Degenerative Lumbar Spinal Stenosis Research Articles

Reliability and Validity of the Thai Version of the Swiss Spinal Stenosis Questionnaire.

The original Swiss Spinal Stenosis (SSS) questionnaire was translated into the Thai version and culturally adapt for use in Thailand. The Thai version—SSS is valid and reliable to use in both clinical and research to address the functional, symptom severity, and satisfaction in Thai lumbar spinal stenosis patients. Study Design.. Cross-sectional study. Objective.. To evaluate the reliability and validity of the Thai version of the Swiss Spinal Stenosis (SSS) questionnaire. Summary of Background Data.. The SSS questionnaire was developed to assess symptom severity, physical functional status, and patient satisfaction in spinal stenosis patients that was previously reported to have good reliability and validity. There is currently no Thai version of the SSS questionnaire. Methods.. The SSS questionnaire was translated into Thai language to create the Thai version of the Swiss Spinal Stenosis (Thai-SSS) questionnaire. Translation was performed according to international standards using a forward-backward translation protocol. Translation was performed by two expert translators and one physician, and the final version was approved by an expert committee. Thai patients with degenerative lumbar spinal stenosis were enrolled and evaluated using the Thai-SSS questionnaire, the Thai version of the Short Form-36 (SF-36), and a visual analogue scale (VAS) before and after treatment. Reliability and validity of the Thai-SSS were assessed via comparison with the SF-36 and the VAS. Results.. One hundred seven patients were included. Eighty patients underwent decompression and fusion surgery, and the others underwent decompression alone. Cronbach's alpha of all domains of the Thai-SSS showed excellent internal consistency (0.869–0.921). The intraclass correlation coefficient for test–retest reliability was 0.77 (95% CI: 0.65–0.85). Regarding concurrent validity, the physical function scale of the Thai-SSS was strongly correlated with the physical functioning domain of the SF-36 (r = 0.70). The symptom severity domain of the Thai-SSS was strongly correlated with the bodily pain domain of the SF-36 and the VAS (r = 0.76 and 0.78, respectively). Conclusion.. The Thai-SSS was found to be a valid and reliable tool for evaluating symptom severity, physical function, and patient satisfaction after treatment in Thai patients with spinal stenosis. Level of Evidence: 4

Degenerative central lumbar spinal stenosis: is endoscopic decompression through bilateral transforaminal approach sufficient?

BackgroundAt present, few reports of percutaneous endoscopic transforaminal decompression surgery have been reported to solve central lumbar spinal stenosis (CLSS). Is endoscopic decompression through bilateral transforaminal approach decompression sufficient for degenerative CLSS?MethodsThis retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively.ResultsAll 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 min. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P = 0.00), 2.47 (P = 0.71), and 19.40% (P = 0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dural tear and 3 cases of transient postoperative dysthesia. The cross-sectional area of the dural sac was significant enlargement at the last fellow up (74.28 ± 13.08 mm2 vs.104.91 ± 12.40 mm2, P = 0.00).ConclusionsExcept for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.

Awake Endospine Disektomi pada Pasien Lumbar Spinal Stenosis karena Hernia Nucleus Pulposus

Lumbar spinal stenosis (LSS) are symptoms from degradation canalis spinalis vertebrae’s size which pressured nerve inside it. Based on its cause, there are two types of LSS, congenital and degenerative. The patient can experience an unpredictable pain phase as well as a stable phase without pain. Bulging of intervertebralis disc or HNP is one of degenerative LSS. HNP disease is one of the causes of low back pain and is a major health problem. HNP prevalention is 1-2 % from population. One of therapy use to medicate LSS is endospine discectomy. This operation done with general anesthesia (GA) or neuroaxial anesthesia (spinal, epidural). GA preferably used because it caused less side effect like airway obstruction or neural injury. Dexmedetomidine has a sedative effect without the risk of respiratory depression and has an analgesic effect. It can be used to awake endospine methods in dissectomy. In this case report, the writer did awake endospine method to accommodate operator so they could know level of pain and motoric function of patient durante operation.

