Surgical treatment of lumbar spinal stenosis in patients older than 75 years of age

View More View Less
  • 1 Departments of Neurological and Orthopedic Surgery, University of Louisville School of Medicine, and Kenton D. Leatherman Spine Center, Louisville, Kentucky
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. The purpose of this study was to evaluate the safety and efficacy of the surgical treatment of lumbar spinal stenosis in patients older than 75 years of age.

Methods. The authors reviewed the records of 65 patients with lumbar spinal stenosis who were at least 75 years of age at the time of surgery, which was performed between November 1990 and May 1996.

The 65 patients (43 women, 22 men; average age 78 years) underwent a total of 71 operations (one patient underwent three, and four patients underwent two). Fifteen patients (21%) underwent isolated lumbar decompression, and 56 patients (79%) underwent decompression in conjunction with posterior spinal fusion. There was an average of 1.7 levels decompressed per isolated lumbar decompression and 2.6 levels per decompression and fusion procedure. Seven patients (10%) experienced one or more serious postoperative complication, which included wound infection, septicemia, small bowel obstruction, stroke, myocardial infarction, gastrointestinal bleeding, and pulmonary embolus. In addition there was one intraoperative complication (hypotension [1%]) that required modification of the planned surgical procedure. No deaths were documented in the perioperative period.

Conclusions. With appropriate preoperative selection and evaluation, careful intraoperative monitoring, and attentive perioperative care, the surgical treatment of elderly patients with lumbar spinal stenosis can effect significant improvement with acceptable levels of morbidity and mortality.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Todd W. Vitaz, M.D., Department of Neurological Surgery, 210 East Gray Street, Suite 1102, Louisville, Kentucky 40202.
  • 1.

    Abumi K, , Panjabi MM, & Kramer KM, et al. : Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine 15:11421147, 1990 Abumi K, Panjabi MM, Kramer KM, et al: Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine 15:1142–1147, 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Atlas SJ, , Deyo RA, & Keller RB, et al. : The Maine Lumbar Spine Study, Part III; 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 21:17871795, 1996 Atlas SJ, Deyo RA, Keller RB, et al: The Maine Lumbar Spine Study, Part III; 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 21:1787–1795, 1996

    • Search Google Scholar
    • Export Citation
  • 3.

    Bolestra MJ, & Bohlman HH: Degenerative spondylolisthesis. Instr Course Lect 38:157165, 1989 Bolestra MJ, Bohlman HH: Degenerative spondylolisthesis. Instr Course Lect 38:157–165, 1989

    • Search Google Scholar
    • Export Citation
  • 4.

    Booth RE, & Spivak J: The surgery of spinal stenosis. Instr Course Lect 43:441449, 1994 Booth RE, Spivak J: The surgery of spinal stenosis. Instr Course Lect 43:441–449, 1994

    • Search Google Scholar
    • Export Citation
  • 5.

    Bridwell KH, , Sedgewick TA, & O'Brien MF, et al. : The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6:461472, 1993 Bridwell KH, Sedgewick TA, O'Brien MF, et al: The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6:461–472, 1993

    • Search Google Scholar
    • Export Citation
  • 6.

    Caputy AJ, & Luessenhop AJ: Long-term evaluation of decompressive surgery for degenerative lumbar stenosis. J Neurosurg 77:669676, 1992 Caputy AJ, Luessenhop AJ: Long-term evaluation of decompressive surgery for degenerative lumbar stenosis. J Neurosurg 77:669–676, 1992

    • Search Google Scholar
    • Export Citation
  • 7.

    Ciol MA, , Deyo RA, & Howell E, et al. : An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc 44:285290, 1996 Ciol MA, Deyo RA, Howell E, et al: An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc 44:285–290, 1996

    • Search Google Scholar
    • Export Citation
  • 8.

    Deen HG, , Zimmerman RS, & Lyons MK, et al. : Analysis of early failures after lumbar decompressive laminectomy for spinal stenosis. Mayo Clinic Proc 70:3336, 1995 Deen HG, Zimmerman RS, Lyons MK, et al: Analysis of early failures after lumbar decompressive laminectomy for spinal stenosis. Mayo Clinic Proc 70:33–36, 1995

    • Search Google Scholar
    • Export Citation
  • 9.

