gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Lumbar spinal stenosis in elderly patients: comparison of different methods of decompression

Lumbale spinale Stenose bei älteren Patienten: Vergleich unterschiedlicher operativer Verfahren

Meeting Abstract

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  • corresponding author M.H. Morgalla - Neurochirurgische Klinik, Universitätsklinikum Tübingen, Tübingen
  • N. Noak - Neurochirurgische Klinik, Universitätsklinikum Tübingen, Tübingen
  • M. Tatagiba - Neurochirurgische Klinik, Universitätsklinikum Tübingen, Tübingen

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.03.06

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Morgalla et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Lumbar canal stenosis due to hypertrophy and calcification of the facet joints or the ligamenta flava is a common condition in the elderly. Less invasive procedures preserving maximal bony and ligamentous structures have been recommended to reduce associated morbidity. We examined the outcome after decompression of spinal stenosis in the elderly comparing the different surgical approaches.

Methods: We investigated 200 elderly patients with a lumbar spinal stenosis (age >60 years, mean age 77.6 years), who were operated on in the period from 2004 until June 2006 at our institution. The diagnosis was made with both magnetic resonance imaging (MRI) and computer tomography (CT) in 32.5% and with additional lumbar myelography in 77.5%. For spinal decompression an unilateral (39%) or bilateral (11.5%) interlaminar decompression, a hemilaminectomy (36.5%), a laminectomy (12%) or in the presence of concomitant instability a fusion (2%) was used. The outcome was assessed at 3, 6 and 12 months post operation.

Results: Lumbar stenosis was decompressed at one (62.5%), two (36%) and three (1.5%) levels. The most common levels were L4/5 (46.7%), L3/4 (36.7%) and L2/3 (10%). A good decompression was achieved in 82.3%. A second decompression was necessary after unilateral interlaminar decompression in 2.7%, after hemilaminectomy in 3.3% and after laminectomy in 2.7%. Ongoing postoperative examinations have shown, that unilateral interlaminar decompression revealed good results. In comparison, laminectomy, fusion or bilateral approaches did not further improve the postoperative outcome so far. Complications included CSF fistula (1.6%), infection (1.1%) and recurrent disc lesion (4.8%). A subsequent fusion after decompression was needed in 2%.

Conclusions: Laminectomy or bilateral approaches did not show advantages over unilateral transmedian approaches. Unilateral interlaminar decompression combined with hemilaminectomy served as a sufficient method to subside the stenosis and seems advantageous in minimizing the procedure and associated morbidity especially in the elderly.