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Functional outcome of surgical management of degenerative lumbar canal stenosis.

Nath R, Middha S, Gupta AK, Nath R - Indian J Orthop (2012)

Bottom Line: No patient had poor outcome.Outcome of the patients improved as the time after surgery increased till 1 year and was sustained thereafter till the last followup.No patient got recurrence of symptoms of nerve compression.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, GSVM Medical College, Kanpur, India.

ABSTRACT

Background: The long term outcomes of decompressive surgery on relief of pain and disability in degenerative lumbar canal stenosis are unclear. The aim of our study was to evaluate the outcome of surgical management of secondary degenerative lumbar canal stenosis and to analyze the effect on outcome variables using Japanese Orthopaedic Association (JOA) score.

Materials and methods: Thirty-two patients of degenerative lumbar canal stenosis managed surgically were included in this study. Laminectomy (n=2), laminectomy with disectomy (n=23), laminectomy and disectomy with instrumental stabilization (n=5), and laminectomy, disectomy with posterior interbody fusion (n=2) were performed. JOA scoring system for low backache was used to assess the patients. The recovery rate was calculated as described by Hirabayashi et al. (1981). Surgical outcome was assessed based on the recovery rate and was classified using a four-grade scale: Excellent, improvement of >90%; good, 75-89% improvement; fair, 50-74% improvement; and poor, below 49% improvement. The patients were evaluated at 3 months, one year and at last followup.

Results: At 3-month followup, 18.75% patients showed excellent outcome, 62.50% patients showed good outcome, and 18.75% showed fair outcome. At 1-year followup, 64% patients showed excellent outcome and 36% patients showed good outcome. At >1 year followup (average 34.2 months, range: 2-110 months), 64% patients showed excellent outcome, 28% showed good outcome, and 8% showed fair outcome. No patient had poor outcome. Outcome of the patients improved as the time after surgery increased till 1 year and was sustained thereafter till the last followup.

Conclusion: Operative treatment in patients of degenerative lumbar canal stenosis yields excellent results as observed on the basis of JOA scoring system. No patient got recurrence of symptoms of nerve compression.

No MeSH data available.


Related in: MedlinePlus

(a) Preoperative AP and (b) Lateral X-rays of a 52 years old male patient who presented with secondary degenerative LCS at L3-4, L4-5 with retrolisthesis of L4 over L5. His preoperative JOA score was 5
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Figure 1: (a) Preoperative AP and (b) Lateral X-rays of a 52 years old male patient who presented with secondary degenerative LCS at L3-4, L4-5 with retrolisthesis of L4 over L5. His preoperative JOA score was 5

Mentions: This prospective study was conducted at our hospital between August 2002 to October 2010 after obtaining clearance from the institutional ethical committee. During this period, 46 patients of degenerative lumbar canal stenosis were deemed eligible for operative treatment based on the inclusion and exclusion criteria out of which 14 patients did not consent and thus a total of 32 patients underwent surgical treatment. Patients who had posture-related radicular pain with claudication distance less than 100 m and who could not carry out their routine daily activities were assessed with magnetic resonance imaging (MRI) [Figure 1A and 1B]. Surgery was performed if the central canal diameter on MRI was found to be less than or equal to 10 mm. Spinal instability was assessed using flexion and extension lateral radiographs using Posner's criteria.8 Patients with primary bony canal stenosis, traumatic lumbar canal stenosis, stenosis due to tumors and infection, and patients not medically fit for surgery due to comorbidities were excluded from the study. Patients were managed with four different surgical techniques according to pre-formulated indications. Laminectomy with decompression was done in all cases. Discectomy was done in all cases with a soft bulging disc intraoperatively. Instrumentated stabilization was done in all cases with preoperative instability and when laminectomy was done at more than one level. In addition, posterior lumbar interbody fusion was performed in cases with degenerative listhesis. All procedures were performed by senior orthopaedic surgeon. According to this protocol, laminectomy with decompression was done in 2 cases, laminectomy and disectomy was done in 23 patients, laminectomy, disectomy with instrumented stabilization was done in 5 cases, and laminectomy, disectomy with posterior lumbar interbody fusion was performed in 2 patients. Average followup period was 34.2 months (range: 3–110 months). 25 patients were followed at one year and more. Pre and posttreatment assessment of the patients was done according to JOA evaluation system for low back pain. The JOA score was determined by direct questioning to assess subjective symptoms, clinical signs, and restriction of activities of daily living. The recovery rate of the patients following treatment was calculated by using the description of Hirabayashi et al. (1981): Recovery rate (%)=(Postoperative score – Preoperative score)/(29 – Preoperative score)×100. Recovery rate was classified using a four-grade scale: Excellent, >90%; good, 75–89%; fair, 50–74%; and poor, below 49%.9


Functional outcome of surgical management of degenerative lumbar canal stenosis.

