Surgical Experience of Lumbar Spinal Stenosis in Twenty New Elder Citizens

Abstract

In the fall of 2000 Dr. S. Hinohara, Tsukiji, Tokyo, launched a campaign of “New Elder Citizen's movements” where people more than 74 years of age are encouraged to lead a more motivated active life. The New Elder Citizen's movement particularly emphasizes physical and mental independence from younger age generations and positive contributions to the contemporary society. During the past three years the authors treated 20 such consecutive elderly patients with lumbar spinal stenosis (LSS) surgically. In this age group of patients the clinical study was conducted to learn how well they can tolerate the operations under general anesthesia, and the various risks existing before the resumption of their previous daily active social life. Causative components of LSS were only one or combination of the two or three or four out of compressive lesions such as intervertebral disc prolapse, hypertrophic lig. flavum, and hypertrophic facets and laminae. Surgical results were evaluated by The Japanese Orthopedic Association (JOA) scores with calculation of recovery rate(%). In 75% of the patients studied, neurogenic intermittent claudication and radicular pain were in complete resolution post operatively, irrelevant to the duration of symptoms, level and number of compressing lesions. None of the 20 patients required spinal fusion because of the absence of spinal instability. During the same span of three years, three patients were considered not to be good candidates for decompressive surgery because of poor physical status for general anesthesia such as severe ischemic coronary heart disease, dementia with hearing loss and pulmonary emphysema with atrial fibrillation and recent stroke.To expect favorable surgical outcomes with full recovery in the age group of patients such as “new elder citizens” with LSS, shorter preoperative duration of symptoms and evaluation of the strong desire to recover and to resume the patient's previous social life without dementia-in-progress seems to be of absolute necessity.