Degenerative Stenosis Research Articles

Correlation of Tumor Necrosis Factor-α Expression with Pain Level in Degenerative Lumbar Canal Stenosis Patients

Introduction: Pain in degenerative lumbar canal stenosis is caused by osteoarthritis of a facet joint and intervertebral disc degeneration. Some inflammatory mediators such as tumor necrosis factor (TNF)-α are present in degenerative lumbar canal stenosis. This study aimed to evaluate the correlation of pain and functional pre-operative scores with the expression of TNF-α in nucleus pulposus, annulus fibrosus, and facet joint. Methods: Patients diagnosed with degenerative lumbar canal stenosis and planned for surgical treatment were included in this study. Patients with history of fracture, neoplasm, and/or infection of the spine were excluded. Tissue samples were collected from the nucleus pulposus, annulus fibrosus, facet joint, flavum ligament and paraspinal muscles of the spine during the surgery. TNF-α expression was examined semi-quantitively and correlated with the axial and radicular pain that were measured using Visual Analog Score (VAS) score. The result was then statistically analyzed. Results: The expression of TNF-α in the paraspinal muscle (6.30±14.20) was significantly higher compared to other locations. TNF-α expression in the facet joint group was significantly correlated with the intensity of low back pain measured by VAS score (r=0.893, p < 0.001), and pre-operative functional outcome based on Oswestry Disability Index (ODI) (r=0.948, p < 0.001). Conclusion: TNF-α expression, especially in the facet joint, is significantly associated with the pain intensity and pre-operative ODI that allow pain reduction with less invasive treatment in lumbar canal stenosis patients.

Three-Dimensional Kinematics of the Pelvis and Caudal Lumbar Spine in German Shepherd Dogs.

Lumbosacral vertebral motion is thought to be a factor in the development of degenerative lumbosacral stenosis in German shepherd dogs. So far, few studies exist describing natural canine lumbosacral movement in vivo. Therefore, this investigation aims to achieve a detailed in vivo analysis of bone movement of the lumbosacral region to gain a better understanding of the origin of degenerative lumbosacral stenosis using three-dimensional non-invasive in vivo analysis of canine pelvic and caudal lumbar motion (at L6 and L7). Biplanar cineradiography of the pelvis and caudal lumbar spine of four clinically sound German shepherd dogs at a walk and at a trot on a treadmill was recorded. Pelvic and intervertebral motion was virtually reconstructed and analyzed with scientific rotoscoping. The use of this technique made possible non-invasive measurement of physiological vertebral motion in dogs with high accuracy. Furthermore, the gait patterns of the dogs revealed a wide variation both between individual steps and between dogs. Pelvic motion showed a common basic pattern throughout the stride cycle. Motion at L6 and L7, except for sagittal rotation at a trot, was largely asynchronous with the stride cycle. Intervertebral motion in all dogs was small with approximately 2–3° rotation and translations of approximately 1–2 mm. The predominant motion of the pelvis was axial rotation at a walk, whereas lateral rotation was predominant at a trot. L7 showed a predominance of sagittal rotation (with up to 5.1° at a trot), whereas lateral rotation was the main component of the movement at L6 (about 2.3° in both gaits). During trotting, a coupling of various motions was detected: axial rotation of L7 and the pelvis was inverse and was coupled with craniocaudal translation of L7. In addition, a certain degree of compensation of abnormal pelvic movements during walking and trotting by the caudal lumbar spine was evident.

Results of posterior decompression with non-instrumented lumbar fusion surgery in cases of degenerative lumbar canal stenosis presenting with neurogenic claudication in a tertiary care hospital

<p><strong>Background:</strong> Degenerative lumbar canal stenosis remains an important public health problem in today’s date. With the overall average age of the world’s population rising steadily it is important to have an optimal treatment plan affordable to the masses. Non-instrumented fusion after decompression remains an important treatment option which is affordable to the masses and effectively treats the instability occurring due to degeneration process. This study aims to understand the results of such treatment in a tertiary care center catering to the masses.</p><p><strong>Methods: </strong>The study was conducted in 34 patients with diagnosed degenerative lumbar canal stenosis with neurogenic claudication who underwent decompressive laminectomy with a posterolateral strut graft posterolateral fusion from July 2018 to August 2020. Each patient was followed up for 12 months.</p><p><strong>Results: </strong>In the present study, a total of 34 patients with degenerative lumbar canal stenosis with neurogenic claudication were included. There were 18 male and 16 female patients. The pre-operative Swiss spinal stenosis Score was 61-80 (52.9%) and these scores improved to a majority of patients in the category of 21-40 (82.4%) at 1 year postoperatively. The average VAS score was 4.7±1.8 preoperatively while the average post op VAS score was 0.8±0.77.</p><p><strong>Conclusions: </strong>Non-instrumented fusion of the vertebrae with decompression has significantly improved results at 1 year follow up postoperatively and it is an excellent easy and cost-effective technique if used in a properly selected patient. Further studies are required to assess its long-term results.</p>

