Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

European Spine Journal

Takashi Yamazaki¹  Kozo Nakamura⁴  Kazuto Hoshi⁴  Hiroyuki Oka²  Hiroshi Kawaguchi⁴  Sei Terayama⁴  Ko Matsudaira⁵  Nobuhiro Hara⁴  Atsushi Seichi³  Motoaki Murakami¹  Katsushi Takeshita⁴ 

[1] Musashino Red Cross Hospital, Sakai-Minami 1-26-1, Tokyo, 180-0023 Japan;Faculty of Medicine, 22nd Century Medical Center, The University of Tokyo, Hongo 7-3-1, Bunkyo, Tokyo, 113-8655 Japan;Jichi Medical University, Yakushiji 3311-1, Tochigi, 329-0498 Japan;Departments of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo, Tokyo, 113-8655 Japan;Clinical Research Centre for Occupational Musculoskeletal Disorders, Kanto Rosai Hospital, 1-1 Sumiyoshicho kizuki, Nakahara-ku, Kawasaki, 211-8510 Japan

关键词: Lumbar spinal stenosis;    Decompression surgery;    Outcome;    Predictor;   

DOI  :  10.1007/s00586-010-1374-1

学科分类：骨科学

来源: Springer

【 摘 要 】

Leg pain/numbness and gait disturbance, two major symptoms in the lower extremities of lumbar spinal stenosis (LSS), are generally expected to be alleviated by decompression surgery. However, the paucity of information available to patients before surgery about specific predictors has resulted in some of them being dissatisfied with the surgical outcome when the major symptoms remain after the procedure. This prospective, observational study sought to identify the predictors of the outcome of a decompression surgery: modified fenestration with restorative spinoplasty. Of 109 consecutive LSS patients who underwent the decompression surgery, 89 (56 males and 33 females) completed the 2 year follow-up. Both leg pain/numbness and gait disturbance determined by the Japanese Orthopedic Association scoring system were significantly improved at 2 years after surgery compared to those preoperative, regardless of potential predictors including gender, preoperative presence of resting numbness in the leg, drop foot, cauda equina syndrome, degenerative spinal deformity or myelographic filling defect, or the number of decompressed levels. However, 27 (30.3%) and 13 (14.6%) patients showed residual leg pain/numbness and gait disturbance, respectively. Among the variables examined, the preoperative resting numbness was associated with residual leg pain/numbness and gait disturbance, and the preoperative drop foot was associated with residual gait disturbance, which was confirmed by logistic regression analysis after adjustment for age and gender. This is the first study to identify specific predictors for these two remaining major symptoms of LSS after decompression surgery, and consideration could be given to including this in the informed consent.

【 授权许可】

Unknown