Management Of Lumbar Spinal Stenosis Research Articles

Sublaminar Decompression and Fusion Versus Sublaminar Trimming Laminoplasty: A Retrospective Cohort

Background: Many surgical options for treating lumbar degenerative disorders have been used to improve health related outcome of those patients. The aim of the study is to compare the functional and radiological outcome of the two techniques in management of Lumbar spinal stenosis (LSS). Methods: Sixty patients with Lumbar spinal stenosis were included in a retrospective cohort study at zagazig university hospital. The inclusion criteria were patients with single level LSS with back and /or leg pain with instability on dynamic radiology not responding to medical treatment. Patients were divided into two groups according to the method of treatment done. Group1 included patients with sublaminar trimming Laminoplasty. group 2 included patients with sublaminar decompression. (VAS) for back and leg pain and the (ODI) for the disability. we measured AP-thecal sac area, foraminal height and the thecal sac area for all patients (pre- and post-operative). Results: no difference in relation to demographic data nor in the diagnosis of the spinal stenosis. Group-2 had longer hospital stay. Both groups improved clinically postoperatively with no statistical difference between them. However, the rate of improvement in group-2 in relation to leg pain was better. Both groups improved radiologically, but AP-thecal sac area, foraminal height and the thecal sac area were much improved in group-2 (p-value<0.001). Conclusion: Sublaminar decompression can particularly achieve better central, foraminal and lateral recess decompression together with a better fusion rate and hence, can be used as alternative to different laminotomy decompression techniques for treating different lumbar degenerative disorders.

Lumbar Spinal Stenosis Due To Spodylolisthesis- Surgical Compared With Nonsurgical Treatment

Background: Lumbar spinal stenosis with spondylolisthesis stands for severe pain and dysfunction because of the narrowing of the spinal canal and vertebral slip. With patients being treated either surgically or by other methods, distinction between the two is necessary to resolve controversies. Objectives: To conduct a comparative analysis between surgery and non-surgery in the management of lumbar spinal stenosis with spondylolisthesis using observational and randomized control study groups. Study Design: A Observational and randomized cohort comparative study Place and duration of study : department of neurosurgery lady reading hospital Peshawar from jan-2020 to jan-2023 Methods: Based on the observational and randomized cohort study conducted in the period jan-2020 to jan-2023 in the Lady Reading Hospital, 604 patients were included in the study. Collectively, treatment embraced either surgical untethering or other mean. Specific patient outcomes such as pain relief and functional gain were measured during the follow-up which ranged up to 3 years. Results: In terms of body pain, surgical intervention provided statistically significant and more superior results in a mean of 18. 1 as compared to nonsurgical management over 3 years of follow up, similarly for physical functions the mean improvement was of 18. 3 and for Oswestry Disability Index it was 16. 7. Conclusion: The decision of preferring surgical intervention for the treatment of lumbar spinal stenosis with spondylolisthesis correspond to the maximum long term advantages of surgical over non surgical treatment principles focusing on the pain relief and functional recovery. Therefore, the present outcomes favour surgical management as the most preferred treatment approach with the adoption of individualised management plans following thorough clinical examinations of the patients. Keywords: Spinal Stenosis, Spondylolisthesis , Surgery Outcomes

Spinal manipulation and electrical dry needling as an adjunct to conventional physical therapy in patients with lumbar spinal stenosis: a multi-center randomized clinical trial

