Journal of Korean Neurosurgical Society

  • 제41권3호
  • /
  • Pages.157-160
  • /
  • 2007
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지

Clinical Analysis of Postoperative Outcome in Elderly Patients with Lumbar Spinal Stenosis

  • Hur, Jin-Woo (Department of Neurosurgery, Cheongju St. Mary's Hospital) ;
  • Kim, Seung-Hyun (Department of Neurosurgery, Cheongju St. Mary's Hospital) ;
  • Lee, Jong-Won (Department of Neurosurgery, Cheongju St. Mary's Hospital) ;
  • Lee, Hyun-Koo (Department of Neurosurgery, Cheongju St. Mary's Hospital)
  • 발행 : 2007.03.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : The purpose of this study was to evaluate the efficacy and safety of the surgical treatment for lumbar spinal stenosis in elderly patients. Methods : The authors reviewed the medical records of 49 patients older than 65 years of age with lumbar spinal stenosis who underwent surgical treatment from January 2002 to December 2004 in our institute. Results : Average age of patients was 70 years old [32 women, 17 men]. Twenty-four patients had chronic medical disorders. All patients were operated under the general anesthesia of these, 29 patients underwent decompressive laminectomy and decompressive laminectomy with instrumentation and fusion in 20 patients. The mean operation time was 193.5 minutes, mean estimated blood loss was 378cc and mean postoperative hospital stay length was 15.3 days. The mean follow-up duration was 11.9 months. The evaluation of outcome was assessed by Macnab classification. At first month after operation, the outcome showed excellent in 7 [14.3%]. good in 35 [71.4%], fair in 5 [10.2%], and poor in 2 [4.1%]. And at 6 months after operation, 17 patients were lost in follow-up, the outcome showed excellent in 4 [12.5%], good in 25 [78.1%], fair in 3 [9.4%], and no poor cases. There was no significant difference between outcome of laminectomy alone and that of laminectomy with fusion. Six patients [12.2%] experienced postoperative complications which included wound infection [3], nerve root injury [1], disc herniation [1], and reoperation due to insufficient decompression [1]. There were no deaths related to operation. Conclusion : We conclude that the surgical treatment for lumbar spinal stenosis in elderly patients can provide good results with acceptable morbidity when carefully selected. In addition, decision on lumbar spinal fusion should not be against solely on advanced age.

키워드

참고문헌

  1. Aryanpur J, Ducker T : Multilevel lumbar laminotomies : an alternative to laminectomy in the treatment of lumbar stenosis. Neurosurgery 26 : 429-432, 1990 https://doi.org/10.1227/00006123-199003000-00009
  2. 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
  3. Cho JM, Yoon SH, Park HC, Park HS, Kim EY, Ha Y : Surgery of spinal stenosis in elderly patients-bilateral canal widening through unilateral approach. J Korean Neurosurg Soc 35 : 492-497, 2004
  4. Ciricillo SF, Weinstein PR : Lumbar spinal stenosis. West J Med 158 : 171-177, 1993
  5. Conley FK, Cady CT, Lieberson RE : Decompression of lumbar spinal stenosis and stabilization with knodt rods in the elderly patients. Neurosurgery 26 : 758-763, 1990 https://doi.org/10.1227/00006123-199005000-00004
  6. 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
  7. Fast A, Robin GC, Floman Y : Surgical treatment of lumbar spinal stenosis in the elderly. Arch Phys Med Rehabil 66 : 149-151, 1985
  8. Fujita T, Kostuik JP, Huckell CB, Sieber AN : Complications of spinal fusion in adults patients more than 60 years of age. Orthop Clin North Am 29 : 669-678, 1998 https://doi.org/10.1016/S0030-5898(05)70040-7
  9. Ganz, JC : Lumbar spinal stenosis : postoperative results in terms of preoperative posture-related pain. J Neurosurg 72 : 71-74, 1992
  10. Grabias S : The treatment of spinal stenosis. J Bone Joint Surg Am 62A : 308-313, 1980
  11. Herron LD, Margelsdorf C : Lumbar spinal stenosis : results of surgical treatments. J Spinal Disord 4 : 26-33, 1991
  12. Ji YC, Kim YB, Hwang SN, Park SW, Kwon JT, Min BK : Efficacy of unilateral laminectomy for bilateral decompression in elderly lumbar spinal stenosis. J Korean Neurosurg Soc 37 : 410-415, 2005
  13. Johnsson KE, Rosen I, Uden A : The natural course of lumbar spinal stenosis. Clin Orthop 279 : 82-86, 1992
  14. Kalbarczyk A, Lukes A, Seiler RW : Surgical treatment of lumbar spinal stenosis in the elderly. Acta Neurochir 140 : 637-641, 1998 https://doi.org/10.1007/s007010050155
  15. Kim DW, Kim SB, Kim YS, Ko Y, Oh SH, Oh SJ : Surgical treatment of lumbar spinal stenosis in geriatric population : is it risky? J Korean Neurosurg Soc 38 : 107-110, 2005
  16. Lee SY, Youn SH, Cho J, Moon CT, Chang SK : The analysis of surgical results to the lumbar spinal disorders of aged persons. J Korean Neurosurg Soc 29 : 1612-1619, 2000
  17. Lin PM : Internal decompression of multiple levels of lumbar spinal stenosis : a technical note. Neurosurgery 26 : 429-432, 1990 https://doi.org/10.1227/00006123-199003000-00009
  18. Pappas CTE, Sonntag VKH : Lumbar stenosis in the elderly. Neurosurg Quarterly 4 : 102-112, 1994 https://doi.org/10.1097/00013414-199406000-00004
  19. Quigley MR, Kortyna R, Goodwin C, Maroon JC : Lumbar surgery in the elderly. Neurosurgery 30 : 672-674, 1992
  20. Sanderson PL, Wood PL : Surgery for lumbar spinal stenosis in old people. J Bone Joint Surg 75 : 393-397, 1993
  21. Tsuji H, Itoh T, Sekido H : Expansive laminoplasty for lumbar spinal stenosis. Int Orthop 14 : 309-314, 1990
  22. Yone K, Sakou T, Kawauchi Y, Yamaguchi M, Yanase M : Indication of fusion for lumbar spinal stenosis in elderly patients and its significance. Spine 21 : 242-248, 1996 https://doi.org/10.1097/00007632-199601150-00016
  23. Young S, Veerapen R, O Laoire SA : Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy : preliminary report. Neurosurgery 23 : 628-633, 1988 https://doi.org/10.1227/00006123-198811000-00014