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Lumbal Spinal Stenosis ODI Score
Lumbal Spinal Stenosis ODI Score
Abstract
Introduction
Stenosis is the commonest problem of lumbar spine in people over the age 65 years. The initial
treatment should be conservative. Surgery is required after the failure of conservative care. Our
study refers to patients with degenerative spinal stenosis. The patients were treated by
decompression posterior stabilisation fusion. We analyzed the outcome in terms of functional
recovery.
Result
Postoperative ODI improved significantly. Preoperatively, 14/33 patients were moderate
disability. Three months after the surgery, 12/33 patients cope with most of living activities.
Six months after the surgery, there were 23 of 33 patients in this group.
Discussion
Functional outcome of the patient treated with surgery improved significantly as measured with
ODI after 3 and 6 months. this resulted was supported by another research that conclude surgery
improved all the patient-reported outcome measures.
Conclusion
In conclusion we found that wide posterior decompression, Posterior Stabilisation
Posterolateral fusion, improved all the patient-reported outcome measures with ODI score.
Keywords
Lumbar Spinal Canal Stenosis, Decompression Posterior Stabilisation Posterolateral Fusion,
Oswestry Disability Index
Introduction
Stenosis is the commonest problem of the lumbar spine in people over the age of 65 years and
surgery is required with increasing frequency. Spinal stenosis has been defined as a narrowing
of the vertebral canal and/or the foramen, to a degree that gives rise to compression of
lumbosacral nerve roots or the cauda equine.1 This narrowing derives from facet or ligamentum
flavum hypertrophy, extruded disc, spondylolisthesis or any combination of the above. It may
form part of a generalized degenerative process at several spinal levels or may be more
localized.1,2
congenital or developmental and acquired or degenerative stenosis. Spinal stenosis may cause
chronic pain and difficulty in walking.1 The diagnosis depends on various factors, including
the presenting history, physical findings and imaging modalities. Magnetic resonance imaging
(MRI) has been proven to be the mainstay of investigation.3 The initial treatment should be
unsatisfactory. In a study of conservatively managed patients followed for four years, Johnsson,
Rosen and Uden noted that 77% had persistent claudication, 85% were unchanged or had
deteriorated, and 63% had continual. Surgery is required after the failure of conservative care.
The procedure aims to decompress the spinal canal and the foramen while minimising the risk
of secondary instability.2,3
Although there is a lot of interest in this topic, there has been a lack of randomized
Our study refers to patients with degenerative spinal stenosis. The patients were treated
by decompression posterior stabilization fusion with bone graft. We analyzed the outcome in
terms of functional recovery and also the extent to which the results of surgery were long-
lasting.
Material and Method
Between 2012 and 2016, 33 patients suffering from lumbar spinal stenosis in Sanglah General
at Sanglah Hospital.
Clinical evaluation
radiographic examination. Patients had suffered from spinal stenosis with serious symptoms of
back pain and/or sciatica for periods ranging from 6 months up to many years. The preoperative
clinical test also included completing the Oswestry disability index. All patients had to
complete the above-mentioned test on admission to the department, under the supervision of
Inclusion Criteria.4
Patients with symptoms related to lumbar spinal stenosis together with radiological
management.
Patients that have documented clinical outcome data (Oswestry Disability Index)
prior to the surgery and at the 3rd and 6th month of the surgery.
