Outcome Of Lumbar Spinal Stenosis Research Articles

Comparison of clinical outcome of lumbar spinal stenosis surgery in patients with and without osteoporosis: a prospective cohort study

BackgroundOsteoporosis is one of the most important risk factors for failure of the spine instrumentation. Management of patients with osteoporosis who requires spinal surgery because of the difficulty in instrument placement and the potential complications is still a challenge. This study was designed to evaluate the clinical outcome of lumbar spinal canal stenosis after instrumentation in patients with and without osteoporosis.MethodsThis prospective cohort study was performed from June 2018 to December 2020, in Be'sat Hospital, Hamadan, Iran. The sample consisted of patients over 50 years old referred to Be'sat Hospital with a diagnosis of lumbar spinal canal stenosis who underwent instrumental surgery (n = 107). Based on bone densitometry, the sample was divided into two groups with osteoporosis (n = 34) and without osteoporosis (n = 73). To collect data, we used a three-part researcher-made questionnaire (demographic information, medical records information, and paraclinical parameters). Statistical analyzes were performed by the Fisher Exact, chi-square, independent t-test, Multiple ANCOVA, Mann–Whitney and the Rank Wilcoxson tests using Stata version 17 software.ResultsThe mean age (SD) of patients in the two groups with and without osteoporosis was 67.9 (7.0) and 59.1 (5.1) years, respectively (p = 0.001). The results indicated that a significant difference was observed between the two groups in sex (p = 0.032), educational status (p = 0.001), marital status (p = 0.023), employment status (p = 0.004), menopausal status (p = 0.018), taking corticosteroids (p = 0.028), and body mass index (p = 0.015). Also, there was a significant difference between two groups in the loosening of instrument (p = 0.039), the postoperative pain intensity (p = 0.007), fusion (p = 0.047), and neurogenic claudication (p = 0.003). Based on multiple ANCOVA test, there was not a significant difference between two groups in the clinical and paraclinical charatecristics (p > 0.05). The mean (SD) of T-Score in the osteoporosis group was 3.06 (0.37).ConclusionThis study provides evidence that there is no significant difference in the clinical outcomes of lumbar spine instrumentation due to spinal canal stenosis in patients with and without osteoporosis. Because of the high cost of specific instrumentation developed for patients with osteoporosis and their unavailability, it seems that the use of conventional instrumentation along with complete treatment of osteoporosis can help improve the clinical outcome of surgery in these patients.

Impact of Diffuse Idiopathic Skeletal Hyperostosis on Clinico-Radiological Profiles and Prognosis for Thoracic Ossification of Ligamentum Flavum-Myelopathy: A Propensity-Matched Monocentric Analysis.

Background: Diffuse idiopathic skeletal hyperostosis (DISH) has been evaluated as a potential risk factor of poor surgical outcomes for lumbar spinal stenosis, whereas the influence of DISH on neuroimaging characteristics and postoperative prognosis of patients with thoracic myelopathy has not been established. Therefore, this study aimed to shed light on this issue. Methods: A monocentric study enrolled 167 eligible patients with thoracic ossification of ligamentum flavum (TOLF), who were followed up for at least 2 years. Clinico-radiological parameters and surgical outcomes were compared between the DISH+ and DISH− groups before and after propensity matching. Subgroup analysis was conducted to compare the functional outcomes between mild DISH (M-DISH) and moderately severe DISH (MS-DISH) groups. Results: Fifty-eight patients were diagnosed as DISH, and its prevalence was 34.7%. Patients with DISH presented with older age, more males, taller stature, heavier weight, more commonly diffuse-type TOLF (p < 0.05). The DISH group showed significantly worse recovery rate (RR) at the final follow-up before and after propensity matching (p < 0.01), and slightly lower preoperative VAS, higher postoperative VAS and lower VAS reduction, despite not reaching the significant differences. Subgroup analysis demonstrated that the M-DISH group was associated with the lower mJOA score (p = 0.01) and RR at the final follow-up (p = 0.001), and tended to present higher preoperative VAS than the MS-DISH group. Conclusions: DISH has a significant predisposition to the elderly males with diffuse-type TOLF. Although the presence of M-DISH might bring about a suboptimal surgical outcome, both DISH and non-DISH patients experienced good neurological function improvements and pain relief through thoracic posterior decompression.

