Decompressive lumbar laminectomy for spinal stenosis

Restricted access

✓ A total of 258 consecutive decompressive lumbar laminectomies performed on 244 individuals presenting with spinal stenosis were analyzed retrospectively. Spinal fusion was avoided in all but two patients. Outcome in terms of pain relief and return to normal activity was evaluated in two stages, one derived from patient charts and having a relatively short-term follow-up time (mean 8.4 months) and a second derived from patient responses to a questionnaire (which also scored for satisfaction with the results of surgery), which had a longer follow-up time (mean 4.7 years). More than 20 clinical and operative parameters were analyzed. Overall, a high degree of success (93% pain relief, 95% return to normal activity) was achieved in the short term, which was supported by the longer-term follow-up data (64% pain relief, 56% activity return, 75% satisfaction). The following factors were not significantly correlated with outcome: patient age; sex; worker's compensation or no-fault insurance status; employed versus not employed; a history of back surgery prior to the laminectomy studied; existence of degenerative spondylolisthesis or scoliosis; complete versus incomplete myelographic block; or the level of the lumbar spine undergoing surgery.

The major conclusions arising from these data are: 1) for all age groups through at least the eighth decade of life, decompressive lumbar laminectomy is a relatively safe operation having a high medium-to-long-term success rate; 2) lumbar instability following laminectomy is rare, even in individuals presenting prior to surgery with degenerative instability conditions; and 3) lumbar fusion in addition to the decompressive laminectomy procedure is rarely required for degenerative spinal stenosis.

Article Information

Address reprint requests to: H. Roy Silvers, M.D., Southtowns Neurological Surgeons Associates, 550 Orchard Park Road, Buffalo, New York 14224.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Bar graph showing the distribution of follow-up time after decompressive lumbar laminectomy. Two types of follow-up data are indicated, including short-term follow-up data based on patient records (open bars; numbers atop bars represent laminectomies; total 258 cases) and long-term follow-up data based on responses to a questionnaire (solid bars; numbers atop bars represent responses; total 128 cases).

  • View in gallery

    Bar graph showing the age distribution of patients at the time of lumbar laminectomy. Represented are all laminectomies (258 procedures) performed on 244 patients included in the present study.

References

1.

Bailey PCasamajor L: Osteoarthritis of the spine as cause of compression of the spinal cord and its roots. With reports of five cases. J Nerv Dis 38:5886091911Bailey P Casamajor L: Osteoarthritis of the spine as cause of compression of the spinal cord and its roots. With reports of five cases. J Nerv Dis 38:588–609 1911

2.

Blau JNLogue V: Intermittent claudication of the Cauda equina. An unusual syndrome resulting from central protrusion of a lumbar intervertebral disc. Lancet 1:108110861961Blau JN Logue V: Intermittent claudication of the Cauda equina. An unusual syndrome resulting from central protrusion of a lumbar intervertebral disc. Lancet 1:1081–1086 1961

3.

Cotler JMCotler HB: Spinal Fusion: Science and Technique. New York: Springer-Verlag1990Cotler JM Cotler HB: Spinal Fusion: Science and Technique. New York: Springer-Verlag 1990

4.

Cramer F: A note concerning the syndrome of cauda equina radiculitis. Bull Neurol Inst NY 3:5011934Cramer F: A note concerning the syndrome of cauda equina radiculitis. Bull Neurol Inst NY 3:501 1934

5.

Ehni G: Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. Part 1: Introduction. J Neurosurg 31:4904941968Ehni G: Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. Part 1: Introduction. J Neurosurg 31:490–494 1968

6.

Fast ARobin GCFloman Y: Surgical treatment of lumbar spinal stenosis in the elderly. Arch Phys Med Rehabil 66:1491511985Fast A Robin GC Floman Y: Surgical treatment of lumbar spinal stenosis in the elderly. Arch Phys Med Rehabil 66:149–151 1985

7.

Ganz JC: Lumbar spinal stenosis: postoperative results in terms of preoperative posture-related pain. J Neurosurg 72:71741990Ganz JC: Lumbar spinal stenosis: postoperative results in terms of preoperative posture-related pain. J Neurosurg 72:71–74 1990

8.

Gartland JJ: The future of spinal fusions in Cotler JMCoder HB (eds): Spinal Fusion: Science and Technique. New York: Springer-Verlag1990 pp 391395Gartland JJ: The future of spinal fusions in Cotler JM Coder HB (eds): Spinal Fusion: Science and Technique. New York: Springer-Verlag 1990 pp 391–395

9.

Hall SBartleson JDOnofrio BMet al: Lumbar spinal stenosis. Clinical features, diagnostic procedures, and results of surgical treatment in 68 patients. Ann Intern Med 103:2712751985Hall S Bartleson JD Onofrio BM et al: Lumbar spinal stenosis. Clinical features diagnostic procedures and results of surgical treatment in 68 patients. Ann Intern Med 103:271–275 1985

10.

