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Abstract
Objectives
We wanted to assess the clinical outcomes of posterior dynamic stabilization with selective wide decompression for treating multilevel lumbar stenosis in old age.
Summary of Literature Review
Deciding on the segments to be operated on is challenging problem for old age patients with multilevel lumbar stenosis. There have been no reports on posterior dynamic stabilization with selective wide decompression for treating multilevel lumbar stenosis.
Materials and Methods
We evaluated 18 patients who underwent posterior dynamic stabilization with selective decompression for multilevel disc degeneration and spinal stenosis. The mean age was 70.2 years and mean followup was 15.1 months. We evaluated the segmental angle, the range of motion (ROM) and pedicle screw loosening. The clinical results were evaluated according to the operative time, blood loss, the visual analogue scale (VAS) for the back pain and leg pain and and the Oswestry disability index (ODI).
Results
The mean number of operated segments was 2.16. The lordosis of the lumbar and operated segments showed no significant difference. However, the ROM of the total lumbar spine and the operation segment was significantly decreased from 36.8 to 24.3 and 22.9 to 13.1, respectively. The ROM for the adjacent segment did not show a significant difference. A radiolucent line around the pedicle screw appeared at 22 screws (19.3%) out of a total 114 screws. The VAS for back and leg pain were improved from 7.5 and 8.6 to 2.3 and 2.1, respectively. The ODI was improved from 41.5 to 13.4.
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Figures and Tables%
Fig. 1.
Preoperative T2 sagittal MR image and postoperative 20 months’ radiographs of 72-year-old female patient showing 13 degrees of segmental motion at L3-4-5 without radioluscent line.
Fig. 2.
Serial radiographs of 66-year-old female (same patient of figure 1) at 3 months (A), 6months (B), 12 months (C) and 16 months (D) after operation. Radiolucent lines (RLL) around Rt L4 and both S1 screws (black arrows) were found from postoperative 6 months and RLL around Lt L4 screw was found at postoperative 12 months (white arrows). The thickness of all RLL was less than 2mm and not increased definitely during follow up.
Table 1.
Grading system of the assessment of disc degeneration by Pfirmman et al.113)
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