Abstract
Study design: A retrospective surgical case series was conducted using a condition-specific, patient-based outcomes assessment. Objective: The goal of this study was to describe the outcome predictors of decompressive surgery for degenerative lumbar spinal stenosis (DLSS). Summary of background data: Surgical decompression is the recommended treatment for patients with moderate to severe DLSS. Previous studies have reported that factors such as the number of operated levels and patient health status are predictors of surgical outcomes. Methods: This study analyzed the success rates of 58 DLSS patients treated with decompressive surgery. Outcomes were measured with the Zurich Claudication Questionnaire (ZCQ) completed pre-operatively and at least 12 months post-operatively (range 12–54 months). The ZCQ includes three distinct domains that involve symptom severity, physical function, and patient satisfaction. Variables such as age, sex, pre-operative symptom severity, and arthrodesis were analyzed as predictors of success. Results: The study group included 21 males and 37 females, and the mean age of all patients was 66 years (range 41–80 years). Overall, 63.8% of the patients had significant clinical improvement in Symptom Severity, 55.2% had significant clinical improvement in Physical Function, and 58.6% of the patients were at least somewhat satisfied; 63.8% (37/58) of the patients were considered to be clinically successful. Patients with more severe pre-operative symptoms and more physical function restrictions had better success results than those patients with milder symptoms and less restrictive physical function. Also, patients who were followed for less than 24 months had better success than those followed for more than 24 months. There was no significant difference in the clinical success rates of (1) patients who were fused and those not fused, (2) males and females, (3) patients aged less than 65 years and those greater than 65 years, and (4) patients who were treated at one or two levels and those treated at three or four levels. Conclusion: The results of this retrospective study indicate that operative decompression of the lumbar spine offers significant improvement for patients with DLSS. Although not all comparisons were statistically significant, there was a trend for DLLS patients aged less than 65 years with more severe pre-operative symptoms and physical function disturbances treated at one or two levels with a laminectomy and fusion to have the best outcomes.
Similar content being viewed by others
References
Abumi K, Panjabi MM, Kramer KM, Duranceau J, Oxland T, Crisco JJ (1990) Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine 15:1142–1147
Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F (2000) Lumbar spinal stenosis: conservative or surgical management? A prospective 10-year study. Spine 25:1424–1435; discussion 1435–1436
Atlas SJ, Chang Y, Kammann E, Keller RB, Deyo R, Singer DE (2000) Long-term disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation. J Bone Joint Surg 82-A:4–15
Benz RJ, Garfin SR (2001) Current techniques of decompression of the lumbar spine. Clin Orthop 384:75–81
Boden SD, Martin C, Rudolph R, Kirkpatrick JS, Moeini SM, Hutton WC (1994) Increase of motion between lumbar vertebrae after excision of the capsule and cartilage of the facets. A cadaver study. J Bone Joint Surg Am 76:1847–1853
Brunon J, Chazal J, Chirossel JP, Houteville JP, Lagarrigue J, Legars D, Moreau JJ, Perrin G, Tremoulet M (1996) When is spinal fusion warranted in degenerative lumbar spinal stenosis? Rev Rhum Engl Ed 63:44–50
Carreon LY, Puno RM, Dimar JR 2nd, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85-A:2089–2092
Conley FK, Cady CT, Lieberson RE (1990) Decompression of lumbar spinal stenosis and stabilization with Knodt rods in the elderly patient. Neurosurgery 26:758–763
Deyo RA, Ciol MA, Cherkin DC, Loeser JD, Bigos SJ (1993) Lumbar spinal fusion. A cohort study of complications, reoperations, and resource use in the Medicare population. Spine 18:1463–1470
Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT (1997) Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:2807–2812
Fox MW, Onofrio BM, Hanssen AD (1996) Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg 85:793–802
Fritz JM, Erhard RE, Vignovic M (1997) A nonsurgical treatment approach for patients with lumbar spinal stenosis. Phys Ther 77:962–73
Fujita T, Kostuik JP, Huckell CB, Sieber AN (1998) Complications of spinal fusion in adult patients more than 60 years of age. Orthop Clin North Am 29:669–678
Ganz JC (1990) Lumbar spinal stenosis: postoperative results in terms of preoperative posture-related pain. J Neurosurg 72:71–74
Grob D, Humke T, Dvorak J (1995) Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am 77:1036–1041
Gunzburg R, Keller TS, Szpalski M, Vandeputte K, Spratt KF (2003) Clinical and psychofunctional measures of conservative decompression surgery for lumbar spinal stenosis: a prospective cohort study. Eur Spine J 12:197–204
