Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study

Restricted access

Object. Decompressive laminectomy for stenosis is the most common operation performed in the lumbar spine in older patients. This prospective study was designed to evaluate long-term results in patients with symptomatic lumbar stenosis.

Methods. Between January 1984 and January 1995, 170 patients underwent surgery for lumbar stenosis (86 patients), lumbar stenosis and herniated disc (61 patients), or lateral recess stenosis (23 patients). The male/female ratio for each group was 43:43, 39:22, and 14:9, respectively. The average age for all groups was 61.4 years. For patients with lumbar stenosis, the success rate was 88.1% at 6 weeks and 86.7% at 6 months. For patients with lumbar stenosis and herniated disc, the success rate was 80% at 6 weeks and 77.6% at 6 months, with no statistically significant difference between the two groups. For patients with lateral recess stenosis, the success rate was 58.7% at 6 weeks and 63.6% at 6 months; however, the sample was not large enough to be statistically significant. One year after surgery a questionnaire was sent to all patients; 163 (95.9%) responded. The success rate in patients with stenosis had declined to 69.6%, which was significant (p = 0.012); the rate for patients with stenosis and herniated disc was 77.2%; and that for lateral recess stenosis was 65.2%. Another follow-up questionnaire was sent to patients 1 to 11 years after surgery (average 5.1 years); 146 patients (85.9%) responded, 10 (5.9%) were deceased, and 14 (8.2%) were lost to follow-up review. At 1 to 11 years the success rate was 70.8% for patients with stenosis, 66.6% for those with stenosis and herniated disc, and 63.6% for those with lateral recess stenosis. Eleven patients who underwent reoperation were included in the group of patients whose surgeries proved unsuccessful, regardless of their ultimate outcome. There was no statistically significant difference in outcome between 1 year and 1 to 11 years with respect to stenosis, stenosis with herniated disc, and lateral recess stenosis.

Conclusions. In conclusion, long-term improvement after laminectomy was maintained in two-thirds of these patients.

Article Information

Address reprint requests to: Manucher J. Javid, M.D., University of Wisconsin Medical School, H4/346 Clinical Science Center, 600 Highland Avenue, Madison, Wisconsin 53792.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Bar graphs. Upper: Overall results 6 weeks after laminectomy. Center: Overall results 6 months after laminectomy. Lower: Overall results 1 year after laminectomy. HNP = herniated disc.

  • View in gallery

    Bar graph depicting overall results 1 to 11 years after laminectomy.

  • View in gallery

    Bar graph showing the percentages of improvement in symptoms 1 to 11 years after laminectomy in the three groups of patients.

  • View in gallery

    Bar graphs depicting patients' perceptions of improvement in symptoms. Upper: Patients with lumbar stenosis. Center: Patients with lumbar stenosis and herniated disc. Lower: Patients with lateral recess stenosis.

  • View in gallery

    Bar graph showing patients' perception of improvement in walking in the three groups.

  • View in gallery

    Bar graph showing percentages of patients who, retrospectively, would still choose surgery.

References

1.

Airaksinen DHerno ATurunen Vet al: Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine 22:227822821997Airaksinen D Herno A Turunen V et al: Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine 22:2278–2282 1997

2.

Atlas SJDeyo RAKeller RBet al: The Maine Lumbar Spine Study, Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 21:178717951996Atlas 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

3.

Bailey PCasamajor L: Osteo-arthritis of the spine as a cause of compression of the spinal cord and its roots: with report of five cases. J Nerv Ment Dis 38:5886091911Bailey P Casamajor L: Osteo-arthritis of the spine as a cause of compression of the spinal cord and its roots: with report of five cases. J Nerv Ment Dis 38:588–609 1911

4.

Ciol MADeyo RAHowell Eet al: An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc 44:2852901996Ciol 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

5.

Ciric IMikhael MTarkington JAet al: The lateral recess syndrome. A variant of spinal stenosis. J Neurosurg 53:4334431980Ciric I Mikhael M Tarkington JA et al: The lateral recess syndrome. A variant of spinal stenosis. J Neurosurg 53:433–443 1980

6.

Dejerine: La claudration intermittente de la moelle épinière. Press Med 19:9819841911Dejerine: La claudration intermittente de la moelle épinière. Press Med 19:981–984 1911

7.

Deyo RACiol MACherkin DCet al: Lumbar spinal fusion. A cohort study of complications, reoperations, and resource use in 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 Medicare population. Spine 18:1463–1470 1993

8.

Epstein JAEpstein BSRosenthal ADet al: Sciatica caused by nerve root entrapment in the lateral recess: the superior facet syndrome. J Neurosurg 36:5845891972Epstein JA Epstein BS Rosenthal AD et al: Sciatica caused by nerve root entrapment in the lateral recess: the superior facet syndrome. J Neurosurg 36:584–589 1972

9.

Fischgrund JSMackay MHerkowitz HNet al: Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:280728121997Fischgrund JS Mackay M Herkowitz HN et al: 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

10.

Grob DHumke TDvorak J: Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg (Am) 77:103610411995Grob D Humke T Dvorak J: Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg (Am) 77:1036–1041 1995

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.