Outcome of Transforaminal Lumbar Interbody Fusion versus Posterolateral Lumbar Fusion with Instrumentation in Treatment of Degenerative Lumbar Disorders

Background Data: Degenerative lumbar spine disorders are common pathologies that usually affect females in their sixth decade or older. Patients usually present with various symptoms, including back pain, radiculopathy, or neurogenic claudication, among other less common presentations. Different fusion procedures are available to manage these problems. Purpose: This study was designed to evaluate the clinical and radiological outcome of transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) in managing degenerative lumbar disorders. Study Design: A prospective study. Patients and Methods: This study was conducted on patients with degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis who underwent lumbar spine fixation with either TLIF or PLF. Patients were randomized into two groups according to the operative procedure: Group A (20 patients) underwent TLIF and Group B (20 patients) underwent PLF. Patients were followed up and assessed for back and leg pain, functional disability, and spinal fusion. Results: We found that both TLIF and PLF improve disability and pain in patients with degenerative lumbar disorders. TLIF was found to be superior to PLF as regards achieving radiographic outcomes. We did not find strong evidence to support the use of interbody fusion along with transpedicular fixation compared to traditional posterolateral fusion in the treatment of degenerative lumbar disorders, taking into consideration the higher material costs added with interbody fusion. Conclusion: The reported data in the present study suggest that both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar disorders. They also suggest that TLIF is superior to PLF when comparing the achievement of radiographic fusion. However, there is no significant clinical outcome difference to recommend using TLIF over traditional PLF in treating degenerative lumbar disorders, especially with the higher treatment costs related to the use of interbody fusion. (2020ESJ217)

Degenerative Lumbar Spine Stenosis Consensus Conference: the Italian job. Recommendations of the Spinal Section of the Italian Society of Neurosurgery.

In the modern era evidence-based medicine, guidelines and recommendations represent a key-point of daily activity. The Spinal Section of the Italian Society of Neurosurgery introduced some recommendations regarding Degenerative Lumbar Spine Stenosis based on those of the Spine Committee of World Federation of Neurosurgical Societies, revising them on the basis of Italian common practice. In June 2019, a Committee of 21 spine surgeons met in Rome to validate the recommendations of the WFNS. Furthermore, they decided to review the ones that did not reach a consensus to create Italian Recommendations on Degenerative Lumbar Spine Stenosis. A literature review of the last ten years was performed and the statements were voted using the Delphi method. Forty-one statements were discussed, and 7 statements were voted again to reach a consensus with respect to those of the WFNS. A total of 40 statements reached a consensus, of which 36 reached a positive consensus and 4 a negative consensus, while no consensus was reached in 1 case. Conservative multimodal therapy, tailored on the patient, is a reasonable and effective first option choice for the treatment of LSS patients with tolerable moderate symptoms. Surgical treatment is reserved for symptomatic patients non-responding to conservative treatment or with neurological deficits. The best surgical technique to use depends on personal experience; modern MISS techniques are equivalent to open decompressive surgery with some advantages and higher cost-effectiveness. Fusion surgery and mobility preserving surgery only have a marginal role in the treatment of DLSS without instability.

Development of an In Vitro 3D Model for Investigating Ligamentum Flavum Hypertrophy

