Degenerative lumbar spinal stenosis - Long-term results after undercuttingdecompression compared with decompressive laminectomy alone or with instrumented fusion

The aim of the study was to evaluate the longterm outcome of various surgic al procedures for lumbar spinal stenosis. Operations were performed on 117 consecutive patients for lumbar spinal stenosis between 1987 and 1992. Pre- and intraoperative data were recorded in a standardized manner. Three trea tment groups were distinguished: group I consisting of 39 patients submitte d to undercutting decompression; group II, 51 patients, submitted to lamine ctomy and foraminal decompression alone: and group III, 27 patients, who un derwent foraminal decompression and laminectomy with instrumented fusion. E ight years (5-10 years) after surgery a questionnaire was mailed to the pat ients containing the outcome scales according to Greenough and Fraser [6] a nd Turner et al. [22] together with questions about residual pain, necessit y of treatment and satisfaction with the operative outcome. A total of 72 q uestionnaires (61.6%) gave enough information for analysis. After a mean fo llow-up of 8 years, walking capacity had increased significantly in all gro ups (P < 0.001). Compared to preoperative values. pain had decreased signif icantly in all groups (P < 0.01). In group I 36% had good-to-excellent outc omes, and 30.8% and 23.8% in groups II and III (P > 0.05). Forty percent of group I patients were unsatisfied with the result, compared to 38.4% and 3 3.3% in the other groups (P > 0.05). Overall, 25 of 72 patients (34.7%) had severe constant back and/or leg pain requiring daily administration of ana lgesics. We conclude that the long-term outcome of decompressive surgery of the lumbar spinal canal, without and with instrumented fusion, is less fav ourable than was previously reported.