研究背景與目的：神經根長期受到壓迫除了會造成腰脊髓腔狹窄病人背部與下肢的症狀外，也常使得病人的神經功能下降以及功能狀態受限。根據過去的文獻報告減壓手術能夠有效的改善病人的症狀和功能狀態 (成功率為64%~91%不等)，然而也有文獻指出病人術後功能狀態的進步和解剖構造上壓迫的解除沒有顯著的相關，此外也發現目前對於病人在手術後神經功能的恢復方面仍很缺乏，因此對於病人術後功能狀態的改善與神經功能恢復之間的關係也仍存在著疑問。所以本研究的目的是要探討腰脊髓腔狹窄病人在接受減壓手術後神經功能恢復的情形以及神經功能恢復與功能狀態改善之間的關係。
　
　　研究材料與方法：本實驗共收集19位經過醫師臨床檢查以及放射學影像確定診斷為退化性腰脊髓腔狹窄且需要接受手術的病人，病人分別會在手術前1個月、1天接受評估而這兩次的評估是作為手術後比較的基準；另外在手術後3星期、7星期與3個月病人也會再次接受評估來看手術立即與短期的效果。手術效果的評估主要包含了三大部分：病人對於臨床症狀的主觀描述、神經功能效果以及功能性效果；在病人對於臨床症狀主觀描述部分會使用visual analog scale來評估病人症狀的嚴重程度；在神經功能效果的評估項目方面則包括了下肢深肌腱反射、振動覺閾值以及神經傳導速度；而在功能性效果方面則包括了使用Oswestry low back pain disability questionnaire評估病人主觀殘疾程度，使用手握式測力器量測病人下肢肌肉力量，以及分別使用力板評估病人靜態平衡能力、前伸測試評估動態平衡能力、計時起身走路測試評估病人功能性平衡的能力。

結果：手術前的兩次評估發現各項參數都沒有顯著的變化。手術後的評估和手術前1天的評估相比則發現病人症狀的嚴重程度在手術後3星期開始就有顯著的下降而這樣的現象一直持續到手術後3個月；而功能性預後的方面則發現病人的主觀殘疾程度在手術後7星期和3個月時和手術前1天相比有顯著的改善。在神經功能方面則發現代表神經功能的參數在手術後不管是3星期、7星期或3個月和手術前1天相比都沒有顯著的變化。

　　結論：減壓手術能夠有效的減輕病人的症狀以及增加病人的功能狀態，而症狀的減輕要比功能狀態的改善來的迅速，此外神經功能在手術前後沒有明顯的變化，這樣的結果也顯示了症狀的減輕、功能狀態的改善與神經功能的完整性之間並沒有直接的因果關係。此外在手術後病人症狀減輕的時間比功能狀態改善的時間要來的快也顯示病人在接受減壓手術後物理治療師可以儘早介入來幫助病人加速功能狀態的恢復。

　　Background and Purpose：In addition to the symptoms on back and leg, chronic compression of the spinal nerve root can lead to neurological deficits and functional disability in patients with lumbar spinal stenosis. Previous studies have reported that decompressive surgery could alleviate the symptoms effectively (successful rate of decompressive surgery ranged from 64~91%). However, it has been reported that there was no significant relationship between the degree of the decompression and functional recovery, and also the investigation on the neurological recovery after decompressive surgery was still lacking. Thus, neurological recovery and its relationship with the functional recovery after decompressive surgery are still questioned. The purpose of this study was to investigate the neurological and functional outcome after decompressive surgery in patients with lumbar spinal stenosis.