BackgroundLigamentum flavum hypertrophy (LFH) is among the most crucial factors in degenerative lumbar spinal stenosis, which can cause back pain, lower extremity pain, cauda equina syndrome and neurogenic claudication. The exact pathogenesis of LFH remains elusive despite extensive research. Most in vitro studies investigating LFH have been carried out using conventional two-dimensional (2D) cell cultures, which do not resemble in vivo conditions, as they lack crucial pathophysiological factors found in three-dimensional (3D) LFH tissue, such as enhanced cell proliferation and cell cluster formation. In this study, we generated ligamentum flavum (LF) clusters using spheroid cultures derived from primary LFH tissue.ResultsThe cultured LF spheroids exhibited good viability and growth on an ultra-low attachment 96-well plate (ULA 96-plate) platform according to live/dead staining. Our results showed that the 100-cell culture continued to grow in size, while the 1000-cell culture maintained its size, and the 5000-cell culture exhibited a decreasing trend in size as the culture time increased; long-term culture was validated for at least 28 days. The LF spheroids also maintained the extracellular matrix (ECM) phenotype, i.e., fibronectin, elastin, and collagen I and III. The 2D culture and 3D culture were further compared by cell cycle and Western blot analyses. Finally, we utilized hematoxylin and eosin (H&E) staining to demonstrate that the 3D spheroids resembled part of the cell arrangement in LF hypertrophic tissue.ConclusionsThe developed LF spheroid model has great potential, as it provides a stable culture platform in a 3D model that can further improve our understanding of the pathogenesis of LFH and has applications in future studies.

65. Indirect decompression for the treatment of degenerative lumbar stenosis: clinical outcome in a consecutive series of 568 patients

BACKGROUND CONTEXT Surgical treatment of symptomatic lumbar stenosis has traditionally included laminectomy for direct decompression. With expanding options for lumbar interbody fusion, interest has been increasing in indirect decompression to treat degenerative stenosis. Segmental distraction afforded by these interbody techniques is thought to increase foraminal height and reduce ligamentous infolding, thereby indirectly decompressing neural elements. PURPOSE The primary purpose of this study was to determine whether indirect decompression via anterior lumbar interbody fusion (ALIF) can provide symptomatic relief in patients with lumbar spinal stenosis. Secondary purposes were to: (1) determine if risk factors for failure of indirect decompression could be identified, and (2) compare outcomes between patients undergoing stand-alone ALIF vs those with supplemental posterior fixation (ALIF+PF). STUDY DESIGN/SETTING This was a retrospective chart review study. PATIENT SAMPLE The study was based on a consecutive series of 568 patients undergoing single-level ALIF without posterior decompression to treat degenerative stenosis during a 5-year period. OUTCOME MEASURES Data recorded included general demographics, symptom type, Oswestry Disability Index (ODI) scores, visual analog scale (VAS) data separately assessing back and leg pain, and re-operations. METHODS Failure of indirect decompression was defined as return to the operating room for direct decompression. Patients who failed indirect decompression were compared to those who did not to determine whether differences between groups could be identified. An additional subgroup analysis was performed to compare outcomes of patients who underwent stand-alone ALIF (n=247) vs those in whom supplemental posterior fixation was used (ALIF+PF; n=321). RESULTS Re-operation due to failure of indirect decompression occurred in 4.0% (23/568) of patients. The only factor found to be related to failure was age. Patients greater than 60 years of age were more likely to fail indirect decompression than were younger patients (7.0% vs 3.1%, p 0.50). For example, prior to surgery, ODI scores were 44.0 and 43.8 in the ALIF and ALIF+PS groups, respectively. These improved significantly to 27.3 and 27.5 after surgery. The percentage of patients in the 2 groups undergoing re-operation for direct decompression was not significantly different (ALIF 4.9% vs. ALIF+PS 3.4%; p>0.05). CONCLUSIONS Indirect decompression via ALIF was effective in treating appropriately-selected patients with degenerative lumbar spinal stenosis. Significant improvements on ODI and pain scores were observed. Only 4% of patients underwent subsequent direct decompression. Increased age was the only identified risk factor for failure of indirect decompression. This may be related to increased osseous stenosis in older individuals, which may be less amenable to indirect decompression. There were no significant differences in clinical outcomes or re-operation rates when comparing ALIF vs ALIF+PF, suggesting that posterior instrumentation may be omitted without sacrificing the effectiveness of indirect decompression unless there is a well-defined indication for it. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Lumbar degenerative disease after oblique lateral interbody fusion: sagittal spinopelvic alignment and its impact on low back pain

