Degenerative Lumbar Stenosis Research Articles

Can abdominal aortic calcification detected on lateral lumbar radiography predict instrument-related complications in patients undergoing posterior lumbar fusion?

Objective: Abdominal aortic calcification (AAC) is well known as a useful and simple clinical indicator of the risk of fracture and cardiovascular disease. However, no studies have directly compared the postoperative implications of AAC in spinal surgery. The purpose of this study was thus to examine whether extended AAC (scores ≥5) negatively affected clinical outcomes after posterior lumbar fusion with instrumentation for degenerative lumbar stenosis or degenerative spondylolisthesis.Methods: The subjects comprised 101 consecutive patients with spinal stenosis or degenerative spondylolisthesis who underwent posterior lumbar fusion and instrumentation between January 2016 and January 2019 and were followed for over 2 years. Propensity score matching was employed to assemble patient groups with similar baseline characteristics. Postoperative complications and radiologic outcomes were compared between the groups (33 patients in each) divided by extended AAC score.Results: The incidence rates of junctional failure (6.1% vs. 30.3%, P=0.008) and screw-related complications (12.1% vs. 36.4%, P=0.019) were higher in the extended AAC group than in the mild AAC group. However, the rates of adjacent segment disease (24.2% vs. 36.4%, P=0.283) and revision (6.1% vs. 9.1%, P=0.642) were not significantly different between the 2 groups. In terms of postoperative medical complications, cardiovascular and cerebrovascular diseases were significantly more common in the extended AAC group than in the mild AAC group (0% vs. 15.2%, P=0.020).Conclusion: Extended AAC indicates increased risk for postoperative junctional failure and screw-related complications, regardless of age, osteoporosis, and comorbidities.

Endoscopic and microsurgical decompression for central lumbar spinal stenosis

Objective. To perform comparative analysis of the results of endoscopic and microsurgical decompression for lumbar spinal stenosis.Material and Methods. Design: Retrospective monocentric intra-cohort comparison of two groups of patients. The study included 99 patients aged 51–88 years with clinically significant lumbar spinal stenosis manifested by neurogenic intermittent claudication syndrome. Endoscopic decompression was performed in 51 patients, and microsurgical decompression – in 48 patients. To objectify and standardize clinical symptoms, walking distance in meters, pain syndrome and quality of life were assessed before and after surgery using standard scales and questionnaires (VAS, ODI). On the first day after surgery, back and lower limb pain were assessed, and during the observation period back and lower limb pain, quality of life and walking distance were assessed. Functional lumbar radiography was performed to exclude instability of the spinal motion segment. Using MRI, the cross-sectional area of the dural sac at the level of stenosis was measured before and after surgery. Clinical efficacy was assessed using the MCID (Minimal Clinical Important Difference) criterion. The results of the operation were followed-up for 12 months after the operation.Results. Blood loss in the endoscopic intervention group was less than in the microsurgical group. Pain in the lumbar spine and in the lower extremities decreased, and the cross-sectional area of the dural sac increased. In the first days after surgery, patients after endoscopic decompression had less severe back and lower extremity pain than patients after microsurgical decompression due to less soft tissue trauma. Pain syndrome in back 10–12 months after surgery was without statistically significant difference between the groups. Patients after endoscopic decompression had statistically significantly better quality of life according to ODI, lesser pain in the lower extremities according to VAS and longer walking distance than those in the microsurgical decompression group. Surgical treatment in both groups turned out to be effective, which is confirmed by MCID. The time of endoscopic intervention is significantly longer than that of microsurgical intervention. The length of the incision during endoscopic decompression is shorter than that of microsurgical decompression.Conclusion. A comparative analysis of the results of endoscopic and microsurgical decompression for degenerative central lumbar stenosis showed comparable effectiveness of both methods, including an increase in the spinal canal dimension and ensuring regression of clinical symptoms. The results of the comparison do not allow making a sufficiently substantiated judgment on the advantages of one of the methods, which dictates the need for further research.