BACKGROUND CONTEXTNonoperative management of lumbar spinal stenosis (LSS) includes activity modification, medication, injections, and physical therapy. Conventional physical therapy includes a multimodal approach of exercise, manual therapy, and electro-thermal modalities. There is a paucity of evidence supporting the use of spinal manipulation and dry needling as an adjunct to conventional physical therapy in patients with LSS. PURPOSEThis study aimed to determine the effects of adding thrust spinal manipulation and electrical dry needling to conventional physical therapy in patients with LSS. STUDY DESIGN/SETTINGRandomized, single-blinded, multi-center, parallel-group clinical trial. PATIENT SAMPLEOne hundred twenty-eight (n=128) patients with LSS from 12 outpatient clinics in 8 states were recruited over a 34-month period. OUTCOME MEASURESThe primary outcomes included the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI). Secondary outcomes included the Roland Morris Disability Index (RMDI), Global Rating of Change (GROC), and medication intake. Follow-up assessments were taken at 2 weeks, 6 weeks, and 3 months. METHODSPatients were randomized to receive either spinal manipulation, electrical dry needling, and conventional physical therapy (MEDNCPT group, n=65) or conventional physical therapy alone (CPT group, n=63). RESULTSAt 3 months, the MEDNCPT group experienced greater reductions in overall low back, buttock, and leg pain (NPRS: F=5.658; p=.002) and related-disability (ODI: F=9.921; p<.001; RMDI: F=7.263; p<.001) compared to the CPT group. Effect sizes were small at 2 and 6 weeks, and medium at 3 months for the NPRS, ODI, and RMDI. At 3 months, significantly (p=.003) more patients in the MEDNCPT group reported a successful outcome (GROC≥+5) than the CPT group. CONCLUSIONPatients with LSS who received electrical dry needling and spinal manipulation in addition to impairment-based exercise, manual therapy and electro-thermal modalities experienced greater improvements in low back, buttock and leg pain and related-disability than those receiving exercise, manual therapy, and electro-thermal modalities alone at 3 months, but not at the 2 or 6 week follow-up.

LUMBAR SPINAL STENOSIS: UNDERSTANDING SYMPTOMS, CAUSES, DIAGNOSIS, AND TREATMENT OPTIONS

Lumbar spinal stenosis is a degenerative condition characterized by the narrowing of the spinal canal in the lower back, leading to compression of the spinal cord and nerves. It primarily affects older individuals and is associated with age-related changes in the spine, such as osteoarthritis and disc degeneration. The condition presents with symptoms such as neurogenic claudication, radiculopathy, and loss of balance. Diagnosis involves medical history, physical examination, and imaging studies. Treatment options include non-surgical approaches like medication, physical therapy, and injections, as well as surgical interventions when conservative measures fail. A multidisciplinary approach is essential for effective management of lumbar spinal stenosis, improving symptoms and enhancing the quality of life for affected individuals.

The Efficacy And Factors Associated With Epidural Injections In The Management Of Lumbar Spinal Stenosis And In Terms Of Delaying Laminectomy

The Efficacy And Factors Associated With Epidural Injections In The Management Of Lumbar Spinal Stenosis And In Terms Of Delaying Laminectomy

Delta large-channel technique versus microscopy-assisted laminar fenestration decompression for lumbar spinal stenosis: a one-year prospective cohort study

PurposeWhen it comes to treating lumbar spinal stenosis (LSS), a procedure known as microscope-assisted fenestration decompression has expediently become the gold standard. With the advancement of spinal endoscopy, the Delta large-channel approach has shown promising clinical outcomes in the management of lumbar spinal stenosis. However, case studies of this method being used to treat lumbar spinal stenosis are still uncommon. The purpose of this research was to examine how well microscopy-assisted laminectomy and the Delta large-channel approach work in treating LSS in the clinic.MethodsFrom May 2018 to June 2020, 149 patients diagnosed with LSS were divided into 80 patients in Delta large-channel technique groups (FE group) and 69 patients in microscope groups (Micro group). Lower back and lower limb pain were measured using the visual analogue scale (VAS-LBP and VAS-LP), while lower limb numbness was evaluated using the 11-point numerical rating scale (NRS-LN); modified Oswestry Disability Index (ODI) was used to evaluate the quality of life, and modified MacNab criteria were used to assess the clinical efficacy before surgery and at one week, three months, six months, and 12 months after surgery. All patients had single-level lumbar spinal stenosis, and clinical data such as hospital stay, operation time, intraoperative blood loss were statistically analyzed.ResultsFinally, 111 patients (62 in FE group and 49 in Micro group) completed follow-up. Compared with preoperative results, postoperative VAS-LBP, VAS-LP, NRS-LN score and modified ODI score were significantly improved in 2 groups (P < 0.05), but there was no significant difference in postoperative follow-up at each time point (P > 0.05), Except 1 week after surgery, VAS-LBP in FE group was lower than that in Micro group (P < 0.05). It is noteworthy that the FE group had a shorter hospital stay, less intraoperative blood loss, and a quicker time of getting out of bed when compared with the microscope group，but the operation time was just the opposite (P < 0.05). The excellent and good rate was 83.87% in FE group and 85.71% in Micro group (P > 0.05).ConclusionsBoth microscope-assisted laminar fenestration decompression and Delta large-channel procedures provide satisfactory treatment outcomes, however the Delta large-channel approach has some potential advantages for the treatment of LSS, including quicker recovery and sooner reduced VAS-LBP. Long-term consequences, however, will necessitate additional follow-up and research.

