Avtor/Urednik		Fokter, Samo K
Naslov		Operativno zdravljenje degenerativne stenoze ledvene hrbtenice
Prevedeni naslov		Operative treatment for degenerative lumbar spinal stenosis
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 71, št. 11
Leto izdaje		2002
Obseg		str. 673-8
Jezik		slo
Abstrakt		Background. Degenerative lumbar spinal stenosis (DLSS) is a common cause of low back and leg pain in the elderly. Conservative treatment seldom results in sustained improvement. Methods. Fifty-six patients (33 women, 23 men) older than 50 years (mean 67 years, range 51 to 82 years) and with no prior low back surgery were treated from 1993 to 1999 for clinical and radiologic evidence of DLSS The goal of this study was to describe the results of decompressive laminectomy with or without fusion in terms of reoperation, severity of back pain, leg pain and patient satisfaction. Answers to Swiss spinal stenosis questionnaires completed before surgery and one to five years afterwards were evaluated. Seven patients (12.5%) with degenerative spondylolisthesis, scoliosis and/or more radical facetectomies received fusion. Results. Of the 56 patients in the original cohort, two were deceased and two had undergone reoperation by follow-up. Forty-eight patients answered questionnaires. Average duration of follow-up was 2.5 years. More than 70 percent of the respondents had no or only mild back or buttock pain at follow-up and more than 60 percent were able to walk more than 500 m. Added fusion reduced the incidence of low back pain and pain frequency, and increased walking distance (ANOVA). Conclusions. Eighty-one percent of patients were satisfied with the results of surgery and 87.5% would choose to have the operation again if they had the choice. Decompressive laminectomy for DLSS yields best results if instrumented fusion is included in the procedure.
Izvleček		Izhodišča. Degenerativna stenoza ledvene hrbtenice (DSLH) je v starosti čest vzrok za bolečino v križu in spodnjih udih. S konzervativnim zdravljenjem redko dosežemo trajno izboljšanje. Metode. V letih od 1993 do vključno 1999 smo zdravili 56 bolnikov (33 žensk in 23 moških), starejših od 50 let (povprečna starost 67 let, razpon od 51 do 82 let), s kliničnimi in radiološkimi znaki DSLH in brez prestane operacije na ledveni hrbtenici. Namen pričujoče študije je bil s pomočjo števila ponovnih operacij, jakosti bolečine v križu in spodnjih udih ter zadovoljnosti bolnikov ovrednotiti rezultate dekompresivne laminektomije s sočasno opravljeno spondilodezo oziroma brez spondilodeze. Primerjali smo odgovore bolnikov na švicarski vprašalnik za spinalno stenozo pred operacijo in eno do pet let po njej. Sedmim bolnikom (12,5% z degenerativno spondilolistezo, skoliozo in/ali radikalnejšo odstranitvijo fasetnih sklepov, smo napravili spondilodezo. Rezultati. Od 56 bolnikov celotne skupine sta bila dva ob zaključni kontroli pokojna in dva ponovno operirana. Na vprašalnik je odgovorilo 48 bolnikov. Povprečna opazovalna doba je znašala dve leti in pol. Več kot 70 odstotkov bolnikov, ki so odgovorili na vprašalnik, ni imelo bolečin v križu ali stegnu, ali pa so bile te blage, prek 60 odstotkov bolnikov je zmoglo hoditi dlje kot 500 m. Bolniki z oprav jeno spondilodezo so imeli blažje bolečine v križu, bolečine so čutili manj pogosto in zmogli daljšo hojo (ANOVA). Zaključki. Enainosemdeset odstotkov bolnikov je bilo zadovo jnih z rezultatom operativnega zdravljenja, 87,5 % bi se jih za poseg ponovno odločilo. Z dekompresivno laminektomijo smo dosegli najbojše rezultate zdravljenja DSLH, kadar smo sočasno opravili spondilodezo z notranjim fiksatorjem.
Deskriptorji		SPINAL STENOSIS LUMBAR VERTEBRAE SPINAL FUSION LOW BACK PAIN TREATMENT OUTCOME