Multifactorial Lumbar Stenosis Treated Successfully with Primary Factor Treatment Only
Source: The 2012 AANS/CNS Section on Disorders of the Spine and Peripheral Nerve Annual Meeting , Mar 2012. Orlando Florida.
David A. Ditsworth M.D.; Luis Lombardi M.D.
Multifactorial Spinal stenosis, whether central, lateral or foraminal, affects
millions of Americans. The clinical presentation ranges from asymptomatic
(radiological finding) to neurological claudication and radicular pain.
After exhausting conservative methods of treatment, most surgical solutions
entail generous bone, ligament flavum, articular facet and disc removal. This in
turn could generate, in a high percentage of cases, spinal instability which leads
to fusion and possibly to failed back surgery syndrome.
The present abstract deals with the treatment of multifactorial spinal stenosis
by treating one of the factors, the disc, with a focused lumbar discectomy.
27 cases were obtained from a retrospective chart review from 2009 up to
date. We included cases of patients older than 50 years of age with
multifactorial spinal stenosis diagnosed by MRI and CT scan, interpreted by
independent radiologists. All patients underwent CT scan after discography and
were treated with a focused lumbar discectomy. Ages ranged from 50 to 86;
41% females and 59% males. 70 % of patients presented with a combination
of central, recess and foraminal stenosis; 78% with radicular symptoms, 11%
with lumbago and 11 % with neurological claudication, the latter in combination
with radicular presentation. Average follow up was 8 wks.
Utilizing the MacNabb criteria the results were as follows: 41 % (n=11)
excellent, 52% (n=14) good and 7% (n=2) Fair with a success rate of 93%. No
complications were reported.
The treatment of multifactorial spinal stenosis with solely a primary factor
approach lumbar discectomy is very effective and safe. At the same time it does
not preclude the use of other more invasive surgical options should this
approach be insufficient