Acta Ortopédica Mexicana

Miramontes MV, Rosales OLM, Reyes-Sánchez AA
Surgical treatment of the lumbar spinal canal stenosis
Acta Ortop Mex 2002; 16 (2)

Language: Español
References: 41
Page: 70-75
PDF: 247.03 Kb.

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ABSTRACT

Objective. First description available data from symptoms of lumbar spinal canal stenosis are from 1899. Disease is known as well as spondylosis, vertebral degenerative syndrome and spondyloarthrosis. Abnormal decrease in diameters of either spinal canal, root canal or foramina, produce neural symptoms of deficit such as neurogenic claudication, numbness, dysesthesia or weakness of lower limbs that worsen as a result of activity and improve with rest. This paper has been designed in order to assess the results of recalibrating all interior structures of the spine as outlined before, as well as posterior fusion and transpedicular instrumentation in cases of lumbar stenosis. Material and methods. A series of 86 patients who were operated on as described above because of a history from 10 days to 20 years (av. 5.3 years, mean 10) of symptomatic lumbar spine stenosis syndrome that failed to improve with conservative treatment is reported. There were 50 females and 36 males, with age from 50 to 84 years (av. 67, mean 62). Recalibration was performed in all, while fusion and fixation only in 65 and fusion without fixation in the remaining 21. All patients were assessed at one year and at 7 years after operation. Results. According to the Talghot scale, overall results in terms of pain at one year were excellent in 60 cases (70.5%), good in 8 (9.3%), fair in 16 (18.6%) and poor in 2 (2.3%). At 7 years, the rate of pain had a slight worsening since results were excellent in 60 (70.5%), good in 6 (7.05%), fair in 12 (14.1%) and poor in 7 (8.2%). Asymptomatic loosening of instrumentation occurred in 20 (23.5%), symptomatic in 20 (23.5%) and it was completely broken in 5 (5.8%). Instrumentation was removed in 45 patients. Neurological symptoms relieved in 76 patients (88.2%) and revision surgery was performed in 10 (one with instrumentation and 9 without it) out of the 86 patients (10.7%) because of neural relapsing symptoms which were produced by fibrous neoformation peridural tissue. Conclusion. Surgery for lumbar spinal stenosis must be done only in those cases in whom conservative treatment has failed. Surgical technique is recommended as follows: recalibration and fusion in patients younger than 50 years; laminectomy, recalibration, arthrodesis and transpedicular fixation in those from 50 to 65 years; recalibration, fusion and trans-pedicular fixation in people from 65 to 75 years and postero-lateral arthrodesis and laminectomy without fixation in those older than 75 years.


Key words: lumbar stenosis, arthrodesis, screw, fixation.


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