Hanley EN Jr: Decompression and distraction-derotation arthrodesis for degenerative spondylolisthesis. Spine 11:2692761986Hanley EN Jr: Decompression and distraction-derotation arthrodesis for degenerative spondylolisthesis. Spine 11:269–276 1986

11.

Herron LDTrippi AC: L4–5 degenerative spondylolisthesis. The results of treatment by decompressive laminectomy without fusion. Spine 14:5345381989Herron LD Trippi AC: L4–5 degenerative spondylolisthesis. The results of treatment by decompressive laminectomy without fusion. Spine 14:534–538 1989

12.

Herron LDTurner JClancy Set al: The differential utility of the Minnesota Multiphasic Personality Inventory. A predictor of outcome in lumbar laminectomy for disc herniation versus spinal stenosis. Spine 11:8478501986Herron LD Turner J Clancy S et al: The differential utility of the Minnesota Multiphasic Personality Inventory. A predictor of outcome in lumbar laminectomy for disc herniation versus spinal stenosis. Spine 11:847–850 1986

13.

Hood SAWeigl K: Lumbar spinal stenosis: surgical intervention in the older person. Isr J Med Sci 19:1691721983Hood SA Weigl K: Lumbar spinal stenosis: surgical intervention in the older person. Isr J Med Sci 19:169–172 1983

14.

Hopp ETsou PM: Postdecompression lumbar instability. Clin Orthop 227:1431511988Hopp E Tsou PM: Postdecompression lumbar instability. Clin Orthop 227:143–151 1988

15.

Johnsson KERedlund-Johnell IUden Aet al: Preoperative and postoperative instability in lumbar spinal stenosis. Spine 14:5915931989Johnsson KE Redlund-Johnell I Uden A et al: Preoperative and postoperative instability in lumbar spinal stenosis. Spine 14:591–593 1989

16.

Johnsson KEWillner SJohnsson K: Postoperative instability after decompression for lumbar spinal stenosis. Spine 11:1071101986Johnsson KE Willner S Johnsson K: Postoperative instability after decompression for lumbar spinal stenosis. Spine 11:107–110 1986

17.

Johnsson KEWillner SPettersson H: Analysis of operated cases with lumbar spinal stenosis. Acta Orthop Scand 52:4274331981Johnsson KE Willner S Pettersson H: Analysis of operated cases with lumbar spinal stenosis. Acta Orthop Scand 52:427–433 1981

18.

Kaneda KKazama HSatoh Set al: Follow-up study of medial facetectomies and posterolateral fusion with instrumentation in unstable degenerative spondylolisthesis. Clin Orthop 203:1591671986Kaneda K Kazama H Satoh S et al: Follow-up study of medial facetectomies and posterolateral fusion with instrumentation in unstable degenerative spondylolisthesis. Clin Orthop 203:159–167 1986

19.

Kirkaldy-Willis WHMcIvor GWD: Lumbar spinal stenosis. Clin Orthop 115:231976 (Editorial)Kirkaldy-Willis WH McIvor GWD: Lumbar spinal stenosis. Clin Orthop 115:2–3 1976 (Editorial)

20.

Kirkaldy-Willis WHPaine KWECauchoix Jet al: Lumbar spinal stenosis. Clin Orthop 99:30501974Kirkaldy-Willis WH Paine KWE Cauchoix J et al: Lumbar spinal stenosis. Clin Orthop 99:30–50 1974

21.

Kostuik JP: Recent advances in the treatment of painful adult scoliosis. Clin Orthop 147:2382521986Kostuik JP: Recent advances in the treatment of painful adult scoliosis. Clin Orthop 147:238–252 1986

22.

Kostuik JPErrico TJGleason TF: Techniques of internal fixation for degenerative conditions of the lumbar spine. Clin Orthop 203:2192311986Kostuik JP Errico TJ Gleason TF: Techniques of internal fixation for degenerative conditions of the lumbar spine. Clin Orthop 203:219–231 1986

23.

Lombardi JSWiltse LLReynolds Jet al: Treatment of degenerative spondylolisthesis. Spine 10:8218271985Lombardi JS Wiltse LL Reynolds J et al: Treatment of degenerative spondylolisthesis. Spine 10:821–827 1985

24.

Mauersberger WNietgen T: Surgical treatment of lumbar stenosis: long-term results. Neurosurg Rev 12:2912951989Mauersberger W Nietgen T: Surgical treatment of lumbar stenosis: long-term results. Neurosurg Rev 12:291–295 1989

25.

McIvor GWDKirkaldy-Willis WH: Pathological and myelographic changes in the major types of lumbar spinal stenosis. Clin Orthop 115:72761976McIvor GWD Kirkaldy-Willis WH: Pathological and myelographic changes in the major types of lumbar spinal stenosis. Clin Orthop 115:72–76 1976

26.

Nasca RJ: Rationale for spinal fusion in lumbar spinal stenosis. Spine 14:4514541989Nasca RJ: Rationale for spinal fusion in lumbar spinal stenosis. Spine 14:451–454 1989

27.

