scholarly journals Pathogenesis, presentation, and treatment of lumbar spinal stenosis associated with coronal or sagittal spinal deformities

2003 ◽  
Vol 14 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Justin F. Fraser ◽  
Russel C. Huang ◽  
Federico P. Girardi ◽  
Frank P. Cammisa
Keyword(s):  
Spinal Fusion ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Deformity Correction ◽  
Potential Benefits ◽  
Risk Of Disease ◽  
Plane Deformity ◽  
Flat Back ◽  
Lumbar Spinal

Sagittal- or coronal-plane deformity considerably complicates the diagnosis and treatment of lumbar spinal stenosis. Although decompressive laminectomy remains the standard operative treatment for uncomplicated lumbar spinal stenosis, the management of stenosis with concurrent deformity may require osteotomy, laminectomy, and spinal fusion with or without instrumentation. Broadly stated, the surgery-related goals in complex stenosis are neural decompression and a well-balanced sagittal and coronal fusion. Deformities that may present with concurrent stenosis are scoliosis, spondylolisthesis, and flatback deformity. The presentation and management of lumbar spinal stenosis associated with concurrent coronal or sagittal deformities depends on the type and extent of deformity as well as its impact on neural compression. Generally, clinical outcomes in complex stenosis are optimized by decompression combined with spinal fusion. The need for instrumentation is clear in cases of significant scoliosis or flatback deformity but is controversial in spondylolisthesis. With appropriate selection of technique for deformity correction, a surgeon may profoundly improve pain, quality of life, and functional capacity. The decision to undertake surgery entails weighing risk factors such as age, comorbidities, and preoperative functional status against potential benefits of improved neurological function, decreased pain, and reduced risk of disease progression. The purpose of this paper is to review the pathogenesis, presentation, and treatment of lumbar spinal stenosis complicated by scoliosis, spondylolisthesis, or flat-back deformity. Specific attention is paid to surgery-related goals, decision making, techniques, and outcomes.

scholarly journals Prediction of walking ability following posterior decompression for lumbar spinal stenosis

2021 ◽  
Author(s):  
Suzanne McIlroy ◽  
Feroz Jadhakhan ◽  
David Bell ◽  
Alison Rushton
Keyword(s):  
Quality Of Life ◽  
Higher Education ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Walking Distance ◽  
Walking Ability ◽  
Poor Outcome ◽  
Lumbar Spinal ◽  
Reduced Risk

Abstract Purpose Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS. Methods An observational cohort study was conducted using data from the British Spine Registry (2017–2018) of adults (≥ 50 years) with LSS, who underwent ≤ 2 level posterior lumbar decompression. Patients receiving fixation or who had previous lumbar surgery were excluded. Walking ability was assessed by a single item on the Oswestry Disability Index and dichotomised into poor/good outcome. Multivariable regression models were performed. Results 14,485 patients were identified. Pre-operatively 30% patients reported poor walking ability, this decreased to 8% at 12 months follow-up. Predictors associated with poor walking ability at 12 months were: increasing age (≥ 75 years OR 1.54, 95% CI 1.07, 2.18), BMI ≥ 35 kg/m2 (OR 1.52, 95% CI 1.00, 2.30), severity of leg pain (OR 1.10, CI 95% 1.01, 1.21), disability (OR 1.01, 95% CI 1.01, 1.02) and quality of life (OR 0.72, 95% CI 0.56, 0.89). Pre-operative maximum walking distance (OR 1.10, 95% CI 1.05, 1.25) and higher education (OR 0.90, 95% CI 0.80, 0.96) were associated with reduced risk of poor walking ability at 12 months; p < 0.05. Depression, fear of movement and symptom duration were not associated with risk of poor outcome. Conclusion Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.

Health-related quality of life and comorbidities associated with lumbar spinal stenosis

2012 ◽  
Vol 12 (3) ◽  
pp. 189-195 ◽  
Author(s):  
Michele C. Battié ◽  
C. Allyson Jones ◽  
Donald P. Schopflocher ◽  
Richard W. Hu
Keyword(s):  
Quality Of Life ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Lumbar Spinal

scholarly journals Long-term Clinical Outcomes and Quality of Life in Elderly Patients Treated with Interspinous Devices for Lumbar Spinal Stenosis

2017 ◽  
Vol 79 (02) ◽  
pp. 139-144 ◽  
Author(s):  
Massimo Miscusi ◽  
Stefano Forcato ◽  
Alessandro Ramieri ◽  
Filippo Polli ◽  
Antonino Raco ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Spinal Stenosis ◽  
Local Anesthesia ◽  
Lumbar Spinal Stenosis ◽  
Short Form ◽  
Meaningful Improvement ◽  
Lumbar Spinal

Background and Objective Lumbar spinal stenosis (LSS) is a common degenerative condition that occurs in the spine with increasing age. Clinically, LSS causes a progressive reduction in walking autonomy, resulting in a poor quality of life and impaired functional capacity. The aim of this study was to evaluate the clinical outcome and quality of life of elderly patients presenting with LSS and associated comorbidities after a 5-year follow-up who were treated with an interspinous process device (IPD). Material and Methods Sixty patients > 75 years of age presenting with symptomatic degenerative LSS were included. All were treated with an IPD under local anesthesia. American Society of Anesthesiology score, Zurich Claudication Questionnaire, and Short Form 36 were evaluated pre- and postoperatively and at the follow-up visit each year for 5 years. Results The mean surgery time while under local anesthesia was 20 minutes. Forty-eight patients were followed for 5 years. Significant clinical improvements in all outcome scores (p < 0.05) both postoperatively or at follow-up were found. Conclusions IPD seems to be an effective and safe treatment for LSS in elderly patients with general comorbidities. In our study, all followed up patients had a meaningful improvement of their quality of life even at 5 years after surgery.

Predictors of Quality of Life and Physical Function After Surgical Treatment of Lumbar Spinal Stenosis

2012 ◽  
Vol 12 (9) ◽  
pp. S111-S112
Author(s):  
Natalie Egge ◽  
Daniel Mandell ◽  
Anthony S. Lapinsky ◽  
Hanbing Zhou ◽  
Jason C. Eck ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Physical Function ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Spinal
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