title: Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study.
abstract: BACKGROUND
  To assess safety, risk factors and clinical outcomes in elderly patients with spinal stenosis after decompressive laminectomy.
  
  
  METHODS
  A prospective cohort of patients 70 years and older with spinal stenosis undergoing conventional laminectomy without fusion (n = 101) were consecutively enrolled from regular clinical practice and reassessed at 3 and 12 months. Primary outcome was change in health related quality of life measured (HRQL) with EuroQol-5 D (EQ-5D). Secondary outcomes were safety assessment, changes in Oswestry disability index (ODI), Visual Analogue Scale (EQ-VAS) score for self reported health, VAS score for leg and back pain and patient satisfaction. We used regression analyses to evaluate risk factors for less improvement.
  
  
  RESULTS
  The mean EQ-5 D total score were 0.32, 0.63 and 0.60 at baseline, 3 months and 12 months respectively, and represents a statistically significant (P < 0.001) improvement. Effect size was > 0.8. Mean ODI score at baseline was 44.2, at 3 months 25.6 and at 27.9. This represents an improvement for all post-operative scores. A total of 18 (18.0%) complications were registered with 6 (6.0%) classified as major, including one perioperative death. Patients stating that the surgery had been beneficial at 3 months was 82 (89.1%) and at 12 months 73 (86.9%). The only predictor found was patients with longer duration of leg pain had less improvement in ODI (P < 0.001). Increased age or having complications did not predict a worse outcome in any of the outcome variables.
  
  
  CONCLUSIONS
  Properly selected patients of 70 years and older can expect a clinical meaningful improvement of HRQL, functional status and pain after open laminectomy without fusion. The treatment seems to be safe. However, patients with longstanding leg-pain prior to operation are less likely to improve one year after surgery.
authors.affiliation: Department of Neurosurgery, St. Olavs Hospital HF, Trondheim, Norway. asjakola@yahoo.no
authors.forename: Asgeir S
authors.initials: AS
authors.lastname: Jakola
authors.forename: Andreas
authors.initials: A
authors.lastname: Sørlie
authors.forename: Sasha
authors.initials: S
authors.lastname: Gulati
authors.forename: Oystein P
authors.initials: OP
authors.lastname: Nygaard
authors.forename: Stian
authors.initials: S
authors.lastname: Lydersen
authors.forename: Tore
authors.initials: T
authors.lastname: Solberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome