Level Spinal Stenosis Research Articles

L3-L4 Hyperlordosis and Decreased Lower Lumbar Lordosis Following Short-Segment L4-L5 Lumbar Fusion Surgery is Associated With L3-L4 Revision Surgery for Adjacent Segment Stenosis.

Retrospective review of prospective cohort. Reoperation at L3-L4 for adjacent segment disease (ASD) is common after L4-L5 spine fusion. L4-S1 lower lumbar lordosis (LLL) accounts for the majority of global lumbar lordosis (GLL) and is modifiable during surgery. We sought to determine if a reduction in LLL leads to an increase in L3-L4 focal lumbar lordosis (L3-L4 FLL) and resulting risk of ASD at L3-L4. We reviewed the records of a prospective cohort with lumbar spinal stenosis who underwent L4-L5 or L4-L5-S1 fusion between 2006 and 2012. Radiographic parameters-GLL, LLL, L3-L4 FLL, upper lumbar lordosis, lordosis distribution index, pelvic tilt, and pelvic incidence-were extracted from preoperative and postoperative lumbar spine radiographs. Statistical comparisons were made between those who underwent revision for post-fusion adjacent level stenosis at L3-L4 (REVISION) and those who did not (NO REVISION). Inclusion criteria were met by 104 patients. The REVISION cohort included 19 individuals. No significant differences in baseline demographics or operative details for the index procedure were found between groups. Postoperatively, when compared to the NO REVISION cohort, the REVISION cohort had a decrease in LLL (-2.6° vs + 1.5°, P = .011) and LDI (-5.1% vs + 1.3%, P = .039), and an increase in L3-L4 FLL (+2.6° vs -.6°, P = .001). A reduction in LLL and compensatory increase in L3-L4 FLL after initial lower lumbar fusion surgery resulted in more reoperation at L3-L4 for post-fusion adjacent level spinal stenosis.

Lumbar spinal stenosis – surgical outcome and the odds of revision-surgery: Is it all due to the surgeon?

Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when non-operative treatment has failed. Apart from acute complications such as hematoma and infections, same-level recurrent lumbar stenosis and adjacent-segment disease (ASD) are factors that can occur after index lumbar spine surgery. The aim of this retrospective case series was to evaluate the outcome of surgery and the odds of necessary revisions. Patients who had undergone either decompressive lumbar laminotomy or laminotomy and spinal fusion due to lumbar spinal stenosis (LSS) between 2000 and 2011 were included in this analysis. Demographic, perioperative and radiographic data were collected. Clinical outcome was evaluated using numeric rating scale (NRS), the symptom subscale of the adapted version of the german Spinal Stenosis Measure (SSM) and patient-sreported ability to walk. Within the LSS- cohort of 438 patients, 338 patients underwent decompression surgery only, while instrumentation in addition to decompression was performed in 100 cases (22.3%). 38 patients had prior spinal operations (decompression, disc herniation, fusion) either at our hospital or elsewhere. Thirty-five intraoperative complications were documented with dural tear with CSF leak being the most common (33/35; 94.3%). Postoperative complications were defined as complications that needed surgery and differentiated between immediate postoperative complications (⩽ 3weeks post operation) and complications that needed revisions surgery at a later date. Within all patients 51 revisions were classified as immediate complications of the index operation with infections, neurological deficits and hematoma being the most common. Within this group only 22 patients had fusion surgery in the first place, while 29 were treated by decompression. Revision surgery was indicated by 53 patients at a later date. While 4 patients decided against surgery, 49 revision surgeries were planned. 28 were performed at the same level, 10 at the same level plus an adjacent level, and 10 were executed at index level with indications of adjacent level spinal stenosis, adjacent level spinal stenosis plus instability and stand-alone instability. Pre- operative VAS score and ability to walk improved significantly in all patients. While looking for predictors of revision surgery due to re-stenosis, instability or same/adjacent segment disease none of these were found. Within our cohort no significant differences concerning demographic, peri-operative and radiographic data of patients with or without revision wer noted. Patients, who needed revision surgery were older but slightly healthier while more likely to be male and smoking. Surprisingly, significant differences were noted regarding the distribution of intraoperative and early postoperative complications among the 6 main surgeons while these weren't obious within the intial index group of late revisions.