Hanakita J, Suwa H, Mizuno M (1999) Surgical treatment of lumbar canal stenosis in the elderly. Neurol Med Chir (Tokyo) 39:519–522; discussion 522–523
Hansraj KK, Cammisa FP Jr, O’Leary PF, Crockett HC, Fras CI, Cohen MS, Dorey FJ (2001) Decompressive surgery for typical lumbar spinal stenosis. Clin Orthop 384:10–17
Hansraj KK, O’Leary PF, Cammisa FP Jr, Hall JC, Fras CI, Cohen MS, Dorey FJ (2001) Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis. Clin Orthop 384:18–25
Hee HT, Wong HK (2003) The long-term results of surgical treatment for spinal stenosis in the elderly. Singapore Med J 44:175–180
Herkowitz HN (1997) Indications for arthrodesis and spinal instrumentation. Instr course Lect 43:425–433
Herkowitz HN, Kurz LT (1991) 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
Johnsson KE, Redlund-Johnell I, Uden A, Willner S (1989) Preoperative and postoperative instability in lumbar spinal stenosis. Spine 14:591–593
Johnsson KE, Willner S, Johnsson K (1986) Postoperative instability after decompression for lumbar spinal stenosis. Spine 11:107–110
Johnsson KE, Willner S, Pettersson H (1981) Analysis of operated cases with lumbar spinal stenosis. Acta Orthop Scand 52:427–433
Jonsson B, Stromqvist B (1994) Lumbar spine surgery in the elderly. Complications and surgical results. Spine 19:1431–1435
Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH (1996) Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 21:92–98
Katz JN, Lipson SJ, Larson MG, McInnes JM, Fossel AH, Liang MH (1991) The outcome of decompressive laminectomy for degenerative lumbar stenosis. J Bone Joint Surg Am 73:809–816
Katz JN, Lipson SJ, Lew RA, Grobler LJ, Weinstein JN, Brick GW, Fossel AH, Liang MH (1997) Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes. Spine 22:1123–1131
Katz JN, Stucki G, Lipson SJ, Fossel AH, Grobler LJ, Weinstein JN (1999) Predictors of surgical outcome in degenerative lumbar spinal stenosis. Spine 24:2229–2233
Little DG, MacDonald D (1994) The use of the percentage change in Oswestry Disability Index score as an outcome measure in lumbar spinal surgery. Spine 19:2139–2143
Lombardi JS, Wiltse LL, Reynolds J, Widell EH, Spencer C 3rd (1985) Treatment of degenerative spondylolisthesis. Spine 10:821–827
Mannion AF, Junge A, Fairbank JCT, Dvorak J, Grob D (2005a) Development of a German version of the Oswestry Disability Index. Part 1: cross-cultural adaptation, reliability, and validity. Eur Spine J. Online First April 26
Mannion AF, Junge A, Grob D, Dvorak J, Fairbank JCT (2005b) Development of a German version of the Oswestry Disability Index. Part 2: sensitivity to change after spinal surgery. Eur Spine J. Online First April 26
Nasca RJ (1989) Rationale for spinal fusion in lumbar spinal stenosis. Spine 14:451–454
O’Leary PF, McCance SE (2001) Distraction laminoplasty for decompression of lumbar spinal stenosis. Clin Orthop 384:26–34
Paine KW (1976) Results of decompression for lumbar spinal stenosis. Clin Orthop 115:96–100
Pratt RK, Fairbank JC, Virr A (2002) The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine 27:84–91
Quigley MR, Kortyna R, Goodwin C, Maroon JC (1992) Lumbar surgery in the elderly. Neurosurgery 30:672–674
Reeg SE (2001) A review of comorbidities and spinal surgery. Clin Orthop 384:101–109
Simmons ED Jr, Simmons EH (1992) Spinal stenosis with scoliosis. Spine 17:S117–S120
Simotas AC (2001) Nonoperative treatment for lumbar spinal stenosis. Clin Orthop 384:153–161
Spengler DM (1987) Degenerative stenosis of the lumbar spine. J Bone Joint Surg Am 69:305–308
Spratt KF, Keller TS, Szpalski M, Vandeputte K, Gunzburg R (2004) A predictive model for outcome after conservative decompression surgery for lumbar spinal stenosis. Eur Spine J 13:14–21
Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN (1996) Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine 21:796–803
Stucki G, Liang MH, Fossel AH, Katz JN (1995) Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis. J Clin Epidemiol 48:1369–1378
Tuli SK, Yerby SA, Katz JN (2005) Methodological approaches to developing criteria for improvement in lumbar spinal stenosis surgery. World Spine III
Turner JA, Ersek M, Herron L, Haselkorn J, Kent D, Ciol MA, Deyo R (1992) Patient outcomes after lumbar spinal fusions. Jama 268:907–911
Verbiest H (1954) A radicular syndrome from developmental narrowing of the lumbae vertebral canal. J Bone Joint Surg 36B:230–237
Yone K, Sakou T, Kawauchi Y, Yamaguchi M, Yanase M (1996) Indication of fusion for lumbar spinal stenosis in elderly patients and its significance. Spine 21:242–248
Zucherman J, Hsu K, Hartjen C, Mehalic T, Implicito D, Martin M, Johnson D, Skidmore G, Vessa P, Dwyer J, Puccio S, Cauthen J, Ozuna R (2005) A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine 30:1351–1358
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fokter, S.K., Yerby, S.A. Patient-based outcomes for the operative treatment of degenerative lumbar spinal stenosis. Eur Spine J 15, 1661–1669 (2006). https://doi.org/10.1007/s00586-005-0033-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-005-0033-4