Results of surgical treatment of degenerative stenosis of the lumbar spine in elderly and old patients

Aim. To evaluate the results of surgical treatment in older patients with lumbar spinal stenosis.Materials and methods. The study is based on the results of a comprehensive examination and surgical treatment of 20 patients who were hospitalized in the neurosurgery department of the SI NMC “Shifobakhsh” in the Department of Neurosurgery and Combined Trauma of the ATSMU with stenosis of the lumbar spine with various options for the clinical course. Assessment of the neurological status in degenerative spinal disease was conducted using a visual analog scale (VAS.)Results. When comparing subgroups, it was noted that decompressive interventions show the best results for lumbar spinal stenosis in the older age group.Conclusion. The use of differentiated microsurgical decompression techniques in older patients with degenerative lateral and central spinal canal stenosis provides an improvement in quality of life.

SY5.6. Intraoperative neurophysiological monitoring in cervical spine surgery

Intraoperative monitoring (IOM) has been utilized for surgery of degenerative, neoplastic and traumatic causes of cervical spine disease. However, controversy still exits with regards to its clinical efficacy. Most studies to date have analyzed spinal or scoliosis surgery, while few focusing solely on cervical decompression are available. Early studies have described good sensitivity and specificity in the IOM of cervical spondylosis surgery with (Kim et al., 2007) or without myelopathy (Xu et al., 2011). However, this has been challenged by 2 subsequent ones which (Ajiboye et al., 2017, 2017) contradict the earlier findings. A systematic review conducted recently concluded that IOM is useful for detection of intraoperative neural damage in cervical spine surgery involving degenerative canal stenosis (de Martino et al., 2019). IOM has been reported to be efficacious for early identification of intraoperative C5 palsy after cervical myelopathy surgery, despite its rarity and cryptogenic nature. There is a current lack of systematic studies addressing IOM for cervical tumour surgery, and further research is needed. A recent study on motor evoked potentials (MEP) during IOM of cervical spondylotic myelopathy suggested that a 9 pulse stimulation train may be more efficacious than a 5 pulse train, whereby intraoperative improvement of MEP is more frequently observed in the former (Lo et al., 2020). The new findings may be relevant for future research into false positive and negatives during IOM of diseased spinal cords (Iorio et al., 2015; Lee et al., 2016).

A 10-year follow-up study of indications for artificial cervical disc replacement