The 3-Steps Approach for Lumbar Stenosis with Anatomical Insights, Tailored for Young Spine Surgeons.

Background/Objectives: Lumbar decompression surgery for degenerative lumbar stenosis is an intervention which addresses a degenerative condition affecting many patients. This article presents a meticulous three-phase surgical approach, derived from our clinical experiences and intertwining anatomical insights, offering a nuanced perspective tailored for the educational needs of young spinal surgeons. Methods: Six hundred and eighty-seven patients who underwent lumbar decompression surgery at a single institution were included in the present study. A retrospective analysis of patient demographics and surgical techniques was performed. All surgeries were performed by a consistent surgical team, emphasizing uniformity in approach. The surgical technique involves a meticulous three-phase process comprising exposure and skeletal visualization; microscopic identification and decompression; and undermining of the spinous process base and contralateral decompression. Results: Presenting results from 530 patients, the study examines demographic characteristics, health profiles, operative details, complications, and clinical assessments. The three-phase approach demonstrates low complication rates, absence of recurrences, and improved clinical outcomes, emphasizing its efficacy. Conclusions: The three-phase surgical approach emerges as a valuable educational tool for both novice and seasoned spinal surgeons. Rooted in anatomical insights, the structured methodology not only caters to the educational needs of young surgeons, but also ensures a standardized and safe procedure. The emphasis on tissue preservation and anatomical points aligns with current trends toward minimally invasive techniques, promising enhanced patient outcomes and satisfaction.

How does cervical sagittal profile change after the spontaneous compensation of global sagittal imbalance following one- or two-level lumbar fusion.

This study aimed to evaluate the cervical sagittal profile after the spontaneous compensation of global sagittal imbalance and analyze the associations between the changes in cervical sagittal alignment and spinopelvic parameters. In this retrospective radiographic study, we analyzed 90 patients with degenerative lumbar stenosis (DLS) and sagittal imbalance who underwent short lumbar fusion (imbalance group). We used 60 patients with DLS and sagittal balance as the control group (balance group). Patients in the imbalance group were also divided into two groups according to the preoperative PI: low PI group (≤ 50°), high PI group (PI > 50°). We measured the spinal sagittal alignment parameters on the long-cassette standing lateral radiographs of the whole spine. We compared the changes of spinal sagittal parameters between pre-operation and post-operation. We observed the relationships between the changes in cervical profile and spinopelvic parameters. Sagittal vertical axis (SVA) occurred spontaneous compensation (p = 0.000) and significant changes were observed in cervical lordosis (CL) (p = 0.000) and cervical sagittal vertical axis (cSVA) (p = 0.023) after surgery in the imbalance group. However, there were no significant differences in the radiographic parameters from pre-operation to post-operation in the balance group. The variations in CL were correlated with the variations in SVA (R = 0.307, p = 0.041). The variations in cSVA were correlated with the variations in SVA (R=-0.470, p = 0.001). Cervical sagittal profile would have compensatory changes after short lumbar fusion. The spontaneous decrease in CL would occur in patients with DLS after the spontaneous compensation of global sagittal imbalance following one- or two-level lumbar fusion. The changes of cervical sagittal profile were related to the extent of the spontaneous compensation of SVA.

Success predictors of decompressive surgical treatment for lumbar degenerative spinal canal stenosis

