Top

Journal of Orthopaedics and Traumatology

Published in:

Open Access 01-12-2018 | Original Article

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up

Authors: Riccardo Caruso, Alessandro Pesce, Valentina Martines, Venceslao Wierzbicki, Emanuele Piccione, Sergio Paolini, Tiziana Lanciano

Published in: Journal of Orthopaedics and Traumatology | Issue 1/2018

Abstract

Background

The degenerative lumbar spinal stenosis is one of the most commonly treated spinal disorders in older adults; despite its increasing frequency, it is not yet clear what the most effective therapy might be. The aim of this study is to investigate the very long term results of a homogenized cohort of patients suffering from lumbar spinal stenosis: the first subset of patients operated on with laminectomy and the second subset of patients was also advised to undergo laminectomy but never operated on.

Methods

Patients from both subgroups were advised to undergo surgery, according to the same criteria, in the period between 2000 and 2010 and were re-evaluated in the period between January and December 2016.

Results

Comparing the two subsets of patients, both suffering from clinically relevant LSS, the first subset returns a statistically significant clinical improvement at follow-up. The rate of excellent results decreases over years. Iatrogenic spinal instability incidence was found to be 3.8% in the present cohort.

Conclusions

Although the improvement of the first postoperative years decreases over time and despite the lack of general consensus, the lack of established shared guidelines and the limitations of this research, the results support the utilisation of surgery for the management of this condition.

Level of Evidence

Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, Hunter DJ (2009) Spinal stenosis prevalence and association with symptoms: The Framingham Study. Spine J 9(7):545–550. https://doi.org/10.1016/j.spinee.2009.03.005 CrossRefPubMedPubMedCentral

Roberson GH, Llewellyn HJ, Taveras JM (1973) The narrow lumbar spinal canal syndrome. Radiology 107:89–97CrossRefPubMed

Fanuele JC, Birkmeyer NJ, Abdu WA, Tosteson TD, Weinstein JN (2000) The impact of spinal problems on the health status of patients: have we underestimated the effect? Spine 25:1509–1514CrossRefPubMed

Weinstein JN, Tosteson TD, Lurie JD et al (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358(8):794–810CrossRefPubMedPubMedCentral

Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J, Dalin-Hirvonen N, Seitsalo S, Herno A, Kortekangas P, Niinimäki T, Rönty H, Tallroth K, Turunen V, Knekt P, Härkänen T, Hurri H, Finnish Lumbar Spinal Research Group (2007) Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine 32(1):1–8CrossRefPubMed

Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H (2010) Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the spine patient outcomes research trial. Spine 35(14):1329–1338. https://doi.org/10.1097/brs.0b013e3181e0f04d CrossRefPubMedPubMedCentral

Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine 30(8):936–943CrossRefPubMed

Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleâs F (2010) Lumbar spinal stenosis: conservative or surgical management?: a prospective 10-year study. Spine 25(11):1424–1435 (discussion 1435-6) CrossRef

Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, Hu SS (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis: four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91(6):1295–1304. https://doi.org/10.2106/JBJS.H.00913 CrossRefPubMedPubMedCentral

10.

Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, Garber MB, Bennett AC, Fritz JM (2006) A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine 31(22):2541–2549CrossRefPubMed

11.

Simotas AC, Dorey FJ, Hansraj KK, Cammisa F (2000) Nonoperative treatment for lumbar spinal stenosis: clinical and outcome results and a 3-year survivorship analysis. Spine 25(2):197–203 (discussions 203-4) CrossRefPubMed

12.

Onel D, Sari H, Dönmez C (1993) Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients-conservative treatment or surgical intervention? Spine 18(2):291–298CrossRefPubMed

13.

Thomé C, Zevgaridis D, Leheta O, Bäzner H, Pöckler-Schöniger C, Wöhrle J, Schmiedek P (2005) Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3(2):129–141CrossRefPubMed

14.

Landi A, Gregori F, Mancarella C, Maiola V, Maccari E, Marotta N, Delfini R (2015) Lumbar spinal degenerative “microinstability”: hype or hope? Proposal of a new classification to detect it and to assess surgical treatment. Eur Spine J 24(Suppl 7):872–878. https://doi.org/10.1007/s00586-015-4274-6 (Epub 2015 Oct 20) CrossRefPubMed

15.

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(1):84–91CrossRefPubMed

16.

