gms | German Medical Science

Objective: Degenerative spinal stenosis is an acquired disease of elderly people. Patients are older than 50yrs and suffer from multiple comorbidities. Women are affected more frequently. Different surgical procedures are possible. Operations are performed in case of appropriate symptoms such as low back pain, claudication or neurological deficits. Two major procedures are performed: decompression with or without stabilisation. The risk of perioperative complications in operations with stabilisation is significantly higher than in spinal decompression without stabilisation. We performed a retrospective analysis of cases to determine a difference in outcome after decompression with or without stabilisation.

Method: In the departement of Neurosurgery 1.330 patients were treated micro surgically because of a degenerative spinal stenosis from 04/2007 to 08/2015. Clinical examination and neuroradiological imaging (MRI, CT, X-ray) were performed prior to surgery. In special cases additional imaging like myelography and postmyelo-CT were performed. The patients underwent a second imaging after surgery. Follow-up examinations were performed after 3 to 6 months. Level of pain was measured with numeric analogue scale (NAS).

Results: N=1.330 patients were included in this study. 59% of treated patients were female, 41% male. The median age was 73 ys.1.261 patients underwent microsurgical trans median decompression. 69 patients received an additional stabilisation such as T-LIF or P-LIF due to verified spinal instability (with functional X-ray imaging). Only 6 patients initially treated with only decompression needed a second operation for stabilisation. Dural lesions occurred in 89 (7,1%) patients with only decompression and in 7 patients (10,1%) with a stabilisation. Three patients needed revision surgery due to inaccurate screw positioning resulting in paresis. Wound healing disorder occurred in 3 following stabilisation. All patients reported postoperative decreased level of pain. The average level of back and leg pain was in both groups NAS 8 prior to surgery. The mean level after surgery was NAS 4 for back pain and NAS 2 for leg pain.

Conclusions: The Microsurgical decompression as a single procedure in lumbar degenerative spinal stenosis of the elderly patient is a sufficient surgery. The majority of patients did not require an additional stabilization. The occasion for additional stabilisation should be handled restrictively and only in cases with proven and distinct spinal instability. Surgical risk can be reduced.