Long-term Outcomes of Two Different Decompressive Techniques for Lumbar Spinal Stenosis

From Spine

Yi-Shan Fu, MD; Bing-Fang Zeng, MD; Jian-Guang Xu, MD

Abstract and Introduction
Introduction

Study Design: A prospective study to evaluate the outcomes of 2 different decompressive techniques for lumbar spinal stenosis.
Objective: To explore a more effective and less invasive decompression technique without instrument and fusion for lumbar spinal stenosis.
Summary of Background Data: The traditional surgical decompression of spinal stenosis involves laminectomy or unilateral laminotomy. Even in unilateral laminotomy cases, 85.3% had an excellent-to-fair operative result, and the incidence of complications was 9.8%. Although the addition of instrumentation does not increase the complication rate, but compared to the efficiency, the higher costs was controversial. Minimal invasion and destabilization are recommended.
Methods: This prospective study included 152 consecutive patients, sequentially divided into 2 groups, underwent Windows technique (group A) and decompressive laminectomy (group B) by 2 groups of surgeons.
Results: The evaluation of the back pain, leg pain, walking tolerance, and neurologic recovery were performed before surgery and after surgery. In group A, at the final evaluation, the overall results were good to excellent in 89% (68/76) of the patients, fair 11% (8/76), and poor 0%. In group B, at the final evaluation, the overall results were good to excellent in 63% (48/76) of the patients, fair 30% (23/76), and poor 7% (5/76).
Conclusion: Degenerative spinal stenosis can be decompressed adequately with preserving the posterior elements. The Windows technique laminoforaminotomy, which obtained satisfactory long-term outcomes with few complications and low cost, can be a standard procedure for the surgical treatment of the degenerative spinal stenosis even with slight congenital spinal stenosis.
Introduction

Acquired spinal stenosis is the most common condition leading to spine surgery in the geriatric population. Degenerative changes lead to central stenosis from ligamentum flavum hypertrophy, disc bulging, and osteophytes. Lateral recess or foraminal compression can result from facet hypertrophy and settling. Several studies on nonoperative treatment of patients with between 1 and 5 years of follow-up suggest that variably 15% to 43% of patients will have continued improvement after nonoperative treatment.[1] On the other side, for most patients, surgical procedures are preferred.

Traditionally, laminectomy is the most popular surgical decompression of spinal stenosis involved extensive removal of the posterior elements including the lamina, spinous processes, interspinous ligaments, and even facet joints.
Although, the short-term outcome of the laminectomy is good enough but the long-term outcome is not so satisfactory.
Seven to 10 years after decompressive surgery for spinal stenosis, 23% of patients had undergone reoperation and 33% of respondents had severe back pain. Even in unilateral laminotomy cases, 85.3% had an excellent-to-fair operative result, and the incidence of complications was 9.8%.[3]

A minimal removal decompressive procedure was prospectively evaluated for the treatment of lumbar spinal stenosis compared to traditional laminectomy. From 2002 to 2004 in our hospital, a total of 152 consecutive patients were divided into 2 groups and operated by different spine surgeons. No instruments and fusions were performed. At an average follow-up assessment of 40 months, the outcomes in 2 groups were evaluated prospectively.

http://www.medscape.com/viewarticle/573223