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| ZHU Di,LI Weishi,CHEN Zhongqiang.Long-term outcome and associated factors of lumbar decompression, internal fixation and fusion for lumbar spinal stenosis[J].Chinese Journal of Spine and Spinal Cord,2013,(10):865-871. |
| Long-term outcome and associated factors of lumbar decompression, internal fixation and fusion for lumbar spinal stenosis |
| Received:March 26, 2013 Revised:May 06, 2013 |
| English Keywords:Lumbar spinal stenosis Decompression and fusion Long-term efficacy Influence factors |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the long-term outcome and associated factors of lumbar decompression, internal fixation and fusion for lumbar spinal stenosis. Methods: 456 patients in Beijing during January 2002 and December 2006 undergoing lumbar decompression, internal fixation and fusion in our hospital were reviewed retrospectively. 118 patients were followed up. There were 54 males and 64 females with a mean age of 55.7 years(range, 31-74 years). The average follow-up period was 84.6 months(range, 58-120 months). The preoperative back pain VAS score, leg pain VAS score, JOA score and ODI score was 6.64±3.07, 7.40±2.78, 8.16±6.58, and 30.55±11.30 respectively. The VAS, JOA, ODI scores and Fischgrund standard were used to evaluate the final follow-up outcome. All the patients took X-ray and MRI to evaluate the operative and adjacent segment. Factors that might affect the outcome such as age, gender, body mass index, duration of disease, neurological claudication distance, preoperative lower extremity numbness, comorbidities, preoperative VAS, JOA, ODI scores, previous history of lumbar spine surgery, fusion, the length of fusion, postoperative adjacent segment degeneration were analyzed retrospectively, and the results were selected to undergo multivariate regression analysis to determine the associated factors. Results: At final follow-up, the back pain VAS score, leg pain VAS score, JOA score and ODI score was 4.06±3.70, 4.90±3.40, 19.98±14.0, and 13.67±8.56 respectively, which showed significant difference compared with the preoperative ones(P<0.05). There were 21 excellent, 60 good, 28 fair and 9 poor, with an excellent-good rate of 74.6%. Based on the radiographic findings, 5 cases had radiolucent line around the screws, srew loosening in 2 cases, bony nonunion in 1 case, bone graft resorption in 1 case. 71(60.2%) cases showed adjacent segment degeneration. Symptomatic adjacent segment degeneration was noted in 13 cases(11.0%). Multiple linear regression analysis showed that sex influenced the postoperative low back pain VAS score; previous history of lumbar surgery and preoperative limb numbness affected postoperative limb pain VAS score. Age affected postoperative ODI(P<0.05). Comorbidities, fusion methods, adjacent segment degeneration, the length of fusion had no effect on the outcome(P>0.05). Conclusions: Lumbar spinal stenosis decompression and fusion is still satisfied for at least five years. Gender, age, previous history of lumbar surgery, preoperative numbness affects the long-term efficacy. |
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