back pain by decompressive surgery was significantly less successful than the relief of leg pain. It is therefore suggested that surgery be restricted to as few levels as possible.

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Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.2.5.0624 ◽

2005 ◽

Vol 2 (5) ◽

pp. 624-633 ◽

Cited By ~ 79

Author(s):

Ko Ikuta ◽

Junichi Arima ◽

Takayuki Tanaka ◽

Masayoshi Oga ◽

Soichiro Nakano ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Japanese Orthopaedic Association ◽

Posterior Decompression ◽

Technical Problems ◽

Content Type ◽

The Mean ◽

Lumbar Spinal ◽

Fine Print

Object. The authors applied the technique of microendoscopic discectomy to posterior decompression procedures for lumbar spinal stenosis. The purpose of this study was to determine the feasibility of using an endoscopic technique to treat lumbar spinal stenosis and to evaluate the clinical and radiographic results of microendoscopic posterior decompression (MEPD). Methods. Microendoscopic posterior decompression, which involves a unilateral endoscopic approach for bilateral decompression, was performed in 47 patients. Clinical and radiographic/neuroimaging results were evaluated during the follow-up period (minimum duration 1 year). The clinical results were compared with those of the conventional laminotomy. Radiographic instability and the degree of surgical invasion of the facet joints were evaluated. In a control a group of 29 patients open laminotomy was performed. The clinical outcome was evaluated in 44 patients. The mean follow-up duration was 22 months. The mean rate of improvement was 72% based on the Japanese Orthopaedic Association score, and good results were obtained in 38 patients. Although the rate of morbidity decreased in the MEPD group, the incidence of complication was slightly higher. Effective decompression was demonstrated in the majority of the patients by using magnetic resonance imaging. Radiographic instability appeared in one patient postoperatively, and based on computerized tomography scanning, a tendency toward invasion of the facet joint on the approach side was noted. Conclusions. Microendoscopic posterior decompression is a minimally invasive procedure and is as useful as other conventional procedures in treating lumbar spinal stenosis; however, a few technical problems remain to be solved.

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Spinal stenosis due to ossified lumbar lesions

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.3.4.0262 ◽

2005 ◽

Vol 3 (4) ◽

pp. 262-270 ◽

Cited By ~ 17

Author(s):

Yoshiharu Kawaguchi ◽

Takeshi Oya ◽

Yumiko Abe ◽

Masahiko Kanamori ◽

Hirokazu Ishihara ◽

...

Keyword(s):

Spinal Stenosis ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Neurological Deterioration ◽

Surgical Results ◽

Content Type ◽

Spinal Lesions ◽

Whole Spine ◽

Fine Print

Object. Spinal stenosis due to lumbar ossified lesions is a rare pathological entity. The authors retrospectively evaluated the clinical features and surgical results associated with cases involving lumbar ossified lesion—induced stenosis. Methods. Data obtained in 20 surgically treated patients with lumbar hyperostotic spinal stenosis were included. To evaluate the background of the disease, body mass index and general complications were assessed. Whole-spine radiological examination was conducted. The presence of ossification of the posterior longitudinal ligament or ossification of the ligamentum flavum was evaluated. Surgical results were classified according to the Japanese Orthopaedic Association (JOA) scale. In the patients in whom neurological deterioration was observed during follow up, the causes of deterioration were reviewed. Seven patients (35%) were obese and six patients (30%) suffered diabetes mellitus. Twelve patients harbored coexisting cervical and/or thoracic ossified lesions. The overall mean JOA score improved from 10.2 to a peak of 22.5; at last follow-up examination the mean JOA score was 20.9. In female and older patients with a long history of preoperative symptoms, a low preoperative JOA score, and other spinal lesions, recovery tended to be poorer. Recovery was poor in one patient, and neurological deterioration due to coexisting ossified spinal lesions occurred in another patient during the follow-up period. Conclusions. Because coexisting ossified lesions were frequently seen, whole-spine analysis is recommended. Early diagnosis and appropriate treatment are important to achieve a better surgical outcome.

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Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone

Journal of Neurosurgery ◽

10.3171/jns.1996.85.5.0793 ◽

1996 ◽

Vol 85 (5) ◽

pp. 793-802 ◽

Cited By ~ 128

Author(s):

Mark W. Fox ◽

Burton M. Onofrio ◽

Arlen D. Hanssen

Keyword(s):