    Deyo RA, , Cherkin DC, & Loeser JD, et al. : Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg (Am) 74:536543, 1992 Deyo RA, Cherkin DC, Loeser JD, et al: Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg (Am) 74:536–543, 1992

    • Search Google Scholar
    • Export Citation
  • 10.

    diPierro CG, , Helm GA, & Shaffrey CI, et al. : Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results. J Neurosurg 84:166173, 1996 diPierro CG, Helm GA, Shaffrey CI, et al: Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results. J Neurosurg 84:166–173, 1996

    • Search Google Scholar
    • Export Citation
  • 11.

    Esses SI, & Huler RJ: Indications for lumbar spine fusion in the adult. Clin Orthop 279:87100, 1992 Esses SI, Huler RJ: Indications for lumbar spine fusion in the adult. Clin Orthop 279:87–100, 1992

    • Search Google Scholar
    • Export Citation
  • 12.

    Feffer HL, , Wiesel SW, & Cuckler JM, et al. : Degenerative spondylolisthesis: to fuse or not to fuse. Spine 10:287289, 1985 Feffer HL, Wiesel SW, Cuckler JM, et al: Degenerative spondylolisthesis: to fuse or not to fuse. Spine 10:287–289, 1985

    • Search Google Scholar
    • Export Citation
  • 13.

    Fischgrund JS, , Mackay M, & Herkowitz HN, et al. : 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:28072812, 1997 Fischgrund JS, Mackay M, Herkowitz HN, et al: 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:2807–2812, 1997

    • Search Google Scholar
    • Export Citation
  • 14.

    Fox MW, , Onofrio BM, & Hanssen 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 85:793802, 1996 Fox MW, Onofrio BM, Hanssen 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 85:793–802, 1996

    • Search Google Scholar
    • Export Citation
  • 15.

    Frazier DD, , Lipson SJ, & Fossel AH, et al. : Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine 22:20252029, 1997 Frazier DD, Lipson SJ, Fossel AH, et al: Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine 22:2025–2029, 1997

    • Search Google Scholar
    • Export Citation
  • 16.

    Garfin SR, , Mirkovic S, & Herkowitz HN: Spinal stenosis: indications for laminectomy. Instr Course Lect 43:411414, 1994 Garfin SR, Mirkovic S, Herkowitz HN: Spinal stenosis: indications for laminectomy. Instr Course Lect 43:411–414, 1994

    • Search Google Scholar
    • Export Citation
  • 17.

    Garfin SR, & Ozanne S: Spinal pedicle fixation; in Weinstein JN (ed); Clinical Efficacy and Outcome in the Diagnosis and Treatment of Low Back Pain. New York: Raven Press, 1992, pp 137174 Garfin SR, Ozanne S: Spinal pedicle fixation; in Weinstein JN (ed); Clinical Efficacy and Outcome in the Diagnosis and Treatment of Low Back Pain. New York: Raven Press, 1992, pp 137–174

    • Search Google Scholar
    • Export Citation
  • 18.

    Grob D, , Humke T, & Dvorak J: Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg (Am) 77:10361041, 1995 Grob D, Humke T, Dvorak J: Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg (Am) 77:1036–1041, 1995

    • Search Google Scholar
    • Export Citation
  • 19.

    Hanley EN Jr: The indications for lumbar spinal fusion with and without instrumentation. Spine 20:143S153S, 1995 Hanley EN Jr: The indications for lumbar spinal fusion with and without instrumentation. Spine 20:143S–153S, 1995

    • Search Google Scholar
    • Export Citation
  • 20.

    Herkowitz HN: Lumbar spinal stenosis: Indications for arthrodesis and spinal instrumentation. Instr Course Lect 43:425433, 1994 Herkowitz HN: Lumbar spinal stenosis: Indications for arthrodesis and spinal instrumentation. Instr Course Lect 43:425–433, 1994

    • Search Google Scholar
    • Export Citation
  • 21.

    Herkowitz HN: Spine update. Degenerative lumbar spondylolisthesis. Spine 20:10841090, 1995 Herkowitz HN: Spine update. Degenerative lumbar spondylolisthesis. Spine 20:1084–1090, 1995

    • Search Google Scholar
    • Export Citation
  • 22.

