Lumbar spinal stenosis: prognostic factors for bilateral microsurgical decompression using a unilateral approach.
Standard
Lumbar spinal stenosis: prognostic factors for bilateral microsurgical decompression using a unilateral approach. / Papavero, Luca; Thiel, Marco; Fritzsche, Erik; Kunze, Christina; Westphal, Manfred; Kothe, Ralph.
in: NEUROSURGERY, Jahrgang 65, Nr. 6, 6, 2009, S. 182-187.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Lumbar spinal stenosis: prognostic factors for bilateral microsurgical decompression using a unilateral approach.
AU - Papavero, Luca
AU - Thiel, Marco
AU - Fritzsche, Erik
AU - Kunze, Christina
AU - Westphal, Manfred
AU - Kothe, Ralph
PY - 2009
Y1 - 2009
N2 - OBJECTIVE: We describe a prospective cohort study that investigated the effectiveness of microsurgical bilateral decompression using unilateral laminotomy for lumbar spinal stenosis and assessed the factors influencing the outcome. METHODS: A total of 165 consecutive patients underwent decompression for lumbar spinal stenosis. They were divided into 3 age groups: A (75 years). Further classification was performed according to body mass index (BMI): BMI 1 (30), anesthesiological risk factors (American Society of Anesthesiologists), and the number of levels decompressed. The outcome was monitored by an independent observer at 1 week, 3 months, and 1 year after surgery. The following parameters were evaluated: pain (visual analog scale and analgesic consumption), functional improvement (Neurogenic Claudication Outcome Score), and walking performance, defined as walking distance x speed (treadmill). RESULTS: One week after surgery, pain decreased in 85.9% of patients, and a comparison of the pre- and postoperative use of analgesics showed that 38% of nonopioid use and 74% of opioid use were discontinued, whereas nonsteroidal anti-inflammatory drug consumption increased 13%. One year after surgery, pain remained decreased in 83.9% of patients, Neurogenic Claudication Outcome Score increased in 90.3% of patients, and walking performance improved in 92.2% of patients. BMI greater than 30 was the only negative prognostic factor for pain reduction (P = 0.012) and Neurogenic Claudication Outcome Score improvement (P = 0.019). Surprisingly, patients who underwent multilevel decompression benefitted more from surgery than those who underwent single-level decompression. CONCLUSION: Microsurgical bilateral decompression using unilateral laminotomy is an effective surgical option for lumbar spinal stenosis, even in high-risk patients with multilevel stenosis.
AB - OBJECTIVE: We describe a prospective cohort study that investigated the effectiveness of microsurgical bilateral decompression using unilateral laminotomy for lumbar spinal stenosis and assessed the factors influencing the outcome. METHODS: A total of 165 consecutive patients underwent decompression for lumbar spinal stenosis. They were divided into 3 age groups: A (75 years). Further classification was performed according to body mass index (BMI): BMI 1 (30), anesthesiological risk factors (American Society of Anesthesiologists), and the number of levels decompressed. The outcome was monitored by an independent observer at 1 week, 3 months, and 1 year after surgery. The following parameters were evaluated: pain (visual analog scale and analgesic consumption), functional improvement (Neurogenic Claudication Outcome Score), and walking performance, defined as walking distance x speed (treadmill). RESULTS: One week after surgery, pain decreased in 85.9% of patients, and a comparison of the pre- and postoperative use of analgesics showed that 38% of nonopioid use and 74% of opioid use were discontinued, whereas nonsteroidal anti-inflammatory drug consumption increased 13%. One year after surgery, pain remained decreased in 83.9% of patients, Neurogenic Claudication Outcome Score increased in 90.3% of patients, and walking performance improved in 92.2% of patients. BMI greater than 30 was the only negative prognostic factor for pain reduction (P = 0.012) and Neurogenic Claudication Outcome Score improvement (P = 0.019). Surprisingly, patients who underwent multilevel decompression benefitted more from surgery than those who underwent single-level decompression. CONCLUSION: Microsurgical bilateral decompression using unilateral laminotomy is an effective surgical option for lumbar spinal stenosis, even in high-risk patients with multilevel stenosis.
M3 - SCORING: Zeitschriftenaufsatz
VL - 65
SP - 182
EP - 187
JO - NEUROSURGERY
JF - NEUROSURGERY
SN - 0148-396X
IS - 6
M1 - 6
ER -