Objective: To investigate the influence of the preoperative factors on the segmental range of motion (ROM) during long-term follow-up after artificial cervical disc replacement (ACDR), so as to further improve the selection of surgical indications for ACDR. Methods: Retrospective analysis was performed on 71 patients with cervical degenerative diseases who underwent single-segment Bryan ACDR in Beijing Jishuitan Hosptial from December 2003 to December 2008, and a 10-year clinical follow-up was conducted. Among the patients, 44 were males and 27 were females, with a mean age of (45±8) years at operation. The mean follow-up time was (129±14) months. Preoperative and follow-up imaging evaluation including measurement of the segmental range of motion (ROM) by cervical X-ray, and preoperative height of intervertebral space was measured by cervical lateral X-ray. According to CT and coronal reconstruction, the grade of paravertebral ossification (PO) was assessed. Clinical symptoms assessment including the Japanese Orthopaedic Association scoring (JOA), the Neck Disability Index (NDI) evaluation was performed preoperatively. Multivariate logistic regression analysis was used to analyze the influencing factors of the range of motion of the surgical segment during follow-up. The best cut-off value was calculated by receiver operating characteristic (ROC) curve. Results: The preoperative and follow-up ROM at the operated segment was 9.7°±4.5° and 8.7°±5.4°, respectively (P>0.05). Univariate analysis revealed that the postoperative segmental ROM was not significantly correlated with the factors including the surgical level, gender, age, and preoperative clinical diagnosis (1: Radiculopathy; 2: Myelopathy; 3: Mixed type), preoperative segmental ROM, preoperative JOA score and preoperative NDI score (all P>0.05), and was significantly correlated with imaging diagnosis (1: cervical disc herniation; 2: degenerative cervical stenosis), preoperative PO grade (both P<0.05). The multi-factor analysis showed that preoperative segmental ROM (OR=1.228, 95%CI:1.012-1.489, P<0.05) and PO grade (OR=0.190, 95%CI: 0.085-0.424, P<0.05) had significance in the overall test, but imaging diagnosis had no significance in the overall test (P>0.05). The optimal cutoff value of preoperative segmental ROM and PO grade was 9.185° and grade 2.5 assessed by ROC curve, and the area under the ROC curve was 0.86 and 0.72, respectively. Conclusions: ACDR surgery can achieve satisfactory long-term effects for patients with nerve root type, spinal cord type and mixed type cervical degenerative diseases, and effectively retain the overall ROM of the cervical spine and the ROM of replacement segments. Patients with good preoperative segmental ROM and lower PO levels have a greater chance of obtaining good segmental ROM in the long-term postoperatively.

Homeostasis Regulating Factors, Innervation, Ischemia and Inflammatory Markers in the Right Atrial Tissue from Patients with Degenerative Aortic Valve Stenosis and Coronary Heart Disease

Abstract Both coronary heart disease (CHD) and degenerative aortic valve (AoV) stenosis have common risk factors, such as age, high blood cholesterol, diabetes, smoking, high blood pressure, inflammation, and metabolic syndrome. However, these diseases are not always observed together, confirming the existence of risk and pathogenesis factors specific to each disease. The aim of this study was to identify presence and distribution of common and different homeostasis regulating factors, innervation, ischemia and inflammatory markers in the right atrial tissue from patients with degenerative AoV stenosis and CHD. During elective cardiac surgery, right atrial tissue fragments were taken from 20 patients with CHD and from 9 patients with degenerative AoV stenosis. All tissue fragments were stained for immunohistochemical detection of protein-gene peptide 9.5 (PGP 9.5), atrial natriuretic peptide (ANUP), vascular endothelial growth factor (VEGF), chromogranin A, endothelin, interleukin 1 and 10 (Il-1 and Il-10) and β defensins 2, and 3 (βD2 and βD3). For the quantification of structures, a semi-quantitative counting method was used. Mostly numerous Il-10 positive cardiomyocytes and epi-/endocardial endothelial cells were detected in all specimens taken from patients with CHD, and statistically more than in specimens taken from patients with degenerative AoV disease (p = 0.007 and p = 0.016). Also, the number of βD3 positive cardiomyocytes was higher in the coronary heart disease group (p = 0.026). All other tested markers such as PGP 9.5, ANUP, VEGF, endothelin, chromogranin A, Il-1 and βD2 showed similar expression in both groups. Increased production of ANUP in right atrial tissue characterises both CHD and degenerative AoV stenosis. Production of ChgA in right atrial endocardial endothelial cells might represent regulation of sympathetic activity as a compensatory homeostatic response. Increased PGP 9.5-containing innervation is characteristic in patients with degenerative AoV disease and secondary mitral insufficiency. A stable increase of VEGF and variations of endothelin without statistically significant difference suggest influence of ischemia on the local vascular blood supply. Decreased production of Il-1α together with moderate to rich production of Il-10, βD2, and βD3 indicates the dominance of the local immune system over inflammation.

Neurogenic Factors in the Development of Hip-Spine Syndrome (Review)

Summary. Complaints of pain in the buttocks, hip, knee, and lameness are very common among patients with both degenerative changes in the hip joint and the lumbar spine. Failure to pinpoint the source of pain leads to ineffective treatment. Degenerative stenosis of the transverse spine also manifests itself as pain in the extremities and limitation in walking. This is the most common indication for spinal surgery over the age of 65. Before choosing a treatment option for coxarthrosis, it is necessary to take into account the need for intervention at the level of the lumbosacral spine. In the early stages of the development of pathology, preference should be given to active treatment tactics. It is necessary to inform the category of patients with such clinic of damage to the hip joints and spine about the possibility of increased pain after surgery on only one segment and about the probability of surgery on another segment of the biomechanical triangle at the next stage.

