Abstract
Introduction
Decompression with fusion is usually recommended in patients with lumbar spinal stenosis (LSS) combined with degenerative lumbar scoliosis (DLS). However, elderly patients with LSS and DLS often have other comorbidities, and surgical treatment must be both safe and effective. The aim of this study was to investigate whether decompression surgery alone alleviates low back pain (LBP) in patients with LSS and DLS, and to identify the predictors of postoperative residual LBP.
Materials and methods
A total of 75 patients (33 males and 42 females) with a mean age of 71.8 years (range 53–86 years) who underwent decompression surgery for LSS with DLS (Cobb angle ≥ 10°) and had a minimum follow-up period of 1 year, were retrospectively reviewed using the Japanese Orthopaedic Association scoring system for the assessment of lumbar spinal diseases (JOA score). Radiographic measurements included coronal and sagittal Cobb angles, apical vertebral rotation (Nash-Moe method), and anteroposterior and lateral spondylolisthesis. Logistic regression analysis was performed to investigate the predictors of residual LBP after surgery.
Results
Forty-nine patients had preoperative LBP, of which 29 (59.1 %) experienced postoperative relief of LBP. Logistic regression analysis demonstrated that the degree of apical vertebral rotation on preoperative radiography was significantly associated with postoperative residual LBP (odds ratio, 8.16, 95 % confidence interval, 1.55–83.81, p = 0.011).
Conclusion
A higher degree of apical vertebral rotation may therefore be an indicator of mechanical LBP in patients with LSS and DLS. Decompression with fusion should be recommended in these patients.
Similar content being viewed by others
References
Airaksinen O, Herno A, Veli T, Saari T, Olavi S (1997) Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine (Phila Pa 1976) 22:2278–2282
Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilkleas F (2000) Lumbar spinal stenosis: conservative or surgical treatment? A prospective 10-year study. Spine (Phila Pa 1976) 25:1424–1435
Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8–10 year results from the maine lumbar spine study. Spine (Phila Pa 1976) 30:936–943
Benner B, Ehni G (1979) Degenerative lumbar scoliosis. Spine (Phila Pa 1976) 4:548–552
Binder DK, Schmidt MH, Weinstein PR (2002) Lumbar spinal stenosis. Semin Neurol 22:157–165
Cobb JR (1948) Outline for the study of scoliosis. Am Acad Orthop Surg Instr Course Lect 5:261–275
Djurasovic M, Carreon LY, Crawford III CH, Zook JD, Bratcher KR, Glassman SD (2012) The influence of preopoerative MRI findings on lumbar fusion clinical outcomes. Eur Spine J 21:1616–1623
Epstein JA, Epstein BS, Lavive LS (1974) Surgical treatment of nerve root compression caused by scoliosis of the lumbar spine. J Neurosurg 41:449–454
Epstein JA, Epstein BS, Lavive LS (1979) Symptomatic lumbar scoliosis with degenerative changes in the elderly. Spine (Phila Pa 1976) 4:542–547
Frazier DD, Lipson SJ, Fossel AH, Katz JN (1997) Association between spinal deformity and outcomes after decompression for spinal stenosis. Spine (Phila Pa 1976) 22:2025–2029
Freynhagen R, Rolke R, Baron R, Tölle TR, Rutjes AK, Schu S, Treede RD (2008) Pseudoradicular and radicular low-back pain: a disease continuum rather than different entities? Answers from quantitative sensory testing. Pain 135:65–74
Fujiwara A, Kobayashi N, Saiki K, Kitagawa T, Tamai K, Saotome K (2003) Association of the japanese orthopaedic association score with the oswestry disability index, roland-morris disability questionnaire, and short-form 36. Spine (Phila Pa 1976) 28:1601–1607
Gelalis ID, Stafilas KS, Korompilias AV, Zacharis KC, Beris AE, Xenakis TA (2006) Decompressive surgery for degenerative lumbar spinal stenosis. Int Orthop 30:59–63
Grob D, Humke T, Dvorak J (1995) Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am 77:1036–1041
