The natural history of asymptomatic lumbar canal stenosis in patients undergoing surgery for cervical myelopathy
Autor: | Takahiro Tsutsumimoto, Hiromichi Misawa, Hiroshi Ohta, Mutsuki Yui, M. Shimogata |
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Rok vydání: | 2012 |
Předmět: |
Adult
Male musculoskeletal diseases medicine.medical_specialty Decompression Kaplan-Meier Estimate Asymptomatic Myelopathy Age Distribution Spinal Stenosis Lumbar medicine Humans Orthopedics and Sports Medicine Gait Disorders Neurologic Aged Retrospective Studies Lumbar Vertebrae medicine.diagnostic_test business.industry Laminectomy Magnetic resonance imaging Retrospective cohort study Middle Aged Lumbar canal stenosis Decompression Surgical medicine.disease Magnetic Resonance Imaging Surgery Natural history Treatment Outcome Cervical Vertebrae Female Radiology medicine.symptom business Spinal Cord Compression |
Zdroj: | The Journal of Bone and Joint Surgery. British volume. :378-384 |
ISSN: | 2044-5377 0301-620X |
Popis: | We retrospectively examined the prevalence and natural history of asymptomatic lumbar canal stenosis in patients treated surgically for cervical compressive myelopathy in order to assess the influence of latent lumbar canal stenosis on the recovery after surgery. Of 214 patients who had undergone cervical laminoplasty for cervical myelopathy, we identified 69 (32%) with myelographically documented lumbar canal stenosis. Of these, 28 (13%) patients with symptomatic lumbar canal stenosis underwent simultaneous cervical and lumbar decompression. Of the remaining 41 (19%) patients with asymptomatic lumbar canal stenosis who underwent only cervical surgery, 39 were followed up for ≥ 1 year (mean 4.9 years (1 to 12)) and were included in the analysis (study group). Patients without myelographic evidence of lumbar canal stenosis, who had been followed up for ≥ 1 year after the cervical surgery, served as controls (135 patients; mean follow-up period 6.5 years (1 to 17)). Among the 39 patients with asymptomatic lumbar canal stenosis, seven had lumbar-related leg symptoms after the cervical surgery. Kaplan–Meier analysis showed that 89.6% (95% confidence interval (CI) 75.3 to 96.0) and 76.7% (95% CI 53.7 to 90.3) of the patients with asymptomatic lumbar canal stenosis were free from leg symptoms for three and five years, respectively. There were no significant differences between the study and control groups in the recovery rate measured by the Japanese Orthopaedic Association score or improvement in the Nurick score at one year after surgery or at the final follow-up. These results suggest that latent lumbar canal stenosis does not influence recovery following surgery for cervical myelopathy; moreover, prophylactic lumbar decompression does not appear to be warranted as a routine procedure for coexistent asymptomatic lumbar canal stenosis in patients with cervical myelopathy, when planning cervical surgery. |
Databáze: | OpenAIRE |
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