BACKGROUND: Decompressive surgical treatment for degenerative lumbar stenosis significantly improves patient clinical status. However, in some cases, patients are not satisfied with the outcomes. Various studies have examined clinical and morphological factors to improve the results of surgical interventions. AIM: To identify clinical and morphological predictors of the success of decompressive surgical interventions for lumbar degenerative stenosis. MATERIALS AND METHODS: This retrospective study included 61 patients who underwent surgery for mono- and postsegmental lumbar degenerative stenosis. Clinical and demographic data and the stage of degenerative changes in the functional spinal unit and sagittal balance of the spine were assessed. The success of surgical treatment was defined as simultaneous compliance with three criteria after 6–18 months: achievement of MCID for ODI (≥12%), recalibration of the spinal canal at the level of intervention according to MRI data (Schizas regression to ≥1 stage), and improvement of the patient’s subjective feeling (4–5 on the Likert scale). Logistic regression analysis was used to identify predictors of treatment outcome. RESULTS: A significant decrease in the intensity of pain syndrome (VAS in back and leg) and an improvement in the quality of life (ODI) after surgery (p 0.001) were found in all patients. In 73.8% of cases, the MCID threshold exceeded for ODI, whereas in 75.41%, patients were satisfied with surgical treatment. The success rate of surgical intervention was 65.57%. In one-factor regression analysis of clinical, demographic, and morphological parameters, the only independent predictor of surgical treatment was neuropathic pain before surgery according to the DN4 questionnaire (OR=1.52; p=0.011). CONCLUSION: Decompressive surgical treatment for degenerative lumbar stenosis is an effective treatment method, regardless of the extent and degree of degenerative changes in the spinal–motor segments and concomitant degenerative pathology, including disruption of sagittal balance. The predicting factor of the success of decompressive intervention is the severity of preoperative neuropathic pain.

406 Long-term Outcomes of Lumbar Facet Arthroplasty versus Spinal Fusion in the Treatment of Degenerative Spondylolisthesis and Stenosis

INTRODUCTION: Facet arthroplasty is a proposed alternative to lumbar fusion for treating degenerative lumbar spondylolisthesis and stenosis. Facet arthroplasty provides stabilization and preserves range of motion. METHODS: Patient-reported outcomes (PROMS), including Oswestry disability index (ODI), visual analog pain scales (VAS), and Zurich claudication questionnaires (ZCQ), were assessed at baseline and at multiple timepoints postoperatively. Flexion/extension range of motion (ROM) were radiographically evaluated at baseline, 12 months, and 24 months. Data were analyzed following an intention-to-treat model. RESULTS: A total of 299 patients were included (TOPS = 206, TLIF = 93). There were no significant differences at baseline. At 2 years, the TOPS group had a significantly greater proportion of patients report =30% improvement for ODI (93.8% versus 74.3%, p = 0.004) and =20-point improvement for VAS back (84.4% versus 61.8%, p = 0.014). At 1 year, TOPS group had a significantly greater proportion of patients report clinically significant improvements in all ZCQ categories (91.6% versus 78.5%, p = 0.012). In patients <65 years, the TOPS group had significantly improved PROMS compared to TLIF at 2 years; however, these differences were not observed in patients =65 years old. The TOPS groups preserved significantly more ROM at 12 (2.8° 95% CI [1.87; 3.74], p < 0.0001) and 24 (2.99° 95% CI [1.82; 4.15], p < 0.0001) months postoperatively compared to TLIF. ROM was similarly preserved in patients aged <64 and =65. The rate of adverse events did not differ significantly between groups (65.2% TOPS versus 61.5% TLIF). CONCLUSIONS: Facet arthroplasty preserves significantly more ROM and leads to improved PROMS compared to TLIF, particularly in younger patients. In older patients, the procedure improved outcomes significantly from baseline.

Evaluation of the Concentration of Selected Elements in the Serum of Patients with Degenerative Stenosis of the Lumbosacral Spine.

