The Clinical Research Study On Surgical Treatment Of Lumbar Spinal Stenosis In The Elderly Patients Above65

Objective To evaluate the surgical results of lumbar spinal stenosis in the elderly and to investigate the indications, surgical technical and factors which may contribute to the outcome.Methods This is a retrospective study of673patients aged65and above who had different kinds of decompression laminectomy for lumbar spinal stenosis between1990and2012. The mean age at surgery was71.43years (65-88years old).486cases had co-existing illnesses.62had concomitant degenerative spondylolisthesis.488had spinal instrumentation. Functional result was graded to excellent, good, fair and poor.Results There were86.5%excellent and good,10.5%fair and19cases poor results. Eight patients had re-operations because of post operation hematomas. Multivariate analysis revealed that age, sex, co-morbidity score, number of levels decompressed, and degenerative spondylolisthesis did not predict worse outcomes.Conclusions The surgical results of spinal stenosis in the elderly are favourable and comparable to those reported for the general population.Carefully perioperative preparation is very important in the treatment of old patient’s of lumbar spinal stenosis. Objective To investigate the long-term regularity of the radiology changes of the spine of old patients with degenerative lumbar spinal stenosis after laminectomy through analysis of X-ray data of73patients.Methods The mean age of all patients at surgery was73.3years (range,65-87). The average follow-up period was7.3years (range,5-16years). We analyzed and compared the radiological change of73patients, which consisted of the relative distance and migration between vertebral body, the dynamic vertebral sagittal rotation between flexion and extension, relatively horizontal rotation of the segment, coronal dynamic rotation of the segment.Results There was significant difference between preoperative and postoperative data of the relative distance (P=0.001) between vertebral body and the dynamic vertebral sagittal rotation (P=0.01) and relatively horizontal rotation (P=0.01) of the146segments only treated by laminectomy. No significant difference was found between preoperative and postoperative data of all the index of the112segments up and down adjacent segment treated by laminectomy (P>0.05)Conclusions There was obvious degenerative appearance in the segment by laminectomy of the old patients with degenerative lumbar spinal stenosis after laminectomy. There was no obviously degenerative appearance in the up and down adjacent segment. Objective To analysis fusion effect through comparing lumbar posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF).Methods The data of patient who were admitted in Orthopedics of Beijing Hospital of the Ministry of Health were retrospectively analyzed during January1996to December2011. I:PLF group,116cases, II:PLIF group,197cases. We analyze the data of fusion, operative time, operative blood-loss and complications statistically.Results The PLF group fusion rate was84.5%while the PLIF group was98%. The average operative time of PLF group was247.83min (120-480min) while the PLIF group was240.58min (90-600min). The PLF group blood-loss was1142.87ml (200-4500ml); the PLIF group was927.02ml (200-2800ml).38cases of the PLF group developed complications;36cases of the PLIF group developed complications. There are significant differences in fusion, operative time, operative blood-loss, complications, differences between the two groups were were significant statisticallyConclusion PLIF group is better than PLF group on fusion rate and fusion grade.