Exclusion Criteria
The preoperative radiographic examination included plain radiographs. All patients underwent
substantial degree of concurrent scoliosis, myelography and myelo-CT were chosen. The
from MRI or myelo-CT.1 For radiological evaluation, T2-weighted axial MR sections were
used to assess the lumbar canal diameter. Anterior-posterior canal diameter between 13 – 10
mm was recorded as mild stenosis and 10 – 7 mm as moderate stenosis. Values smaller than 7
Surgical Technique
Midline skin incision was made over the relevant segment which was determined by
process and lamina was achieved by blunt dissection and monopolar cautery. Meticulous
hemostasis was achieved with bipolar coagulation. Lateral extend of the dissection included
only the lamina of the relevant segment. Facet articulations were left untouched.4 The surgical
technique started with pedicular screw fixation at levels to be decompressed. Next, wide
decompression was done through a laminectomy, including the spinous process and the
ligamentum flavum, from the outer edge of one lateral recess to the outer edge of the
corresponding one. Decompression took place at those levels where the posterior segments
placed significant pressure on the spinal cord, the cauda equina, or the exiting nerve roots, as
confirmed by the radiological examinations and the patient’s symptoms. This technique
facilitated direct access to the meningeal sac, the roots that exit from it and the region where
the roots enter the intervertebral foramen. In cases where there was pressure on the root in the
lateral recess or the intervertebral foramen, a wide decompression was performed in those two
structures.1
The operation was completed through the placement of autogenous and synthetic
allografts between the exposed facets and transverse processes of decompressed vertebrae, in
order to achieve posterolateral fusion. The patients were fully activated on the second
postoperative day, with drainage removal. No protective body cast was used.1
Follow Up
disability index on a monthly basis. The forms were completed by the patients themselves.1
Oswestry Disability Index is a simple, condition specific, multidimensional tool with the
advantage of easy patient comprehension and compliance. Patients were asked to fill the
questionnaire the day before their surgery and at 3rd and 6th months. They were not aware of
the scoring of the questionnaire, nor did they see their previous scores on follow-up. The mean
ODI scores at each time period as well as the change in ODI scores were calculated.1,4
extension plain films. With these views, stability of the fixed levels, fusion, and condition of
Statistics
The differences that were observed diachronically (before the operation and 3, and 6 month
after the operation) were evaluated by Wilcoxon Non Parametric test, where the significance
was determined as p < 0.05. Results of Oswestry index sections. The scale is graded 0–5, with
Op Op
Table 1. Mean Oswestry Disability Index Score preoperatively, 3 month and 6 month
postoperatively.
Result
We review 33 patients suffering from lumbar spinal stenosis between 2012 and 2016 whom
evaluate ODI score preoperatively, 3 month and 6 month after the surgery. ODI score consist
of 10 sections called pain, personal care, lifting, walking, sitting, standing, sleeping, sex life,
social life and traveling. Each section scale is grade 0-5, with 5 meaning maximum disability
and 0 meaning minimum disability.5 The score for each sections were tabulated and calculated
for descriptive and normality test with saphiro wilk. The scores of all parameter was not
normally distribute, and still not normally distributed after data transformation process .
related data with not normally distributed. Postoperative Oswestry Disability index improved
experiences more pain and difficulty with sitting, lifting and standing. Travel and social life
are more difficult and they may be disabled from work. No patient can cope with most living
activities and there were 3/33 patients either bed-bound or exaggerating their symptom. Three
months after the surgery, 12/33 patients start to cope with most of living activities, nine patients
still experiences more pain and difficulty with sitting, lifting and standing but no patient was
bed bound. This result was statistically significant (P 0.00). Six months after the surgery, the
patient whom can cope with most living activities increase significantly, there were 23 of 33
patients in this group, 4 patients still experiences pain and difficulty with sitting, lifting and
standing, and also 5 and 1 patient still have pain as the main problem and back pain impinges
Discussion
Functional outcome of the patient with lumbar spinal canal stenosis treated with decompression
stabilization fusion surgery improved significantly as measured with Oswestry Disability Index
after 3 and 6 months of observation. Oswestry disability index (also known as the Oswestry
Low Back Pain Disability Questionnaire) is a tool to measure patient’s permanent functional
disability, consist of 10 sections. For each section the total possible score is 5; if the first
statement is marked the section score 0; if the last statement is marked, score 5. If all 10 sections
are completed, the total score divide by maximum possible score (50) times 100%. The
interpretation of the score was, 0-20% minimal disability, 21-40% moderate disability, 41-60%
severe disability, 61-80% Crippled and 81-100% the patients are either bed – bound or
patient has minimal disability with 3 patients were bed bound. Three month after the surgery,
12 patients were minimal disability, 9 patients moderate disability and no patient bed bound.