Hansraj KK, O’Leary PF, Cammisa FP, Hall JC, Fras CI, Cohen MS, Dorey FJ (2001) Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis. Clin Orthop Relat Res 384:18–25
Herno A, Airaksinen O, Saari T (1993) Long-term results of surgical treatment of lumbar spinal stenosis. Spine (Phila Pa 1976) 18:1471–1474
Iguchi T, Kurihara A, Nakayama J, Sato K, Kurosaka M, Yamasaki K (2000) Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 14:1754–1759
Izmida S, Inoue S (1986) Assessment of treatment for low back pain. J Jpn Orthop Assoc 60:391–394 (in Japanese)
Johnsson KE, Uden A, Rosen I (1991) The effect of decompression on the natural course of spinal stenosis. A comparison of surgically treated and untreated patiedts. Spine (Phila Pa 1976) 16:615–619
Jonsson B, Annertz M, Sjoberg C, Stromqvist B (1997) A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: Five-year follow-up by an independent observer. Spine (Phila Pa 1976) 22:2938–2944
Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH (1996) Seven to ten-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 21:92–98
Kirkaldy-Willis WH, Farfan HF (1982) Instability of the lumbar spine. Clin Orthop Relat Res 165:110–123
Kleinstueck FS, Fekete TF, Mannion AF, Grob D, Porchet F, Mutter U, Jeszenszky D (2012) To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer? Eur Spine J 21:268–275
Kobayashi T, Atsuta Y, Takemitsu M, Matsuno T, Takeda N (2006) A prospective study of de novo scoliosis in a community based cohort. Spine (Phila Pa 1976) 31:178–182
Kostuik JP, Israel J, Hall JE (1973) Scoliosis surgery in adults. Clin Orthop 93:225–234
Kostuik JP, Bentivoglio J (1981) The incidence of low-back pain in adult scoliosis. Spine (Phila Pa 1976) 6:268–273
Kuslich SD, Ulstrom CL, Michael CJ (1991) The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am 22:181–187
Murata Y, Takahashi K, Hanaoka E, Utsumi T, Yamagata M, Moriya H (2002) Changes in scoliotic curvature and lordotic angle during the early phase of degenerative lumbar scoliosis. Spine (Phila Pa 1976) 27:2268–2273
Nash CL, Moe JH (1969) A study of vertebral rotation. J Bone Joint Surg Am 51:223–229
Panjabi MM (2003) Clinical spinal instability and low back pain. J Electromyogr Kinesiol 13:371–379
Pao JL, Chen WC, Chen PQ (2009) Clinical outcomes of microendoscopic decompressive laminotomy for degenerative lumbar spinal stenosis. Eur Spine J 18:672–678
Ploumis A, Transfeldt EE, Gilbert TJ, Mehbod AA, Dykes DC, Perra JE (2006) Degenerative lumbar scoliosis: radiographic correlation of lateral rotatory olisthesis with neural canal dimensions. Spine (Phila Pa 1976) 31:2353–2358
Ploumis A, Transfeldt EE, Denis F (2007) Degenerative lumbar scoliosis associated with spinal stenosis. Spine J 7:428–436
Pritchett JW, Bortel DT (1993) Degenerative symptomatic lumbar scoliosis. Spine (Phila Pa 1976) 18:700–703
Simmons ED (2001) Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Clin Orthop Relat Res 384:45–53
Transfeldt EE, Topp R, Mehbod AA, Winter RB (2010) Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine (Phila Pa 1976) 35:1872–1875
Turner JA, Er Teek M, Herron L, Deyo R (1992) Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine (Phila Pa 1976) 17:1–8
Velis KP, Thorne RP (1979) Lateral spondylolisthesis in idiopathic scoliosis. Orthop Trans 3:282
Yang KH, King AI (1984) Mechanism of facet load transmission as a hypothesis for low-back pain. Spine (Phila Pa 1976) 9:557–565
Conflict of interest
No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tsutsui, S., Kagotani, R., Yamada, H. et al. Can decompression surgery relieve low back pain in patients with lumbar spinal stenosis combined with degenerative lumbar scoliosis?. Eur Spine J 22, 2010–2014 (2013). https://doi.org/10.1007/s00586-013-2786-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-2786-5