Functional and clinical evaluation for the surgical treatment of degenerative stenosis of the lumbar spinal canal

Clinical article

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Object

This study was designed to evaluate the efficacy of decompressive surgery for degenerative lumbar spinal stenosis (LSS) on a functional and clinical basis.

Methods

A prospective analysis and follow-up of 125 consecutive patients with degenerative LSS between 2000 and 2006 were performed. All patients underwent surgery for lumbar stenosis. Functional evaluations of the patients were performed using a treadmill, the visual analog scale, and the Oswestry Disability Questionnaire (ODQ). These parameters were recorded before surgery and the 3rd month and 1st and 2nd years after treatment. The first symptom time (FST), maximal walking duration (MWD), and thecal sac cross-sectional area (CSA) before and after surgery were also recorded. Statistical relations between variables were calculated.

Results

As patient ages increased, the CSA of the thecal sac decreased. Decompressive surgery reached the target according to the difference between the preoperative and postoperative thecal sac CSA. A correlation between the CSA of the thecal sac and FST, and between the CSA of the thecal sac and MWD could not be established. There was a significant correlation between the FST and MWD, and a negative correlation could be established between the MWD and the ODQ score. Surgery led to significant decreases in the ODQ score. Maximal improvement was observed in the 3rd month after decompressive surgery.

Conclusions

The treatment for LSS should be decided using functional criteria; radiological criteria may not correlate with the severity of the disease. Improvements following lumbar decompression surgery continued within 1 year of treatment according to the ODQ and did not change significantly thereafter.

Abbreviations used in this paper: CSA = cross-sectional area; FST = first symptom time; LSS = lumbar spinal stenosis; MWD = maximal walking duration; ODQ = Oswestry Disability Questionnaire.

Article Information

Address correspondence to: Uygur Er, M.D., Söğütözü C., 4th Sk., No. 22/7, 06510, Çankaya, Ankara, Turkey. email: uygurer@gmail.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Bar graph showing improvement in the CSA of the thecal sac. CSA1 = pre-CSA; CSA2 = 3-mo CSA.

  • View in gallery

    Bar graph demonstrating improvements in the ODQ score. ODQ1 = pre-ODQ; ODQ2 = 3-mo ODQ; ODQ3 = 1-yr ODQ; ODQ4 = 2-yr ODQ.

  • View in gallery

    Bar graph showing improvements in the FST on the treadmill. FST1 = pre-FST; FST2 = 3-mo FST; FST3 = 1-yr FST.

  • View in gallery

    Bar graph showing the improvements in the MWD on the treadmill. MWD1 = pre-MWD; MWD2 = 3-mo MWD; MWD3 = 1-yr MWD.

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