Outcome after laminectomy for lumbar spinal stenosis

Part I: Clinical correlations

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✓ All patients who underwent decompressive lumbar laminectomy in the Washtenaw County, Michigan metropolitan area during a 7-year period were studied for the purpose of defining long-term outcome, clinical correlations, and the need for subsequent fusion. Outcome was determined by questionnaire and physical examination from a cohort of 119 patients with an average follow-up evaluation interval of 4.6 years. Patients graded their outcome as much improved (37%), somewhat improved (29%), unchanged (17%), somewhat worse (5%), and much worse (12%) compared to their condition before surgery. Poor outcome correlated with the need for additional surgery, but there were few additional significant correlations. No patient had a lumbar fusion during the study interval.

The outcome after laminectomy was found to be less favorable than previously reported, based on a patient questionnaire administered to an unbiased patient population. Further randomized, controlled trials are therefore necessary to determine the efficacy of lumbar fusion as an adjunct to decompressive lumbar laminectomy.

Article Information

Address reprint requests to: Gerald F. Tuite, M.D., Section of Neurosurgery, University of Michigan Hospital, 1500 East Medical Center Drive, Taubman 2128, Ann Arbor, Michigan 48109–0338.

© AANS, except where prohibited by US copyright law.

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Figures

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    Bar graph showing the percentage of patients by the number of lumbar levels that were decompressed during laminectomy.

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    Bar graph showing the percentage of surgical cases that involved the various lower lumbar spinal levels.

References

1.

Alexander E JrKelly DL JrDavis CH Jret al: Intact arch spondylolisthesis. A review of 50 cases and description of surgical treatment. J Neurosurg 63:8408441985Alexander E Jr Kelly DL Jr Davis CH Jr et al: Intact arch spondylolisthesis. A review of 50 cases and description of surgical treatment. J Neurosurg 63:840–844 1985

2.

Bernhardt MSwartz DEClothiaux PLet al: Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation. Clin Orthop 284:1091151992Bernhardt M Swartz DE Clothiaux PL et al: Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation. Clin Orthop 284:109–115 1992

3.

Caputy AJLuessenhop AJ: Long-term evaluation of decompressive surgery for degenerative lumbar stenosis. J Neurosurg 77:6696761992Caputy AJ Luessenhop AJ: Long-term evaluation of decompressive surgery for degenerative lumbar stenosis. J Neurosurg 77:669–676 1992

4.

Deyo RACiol MACherkin DCet al: Lumbar Spinal Fusion. A Cohort Study of Complications, Reoperations, and Resource Use in the Medicare Population. Spine 18:146314701993Deyo RA Ciol MA Cherkin DC et al: Lumbar Spinal Fusion. A Cohort Study of Complications Reoperations and Resource Use in the Medicare Population. Spine 18:1463–1470 1993

5.

Epstein NEEpstein JACarras Ret al: Degenerative spondylolisthesis with an intact neural arch: a review of 60 cases with an analysis of clinical findings and the development of surgical management. Neurosurgery 13:5555611983Epstein NE Epstein JA Carras R et al: Degenerative spondylolisthesis with an intact neural arch: a review of 60 cases with an analysis of clinical findings and the development of surgical management. Neurosurgery 13:555–561 1983

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.

Fitzgerald JAWNewman PH: Degenerative spondylolisthesis. J Bone Joint Surg (Br) 58:1841921976Fitzgerald JAW Newman PH: Degenerative spondylolisthesis. J Bone Joint Surg (Br) 58:184–192 1976

8.

Frymoyer JW: Back pain and sciatica. N Engl J Med 318:2913001988Frymoyer JW: Back pain and sciatica. N Engl J Med 318:291–300 1988

9.

Garfin SRGlover MBooth REet al: Laminectomy: a review of the Pennsylvania Hospital experience. Journal of Spinal Disord 1:1161331988Garfin SR Glover M Booth RE et al: Laminectomy: a review of the Pennsylvania Hospital experience. Journal of Spinal Disord 1:116–133 1988

10.

Getty CJM: Lumbar spinal stenosis. The clinical spectrum and the results of operation. J Bone Joint Surg (Br) 62:4814851980Getty CJM: Lumbar spinal stenosis. The clinical spectrum and the results of operation. J Bone Joint Surg (Br) 62:481–485 1980

11.

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

12.

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

13.

Harms-Ringdahl KCarlumbar spinal stenosison AMEkholm Jet al: Pain assessment with different intensity scales in response to loading of joint structures. Pain 27:4014111986Harms-Ringdahl K Carlumbar spinal stenosison AM Ekholm J et al: Pain assessment with different intensity scales in response to loading of joint structures. Pain 27:401–411 1986

14.

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

15.

Herno AAiraksinen OSaari T: Long-term results of surgical treatment of lumbar spinal stenosis. Spine 18:147114741993Herno A Airaksinen O Saari T: Long-term results of surgical treatment of lumbar spinal stenosis. Spine 18:1471–1474 1993

16.