120. The clinical and operative impact of lumbar epidural steroid injections prior to spine surgery for lumbar spinal stenosis

<h3>BACKGROUND CONTEXT</h3> Lumbar spinal stenosis is a common finding in the adult population. Lumbar epidural steroid injections (ESIs) are often used in management of this condition, with conflicting evidence regarding their efficacy. Previous research has suggested a negative impact of ESIs on the operative times and postoperative outcomes when ESIs are administered preoperatively prior to spine surgery in this population. Our retrospective study was performed to gain greater insight into the impact of preoperative ESIs on postoperative outcomes following spine surgery in management of lumbar stenosis. <h3>PURPOSE</h3> Our objective is to determine how preoperative ESIs impact postoperative outcomes following spine surgery in management of lumbar stenosis. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort involving patients who underwent surgical management of lumbar stenosis. Data for patients with preoperative ESI was compared to those without preoperative ESI administration. <h3>PATIENT SAMPLE</h3> Patient data for this retrospective cohort was retrieved solely from a patient database of a medical institution in north Texas, US. Patients were included in the study if they underwent surgical management of lumbar spinal stenosis between January 2016 and December 2020. The inclusion criteria required an active diagnosis of lumbar spinal stenosis. Patients who received an ESI within three months prior to the spine surgery were included in the "ESI" group, while those who did not receive a lumbar ESI within three months prior to the spine surgery were included in the "Non-ESI" group. <h3>OUTCOME MEASURES</h3> Primary outcome measures were ODI (Oswestry Disability Index) back, NDI (Neck Disability Index) back, VAS (Visual Analog Scale) leg pain, VAS back pain, PROMIS (Patient-Reported Outcomes Measurement Information System) pain, PROMIS pain interference, PROMIS satisfaction, PROMIS physical function at time of spine surgery (baseline) and at three months after surgery. <h3>METHODS</h3> This study was conducted at a medical institution in north Texas, US, utilizing the institution's spine center database. The institutional review board approved the standardized protocol. This study included a retrospective cohort. All results were collated on a Microsoft Excel file as retrieved from a patient registry of a medical institution in north Texas based on exclusion and inclusion criteria above. Statistical analysis was performed using IBM SPSS software, with t-test and ANOVA used to determine significance. P-value less than 0.05 was considered statistically significant. <h3>RESULTS</h3> Patients receiving an ESI in the preoperative period had shorter operative times (ESI 157 minutes vs Non-ESI 187 minutes, p=.10) during spine surgery than did patients in the Non-ESI group. Both ESI and Non-ESI groups showed significant improvements in VAS leg, VAS back, ODI and PROMIS pain scores at three months after surgery, with the ESI group showing a significantly larger improvement compared to the Non-ESI group in PROMIS pain scores. <h3>CONCLUSIONS</h3> Regardless of preoperative ESI administration, this study demonstrated improvement in pain and disability scores in the postoperative period following surgical management of lumbar stenosis. Patients who received ESI in the preoperative course had shorter operative times and greater improvements in PROMIS pain scores in the postoperative course compared to those who did not receive ESI. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Impact of lumbar spinal stenosis on metabolic syndrome incidence in community-dwelling adults in Aizu cohort study (LOHAS)

