Dan M. Spengler, MD
Degenerative lumbar stenosis is a disabling syndrome of low-back pain that results from chronic compression of the cauda equina by degenerative hypertrophic lesions of the lumbar zygapophyseal (facet) joints, lumbar intervertebral discs and ligamentum flavum, generally occurring in the sixth or seventh decade of life. It has been reported that in 1987 in the United States, a laminectomy was performed, most often for degenerative lumbar stenosis, on one of every 100 persons who were more than sixty-five years old. Studies of the results of operative intervention for lumbar stenosis that were published when this video was filmed have reported success rates ranging from 64 to 95 percent. And while short-term results appear gratifying, later studies with longer-term outcomes are variable, with progressive deterioration over time.
The traditional surgical approach for lumbar stenosis is to perform a wide, bilateral decompressive laminectomy along with resection of the medial portion of the facet joints to decompress the affected neural elements. Although this approach can successfully alleviate nerve compression symptoms, there are drawbacks, including amount of soft tissue dissection, blood loss, postoperative pain, and the potential for iatrogenic instability of the spinal segment. These concerns are magnified when treating an elderly fragile patient.
Properly selected patients of 60 years and older can expect a clinically meaningful improvement of HRQL, functional status and pain after decompressive laminectomy without fusion. The treatment seems to be safe. However, patients with longstanding leg-pain prior to operation are less likely to improve one year after surgery. Increased age per se should not be a contraindication for surgery.
- Total Run Time: 23:46 minutes
- Catalog Number: 8005
- VJO Publication Date: December, 1989