A new classification for spinal epidural hematoma following microendoscopic decompressive laminotomy: A prospective clinical and magnetic resonance imaging study of 245 patients.

The aim of this study was to develop a new radiological classification system for postoperative spinal epidural hematoma (SEH) using magnetic resonance imaging (MRI) and to determine the correlation of this classification system with clinical and radiological outcomes. This prospective study included a total of 245 consecutive patients (126 females, 119 males; mean age=72 years; age range=39-91 years) with single level spinal stenosis who were treated by microendoscopic decompressive laminotomy (MEDL). MRI was performed for all patients 24 hours postoperatively and at 12 months. SHEs were categorized into four grades using our new MRI-based classification system based on the measurement of dural sac area: Grade A, small hematoma with a round shape; grade B, small hematoma that show no round shape; grade C, moderate hematoma; grade D: severe hematoma. Patients were then divided into four groups according to their hematoma grades, Group A, 107 patients with grade A hematomas; group B, 47 with grade B; group C, 67 with grade C; group D, 24 with grade D. Also, patients who had neurological deterioration or who pain resistant to medical treatment were treated surgically, and those were assigned to group H+(14 patients). The study, therefore, contained five groups. Clinical evaluation was done using Japanese Orthopaedic Association (JOA) score preoperatively and at 12 months postoperatively. No significant difference existed among groups in the preoperative median measurement of the dural sac area, which were 0.90 cm2 in group A, 0.80 cm2 in group B, 0.70 cm2 in group C, 1.1 cm2 in group D, and 0.80 cm2 in group H+ (p=0.076). At the postoperative 12-month measurement, no significant difference was noted among groups A (2.05 cm2), B (1.80 cm2 ), and H+ (1.90cm2) (A vs B: p=0.891, A vs H+: p=0.089, B vs H +: p=0.933). The measurements were greater in groups A and B than in groups C and D (p<0.05). Also, larger dural sac areas were determined in group H+ (1.90cm2) compared to Groups C (1.80 cm2) and D (1.60 cm2) but the difference reached no statistical significance (p=0.078). In preoperative JOA scores, there were no significant differences among groups (p>0.05). At 12-month JOA scores, no significant difference was observed between groups A and B (p=0.061) and between groups C and D (p=0.511). The scores were higher in groups A and B than in groups C and D (p<0.05). It seems that the narrower the preoperative dural sac area, the better the clinical symptoms of the patients with SEHs based on our new MRI-based classification system. This classification may be useful to predict the clinical status of these patients at one-year follow-up. Level IV, Diagnostic study.

Tuberculosis of the spine with severe angular kyphosis: mean 34-year post-operative follow-up shows that prevention is better than salvage.

To address the natural history of severe post-tuberculous (TB) kyphosis, with focus upon the long-term neurological outcome, occurrence of restrictive lung disease, and the effect on life expectancy. This is a retrospective clinical review of prospectively collected imaging data based at a single institute. A total of 24 patients of Southern Chinese origin who presented with spinal TB with a mean of 113° of kyphosis (65° to 159°) who fulfilled inclusion criteria were reviewed. Plain radiographs were used to assess the degree of spinal deformity. Myelography, CT and MRI were used when available to assess the integrity of the spinal cord and canal. Patient demographics, age of onset of spinal TB and interventions, types of surgical procedure, intra- and post-operative complications, and neurological status were assessed. All except one of the 24 patients were treated with anti-TB chemotherapy when they were first diagnosed with spinal TB. They subsequently received surgery either for neurological deterioration, or deformity correction in later life. The mean follow-up was 34 years (11 to 59) since these surgical interventions. Some 16 patients (66.7%) suffered from late neurological deterioration at a mean of 26 years (8 to 49) after the initial drug treatment. The causes of neurological deterioration were healed disease in nine patients (56.2%), re-activation in six patients (37.5%) and adjacent level spinal stenosis in one patient (6.3%). The result of surgery was worse in healed disease. Eight patients without neurological deterioration received surgery to correct the kyphosis. The mean correction ranged from 97°to 72°. Three patients who were clinically quiescent with no neurological deterioration were found to have active TB of the spine. Solid fusion was achieved in all cases and no patient suffered from neurological deterioration after 42 years of follow-up. On final follow-up, six patients were noted to have deceased (age range: 47 years to 75 years). Our study presents one of the longest assessments of spinal TB with severe kyphosis. Severe post-TB kyphosis may lead to significant health problems many years following the initial drug treatment. Early surgical correction of the kyphosis, solid fusion and regular surveillance may avoid late complications. Paraplegia, restrictive lung disease and early onset kyphosis might relate to early death. Clinically quiescent disease does not mean cure. Cite this article: Bone Joint J 2017;99-B:1381-8.