A Clinical Case of the Hereditary Transthyretin Amyloidosis

Introduction: Transthyretin (ATTR) amyloidosis is a severe rare disease with wide range of characters without specific symptoms including the damage to the peripheral nervous system and cardiac involvement. Case report: A 60-year-old female patient represented with weakness and paresthesia in the distal parts of the lower limbs, impeding walking for 2 years. Initially, symptoms were considered as a manifestation of degenerative stenosis of the lumbar spine, decompressive laminectomy was performed but the symptoms after surgical treatment persisted. Based on data from clinical and electroneuromyographic examinations, axonal sensorimotor polyneuropathy was diagnosed. Genetic testing of the patient, her elder sister, son and daughter using the Sanger sequencing method detected a variant of the nucleotide sequence in the fourth exon of the transthyretin gene (Chr18: 29178562, rs148538950, NM_000371.3: c.G368A: p. Arg123His) in the heterozygous state. A subcutaneous fatty tissue biopsy of abdominal wall with a Congo red stain and polarized light examination revealed amyloid microdeposits, grade CR 1+ (minimal deposits), confirmed the diagnosis of familial ATTR-amyloidosis. Echocardiography revealed concentric left ventricular wall thickening with normal end diastolic size and volume, preserved ejection fraction, left atrial enlargement, pulmonary hypertension and type 1 diastolic dysfunction. Specific anti-amyloid therapy — tafamidis was prescribed. Conclusion: In patients with peripheral polyneuropathy and left ventricular hypertrophy of unknown etiology, a complex examination is necessary for the timely detection and treatment of amyloid polyneuropathy and cardiomyopathy.

Anterior Canal Reconstruction and Fusion for Myelopathy Caused by Degenerative Cervical Kyphosis and Stenosis With or Without Ossification of the Posterior Longitudinal Ligament.

This was a retrospective study. To introduce an anterior surgical technique for myelopathy caused by degenerative cervical kyphosis and stenosis (DCKS) with or without ossification of the posterior longitudinal ligament (OPLL). The optimal approach in the treatment of DCKS remains a controversy because each anterior or posterior route surgery has advantages and disadvantages. In the period from June 2017 through June 2019, a consecutive cohort of adults diagnosed with DCKS underwent anterior canal reconstruction and fusion (ACRF). All patients underwent x-ray, computed tomography, and magnetic resonance imaging of the cervical spine. Radiologic assessment included kyphosis, canal area, canal reconstruction, OPLL, and spinal cord curvature and morphology. The Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological status. Surgery-related and implant-related complications were all recorded. Follow-up was carried out at 3, 6, 12, 24, and 36 months postoperation. Fourty-one patients were included in the study, of which 19 presented with OPLL. Postoperatively, the canal area were significantly greater at last follow-up compared with preoperation (208.4 vs. 123.2 mm2; P=0.001). There was significant kyphosis correction (-17.6 vs. 8.5 degrees, P=0.001) at last follow-up. Ninety-six segmental canal reconstruction were performed, 89 (92.7%) reached bone fusion at both grooves with a mean time of 7.9 months. On sagittal magnetic resonance imaging, 33 (80.5%) patients presented with lordosis in the spinal cord curvature, 8 (19.5%) with straight. The mean JOA score at last follow-up was significantly better than preoperation (15.0 vs. 9.3 points; P<0.01). One patient presented with cerebrospinal fluid leakage, 1 with screw displacement and 2 with dysphagia. ACRF, receiving good correction of kyphosis, amplified canal area, solid instrumented fusion and circumferential decompression, is an effective and safe surgical technique for cervical myelopathy caused by DCKS with or without OPLL. Level III-a retrospective analysis.

Transcatheter treatment by valve-in-valve and valve-in-ring implantation for prosthetic tricuspid valve dysfunction.

