Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis

Between 1990 and 1993, 54 consecutive patients were treated with decompress ion, fusion and instrumentation surgery for complex lumbar spinal stenosis. The mean age of the patients was 60 years. The average followup was 39 mon ths. Clinically, there was one deep wound infection, and three mechanical f ailures. There were two staged operations. There were three revision surger ies performed for mechanical reasons. Of the 47 patients who completed the questionnaire, 96% of patients were very satisfied or somewhat satisfied wi th the operation, 98% were satisfied with relief of pain, 94% were satisfie d with their ability to walk, 89% were satisfied with their strength, and 9 4% were satisfied with balance. Survivorship analysis (failure endpoint was revision surgery) revealed that at the end of 4 years, the patient had a 9 2% chance of not undergoing revision surgery for any reason (mechanical and infectious), and a 94% chance of not undergoing revision surgery for mecha nical reasons. Lumbar decompression, fusion, and instrumentation surgery se ems to be efficacious in patients with complex lumbar spinal stenosis (asso ciated previous lumbar spine operations with evidence of radiographic insta bility, radiographic evidence of junctional stenosis after surgery, radiogr aphic evidence of instability, degenerative spondylolisthesis greater than Grade I with instability, if present, and degenerative scoliosis with a cur ve greater than 20 degrees).