Commentary on: A randomized controlled trial of fusion surgery for lumbar spinal stenosis (Forsth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, et al. N Eng J Med 2016;374:1414-23).

Background:This article by Forsth et al. published in the New England Journal of Medicine entitled A randomized controlled trial of fusion surgery for lumbar spinal stenosis determined that decompressions alone vs. decompressions/fusions were equally effective in treating 1-2 level spinal stensois with/without degenerative spondylolisthesis (DS). Additionally, decompression alone reduced the perioperative morbidity, while reducuing the length of hospital stay (LOS), operative time, and surgical costs.Methods:Utilizing a randomized controlled design, the efficacy of 1-2 level decompressions alone vs. decompressions with fusions for lumbar spinal stenosis with/without DS (135 patients) was assessed in 247 patients between the ages of 50–80. Outcomes were analyzed at 2 and 5 postoperative years utilizing the 6-minute walk test, and the Oswestry disability index (ODI).Results:At 2 and 5 postoperative years, there were no significant clinical differences between the two groups (e.g., on the average ODI or 6-minute walk test). In addition, with decompressions alone, the LOS (averaging 7.4 days for fusion vs. 4.1 days for decompression alone), surgical time, and operative costs were markedly reduced. Furthermore, at 6.5 postoperative years, reoperation rates were comparable for both groups; 22% for decompression/fusion vs. 21% for decompression alone.Conclusions:The authors concluded that at 2 and 5 postoperative years, patients with 1-2 level spinal stenosis did equally well with decompressions alone vs. decompressions with fusions with/without degenerative spondylolisthesis. This article offers a clear message for spinal surgeons; for older patients with 1-2 level spinal stenosis with/without DS, decompresions alone will typically suffice. This reduces patient morbidity along with LOS, operative time, and surgical costs.

Effects of minimally invasive decompression surgery on quality of life in older patients with spinal stenosis

ObjectivesLumbar spinal stenosis (LSS) in the elderly may result in a progressive narrowing of the spinal canal leading to compression of nerve roots in some individuals. The aim of this study was to evaluate the quality of life changes after minimally invasive decompression surgery without instrumentation in geriatric patients with lumbar spinal stenosis. Patients and methodsThis prospective clinical study included 37 patients with American Society of Anesthesiologists (ASA) II–III scores between the ages of 65 and 86 years, who were planned to undergo surgical intervention due to LSS. All patients had neurogenic claudication and pain in the hips, thighs, and legs. Measurements of the osseous spinal canal were evaluated by magnetic resonance imaging. Before the surgical intervention, patient demographics and clinical characteristics were recorded. The Short-Form-36 test, the Oswestry Disability Index, and the Visual Analog Scale were applied to all patients preoperatively and two years postoperatively. ResultsIn the study population, 11 patients had single level of spinal stenosis, 20 patients had two levels of spinal stenosis, and six patients had three levels of spinal stenosis. There were significant differences between the preoperative and postoperative ODI and VAS scores. There was a statistically significant difference in all subscales of the SF-36 test with the exception of general health scores. Three patients who had dural damage during the operation were treated with bio glue. Also, no patients were recorded to have any neurological deficits and root injuries postoperatively. ConclusionMinimally invasive decompression surgery, without instrumentation, for lumbar spinal stenosis in geriatric patients significantly improves the patients’ quality of life.

Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates.

Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when nonoperative treatment has failed. Standard open laminectomy is an effective procedure, but minimally invasive laminectomy through tubular retractors is an alternative. The aim of this retrospective case series was to evaluate the clinical and radiographic outcomes of this procedure in patients who underwent LSS and to compare outcomes in patients with and without preoperative spondylolisthesis. Patients with LSS without spondylolisthesis and with stable Grade I spondylolisthesis who had undergone minimally invasive tubular laminectomy between 2004 and 2011 were included in this analysis. Demographic, perioperative, and radiographic data were collected. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, as well as Macnab's criteria. Among 110 patients, preoperative spondylolisthesis at the level of spinal stenosis was present in 52.5%. At a mean follow-up of 28.8 months, scoring revealed a median improvement of 16% on the ODI, 2.75 on the VAS back, and 3 on the VAS leg, compared with the preoperative baseline (p < 0.0001). The reoperation rate requiring fusion at the same level was 3.5%. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical outcome or reoperation rate. Minimally invasive laminectomy is an effective procedure for the treatment of LSS. Reoperation rates for instability are lower than those reported after open laminectomy. Functional improvement is similar in patients with and without preoperative spondylolisthesis. This procedure can be an alternative to open laminectomy. Routine fusion may not be indicated in all patients with LSS and spondylolisthesis.

Spinous Process splitting Laminectomy: Clinical outcome and Radiological analysis of extent of decompression.

Spinous process splitting laminectomy (SPSL) is a useful technique in achieving adequate decompression for lumbar canal stenosis, has the advantage of simultaneously decompressing multiple levels and minimising injury to the paraspinal muscles. Some concern has been expressed over the efficacy of this technique in decompressing lateral recesses. This study was undertaken to assess the clinical outcome of SPSL technique and radiologically assess the extent of decompression. Thirty-nine consecutive patients treated by SPSL for degenerative lumbar spinal stenosis were methodically assessed for demographic data, clinical findings, Pre- and post-op VAS, JOA scores and spinal canal dimensions on imaging. Surgical technique for SPSL is described. The mean age of the patients was 66.9 yrs. The mean follow-up was 7.3 months. The mean pre- and post-operative VAS scores were 7.8 and 3.7, respectively. The mean pre- and post-operative JOA scores were 6.3 and 11.2, respectively. The mean JOA recovery rate was 57.3%. 77% of the patients were in the 'good' or 'excellent' McNab's grades at follow-up. Radiologic results were assessed separately at the 118 levels decompressed by the SPSL technique. The ratio increase for the spinal canal dimensions on post-operative images were as follows - Interfacet distance-116.6%; Effective AP distance-67.6%; Right lateral recess depth-165.1%; Right lateral recess angle-145.5%; Left lateral recess depth-149.3%; Left lateral recess angle-133.6%; Cross-sectional spinal canal area-163.8%. There was no worsening of pre-existing degenerative listhesis or scoliosis in any case. SPSL achieves effective central and lateral recess decompression, at the same time minimising injury to the paraspinal muscles thus reducing post-operative pain and aiding in quicker mobilisation and recovery. It is an effective tool to treat multiple level spinal stenosis, especially in elderly patients who have pre-existing spinal deformities which can precipitate into frank instability after conventional procedures.

Minimally Invasive Laminectomy for Lumbar Spinal Stenosis in Patients with and without Preoperative Spondylolisthesis: Clinical Outcome and Reoperation Rate

Introduction Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when nonoperative treatment has failed. Standard open laminectomy is an effective procedure. Minimally invasive laminectomy through tubular retractors is an alternative procedure. The aim of our cohort study was to evaluate the clinical and radiographic outcome of this procedure in LSS patients with or without preoperative spondylolisthesis. Materials and Methods Patients with LSS without spondylolisthesis and with stable spondylolisthesis who underwent MIS tubular laminectomy between 2004 and 2011 were included. Demographic, perioperative, and radiographic data were collected. Clinical outcome was evaluated by Oswestry disability index (ODI) and visual analog scale (VAS) scores, as well as by MacNab criteria. Results In a total of 110 patients, preoperative spondylolisthesis at the level of spinal stenosis was present in 52.5%. ODI and VAS pain scores at a mean follow-up of 28.8 months revealed a median improvement of 16% in ODI, 2.75 in VAS back, and 3 in VAS leg scores, compared with the preoperative baseline ( p &lt; 0.0001). The reoperation rate requiring fusion was 3.5%. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical outcome or the reoperation rate. Conclusion MIS laminectomy is an effective procedure for treatment of LSS. Reoperation rates for instability are lower than reported after open laminectomy. Functional improvement is similar in patients with and without preoperative spondylolisthesis. This procedure can be a viable alternative to open laminectomy. Routine fusion may not be indicated in all patients with LSS and spondylolisthesis. Disclosure of Interest None declared