BackgroundWe determined the incidence and risk factors of low back pain (LBP) in patients with lumbar degenerative disease after single-level oblique lateral interbody fusion (OLIF).MethodsWe retrospectively reviewed 120 lumbar degenerative disease patients who underwent single-level OLIF. We compared preoperative and postoperative radiographic parameters, including segmental lordosis (SL), lumbar lordosis (LL), disk height (DH), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), and C7-sagittal vertical axis (SVA). Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for back and leg pain. All patients were followed up for at least 2 years.ResultsThirty-eight patients had postoperative LBP (VAS score for back pain ≥3; LBP group); the remaining 82 patients were in the non-LBP group. Age (P = 0.082), gender (P = 0.425), body mass index (P = 0.138), diagnosis (degenerative spondylolisthesis vs. lumbar spinal stenosis; P = 0.529), surgical level (P = 0.651), blood loss (P = 0.889), and operative time (P = 0.731) did not differ between the groups. In both groups, the ODI and VAS scores for back pain and leg pain significantly improved at the final follow-up compared with the preoperative scores (P = 0.003). Except for the VAS score for back pain (P = 0.000), none of the scores significantly differed between the two groups at the final follow-up (P > 0.05). In the non-LBP group, LL, SL, DH, TK, and SS significantly improved, while PT and C7-SVA significantly decreased at the final follow-up as compared with the preoperative values. In both groups, DH significantly improved postoperatively, with no significant between-group difference (P = 0.325). At the final follow-up, LL, PI-LL mismatch, PT, and C7-SVA showed significantly greater improvement in the non-LBP group than in the LBP group (P < 0.05). Multivariate analysis identified PT, PI-LL mismatch, and C7-SVA as significant risk factors for LBP after OLIF.ConclusionOLIF for single-level lumbar degenerative disease had satisfactory clinical outcomes. PT, PI-LL mismatch, and C7-SVA were significant risk factors for postoperative LBP. Patients with appropriately decreased PT, improved C7-SVA, and PI-LL match experienced less LBP.

Spinal cord electrostimulation in patients with degenerative lumbar spinal stenosis

The study objective is to assess the effectiveness of spinal cord electrostimulation in patients with degenerative lumbar spinal stenosis. Materials and methods . A study was conducted among 20 patients with degenerative lumbar spinal stenosis. All patients had radicular symptoms or neurogenic claudication. Most patients (n = 18) were rejected from open decompression because of severe concomitant somatic pathology. Two patients refused from open intervention, they were offered electrostimulation. All patients (n = 20) were implanted of the test epidural electrode for spinal cord electrostimulation. Outcomes were assessed by using a visual analogue scale and increasing of the distance of non-stop walking in 8 days after surgery. Among patients with chronic spinal cord electrostimulation, outcomes were assessed in 6 months after implantation. A satisfactory result was considered as a decreasing of pain more than 50 %. Results. А satisfactory result of test electrostimulation was noted in 18 patients, all of them were implanted of system of the chronic spinal cord electrostimulation. The average value of lumbar pain changed from 4.2 to 3.1 points, and the average value of leg-pain changed from 7.2 to 2.2 points. The average value of the non-stop walking distance changedfrom 58 to 245 meters. At the same time, the motor component of neurogenic claudication decreased in only 1 patient. In some patients, after regression of radicular pain, heart complaints became the main factor limiting walking. Before electrostimulation, only 3 patients had no walking restriction. After electrostimulation 7 patients had no walking restriction. Conclusion. Spinal cord electrostimulation is an effective palliative option in patients with degenerative lumbar spinal stenosis.