　　Materials and Methods：19 patients diagnosed as degenerative lumbar spinal stenosis confirmed by clinical and radiological findings, were evaluated 1 month and 1 day (PRE-1D) before surgery for baseline comparisons, and re-evaluated 3 weeks (POST-3W), 7 weeks (POST-7W), and 3 months (POST-3M) after surgery. Surgical outcome consisted of subjective descriptions of clinical features, and neurological and functional outcome. Symptom intensity was evaluated by visual analog scale. Neurological outcome included deep tendon reflex, vibration sense, and nerve conduction velocity. Functional outcome included subjective disability measured by Oswestry low back pain disability questionnaire, lower extremity strength tested with hand-held dynamometer. Static balance was tested with a force plate in both quite stand and Romberg stand with eyes open and closed, dynamic balance was tested with forward reaching test, and functional balance was tested with timed get up and go test.
　　
　　Results：None of the variables changed significantly between the two baseline measurements. After surgery, symptom intensity decreased at POST-3W, POST-7W and POST-3M, compared with PRE-1D. In functional outcome, comparing PRE-1D, subjective disability significantly improved at POST-7W and POST-3M. Variables representing neurological outcome didn’t change significantly in POST-3W, 7W or 3M.

　　Conclusion：Decompressive surgery alleviated the symptoms and improved functional status effectively, with symptom alleviation occurring sooner than functional recovery. These changes, however, were not accompanied by neurological recovery. It seemed that there was no direct cause-effect relationship between neurological function recovery and symptom and functional recovery. The finding that symptoms alleviation came sooner than functional recovery suggest that physical therapy intervention should begin soon after decompressive surgery to facilitate the functional recovery in patients with lumbar spinal stenosis.

1. Portal A. Cours d’anatomic medicale on elements de l’anatomic de phomme. 1st edition. Paris: Badoin; 1802. p. 299.

2. Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. Journal of Bone & Joint Surgery - British Volume. 1954;36:230-7.

3. Arnoldi CC, Brodsky AE, Cauchoix J, Crock HV, Dommisse GF, Edgar MA, et al. Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification. Clinical Orthopaedics & Related Research. 1976;115:4-5.

4. Spivak JM. Degenerative lumbar spinal stenosis. Journal of Bone & Joint Surgery - American Volume. 1998;80:1053-66.

5. Fritz JM, Delitto A, Welch WC, Erhard RE. Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements. Archives of Physical Medicine & Rehabilitation. 1998;79:700-8.

6. Van Akkerveeken P. Classification and treatment of spinal stenosis. In: Wiesel SW, Weinstein JN, Herkowitz H, Dvorak J, Bell G, editors. The lumbar spine. Pheladelphia: W.B. Saunders: 1996. p. 724-36.

7. Rauschning W. Pathoanatomy of lumbar disc degeneration and stenosis. Acta Orthopaedica Scandinavica. Supplementum. 1993;251:3-12.

8. Getty CJ. Lumbar spinal stenosis: the clinical spectrum and the results of operation. Journal of Bone & Joint Surgery - British Volume. 1980;62:481-5.

9. Storm PB, Chou D, Tamargo RJ. Lumbar spinal stenosis, cauda equina syndrome, and multiple lumbosacral radiculopathies. Physical Medicine & Rehabilitation Clinics of North America. 2002;13:713-33.

10. Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine. 1978;3:319-28.

11. Kirkaldy-Willis WH. The relationship of structural pathology to the nerve root. Spine. 1984;9:49-52.

12. Kirkaldy-Willis WH, Paine KW, Cauchoix J, McIvor G. Lumbar spinal stenosis. Clinical Orthopaedics & Related Research. 1974;99:30-50.

13. Yoshida M, Shima K, Taniguchi Y, Tamaki T, Tanaka T. Hypertrophied ligamentum flavum in lumbar spinal canal stenosis. Pathogenesis and morphologic and immunohistochemical observation. Spine. 1992;17:1353-60.

14. Hilibrand AS, Rand N. Degenerative lumbar stenosis: diagnosis and management. Journal of the American Academy of Orthopaedic Surgeons. 1999;7:239-49.

15. Zinreich SJ, Heithoff KB, Gerzog RJ: Computed tomography of the spine, In: Frymoyer JW, Ducker TB, Hadler NM, Kostuik JP, Weinstein JN, Whitecloud TS III. The Adult Spine: Principles and Practice. 2nd ed. Pailadelphia: Lippincott Raven; 1997. p. 467-522.

16. Wiltse LL, Guyer RD, Spencer CW, Glenn WV, Porter IS. Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome. Spine. 1984;9:31-41.

