LUMBAR SPINAL STENOSIS: TREATMENT OPTIONS AND RESULTS

ABSTRACT

A variety of modalities are available for the treatment of lumbar spinal stenosis. The nonoperative treatment techniques include anti-inflammatories, physical therapy and steroid injections. Controlled, randomized trials of these various treatment modalities have not been undertaken. The available data suggest that nonoperative treatment modalities have a sustained benefit in a minority of patients. The majority of patients who present with symptoms and signs of stenosis do not improve with nonoperative treatment, but typically do not progress over the short term. The indication to operate is based upon the severity of symptoms and the degree of associated disability.

Decompressive operative techniques available for stenosis include a laminectomy, laminectomy and mesial facetectomy and laminotomies. The techniques vary in their degree of technical difficulty and the likelihood of incurring complications. The principle of decompressive surgery is to effect adequate decompression of the neural elements without inducing instability. Indications to proceed with segmental fusion are not clear. Overall, results of incorporating a fusion along with a decompression are better than with a decompression alone in selected patients, although there is an associated increase in complication potential.

There is a spectrum of outcomes reported following surgery for spinal stenosis. Summaries of the retrospective and prospective data indicate the overall good to excellent outcome following surgery is 64 and 67%, respectively. Better controlled studies indicate the overall likelihood of improvement following surgery is in the order of 79%, the likelihood of relieving leg pain is greater than 75%. Preoperative leg pain and severe stenosis are favorable prognostic factors, whereas the presence of a comorbid medical condition and the occurrence of surgical complications adversely affect outcome.

Decompressive surgery is a physiologically appropriate and effective treatment for appendicular symptoms from stenosis. If the surgeon's and patient's expectations for the results of surgery are oriented toward relief of leg symptoms with surgery, the subjective and objective results of surgery should be optimized.

KEYWORD

Lumbar stenosis - surgery - outcome

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