Efficacy of acupuncture for treatment of intermittent claudication in patients with degenerative lumbar spinal stenosis: protocol for a randomized controlled trial

BackgroundDegenerative lumbar spinal stenosis (DLSS) is a common condition secondary to degenerative changes. Acupuncture may be effective for treating DLSS. However, there is a lack of sufficient evidence showing the efficacy of acupuncture. The aim of this study is to assess the efficacy and safety of acupuncture for relieving neurogenic claudication in patients with DLSS.MethodsA total of 196 patients will be randomly assigned to an acupuncture group or a sham acupuncture group at a ratio of 1:1. Patients will receive 18 sessions of treatment for 6 continuous weeks. The primary outcome will be the change in the Modified Roland-Morris Disability Questionnaire score from baseline to week 6. The secondary outcomes will include the change in the scores from baseline for the Numerical Rating Scale, Swiss Spinal Stenosis Questionnaire, and Anxiety and Depression Scale. Additionally, the expectancy of acupuncture, blinding, and safety will also be assessed. All analysis will be performed based on intention-to-treat.DiscussionThe aim of this study is to evaluate the efficacy and safety of acupuncture for the treatment of neurogenic claudication in patients with DLSS. A limitation of this study is that acupuncturists cannot be blinded according to the characteristics of acupuncture, which may introduce some bias.Trial registrationClinicalTrials.gov NCT03784729 and protocol ID 2018-161-KY. Registered on 18 December 2018.

Degenerative Lumbar Spinal Stenosis.

Degenerative lumbar spinal stenosis is the most frequent cause of low back pain and/or sciatica in the elderly patient. Epidemiology, pathophysiology, clinical manifestations and testing are reviewed in a wide current bibliographic investigation. The importance of the relationship between clinical presentation and imaging study, especially magnetic resonance imaging (MRI), is emphasized. Prior to treatment indication, it is necessary to identify the precise location of pain, as well as the differential diagnosis between neurological and vascular lameness. Conservative treatment combining medications with various physical therapy techniques solves the problem in most cases, while therapeutic testing with injections, whether epidural, foraminal or facetary, is performed when pain does not subside with conservative treatment and before surgery is indicated. Injections usually perform better results in relieving sciatica symptoms and less in neurological lameness. Equine tail and/or root decompression associated or not with fusion is the gold standard when surgical intervention is required. Fusion after decompression is necessary in cases with segmental instability, such as degenerative spondylolisthesis. When canal stenosis occurs at multiple levels and is accompanied by axis deviation, whether coronal and/or sagittal, correction of axis deviations should be performed in addition to decompression and fusion, especially of the sagittal axis, in which a lumbar lordosis correction is required with techniques that correct the rectified lordosis to values close to the pelvic incidence.

Clinical efficacy and radiographic K-rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis

BackgroundThis study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS).MethodsA total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n = 25) and rigid systems (n = 15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system.ResultsJOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system.ConclusionsCompared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.

Facet Tropism and Orientation: Risk Factors for Degenerative Lumbar Spinal Stenosis.

The aim of this study is to establish whether facet tropism (FT) and orientation (FO) are associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study including 274 individuals was divided into two groups: control (82 males and 81 females) and stenosis (59 males and 52 females). All participants have undergone high-resolution CT scan of the lumbar spine in the same position. FT and FO were measured at L1-2 to L5-S1. Significant sagittal FO was noted in the stenosis males (L2-3 to L4-5) and females (L2-3 to L5-S1) compared to the controls. The prevalence of FT was remarkably greater in the stenosis males (L4-5, L5-S1) and females (L3-4, L5-S1) compared to their counterparts in the control group. Our results also showed that FT (L3-4 to L5-S1) increases approximately 2.9 times the likelihood for DLSS development. This study indicates that FO and FT in the lower lumbar spine are significantly associated with DLSS.

Low back pain as an equivalent of neurogenic claudication in elderly patient: Case report

This clinical report presents the case of chronic low back pain in elderly female referring to multilevel (L2-L5) degenerative lumbar spinal stenosis without typical neurogenic claudication and leg pain. Subsequent minimally invasive surgical decompression produced complete resolve of the pain and drastic improvement life quality. This surgery confirmed the pain origin and proves the possibility of sole low back pain as an equivalent of neurogenic claudication. Considering this type of clinical pattern of spinal stenosis can direct general practitioner or other medical professional to correct diagnosis and prompt surgical treatment.