Steurer J, Roner S, Gnannt R, Hodler J (2011) Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord 12:175. https://doi.org/10.1186/1471-2474-12-175 CrossRefPubMedPubMedCentral

17.

Herzog RJ, Kaiser JA, Saal JA, Saal JS (1991) The importance of posterior epidural fat pad in lumbar central canal stenosis. Spine 16(6 Suppl):S227–S233CrossRefPubMed

18.

Cheung PWH, Tam V, Leung VYL, Samartzis D, Cheung KMC, Luk KDK, Cheung JPY (2016) The paradoxical relationship between ligamentum flavum hypertrophy and developmental lumbar spinal stenosis. Scoliosis Spinal Disord 11(1):26. https://doi.org/10.1186/s13013-016-0088-5 CrossRefPubMedPubMedCentral

19.

Yoshiiwa T, Miyazaki M, Notani N, Ishihara T, Kawano M, Tsumura H (2016) Analysis of the relationship between ligamentum flavum thickening and lumbar segmental instability, disc degeneration, and facet joint osteoarthritis in lumbar spinal stenosis. Asian Spine J 10(6):1132–1140 (Epub 2016 Dec 8) CrossRefPubMedPubMedCentral

20.

Schöller K, Steingrüber T, Stein M, Vogt N, Müller T, Pons-Kühnemann J, Uhl E (2016) Microsurgical unilateral laminotomy for decompression of lumbar spinal stenosis: long-term results and predictive factors. Acta Neurochir 158(6):1103–1113. https://doi.org/10.1007/s00701-016-2804-6 (Epub 2016 Apr 15) CrossRefPubMed

21.

Papagelopoulos PJ, Peterson HA, Ebersold MJ, Emmanuel PR, Choudhury SN, Quast LM (1997) Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine 22(4):442–451CrossRefPubMed

22.

McGirt MJ, Garcés-Ambrossi GL, Parker SL, Sciubba DM, Bydon A, Wolinksy JP, Gokaslan ZL, Jallo G, Witham TF (2010) Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors: analysis of 238 patients. Neurosurgery 66(5):1005–1012. https://doi.org/10.1227/01.NEU.0000367721.73220.C9 CrossRefPubMed

23.

Försth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, Öhagen P, Michaëlsson K, Sandén B (2016) A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 374(15):1413–1423. https://doi.org/10.1056/nejmoa1513721 CrossRefPubMed

24.

Zaina F, Tomkins-Lane C, Carragee E, Negrini S (2016) Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev 1:CD010264. https://doi.org/10.1002/14651858.cd010264.pub2 CrossRef

25.

Gatchel RJ, Polatin PB, Mayer TG (1995) The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine 20(24):2702–2709CrossRefPubMed

26.

Pincus T, Burton AK, Vogel S, Field AP (2002) A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 27(5):E109–E120CrossRefPubMed

27.

Katz JN (2006) Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am 88(Suppl 2):21–24PubMed

28.

Lurie JD, Tosteson TD, Tosteson A, Abdu WA, Zhao W, Morgan TS, Weinstein JN (2015) Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine 40(2):63–76. https://doi.org/10.1097/brs.0000000000000731 CrossRefPubMedPubMedCentral

Title: Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up
Authors: Riccardo Caruso
Alessandro Pesce
Valentina Martines
Venceslao Wierzbicki
Emanuele Piccione
Sergio Paolini
Tiziana Lanciano
Publication date: 01-12-2018
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 1/2018
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1186/s10195-018-0497-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up

Abstract

Background

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 1/2018

Can tape–screw fixation of a quadrupled semitendinosus graft in a full-length tibial tunnel provide superior fixation compared with a doubled semitendinosus–gracilis held with an interference screw? A matched-pair cadaveric biomechanical comparison

Fixed-bearing versus high-flexion RP total knee arthroplasty (TKA): midterm results of a randomized controlled trial

Percutaneous suction and irrigation for the treatment of recalcitrant pyogenic spondylodiscitis

Clinical and radiographic comparison of a single LP-PRP injection, a single hyaluronic acid injection and daily NSAID administration with a 52-week follow-up: a randomized controlled trial

Pyrocarbon arthroplasty in acute unreconstructable radial head fractures: mid-term to long term results

Long-term results of the M2A-38-mm metal-on-metal articulation