Main Article Content
Objective: To evaluate the results of DLF in MDLS performed by a single experienced spine surgeon for both radiographic and clinical outcomes.
Materials and Methods: The database of single-institution was retrospectively reviewed. To identify MDLS patients who had undergone DLF (> 2 levels) between 2007 and 2017. Clinical presentation, radiographic measurements, perioperative complications, and postoperative results were analyzed. The Oswestry disability index (ODI) and EuroQol five dimensions’ questionnaire (EQ-5D-5L) were used to evaluate the outcomes comparing the preoperative and the most recent postoperative results.
Results: In total, 84 patients (23 males and 61 females) were enrolled, with an average age of 64.4±8.6 (46-81) years old. Among these, 39 patients had fusion to L5 and 45 patients had fusion to the sacrum. Mean operative time was 66.9+23.4 minutes per level (range: 22.2-140) and the average length of stay was 10.7+5.7 days (range: 5-39). The mean estimated blood loss was 290.6+168.5 ml (range: 21.4-666.7). Average follow-up was 50.0+29.8 months (range: 0.5-124). The average preoperative ODI score was 60.6+16.3 (28-97.8) and 24.2+17.3 (0-71.1) postoperatively, while the average preoperative and postoperative EQ-5D-5L scores were 0.161+0.268 and 0.818+0.225, respectively. Both these clinical scores (ODI and EQ-5D-5L) showed a statistically significant improvement (p < 0.001). Finally, 13% (11/84) of patients had further surgery.
Conclusion: Decompressive laminectomy and long spinal fusion performed in patients with multi-level deteriorating lumbar spinal stenosis are safe and effective in terms of the patients’ quality of life and disability improvement.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
All articles published in the Siriraj Medical Journal (SMJ) are protected by copyright. No material in this journal may be reproduced on any platform including electronic or in print or transmitted by any means, in whole or in part, without the prior written permission of the Editor of the SMJ. Written permission must also be obtained before any part of the SMJ is stored in any retrieval system of any nature.
Sun W, Xue C, Tang XY, Feng H, Yuan F, Guo KJ, et al. Selective versus multi-segmental decompression and fusion for multi-segment lumbar spinal stenosis with single-segment degenerative spondylolisthesis. J Orthop Surg Res. 2019;14(1):46.
Keorochana G, Tawonsawatruk T, Laohachareonsombat W, Wajanavisit W, Jaovisidha S. The results of decompression and instrumented fusion with pedicular screw plate system in degenerative lumbar scoliosis patients with spinal stenosis: a prospective observational study. J Med Assoc Thai. 2010;93(4):457-61.
Sanjaroensuttikul N. The Oswestry low back pain disability questionnaire (version 1.0) Thai version. J Med Assoc Thai. 2007;90(7):1417-22.
Sakthong P, Sonsa-Ardjit N, Sukarnjanaset P, Munpan W. Psychometric properties of the EQ-5D-5L in Thai patients with chronic diseases. Qual Life Res. 2015;24(12):3015-22.
Yabuki S, Fukumori N, Takegami M, Onishi Y, Otani K, Sekiguchi M, et al. Prevalence of lumbar spinal stenosis, using the diagnostic support tool, and correlated factors in Japan: a population-based study. J Orthop Sci. 2013;18(6):893-900.
Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, et al. Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: the Wakayama Spine Study. Osteoarthritis Cartilage. 2012;20(10):1103-8.
Srisajjakul S, Chawalparit O. Multiplanar Reconstruction Computed Tomography of Lumbar Spinal Stenosis in Correlation with Surgical Findings: Initial Experience. Siriraj Med J. 2003;55(8):478-90.
Lee CH, Chung CK, Sohn MJ, Kim CH. Short Limited Fusion Versus Long Fusion With Deformity Correction for Spinal Stenosis With Balanced De Novo Degenerative Lumbar Scoliosis: A Meta-analysis of Direct Comparative Studies. Spine (Phila Pa 1976). 2017;42(19):E1126-E32.
Siripohn P, Visavajarn P, Suwannatrai U, Suwannatrai S, Butdapan P, Ruangchainikom M. The Effects of the Thai Traditional Medicine of Abdominal Massage on Defecation in Post Lumbar Laminectomy Patients. Siriraj Med J. 2019;71(3):214-9.
Fan G, Wu X, Yu S, Sun Q, Guan X, Zhang H, et al. Clinical Outcomes of Posterior Lumbar Interbody Fusion versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in Three-Level Degenerative Lumbar Spinal Stenosis. Biomed Res Int. 2016;2016:9540298.
Wu H, Yu WD, Jiang R, Gao ZL. Treatment of multilevel degenerative lumbar spinal stenosis with spondylolisthesis using a combination of microendoscopic discectomy and minimally invasive transforaminal lumbar interbody fusion. Exp Ther Med. 2013;5(2):567-71.
Son S, Kim WK, Lee SG, Park CW, Lee K. A comparison of the clinical outcomes of decompression alone and fusion in elderly patients with two-level or more lumbar spinal stenosis. J Korean Neurosurg Soc. 2013;53(1):19-25.