Advertisement

LO SCALPELLO-OTODI Educational

, Volume 26, Issue 3, pp 123–128 | Cite as

La stenosi del canale vertebrale lombare: il trattamento stabilizzante decompressivo

  • S. Aleotti
  • P. Viglierchio
  • A. Coniglio
Aggiornamenti
  • 128 Downloads

Abstract

Patients with lumbar spinal stenosis may be treated non-operatively or surgically by decompression alone or by decompression with instrumentation (fusion or not fusion). Preservation of spinal stability is critical to prevent late failure. To avoid iatrogenic instability is mandatory to maintain facet joint integrity by undercutting them instead of excision. When spinal stenosis is associated with instability, degenerative spondylolisthesis, deformity, postoperative instability, or recurrent stenosis, intervertebral instrumented fusion is recommended. Elderly patients aged over 70 years benefit from lumbar decompression and posterolateral fusion with instrumentation and there is no need to force an intersomatic fusion with the related surgical complications. The indirect decompression techniques have still not yet had widespread consensus and they need further randomized controlled trials.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Bibliografia

  1. 1.
    Ciol MA, Deyo RA, Howell E, Kreif S. An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc 1996;44:285–290PubMedGoogle Scholar
  2. 2.
    Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F. Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Spine 2000;25:1424–1435; discussion 35–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Katz JN, Lipson SJ, Lew RA, Grobler LJ, Weinstein JN, Brick GW, et al. Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes. Spine 1997;22:1123–1131Google Scholar
  4. 4.
    Hansraj KK, O’Leary PF, Cammisa Jr FP, Hall JC, Fras CI, Cohen MS, et al. Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosisGoogle Scholar
  5. 5.
    Yong-Hing K, Kirkaldy-Willis WH. The pathophysiology of degenerative disease of the lumbar spine Orthop Clin North Am 1983; 14 491–504PubMedGoogle Scholar
  6. 6.
    Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH. Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 1996;21:92–98PubMedCrossRefGoogle Scholar
  7. 7.
    Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 1991;73:802–808PubMedGoogle Scholar
  8. 8.
    Sengupta D K, Herkowitz H. N. Lumbar spinal stenosis: Treatment strategies and indications for surgery Orthop Clin N Am 34 2003 281–295CrossRefGoogle Scholar
  9. 9.
    Postacchini F, Cinotti G. Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg Br 1992;74:862–869PubMedGoogle Scholar
  10. 10.
    Zdeblick TA. A prospective, randomized study of lumbar fusion. Preliminary results. Spine 1993;18: 983–991Google Scholar
  11. 11.
    Mardjetko SM, Connolly PJ, Shott S. Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970–1993. Spine 1994;19:2256S–2265SPubMedCrossRefGoogle Scholar
  12. 12.
    Montgomery DM, Fischgrund JS. Passive reduction of spondylolisthesis on the operating room table: a prospective study. J Spinal Disord 1994;7:167–172PubMedCrossRefGoogle Scholar
  13. 13.
    Truumees E, Herkowitz HN. Lumbar spinal stenosis: treatment options. Instr Course Lect 2001;50:153–161PubMedGoogle Scholar
  14. 14.
    Hanley EN Jr et al,: Who should be fused?: The Adult Spine: Princeples and Practices. New York: Raven Press, 1991; 1893–1917Google Scholar
  15. 15.
    Endres S. et al: Instrumented intervertebral or posterolateral fusion in elderly patients. Clinical results of a single centre. BMC Muscoloskeletal Disorders 2011, 12:189CrossRefGoogle Scholar
  16. 16.
    Kepler C.K. et al. Indirect foraminal decompression after lateral transpsoas interbody fusion. J Neurosurg Spine 16:329–333, 2012PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • S. Aleotti
    • 1
  • P. Viglierchio
    • 1
  • A. Coniglio
    • 1
  1. 1.S.C.Chirurgia VertebraleAzienda Ospedaliera CTO/Maria AdelaideTorinoItaly

Personalised recommendations