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Neural arch resection for lumbar spinal stenosis.

In a series of 50 patients with lumbar stenosis who have undergone the procedure of neural arch resection, the patients were predominantly in the fifth and sixth decades of life. Females exceeded males 3:2. Long histories and previous surgical treatment were characteristic, with unilateral symptoms predominating. However, physical examination demonstrated the reverse, i.e., bilateral signs and multisegmental disease. Lumbosacral radiographs suggested the stenotic condition and myelography was corroborative. The definitive test was axial tomography. Neural arch resection removes, bilaterally, the spinous processes, laminae, articular processes and the pedicles, if the latter are hypertrophied or narrowly placed. Resection must be accomplished at all levels of disease for optimum results. Fusion has not been required. Half of the group of 50 totally disabled patients have been returned to full function and comfort, one-fourth to perform acts of daily living with some pain, and one-fourth remain disabled. Complications include infections in six and one case of postoperative spondylolisthesis. Neural arch resection is a procedure for the management of lumbar stenosis and its elemental categories. The results indicate at least a 50% expectation of return to function in comfort, provided that the principles of surgery as to extent and removal of disease at all levels are followed, and that the patients participate in a back rehabilitation and conditioning program.