In humans, 23 elements have been shown to have biological activity. The purpose of this study was to evaluate the concentrations of iron (Fe), zinc (Zn), sodium (Na), potassium (K), magnesium (Mg), phosphorus (P), and calcium (Ca) in the serum of patients diagnosed with lumbar degenerative stenosis when compared to the concentrations of those elements in the serum of healthy volunteers. The study group consisted of 60 patients who were diagnosed with degenerative stenosis of the lumbosacral spine and who qualified for hemilaminectomy. The control group included 60 healthy volunteers without degenerative spinal stenosis. The clinical specimens studied had sera collected from both groups. The quantitative analysis of the selected elements revealed statistically significant (p < 0.05) lower concentrations of Zn (740 ± 110 µg/L vs. 880 ± 160 µg/L) and Mg (22,091 ± 4256 µg/L vs. 24,100 ± 4210 µg/L) in the serum of the patients from the study group when compared to the controls. By contrast, K (16,230 µg/L ± 1210 µg/L vs. 13,210 µg/L ± 1060 µg/L) and Fe (141.87 µg/L ± 11.22 µg/L vs. 109.1 µg/L ± 26.43 µg/L) levels were significantly higher in the study group compared to the controls (p < 0.05). No statistically significant changes were detected in the concentrations of the assessed micronutrients and macronutrients in both sexes in either the study group, the control group, or those based on body mass index (p > 0.05). In the serum samples from the study group, the strongest correlations were noted between the concentrations. In the study group, we showed a significant relationship between the levels of Fe/Zn (r = 0.41), Fe/Na (r = 0.41), Fe/P (r = 0.55), Zn/P (r = 0.68), Zn/K (r = 0.48), Zn/Ca (r = 0.94), Mg/Ca (r = 0.79), and Na/K (r = 0.67). We showed that only Mg concentration varied statistically significantly with the severity of pain (p < 0.05). These findings suggest that the assessment of Fe, Zn, Mg, and K concentrations can be helpful in predicting the onset of degenerative changes in the spine.

A Retrospective Study of the Effect of Spinopelvic Parameters on Fatty Infiltration in Paraspinal Muscles in Patients With Lumbar Spondylolisthesis.

The effect on fat infiltration (FI) of paraspinal muscles in degenerative lumbar spinal diseases has been demonstrated except for spinopelvic parameters. The present study is to identify the effect of spinopelvic parameters on FI of paraspinal muscle (PSM) and psoas major muscle (PMM) in patients with degenerative lumbar spondylolisthesis. A single-center, retrospective cross-sectional study of 160 patients with degenerative lumbar spondylolisthesis (DLS) and lumbar stenosis (LSS) who had lateral full-spine x-ray and lumbar spine magnetic resonance imaging was conducted. PSM and PMM FIs were defined as the ratio of fat to its muscle cross-sectional area. The FIs were compared among patients with different pelvic tilt (PT) and pelvic incidence (PI), respectively. The PSM FI correlated significantly with pelvic parameters in DLS patients, but not in LSS patients. The PSM FI in pelvic retroversion (PT > 25°) was 0.54 ± 0.13, which was significantly higher in DLS patients than in normal pelvis (0.41 ± 0.14) and pelvic anteversion (PT < 5°) (0.34 ± 0.12). The PSM FI of DLS patients with large PI ( > 60°) was 0.50 ± 0.13, which was higher than those with small ( < 45°) and normal PI (0.37 ± 0.11 and 0.36 ± 0.13). However, the PSM FI of LSS patients didn't change significantly with PT or PI. Moreover, the PMM FI was about 0.10-0.15, which was significantly lower than the PSM FI, and changed with PT and PI in a similar way of PSM FI with much less in magnitude. FI of the PSMs increased with greater pelvic retroversion or larger pelvic incidence in DLS patients, but not in LSS patients.