Nasca RJ: Surgical management of lumbar spinal stenosis. Spine 12:8098161987Nasca RJ: Surgical management of lumbar spinal stenosis. Spine 12:809–816 1987

28.

Pappas CTSonntag VKHarrington T: A prospective study of 206 cases of lumbar stenosis in the elderly to determine surgical contraindications and spinal instability. J Neurosurg 76:373A374A1992 (Abstract)Pappas CT Sonntag VK Harrington T: A prospective study of 206 cases of lumbar stenosis in the elderly to determine surgical contraindications and spinal instability. J Neurosurg 76:373A–374A 1992 (Abstract)

29.

Parker HLAdson AW: Compression of the spinal cord and its roots by hypertrophic osteo-arthritis. Diagnosis and treatment. Surg Gynecol Obstet 41:1141925Parker HL Adson AW: Compression of the spinal cord and its roots by hypertrophic osteo-arthritis. Diagnosis and treatment. Surg Gynecol Obstet 41:1–14 1925

30.

Petropoulos BP: Lumbar spinal stenosis syndrome. Clin Orthop 246:70801989Petropoulos BP: Lumbar spinal stenosis syndrome. Clin Orthop 246:70–80 1989

31.

Reynolds JBWiltse LL: Surgical treatment of degenerative spondylolisthesis. Spine 4:1481491979 (Abstract)Reynolds JB Wiltse LL: Surgical treatment of degenerative spondylolisthesis. Spine 4:148–149 1979 (Abstract)

32.

Sachs BFraenkel J: Progressive ankylotic rigidity of the spine. J Nerv Ment Dis 27:1151900Sachs B Fraenkel J: Progressive ankylotic rigidity of the spine. J Nerv Ment Dis 27:1–15 1900

33.

San Martino AD'Andria FMSan Martino C: The surgical treatment of nerve root compression caused by scoliosis of the lumbar spine. Spine 8:2612651983San Martino A D'Andria FM San Martino C: The surgical treatment of nerve root compression caused by scoliosis of the lumbar spine. Spine 8:261–265 1983

34.

Shibata TMori VMori M: A new surgical procedure for the treatment of lumbar spinal canal stenosis especially recommendable for degenerative and combined stenosis. Nippon Geka Hokan 54:3974051985Shibata T Mori V Mori M: A new surgical procedure for the treatment of lumbar spinal canal stenosis especially recommendable for degenerative and combined stenosis. Nippon Geka Hokan 54:397–405 1985

35.

Silvers HR: Microsurgical versus standard lumbar discectomy. Neurosurgery 22:8378411988Silvers HR: Microsurgical versus standard lumbar discectomy. Neurosurgery 22:837–841 1988

36.

Spanu GMessina ALAssietti Ret al: Lumbar canal stenosis: results in 40 patients surgically treated. Acta Neurochir 94:1441491988Spanu G Messina AL Assietti R et al: Lumbar canal stenosis: results in 40 patients surgically treated. Acta Neurochir 94:144–149 1988

37.

Strefling MSNess DA: Lumbar laminectomy. Experience in 228 consecutive cases. Minn Med 67:1431471984Strefling MS Ness DA: Lumbar laminectomy. Experience in 228 consecutive cases. Minn Med 67:143–147 1984

38.

Sypert GW: Low back pain disorders: lumbar fusion? Clin Neurosurg 33:4574831986Sypert GW: Low back pain disorders: lumbar fusion? Clin Neurosurg 33:457–483 1986

39.

Towne EBReichert FL: Compression of the lumbosacral roots of the spinal cord by thickened ligamenta flava. Ann Surg 94:3273361931Towne EB Reichert FL: Compression of the lumbosacral roots of the spinal cord by thickened ligamenta flava. Ann Surg 94:327–336 1931

40.

Verbiest H: Further experiences on the pathological influence of a developmental narrowness of the bony lumbar vertebral canal. J Bone Joint Surg (Br) 37:5765831955Verbiest H: Further experiences on the pathological influence of a developmental narrowness of the bony lumbar vertebral canal. J Bone Joint Surg (Br) 37:576–583 1955

41.

Verbiest H: Pathomorphology aspects of developmental lumbar stenosis. Orthop Clin North Am 6:1771961975Verbiest H: Pathomorphology aspects of developmental lumbar stenosis. Orthop Clin North Am 6:177–196 1975

42.

Verbiest H: A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br) 36:2302371954Verbiest H: A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br) 36:230–237 1954

43.

Verbiest H: Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal. A review of twenty-seven years' experience. J Bone Joint Surg (Br) 59:1811881977Verbiest H: Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal. A review of twenty-seven years' experience. J Bone Joint Surg (Br) 59:181–188 1977

44.

Wiltse LLKirkaldy-Willis WHMcIvor GWD: The treatment of spinal stenosis. Clin Orthop 115:83911976Wiltse LL Kirkaldy-Willis WH McIvor GWD: The treatment of spinal stenosis. Clin Orthop 115:83–91 1976

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 35 35 22
Full Text Views 137 137 40
PDF Downloads 106 106 25
EPUB Downloads 0 0 0

PubMed

Google Scholar