Metabolic syndrome and lumbar spinal stenosis (LSS) are common age-related diseases. However, the causal relationship between them remains unclear. This study aimed to identify the effects of LSS on metabolic syndrome incidence in community-dwelling adults. This prospective cohort study included participants of the Aizu cohort study (LOHAS) aged < 75 years as of 2008. Participants with metabolic syndrome at baseline were excluded. The primary outcome measure was metabolic syndrome incidence, and the main explanatory variable was the presence of LSS, as assessed by a self-reported questionnaire. A multivariate Cox proportional hazard regression model was used to estimate hazard ratios (HRs) for metabolic syndrome incidence during the 6-year follow-up period. Complete-case analyses were compared with the multiple imputation results. Among 1599 participants, 1390 complete cases were analyzed (mean [SD] age 62.3 [9.0] years; females, 734 [52.8%]). Among those participants, 525 (37.8%) developed metabolic syndrome during the follow-up of 3.89 [1.96] years. The presence of LSS was associated with developing metabolic syndrome (HR, 1.41; 95% confidence interval [CI] 1.02–1.95). Multiple imputation results showed similar trends of those having complete-case data (HR, 1.47; 95% CI 1.08–2.00). This finding suggests the importance of prevention and management of LSS in community settings.

Research Progress and Analysis of Perioperative Pain Management of Lumbar Spinal Stenosis

Research Progress and Analysis of Perioperative Pain Management of Lumbar Spinal Stenosis

Surgical management of lumbar spinal stenosis in patients over 80: is there an increased risk?

Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complication rate was higher for elderly patients and to find confounding factors. We conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded. Nine hundred ninety-six patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. Of the patients, 5.2% presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI and accidental durotomies were independent risk factors for SC. Surgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complication risk is increased although an optimal preparation is the way to avoid them.

Comparison of Plain X-ray and MRI Findings By Determining The Sensitivity and Specificity in the Diagnosis of Lumbar Spinal Stenosis

Background: Lumbar spinal stenosis is the most frequent indication for spine surgery. The X-ray and MRI are the choice of investigation. Justified use of radiography can be cost effective in the management of lumbar spinal stenosis. Objective: To evaluate and compare the sensitivity and specificity of the plain X-ray and MRI in the diagnosis of the lumbar spinal stenosis. Materials and Methods: A multicenter cross sectional analytical study was carried out from January 2014 to December 2015 on 70 patients of both sexes aged more than 25 years with chronic low back pain. Plain x-ray and MRI were done in all patients. The interval between plain x-ray and MRI was less than 3 months. A descriptive analysis was performed for all data. Results: The mean age (+ SD) was 45.1 (+ 5.4) years. Forty two (60%) were male and 28 (40%) were female. In plain x-ray of the lumbosacral spine, 30 (42.9%) had diskogenic spinal canal stenosis and 22 (31.4%) had both diskogenic and non diskogenic spinal canal stenosis. In the MRI, 35 (50.0%) cases had diskogenic spinal canal stenosis and 24 (34.3%) had both diskogenic and non diskogenic spinal canal stenosis. The validity of MRI evaluation for only diskogenic spinal canal stenosis was correlated, where the calculated values of plain x-ray were: sensitivity 80.0%, specificity 60.0%, accuracy 77.5%, positive predictive value 93.3% and negative predictive value 30.0%. The validity of MRI evaluation for both diskogenic and non diskogenic spinal canal stenosis was correlated, where the calculated values of plain x-ray were: sensitivity 83.3%, specificity 66.7%, accuracy 80.0%, positive predictive value 90.9% and negative predictive value 50.0%. Conclusion: Plain x-ray is a useful and reliable diagnostic modality for the evaluation, assessment and the subsequent appropriate management of lumbar spinal stenosis. KYAMC Journal. 2021;12(3): 161-165

Mean 5-Year Follow-Up Results of a Facet Replacement Device in the Treatment of Lumbar Spinal Stenosis and Degenerative Spondylolisthesis