Establishment and Validation of Nomograms and Web Calculators for Different Cement Leakage Risk Types in Pedicle Screw Augmentation for Degenerative Lumbar Stenosis in Osteoporotic Vertebrae

BackgroundThe use of cement in pedicle screw augmentation (PSA) enhances the pullout force of pedicle screws in vertebrae affected by osteoporosis. Risks involved in the use of cement for PSA include nerve injury and vascular damage caused by cement leakage. MethodsOur study included all individuals who received PSA for degenerative lumbar stenosis (DLS) in osteoporotic vertebrae from January 2014 to May 2022. Postoperative CT scan will be used to assess cement leakage. Correlation analysis and logistic regression analyses were utilized to establish the associated clinical or radiological factors, which were then used to construct Nomograms and web calculators. ResultsOur study included a total of 181 patients, with 886 screws being inserted into 443 vertebrae. Perivertebral cement leakage was significantly associated with female, decreased BMD, solid screws, and scattered cement distribution. The majority of cement leakage happened through segmental veins (type S, 72.1%), with basivertebral veins (type B, 23.9%) and instrument-related leakage (type I, 13.9%) following suit. Lower BMD and scattered cement distribution were more likely to experience type S or type B leakage. Our analysis data showed that cement augmentation with cannulated and fenestrated screws tended toward concentrated cement distribution. The creation and verification of each Nomogram additionally showcased the prognostic capability and medical significance of the corresponding model. ConclusionNomograms and web-based calculators can accurately forecast the probability of cement leakage. We should regularly perform the procedure using cannulated and fenestrated screws, along with a moderate amount of high-viscosity cement, while continuously monitoring with fluoroscopy during PSA.

Analysis of Predictors for Spinal Fusion in Degenerative Lumbar Stenosis in Chile Based on Diagnosis-Related Groups

Analysis of Predictors for Spinal Fusion in Degenerative Lumbar Stenosis in Chile Based on Diagnosis-Related Groups

Supplementary posterior fusion in patients operated on employing TLIF may decrease the instrumentation failure rate.

It is supposed that additional posterior fusion may provide additional stability of the pedicle screw; however, the clinical impact of additional posterior fusion in patients treated with TLIF remains uncertain. The objective of this study is to assess the clinical efficacy of circumferential fusion in patients treated with TLIF. This is a single-center retrospective evaluation of consecutive 179 patients with degenerative lumbar stenosis and instability of spinal segments. Patients with axial pain and neurogenic claudication or radiculopathy associated with spinal stenosis were enrolled during the period from 2012 to 2018. Transforaminal lumbar interbody fusion (TLIF) with a single cage was used to treat patients. In 118 cases a supplementary posterior fusion was made. The duration of follow-up accounted for 24 months, logistic regression analysis was used to assess factors that influence the complication rate. The rate of pedicle screw loosening was growing with radiodensity getting decreased and was more frequent in patients with two level fusion. An increase in pedicle screw loosening rate correlated with anterior nonunion Tan 2 and 3 grade while both posterior complete and incomplete fusion resulted in a decline in the complication rate. Lumbosacral fusion, bilateral facet joints` resection and laminectomy turned out to be insignificant factors. The overall goodness of fit of the estimated general multivariate model was χ2 = 87.2230; P < 0.0001. To confirm clinical relevance of those findings, a univariate logistic regression was performed to assess the association between clinically significant pedicle screw instability and posterior fusion in patients operated on employing TLIF. The results of logistic regression analysis demonstrate that additional posterior fusion may decrease the rate of instrumentation failure that requires revision surgery in patients treated with TLIF [B0 = 1.314321; B1 = -3.218279; p = 0.0023; OR = 24.98507; 95% CI (3.209265; 194.5162), the overall goodness of fit of the estimated regression was χ2 = 22.29538, p = <0.0001]. Circumferential fusion in patients operated on employing TLIF is associated with a decline in the rate of pedicle screw loosening detected by CT imaging and clinically significant instrumentation failure.

Results of treatment of patients with degenerative lumbar stenosis using spinal epidural neurostimulation

The article provides the results of treatment of patients with degenerative lumbar stenosis; a detailed analysis of the main components of pain syndrome, neurogenic intermittent claudication, and factors of patient disability has been carried out. The efficacy of volley and tonic neurostimulation has been compared, factors of the effectiveness of neurostimulation have been identified, and an algorithm for managing patients with degenerative lumbar stenosis with severe concomitant diseases that prevent decompressive surgery has been developed.

