Syndrome Of Intermittent Claudication Research Articles

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.

Surgical Treatment Options for Degenerative Lumbosacral Spinal Stenosis

Degenerative spinal stenosis is the most common type of degenerative and dystrophic spine disease. The clinical picture of stenosis, which may include axial pain syndrome, leg pain, intermittent claudication syndrome, weakness and loss of sensitivity in the legs, and impaired pelvic functions, can significantly worsen patients’ quality of life and reduce their ability to work and lead an active lifestyle.
 Degenerative spinal stenosis mostly affects the elderly. Therapeutic and neurological communities have stereotypes about spine surgery being too traumatic and invasive, and, therefore, they believe that their use should be contraindicated to and limited in elderly patients. However, surgeons are increasingly giving preference to minimally invasive interventions with high efficacy and safety together with a low risk of complications.
 We aimed at reviewing current treatment methods for degenerative lumbosacral spinal stenosis with an emphasis on surgical treatment methods.

Criteria for selection of patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis

Aim – to evaluate clinical and instrumental correlation (MRI data) in patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis for optimizing the indications for differentiated surgical treatment. Materials and methods. Clinical and neurological manifestations and MRI data in 80 patients (men – 36, women – 44), aged 27 to 72 years with a diagnosis of intervertebral disc herniation complicated by spinal canal stenosis were retrospectively analyzed. Depending on the size of the spinal canal, there were 2 groups: the first – with relative spinal canal stenosis (n = 20) – 75–100 mm2, and the second group – with absolute spinal canal stenosis (n = 60) – less than 75 mm2. We examined the correlation between the clinical and neurological presentations and MRI findings. Results. Our retrospective analysis has found that the first group consisted mainly of younger patients (46 years) and with a mean intervertebral disc herniation of 8.35 mm, while the second group included older patients (51.7 years) and the mean size of intervertebral disc herniation was 7.3 mm. The group of relative spinal canal stenosis was dominated by patients with radiculopathy syndrome (70 %) and pain in one lower limb (85 %). Radiculoischemia syndrome (50 %), pain in both lower extremities (33 %), neurogenic intermittent claudication syndrome (46.6 %), knee reflex disorders (58.3 %), pelvic organ dysfunction (11.6 %) were more common in the second group of patients. In addition, the longest disease duration (more than 24 months) was observed among patients of this group. We have found a relationship between pain syndrome (according to VAS), muscle strength, the disease duration and the spinal canal area. Conclusions. The correlation of clinical and instrumental methods of examination in patients with intervertebral disc herniation complicated by spinal canal stenosis allows the indications for differentiated surgery to be optimized.

THE IMPORTANCE OF PSYCHOLOGICAL TESTING IN PREDICTING THE EFFECTIVENESS OF LUMBAR SPINE SURGERY

ABSTRACT Objective: The result of treatment of patients with degenerative disc diseases is partly determined by the psychological characteristics of the patients. The aim of this study was to examine the correlations between the psychological scales scores in patients with degenerative lumbar disc diseases and the effectiveness of surgical treatment. Methods: The efficacy of the operation and patients’ satisfaction were compared with the preoperative psychological characteristics, according to the questionnaires and scales (BBQ Symonds, Zung Scale, FABQ, PCI, BBQ Catastrophization). Results: In patients with neurogenic intermittent claudication syndrome without significant pain, the operative treatment depended significantly on the value of the BBQ Symonds scale (p = 0.016). In patients with severe radicular pain in the lower extremity, the effectiveness of the operation depended significantly on the value of the subscale “protection” of the PCI questionnaire (p = 0.04), the ODI index filled out before the operation (p = 0.0). In patients with lumbar syndrome, the effectiveness of operation depended significantly on the value of the PCI questionnaire as a whole (p = 0.042) and its subscores “rest” (p = 0.028), the index of the Oswestry filled out before the operation (p = 0.035). Conclusion: The effectiveness of the operation of degenerative lumbar disc diseases is associated with the results of preoperative psychological testing. It has been established that the BBQ Symonds scale, PCI protection and rest subscales, and the ODI questionnaire are the most significant; these psychological scales have the power to predict the effectiveness of surgical treatment. Level of Evidence II; Therapeutic Study - Investigating the Results of Treatment.

PREVALENCE OF MULTI-FOCAL ATHEROSCLEROTIC PATHOLOGY ACROSS AGE GROUPS

Aim. To compare the prevalence of multi-focal subclinical atherosclerotic pathology and its determinants in cardiovascular surgery patients.Material and methods. The study included 1018 patients — 825 en and 193 women (mean age 59,0±12,0 years) — who were hospitalised for a planned intervention on coronary or other arteries. Group I (n=542) was aged under 60 years, Group II (n=215) — 60–64 years, Group III (n=141) — 65–69 years, and Group IV (n=120) — 70 years or older. All participants underwent coronary angiography and Doppler ultrasound; peripheral angiography was performed, if necessary. Multi-focal atherosclerosis (MFA) criteria were the presence of stenosis (≥30%) or revascularisation in two or more vascular territories.Results. Subclinical atherosclerotic pathology of various localisation was observed in 52,3% of the patients. Advanced age was linked to an increase in the MFA prevalence: from 45,8% in Group I to 58,6% in Group II, 58,2% in Group III, and 63,3% in Group IV (p=0,0001). In Group I, MFA was associated with the intermittent claudication syndrome (ICS), decreased body mass index (BMI), increased intima-media thickness (IMT), elevated total cholesterol (TCH). However, in Groups II–IV, the only association observed was between MFA and ICS.Conclusion. Taking into account the subclinical (hemodynamically insignificant) arterial pathology had resulted in a high prevalence of MFA. Advanced age was associated with a higher MFA prevalence. Other factors linked to MFA were increased IMT, elevated TCH, decreased BMI, and ICS.

