RESUMEN
All patients who underwent decompressive lumbar laminectomy in the Washtenaw County, Michigan metropolitan area during a 7-year period were studied for the purpose of defining long-term outcome, clinical correlations, and the need for subsequent fusion. Outcome was determined by questionnaire and physical examination from a cohort of 119 patients with an average follow-up evaluation interval of 4.6 years. Patients graded their outcome as much improved (37%), somewhat improved (29%), unchanged (17%), somewhat worse (5%), and much worse (12%) compared to their condition before surgery. Poor outcome correlated with the need for additional surgery, but there were few additional significant correlations. No patient had a lumbar fusion during the study interval. The outcome after laminectomy was found to be less favorable than previously reported, based on a patient questionnaire administered to an unbiased patient population. Further randomized, controlled trials are therefore necessary to determine the efficacy of lumbar fusion as an adjunct to decompressive lumbar laminectomy.
Asunto(s)
Laminectomía , Estenosis Espinal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Empleo , Femenino , Estudios de Seguimiento , Humanos , Pierna/fisiopatología , Dolor de la Región Lumbar/fisiopatología , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Dolor/fisiopatología , Satisfacción del Paciente , Selección de Paciente , Reoperación , Trastornos de la Sensación/fisiopatología , Fusión Vertebral , Estenosis Espinal/fisiopatología , Resultado del Tratamiento , Caminata/fisiologíaRESUMEN
The pre- and postoperative lumbar spine radiographs of 119 patients who underwent decompressive lumbar laminectomy were studied to evaluate radiographic changes and to correlate them with clinical outcome. An accurate and reproducible method was used for measuring pre- and postoperative radiographs that were separated by an average interval of 4.6 years. Levels of the spine that underwent laminectomy showed greater change in spondylolisthesis, disc space angle, and disc space height than unoperated levels. Outcome correlated with radiographic changes at operated and unoperated levels. This study demonstrates that radiographic changes are greater at operated than at unoperated levels and that some postoperative symptoms do correlate with these changes. Lumbar fusion should be considered in some patients who undergo decompressive laminectomy. The efficacy of and unequivocal indications for lumbar fusion can only be determined from randomized, prospective, controlled trials, however, and these studies have not yet been undertaken.