Timeoutofmind

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Anyone recommend any of these treatments as reasonable/effective at this current point in time?

Saw a healthy, active, pleasant 60 year old with severe single level lumbar stenosis with a lot of ligamantum flavum hypertrophy today...had been offered decompression/fusion...not doing well with conservative tx. Got me thinking...
 

Taus

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Unless he's got a significant and/or mobile spondy I'd rec, if it was my family, to get another opinion for a simple decompression without fusion. IMO a Young and healthy patient should get this problem truly fixed, not a gizmo.


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Timeoutofmind

Timeoutofmind

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Apr 6, 2013
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Unless he's got a significant and/or mobile spondy I'd rec, if it was my family, to get another opinion for a simple decompression without fusion. IMO a Young and healthy patient should get this problem truly fixed, not a gizmo.


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Sorry forgot to clarify...grade 1 listhesis. Stable in flex/ex

I guess it makes some since they would want to fuse her given the listhesis? Although with a grade one seems that a decompression should still be adequate without a fusion?
 

lobelsteve

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The literature review refutes need for fusion with a stable spondylolisthesis. Decompression only. The other options don't seem reasonable or effective.
 
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SSdoc33

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the younger spine surgeons usually can decompress without fusion for a stable grade 1 degenerative spondy. the "classic" teaching is that you need to fuse these, so the older surgeons (or more greedy ones) fuse as well. if they have a concomitant spondylolysis, then a fusion is necessary
 
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Timeoutofmind

Timeoutofmind

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Apr 6, 2013
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the younger spine surgeons usually can decompress without fusion for a stable grade 1 degenerative spondy. the "classic" teaching is that you need to fuse these, so the older surgeons (or more greedy ones) fuse as well. if they have a concomitant spondylolysis, then a fusion is necessary
Prob depends how much facet arthropathy is contributing to the stenosis, and how much of the facets they have to take to clear out the canal. If they take enough, prob have to fuse for stability purposes
 

bedrock

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Prob depends how much facet arthropathy is contributing to the stenosis, and how much of the facets they have to take to clear out the canal. If they take enough, prob have to fuse for stability purposes
True, but ssdoc makes a good point. If this was my mother, I'd ensure she had 2 and 3rd opinions with two other younger spine surgeons.