After 6 months observation, we found that 23 patients have minimal disability, 4 patients
moderate, 5 severe and 1 crippled. We performed Wilcoxon test for comparative hypothesis
data from 3.420 consecutive patients with clinical and magnetic resonance imaging confirmed
Lumbar Spinal Stenosis, patients were treated with posterior decompression surgery without
fusion, the outcome measures were Oswestry Disability Index (ODI), VAS, MCS (36-Short
Form Mental Component Summary), PCS (36-Short Form Physical Component Summary) and
Self-Reported Walking Distance. Of 3,420 cases enrolled, 2,591 (75%) had complete data after
a minimum interval of one year. The mean ODI scores were 39.8 and improved to 24. The
mean EQ-5D score was 0.40 and improved to 0.66. The mean VAS-leg improved from 54 to
36. The mean VAS-back improved from 46 to 34. The mean MCS improved from 28 to 36,
and, finally, the mean PCS improved from 40 to 45. All p-values were 0.0000. They conclude
that surgery improved all the patient-reported outcome measures and 82% of patients were
satisfied.6
Kaymaz et al (2011), performed study with Patients requiring surgery for severe,
symptomatic, lumbar spinal stenosis which evaluated retrospectively. Patients were treated
with single posterior decompression laminectomy. Oswestry disability index scores as well as
the complications attributable to surgery were recorded before, at the sixth month and at the
twelfth month of the surgery. Eighty patients were enrolled to the study. The mean age of the
population was 63,14. Neurogenic claudication was the most common finding (65%). Of the
patients, 67.5% had severe spinal stenosis. The mean ODI score at the baseline was relatively
high than in the literature and was measured as 74.30. At the end of the 6 months follow-up
period, all patients’ ODI scores significantly improved. Moreover, this improvement continued
till the end of the 12 month. They conclude that, in selected cases of symptomatic lumbar spinal
Panagiotis et al (2009), performed study Between 1997 and 2003, 41 patients suffering
from degenerative lumbar spinal stenosis were included in a prospective clinical study. The
spinal stenosis was multilevel in all patients and in 13 of them there was degenerative scoliosis,
in 18 there was degenerative spondylolisthesis, and in 10 there was segmental instability. The
patients were assessed clinically with the Oswestry disability index (ODI) and visual analog
scale (VAS). Surgery included wide posterior decompression Stabilization and fusion and bone
graft. After a mean follow-up of 3.7 (1–6) years, the patients’ clinical improvement on the ODI
and VAS was statistically significant. Recurrent stenosis was not observed, and 39 of 41
patients were satisfied with the outcome. 3 patients with improvement initially had later surgery
because of instability. According to the above study, the surgery procedure gives good and
long lasting clinical result, when selection of patients is done carefully and when the spinal
subjective, and varies according to patient expectations and lifestyle. There is no indication for
decompression in the patient with radiological stenosis, but with no symptoms of stenosis, or
with back pain only. The risk of not treating spinal stenosis is minimal, while that of operating
on an elderly patient with other health problems is unpredictable and sometimes substantial.
Obviously the primary aim of surgery is to create space for the neural elements by
decompression. In certain circumstances, fusion may also be considered, the main indication
Decompress all stenosis areas and levels, paying specific attention to the foramen, which is the
a stable spine is anticipated (narrowed disc with osteophytes) or where fusion will be
possible (at least 50%), to reduce the risk of iatrogenic instability. Discectomy should be
avoided as far as possible, and reserved for overt herniation. Decompression has been found to
provide long-term relief of stenosis symptoms in two out of three patients, although the results
decline with time. The biggest cause of dissatisfaction is persistent back pain, but there is no
Conclusion
In conclusion we found that wide posterior decompression stabilization posterolateral fusion,
improved all the patient-reported outcome measures with ODI score.
References
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10.1080/17453670610012773
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Lumbar Spinal Stenosis Four-Year Results of the Spine Patient Outcomes Research Trial.
Lippincott Williams & Wilkins Spine 2010;35:1329-1338
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Shashidhar BK, Sament R. Comparison of the Oswestry Disability Index and Magnetic
Resonance Imaging Findings in Lumbar Canal Stenosis: An Observational Study. Asian
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