Acute intracranial subdural hematoma following incidentally durotomy after revisional lumbar spinal surgery; case report

Abstract A fifty-four-year-old man was admitted with left leg severe radiating pain with a history of previous lumbar spinal fusion(L5/S1) presented with upper adjacent level spinal stenosis. He underwent a revision spinal arthrodesis

Clinical and neurophysiological characteristics of patients with neurogenic intermittent claudication at the lumbar level spinal stenosis

Purpose. The purpose of the study is to investigate the possibility of objectifying the nature and degree of spinal radicular structures and lumbar spinal cord dysfunction by using MEP-ENMG indicators.Materials. Preoperative results of 30 patients with neurogenic intermittent claudication in lumbar stenosis (LS) were analyzed.Results. MEP performance most significantly changed in patients who failed to cover a distance of 500 m (14 patients), those with bilateral symptoms (12), those with severity on the VAS scale for numbness of more than 8 points (12). Dependence of the indicators and the duration of disease was not established. After the walking tests 11 patients showed changes in NPh indicators: increase in (P&lt;0.05) minimum latentсy of F-waves, increase in chronodyspersy ; increase in MEP and CCMT latentcy.Conclusions. Probable changes were determined in NPh indicators of functional condition of radicular and spinal structures, which to some extent reflect the severity of lumbar stenosis and which may be useful for substantiating the prognosis and tactics of treatment of such patients. The use of MEP-ENMG methods can improve diagnosis of the degree of dysfunction of peripheral and spinal structures in LS patients at the preoperative stage.

Surgical Experience of Gas-Containing Disk Herniation

Disk herniation with gas or gas-containing disk herniation (GCDH) is rare, although epidural gas is associated with the vacuum phenomenon. The clinical, radiologic, and surgical findings were retrospectively analyzed of 18 patients with GCDH. The demographic, clinical, and radiologic findings including computed tomography and magnetic resonance imaging, as well as operative methods were examined. The mean age was 64.4 years (range 51-84 years). All patients presented with acute radiculopathy or exacerbation of chronic pain associated with GCDH of the lumbar spine. All lumbar GCDHs were related to the vacuum phenomenon. Ruptured disks predominantly compressed the nerve root with gas in 17 cases, except in one with only compressed nerve root by gas without disk herniation. All patients had confirmed GCDH at surgery. All patients underwent removal of GCDH and five with another level of spinal stenosis or disk herniation underwent selective decompression. The six patients with instability underwent fusion. Visual analogue scale score of radicular pain was improved from 7.4 ± 0.9 before surgery to 3.2 ± 0.7 at the 3-month follow-up examination. No recurrence occurred after surgery. GCDH can occur as a space-occupying lesion in epidural space as well as a cause of radiculopathy. GCDH may indicate the source of clinical symptoms in the degenerative spine, especially combined with spinal stenosis or multiple spinal disk herniations.

Cervical Myelopathy Due to a Hypoplastic Atlas

Congenital hypoplasia of the atlas is a rare cause of cervical myelopathy. We report a case of a 30-year-old man with cervical myelopathy caused by spinal stenosis at the level of the atlas associated with a hypoplastic but complete posterior arch of C1. Repetitive and persistent hyperextension causes micro- traumas at the level of spinal stenosis in the spinal cord. Hypoplasia of the atlas may result in serious neurologic manifestations and complications in time. In our case, the spinal canal diameter was calculated to be 11 mm at the level of the atlas on computerized tomography imaging. However, this diameter was 8 mm on magnetic resonance imaging owing to the thickened atlanto-occipital membrane. We suggest that the spinal canal diameter should be measured by magnetic resonance imaging. Treatment of developmental cervical steno- sis is surgical removal of the thickened posterior arc of the atlas and surrounding degenerative ligaments in symptomatic cases. The symptoms related to myelopathy may improve after surgery.

