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Master Thesis

Le canal lombaire étroit chez la personne âgée de plus de 75 ans. Facteurs déterminants du résultat fonctionnel

Abstract : Introduction: lumbar spinal stenosis is a common pathology. When symptomatic, an intermittent radicular claudication appears. The stenosis seen most commonly develops focally, at the intervertebral junction, as a result of a complex process of ligamentum flavum hypertrophy, facet arthropathy, disc herniation, and sometimes spondylolisthesis. Degenerative lumbar spinal stenosis is the most frequent indication for functional spine neurosurgery in the elderly. Aging population in developed countries lives with significant comorbidities wich complicates patient management. The screening of patient's eligibility for surgery implies the knowledge of all issues including the prognosis factors related to functional improvement.
Objectives: This retrospective study aims to discuss the effectiveness of surgery, in terms of pain/satisfaction, for 73 patients aged 75 years and above suffering from a lumbar canal stenosis, treated between 2006 and 2014.
Patients and methods: We reviewed all files information: demographic, pre- and postoperative clinical, non-clinical therapeutic and surgical data.
Results: seventy-three patients met the study criteria. The median level of satisfaction was 85%. No deterioration after surgery or deaths occured. Statistical analysis using multiple linear regression indicates that analgesic intake before (p<0,0005) or after surgery (p<0,0023) and radicular pain persistence (p<0,00018) were linked to the functional recovery estimated by patient satisfaction. There was a trend non-statistically significant among the number of laminae removed and patient satisfaction, the higher the laminectomy is done, the less is the satisfaction (p=0,15).
Conclusion: functional outcome of surgery for lumbar spinal stenosis is very good, despite advanced age. Elderly should not be a contraindication for decompressive lumbar spine surgery, however, since this high-risk population is more likely to suffer operative complications, special precautions are required. Factors associated with post-operative satisfaction are painkilling medication use and persistence of the radicular pain. A prospective study using patient-satisfaction standardised questionnaire would allow us to consolidate and potentially complete our results.
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Master Thesis
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Submitted on : Friday, October 30, 2015 - 10:08:54 AM
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Mathilde Fouet. Le canal lombaire étroit chez la personne âgée de plus de 75 ans. Facteurs déterminants du résultat fonctionnel. Médecine humaine et pathologie. 2015. ⟨dumas-01222496⟩

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