Neurológia pre prax 6/2009

Lumbar spinal stenosis in the elderly

Introduction: Lumbar spinal stenosis is a relatively common disorder in patients of higher age groups. Opinions on treatment options vary. Material and methods: Sixty-seven patients were operated on for central spinal stenosis at L2–L5 at our department between 2004 and 2008. All were over 60 years of age and 75 % of them had one-level stenosis mostly at L4–L5 or L3–L4. The length of the stenotic segment was 4–9 mm at the site of maximal involvement. The major symptoms included claudications, nocturnal pain, and/or complete chronic cauda equina syndrome. All patients underwent MRI and functional imaging of the lumbar spine. Given their age and the typical finding of osteophytes that had a stabilizing effect, no shift or instability of the lumbar vertebrae were present concurrently. In the case of failure of conservative treatment (rehabilitation, oxygen therapy, staying at a health resort), surgery was usually performed which, in this age group, i. e. the elderly, involved laminectomy with sparing the facets of the intervertebral joints. Results: In the early postoperative period (six weeks), 56 (84 %) patients were improved showing disappearance of paraesthesias and improved ambulation and life comfort. Out of them, 13 (15 %) reported a feeling of weakness in the lumbar area when working. Fifty (75 %) patients were still improved at two years postoperatively. Conclusion: Laminectomy without stabilization is usually an adequate and effective management strategy in patients with lumbar spinal stenosis in this age group. Postoperatively, many patients return to their previous recreational, sports, or work activities.

Keywords: elderly, lumbar spinal stenosis.