Nath R, Middha S, Gupta AK, Nath R - Indian J Orthop (2012)

(a) Preoperative AP and (b) Lateral X-rays of a 52 years old male patient who presented with secondary degenerative LCS at L3-4, L4-5 with retrolisthesis of L4 over L5. His preoperative JOA score was 5
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3377138&req=5

Figure 1: (a) Preoperative AP and (b) Lateral X-rays of a 52 years old male patient who presented with secondary degenerative LCS at L3-4, L4-5 with retrolisthesis of L4 over L5. His preoperative JOA score was 5
Mentions: This prospective study was conducted at our hospital between August 2002 to October 2010 after obtaining clearance from the institutional ethical committee. During this period, 46 patients of degenerative lumbar canal stenosis were deemed eligible for operative treatment based on the inclusion and exclusion criteria out of which 14 patients did not consent and thus a total of 32 patients underwent surgical treatment. Patients who had posture-related radicular pain with claudication distance less than 100 m and who could not carry out their routine daily activities were assessed with magnetic resonance imaging (MRI) [Figure 1A and 1B]. Surgery was performed if the central canal diameter on MRI was found to be less than or equal to 10 mm. Spinal instability was assessed using flexion and extension lateral radiographs using Posner's criteria.8 Patients with primary bony canal stenosis, traumatic lumbar canal stenosis, stenosis due to tumors and infection, and patients not medically fit for surgery due to comorbidities were excluded from the study. Patients were managed with four different surgical techniques according to pre-formulated indications. Laminectomy with decompression was done in all cases. Discectomy was done in all cases with a soft bulging disc intraoperatively. Instrumentated stabilization was done in all cases with preoperative instability and when laminectomy was done at more than one level. In addition, posterior lumbar interbody fusion was performed in cases with degenerative listhesis. All procedures were performed by senior orthopaedic surgeon. According to this protocol, laminectomy with decompression was done in 2 cases, laminectomy and disectomy was done in 23 patients, laminectomy, disectomy with instrumented stabilization was done in 5 cases, and laminectomy, disectomy with posterior lumbar interbody fusion was performed in 2 patients. Average followup period was 34.2 months (range: 3–110 months). 25 patients were followed at one year and more. Pre and posttreatment assessment of the patients was done according to JOA evaluation system for low back pain. The JOA score was determined by direct questioning to assess subjective symptoms, clinical signs, and restriction of activities of daily living. The recovery rate of the patients following treatment was calculated by using the description of Hirabayashi et al. (1981): Recovery rate (%)=(Postoperative score – Preoperative score)/(29 – Preoperative score)×100. Recovery rate was classified using a four-grade scale: Excellent, >90%; good, 75–89%; fair, 50–74%; and poor, below 49%.9

Bottom Line: No patient had poor outcome.Outcome of the patients improved as the time after surgery increased till 1 year and was sustained thereafter till the last followup.No patient got recurrence of symptoms of nerve compression.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, GSVM Medical College, Kanpur, India.

ABSTRACT

Background: The long term outcomes of decompressive surgery on relief of pain and disability in degenerative lumbar canal stenosis are unclear. The aim of our study was to evaluate the outcome of surgical management of secondary degenerative lumbar canal stenosis and to analyze the effect on outcome variables using Japanese Orthopaedic Association (JOA) score.

Materials and methods: Thirty-two patients of degenerative lumbar canal stenosis managed surgically were included in this study. Laminectomy (n=2), laminectomy with disectomy (n=23), laminectomy and disectomy with instrumental stabilization (n=5), and laminectomy, disectomy with posterior interbody fusion (n=2) were performed. JOA scoring system for low backache was used to assess the patients. The recovery rate was calculated as described by Hirabayashi et al. (1981). Surgical outcome was assessed based on the recovery rate and was classified using a four-grade scale: Excellent, improvement of >90%; good, 75-89% improvement; fair, 50-74% improvement; and poor, below 49% improvement. The patients were evaluated at 3 months, one year and at last followup.

Results: At 3-month followup, 18.75% patients showed excellent outcome, 62.50% patients showed good outcome, and 18.75% showed fair outcome. At 1-year followup, 64% patients showed excellent outcome and 36% patients showed good outcome. At >1 year followup (average 34.2 months, range: 2-110 months), 64% patients showed excellent outcome, 28% showed good outcome, and 8% showed fair outcome. No patient had poor outcome. Outcome of the patients improved as the time after surgery increased till 1 year and was sustained thereafter till the last followup.

Conclusion: Operative treatment in patients of degenerative lumbar canal stenosis yields excellent results as observed on the basis of JOA scoring system. No patient got recurrence of symptoms of nerve compression.

No MeSH data available.


Related in: MedlinePlus