Can fat infiltration in the multifidus muscle be a predictor of postoperative symptoms and complications in patients undergoing lumbar fusion for degenerative lumbar spinal stenosis? A case–control study

PurposeThis study aimed to explore whether 25% as the cutoff value of fat infiltration (FI) in multifidus (MF) could be a predictor of clinical outcomes of lumbar spinal stenosis (LSS) patients.MethodsA total of 461 patients undergoing posterior lumbar interbody fusion for LSS with 1-year follow-up were identified. After sex- and age-match, 160 pairs of patients were divided into a FI < 25% group and a FI ≥ 25% group according to FI of MF at L4 on preoperative magnetic resonance imaging. Patient-reported outcomes including the visual analog scale scores (VAS) for back pain and leg pain and the Oswestry disability index (ODI) scores were evaluated. Bone nonunion and screw loosening were evaluated by dynamic X-ray.ResultsAfter matching, there was no significant difference in age, sex, body mass index, fusion to S1, number of fusion levels, osteoporosis, spondylolisthesis, smoking and diabetes. FI ≥ 25% group had significantly higher VAS for back pain, VAS for leg pain and ODI than FI < 25% group at 1-year follow-up. However, there was no significant difference in the change of them from baseline to 1-year follow-up between the two groups. In light of complications, FI ≥ 25% group had a significantly higher rate of bone nonunion than FI < 25% group, whereas there was no significant difference of screw loosening rates between the two groups.ConclusionMF FI might be a pragmatic cutoff value to predict bone nonunion in LSS patients, but it has little predictive value on screw loosening and postoperative improvement of symptoms.

Physical Predictors of Favorable Postoperative Outcomes in Patients Undergoing Laminectomy or Laminotomy for Central Lumbar Spinal Stenosis: Secondary Analysis of a Randomized Controlled Trial.

Study DesignSecondary analysis of a randomized controlled trial.ObjectiveTo identify preoperative physical variables associated with favorable postoperative outcome in individuals undergoing laminectomy or laminotomy for degenerative central lumbar spinal stenosis.Summary of Background DataClinical or condition specific variables have most commonly been studied as predictors of postoperative outcome in lumbar spinal stenosis. If associated to favorable postoperative outcome, modifiable physical variables would inform prehabilitation interventions for patients with degenerative central lumbar spinal stenosis.MethodsPatients awaiting surgery for central lumbar spinal stenosis were recruited to participate in a randomized controlled trial. Following baseline data collection of demographics, clinical portrait and physical testing, participants were randomized to either 6-week active prehabilitation program or hospital standard care. Complete baseline and postoperative data were obtained from 58 participants which were included in the present analysis. Favorable postoperative outcome was determined based on two outcome measures. Favorable outcome was defined as a decrease of ≥30% on the Numerical Rating Scale for leg pain intensity and a decrease of ≥30% on the Oswestry Disability Index for low back disability. Baseline physical variables were used to conduct binary logistic regression.ResultsSixty percent of participants were determined as having a favorable postoperative outcome. None of the included physical variables were found to be predictors of a favorable postoperative outcome based on leg pain intensity and low back pain-associated disability [trunk flexors muscle strength (OR = 0.73; 95%CI (0.02–27.12)] lumbar extensors muscle endurance [OR= 1.09; 95%CI (0.95–1.24)] total ambulation time [OR = 1.00 95%CI (0.99–1.01)] lumbar active range of motion in extension [OR = 1.08; 95%CI (0.95–1.23)] and knee extensors muscle strength [OR=1.02; 95%CI (0.98–1.06)].ConclusionResults show that none of the investigated variables, all related to low back and lower limbs physical capacity, were predictors of postoperative recovery. Further testing in larger cohort is needed to assess the full potential of physical outcome measures as predictors of postoperative recovery.

Prevalence of Restless Legs Syndrome and its Symptoms among Patients with Spinal Disorders.