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

13.

Jönsson BAnnertz MSjoberg Cet al: A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: Five year follow-up by an independent observer. Spine 22:293829441997Jönsson 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

14.

Katz JNLipson SJBrick GWet al: Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine 20:115511601995Katz JN Lipson SJ Brick GW et al: Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine 20:1155–1160 1995

15.

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

16.

Kennedy FElsberg CALambert CI: A peculiar and undescribed disease of the nerves of the cauda equina. Am J Med Sci 147:6456671914Kennedy F Elsberg CA Lambert CI: A peculiar and undescribed disease of the nerves of the cauda equina. Am J Med Sci 147:645–667 1914

17.

Kent DLHaynor DRLarson EBet al: Diagnosis of lumbar spinal stenosis in adults: a meta-analysis of the accuracy of CT, MR and myelography. AJR 158:113511441992Kent DL Haynor DR Larson EB et al: Diagnosis of lumbar spinal stenosis in adults: a meta-analysis of the accuracy of CT MR and myelography. AJR 158:1135–1144 1992

18.

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

19.

Kirkaldy-Willis WHWedge JMYoung-Hing Ket al: Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 3:3193281978Kirkaldy-Willis WH Wedge JM Young-Hing K et al: Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 3:319–328 1978

20.

Lane WA: Case of spondylolisthesis associated with progressive paraplegia: laminectomy. Lancet 1:9919921893Lane WA: Case of spondylolisthesis associated with progressive paraplegia: laminectomy. Lancet 1:991–992 1893

21.

Larequi-Lauber TVader JPBurnand Bet al: Appropriateness of indications for surgery of lumbar disc hernia and spinal stenosis. Spine 22:2032091997Larequi-Lauber T Vader JP Burnand B et al: Appropriateness of indications for surgery of lumbar disc hernia and spinal stenosis. Spine 22:203–209 1997

22.

Pappas CTESonntag VKH: Lumbar stenosis in the elderly. Neurosurg Q 4:1021121994Pappas CTE Sonntag VKH: Lumbar stenosis in the elderly. Neurosurg Q 4:102–112 1994

23.

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

24.

Rydevik BLCohen DBKostuik JP: Spine epidural steroids for patients with lumbar spinal stenosis. Spine 22:231323171997Rydevik BL Cohen DB Kostuik JP: Spine epidural steroids for patients with lumbar spinal stenosis. Spine 22:2313–2317 1997

25.

Sachs BFraenkel J: Progressive ankylotic rigidity of the spine (spondylose rhizomélique). J Nerve Ment Dis 27:1151900Sachs B Fraenkel J: Progressive ankylotic rigidity of the spine (spondylose rhizomélique). J Nerve Ment Dis 27:1–15 1900

26.

Schlesinger PT: Incarceration of the first sacral nerve in a lateral bony recess of the spinal canal as a cause of sciatica. J Bone Joint Surg (Am) 37:1151241955Schlesinger PT: Incarceration of the first sacral nerve in a lateral bony recess of the spinal canal as a cause of sciatica. J Bone Joint Surg (Am) 37:115–124 1955

27.

Tuite GFStern JDDoran SEet al: Outcome after laminectomy for lumbar spinal stenosis Part I: Clinical correlation. J Neurosurg 81:6997061994Tuite GF Stern JD Doran SE et al: Outcome after laminectomy for lumbar spinal stenosis Part I: Clinical correlation. J Neurosurg 81:699–706 1994

28.

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

29.

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

30.

Van Itallie TB: Health implications of overweight and obesity in the United States. Ann Intern Med 103:9839881985Van Itallie TB: Health implications of overweight and obesity in the United States. Ann Intern Med 103:983–988 1985

31.

Verbiest H: Radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br) 26:2302371954Verbiest H: Radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br) 26:230–237 1954

32.

Verbiest H: Sur Certaines Formes Rares de Compression de la Queue de Cheval. Hommage à Clovis Vincent. Paris: Maloine1949 pp 161174Verbiest H: Sur Certaines Formes Rares de Compression de la Queue de Cheval. Hommage à Clovis Vincent. Paris: Maloine 1949 pp 161–174

33.

Von Bechtrew WV: Rigidity and curvature of the vertebral column as a special form of disease. Dtsch Ztschr Nervenheilk 11:3273371892Von Bechtrew WV: Rigidity and curvature of the vertebral column as a special form of disease. Dtsch Ztschr Nervenheilk 11:327–337 1892

34.

Weinstein JNScafuri RLMcNeill TW: The Rush-Presbyterian St. Luke's lumbar spine analysis form: a prospective study of patients with spinal stenosis. Spine 8:8918961983Weinstein JN Scafuri RL McNeill TW: The Rush-Presbyterian St. Luke's lumbar spine analysis form: a prospective study of patients with spinal stenosis. Spine 8:891–896 1983

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 27 27 10
Full Text Views 129 129 32
PDF Downloads 60 60 14
EPUB Downloads 0 0 0

PubMed

Google Scholar