Surgical Treatment of Lumbar Spinal Stenosis in Geriatric Population : Is It Risky?

  • Kim, Dong-Won (Department of Neurosurgery, Hanyang University College of Medicine) ;
  • Kim, Sung-Bum (Department of Neurosurgery, Hanyang University College of Medicine) ;
  • Kim, Young-Soo (Department of Neurosurgery, Hanyang University College of Medicine) ;
  • Ko, Yong (Department of Neurosurgery, Hanyang University College of Medicine) ;
  • Oh, Seong-Hoon (Department of Neurosurgery, Hanyang University College of Medicine) ;
  • Oh, Suck-Jun (Department of Neurosurgery, Hanyang University College of Medicine)
  • Published : 2005.08.28

Abstract

Objective : Lumbar spinal stenosis is increasingly recognized as a common cause of low back pain in elderly patients. Conservative treatment has been initially applied to elderly patients, however, surgical treatment is sometimes indispensable to relieve severe pain. We retrospectively examine the age-related effects on the surgical risk, and results following general anesthesia and operative procedure in geriatric patients for two different age groups of at least 65years old. Methods : Consecutive 51 patients [${\ge}$ 65years], who underwent open surgical procedure for degenerative lumbar spinal stenosis, were selected in the study. Patients were divided into two groups. Group A included all patients who were between 65 and 69years of age at the time of surgery. Group B included all patients who were at least 70years of age at the time of surgery. We reviewed medical history including preoperative American Society of Anesthesiologists[ASA] classification of physical status, anesthetic risk factor, operative time, estimated blood loss, transfusion requirements, hospital stay, operated level, and clinical outcome to look for comparisons between two age groups [$65{\sim}69$ and over 70years]. Results : In preoperative evaluation, mean anesthetic risk factor of patients was numerically similar between the groups. The American Society of Anesthesiologists classification of physical status was similar between two groups. There was no difference in operated level, operative time, estimated blood loss, hospital stay, and anesthetic risk factor between the two groups. The clinical successful outcome showed 82.7% for Group A and 81.8% for group B. The overall postoperative complication rates were similar for both group A and B. Conclusion : We conclude that advanced age per se, did not increase the associated morbidity and mortality in surgical decompression for spinal stenosis.

Keywords

References

  1. Arinzon ZH, Fredman B, Zohar E, Shabat S, Feldman JS, Jedeikin R, et al : Surgical management ofspinal stenosis: a comparison of immediate and long term outcome in two geriatric patient populations. Arch Gerontal Geriatr 36 : 273-279, 2003 https://doi.org/10.1016/S0167-4943(02)00172-3
  2. Arnoldi CC, Brodsky AE, Cauchoix J, Crock HV, Dommisse GF, Edgar MA, et al : Lumbar spinal stenosis and nerve root entrapment syndromes: Definition and classification. Clin Orthop 115: 4-5, 1976
  3. Benz RJ, Ibrahim ZG, Afshar P, Garfin SR : Predicting complications in elderly patients undergoing lumbar decompression. Clin Orthop 384: 116-121, 2001 https://doi.org/10.1097/00003086-200103000-00014
  4. Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA : Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg 74A: 536-543, 1992
  5. Esses S, Huler R : Indications for lumbar spine fusion in the adult. Clin Orthop 279 : 87-100, 1992
  6. Herkowitz HN, Kurz LT : Degenerative lumbar spondylolisthesis with spinal stenosis : A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg 73A: 802-808, 1991
  7. Johnsson KE, Willner S, Pettersson H : Analysis of operated cases with lumbar spinal stenosis. Acta Orthop Scand 52 : 427-433, 1981 https://doi.org/10.3109/17453678109050123
  8. Jonsson B, Stromqvist B : Symptoms and signs of degeneration of the lumbar spine: A prospective, consecutive study of 300 operated patients. J Bone Joint Surg 75B: 381-385, 1993
  9. Katz JN, Lipson SJ, Brick GW, Grobler LJ, Weinstein JN, Fossel AH, et al : Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine 20 : 1155-1160, 1995 https://doi.org/10.1097/00007632-199505150-00008
  10. Katz JN, Lipson SJ, Larson MG, McInnes JM, Fossel AH, Liang MH : The outcome of decompressive laminectomy for degenerative lumbar stenosis. J Bone Joint Surg 73A : 809-816, 1991
  11. Lieberman JR, Frederick D, Shekelle P, Schumacher L, Thomas BJ, Kilgus DJ, et al : Differences between patients' and physicians' evaluations of outcome after total hip arthroplasty. J Bone Joint Surg 78A : 835-838, 1996
  12. Posracchini F, Cinotti G, Gumina S, Perugia D : Long-term results of surgety in lumbar stenosis: 8-year review of 64 patients. Acta Orthop Scand 64 : 78-80, 1993 https://doi.org/10.3109/17453679309160127
  13. Ragab AA, Fye MA, Bohlman HH : Surgery of the lumbar spine for spinal stenosis in 118 patients 70 years of age or older. Spine 28 : 348-353, 2003 https://doi.org/10.1097/00007632-200302150-00007
  14. Rha HK, Lee KJ, Cho KK, Park SC, Park HK, Choi CR : Neurosurgery for the Elderly. J Korean Neurosurg Soc 26: 1699-1704, 1997
  15. Sanderson PL, Wood PL : Surgery for lumbar spinal stenosis in old people. J Bone Joint Surg 75B : 393-397, 1993
  16. Silvers HR, Lewis PJ, Asch HL: Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg 78: 695-701, 1993 https://doi.org/10.3171/jns.1993.78.5.0695
  17. Yong-Hing K, Kirkaldy-Willis W : The pathophysiology of degenerative disease of the lumbar spine. Orthop Clin North Am 4 : 491-504, 1983