The Long-Term Results of Surgical Treatment for Spinal Stenosis in the Elderly

HT Hee, HK Wong
Correspondence: A/Prof Wong Hee Kit, doswhk@nus.edu.sg

ABSTRACT
Purpose To evaluate the surgical results of spinal stenosis in the elderly and to investigate which factors may contribute to a poor outcome.
Methods This is a retrospective study of 68 patients aged 60 and above who had decompression laminectomy for lumbar spinal stenosis between 1989 and 1991. They were evaluated at an average of eight years after surgery. The mean age at surgery was 68 years. Twenty-eight had co-existing illnesses. Twenty-one had concomitant degenerative spondylolisthesis. Thirty-two (47%) had decompression laminectomy performed at one level. Eleven (16%) had arthrodesis. Seven had spinal instrumentation, of which six were Hartshill rectangles. Functional result was graded using modified Paine classification. Multivariate analysis with logistic and linear regression was used to determine predictors of poorer outcomes.
Findings There were 68% excellent and good, 22% fair and 10% poor results. Back pain was relieved in 91% of the patients. Leg pain was relieved in 76% of the patients. Numbness was relieved in 87% of the patients. Five patients had re-operations. Multivariate analysis revealed that age, sex, co-morbidity score, number of levels decompressed, and degenerative spondylolisthesis did not predict worse outcomes. However, Hartshill rectangle instrumentation and pre-operative leg numbness predicted less favourable results.
Conclusion The surgical results of spinal stenosis in the elderly are favourable and comparable to those reported for the general population at an eight-year follow-up.

Keywords: Decompression laminectomy, elderly, Fusion, Hartshill rectangles, Spinal stenosis
Singapore Med J 2003; 44(4): 175-180