2013, Number 2
<< Back Next >>
Revista Cubana de Ortopedia y Traumatología 2013; 27 (2)
Surgical treatment of degenerative lumbar stenosis in elderly patients based on imaging findings
Tabares NHI, Díaz QJM, Tabares SH, Tabares SL
Language: Spanish
References: 22
Page: 157-172
PDF size: 430.76 Kb.
ABSTRACT
Introduction: degenerative lumbar stenosis in elderly patients is a serious health problem.
Objective: demonstrate the validity of the surgical treatment of degenerative lumbar stenosis in elderly patients when decision on what technique to apply is based on Xray
and magnetic resonance imaging findings.
Methods: a study was conducted of 102 patients aged over 65 cared for at the Center for Research on Longevity, Aging and Health from 1 January 2002 to 31 December 2008. The variables considered were age, sex, location, main comorbid conditions, and classification based on X-ray and magnetic resonance imaging. Decision on the surgical technique to apply was based on imaging findings. The
Oswestry index and the Pain Visual Analog Scale were used as evaluation instruments. The surgical techniques applied were simple release, recalibration and laminectomy, instrumentation and fusion.
Results: there was a predominance of male patients in the 65-70 age group with location at two vertebral levels and cardiovascular comorbid conditions. The largest number of cases were classed as degrees 3 and 4 on Kellgren's scale, and IV and V on Pfirrmann's. The Oswestry index and the Pain Visual Analog Scale showed significant improvement at two years, and 88 % of the results obtained were good.
Conclusions: determination of the surgical technique to apply based on imaging findings makes it possible to obtain good results in a high percentage of the patients
undergoing surgery. There is an appropriate relationship between imaging findings and surgical technique.
REFERENCES
Oficina Nacional de Estadísticas, CEPDE. Esperanza de vida. Cuba y provincias. 2005-2007. Cálculo por sexo y edades. La Habana: ONE; 2008 [citado 5 Mar 2012]. Disponible en: http://www.one.cu/esperanzadevida.htm
Santos Coto C, Rivas Hernández R, Fleites Marrero E. Tratamiento quirúrgico de la estenosis del canal lumbar. Rev Cubana Ortop Traumatol. 2009 [citado 28 Nov 2012 ];23(2). Disponible en: http://scielo.sld.cu/scielo.php?script=sci _arttext&pid=S0864-215X2009000200002&lng=es
Garfin SR, Rydevik BL, Lipson S. Estenosis del conducto raquideo: Mc Graw Hill; Rothman-Simeone. 5 ed. México, D: F.: The Spine;2010.
Dai SM, Shann ZZ, Nakamura H. Catabolic stress induces features of chondrocyte senescence of through overexpression of caveolin 1: possible involvement of caveolin 1-induced down-regulation of articular chondrocytes in the pathogenesis of osteoarthritis. Arth Rheum. 2006;54:818-31.
Zhou G-Q, Yang F, Leung VVL. Molecular and cellular biology of the intervertebral disc and the use of animal models. Current Orthopaedics. 2008;22:267-73.
Singh K, Masuda K, Thonar Eugene JM. Age-Related Changes in the Extracellular Matrix of Nucleus Pulposus and Anulus Fibrosus of Human Intervertebral Disc. Spine. 2009;34(1):10-6.
Shirazi-Adl A. Analysis of cell viability in intervertebral disc: Effect of endplate permeability on cell population. J Biomechanics. 2010;43(7):1330-6.
Johann S, Simon R. Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. Musculoskeletal Disord. 201112:75.
Shabat S, Folman Y. Failure of conservative treatment for lumbar spinal stenosis in elderly patients. Arch Gerontology Geriatrics. 2007;44:235-41.
Lucy H, Gerit K, Delphine R. Is spinal stenosis assessment dependent on slice orientation? A magnetic resonance imaging study. Eur Spine J. 2012;Suppl 6:S760-4.
Morita M, Miyauchi A, Okuda S, Oda T. Comparison between MRI and myelography in lumbar spinal canal stenosis for the decision of levels of decompression surgery. J Spinal Disord Tech. 2011;4:31-6.
Schizas C, Theumann N. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine. 2010;35(21):1919-24.
Wassenaar M, van Rijn RM. Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J. 2012;21(2):220-7.
Kellgren JH, Lawrence JS. Osteoarthrosis and disc degeneration in an urban population. Ann Rheum Dis. 1958;17:388-97.
Pfirrmann CW, Metzdorf A, Zanetti M. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001;26:1873-8.
Best NM, Sasso RC. Outpatient Lumbar Spine Decompression in 233 patients 65 Years of Age or Older. Spine. 2007;32(10):11359.
Cassinelli EH, Eubanks J, Vogt M, Furey C, Yoo J, Bohlman H. Risk Factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis. An Analysis of 166 Patients. Spine. 2007;32(2):2305.
Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;3:1259-65.
Jakola AS, Sorlie A, Gulati S, Nygaard OP, Lydersen S, Solberg T. Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study. BMC Surgery. 2010;10:34.
Li G, Patil ChG, Lad SP, Ho C, Tian W, Boakye M. Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine. 2008;33(11):1250-5.
Jansson KA, Németh G, Granath F, Jönsson B, Blomqvist P. Health-related quality of life (EQ-5D) before and one year after surgery for lumbar spinal stenosis. J Bone Joint Surg [Br]. 2009;91:210-6.
Strömqvist F, Jönsson B, Strömqvist B. Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome. Eur Spine J. 2012;21:8258.