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

Clinical article

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


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.


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.


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:

© AANS, except where prohibited by US copyright law.



  • 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.


  • 1

    Abumi KPanjabi MMKramer KMDuranceau JOxland TCrisco JJ: Biomechanical evaluation of lumbar spinal instability after graded facetectomies. Spine 15:114211471990

  • 2

    Amundsen TWeber HNordal HJMagnaes BAbdelnoor MLilleas F: Lumbar spinal stenosis. Conservative or surgical management? A prospective 10-year study. Spine 25:142414352000

  • 3

    Arbit EPannullo S: Lumbar stenosis. A clinical review. Clin Orthop Relat Res 384:1371432001

  • 4

    Atlas SJDeyo RAKeller RBChapin AMPatrick DLLong JM: The maine lumbar spine study, part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 21:178717941996

  • 5

    Atlas SJKeller RBRobson DDeyo RASinger DE: Surgical and nonsurgical management of lumbar spinal stenosis: Four-year outcomes from the maine lumbar spine study. Spine 25:5565622000

  • 6

    Atlas SJKeller RBWu YADeyo RASinger DE: Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year outcomes from the maine lumbar spine study. Spine 30:9369432005

  • 7

    Bailey PCasamajor L: Osteoarthritis of the spine as a cause of compression of the spinal cord and its roots. J Nerv Ment Dis 38:5886091911

  • 8

    Blau JNLogue V: The natural history of intermittent claudication of the cauda equina. Brain 101:2112221978

  • 9

    Deyo RACherkin DCLoeser JDBigos SJCiol MA: Morbidity and mortality in association with operations on the lumbar spine: the influence of age, diagnosis, and procedure. J Bone Joint Surg Am 74:5365431992

  • 10

    DiPierro CGHelm GAShaffrey CIChadduck JBHenson SLMalik JM: Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results. J Neurosurg 84:1661731996

  • 11

    Fox MWOnofrio BMHanssen AD: Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg 85:7938021996

  • 12

    Frymoyer JWSelby DK: Segmental instability: rationale for treatment. Spine 10:2802861985

  • 13

    Herkowitz HNKurz LT: Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransvers process arthrodesis. J Bone Joint Surg Am 73:8028081991

  • 14

    Hopp ETsou PM: Postdecompression lumbar instability. Clin Orthop Relat Res 227:1431511998

  • 15

    Lohman CMTallroth KKettunen JALindgren KA: Comparison of radiologic signs and clinical symptoms of spinal stenosis. Spine 31:183418402006

  • 16

    Nasca RJ: Surgical management of spinal stenosis. Spine 12:8098161987

  • 17

    Palmer STurner RPalmer R: Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. J Neurosurg 2 Suppl97:2132172002

  • 18

    Postacchini F: Management of lumbar spinal stenosis. J Bone Joint Surg Br 78:1541641996

  • 19

    Postacchini FCinotti GGumina SPerugia D: Long-term results of surgery in lumbar stenosis: 8 year review of 64 patients. Acta Orthop Scand Suppl 251:78801993

  • 20

    Postacchini FCinotti GPerugia DGumina S: The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br 75:3863921993

  • 21

    Richards JCMajumdar SLindsey DPBeaupre GSYerby SA: The treatment mechanism of an interspinous process implant for lumbar neurogenic intermittent claudication. Spine 30:7447492005

  • 22

    Thomas NWRea GLPikul BKMervis LJIrsik RMcGregor JM: Quantitative outcome and radiographic comparisons between laminectomy and laminotomy in the treatment of acquired lumbar stenosis. Neurosurgery 41:5675741997

  • 23

    Truumees E: Spinal stenosis: pathophysiology, clinical and radiologic classification. Instr Course Lect 54:2873022005

  • 24

    Tuite GFDoran SEStern JDMcGillicuddy JEPapadopoulos SMLundquist CA: Outcome after laminectomy for lumbar spinal stenosis. Part II: Radiographic changes and clinical correlations. J Neurosurg 81:7077151994

  • 25

    Turner JAHerron LDeyo RA: Meta-analysis of the results of lumbar spine fusion. Acta Orthop Scand Suppl 251:1201221993

  • 26

    Verbiest H: A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br 36:2302371954

  • 27

    Yamashita KOhzono KHiroshima K: Five-year outcomes of surgical treatment for degenerative lumbar spinal stenosis. A prospective observational study of symptom severity at standard intervals after surgery. Spine 31:148414902006

  • 28

    Zucherman JFHsu KYHartjen CAMehalic TFImplicito DAMartim MJ: A multicenter, prospective, randomized trial evaluating the X-STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication. Spine 30:135113582005




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