gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Focus on elderly patients suffering from lumbar spinal stenosis – Development of a clearly defined therapeutical strategy

Fokus: spinale Lumbalkanalstenose bei älteren Patienten - Entwicklung eines klar definierten Therapiekonzeptes

Meeting Abstract

Suche in Medline nach

  • corresponding author Laila Siam - Neurochirurgische Universitätsklinik, Robert-Koch-Str. 40, 37075 Göttingen
  • R. Verheggen - Neurochirurgische Universitätsklinik, Robert-Koch-Str. 40, 37075 Göttingen
  • M. Buchfelder - Neurochirurgische Universitätsklinik, Robert-Koch-Str. 40, 37075 Göttingen

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.03.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0172.shtml

Veröffentlicht: 23. April 2004

© 2004 Siam et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Lumbar spinal stenosis is a common condition in elderly patients caused by disc and facet degeneration, facet hypertrophy as well as hypertrophy or calcification of the ligamentum flavum. Due to conflicting results in the literature regarding the long-term course of patients with lumbar spinal stenosis, we have evaluated 205 patients in a retrospective analysis.

Methods

In the last 3 years, 219 patients from 60 upwards (female predominance; age ratio 1.72 : 1) with confirmed diagnosis of lumbar spinal stenosis were treated either conservatively (126) or surgically (93). As typical complaints spinal claudication, leg weakness, cramping or radiating pain were mentioned. Due to the age and reduced general condition the subsequent therapeutical algorithm was used. In cases without paresis or sensory disturbances either a peridural anaesthesia, facet infiltration or nerve infiltration using steroids and local anaesthetics was performed. Surgery was recommended under the following conditions: neurological deficits, reduced walking distance, difficulty in standing or walking, ineffective conservative therapy and intractable pain. Lumbar spinal stenosis was relieved by the removal of the overgrowth portions of the facet joints, laminectomy and infrequently by stabilisation and fusion of the involved vertebrae.

Results

Initially, all patients with spinal stenosis and lack of neurological deficits were treated conservatively as rapid deterioration is unlikely. 79.44% of all patients, treated either conservatively or surgically showed a significant improvement and 19.76% expressed satisfaction with the treatment and resumed daily activities and independence. Only two patients deteriorated post-operatively due to secondary haemorrhage. Advanced age did not increase the morbidity associated with surgery. Seventy-seven patients had near complete relief of their pain after surgery. No perioperative deaths were recorded in our series. In all patients undergoing surgery rehabilitation was induced to guide a return to normal life.

Conclusions

The majority of patients may improve or remain stable over long-term follow-up with non-surgical treatment. Surgical release of lumbar spinal stenosis is a safe and effective treatment option in geriatric patients with a sufficient general condition (ASA I-II). Medical evaluation is mandatory due to frequent co-morbidities. For long-term results, surgery is the therapy of choice providing meaningful pain relief and an improved quality of life.