Antithrombotic therapy and spinal surgery: a retrospective cohort study of 289 consecutive elderly patients with degenerative lumbar stenosis.

Lumbar spinal stenosis (LSS) is a disabling degenerative process of the spine, mainly affecting older patients. LSS manifests with low-back and leg pain and neurogenic claudication. Disability and impairment in activities of daily living are consequences of the progressive narrowing of the lumbar spinal canal. Surgical decompression has been shown to be superior to conservative management. Nonetheless, intraoperative and postoperative blood loss in elderly patients taking antiplatelet or anticoagulant drugs owing to cardiovascular comorbidities may be a special issue. This study describes and compares early outcomes after surgical procedures in different groups of patients receiving antithrombotic drugs. The authors' study retrospectively recruited 289 consecutive patients aged ≥ 65 years who received lumbar decompression for spinal stenosis between January 2021 and May 2022. First, 183 patients taking antiplatelet therapy were divided into two groups according to the rationale for use: primary versus secondary prophylaxis of cardiovascular events (group 1 vs group 2). Primary prevention was stopped preoperatively, or secondary prevention was not discontinued during the perioperative period. Secondly, 106 patients who were not taking antiplatelet mediation were divided into two groups, depending on whether preoperative low-molecular-weight heparin had not been administered or had been (group A vs group B). Intraoperative blood loss, surgical time, and postoperative hospitalization were analyzed. No significant statistical differences were observed between groups 1 and 2 in terms of intraoperative blood loss and time of surgery, or between groups A and B in terms of all analyzed variables. No early or delayed complications were observed, perioperatively or during the postoperative 3-month follow-up period. The results of this study suggest that the use of anticoagulant and antiplatelet therapies in elective decompressive surgery could be devoid of early complications and could be safely continued perioperatively.

Comparison between OLIF and MISTLIF in degenerative lumbar stenosis: an age-, sex-, and segment-matched cohort study

To compare outcomes after oblique lateral interbody fusion (OLIF) versus minimally invasive transforaminal lumbar interbody fusion (MISTLIF) with bilateral decompression via unilateral approach for treating mild to moderate symptomatic degenerative lumbar spinal stenosis (DLSS). We retrospectively compared patients who underwent single-level (L4/5) OLIF with an age-, sex-, and segment-matched MISTLIF with bilateral decompression via unilateral approach cohort. Perioperative data were collected for the operative time, intraoperative blood loss, drainage in the first postoperative day, postoperative hospital stay, cost, intraoperative fluoroscopy, and complications. Lumbar radiographs were measured for changes in posterior intervertebral space height (PISH), intervertebral space foramen height (IFH), intervertebral foramen area (IFA), and area of the spinal canal (ASC). Clinical and psychological outcomes included the visual analog scale (VAS), Oswestry Disability Index (ODI), and hospital anxiety and depression scale (HADS). 35 OLIF patients were compared with 35 MISTLIF patients in L4/5 DLSS. The OLIF group had shorter bedtime, postoperative hospital stays, less intraoperative and postoperative blood loss (all P < 0.05), but had more times of intraoperative fluoroscopy, longer operative time, and higher cost (all P < 0.05). The complication rates were equivalent (OLIF vs MISTLIF: 22.86% vs 17.14%). PISH (11.94 ± 1.78 mm vs 9.42 ± 1.94 mm, P < 0.05), IFH (23.87 ± 3.05 mm vs 21.41 ± 2.95 mm, P < 0.05), and IFA (212.14 ± 51.82 mm2 vs 177.07 ± 51.73 mm2, P < 0.05) after surgery were significantly increased in the OLIF group. The ASC was increased significantly after the operation in both groups, but the ASC in the MISTLIF group was increased significantly more than that in the OLIF group (450.04 ± 66.66 mm2 vs 171.41 ± 58.55 mm2, P < 0.05). The lumbar VAS scores at 1 month (1.89 ± 0.87 vs 2.34 ± 0.84, P = 0.028) and 6 months (1.23 ± 0.97 vs 1.80 ± 0.99, P = 0.018) after operation in the OLIF group were significantly lower. There were no significant differences in lower extremity VAS and ODI scores between the two groups. Compared with MISTLIF group, HADS scores on postoperative day 3 (2.91 ± 1.46 vs 4.89 ± 1.78, P < 0.05) and prior to hospital discharge (PTD) (2.54 ± 1.38 vs 3.80 ± 1.78, P = 0.002) in the OLIF group were decreased significantly. OLIF showed more advantages of less surgical invasion, lower incidence of postoperative low back pain, faster postoperative recovery, and less anxiety compared with MISTLIF. Regardless of cost, OLIF seems to be a better option to treat mild to moderate symptomatic DLSS.