The Posterior Decompression and Posterior Lumbar Interbody Fusion Using a Mini-open Technique: New Suggestion of Minimally Invasive Technique A Preliminary Report

Purpose: To introduce mini-open posterior decompression with posterior lumbar interbody fusion (PLIF) and to assess its clinical outcomes. Materials and Methods: Eight patients who underwent L4-5 posterior decompression with PLIF using a mini-open technique were followed up for an average 8 months. Three patients had degenerative lumbar spinal stenosis and five patients had spinal stenosis with degenerative spondylolisthesis. We performed posterior decompression with PLIF through a mini-incision (2.5 cm paramedian incision at the both sides) including percutaneous pedicle screw fixation. The operative time, amount of blood loss and complications were analyzed. Clinical outcomes were assessed by using McNab criteria and VAS (visual analogue scale) for postoperative back pain. Results: The mean operative time was 172.5 min (range, 130-235 min). The mean amount of intraoperative blood loss was 178.1 mL (range, 95-310 mL). All procedures were completed without transfusion. VAS for back pain rapidly reduced from 10 on the immediate postoperative day to 3 on the third day and 2 on the seventh day. At the last follow up, five patients had no back pain and the three remaining patients had a VAS 0.75. The clinical outcomes were excellent in 5 patients and good in 3 patients. Conclusion: Mini-open posterior decompression and the PLIF technique offer a useful minimally-invasive modality for the treatment of single level spinal stenosis.

Spinal cord and nerve root blood flow in acute double level spinal stenosis.

Twenty-four pigs were randomized into three groups of eight pigs; a control group with 0% stenosis, a 25% stenosis group, and a 50% stenosis group. A fourth 75% stenosis group was added when results of the randomized experiment had been analyzed. Blood flow of the spinal cord and nerve roots and spinal evoked potentials were determined before and 1 hour after induction of the spinal stenoses. To study the acute effects of different degrees of spinal stenosis on neural tissue blood flow and spinal evoked potentials. Spinal cord dysfunction may be caused by vascular impairment or mechanical injury to neural tissue. Experimental double level compression of the cauda equina causes reversible nerve root edema, stasis, blood flow decrease, and compromised neural function. The vascular pathophysiology after spinal cord trauma was studied previously, and both increased and decreased neural tissue blood flow have been reported. Two level spinal stenosis was introduced by placement of stenosing bands around the dural sac at L4 and L6. Neurologic function was monitored by sensory and motor evoked potentials. Regional blood flow (RBF) was measured in the stenotic segments between the bands and other regions of neural tissue by radioactive microspheres before and after induction of stenosis. Regional blood flow increased in the stenotic segments after 0% sham stenosis. Analysis of variance revealed no differences in RBF between the three randomized groups under comparable conditions of 0% stenosis. However, the RBF level of the added 75% group was lower than that of the other three groups. By comparison of RBF within groups before and after stenosis, no decrease in RBF was found between the stenosing bands in any of the groups. Fifty percent stenosis changed the amplitude of evoked potentials in half of the animals. Seventy-five percent stenosis caused severe changes in evoked potentials in 7 of 8 animals. Blood supply of the spinal cord and nerve roots in the segments between two central stenoses is preserved immediately after stenosis introduction by way of the segmental nerve pathway, even if nerve conduction is impaired.

Decompression of lumbar spinal stenosis and stabilization with Knodt rods in the elderly patient

We present a series of 25 elderly patients who exhibited signs and symptoms of neurogenic claudication and who were found to have one or two levels of spinal stenosis. At the time of decompressive surgery, excessive movement was found at the stenotic levels, so a simple stabilization procedure was performed using Knodt rods and a facet fusion. The expectation was that spine fixation would decrease the amount of postoperative back pain, which can be a result of continued abnormal mobility. All of the patients have been followed for 2 or more years. This elderly group of individuals tolerated surgery well, and long-term results were good.

Decompression of Lumbar Spinal Stenosis and Stabilization with Knodt Rods in the Elderly Patient

Abstract We present a series of 25 elderly patients who exhibited signs and symptoms of neurogenic claudication and who were found to have one or two levels of spinal stenosis. At the time of decompressive surgery, excessive movement was found at the stenotic levels, so a simple stabilization procedure was performed using Knodt rods and a facet fusion. The expectation was that spine fixation would decrease the amount of postoperative back pain, which can be a result of continued abnormal mobility. All of the patients have been followed for 2 or more years. This elderly group of individuals tolerated surgery well, and long-term results were good.