Valve degeneration after surgical tricuspid valve replacement or repair is frequent and may require repeat replacement/repair. For high-risk patients, transcatheter valve-in-valve and valve-in-ring procedures have emerged as valuable treatment alternatives. Preprocedural transthoracic echocardiography is the method of choice to detect malfunction of the prosthesis including degenerative stenosis and/or regurgitation requiring reintervention. Subsequently, computed tomography is helpful for detailed anatomical analysis and periprocedural planning. Device selection and sizing depend on the size and structural details of the implanted ring or prosthesis. The procedure is mainly guided by fluoroscopy; however, transesophageal echocardiography provides complementary guidance during device implantation. Preferred access route is the right femoral vein but in cases of more horizontal implants a jugular approach might be feasible. Suitable transcatheter valves are the Edwards Sapien 3 and the Medtronic Melody valves. Differences in surgical prostheses or annuloplasty implants are important for device selection, height consideration and additional ballooning prior to or after implantation. Transesophageal echocardiography postimplantation is convenient for the assessment of transvalvular gradients or paravalvular leaks.Supplementary InformationThe online version of this article (10.1007/s00508-021-01842-x) contains supplementary material, which is available to authorized users.

Comparison of the Operative Time and Post-Operative Pain with Peek Cage versus Autologous Iliac Crest Bone Graft in Anterior Cervical Discectomy and Fusion

Objective: To compare the operative time and post-operative pain with PEEK cage method versus autologous iliac crest bone graft in anterior cervical discectomy and fusion in the cervical spine.&#x0D; Material &amp; Methods: This randomized control trial study (RCT). 90 patients with cervical disc disease, cervical stenosis with or without myelopathy and cervical trauma (fractures or facet jumps with disrupted disc) were included in the study from the Department of Neurosurgery, LGH, PINS, Lahore. Patients were evaluated with plain X-rays and MRI scans of the cervical spine. All patients underwent anterior cervical decompression and fusion. In 45 patients (group A), cervical fusion was achieved with PEEK cage method and in other 45 patients (group B), autologous Iliac Crest Bone graft was used.&#x0D; Results: Mean age in group A was 57.1 years and in group B, it was 54.7 years. In group A, 31.1% patients were of cervical disc disease, 28.8% of cervical degenerative stenosis and 40% were of cervical trauma. In group B, 15 patients 33.3% were of cervical disc disease, 24.4% of cervical degenerative stenosis and 42.2% were of cervical trauma. The mean Postoperative Visual Analogue Scale (VAS) score for pain was 2.8 in group A and 5.4 in group B patients.&#x0D; Conclusion: The patients of group A (PEEK cage method) could be easily mobilized within bed and out of bed depending upon their neurological status. Decreased operative time and less post-operative pain makes PEEK cage method superior to autologous iliac crest bone graft in anterior cervical decompression and fusion.

Unilateral Biportal Endoscopy Versus Tubular Microendoscopy in Management of Single Level Degenerative Lumbar Canal Stenosis: A Prospective Study.

Prospective clinical study. To the authors knowledge, there are no previous prospective studies to test the feasibility of the unilateral biportal endoscopic (UBE) technique in management of lumbar canal stenosis. The study was conducted to compare clinical results of the UBE technique with the tubular microendoscopic (TME) surgery for management of degenerative lumbar canal stenosis. One hundred fifty-four cases of single level degenerative lumbar canal stenosis were randomly divided into 2 groups. Each group consisted of 77 cases: one group underwent UBE and the other TME. Clinical outcome was assessed periodically: early postoperative, at 1, 3, and every 6 months for 2 years. Clinical outcome assessment operatives included the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and patient satisfaction using Modified Macnab Criteria (MMC). In addition, the admission period, operative time, and estimated blood loss were compared. In UBE cases, ODI and ZCQ were statistically superior to TME for all periods (P<0.05). For both approaches, values presented progressive improvement until the 24th month. Regarding ODI, UBE and TME had an 84% and 79% success rate, respectively. In ZCQ, UBE and TME had a 79% and 73% success rate, respectively, at the end of the 24th month. Regarding the MMC, UBE and TME had 63% and 29% excellent results, respectively. UBE also has shorter admission period (days: 1.11 vs. 1.28), operative time (minutes: 57.74 vs. 65.31), and less estimated blood loss (mL: 49.47 vs. 53.57). Given its demanding learning curve, UBE is considered an effective alternative to TME with a higher clinical success rate.