Spinal Stenosis ◽

Patient Reported Outcome ◽

Dynamic Imaging ◽

Content Type ◽

Degenerative Lumbar Spinal Stenosis ◽

Poor Outcome ◽

Patient Reported ◽

Patients At Risk ◽

Lumbar Spinal ◽

Fine Print

✓ One hundred twenty-four patients with degenerative lumbar stenosis underwent decompression with fusion (32 patients) and without fusion (92 patients) during a 30-month period between 1986 and 1988. Patient-reported satisfaction at a mean follow-up period of 5.8 years (range 4.6–6.8 years) revealed a 79% good or fair outcome and a 21% poor outcome (26 patients). Seven patients (6%) developed lumbar instability, three patients (2%) developed new stenosis at an adjacent unoperated level, and three patients (2%) developed a new disc herniation between 2 and 5 years after surgery. Progressive postoperative spondylolisthesis occurred in 31% of patients with normal preoperative alignment (mean 7.8 mm, range 2–20 mm) and in 73% of patients with preoperative subluxation (mean 5.1 mm, range 2–13 mm) in whom fusion was not attained. Radiological progression did not correlate well with patient-reported outcome. The major conclusions from this study are the following: 1) the majority of patients respond well to this surgery, but complication (22%) and late deterioration (10%) rates are not insignificant; 2) radiological instability is common after decompression for degenerative lumbar spinal stenosis, but this correlates poorly with clinical outcome; 3) there are no definitive clinical or radiological factors that preoperatively predict patients at risk for a poor outcome; 4) postoperative radiological instability is more likely to occur when the following criteria are present: preoperative spondylolisthesis, abnormal motion detected on preoperative dynamic imaging, decompression occuring across a minimally degenerated L-4 or a markedly degenerated L-3 disc; and when a radical and extensive decompression greater than one level is planned; and 5) the group at greatest risk for a poor outcome consists of those patients with normal preoperative alignment who do not suffer slippage following surgery.

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Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: a useful indicator of functional status and surgical outcome

Journal of Neurosurgery ◽

10.3171/jns.1995.83.1.0027 ◽

1995 ◽

Vol 83 (1) ◽

pp. 27-30 ◽

Cited By ~ 42

Author(s):

H. Gordon Deen ◽

Richard S. Zimmerman ◽

Mark K. Lyons ◽

Malcolm C. McPhee ◽

Joseph L. Verheijde ◽

...

Keyword(s):

Functional Status ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Exercise Tolerance ◽

Walking Speed ◽

Neurogenic Claudication ◽

Content Type ◽

The Mean ◽

Lumbar Spinal ◽

Mean Time

✓ A prospective study of patients with neurogenic claudication and lumbar spinal stenosis was undertaken to determine whether measurement of exercise tolerance on the treadmill would be useful in defining baseline functional status and response to surgical treatment. Twenty patients with an average age of 73 years, all of whom had intractable neurogenic claudication and radiographically confirmed severe lumbar spinal stenosis, were studied. Lumbar decompressive laminectomy was performed in all patients. Preoperatively and 2 months postoperatively, quantitative assessment of ambulation was conducted on a treadmill at 0° ramp incline at two different speeds: 1.2 mph and the patient's preferred walking speed. The following information was recorded: time to first symptoms, time to severe symptoms, and nature of symptoms (leg pain, back pain, or generalized fatigue). The examination was stopped after 15 minutes or at the onset of severe symptoms. In the preoperative 1.2-mph trial, the mean time to first symptoms was 2.68 minutes (median 1.31) and the mean time to severe symptoms was 5.47 minutes (median 3.42). In the postoperative trial at the same speed, 13 patients (65%) were able to walk symptom free for 15 minutes. The mean time to first symptoms was 11.12 minutes (median 15) and the mean time to severe symptoms was 11.81 minutes (median 15). Similar findings were recorded in the preferred walking—speed trials. There were no complications from the treadmill testing procedure. These findings indicate that exercise stress testing on a treadmill is a safe, easily administered, and quantifiable means of assessing baseline functional status and outcome following laminectomy in patients with symptomatic lumbar spinal stenosis.

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Topacheous gout as a rare cause of spinal stenosis in the lumbar region

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.2.2.0215 ◽

2005 ◽

Vol 2 (2) ◽

pp. 215-217 ◽

Cited By ~ 21

Author(s):

Joseph Kelly ◽

Chris Lim ◽

Mahmoud Kamel ◽

Catherine Keohane ◽

Michael O'Sullivan

Keyword(s):

Spinal Stenosis ◽

Metabolic Disorder ◽

Axial Skeleton ◽

Neurological Deficits ◽

Lumbar Region ◽

Pathological Features ◽

Content Type ◽

History Of ◽

Lumbar Spinal ◽

Fine Print

✓ Despite the fact that gout is a common metabolic disorder, because its involvement of the axial skeleton is rare the diagnosis is often delayed, even in patients with long-standing gout who present with neurological deficits. The authors report the case of a woman with a history of extensive gout, emphasizing the clinical, radiological, and pathological features of a lumbar spinal stenosis.

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Surgical management of lumbar stenosis: decompression and indications for fusion

Neurosurgical FOCUS ◽

10.3171/foc.1997.3.2.4 ◽

1997 ◽

Vol 3 (2) ◽

pp. E3 ◽

Cited By ~ 13

Author(s):

Nancy E. Epstein

Keyword(s):

Spinal Stenosis ◽

Surgical Management ◽

Lumbar Spinal Stenosis ◽

Older Patients ◽

Clinical Evidence ◽

Degenerative Spondylolisthesis ◽

Lumbar Stenosis ◽

Degenerative Scoliosis ◽

Disc Herniations ◽

Lumbar Spinal

Review of the clinical, neuroradiological, and surgical management of lumbar spinal stenosis reveals that 90 to 95% of congenital or acquired variants may be adequately managed by means of decompression without fusion. These decompressive procedures often simultaneously treat disc herniations, limbus fractures, degenerative spondylolisthesis, rare selected cases of spondylolisthesis accompanied by lysis in older patients, and degenerative scoliosis. Fusion should be reserved for the approximately 5 to 10% of patients in whom there is clinical evidence of instability prior to surgery or for the few who develop slippage following laminectomy and facetectomy.

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