J Korean Neurosurg Soc.  2013 Jan;53(1):19-25. 10.3340/jkns.2013.53.1.19.

A Comparison of the Clinical Outcomes of Decompression Alone and Fusion in Elderly Patients with Two-Level or More Lumbar Spinal Stenosis

• Son S
• Kim WK
• Lee SG
• Park CW
• Lee K

• KMID: 2066980
• DOI: http://doi.org/10.3340/jkns.2013.53.1.19

Abstract

OBJECTIVE
We compared the results of two surgical techniques by retrospective study of 60 elderly patients (65 years or older) who underwent either decompression alone or fusion for the treatment of two-level or more lumbar spinal stenosis.
METHODS
During the period of 2003 and 2008, two-level or more decompression alone or fusion was performed for lumbar spinal stenosis by three surgeons at our institution. Patients were allocated to two groups by surgical modality, namely, to a decompression group (31 patients) or a fusion group (29 patients). Overall mean age was 71.1 years (range, 65-84) and mean follow-up was 5.5 years (range, 3-9). A retrospective review of clinical, radiological, and surgical data was conducted.
RESULTS
No significant difference between the two groups was found with respect to age, follow-up period, surgical levels, or preoperative condition. At the last follow-up, correction of lumbar lordotic angle (determined radiologically) was better in the fusion group. However, clinical outcomes including visual analogue scale, Oswestry Disability Index, and the Odom's criteria were not significantly different in the two groups. On the other hand, surgical outcomes, such as, operation time, estimated blood loss, and surgical complications were significantly better in the decompression alone group.
CONCLUSION
Our findings suggest that decompressive laminectomy alone achieves good outcomes in patients with two-level or more lumbar spinal stenosis, associated with an advanced age, poor general condition, or osteoporosis.

Keyword

Laminectomy; Spinal fusion; Spinal stenosis

MeSH Terms

Aged
Decompression
Follow-Up Studies
Hand
Humans
Laminectomy
Osteoporosis
Retrospective Studies
Spinal Fusion
Spinal Stenosis

Figure

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  Fig. 1 Lateral plain radiograph of the lumbar spine showing Cobb's method. Lumbar lordotic angle was determined at the intersection of lines drawn at the level of the inferior plateau of T12 and the superior plateau of S1.

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  Fig. 2 Sequential changes in mean low back pain VAS scores. Mean preoperative VAS for low back pain was 5.9 in decompression group, and 7.1 in fusion group. In decompression group, VAS for low back pain decreased to 3.2 at 6 weeks, 3.2 at 6 months, and to 3.1 at 1 year. In fusion group, VAS for low back pain decreased to 6.1 at 6 weeks, 3.8 at 6 months, 3.5 at 1 year, and to 3.2 at 3 years. f/u : follow-up, pre OP : preoperation, VAS : visual analogue scale.

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  Fig. 3 Sequential changes in mean leg pain VAS scores. The mean preoperative VAS for leg back pain was 7.4 in decompression group, and 7.5 in fusion group. In decompression group, VAS for leg pain decreased to 3.4 at 6 weeks, 3.1 at 6 months, 3.0 at 1 year, and to 2.9 at 3 years. In fusion group, VAS for leg pain decreased to 3.3 at 6 weeks, 3.2 at 6 months, and to 3.1 at 3 years. f/u : follow-up, pre OP : preoperation, VAS : visual analogue scale.

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  Fig. 4 Sequential changes in mean ODI scores. Mean preoperative ODI was 63.1 in decompression group, and 68.6 in fusion group. In decompression group, ODI decreased to 32.0 at 6 weeks, and to 25.4 at last follow-up. In fusion group, ODI decreased to 45.3 at 6 weeks, and to 25.6 at last follow-up. f/u : follow-up, ODI : Oswestry Disability Index, pre OP : preoperation.

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  Fig. 5 Sequential changes in mean lumbar lordotic angles before to after surgery. The mean preoperative lumbar lordotic angle was 35.3° in decompression group, and 32.3° in fusion group. In decompression group, the mean lumbar lordotic angle decreased to 31.8° at last follow-up, but without a significance. In fusion group, the mean lumbar lordotic angle increased to 37.8° at 6 weeks, and since there was no significant change. f/u : follow-up, pre OP : preoperation.

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