Iguchi T, Kurihara A, Nakayama J, Sato K, Kurosaka M, Yamasaki K
Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan.
Spine (Phila Pa 1976). 2000 Jul 15;25(14):1754-9. doi: 10.1097/00007632-200007150-00003.
A retrospective follow-up study was conducted in patients who underwent decompressive laminectomy for degenerative lumbar spinal stenosis.
To describe the long-term outcome of decompressive laminectomy performed for degenerative lumbar spinal stenosis, and to investigate preoperative factors that influenced outcomes, especially risk factors predisposing patients to poor results.
The success rate of surgical treatment of decompressive laminectomy for lumbar spinal stenosis varies. Long-term follow-up investigations have indicated deterioration of outcome; however, the causes of deterioration have not been fully investigated, and there have been no reports with a minimum 10-year follow-up.
Of 151 patients who underwent decompressive laminectomy from 1980 through 1989, 37 were followed up for a minimum of 10 years. The mean age at surgery was 60.9 +/- 8. 2 years (range, 43-76), and the average follow-up period was 13.1 +/- 2.1 years (range, 10.1-17.4). The results were evaluated by the criteria of the Japanese Orthopedic Association Lumbar Score, and the outcome was classified as excellent at more than 75% improved score; good, 50-75%; fair, 25-49%; and poor, 0-24% or less. Information about impairment of activities of daily living was also obtained at follow-up. Associations between preoperative clinical and radiographic variables and clinical outcome were evaluated statistically.
In all patients, the average score improvement of 55.2 +/- 31.6% was regarded as acceptable. The postoperative score and percentage of improvement of low back pain were lower than those of leg pain and walking ability. No impairment in activities of daily living was found in 62.2% of the patients. Rate of improvement was evaluated as excellent in 13 (35.1%), good in 8 (21.6%), fair in 8, and poor in 8 patients. Three patients required additional surgery because of disc herniation at the laminectomied segments. The patients with multiple laminectomy (P = 0.034) and more than 10 degrees preoperative sagittal rotation angle (P = 0.018) showed a significantly poorer outcome than the remainder of the patients.
Long-term follow-up showed that even without spinal fusion, more than half the patients were evaluated as excellent or good. Patients with more than a 10 degrees sagittalrotation angle who need multiple laminectomy, should be given information about the possibility of earlier deterioration of the outcome, and alternative or additional treatment such as concomitant spinal fusion with decompression may be considered.
对因退行性腰椎管狭窄症接受减压性椎板切除术的患者进行了一项回顾性随访研究。
描述因退行性腰椎管狭窄症进行减压性椎板切除术的长期疗效，并调查影响疗效的术前因素，尤其是使患者预后不良的危险因素。
腰椎管狭窄症减压性椎板切除术的外科治疗成功率各不相同。长期随访研究表明疗效会恶化；然而，恶化的原因尚未得到充分研究，且尚无至少10年随访的报告。
在1980年至1989年间接受减压性椎板切除术的151例患者中，37例接受了至少10年的随访。手术时的平均年龄为60.9±8.2岁（范围43 - 76岁），平均随访期为13.1±2.1年（范围10.1 - 17.4年）。结果根据日本骨科协会腰椎评分标准进行评估，结局分类为：改善评分超过75%为优；50 - 75%为良；25 - 49%为中；0 - 24%或更低为差。随访时还获取了日常生活活动障碍的信息。对术前临床和影像学变量与临床结局之间的关联进行了统计学评估。
所有患者的平均评分改善率为55.2±31.6%，被认为是可接受的。术后下腰痛评分及改善百分比低于腿痛和步行能力评分及改善百分比。62.2%的患者日常生活活动无障碍。改善率评估为优的有13例（35.1%），良的有8例（21.6%），中的有8例，差的有8例。3例患者因椎板切除节段的椎间盘突出需要再次手术。接受多节段椎板切除术的患者（P = 0.034）和术前矢状面旋转角度超过10度的患者（P = 0.018）的结局明显比其余患者差。
长期随访表明，即使不进行脊柱融合，超过一半的患者评估为优或良。对于矢状面旋转角度超过10度且需要多节段椎板切除术的患者，应告知其结局可能较早恶化的情况，可考虑替代或额外的治疗，如减压同时进行脊柱融合。
