Long-term Outcome of Lumbar Stenosis Surgery
ABSTRACT & COMMENTARY
Source: Javid MJ, Hadar EJ. Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: A prospective study. J Neurosurg 1998;89:1-7.
Javid and hadar studied 170 patients (average age, 61.4 years) over a 10-year period from 1984 to 1995 who underwent surgery for lumbar stenosis (86 patients), lumbar stenosis and herniated disc (61 patients), or lateral recess stenosis (23 patients). Preoperative symptoms included back pain and leg pain of more than 6-12 months duration in almost all patients, and walking difficulties impaired 50-75% of patients. Diagnoses were made by MRI and CT myelography. Patients were reviewed in follow-up exam at six weeks and six months, and then by questionnaire at one year and longer.
For patients with lumbar stenosis with or without herniated disc, the success at six weeks and six months ranged from 78% to 88%, with no significant difference between groups. For patients with lateral recess stenosis, the success rate at both time points dropped to about 60%. A follow-up at one year showed a significant drop in the success rate for lumbar stenosis surgery to about 70% (P = 0.012), for patients with stenosis and disc to 77%, and that for lateral recess stenosis of about 65%. Similar success rates were maintained on average at five years of follow-up.
COMMENTARY
Decompressive laminectomy for lumbar stenosis is the most common back surgery in older patients-the rate increasing several-fold over the past few decades, due perhaps in part to an aging population. Still, the long-term outcomes and benefits of lumbar laminectomy are not well studied. This prospective study confirms a moderate long-term improvement in two-thirds of patients undergoing surgery for lower degenerative spine disease. Nonetheless, most patients with lumbar stenosis should at first be treated conservatively, because the episodes of back pain and leg pain can improve with time. As reviewed previously in Neurology Alert, epidural steroid injections are thought to be of very limited benefit. Spinal fusion is not thought to be indicated except in rare instances of severe disc degeneration and facet collapse. -ba
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