Artikel
Microsurgical treatment of lumbar spinal stenosis in geriatric patients
Mikrochirurgische Therapie lumbaler Spinalkanalstenosen bei geriatrischen Patienten
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Symptomatic spinal stenosis is one of the most common indications to perform lumbar spine surgery at an advanced age. The purpose of the current study was to determine the long-term clinical outcome of older patients treated minimally invasive by unilateral laminotomy for bilateral decompression and to compare the data with those of younger patients and more invasive surgical methods.
Methods
The data of 132 consecutive patients (72 males, 60 females) treated exclusively with unilateral laminotomy for bilateral decompression of symptomatic lumbar spinal stenosis as primary surgery of the spine between 1993 and 1999 were retrospectively evaluated. The mean age was 64 years (range 30 to 89 years). 64/132 patients aged >65 years (group A) and 68/132 patients <65 years (group B). The long-term results of 94/132 patients (42/94 group A, 52/94 group B) could be investigated. The long-term follow-up period was at minimum 4 years (range 4 to 10 years).
Results
In the 132 patients, surgical-associated complications were minor and rare (9 dural tears, 4 wound healing disturbances, 1 aseptic spondylodiscitis, 1 superficial haematoma). 94% of the patients available for long-term follow-up showed an excellent to fair operative result. 39/94 patients were symptom-free (excellent outcome), 29/94 patients had mild residual pain with normal working capacity (good outcome), 20/94 patients improved slightly (fair outcome). The symptomatology of 5/94 patients remained unchanged, 1/94 patients´ pain increased after surgery. With 93% of group A and 94% of group B showing excellent to fair long-term follow-up outcome, the results of both groups were similar and significant better compared to those of other, more invasive surgical procedures.
Conclusions
Although many comorbid conditions and risk factors for surgery are often present, microsurgical unilateral laminotomy represents a minimally invasive surgical technique for the treatment of symptomatic lumbar spinal stenosis in the elderly, which offers considerate, safe and effective bilateral decompression with good long-term results. Differential diagnosis can be challenging and pre-operative work-up has to be carried out accurate and carefully.