Browsing by Subject "Outcome"

Background: Cervical spondylotic myelopathy (CSM) is a severe degenerative disease of the spine and can lead to significant functional deterioration. Multilevel disease is generally approached with a posterior surgery by either decompressive laminectomy with or without fusion or laminoplasty. Published long-term follow up studies of laminectomy without fusion are scarse. Objective: To retrospectively analyse clinical data of three cohorts of patients who have undergone cervical laminectomy without fusion for CSM at the Department of Neurosurgery in Helsinki University Hospital between years 2000-2011 (n=340 patients) and evaluate the incidence of further cervical surgeries and risk for cervical misalignment as well as current functional status, neck symptoms and quality of life. Results: The subjective clinical outcome was reported good or excellent on the Likert scale by 72 % of the patients in short term clinical follow up. 41 (12.1%) patients had later underwent another cervical surgery. 10 (24 %) of these surgeries were wound revisions, 21 (51 %) early re-decompressions within a year from initial laminectomy and 10 (24 %) decompressions due to further stenosis later during the follow-up of mean 8.5 years (maximum follow-up 17.5 years). The most common indication for further surgery was residual stenosis on adjacent or other cervical levels (14 patients, 34 %). Only 5 (1 %) patients required a further surgery for correction of a sagittal balance problem, namely for olisthesis developing in the area of the laminectomy. In X-ray studies the mean change in sagittal alignment was 4.0 towards lordotic posture and a newly developed kyphosis was found in 3 of 40 (7.5 %) patients median 9.4 years after index laminectomy. The mean Neck Disability Index percentage was 28 % median 9.0 years after laminectomy indicating mild self-rated disability. The mean EQ-5D index score was 58.8 and the mean EQ-VAS 61.1 indicating reduced health related quality of life when compared to a control cohort from the general population selected by propensity matched scoring and also to population norms. Nurick score below 3 before laminectomy or at the follow-up visit (mean 83 days after laminectomy) were statistically significant factors for both, better EQ-5D index score and EQ-VAS. Conclusions: As CSM is a progressive condition, some degree of progression even after surgical treatment might occur and therefore need for further interventions may be necessary. However, the development of post-laminectomy kyphosis and need for correction of sagittal alignment problems is rare. Large randomized studies comparing different approaches would be needed to determine the optimal treatment for multilevel CSM. However, the very low incidence of kyphosis development after laminectomy and in particularly the low rate of corrective surgery needed for alignment issues per se well justifies the role of simple laminectomy in treatment of multilevel CSM.

The role of lumbar fusion in the treatment of degenerative lumbar conditions is still under debate with evidence both in favour and against the addition of fusion to decompressive surgery. Our aim was to assess the symptom-specific outcome for lumbar spinal fusion surgery at 3, 12 and 23 months and examine the rate of reoperations during a 7-year mean follow-up time span. We conducted an open-cohort retrospective study on 357 patients, who had undergone lumbar spinal fusion surgery for degenerative causes at the neurosurgical department of Töölö Hospital during 2007–2013. Patients were divided into four groups based on the baseline dominant symptom; stabbing back or radicular stabbing pain, non-stabbing back pain, radicular non-stabbing pain or neurosensory impairment, and radicular motor impairment. Outcome was assessed using a 3-tier Likert scale at 3, 12 and 23 months after the lumbar fusion operation. The baseline dominant symptom of stabbing back or radicular stabbing pain was associated with the most beneficial outcome at 12 and 23 months (p < 0.01). 19% of patients had undergone reoperations related to a degenerative lumbar condition within a mean of 7 years after the fusion surgery; 3% and 16% of patients within one month and after one month, respectively. In conclusion, spinal lumbar fusion was associated with the most beneficial outcome among patients with stabbing back or leg pain as the dominant baseline symptom. Patient-reported outcome measures and control for baseline characteristics are needed for stronger evidence in this subject.