Dekompression bei lumbaler Spinalstenose. Positive und negative Einflussfaktoren für den Ausgang einer Dekompressionsoperation

Study Design: Retrospective clinical study. Objective: To test whether there are independent factors that positively or negatively influence the outcome of decompression in lumbar spinal stenosis in long-term follow-up. Summary of Background Data: After a conservative therapeutic approach decompressive surgery is widely recommended in lumbar spinal stenosis. However, the outcome of the decompression often is not very satisfying. A high number of patients still suffer from back pain or other symptoms of lumbar spinal stenosis after being operated. To know about independent factors that exert influence on the outcome of a surgical decompression would maybe lead to changes in decision whether to operate or not. Methods: Retrospective clinical study of one hundred patients (mean age: 70 years) with symptomatic lumbar spinal stenosis that underwent decompressive surgery between 2002 and 2006 in the Asklepios Klinik Barmbek or Schön Klinik Eilbek. Results: 100 patients could be evaluated with a mean follow-up of 26.4 months (range: 4.8–70.8 months). Significantly better outcomes of decompressive surgery were achieved with the preoperative factors good physical fitness, isolated or mostly leg pain and no or little back pain, moderate degree of stenosis (no severe stenosis) and a high SF–36-score which means absence of a depressive mind. Tendencies of a worse outcome were seen in a long history, high BMI, back injuring work, more than 3 co-morbidities, urinary incontinence and a central or bilateral localisation of stenosis. No influence regarding the surgical outcome were seen in the factors age, gender, consumption of alcohol or nicotine, preoperative walking distance, faecal incontinence, number of levels affected by stenosis, acute EMG-damages or simultaneous fusion of segments with decompression. 74% of the patients reputed the surgery as a success, evaluated by Oswestry Disability Index and Numeric Analogue Scale the success was even 82% and 79%. Conclusion: Anamnesis of Patients with lumbar spinal stenosis is very important for assessing the present problem and the mental health, thus anamnesis is crucial for the success of decompressive surgery. Conservative treatment is principally the first level of treatment but should not be carried out too long if not successful since the prosperity of surgery decreases the longer the period of anamnesis. The patients should be informed about the fact that the decompression will probably not eliminate all pain or problems, but only part of it to increase the quality of life, and will mostly influence the leg pain, not the back pain.