Flexible stabilization has been utilized to maintain spinal mobility in patients with early-stage lumbar spinal stenosis (LSS). Previous literature has not yet established any nonfusion solution as a viable treatment option for patients with severe posterior degeneration of the lumbar spine. This feasibility study evaluates the mean 5-year outcomes of patients treated with the Total Posterior Spine System (TOPS) facet replacement system in the surgical management of lumbar spinal stenosis and degenerative spondylolisthesis. Ten patients (2 men, 8 women, mean age: 59.6 years) were enrolled into a non-randomized prospective clinical study. Patients were evaluated with standing anteroposterior, lateral, flexion and extension radiographs and magnetic resonance imaging scans, back and leg pain visual analog scale scores, Oswestry Disability Index, Zurich Claudication Questionnaire and the SF-36 questionnaires, preoperatively, 6 months, 1 year, 2 years, and latest follow-up at a mean of 5 years postoperatively (range: 55-74 months). Flexion and extension standing lumbar spine radiographs were obtained at 2 years to assess range of motion at the stabilized segment. The clinical outcome scores for the cohort improved significantly across all scoring systems. Radiographs at 2 years did not reveal any loss of position or loosening of metal work. There were 2 incidental durotomies and no failures at 5 years, with no patient requiring revision surgery. The TOPS implant maintains clinical improvement and motion in the surgical management of LSS and spondylolisthesis, suggesting that it can be considered an option for these indications.

A study of clinical presentations of patients with lumbar spinal stenosis & functional outcome of surgical decompression in lumbar spinal stenosis

Background and Objective: The management of lumbar spinal stenosis by surgery has increased rapidly in the past two decades, however, the results are not uniform as reported by different users. Our aim was to investigate the effectiveness of surgery in the management of patients with lumbar spinal stenosis.Materials and Methods: It is a prospective study which was carried out from August 2015 to January 2017 in MVJ Medical College and Research Hospital, Bengaluru. In this study period 30 patients of degenerative lumbar canal stenosis managed surgically (laminotomy, laminectomy and discectomy) were included after meeting inclusion and exclusion criteria. JOA scoring system was used to assess the patient’s pre operatively and post operatively at 3 weeks, 6 weeks, 3 months and 6 months.Recovery rate was calculated as described by Hirabayashi et al. (1981). Surgical outcomes was assessed based on the recovery rate and was classified using a four grade scale. Excellent, improvement of >90%; good, 75 – 89% improvement; fair, 50 – 74% improvement; poor, below 49% improvement.Results: In our study, majority of the patients were males, at 6 months follow up 27% (n=8) patients showed excellent outcome, 57% (n=17) showed good outcome and 17% (n=5) showed fair outcome.Conclusion: Operative management for lumbar spinal stenosis yields excellent results as observed on basis of JOA scoring system.

Determination of Work Relative Value Units for Management of Lumbar Spinal Stenosis by Open Decompression and Interlaminar Stabilization.

Effective January 1, 2017, open surgical decompression and interlaminar stabilization (ILS) received a Category I Current Procedural Terminology (CPT®) code 22867. The current work relative value units (wRVUs) assigned to the procedure of 13.5 are not reflective of the amount of work involved. During the survey process, CPT® 22867 was erroneously assessed with a percutaneous "sister" code (CPT® 22869), which is performed with no decompression (but within the same new "family") and primarily by nonsurgeons. However, similar CPT® code descriptors assigned to each of these new codes undermined their procedural differences during the survey process and generated confusion among physician survey responders, the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC), and ultimately the Centers for Medicare and Medicaid Services (CMS) regarding the value of ILS. The resulting physician payment determination for the ILS procedure has had severe deleterious effects on this procedure being offered to lumbar spinal stenosis (LSS) patients. Our independent society-driven survey presents new data that assess the accuracy of the assigned wRVUs for CPT® 22867. An independent survey was driven by the International Society for the Advancement of Spine Surgery (ISASS) in November 2018 and sent to 58 US surgeons with experience performing open decompression with ILS (CPT® 22867) and without financial conflicts of interest as analogous to RUC survey financial disclosure requests. Respondents were asked to compare CPT® 22867 with a list of 10 other comparator CPT® codes reflective of common spine surgeries. The survey presented each comparator CPT® code with its code descriptor and corresponding wRVUs alongside the code descriptor for CPT® 22867. A patient vignette was also provided that describes a typical clinical scenario for the surveyed procedure. Respondents were then asked to indicate which comparator CPT® code on the reference list is most similar to the survey code descriptor and typical patient/service vignette provided, as well as specify estimated wRVUs for CPT® 22867 relative to their selected comparator CPT® code. The surgeons' responses were analyzed to determine comparator CPT® codes and estimated wRVUs. Among the 28 surgeons who responded to the survey, both open decompression codes (57.1%) and fusion codes (42.9%) were chosen as most similar to the typical patient/service for CPT® 22867. Furthermore, the laminectomy procedure (CPT® 63047) was chosen as the surveyed surgeons' model response for a reference procedure in terms of similar work intensity and time for CPT® 22867. After calculating the difference between the selected comparator codes and estimated wRVUs, nearly all respondents had a positive calculated difference, indicating that surgeons selected wRVUs lower than they deemed appropriate as a result of the listed CPT® codes they were required to use. In the spirit of the Rasch analysis, the regression analysis estimated wRVUs for CPT® 22867 that are greater than its assigned wRVUs (13.5) and its most comparable procedure (CPT® 63047; reference wRVUs: 15.37). The survey results indicate that the wRVUs assigned to CPT® 22867 are significantly undervalued at 13.50 and have directly resulted in the underreimbursement for surgeons performing the ILS procedure. This misvaluation of the code has created a supply-and-demand anomaly in which the rate of ILS procedures has flatlined despite increasing rates of fusion procedures and an increasing older population. This anomaly is a cause of concern for policy makers and the health care community for the future of safeguarding patient welfare and procedural innovation. Therefore, understanding the clinical economic impact and appropriately addressing potential misvalued codes, such as the ILS procedure, are critical to protecting the future of patient care.

