Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone
| Autor: | M W, Fox, B M, Onofrio, A D, Hanssen |
|---|---|
| Rok vydání: | 1996 |
| Předmět: |
Adult
Male medicine.medical_specialty Decompression Spinal stenosis medicine.medical_treatment Arthrodesis Spinal Stenosis Medicine Humans Aged Subluxation Aged 80 and over business.industry Laminectomy Lumbar spinal stenosis Middle Aged medicine.disease Decompression Surgical Prognosis Spondylolisthesis Surgery Stenosis Spinal fusion Female business |
| Zdroj: | Journal of neurosurgery. 85(5) |
| ISSN: | 0022-3085 |
| Popis: | ✓ 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. |
| Databáze: | OpenAIRE |
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