Surgical Treatment of Spinal Stenosis

Keimyung Medical Journal 1999;18(3):387-400.

척추관 협착증의 수술적 치료

강철형; 구재모

Abstract

Spinal stenosis is a fairly common low back disorder characterized by the narrowing spinal canal and compression of neural element with resultant leg pain and/or intermittent claudication. The usual cause of the spinal stenosis is the degenerative changes of the spine; so symptoms of this disease get worse as the patients get older. Our surgical indications include: 1) when the patient cannot walk more than 200-300 meters due to neurogenic intermittent claudication and/or 2) when the nerve root palsy is noted. From January 1996 to December 1998; there were 86 cases of spinal stenosis who underwent surgery. Of them; 9 cases were excluded due to loss of follow up or other causes; and 77cases were included in this study; who have been followed more than 6 months after surgery. Method of operation at first half of the series was bilateral laminotomy and medial facetectomy in most cases. But low back pain with buttock;thigh pain due to facet joint syndrome was common residual symptoms; so I added the procedure of posterior instrumentation and lateral fusion for decompression. We had analyzed symptoms and results of operation according to Kirkaldy-Willis' criteria. Of the 77 cases; results were graded as excellent or good m 69 cases(88.3%);and fair or poor in 9 cases(11.7%). The result of decompression with instrumentation and fusion was better (91.7% Excellent or Good results) than that of decompression procedure only (82.8% Good or Excellent results). The problem in fusion group was the bone graft site pain. But this pain was self-limited in most cases or was controllable by medication or local steroid injection in some cases Fusion was achieved in 72 1% of cases; which was interpreted by simple X-ray

Key Words: Spinal Stenosis, Decompression, Laminotomy, Medial Facetectomy, la-lateral fusion