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