Clinical Implications of the Epidural Fat Thickness in the Management of Lumbar Spinal Stenosis

Lumbar epidural lipomatosis is a rare condition defined as the excessive accumulation of epidural fat (EF). We herein investigated the indicators of the posterior compression factors, EF and yellow ligament, to identify the clinical features of lumbar epidural lipomatosis. Five hundred consecutive patients who underwent posterior lumbar decompression surgery for lumbar spinal stenosis (LSS) were retrospectively reviewed. The EF/SC-L index (the ratio of the anteroposterior length of the EF to that of the spinal canal [SC]) was evaluated at the spinal level that exhibited maximum dural tube compression. The participants were divided into 3 groups: grade I, EF/SC-L index ≤50%; grade II, EF/SC-L index 51%-74%; grade III, EF/SC-L index ≥75%. EF/SC-A (the ratio of the cross-sectional area of EF to that of SC) and YL/SC-A (the ratio of the cross-sectional area of yellow ligament [YL] to that of SC) were calculated. The clinical outcomes were assessed according to the Japan Orthopaedic Association scale for lumbar disease. EF/SC-L exhibited a significantly positive correlation with EF/SC-A (r= 0.82, P < 0.001), and a negative correlation with YL/SC-A (r=-0.71, P < 0.001). The Japan Orthopaedic Association score recovery rate was 56.7 ± 22.6 in the case-matched control group, 34.5 ± 31.2 in the grade II group (P < 0.001), and 39.6 ± 24.9 in the grade III group (P=0.032). The EF/SC-L index is a simple and reliable indicator to quantitatively evaluate posterior compression in patients with LSS. As the accumulation ofEF is associated with worse operative outcomes, the EF/SC-L index should be considered when planning lumbar decompression surgery for patients with LSS.

Lumbar Spinal Stenosis and Potential Management With Prostaglandin E1 Analogs.

Lumbar spinal stenosis is one of the most commonly diagnosed spinal disorders worldwide and remains a major cause for surgery in older adults. Lumbar spinal stenosis is clinically defined as a progressive degenerative disorder with low back pain and associated neurogenic intermittent claudication. Conservative and surgical management of lumbar spinal stenosis has been shown to be minimally effective on its symptoms. A treatment option that has not been investigated in the United States is the utilization of prostaglandin E1 analogs, which have been used primarily in Japan for the treatment of lumbar spinal stenosis since the 1980s. The vasodilatory and antiplatelet aggregation effects of prostaglandin E1 presumably improve symptoms of lumbar spinal stenosis by increasing blood flow to the spinal nerve roots. This brief report examines the potential vascular pathology of lumbar spinal stenosis, reviews evidence on the use of prostaglandin E1 analog limaprost in Japan for lumbar spinal stenosis, and briefly discusses misoprostol as a possible alternative in the United States. The studies summarized in this report suggest that prostaglandin E1 analogs may provide benefit as a conservative treatment option for patients with lumbar spinal stenosis. However, higher-quality studies conducted in the United States and comparison with other currently used conservative treatments are required before it can be recommended for routine clinical use.