Conservative Treatment and Percutaneous Pain Relief Techniques in Patients with Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations

BackgroundDegenerative lumbar spinal stenosis (LSS) is a progressive disease with potentially dangerous consequences that affect quality of life. Despite the detailed literature, natural history is unpredictable. This uncertainty presents a challenge making the correct management decisions, especially in patients with mild to moderate symptoms, regarding conservative or surgical treatment. This article focused on conservative treatment for degenerative LSS.MethodsTo standardize clinical practice worldwide as much as possible, the World Federation of Neurosurgical Societies Spine Committee held a consensus conference on conservative treatment for degenerative LSS. A team of experts in spinal disorders reviewed the literature on conservative treatment for degenerative LSS from 2008 to 2018 and drafted and voted on a number of statements.ResultsDuring 2 consensus meetings, 14 statements were voted on. The Committee agreed on the use of physical therapy for up to 3 months in cases with no neurologic symptoms. Initial conservative treatment could be applied without major complications in these cases. In patients with moderate to severe symptoms or with acute radicular deficits, surgical treatment is indicated. The efficacy of epidural injections is still debated, as it shows only limited benefit in patients with degenerative LSS.ConclusionsA conservative approach based on therapeutic exercise may be the first choice in patients with LSS except in the presence of significant neurologic deficits. Treatment with instrumental modalities or epidural injections is still debated. Further studies with standardization of outcome measures are needed to reach high-level evidence conclusions.

Outcome of decompressive operative procedure in the treatment of degenerative lumbar spinal canal stenosis: experience of managing consecutive 25 cases

Background: Lumbar spinal canal stenosis (LSCS) is a common medical disorder due to degenerative changesin the middle age and older individual. In this condition, narrowing of lumbar spinal canal and nerve rootcanal leads to painful, debilitating compression of spinal nerves and blood vessels. Decompressive surgery inlumbar spinal canal stenosis is one of modern methods of treatment.The objective of this study was to evaluate the outcome of decompressive operative management in degenerativelumbar spinal canal stenosis.&#x0D; Methods: Thiswas a prospective interventional study carried out at National Institute of Traumatology andOrthopaedic Rehabilitation (NITOR) and City Hospital, Lalmatia, Dhaka from October 2012 to December2014.Total number of patients were 25 who underwent decompressive surgical procedures. Each of patientswas evaluated by the visual analogue scale (VAS) for pain, disability by using Oswestry disability index (ODI)and ModifiedMacnab Criteria (MMC)for assessment of improvement.&#x0D; Results: This was a prospective interventional study carried out at National Institute Of Traumatology and OrthopaedicRehabilitation (NITOR) and City hospital, Lalmatia, Dhaka from October 2012 to December 2014. Out of 25patients, 19 patients(76%)were male and 6 patients (24%) were female, age ranged from 38-65 years with the meanage 48.50 ± 8.65 years. Sixteen (64%) patients were manual worker and 9 patients (36%) were sedentary worker.Sixteen (64%) patients had multilevel stenosis and 9 patients (36%) had single level stenosis. The mean follow upduration was 1.5 years (range: 1-3 years). Mean estimated blood loss was 150ml (range : 100-200ml), meansurgery time was 130mutes (range: 80-180min) and average hospital stay was 7 days (range: 4-10 days). Only 1patient (4%) had discitis, 1 patient (4%) had superficial wound infection and 1 patient (4%) had dural tear. AsMMC, 21 (84%) patients was poor before operation and after operation at 12 months follow up 8 patients (32%)had excellent, 12 patients (48%) had good, 4 patients (16%) had fair and 1 patient (4%) had poor functionaloutcome. Mean (SD) ODI were 75.40 (± 5.01) before operation and reduced to 8.36 (± 13.54) after operation at 3rd(12 month) follow up. Mean (SD) VAS was 7.12 (± 0.86) before operation and reduced to 1.46 (± 1.31) afteroperation at 3rd (12 month) follow up. Twenty (80%) patients had satisfactory functional outcome.&#x0D; Conclusion: Decompressive operation is an effective, safe and acceptable method of treatment in degenerativelumbar spinal canal stenosis (LSCS).&#x0D; Birdem Med J 2020; 10(2): 103-107