Unilateral Fenestration versus Open Laminectomy in Treatment of Degenerative Stenosis of Lumbar Spine

Background: The syndrome of degenerative lumbar canal stenosis accounts for a large percentage of causes of low back pain in the elderly worldwide. Surgical management has demonstrated better clinical and radiological results than conservative treatment. It allows for adequate decompression of the thecal sac and the compressed nerve roots. However, aggressive laminectomy with facetectomy has been linked with many postoperative complications including instability. Hence, new less invasive modalities have been introduced such as fenestration and endoscopic laminotomy. Objective: This study aimed at comparing the safety and outcome of conventional laminectomy to unilateral fenestration in cases of lumbar canal stenosis. Patients and methods: It took place at the Neurosurgery Department at Zagazig University and included thirty six patients with lumbar canal stenosis; eighteen patients were treated by conventional laminectomy and eighteen patients were treated by unilateral fenestration. Results: Decompression led to an intense decrease of total pain in both groups. Matched with that experience in group I, but, with more remaining back and leg pain was found in group II, 6.58±0.99 and 6.75±0.96, respectively, compared with 2.16±0.57 and 2.75±0.86 , respectively, at the 12 weeks follow-up assessment (p < 0.001). The most obvious symptom of lumbar stenosis, neurogenic claudication improved in 91% of patients in group I compared to 83% in Group II. Patient satisfaction was higher in Group I, as the patients who underwent unilateral fenestration showed more decrease in total pain with 12 weeks postoperatively. Conclusion: Unilateral fenestration allows acceptable and safe decompression of the spinal canal in patients with degenerative lumbar stenosis.

Unilateral Fenestration versus Open Laminectomy in Treatment of Degenerative Stenosis of Lumbar Spine

Background: The syndrome of degenerative lumbar canal stenosis accounts for a large percentage of causes of low back pain in the elderly worldwide. Surgical management has demonstrated better clinical and radiological results than conservative treatment. It allows for adequate decompression of the thecal sac and the compressed nerve roots. However, aggressive laminectomy with facetectomy has been linked with many postoperative complications including instability. Hence, new less invasive modalities have been introduced such as fenestration and endoscopic laminotomy. Objective: This study aimed at comparing the safety and outcome of conventional laminectomy to unilateral fenestration in cases of lumbar canal stenosis. Patients and methods: It took place at the Neurosurgery Department at Zagazig University and included thirty six patients with lumbar canal stenosis; eighteen patients were treated by conventional laminectomy and eighteen patients were treated by unilateral fenestration. Results: Decompression led to an intense decrease of total pain in both groups. Matched with that experience in group I, but, with more remaining back and leg pain was found in group II, 6.58±0.99 and 6.75±0.96, respectively, compared with 2.16±0.57 and 2.75±0.86 , respectively, at the 12 weeks follow-up assessment (p < 0.001). The most obvious symptom of lumbar stenosis, neurogenic claudication improved in 91% of patients in group I compared to 83% in Group II. Patient satisfaction was higher in Group I, as the patients who underwent unilateral fenestration showed more decrease in total pain with 12 weeks postoperatively. Conclusion: Unilateral fenestration allows acceptable and safe decompression of the spinal canal in patients with degenerative lumbar stenosis.

Evaluation of posterior decompressive lumbar surgery for multilevel lumbar spinal canal stenosis with and without fusion

BackgroundThere is no consensus regarding the best treatment of patients with multilevel lumbar stenosis. Surgical and invasive procedures are widely used in adults with degenerative lumbar spinal stenosis when conservative treatments fail. However, little is known about the comparative efficacy and safety of these interventions.Aim and objectiveThe aim was to study and evaluate the outcome of surgery for degenerative lumbar canal stenosis (LCS) on a clinical, radiological, and functional basis and to identify whether spinal decompression with fusion has a better effect than decompression alone for patients with degenerative lumbar spinal stenosis or not.Patients and methodsA prospective study of 50 patients was carried out at the Department of Neurosurgery, Matarya Teaching Hospital, in whom the lumbar canal stenosis was confirmed. The functional assessment preoperatively and postoperatively was calculated according to the Japanese Orthopedic Association (JOA) score.ResultsSuccessful outcomes were significantly associated with posterior decompression and fusion. Clinical outcome assessed according to the JOA score was excellent or good in 68% of the patients who underwent posterior decompression alone and in 84% of patients who underwent posterior decompression with posterolateral fusion.ConclusionSurgical treatment of degenerative lumbar canal stenosis with posterior decompression and spinal fusion yields excellent results as observed on the basis of JOA scoring system.