Nerve Root Sedimentation Sign: Can It Predict the Success for Surgical Intervention in Patients With Symptomatic Lumbar Spinal Stenosis?

Introduction: The use of interspinous process devices are less invasive surgical methods designed to manage mild to moderate lumbar spinal stenosis symptoms. Symptomatic relief may not be seen in all patients undergoing this procedure. Magnetic resonance imaging (MRI) parameters have been used to predict the success of clinical outcomes in patients with symptomatic lumbar spinal stenosis for decompressive surgeries. The purpose of this study was to determine the feasibility of using nerve root sedimentation sign to predict mid- to long-term clinical outcomes of patients treated with interspinous spacers for lumbar spinal stenosis.Methods: This was a retrospective study using prospective multicenter Food and Drug Administration Investigational Device Exemption (FDA IDE) trial (Superion™ and X-STOP®) data. Inclusion criteria were patients treated with interspinous spacers, aged 45 or older with lumbar spinal stenosis at one or more contiguous levels from L1 to L5 and symptoms of neurogenic claudication. Preoperative axial T2 weighted MRI images were used to determine nerve root sedimentation sign. Preoperative, six-week, one- and two-year postoperative clinical outcomes were measured using Oswestry Disability Index (ODI) scores. Clinical outcomes were compared between positive and negative nerve root sedimentation sign groups; p ≤0.05 was considered significant.Results: This study included n=374 patients; 40 excluded; 334 included (113=positive nerve root sedimentation sign (NRSS) (34%) and 221=negative NRSS (66%)). At six weeks, significant postoperative ODI correction was noted in both groups (p<0.001). No significant differences in ODI scores were identified between groups. A subgroup analysis with MRI image quality grade 3 and certainty determination grade 5, six-week postoperative ODI correction was significant in both groups. Six-week, one- and two-year postoperative ODI scores were greater by 6 points in the positive nerve root sedimentation sign group compared to the negative nerve root sedimentation sign group.Conclusions: Although satisfactory postoperative improvement occurred in both groups, there were statistically significant differences noted in certain sub-categories. The subgroup analysis indicated MRI image quality and nerve root sedimentation sign certainty of determination may be factors that may aid with planning the surgical management of lumbar spinal stenosis.

Risk Factors for Atherothrombotic Disease and Lumbar Spinal Stenosis: Results from the PREFACE Study

Background and aim: Atherothrombotic disease of feeding arteries of lumbar spine could be an underlying mechanism for Lumbar Spinal Stenosis (LSS). We aimed at evaluating the association of a large panel of risk factors for atherothrombotic disease, alone or in combination, with LSS in multivariable models. Methods: Case-control study: 213 consecutive patients with LSS, eligible for surgery at the Neurosurgery Department of IRCCS Neuromed, were enrolled in the PREFACE study; 426 controls, matched 1: 2 for sex, age (± 6 months) and physical activity, without a history or clinical evidence of LSS were selected from the general population. Odds Ratios (ORs) and their 95% Confidence Intervals (CIs) were calculated using conditional-tomatch (for age and sex) logistic regression. Results: Manual occupation, current smoking, high waist-to-hip ratio, history of hypertension, diabetes and dyslipidemia were independently associated with higher odds of developing LSS in multivariable analysis (p<0.001). Only 1.5% of patients with LSS showed absence of risk factors, in comparison with 6.7% in controls (p<0.001). The risk of LSS linearly increased with the increased presence of risk factors. The presence of 3 or more risk factors compared with none was associated with 13 times higher risk of LSS (OR: 13.04; 95% CI: 2.87-59.27) Conclusion: Risk factors for cardiovascular disease and in particular metabolic risk factors are associated with increased risk of LSS. Management of LSS should take into consideration the control of modifiable atherothrombotic risk factors.