The influence of comorbidity on the results of surgical treatment of elderly and senile patients with degenerative lumbar spinal stenosis

Objective. To analyze the influence of somatic comorbidity on the results of surgical treatment of elderly and senile patients with degenerative lumbar spinal stenosis.Material and Methods. The study design corresponds to a single-center non-randomized retrospective cohort study with level 3 evidence (OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence). The influence of somatic comorbidity on quality of life after surgery for degenerative lumbar spinal stenosis was analyzed in 962 patients 60–85 years old. Analysis and evaluation of the results of the study was carried out in two groups of patients with radicular compression syndrome: Group 1 (less than 5 points according to White – Panjabi criteria) included 625 (65%) patients, and Group 2 (5 or more points according to White – Panjabi criteria) – 337 (35%) patients.Results. Body mass index of patients in Group 1 was statistically significantly lower than in Group 2. Repeated surgical interventions performed during the first year after the primary operation were statistically significantly more frequent in Group 1, and those performed after 3–4 years were more frequent in Group 2 (BMI ≥ 30) due to the development of adjacent level disease. In obese patients, the duration of surgery, blood loss and postoperative hospital stay are statistically significantly increased. One year after surgery, a statistically significant negative effect of increase in BMI on the parameters of back pain, lower limb pain, functional adaptation, and quality of life was revealed in both groups of patients. No association of obesity and complication rates was noted. In Group 2, the incidence of adjacent level disease 2–5 years after the primary operation was higher in patients with BMI ≥ 30 compared with patients with BMI &lt; 30 and with patients in Group 1. It was found that somatic comorbidity and the age of patients statistically significantly prolonged postoperative hospital stay in Group 1 and did not affect its duration in Group 2. No effect of the comorbidity index on the quality of life was noted. Osteoporosis was statistically significantly associated with an increase in the frequency of technical complications during surgery (malposition of pedicle screws, cage migration, and damage to the vertebral endplates).Conclusion. Obesity is statistically significantly associated with an increase in postoperative hospital stay, surgery duration and blood loss, and is a predictor of the development of instability of the spinal motion segment and adjacent level disease. Obese patients have higher levels of back and lower limb pain and worse quality of life parameters after surgical interventions than patients with normal body weight. When using minimally invasive technologies in the surgical treatment of degenerative lumbar spine pathology, the number of complications in obese patients is not higher than in patients with normal body weight. The effect of comorbidity on the results of minimally invasive surgery for degenerative lumbar pathology was not detected. Osteoporosis affects the frequency of technical complications during surgery.

Interbody fusion in degenerative lumbar spinal stenosis with additional posterolateral fusion using Escherichia coli-derived bone morphogenetic protein-2: A Pilot study.

This case series investigated the efficacy and optimal dose of Escherichia coli-derived bone morphogenetic protein-2 (E.BMP-2) as a bone graft substitute for additional posterolateral spinal fusion, accompanying interbody fusion procedures, for treating lumbar degenerative spinal stenosis. This study focused on the optimal dose for each segment and the efficacy of E.BMP-2 as a substitute for autogenous iliac bone graft.Ten patients were enrolled from January 2015 to December 2015, and underwent an additional posterolateral fusion procedure, with 2.5 mg of E.BMP-2 followed by decompression, transpedicular fixation, and interbody fusion. The mean follow-up period was 13.9 months, and regular radiological examinations were performed in every case. Clinical outcomes were measured with a visual analog scale for back pain (VAS-BP), and leg pain (VAS-LP) and the Korean Oswestry Disability Index (K-ODI). All parameters were assessed preoperatively and postoperatively at 12 months.All 18 segments treated with E.BMP-2 completely fused in 6 months as observed on both simple radiography and computed tomography. The mean fusion period was 4.5 months on simple radiography. At 12 months follow-up, VAS-BP, VAS-LP, and K-ODI scores (1.9 ± 1.5, 1.9 ± 1.9, 11.0 ± 6.6, respectively) had improved significantly compared to preoperative scores (5.5 ± 1.9, 6.5 ± 1.9, and 49.9 ± 11.5, respectively, P < .05). There were no postoperative wound infections, neurological symptoms, or complications associated with the use of E.BMP-2 during the follow-up period.E.BMP-2 could be used to enhance the outcomes in posterolateral spinal fusion following interbody fusion surgery. In the present study, 2.5 mg of the E.BMP-2 per segment was sufficient to obtain bony union in posterolateral fusion surgery. Further large-scale trials with long-term follow-up are necessary to evaluate the various complications related to the use of E.BMP-2.

