The conservative surgical treatment of lumbar spinal stenosis in the elderly.

Abstract

Canal stenosis is now the most common indication for lumbar spine surgery in elderly subjects. Degenerative disc disease is by far the most common cause of lumbar spinal stenosis. It is generally accepted that surgery is indicated if a well-conducted conservative management fails. A meta-analysis of the literature showed on average that 64% of surgically treated patients for lumbar spinal stenosis were reported to have good-to-excellent outcomes. In recent years, however, a growing tendency towards less invasive decompressive surgery has emerged. One such procedure, laminarthrectomy, refers to a surgical decompression involving a partial laminectomy of the vertebra above and below the stenotic level combined with a partial arthrectomy at that level. It can be performed through an approach which preserves a maximum of bony and ligamentous structures. Another principle of surgical treatment is interspinous process distraction This device is implanted between the spinous processes, thus reducing extension at the symptomatic level(s), yet allowing flexion and unrestricted axial rotation and lateral flexion. It limits the further narrowing of the canal in upright and extended position. In accordance with the current general tendency towards minimally invasive surgery, such techniques, which preserve much of the anatomy, and the biomechanical function of the lumbar spine may prove highly indicated in the surgical treatment of lumbar stenosis, especially in the elderly.