High Endplate Hounsfield Units Value Indicate Intervertebral Disc Degeneration Following Transforaminal Lumbar Interbody Fusion Surgery.

Lumbar disc degeneration (LDD) is a common cause of low back pain and disability, and its prevalence increases with age. The aim of this study is to investigate whether endplate Hounsfield unit (HU) values have an effect on lumbar disc degeneration (LDD) after transforaminal lumbar interbody fusion (TLIF) surgery in patients with degenerative lumbar stenosis. This study was a retrospective analysis of patients who underwent TLIF surgery in January 2016 to October 2019. One hundred and fifty-seven patients who underwent TLIF surgery for degenerative lumbar stenosis were enrolled in this study. Demographic data was recorded. VAS and ODI values were compared to assess the surgical outcomes in patients with or without process of LDD after TLIF surgery. Correlation analysis was performed to investigate associations between LDD and endplate HU value. Binary logistic regression analysis was carried out to study relationships between the DDD and the multiple risk factors. There was a statistically significant correlation between LDD, body mass index (BMI), age, paraspinal muscle atrophy, and total endplate scores (TEPS). Also, a strong and independent association between endplate HU value and LDD was found at every lumbar disc level (p < 0.01). After conditioning on matching factors, multivariate logistic regression analysis showed that higher endplate HU (odds ratio [OR]: 1.003, p = 0.003), higher TEPS (OR: 1.264, p = 0.002), higher BMI (odds ratio [OR]: 1.202, p = 0.002), a smaller cross-sectional area (CSA) of the paraspinal muscle preoperatively (OR: 0.096, p < 0.001) were significant predictors of LDD development after TLIF surgery. There is a significant association between LDD and endplate HU value after TLIF surgery in patients with degenerative lumbar stenosis. Beyond that, results from this study provide a mechanism by which high endplate HU value predisposes to LDD after TLIF surgery.

Effects Of Decompression Surgery On Pelvic Movements In Patients With Degenerative Lumbar Stenosis

Abstract Objective Pelvic movements when walking should be objectively evaluated in the context of clinical data in order to understand the function of compensatory mechanisms in the onset and management of symptomatic degenerative lumbar stenosis (DLS). The purpose of this study was to compare patients treated with decompression surgery (DS) and patients with symptomatic DLS in terms of pelvic movements while walking. Materials and Methods A total of 107 participants were included in this study. 34 patients who underwent DS performed by the same surgeon were selected as the DS group, while 39 patients with DLS who required surgery were selected as the DLS group. The control group consisted of 34 age-matched healthy individuals who had no disease and no gait disorder. The BTS G-WALK sensor system (G-Walk) was used to measure pelvic movements (tilt, rotation, obliquity) and gait parameters (speed, cadence, stride length). Results DS and control groups had decreased maximum (p=0.008 and p=0.006, respectively) and minimum anterior tilt of the pelvis (p=0.015 and p=0.001, respectively) compared to the DLS group. There was no significant difference between the groups for rotation, oblique and tilt range of motion of the pelvis (p&gt;0.05). Compared to the control group, speed during gait were significantly lower in both the DLS (p=0.012) and DS groups (p=0.016). Conclusions In this study, decompression surgery was found to affect pelvic movements. Patients with DLS walked differently from those who had no symptoms, and this difference usually disappeared following surgical decompression. Pelvic movements may serve as a helpful screening measure to identify early compensatory mechanisms. Key words: lumbar stenosis, pelvic movement, decompression surgery, spine-pelvis lower extremity, sagittal alignment