17. Bridwell KH. Lumbar spinal stenosis. Diagnosis, management, and treatment. Clinics in Geriatric Medicine. 1994;10:677-701.

18. Jones RA Thomson JL. The narrow lumbar canal. A clinical and radiological review. Journal of Bone & Joint Surgery - British Volume. 1968;50:595-605.

19. Roberson GH, Llewellyn HJ, Taveras JM. The narrow lumbar spinal canal syndrome. Radiology. 1973;107:89-97.

20. Lipson SJ. Spinal stenosis. Rheumatic Diseases Clinics of North America. 1988;14:613-8.

21. Katz JN, Dalgas M, Stucki G, Katz NP, Bayley J, Fossel AH, et al. Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis & Rheumatism. 1995;38:1236-41.

22. Katz JN, Dalgas M, Stucki G, Lipson SJ. Diagnosis of lumbar spinal stenosis. Rheumatic Diseases Clinics of North America. 1994;20:471-83.

23. Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine. 1992;17:1-8.

24. Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes B. Lumbar spinal stenosis. Clinical and radiologic features. Spine 1995;20(10):1178-86.

25. Porter RW. Pathophysiology of neurogenic claudication. In: Wiesel SW, Weinstein JN, Herkowitz H, Dvorak J, Bell G, editors. The lumbar spine. Philadelphia: W.B. Saunders; 1996. p. 717-23.

26. Onel D, Sari H, Donmez C. Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention. Spine. 1993;18:291-8.

27. Penning L. Functional pathology of lumbar spinal stenosis. Clinical Biomechanics 1992;7:3-17.

28. Stucki G, Liang MH, Lipson SJ, Fossel AH, Katz JN. Contribution of neuromuscular impairment to physical functional status in patients with lumbar spinal stenosis. Journal of Rheumatology 1994;21(7):1338-43.

29. Guigui P, Benoist M, Delecourt C, Delhoume J, Deburge A. Motor deficit in lumbar spinal stenosis: a retrospective study of a series of 50 patients. Journal of Spinal Disorders. 1998;11:283-8.

30. Jonsson B, Stromqvist B. Motor affliction of the L5 nerve root in lumbar nerve root compression syndromes. Spine. 1995;20:2012-5.

31. Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol
MA. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. Journal of Bone & Joint Surgery - American Volume. 1992;74:536-43.

32. Katz JN. Lumbar spinal fusion. Surgical rates, costs, and complications. Spine. 1995;20:78S-83S.

33. Ciol MA, Deyo RA, Howell E, Kreif S. An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. Journal of the American Geriatrics Society. 1996;44:285-90.

34. Johnsson KE, Rosen I, Uden A. The natural course of lumbar spinal stenosis. Clinical Orthopaedics & Related Research. 1992;279:82-6.

35. Postacchini F. Management of lumbar spinal stenosis. Journal of Bone & Joint Surgery - British Volume. 1996;78:154-64.

36. Hall S, Bartleson JD, Onofrio BM, Baker HL Jr, Okazaki H, O'Duffy JD. Lumbar spinal stenosis. Clinical features, diagnostic procedures, and results of surgical treatment in 68 patients. Annals of Internal Medicine. 1985;103:271-5.

37. Katz JN, Lipson SJ, Brick GW, Grobler LJ, Weinstein JN, Fossel AH, et al. Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine. 1995;20:1155-60.

38. Sengupta DK, Herkowitz HN. Lumbar spinal stenosis. Treatment strategies and indications for surgery. Orthopedic Clinics of North America. 2003;34:281-95.

39. Hansraj KK, Cammisa FP Jr, O'Leary PF, Crockett HC, Fras CI, Cohen MS, et al. Decompressive surgery for typical lumbar spinal stenosis. Clinical Orthopaedics & Related Research. 2001;384:10-7.

40. Hansraj KK, O'Leary PF, Cammisa FP Jr, Hall JC, Fras CI, Cohen MS, et al. Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis. Clinical Orthopaedics & Related Research. 2001384:18-25.