Degenerative lumbar spine stenosis: minimally invasive microsurgical methods of treatment

Degenerative lumbar spine stenosis is one of the main causes of chronic pain and radiculopathy in advanced age people. Along with increase in average life expectancy, degenerative lumbar spine stenosis becomes the most common indication for spinal surgery. There is still no consensus regarding the most optimal surgical approach due to the variety of modern surgical methods. In recent years, minimally invasive spinal surgery has become a more advisable alternative to open surgery due to its advanced technical features combined with less soft tissue damage, lower risk of complications and shorter postoperative recovery.

The role of trabecular bone score, inaddition to FRAX, for the measurementof fracture risk in patients withdegenerative lumbar spine stenosis

Objectives: To investigate the relevance of Concomitant Trabecular Bone Score (TBS) and Areal Bone Mineral Density (aBMD) assessments to estimate fracture risk in patients with Degenerative Lumbar Spine Stenosis (DLSS). Methods: A cross-sectional prospective study was performed. Dual energy X-ray absorptiometry scans of the lumbar spine and hip were acquired in 50 patients with DLSS. TBS and aBMD were calculated from the anteroposterior views of L1-L4 vertebrae. The World Health Organisation Fracture Risk Assessment Tool (FRAX) was utilised to estimate hip or Major Osteoporotic Fracture (MOF) risk. Results: L1-L4 TBS scores revealed degraded microarchitecture, (TBS ≤ 1.20), partially degraded microarchitecture (TBS >1.20 and <1.35) or normal appearances (TBS ≥ 1.35) in 9 (18%), 14 (28%) and 27 (54%) patients, respectively. L1-L4 aBMD assessment demonstrated osteoporosis (T-score ≤- 2.5), osteopenia (T-score between -1.1 and -2.4) or normal bone density in 15 (30%), 11 (22%) and 24 (48%) patients, respectively. There was no relationship seen between L1-L4 aBMD and TBS measurements (r = 0.046; p = 0.75). A negative relationship was observed between TBS and body mass index (r = -0.438; p = 0.001) andbetween L1-L4 aBMD and FRAX (r = -0.617; p < 0.001); the latter included MOF and risk of hip fracture (r = -0.497; p < 0.001).No relationship was observed between TBS and FRAX included MOF and risk of hip fracture (r = -0.118; p = 0.416 and r = -0.014; p = 0.926, respectively) Conclusion: In patients with DLSS, TBS is a reliable, strong and standalone indicator of fracture risk

A prospective study analyzing the clinical outcome of degenerative lumbar canal stenosis treated by laminectomy

A prospective study analyzing the clinical outcome of degenerative lumbar canal stenosis treated by laminectomy

Comparison of Clinical Characteristics, Natural History and Predictors of Disease Progression in Patients With Degenerative Mitral Stenosis Versus Rheumatic Mitral Stenosis

Mitral annular calcification (MAC) is a common echocardiographic finding and an increasingly recognized cause of degenerative mitral stenosis (DMS). However, little is known about the clinical characteristics and disease progression in DMS, particularly in comparison with rheumatic mitral stenosis (RMS). We retrospectively reviewed 203 consecutive patients with mitral stenosis (113 with DMS and 90 with RMS) who underwent echocardiography at our institution between January 2014 and December 2017. We compared the clinical characteristics and disease progression between the 2 groups. In addition, we analyzed the predictors of disease progression (defined as annual progression rate of a mean gradient >0 mm Hg/year) among patients with DMS. Patients with DMS were significantly older and had higher prevalence of atherosclerotic comorbidities than those with RMS. During the median follow-up period of 2.2 years, the annual progression rates were comparable (0.8 ± 0.8 mm Hg/year in DMS vs 1.0 ± 1.2 mm Hg/year in RMS; p = 0.32) and were highly variable (0.0 to 3.5 mm Hg/year in DMS and 0.0 to 5.5 mm Hg/year in RMS) within both groups among disease progression. In DMS patients, atherosclerotic comorbidities and lower initial mean gradient were significantly associated with disease progression even after adjustment by age and sex. There was no significant difference in the disease progression according to the circumferential MAC severity determined by echocardiography among DMS. In conclusion, DMS disease progression was slow but highly variable, similar to that of RMS. In patients with DMS, the baseline MAC severity did not correlate with disease progression, suggesting the importance of follow-up echocardiography regardless of the MAC severity.