SPECIFIC FEATURES OF DEGENERATIVE LUMBAR SPINE DISEASE IN ELDERLY AND SENILE PATIENTS

Objective. To study clinical and morphological features of degenerative lumbar spine disease in elderly and senile patients for substantiation of optimal surgical treatment. Material and Methods. Prospective study included 128 consecutive patients operated for lumbar spine degeneration during 2003–2005. Patients were divided into two age groups: 88 patients of 60–83 years of age (mean 65.7 years) and 40 patients of 19–40 years of age (mean 31.8 years). Complex diagnosis consisted of anamnestic, general clinical, neurological, X-ray, MRI, and CT examinations. Results. Patients with clinical manifestations of segmental instability and neurogenic intermittent claudication syndrome prevailed in the older group. Clinical symptoms in elderly patients were associated primarily with degenerative stenosis of the spinal canal. Radiological and CT signs of segmental instability (or hypermobility) were more frequent in older age group than in young patients. Degenerative spondylolisthesis and degenerative scoliosis of the lumbar spine were found only in elderly patients (20.4 % and 21.5 % of cases, respectively). Segmental hypermobility in elderly patients was presented predominantly as a linear translation of vertebrae. Sagittal translation of vertebrae over 3 mm was registered in 54.5 % of older age group patients and only in 22.5 % of young ones (р < 0,01). Flexion-extension hyperangulation of damaged spine segments was found in 61.3 % of older patients and in 65.0 % of young ones. Conclusion. It may be assumed that surgical treatment of degenerative lumbar spine disease in elderly and senile patients should involve not only extensive decompression of neurovascular formations but also stabilization of damaged spine segments despite a higher risk and implementation difficulties of the surgery.

A 69-year-old woman with intermittent claudication and elevated ESR.

Accepted 23 April 1998 A 69-year-old woman was referred to our out-patient clinic because of long-term hypertension and stable chronic renal failure (creatinine 132 ,umol/l), which had been attributed to...

Spinal claudication versus arterial claudication.

Ninety-three consecutive treadmill exercise stress test were performed for the assessment of peripheral vascular function. Thirty-one were for atypical claudication-like symptoms including pain on standing, relief on sitting and back pain. Pedal pulses were palpable in 24 patients. Twenty-five patients (81%) had a negative stress test, suggesting a non-vascular aetiology and this finding was subsequently confirmed in 24 of the 25. The final diagnoses were spinal stenosis 13, [CT = 3, myelogram = 5, neurosurgeon opinion = 4, MRI = 1], myositis 2, restless leg syndrome 2 and osteoarthritis 7. Four patients had symptoms due to a combination of peripheral occlusive arterial disease and spinal stenosis; the latter was considered the predominant disorder in all four. Of the original 31 patients with atypical symptoms, spinal stenosis was present in 13 (42%). Atypia- in the common syndrome of intermittent claudication should alert the surgeon to the possibility of spinal canal disorders. Further investigation may identify significant pathology spinal stenosis in particular.

Surgical treatment of a sacral nerve root cyst with intermittent claudication in an 85-year-old patient: Case report

The following presents a case of an 85-year-old woman with intermittent claudication of a sacral nerve root cyst. The cyst wall was incised and oversewn while preserving the surrounding nerve fibers by microscopic procedures. All symptoms were eliminated following the operation. The syndrome of intermittent claudication may possibly arise while walking from the transient influx of cerebrospinal fluid into a cyst in a relatively narrow sacral canal. The present case may indicate that a sacral nerve root cyst is curable even in aged patients through thorough evaluation and management.

Arterial occlusions simulating neurological disorders of the lower limbs.

The veterinarian Boullay first described the syndrome of intermittent claudication as early as 1831. 1 In 1858, Jean Marie Charcot described lameness and pain of claudication in horses pulling carriages. His description of a patient with an aneurysm of the common iliac artery was the first that gave an accurate and comprehensive survey of the clinical picture of pain due to vascular insufficiency in the lower extremity of man. 2 Failure of circulation to specific muscle groups and the appearance of sensory changes during exercise are only of relatively recent recognition. Where unusual types of claudication and ischemic hypesthesia appear, they are often confused with neurological syndromes. It is the purpose of this paper to describe several types of pain and sensory changes arising in arterial disease of the lower extremity that manifest a strong resemblance to primary neurological disease and to present illustrative case histories. TYPES OF PAIN It