title: Results of surgery for spinal stenosis adjacent to previous lumbar fusion.
abstract: The literature provides little data to guide surgical management of spinal stenosis adjacent to previous lumbar fusion. Thirty-three consecutive patients who had surgical decompression for spinal stenosis at the lumbar segments adjacent to a previous lumbar fusion were studied. The mean interval between fusion and the adjacent segment surgery was 94 months. Of the 33 patients, 26 were followed for 3-14 years (mean: 5 years) after adjacent segment surgery and were clinically evaluated and independently completed an outcome questionnaire. Of the 26 patients, 15 rated their outcome as completely satisfactory, 6 were neutral toward the surgery, and 5 considered their surgery a failure. The surgery was generally effective at improving or relieving lower extremity neurogenic claudication. The strongest independent predictive factor of patient dissatisfaction was ongoing postoperative low back pain (r = 0.7, p = 0.001). A higher back pain score at follow-up was associated with continued narcotic use (p = 0.001) and decreased ability to perform activities of daily living (p = 0.05). Six patients required further lumbar surgery during the follow-up period. This study provides the longest published follow-up data of surgical results for symptomatic spinal stenosis adjacent to a previously asymptomatic lumbar fusion.
authors.affiliation: University of Chicago Spine Center, Illinois 60640, USA.
authors.forename: F M
authors.initials: FM
authors.lastname: Phillips
authors.forename: G D
authors.initials: GD
authors.lastname: Carlson
authors.forename: H H
authors.initials: HH
authors.lastname: Bohlman
authors.forename: S S
authors.initials: SS
authors.lastname: Hughes
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D012307:Risk Factors; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013130:Spinal Stenosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome