Artikel
Decompression and instrumented fusion for lumbal stenosis and degenerative spondylolisthesis
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Autoren
Veröffentlicht: | 13. Juni 2005 |
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Gliederung
Text
Problem
The management of patients with lumbar stenosis and degenerative spondylolisthesis has two aspects: at first the sufficient decompression of the neural elements and secondly to guarantee the stability.
Material. A consecutive series of 244 patients with lumbar stenosis and/or degenerative spondylolisthesis were retrospectively reviewed. The examination of these patients was performed initially after surgery and thereafter at 3-months intervals. Clinical outcome was analyzed by Prolo scale. The follow-up period was in average 36 months.
Methods
In all patients with lumbar stenosis and/or degenerative spondylolisthesis an extensive decompression was performed, Spondylodesis with autologous bone impacted intercorporelly and pedicle screws followed decompression in all cases.
Results
Based on Prolo scale, an excellent or good 1-year outcome was achieved in 73,4% of patients. Moderate improvement could be found in 25,5% and 1,1% of the patients had no benefit from the surgery. The rate of good outcome was in cases with lumbar stenosis 78,6% and in cases with degenerative spondylolisthesis 77,0%. However, patients with previous spinal surgery showed an improvenemt in 66,2%. Interbody fusion could be proved in 90% using x-ray or CT-scan. Surgical revision was necessary in 3,2% because of radicular lesion due to incomplete decompression or incorrect position of the pedicle screws. Additional surgery because instability in the adjacent vertebral segment was performed in 7,4%.
Discussion
The results of our study indicate that the outcome in cases with lumbar stenosis and/or degenerative spondylolisthesis is excellent or good in more than 75% of patients after surgery with extensive decompression and instrumentated spondylodesis.