Surgical Treatment Of Spinal Stenosis Research Articles

Surgical Outcome of Degenerative Lumbar Spinal Stenosis in Patients over 70 years old -A Comparative Analysis according to Surgical Method-

Study Design: A retrospective study Objectives: To analyze and compare the clinical results of different surgical methods for spinal stenosis, without lumbar instability, in patients over 70 years-old. Summary of Literature Review: Much controversy exists as to the best operative method for spinal stenosis. Materials and Methods : Thirty eight patients that had undergone surgical treatment for spinal stenosis, without lumbar spinal instability, with a mean age of 75.1 years(70 to 91 years) and follow up period was 44 months(24 to 52 months), were retrospectively reviewed. The patients were divided into two groups: * Group A (n=23): posterior decompression alone * Group B (n=15): posterior decompression and posterolateral fusion Clinical outcome and satisfaction were assessed using Bohlman's measurements, on a 10 point pain rating scale, and the clinical outcomes were further analyzed according to the co-morbidity and postoperative complications. Results: Clinically excellent and good outcomes were achieved in 86.9 and 80.0% in groups A and B, respectively. The 10-points pain scale for low back pain showed improvements in both groups. The co-morbidity did not influence the clinical outcome in either group. There were no serious postoperative complications in either group. C o n c l u s i o n s: Posterior decompression alone was an effective surgical method, and was found to be equivalent to posterior decompression and posterolateral fusion in patients over 70 years-old with degenerative lumbar spinal stenosis and without lumbar spinal instability.

Reviewer point of view on the treatment of fixed thoracolumbar kyphosis in immature achondroplastic patient

Sir, In achondroplastic patients the natural history and surgical treatment of spinal stenosis and thoracolumbar kyphosis are notorious for their high rate of neurologic complication [4, 5, 6, 8]. The authors have chosen with success a modern way of correcting this very challenging spinal deformity by a way of posterior spinal column shortening. Classically, some authors would recommend a simple decompression with posterior instrumentation for fear of neurologic complication [8, 9]; however, if the stenosis is associated with kyphosis, simple laminectomy may expose to further instability and kyphosis [10]. This is the reason why other authors would perform an anterior disc excision, followed by a posterior decompression and instrumentation [7]. One of the major disadvantages of this latter approach is that by doing the disc excision first in the presence of a very narrow canal, the anterior spinal manipulation along with the edema induced by the surgery may be harmful to the already compromised spinal cord. By doing an anterior spinal release first, followed by posterior surgery, the cord may even end up being lengthened and further compromised. Bradford and Tribus reported initially in 1997 the concept of spinal column resection for complex and rigid spinal deformities. By doing a two-stage front and back spinal resection they could address rigid coronal decompensation [1]. More recently Suk et al. has popularized the concept of posterior spinal resection for all kinds of spinal deformities [11]. In the meantime pedicle subtraction osteotomies have become popular for the treatment of flat-back deformities and associated syndromes [2, 3]. In the paper published the authors report on a two-level posterior column resection done according to the Thomasen technique; however it is not clear in their description if they removed also the disc of this two-level resection or if they performed a two-adjacent-segments pedicle subtraction osteotomy. It is not possible to judge on the post-operative X-rays that were provided the type of posterior osteotomy that was achieved. Nevertheless, the correction is very impressive and we congratulate the authors for that. I agree that the use of pedicle screws is the safest fixation in these spinal deformities with narrow canal. I would like to emphasize a few concerns relevant to this case. The issue of spinal stenosis must always be considered in these patients. In this specific case, looking at the MRI the stenosis seems to originate at T10 down to L2. In these patients a myelo-CT scan is often more appropriate to judge the extent of the stenosis rather than a sole MRI that may overestimate some stenotic levels. In the case presented the decompressive laminectomy necessary to perform the posterior column resection was carried out only at the level of T12 and L1. This is in my mind insufficient to carry out a safe two-level posterior column resection and did not address the stenoses at T10–T11 and T11–T12. Finally, the other issue of concern is the lack of anterior support or fusion as there is a persisting small angular kyphosis even though the follow-up is 2 years. Even with segmental pedicle instrumentation we have observed failure of constructs well after 2 years. A complementary anterior fusion would have been necessary, in my mind. Overall, we congratulate the author for this very nice result and their innovative way of treatment. Posterior column resection may effectively prove to be safer than the anterior and posterior sequence. I would, however, recommend that posterior decompression extend to all the stenotic levels as seen on a CT myelogram. Should the posterior spinal resection involve two contiguous vertebrae or be staggered with one or two segments left intact will need to be determined. A complementary anterior fusion for stability and longevity purposes may be necessary for the long term.

Changes of Clinical Outcomes after Decompression and Fusion for Spinal Stenosis during 2-Year Follow-up Periods

Study Design: A prospective study Objective: To assess the clinical outcomes after the surgical treatment of spinal stenosis, using patient-centered measurements at the serial follow-up times. Summary of Literature Review: Patient-centered measurements are appropriate to assess the clinical outcomes of surgery for spinal stenosis. Materials and Methods: Thirty-seven patients underwent posterior decompression and posterolateral fusion, with an iliac autograft using pedicle screw instrumentation. They were assessed for their pain using a visual analog scale, and the Oswestry disability index for the preoperative functional disability, at 6 weeks, 3 and 6 months, and at 1 and 2 years, postoperatively. Results: The pain, as measured by the visual analog scale, was 7.42 points before the operation, and 4.12 and 2.76 six weeks and 1 year after the operation, respectively. Compared with the pre-operation scores, 44% has improved after 6 weeks, and 73% after a year. The functional disability, as measured by the Oswestry disability index, was 56.5% before the operation, and 32.13 and 20.1% three months and 1 year after the operation. Compared with the pre-operation, 43% recovered after 3 months, and 65% after a year. The state of recovery state in the functional disability continued for 2 years after the operation. The disability recovered more slowly than the pain. Conclusions: Patient-centered measurements were found to be appropriate for assessing the clinical outcomes to surgery for spinal stenosis. After decompression and fusion for spinal stenosis, the pain and functional disability both improved for 1 year after the operation, with no worsening in the postoperative improvements at 2 years.

A 50-Year-Old Woman With Disabling Spinal Stenosis, 1 Year Later

At the Orthopedics Grand Rounds held approximately 1 year ago, Dr Steven Garfin discussed the management of spinal stenosis in a woman who has a long history of lower back pain and fibromyalgia.1Dr Garfin stressed the importance of the history and physical examination in making a diagnostic assessment, particularly in a patient with multiple problems. Dr Garfin also discussed the appropriateness of surgical treatment for spinal stenosis, emphasizing symptomatic relief in the legs vs the back. We asked the patient and her primary care doctor to comment on what has transpired in the past year. Miss W, THE PATIENT: I had a triple laminectomy performed by a neurosurgeon in September 1995 and I feel great. I have no pain at all in my legs. My back pain has improved a little bit. I walk 3 to 4 miles daily and have lost 25 pounds. The fibromyalgia is off

Surgical Treatment of Spinal stenosis

Surgical Treatment of Spinal stenosis

Surgical Treatment of Spinal Stenosis

Surgical Treatment of Spinal Stenosis