Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study
1 Department of Neurosurgery, St. Olavs Hospital HF, N-7006 Trondheim, Norway
2 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, N-7005, Trondheim, Norway
3 Department of Neurosurgery, University Hospital of North Norway, N-9038 Tromsø, Norway
4 The Norwegian National Registry for Spine Surgery, SKDE, North Norway Regional Health Authority, Tromsø, Norway
5 Department of laboratory medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
6 National Center for Spinal Disorders, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
7 Department for Applied Clinical Research, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
8 Department of Neuroscience, Norwegian University of Science and Technology, N-7005, Trondheim, Norway
BMC Surgery 2010, 10:34 doi:10.1186/1471-2482-10-34Published: 22 November 2010
To assess safety, risk factors and clinical outcomes in elderly patients with spinal stenosis after decompressive laminectomy.
A prospective cohort of patients 70 years and older with spinal stenosis undergoing conventional laminectomy without fusion (n = 101) were consecutively enrolled from regular clinical practice and reassessed at 3 and 12 months. Primary outcome was change in health related quality of life measured (HRQL) with EuroQol-5 D (EQ-5D). Secondary outcomes were safety assessment, changes in Oswestry disability index (ODI), Visual Analogue Scale (EQ-VAS) score for self reported health, VAS score for leg and back pain and patient satisfaction. We used regression analyses to evaluate risk factors for less improvement.
The mean EQ-5 D total score were 0.32, 0.63 and 0.60 at baseline, 3 months and 12 months respectively, and represents a statistically significant (P < 0.001) improvement. Effect size was > 0.8. Mean ODI score at baseline was 44.2, at 3 months 25.6 and at 27.9. This represents an improvement for all post-operative scores. A total of 18 (18.0%) complications were registered with 6 (6.0%) classified as major, including one perioperative death. Patients stating that the surgery had been beneficial at 3 months was 82 (89.1%) and at 12 months 73 (86.9%). The only predictor found was patients with longer duration of leg pain had less improvement in ODI (P < 0.001). Increased age or having complications did not predict a worse outcome in any of the outcome variables.
Properly selected patients of 70 years and older can expect a clinical meaningful improvement of HRQL, functional status and pain after open laminectomy without fusion. The treatment seems to be safe. However, patients with longstanding leg-pain prior to operation are less likely to improve one year after surgery.