41. Lombardi JS, Wiltse LL, Reynolds J, Widell EH, Spencer C 3rd. Treatment of degenerative spondylolisthesis. Spine. 1985;10:821-7.

42. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. Journal of Bone & Joint Surgery - American Volume. 1991;73:802-8.

43. Postacchini F, Cinotti G. Bone regrowth after surgical decompression for lumbar spinal stenosis. Journal of Bone & Joint Surgery - British Volume. 1992;74:862-9.

44. Javid MJ, Hadar EJ. Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. Journal of Neurosurgery. 1998;89:1-7.

45. Mofidi A, O'Connor D, El-Abed K, McCabe JP. Functional outcome study of patients after surgical decompression for lumbar spinal stenosis: effects of concomitant pathology. Journal of Spinal Disorders & Techniques. 2002;15:377-83.

46. Silvers HR, Lewis PJ, Asch HL. Decompressive lumbar laminectomy for spinal stenosis. Journal of Neurosurgery. 1993;78:695-701.

47. Airaksinen O, Herno A, Turunen V, Saari T, Suomlainen O. Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine. 1997;22:2278-82.

48. Jonsson B, Annertz M, Sjoberg C, Stromqvist B. A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: Five-year follow-up by an independent observer. Spine. 1997;22:2938-44.

49. Herno A, Airaksinen O, Saari T. The long-term prognosis after operation for lumbar spinal stenosis. Scandinavian Journal of Rehabilitation Medicine. 1993;25:167-71.

50. Iguchi T, Kurihara A, Nakayama J, Sato K, Kurosaka M, Yamasaki K. Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Spine. 2000;25:1754-9.

51. Herno A, Airaksinen O, Saari T, Sihvonen T. Surgical results of lumbar spinal stenosis. A comparison of patients with or without previous back surgery. Spine. 1995;20:964-9.

52. Stewart G, Sachs BL. Patient outcomes after reoperation on the lumbar spine. Journal of Bone & Joint Surgery - American Volume. 1996;78:706-11.

53. Rittenberg JD, Ross AE. Functional rehabilitation for degenerative lumbar spinal stenosis. Physical Medicine & Rehabilitation Clinics of North America. 2003;14:111-20.

54. Cuckler JM, Bernini PA, Wiesel SW, Booth RE Jr, Rothman RH, Pickens GT. The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. Journal of Bone & Joint Surgery - American Volume. 1985;67:63-6.

55. Ciocon JO, Galindo-Ciocon D, Amaranath L, Galindo D. Caudal epidural blocks for elderly patients with lumbar canal stenosis. Journal of the American Geriatrics Society. 1994;42:593-6.

56. Willner S. Effect of a rigid brace on back pain. Acta Orthopaedica Scandinavica. 1985;56:40-2.

57. Fritz JM, Erhard RE, Vignovic M. A nonsurgical treatment approach for patients with lumbar spinal stenosis. Physical Therapy. 1997;77:962-73.

58. Anonymous. Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine. 1987;12:S1-59.

59. Herno A, Airaksinen O, Saari T, Luukkonen M. Lumbar spinal stenosis: a matched-pair study of operated and non-operated patients. British Journal of Neurosurgery. 1996;10:461-5.

60. Johnsson KE, Uden A, Rosen I. The effect of decompression on the natural course of spinal stenosis. A comparison of surgically treated and untreated patients. Spine. 1991;16:615-9.

61. Atlas SJ, Deyo RA, Keller RB, Chapin AM, Patrick DL, Long JM, et al. The Maine Lumbar Spine Study, Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine. 1996;21:1787-94.

62. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine. 2000;25:556-62.

63. Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F. Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Spine. 2000;25:1424-35.

64. Kent DL, Haynor DR, Larson EB, Deyo RA. Diagnosis of lumbar spinal stenosis in adults: a metaanalysis of the accuracy of CT, MR, and myelography. American Journal of Roentgenology 1992;158(5):1135-44

65. Richmond BJ, Ghodadra T. Imaging of spinal stenosis. Physical Medicine & Rehabilitation Clinics of North America. 2003;14:41-56.