Preoperative Factors Predict Postoperative Trajectories of Pain and Disability Following Surgery for Degenerative Lumbar Spinal Stenosis.

Longitudinal analysis of prospectively collected data. Investigate potential predictors of poor outcome following surgery for degenerative lumbar spinal stenosis (LSS). LSS is the most common reason for an older person to undergo spinal surgery, yet little information is available to inform patient selection. We recruited LSS surgical candidates from 13 orthopedic and neurological surgery centers. Potential outcome predictors included demographic, health, clinical, and surgery-related variables. Outcome measures were leg and back numeric pain rating scales and Oswestry disability index scores obtained before surgery and after 3, 12, and 24 postoperative months. We classified surgical outcomes based on trajectories of leg pain and a composite measure of overall outcome (leg pain, back pain, and disability). Data from 529 patients (mean [SD] age = 66.5 [9.1] yrs; 46% female) were included. In total, 36.1% and 27.6% of patients were classified as experiencing a poor leg pain outcome and overall outcome, respectively. For both outcomes, patients receiving compensation or with depression/depression risk were more likely, and patients participating in regular exercise were less likely to have poor outcomes. Lower health-related quality of life, previous spine surgery, and preoperative anticonvulsant medication use were associated with poor leg pain outcome. Patients with ASA scores more than two, greater preoperative disability, and longer pain duration or surgical waits were more likely to have a poor overall outcome. Patients who received preoperative chiropractic or physiotherapy treatment were less likely to report a poor overall outcome. Multivariable models demonstrated poor-to acceptable (leg pain) and excellent (overall outcome) discrimination. Approximately one in three patients with LSS experience a poor clinical outcome consistent with surgical non-response. Demographic, health, and clinical factors were more predictive of clinical outcome than surgery-related factors. These predictors may assist surgeons with patient selection and inform shared decision-making for patients with symptomatic LSS. 2.

Reducing decompression levels by diffusion tensor imaging and conventional magnetic resonance imaging in degenerative lumbar spinal stenosis

Background The selection of a correct level in lumbar spinal stenosis (LSS) remains a common problem and is critically important to the effectiveness of this surgical treatment. Surgery is invasive, and extended laminectomy may lead to secondary surgical complications. The application of diffuse tensor imagining (DTI) and paraspinal mapping (PM) in addition to conventional magnetic resonance imaging (cMRI) may be helpful in this respect. However, the superiority of cMRI + DTI over cMRI+ (DTI or PM) in reducing decompression has not yet been established. Methods We compared the surgical levels, determined by cMRI + DTI and cMRI+ (DTI or PM) (self-control). Treatment outcome measurements were performed at two weeks, three months, six months, and twelve months postoperatively. Results The surgical levels determined by cMRI ± DTI showed less than that determined by cMRI± (DTI or PM) with statistically significant differences (p value = 0.0199) and cMRI ± PM with no statistically significant differences (p value = 0.5503). Conclusions The effectiveness of cMRI ± DTI in the reduction of the surgical levels in degenerative lumbar spinal stenosis is superior than that of cMRI± (DTI or PM).