    Herkowitz HN, & Kurz LT: Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg (Am) 73:802808, 1991 Herkowitz HN, Kurz LT: Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg (Am) 73:802–808, 1991

    • Search Google Scholar
    • Export Citation
  • 23.

    Herron LD, & Trippi AC: L4–5 degenerative spondylolisthesis. The results of treatment by decompressive laminectomy without fusion. Spine 14:534537, 1989 Herron LD, Trippi AC: L4–5 degenerative spondylolisthesis. The results of treatment by decompressive laminectomy without fusion. Spine 14:534–537, 1989

    • Search Google Scholar
    • Export Citation
  • 24.

    Hu SS, , Holly EA, & Lele C, et al. : Patient outcomes after spinal reconstructive surgery in patients ≥40 years of age. J Spinal Disord 9:460469, 1996 Hu SS, Holly EA, Lele C, et al: Patient outcomes after spinal reconstructive surgery in patients ≥40 years of age. J Spinal Disord 9:460–469, 1996

    • Search Google Scholar
    • Export Citation
  • 25.

    Jonsson B, , Annertz M, & Sjoberg C, et al. : A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: clinical features related to radiographic findings. Spine 22:29322937, 1997 Jonsson B, Annertz M, Sjoberg C, et al: A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: clinical features related to radiographic findings. Spine 22:2932–2937, 1997

    • Search Google Scholar
    • Export Citation
  • 26.

    Jonsson B, , Annertz M, & Sjoberg C, et al. : A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: five-year follow-up by an independent observer. Spine 22:29382944, 1997 Jonsson B, Annertz M, Sjoberg C, et al: A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: five-year follow-up by an independent observer. Spine 22:2938–2944, 1997

    • Search Google Scholar
    • Export Citation
  • 27.

    Katz JN: Lumbar spinal fusion. Surgical rates, costs, and complications. Spine 20:78S83S, 1995 Katz JN: Lumbar spinal fusion. Surgical rates, costs, and complications. Spine 20:78S–83S, 1995

    • Search Google Scholar
    • Export Citation
  • 28.

    Katz JN, , Lipson SJ, & Chang LC, et al. : Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 21:9298, 1996 Katz JN, Lipson SJ, Chang LC, et al: Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 21:92–98, 1996

    • Search Google Scholar
    • Export Citation
  • 29.

    Katz JN, , Lipson SJ, & Lew RA, et al. : Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes. Spine 22:11231131, 1997 Katz JN, Lipson SJ, Lew RA, et al: Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes. Spine 22:1123–1131, 1997

    • Search Google Scholar
    • Export Citation
  • 30.

    Lombardi JS, , Wiltse LL, & Reynolds J, et al. : Treatment of degenerative spondylolisthesis. Spine 10:821827, 1985 Lombardi JS, Wiltse LL, Reynolds J, et al: Treatment of degenerative spondylolisthesis. Spine 10:821–827, 1985

    • Search Google Scholar
    • Export Citation
  • 31.

    Mardjetko SM, , Connolly PF, & Shott S: Degenerative lumbar spondylolisthesis: A meta-analysis of the literature 1970–1993. Spine 19:2256S2265S, 1994 Mardjetko SM, Connolly PF, Shott S: Degenerative lumbar spondylolisthesis: A meta-analysis of the literature 1970–1993. Spine 19:2256S–2265S, 1994

    • Search Google Scholar
    • Export Citation
  • 32.

    Mirkovic S, , Garfin SR, & Rydevik B, et al. : Pathophysiology of spinal stenosis. Instr Course Lect 43:165177, 1992 Mirkovic S, Garfin SR, Rydevik B, et al: Pathophysiology of spinal stenosis. Instr Course Lect 43:165–177, 1992

    • Search Google Scholar
    • Export Citation
  • 33.

    Mullin BB, , Rea GL, & Irsik R, et al. : The effect of postlaminectomy spinal instability on the outcome of lumbar spinal stenosis patients. J Spinal Disord 9:107116, 1996 Mullin BB, Rea GL, Irsik R, et al: The effect of postlaminectomy spinal instability on the outcome of lumbar spinal stenosis patients. J Spinal Disord 9:107–116, 1996

    • Search Google Scholar
    • Export Citation
  • 34.