Post-operative Morbidity and Mortality of Lumbar Spinal Stenosis at one Teaching Hospital in North-eastern Benin.

Background and Aim: Surgical management of Lumbar Spinal Stenosis (LSS) is a common practice. This study aimed to report the morbidities and mortalities observed during surgical treatment of LSS and the outcome of these patients after management over an 8-year study period. Methods and Materials/Patients: It was a retrospective, descriptive, and transversal study performed at the Departmental Teaching Hospital of Borgou in the Republic of Benin (West Africa) from January 2010 to December 2018. This study included the patients who underwent surgical management for LSS. Type of complication, its management, and the patient’s outcomes was registered. Results: During the study period and based on the selection criteria, 239 patients were selected. These patients were divided into 135 men (56.5%) and 104 women (43.5%). The mean age of the patients was 52.3±10.9 years. Laminectomy was performed on one, two, and three lumbar spinal segments in 17.6%, 55.6% and 26.8% of cases, respectively. Laminectomy was associated with discectomy in 6.3% of the cases. No arthrodesis with spinal fixation was performed. Ninety percent of patients had no post-operative complications. Functional post-operative results were considered excellent, good, acceptable and poor in 32.1%, 52.1%, 10.9% and 4.9% of cases, respectively. Five types of complications were observed in 22 patients (9.2%). A reoperation was performed in 1.6% of cases. These different complications included dural tear (4.6%), wound infection (3.3%), stroke (0.8%), cauda equina syndrome (0.4%) and pseudomeningocele (0.4%). The mortality rate was 0.8% (n=2). Conclusion: Lumbar canal stenosis surgery is not without complications. Careful selection of patients, consideration of risk factors, and selection of an appropriate surgical strategy can reduce or avoid these complications.

National Trends in the Surgical Management of Lumbar Spinal Stenosis in Adult Spinal Deformity Patients.

This is a retrospective analysis of national administrative hospital data. This study examines national trends in the surgical management of lumbar spinal stenosis (LSS) in patients with and without coexisting scoliosis between 2010 and 2014. The study also examines revision rates for LSS procedures. There is wide variability in the surgical management of patients with LSS, with and without coexisting spinal deformity. Data were obtained from the Healthcare Cost and Utilization Project's National Inpatient Sample Database. International Classification of Diseases 9th revision- Clinical Modification codes were used to identify all patients with a primary diagnosis of lumbar spinal stenosis. These patients were divided into two groups: 1) LSS alone and 2) LSS with coexisting scoliosis. The two groups were examined for one of three surgical outcomes: 1) decompression alone (discectomy, laminectomy), 2) simple fusion, and 3) complex fusion (>three vertebrae or 360° fusion). The groups were then further examined for revision operations. National Inpatient Sample discharge weights were applied where relevant. In 2014 national estimates of discharged patients indicated 76,275 patients with a primary diagnosis of LSS (population rate, 23.9; in the elderly (65+) the age-adjusted population rate was 95.4). Of these patients, 88.5% were managed through primary surgery (34.6% decompression, 47.2% simple fusion, 5.7% complex fusion). Between 2010 and 2014, the percentage of decompression decreased from 47.5% to 34.6%, the percent of simple fusion increased from 35.3% to 47.2%, and the percent of complex fusion increased from 5.7% to 7.1% (P < 0.01). In patients with coexisting scoliosis, lumbar spinal stenosis was predominantly managed by simple fusion and complex fusion (15.5% decompression, 51.9% simple fusion, 27.3% complex fusion, in 2014). Revision rates were highest among patients without scoliosis managed with complex fusion (15.8% in 2014) compared with patients with scoliosis (8.8% in 2014). Patients with scoliosis who underwent decompression only had revision rates of 1.7% and 0.62% in 2010 and 2014, respectively. We observed a leveling-off of the rate of operation for patients with a primary diagnosis of LSS at around 88%. There was an increase in the rate of fusion and a decrease in the rate of decompression across all patient groups. We report no difference in revision rates between patients with and without scoliosis, except in those undergoing a complex fusion. 3.