Choosing Patients for Laminectomy Based on X-rays
Narrowing of the spinal canal called stenosis is a common problem among older adults. Back and leg pain from this condition can be very disabling. Surgery to remove a piece of the vertebral bone may be helpful. This procedure is called a decompressive laminectomy. Removing this fragment of bone takes the pressure off the spinal cord.
Laminectomy for spinal stenosis is more likely to relieve the leg pain than the back pain. Up to one-third of all patients having a laminectomy for lumbar spinal stenosis continue to report low back pain after surgery.
In this study, researchers used X-ray findings to study patients with lumbar spinal stenosis. They looked for factors that might predict which patients will end up with residual low back pain. All patients had stenosis at one level causing painful symptoms. Laminectomy was performed on each patient.
After the operation, patients were divided into two groups based on pain response. The recovery group had improvement in test scores for pain and function. Symptoms in the nonrecovery group were unchanged. The difference between the two groups was compared using X-rays of the lumbar spine.
The authors found two important factors. These included having a flat back and the loss of lumbar mobility before surgery. Patients with both of these were most likely to have a poor result after a laminectomy for lumbar spinal stenosis. They had ongoing residual back pain that never went away.
Studies so far have suggested that avoiding LBP after surgery for lumbar spinal stenosis is difficult, if not impossible. The results of this study point to the idea that the key to success is in choosing the right patients for this type of surgery.
The angle of the lower lumbar spine and motion in the lumbar area are the most important factors. A natural curve in the low back called lumbar lordosis and normal lumbar motion seen on X-rays before surgery predict a more successful result.
These findings suggest that X-rays can be used to identify patients who might benefit the most from laminectomy for spinal stenosis. Factors such as age, gender, and duration of symptoms did not seem to make a difference in relieving pain.
Yingpeng Xia, MD, et al. Radiographic Predictors of Residual Low Back Pain After Laminectomy for Lumbar Spinal Canal Stenosis. In Journal of Spinal Disorders & Techniques. May 2008. Vol. 21. No. 3. Pp. 153-158.