Journal List > J Korean Soc Spine Surg > v.12(2) > 1035648

Kim, Kang, Park, Park, Sung, Lee, Kim, Ahn, Lee, and Choy: Surgical Outcome of Degenerative Lumbar Spinal Stenosis in Patients over 70 years old -A Comparative Analysis according to Surgical Method-

Abstract

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 75.1years(70 to 91years) 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.

Co nclus ions

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.

REFERENCES

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Table 1.
Clinical Outcome Measurement (by Ragab, et al.1))
  Back Pain Leg Pain Activity Medication
Excellent Occasional None Normal None
Good Mild Mild Normal NSAID
Fair Moderate Moderate Restricted NSAID
Poor Severe Severe Restricted Narcotics
Table 2.
American Society of Anesthesiologists Classification of Physical Status
Class Definition
No systemic disease
Mild to moderate systemic disease
Severe systemic disease
Severe systemic disease that is life threatening
Moribund patient with little chance of survival
Table 3.
Distribution of CX.∗ Relevant to ASA classfication.
  DECOMPRESSION ONLY DECOMP & FUSION
ASA
No.of patient 5 13 5 0 4 9 2 0
Complication                
infection 1              
ileus   01 1          
urinary reten.   02 1   1 2    
pul.∗ edema             1  
confusion 1 01       1    
Total no.of Cx   08       5    

∗Cx.: Complication ∗pul: pulmonary

Table 4.
Distribution of patients outcome
outcome Total Excellent Good Fair Poor Satisfied
All Patients 38 15 17 5 1 32(84%)
Treated with decompression only 23 09 11 2 1 20(86.9%)
Treated with decompression & fusion 15 06 06 3   12(80%)
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