66. Grenier N, Kressel HY, Schiebler ML, Grossman RI, Dalinka MK. Normal and degenerative posterior spinal structures: MR imaging. Radiology. 1987;165:517-25.

67. Dyck PJ. Detection, characterization, and staging of polyneuropathy: assessed in diabetics. Muscle & Nerve 1988;11(1):21-32.

68. Gruener G, Dyck PJ. Quantitative sensory testing: methodology, applications, and future directions. Journal of Clinical Neurophysiology. 1994;11:568-83.

69. Ziegler D. Diagnosis and management of diabetic peripheral neuropathy. Diabetic Medicine 1996;13 Suppl 1:S34-8.

70. Wilbourn AJ, Aminoff MJ. AAEM minimonograph 32: the electrodiagnostic examination in patients with radiculopathies. American Association of Electrodiagnostic Medicine. Muscle & Nerve. 1998;21:1612-31.

71. Braune HJ, Wunderlich MT. Diagnostic value of different neurophysiological methods in the assessment of lumbar nerve root lesions. Archives of Physical Medicine & Rehabilitation. 1997;78:518-20.

72. Iversen MD, Katz JN. Examination findings and self-reported walking capacity in patients with lumbar spinal stenosis. Physical Therapy. 2001;81:1296-306.

73. Woollacott MH. Age-related changes in posture and movement. Journal of Gerontology. 1993;48:56-60.

74. Era P, Schroll M, Ytting H, Gause-Nilsson I, Heikkinen E, Steen B. Postural balance and its sensory-motor correlates in 75-year-old men and women: a cross-national comparative study. Journals of Gerontology Series A-Biological Sciences & Medical Sciences. 1996;51:M53-63.

75. Lin SI, Lin RM. Sensorimotor and balance function in older adults with lumbar nerve root compression. Clinical Orthopaedics & Related Research. 2002 ;394:146-53.

76. Stucki G, Daltroy L, Liang M,. Lipson SJ, Fossel AH, Katz JN. Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine. 1996;21:796-803.

77. Deyo RA, Andersson G, Bombardier C, Cherkin DC, Keller RB, Lee CK, et al. Outcome measures for studying patients with low back pain. Spine. 1994;19:2032S-2036S.

78. Schaufele MK, Boden SD. Outcome research in patients with chronic low back pain. Orthopedic Clinics of North America. 2003;34:231-7.

79. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Medical Care. 1981;19:787-805.

80. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care. 1992;30:473-83.

81. Stucki G, Liang MH, Fossel AH, Katz JN. Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis. Journal of Clinical Epidemiology. 1995;48:1369-78.

82. Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66(8):271-3.

83. Pratt RK, Fairbank JC, Virr A. The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine. 2002;27:84-91.

84. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. Journal of Bone & Joint Surgery - American Volume. 1990;72:403-8.

85. Herno A, Airaksinen O, Saari T. Computed tomography after laminectomy for lumbar spinal stenosis. Patients' pain patterns, walking capacity, and subjective disability had no correlation with computed tomography findings. Spine 1994;19(17):1975-8.

86. Herno A, Airaksinen O, Saari T, Pitkanen M, Manninen H, Suomalainen O. Computed tomography findings 4 years after surgical management of lumbar spinal stenosis. No correlation with clinical outcome. Spine 1999;24(21):2234-9.

87. Herno A, Partanen K, Talaslahti T, Kaukanen E, Turunen V, Suomalainen O, et al. Long-term clinical and magnetic resonance imaging follow-up assessment of patients with lumbar spinal stenosis after laminectomy. Spine 1999;4(15):1533-7.

88. Katz JN, Lipson SJ, Larson MG, McInnes JM, Fossel AH, Liang MH. The outcome of decompressive laminectomy for degenerative lumbar stenosis. Journal of Bone & Joint Surgery - American Volume 1991;73(6):809-16.

89. Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH. Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 1996;21(1):92-8.

90. Ragab AA, Fye MA, Bohlman HH. Surgery of the lumbar spine for spinal stenosis in 118 patients 70 years of age or older. Spine. 2003;28:348-53.

