Abstract
Introduction
A literature review demonstrated conflicting results with different lumbar spine surgery techniques for LSS in the elderly.
Materials and Methods
From 2004 to 2011, a total of 183 consecutive patients at least 65 years old with degenerative LSS underwent decompressive surgery. Patients were divided into two groups: open decompression (Group A, 85 patients) and selective decompression (Group B, 98 patients). All patients were followed for at least 1 year and clinical outcomes were assessed using Visual Analog Scale pain scores (VAS), Oswestry Disability Index (ODI), and MacNab criteria preoperatively, 6 months postoperatively, and at the final follow-up.
Results
A total of 161 patients met the study criteria. The two groups were similar in age, sex, involved levels, preoperative neurologic status distribution, and comorbidities. The mean follow-up period was 22.3 ± 6.7 months (Group A) versus 23.0 ± 7.1 months (Group B) (p > 0.05). Operation time, blood loss, and duration of hospitalization were significantly lower in the selective decompression group. The clinical outcomes (VAS, ODI) were maintained preoperatively, 6 months postoperatively, and at the final follow-up. Mean VAS scores were 7.4 ± 1.7 versus 7.9 ± 1.8; 4.0 ± 2.0 versus 2.6 ± 1.4; and 2.9 ± 1.3 versus 2.5 ± 1.5, respectively. Mean ODI scores were 60.3% ± 11.0% versus 65.1% ± 11.5%; 39.6% ± 8.7% versus 33.0% ± 8.5%; and 42.5% ± 10.8% versus 31.2% ± 8.8%, respectively. Sixty-seven patients (83.8%) versus 74 patients (91.4%) had good to excellent results 6 months postoperatively and 62 patients (77.5%) versus 72 patients (88.9%) had good to excellent results at the final follow-up. There were no surgery-related complications and no deaths among the patients at the last follow-up.
Conclusion
Compared with the open decompression group, selective decompression provided satisfactory clinical outcomes with significant reductions in operation time, blood loss, and duration of hospitalization. Selective decompression of the nerve root canal under direct vision was a safe and effective alternative to microsurgical procedures for elderly patients with LSS.
None declared