Herron LDMangelsdorf C: Lumbar spinal stenosis: results of surgical treatment. J Spinal Disord 4:26331991Herron LD Mangelsdorf C: Lumbar spinal stenosis: results of surgical treatment. J Spinal Disord 4:26–33 1991

17.

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

18.

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

19.

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

20.

Katz JNLipson SJLarson MGet al: The outcome of decompressive laminectomy for degenerative lumbar stenosis. J Bone Joint Surg (Am) 73:8098161991Katz JN Lipson SJ Larson MG et al: The outcome of decompressive laminectomy for degenerative lumbar stenosis. J Bone Joint Surg (Am) 73:809–816 1991

21.

Kim YEGoel VK: Effect of testing mode on the biomechanical response of a spinal motion segment. J Biomechan 23:2892911990Kim YE Goel VK: Effect of testing mode on the biomechanical response of a spinal motion segment. J Biomechan 23:289–291 1990

22.

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

23.

Linn BSLinn MWGurel L: Cumulative illness rating scale. J Am Geriatr Soc 16:6226261968Linn BS Linn MW Gurel L: Cumulative illness rating scale. J Am Geriatr Soc 16:622–626 1968

24.

Nachemson AL: Newest knowledge of low-back pain. A critical look. Clin Orthop 279:8201992Nachemson AL: Newest knowledge of low-back pain. A critical look. Clin Orthop 279:8–20 1992

25.

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

26.

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

27.

Paine KWE: Clinical features of lumbar spinal stenosis. Clin Orthop 115:77821976Paine KWE: Clinical features of lumbar spinal stenosis. Clin Orthop 115:77–82 1976

28.

Paine KWE: Results of decompression for lumbar spinal stenosis. Clin Orthop 115:961001976Paine KWE: Results of decompression for lumbar spinal stenosis. Clin Orthop 115:96–100 1976

29.

Postacchini FCinotti GGumina Set al: Long-term results of surgery in lumbar stenosis. 8-year review of 64 patients. Acta Orthop Scand (Suppl 251):78801993Postacchini F Cinotti G Gumina S et al: Long-term results of surgery in lumbar stenosis. 8-year review of 64 patients. Acta Orthop Scand (Suppl 251):78–80 1993

30.

Quigley MRKortyna RGoodwin Cet al: Lumbar surgery in the elderly. Neurosurgery 30:6726741992Quigley MR Kortyna R Goodwin C et al: Lumbar surgery in the elderly. Neurosurgery 30:672–674 1992

31.

Russin LASheldon J: Spinal stenosis. Report of series and long term follow-up. Clin Orthop 115:1011031976Russin LA Sheldon J: Spinal stenosis. Report of series and long term follow-up. Clin Orthop 115:101–103 1976

32.

Satomi KHirabayashi KToyama Yet al: A clinical study of degenerative spondylolisthesis. Radiographic analysis and choice of treatment. Spine 17:132913361992Satomi K Hirabayashi K Toyama Y et al: A clinical study of degenerative spondylolisthesis. Radiographic analysis and choice of treatment. Spine 17:1329–1336 1992

33.

Silvers HRLewis PJAsch HL: Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg 78:6957011993Silvers HR Lewis PJ Asch HL: Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg 78:695–701 1993

34.

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

35.

Surin VHedelin ESmith L: Degenerative lumbar spinal stenosis. Results of operative treatment. Acta Orthop Scand 53:79851982Surin V Hedelin E Smith L: Degenerative lumbar spinal stenosis. Results of operative treatment. Acta Orthop Scand 53:79–85 1982

36.

Tile MMcNeil SRZarins RKet al: Spinal stenosis. Results of treatment. Clin Orthop 115:1041081976Tile M McNeil SR Zarins RK et al: Spinal stenosis. Results of treatment. Clin Orthop 115:104–108 1976

37.

Tuite GFDoran SEStern JDet al: Outcome of laminectomy for lumbar spinal stenosis. Part 2: Radiographic changes and clinical correlations. J Neurosurg 81:7077151994Tuite GF Doran SE Stern JD et al: Outcome of laminectomy for lumbar spinal stenosis. Part 2: Radiographic changes and clinical correlations. J Neurosurg 81:707–715 1994

38.

Turner JAErsek MHerron Let al: Patient outcomes after lumbar spinal fusions. JAMA 268:9079111992Turner JA Ersek M Herron L et al: Patient outcomes after lumbar spinal fusions. JAMA 268:907–911 1992

39.

Turner JAErsek MHerron Let al: Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 17:181992Turner JA Ersek M Herron L et al: Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 17:1–8 1992

40.

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

41.

Weir BDe Leo R: Lumbar stenosis: analysis of factors affecting outcome in 81 surgical cases. Can J Neurol Sci 8:2952981981Weir B De Leo R: Lumbar stenosis: analysis of factors affecting outcome in 81 surgical cases. Can J Neurol Sci 8:295–298 1981

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