    Porter RW: Spinal stenosis and neurogenic claudication. Spine 21:20462052, 1996 Porter RW: Spinal stenosis and neurogenic claudication. Spine 21:2046–2052, 1996

    • Search Google Scholar
    • Export Citation
  • 35.

    Postacchini F: Management of lumbar spinal stenosis. J Bone Joint Surg (Br) 78:154164, 1996 Postacchini F: Management of lumbar spinal stenosis. J Bone Joint Surg (Br) 78:154–164, 1996

    • Search Google Scholar
    • Export Citation
  • 36.

    Postacchini F, & Cinotti G: Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg (Br) 74:862869, 1992 Postacchini F, Cinotti G: Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg (Br) 74:862–869, 1992

    • Search Google Scholar
    • Export Citation
  • 37.

    Sidhu KS, & Herkowitz HN: Spinal instrumentation in the management of degenerative disorders of the lumbar spine. Clin Orthop 335:3953, 1997 Sidhu KS, Herkowitz HN: Spinal instrumentation in the management of degenerative disorders of the lumbar spine. Clin Orthop 335:39–53, 1997

    • Search Google Scholar
    • Export Citation
  • 38.

    Simmons ED Jr, & Simmons EH: Spinal stenosis with scoliosis. Spine 17:117S120S, 1992 Simmons ED Jr, Simmons EH: Spinal stenosis with scoliosis. Spine 17:117S–120S, 1992

    • Search Google Scholar
    • Export Citation
  • 39.

    Stromqvist B, & Jonsson B: Computerized follow-up after surgery for degenerative lumbar spine diseases. Acta Orthop Scand Suppl 64:138142, 1993 Stromqvist B, Jonsson B: Computerized follow-up after surgery for degenerative lumbar spine diseases. Acta Orthop Scand Suppl 64:138–142, 1993

    • Search Google Scholar
    • Export Citation
  • 40.

    Turner JA, , Ersek M, & Herron L, et al. : Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 17:18, 1992 Turner JA, Ersek M, Herron L, et al: Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 17:1–8, 1992

    • Search Google Scholar
    • Export Citation
  • 41.

    Vaccaro AR, & Garfin S: Internal fixation (pedicle screw fixation) for fusions of the lumbar spine. Spine 20:157S165S, 1995 Vaccaro AR, Garfin S: Internal fixation (pedicle screw fixation) for fusions of the lumbar spine. Spine 20:157S–165S, 1995

    • Search Google Scholar
    • Export Citation
  • 42.

    White AH, & Wiltse LL: Spondylolisthesis after extensive lumbar laminectomy. J Bone Joint Surg 58:727728, 1975 White AH, Wiltse LL: Spondylolisthesis after extensive lumbar laminectomy. J Bone Joint Surg 58:727–728, 1975

    • Search Google Scholar
    • Export Citation
  • 43.

    Yone K, , Sakou T, & Kawauchi Y, et al. : Indication of fusion for lumbar spinal stenosis in elderly patients and its significance. Spine 21:242248, 1996 Yone K, Sakou T, Kawauchi Y, et al: Indication of fusion for lumbar spinal stenosis in elderly patients and its significance. Spine 21:242–248, 1996

    • Search Google Scholar
    • Export Citation
  • 44.

    Yuan HA, , Garfin SR, & Dickman CA, et al. : A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. Spine 20:2279S2296S, 1994 Yuan HA, Garfin SR, Dickman CA, et al: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. Spine 20:2279S–2296S, 1994

    • Search Google Scholar
    • Export Citation
  • 45.

    Zdeblick TA: A prospective, randomized study of lumbar fusion—Preliminary results. Spine 18:983991, 1993 Zdeblick TA: A prospective, randomized study of lumbar fusion—Preliminary results. Spine 18:983–991, 1993

    • Search Google Scholar
    • Export Citation
  • 46.

    Zdeblick TA: The treatment of degenerative lumbar disorders. A critical review of the literature. Spine 20:126S137S, 1995 Zdeblick TA: The treatment of degenerative lumbar disorders. A critical review of the literature. Spine 20:126S–137S, 1995

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 442 114 4
Full Text Views 82 7 0
PDF Downloads 69 5 0
EPUB Downloads 0 0 0