Minimal Invasive Approaches to Lumbar Degenerative Stenosis and Degenerative Disc Disease

Minimal Invasive Approaches to Lumbar Degenerative Stenosis and Degenerative Disc Disease

Survey on Spinal Injections for lumbar degenerative stenosis among spine surgeons in Latin America

Survey on Spinal Injections for lumbar degenerative stenosis among spine surgeons in Latin America

Post-operative tension spinal subdural extra-arachnoid hygroma of the lumbar spine: case series, literature review, and recommendations for clinical management

Objective Case series presentation and literature review of patient group suffering from symptomatic tension subdural extra-arachnoid hygroma following decompressive surgery for degenerative lumbar stenosis or disc disease. The purpose was to better understand this rare post-operative complication with a pathognomic radiological sign to help recommend optimal strategies for clinical management. Methods Retrospective case series comprising seven cases from one tertiary Neurosurgical centre spanning a 10-year period from 2011 to 2021. Patients included were those known to have undergone a spinal procedure and subsequently to have developed a symptomatic spinal subdural extra-arachnoid hygroma (SSEH). A literature review was conducted using PubMed, MEDLINE and EMBASE (keywords ‘subdural hygroma’, ‘lumbar CSF hygroma’, ‘extra arachnoid hygroma’, ‘extra-arachnoid CSF collection’, ‘CSF tension hygroma’, ‘lumbar extra arachnoid hygroma’, ‘lumbar spinal hygroma’, ‘post-operating spinal hygroma’, ‘post-operative spinal CSF collection’) and through reading references cited in relevant articles. Articles involving post-operative SSEH following lumbar spinal surgery were included. Results Rare complication with only five other cases in the literature. Dural breach described intra-operatively in only 5 of 12 total cases from our series and the literature. 5 patients in our series were managed surgically with 2 being managed conservatively. All patients in our series improved symptomatically and radiologically following surgical or conservative management. Conclusions This is a rare post-lumbar surgery complication that can cause rapidly deteriorating lower limb and sphincteric function. Surgical management with wide durotomy and arachnoid marsupialisation can lead to reversal of neurological deterioration and excellent clinical results. A delayed presentation with pseudomeningocele formation may be managed conservatively if neurology is stable or improving. It is a condition that it is important for the clinician to recognise in order to instigate appropriate management in a time-dependent fashion.

A Rare Calcified Complication of Epidural Injections for Lumbar Spinal Stenosis: A Case Presentation and Literature Review

BACKGROUND: Neurogenic claudication secondary to degenerative lumbar stenosis is typically managed with nonsurgical options, such as epidural corticosteroid injections. As a standard and effective treatment for lumbar stenosis, clinicians must be aware of the corticosteroids choice when injecting in the epidural space. CASE REPORT: A 62-year-old man presenting with sciatic pain is treated with multiple neuroforaminal, facet, and caudal corticoid injections over the course of several months without any symptomatic resolution. A magnetic resonance imaging of his lumbar spine revealed focal bilateral central stenosis at the L4-L5 level. A computed tomography revealed hyperdense lesions at that level. The patient was referred for a surgical option. He underwent complete minimally invasive resection of the bilateral lesion with instrumented and interbody fusion. The final pathology report identified the mass as a calcified granuloma. CONCLUSIONS: Following repetitive methylprednisolone acetate injections, one must be aware of all the potential complications arising from particulate corticosteroids. KEY WORDS: Spinal stenosis, epidural injections, granulomas, corticosteroids