91. Sanderson PL, Wood PL. Surgery for lumbar spinal stenosis in old people. Journal of Bone & Joint Surgery - British Volume. 1993;75:393-7.

92. Katz J, Melzack R. Measurement of pain. Surgical Clinics of North America. 1999;79:231-52.

93. Bickley LS, Szilagyi PG. The nervous system. In: Bates' guide to physical examination and history taking. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2003. p. 501-560.

94. Thomas SA. Spinal stenosis: history and physical examination. Physical Medicine & Rehabilitation Clinics of North America. 2003;14:29-39.

95. Haerer A.F. DeJong's The neurologic examination. 5th ed. Philadelphia, Lippincott ; 1992. p. 433-447.

96. Magee DJ. Principles and concepts. In: Orthopedic physical assessment. 3rd ed. Philadelphia: W.B. Saunders; 1997. p. 1-48.

97. Brooks VB. Postural control. In: The neural basis of motor control. Oxford: Oxford University Press; 1986. p. 170-78.

98. McGregor AH, Hughes SP. The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 2: patient expectations and satisfaction. Spine 2002;27:1471-6.

99. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. Journal of Gerontology. 1990;45:M192-7.

100. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Archives of Physical Medicine & Rehabilitation. 1986;67:387-9.

101. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society.
1991;39:142-8.

102. Kendall FP, McCreary EK, Provance PG. Lower extremity strength tests. In: Muscles: Testing and Function. 4th ed. Baltimore: Williams & Wilkins; 1993. p. 201-13.

103. Katz JN, Stucki G, Lipson SJ, Fossel AH, Grobler LJ, Weinstein JN. Predictors of surgical outcome in degenerative lumbar spinal stenosis. Spine. 1999;24:2229-33.

104. Taylor VM, Deyo RA, Cherkin DC, Kreuter W. Low back pain hospitalization. Recent United States trends and regional variations. Spine. 1994;19:1207-12.

105. Herron LD, Mangelsdorf C. Lumbar spinal stenosis: results of surgical treatment. Journal of Spinal Disorders. 1991;4:26-33.

106. Tuite GF, Stern JD, Doran SE, Papadopoulos SM, McGillicuddy JE, Oyedijo DI, et al. Outcome after laminectomy for lumbar spinal stenosis. Part I: Clinical correlations. Journal of Neurosurgery. 1994;81:699-706.

107. Thomas NW, Rea GL, Pikul BK, Mervis LJ, Irsik R, McGregor JM. Quantitative outcome and radiographic comparisons between laminectomy and laminotomy in the treatment of acquired lumbar stenosis. Neurosurgery. 1997;41:567-74.

108. Garfin SR, Rydevik B, Lind B, Massie J. Spinal nerve root compression. Spine. 1995;20:1810-20.

109. Olmarker K, Rydevik B. Pathophysiology of sciatica. Orthopedic Clinics of North America. 1991;22:223-34.

110. Johnsson KE., Rosen I, Uden A. Neurophysiologic investigation of patients with spinal stenosis. Spine. 1987;12:483-7.

111. Nygaard OP, Kloster R, Mellgren SI. Recovery of sensory nerve fibres after surgical decompression in lumbar radiculopathy: use of quantitative sensory testing in the exploration of different populations of nerve fibres. Journal of Neurology, Neurosurgery & Psychiatry. 1998;64:120-3.

112. Thomson FJ, Masson EA,. Boulton AJ. Quantitative vibration perception testing in elderly people: an assessment of variability. Age & Ageing. 1992;21:171-4.

113. Herno A, Saari T, Suomalainen O, Airaksinen O. The degree of decompressive relief and its relation to clinical outcome in patients undergoing surgery for lumbar spinal stenosis. Spine. 1999;24:1010-4.

114. Bohannon RW, Gajdosik RL. Spinal nerve root compression--some clinical implications. A review of the literature. Physical Therapy. 1987;67:376-82.

115. Daube JR. Electrophysiologic studies in the diagnosis and prognosis of motor neuron diseases. Neurologic Clinics. 1985;3:473-93.