Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study

BMC Surgery

Research Article

Stian Lydersen¹  Asgeir S Jakola²  Sasha Gulati³  Øystein P Nygaard⁴  Andreas Sørlie⁵  Tore Solberg⁵ 

[1] Department for Applied Clinical Research, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway;Department of Neurosurgery, St. Olavs Hospital HF, N-7006, Trondheim, Norway;Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, N-7005, Trondheim, Norway;Department of Neurosurgery, St. Olavs Hospital HF, N-7006, Trondheim, Norway;Department of laboratory medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway;Department of Neurosurgery, St. Olavs Hospital HF, N-7006, Trondheim, Norway;The Norwegian National Registry for Spine Surgery, SKDE, North Norway Regional Health Authority, Tromsø, Norway;National Center for Spinal Disorders, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;Department of Neuroscience, Norwegian University of Science and Technology, N-7005, Trondheim, Norway;Department of Neurosurgery, University Hospital of North Norway, N-9038, Tromsø, Norway;The Norwegian National Registry for Spine Surgery, SKDE, North Norway Regional Health Authority, Tromsø, Norway;

关键词: Oswestry Disability Index;    Spinal Stenosis;    Lumbar Spinal Stenosis;    Oswestry Disability Index Score;    Decompressive Laminectomy;   

DOI  :  10.1186/1471-2482-10-34

 received in 2010-04-21, accepted in 2010-11-22,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundTo assess safety, risk factors and clinical outcomes in elderly patients with spinal stenosis after decompressive laminectomy.MethodsA prospective cohort of patients 70 years and older with spinal stenosis undergoing conventional laminectomy without fusion (n = 101) were consecutively enrolled from regular clinical practice and reassessed at 3 and 12 months. Primary outcome was change in health related quality of life measured (HRQL) with EuroQol-5 D (EQ-5D). Secondary outcomes were safety assessment, changes in Oswestry disability index (ODI), Visual Analogue Scale (EQ-VAS) score for self reported health, VAS score for leg and back pain and patient satisfaction. We used regression analyses to evaluate risk factors for less improvement.ResultsThe mean EQ-5 D total score were 0.32, 0.63 and 0.60 at baseline, 3 months and 12 months respectively, and represents a statistically significant (P < 0.001) improvement. Effect size was > 0.8. Mean ODI score at baseline was 44.2, at 3 months 25.6 and at 27.9. This represents an improvement for all post-operative scores. A total of 18 (18.0%) complications were registered with 6 (6.0%) classified as major, including one perioperative death. Patients stating that the surgery had been beneficial at 3 months was 82 (89.1%) and at 12 months 73 (86.9%). The only predictor found was patients with longer duration of leg pain had less improvement in ODI (P < 0.001). Increased age or having complications did not predict a worse outcome in any of the outcome variables.ConclusionsProperly selected patients of 70 years and older can expect a clinical meaningful improvement of HRQL, functional status and pain after open laminectomy without fusion. The treatment seems to be safe. However, patients with longstanding leg-pain prior to operation are less likely to improve one year after surgery.

【 授权许可】

CC BY   
© Jakola et al; licensee BioMed Central Ltd. 2010