Surgical options and outcomes of degenerative lumbar spinal stenosis in octogenarian

English Keywords:Degenerative lumbar spinal stenosis  Senile patients  Selective interlaminar fenestration decompression  Transforaminal lumbar interbody fusion

English Abstract:

  【Abstract】 Objectives: To investigate the surgical options and clinical outcomes of degenerative lumbar spinal stenosis in octogenarian patients. Methods: From March 2012 to March 2015, 39 cases who were eighty years or older with degenerative lumbar spinal stenosis and surgically treated in our hospital were reviewed. The follow-up time was at least 1 year. In the series, there were 21 males and 18 females aging from 80-90 years(average age, 82.4±3.1 years). All patients had severe low back pain and lower extremity radiculopathy or neurogenic claudication. All cases experienced conservative treatment, and the symptoms did not alleviate. Thirteen cases suffered from one type of comorbidity, twelve cases suffered from at least 2 types of comorbidities. All the patients could tolerate surgery under general anesthesia according to American Society of Anesthesiologists(ASA) physical status. Twelve patients with primary symptoms of root pain and neurogenic claudication, with no obvious lumbar instability, were treated with selective interlaminar fenestration decompression(decompression group). Twenty-seven patients with lumbar instability or lumbar spondylolisthesis, complex causes of spinal stenosis and a variety of pressure-causing factors, who could withstand major surgery, were treated with transforaminal lumbar interbody fusion(TLIF)(fusion group). Japanese Orthopaedic Association(JOA) score system and visual analogue scale(VAS) scores system were used to evaluate the surgical outcomes. Results: All operations were successfully performed. Twelve cases experienced perioperative complications which improved by conservative treatment. There were three cases in the decompression group(1 case of pneumonia, 1 case of urinary tract infection, 1 case of pneumonia combined with postoperative anemia) and nine cases in the fusion group(3 cases of pneumonia, 1 case of dural tear, 1 case of urinary retention, 1 case of arrhythmia, 1 case of postoperative anemia, 1 case of postoperative cognitive dysfunction, 1 case of urinary tract infection combined with postoperative cognitive dysfunction). No one died in the perioperative period. JOA score in decompression group improved from preoperative 10.8±2.3 to 19±4.8 after surgery. JOA score in fusion group improved from preoperative 11.8±2.2 to 21.8±3.4 after surgery. The differences of JOA scores before and after surgery were statistically significant(P＜0.05) in both groups. The VAS scores of lower back pain and leg pain in both groups at the last follow-up(3.2±1.7 and 3.5±2.1 in decompression group, 3.0±1.2 and 2.9±1.2 in fusion group) were significantly different from those before operation(7.4±0.9 and 7.8±1.0 in decompression group, 7.4±1.7 and 7.7±1.1 in fusion group)(P<0.05). Conclusions: Satisfactory results can be achieved in octogenarian with degenerative lumbar spinal stenosis, by adequately assessing the general condition, properly handling the comorbidity, and selecting reasonable surgical options, which according to clinical symptoms and signs, imaging data, responsible lesion and pathogenic factors.