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

1996 ◽  
Vol 85 (5) ◽  
pp. 793-802 ◽  
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.

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

1999 ◽  
Vol 91 (2) ◽  
pp. 181-185 ◽  
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.

Familial lumbar spinal stenosis with acute disc herniations

1979 ◽  
Vol 51 (2) ◽  
pp. 234-236 ◽  
Author(s):  
George Varughese ◽  
Gilbert R. C. Quartey
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Case Histories ◽  
Content Type ◽  
Spinal Lesions ◽  
Hereditary Factors ◽  
Disc Herniations ◽  
Lumbar Spinal ◽  
Fine Print

✓ 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.

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

1990 ◽  
Vol 72 (1) ◽  
pp. 71-74 ◽  
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.

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

2005 ◽  
Vol 2 (2) ◽  
pp. 215-217 ◽  
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.

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

2005 ◽  
Vol 2 (5) ◽  
pp. 624-633 ◽  
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.

scholarly journals The identification of novel gene mutations for degenerative lumbar spinal stenosis using whole-exome sequencing in a Chinese cohort

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Xin Jiang ◽  
Dong Chen
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Gene Mutations ◽  
Specific Gene ◽  
Single Nucleotide ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Whole Exome ◽  
Lumbar Spinal

Abstract Background Degenerative lumbar spinal stenosis (DLSS) is a common lumbar disease that requires surgery. Previous studies have indicated that genetic mutations are implicated in DLSS. However, studies on specific gene mutations are scarce. Whole-exome sequencing (WES) is a valuable research tool that identifies disease-causing genes and could become an effective strategy to investigate DLSS pathogenesis. Methods From January 2016 to December 2017, we recruited 50 unrelated patients with symptoms consistent with DLSS and 25 unrelated healthy controls. We conducted WES and exome data analysis to identify susceptible genes. Allele mutations firstly identified potential DLSS variants in controls to the patients’ group. We conducted a site-based association analysis to identify pathogenic variants using PolyPhen2, SIFT, Mutation Taster, Combined Annotation Dependent Depletion, and Phenolyzer algorithms. Potential variants were further confirmed using manual curation and validated using Sanger sequencing. Results In this cohort, the major classification variant was missense_mutation, the major variant type was single nucleotide polymorphism (SNP), and the major single nucleotide variation was C > T. Multiple SNPs in 34 genes were identified when filtered allele mutations in controls to retain only patient mutations. Pathway enrichment analyses revealed that mutated genes were mainly enriched for immune response-related signaling pathways. Using the Novegene database, site-based associations revealed several novel variants, including HLA-DRB1, PARK2, ACTR8, AOAH, BCORL1, MKRN2, NRG4, NUP205 genes, etc., were DLSS related. Conclusions Our study revealed that deleterious mutations in several genes might contribute to DLSS etiology. By screening and confirming susceptibility genes using WES, we provided more information on disease pathogenesis. Further WES studies incorporating larger DLSS patient cohorts are required to comprehend the genetic landscape of DLSS pathophysiology fully.

scholarly journals Prediction of walking ability following posterior decompression for lumbar spinal stenosis

2021 ◽  
Author(s):  
Suzanne McIlroy ◽  
Feroz Jadhakhan ◽  
David Bell ◽  
Alison Rushton
Keyword(s):  
Quality Of Life ◽  
Higher Education ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Walking Distance ◽  
Walking Ability ◽  
Poor Outcome ◽  
Lumbar Spinal ◽  
Reduced Risk

Abstract Purpose Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS. Methods An observational cohort study was conducted using data from the British Spine Registry (2017–2018) of adults (≥ 50 years) with LSS, who underwent ≤ 2 level posterior lumbar decompression. Patients receiving fixation or who had previous lumbar surgery were excluded. Walking ability was assessed by a single item on the Oswestry Disability Index and dichotomised into poor/good outcome. Multivariable regression models were performed. Results 14,485 patients were identified. Pre-operatively 30% patients reported poor walking ability, this decreased to 8% at 12 months follow-up. Predictors associated with poor walking ability at 12 months were: increasing age (≥ 75 years OR 1.54, 95% CI 1.07, 2.18), BMI ≥ 35 kg/m2 (OR 1.52, 95% CI 1.00, 2.30), severity of leg pain (OR 1.10, CI 95% 1.01, 1.21), disability (OR 1.01, 95% CI 1.01, 1.02) and quality of life (OR 0.72, 95% CI 0.56, 0.89). Pre-operative maximum walking distance (OR 1.10, 95% CI 1.05, 1.25) and higher education (OR 0.90, 95% CI 0.80, 0.96) were associated with reduced risk of poor walking ability at 12 months; p < 0.05. Depression, fear of movement and symptom duration were not associated with risk of poor outcome. Conclusion Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.

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