Surgical Treatment of Spinal Stenosis

Cha, Seung Ik; Suk, Se Il; Rha, Jong Deuk; Han, Jin Soo

Abstract

Spinal stenosis was defined as any type of narrowing of the vertebral canal, nerve canals or intervertebral foramina. It is difficult to diagnose spinal stenosis due to obscure symptoms and signs, and there is not established theory on its surgical treatment. Two hundred and three patients who had been treated surgically for lumbar spinal stenosis between 1979 and 1985 at Department of Orthopedic Surgery, Seoul National University Hospital, were studied in an attempt to define the etiology and the diagnosis, and to assess the results of surgical treatment. They were followed up from 1 year to 8 years with average duration of 3.5 years. 1. Degenerative change in the lumbar spine was the principal etiologic factor in 142 patients (70.0%) Spondylolisthesis was found in 47 patients (23 1%). 2. Back pain(81.3%) and intermittent claudication(71.4%) were the predominant symptoms, and sensory (61.1%) and motor(59.6%) deficit were the leading signs. Limitation of straight leg raising was observed only in 12.3%. 3. The most common myelographic finding was hourglass defect(38.4%) and that of CT was facet joint hypertrophy(97.6%). Preoperative CT with myelographic findings were confirmed intraoperatively in 97.4%, revealing their diagnostic significance. 4. Total laminectomy combined with foraminotomy and posterolateral fusion was the most frequently employed procedure and performed in 153 patients(75.4%). 5. The results were classified as excellent or good in 88.2%. Whether or not Knodt rod was used for internal fixation, there was no statistically significant difference between the two groups in reation to the results(P>0.05). Factors for satisfactory results were adequate decompression and posterolateral fusion with sufficient bone graft.