Purpose: To measure outcome in patients undergoing decompression for lumbar canal stenosis (LCS) by lami-nectomy.

Methods: 100 patients (57 men, 43 women) under one consultant surgeon presenting with neurogenic claudication and MRI confirmed LCS were studied . 23 patients had pre –existing spondylolisthesis (21 Grade 1, 2 Grade-2) and were managed by laminectomy without fixation. Patients completed a set of outcome measure questionnaires (SF-36, Visual analogue scores for back pain, leg pain, leg sensory symptoms and the Roland-Morris back disability score) pre-operatively, 3 months post surgery and at longer term follow up (median 2 years). Outcome scores were analysed and for SF-36 compared to age matched normative data. Statistical significance was calculated using Wilcoxon’s matched pairs and correlations using Spearman’s rank test. Statistical analysis was performed using the SPSS statistical package.

Results: Average age 68 years (inter-quartile range 60 – 77). For the cohort visual analogue scores and Roland scores showed significant improvement (p < 0.01) at both 3 months and at long term follow up compared to pre-operative scores. For the physical functioning domain of SF-36, outcome scores improved significantly (p< 0.01) at short and long term follow up with 80% of patients having better long term scores compared to pre-operative scores. The physical functioning domain of SF-36 was significantly correlated with the changes seen in the visual analogue pain scores and the Roland back pain score (p < 0.01). Outcome for the spondylo-listhesis subgroup was similar to the outcome in patients without pre existing spondylolisthesis.

Conclusions: Laminectomy for lumbar canal stenosis is an effective treatment resulting in significant health gains which are maintained in the longer term. Our data validates SF-36 as a measurement of disease severity and outcome in this condition.

Objective: Anterior cervical discectomy (ACD) has been established for 40 years. Most surgeons introduce an interbody spacer despite randomised evidence, which suggests this is unnecessary. Surgeons are concerned about the effects of discectomy on cervical spine alignment causing neck pain and accelerated degenerative changes at adjacent levels. In this study we have investigated the relationships between pre-operative disc height, post-operative radiological changes and clinical outcome following ACD.

Design: Prospective cohort study of patients undergoing ACD

Subjects: Seventy-three patients undergoing ACD for the treatment of cervical myelopathy or radiculopathy. Minimum follow up one year.

Outcome measures: SF 36, Neck Disability Index, visual analogue scores for neck and arm pain, cervical spine alignment, segmental kyphosis, and disc height.

Results: Greater pre-op disc height predicts greater post op percentage loss of disc height but does not correlate with poor outcome (p> 0.05 all measures). Post- op X-rays revealed disturbed alignment in 54% of patients. Analysis of clinical outcome showed no statistical differences in any of the clinical outcome measures between patients with and without radiological abnormalities (p> 0.05) SF 36 scores were significantly worse than population controls in patients with and without radiological abnormalities.

Conclusions: Large discs collapse more than small discs but this does not compromise outcome. Radiological changes occurred in a significant number of patients in this cohort. These abnormalities do not appear to influence clinical outcome at 12–24 months. The study continues and will report outcomes at five years.