Restless legs syndrome (RLS) is a neurological disorder that causes uncomfortable sensations in the legs. The purpose of this study was to evaluate the symptoms of RLS in patients with spinal disorders and the impact of RLS on the clinical outcomes of lumbar spinal stenosis (LSS). The records of 278 patients (age range 65–92 years) with spinal disorders who visited our outpatient clinic were reviewed. We used a survey to identify subjects with RLS based on the International RLS Study Group diagnostic criteria. We further recorded patient characteristics, surgical outcomes, sleeping time, mental health condition, and the occurrence of leg cramps. Thirty-two patients (11.5%) met the criteria for RLS. The prevalence of anxiety (46.9% vs. 26.6%, p = 0.023) and leg cramps (90.6% vs. 73.2%, p = 0.030) was higher in patients with RLS than in those without. RLS was present in 12.3% of LSS patients. The visual analog scale score for lower back pain before surgery and at the final follow-up was significantly higher in LSS patients with RLS than in those without. However, the Japanese Orthopaedic Association (JOA) score, JOA score improvement ratio, and VAS score for leg numbness were not significantly different between the groups.

P134. Midterm clinical and radiological outcomes of lumbar spinal stenosis with concurrent scoliosis and/or spondylolisthesis after minimally invasive lumbar decompression surgery: Minimum 5-year follow-up

<h3>BACKGROUND CONTEXT</h3> Several studies recently have been published about the sagittal spinal alignment of lumbar spinal canal stenosis (LSS) after decompression surgery, however, little is known about these variables of LSS with concurrent degenerative spondylolisthesis (DS) and/or lumbar scoliosis (DLS). With aging of the population, spine surgeons are currently more and more confronted with a wide variety of degenerative changes of the lumbar spine. <h3>PURPOSE</h3> The purpose of this study was to investigate whether the radiological and clinical outcomes differ depend on the concomitance after minimally invasive lumbar decompression surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis of prospectively collected data. <h3>PATIENT SAMPLE</h3> A total of 244 patients underwent bilateral decompression via unilateral approach using microscope or microendscope at our instituted between 2008 and 2013, and were followed up for more than 5 years postoperatively. A total of 169 patients were included in the final analysis (88 women, 81 men; mean age at surgery, 69.5±9.2years). The patients were divided into three groups: LSS group (without DS and DLS; n=91), DS group (n=59) and DLS group (n=19) <h3>OUTCOME MEASURES</h3> Clinical outcomes were evaluated with the Japanese Orthopaedic Association (JOA) scoring system (29 possible points) and visual analog scale (VAS) score for low back pain (LBP), leg pain, leg numbness and achievement of minimal clinically important difference (MCID) of VAS for low back pain (LBP) or leg pain (LP). Furthermore all spinopelvic parameters such as 1) cervical lordosis (CL): C2–7 angle (positive means lordosis); 2) cervicothoracic kyphosis (CTK): C7–T5 angle (positive means kyphosis); 3) thoracic kyphosis (TK): T5–12 angle (positive means kyphosis); 4) lumbar lordosis: T12–S1 angle (positive means lordosis); 5) C7–S1 sagittal vertical axis (SVA): distance between C-7 plumb line and posterosuperior sacrum; 6) pelvic parameters: sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI) and PI – LL were evaluated. <h3>METHODS</h3> All patients underwent bilateral decompression via a unilateral approach to decompress the central and bilateral lateral recess using a microscope or the METRx Microendoscopic Discectomy System (Medtronic Sofamor Danek, Warsaw, IN, USA). Outcomes were quantified comparatively among Simple LSS group vs DS group (with anterior slip of more than 3mm) and DLS group (with ≥ 20° coronal Cobb angle) using low back pain (LBP) /leg pain/leg numbness visual analog scale (VAS) scores, the JOA scores and variables about sagittal plane alignment before surgery, 2 years and 5 years of follow-up. <h3>RESULTS</h3> In patients coexisting DS, the clinical outcomes at 2year and 5-year after surgery were similar with that of LSS except for VAS leg numbness. In patients coexisting DLS, the VAS leg pain at 2-year after surgery was significantly higher (34.5 vs 14.5, P=0.001) and the achievement rate of the minimal clinically important difference in VAS LBP and leg pain was significantly lower than LSS group (26.3% vs 52.7%; P=0.036, 42.1% vs 72.5%; P=0.01). The reoperation rate of DS group was significantly lower than that of LSS group (3.4% vs16.5%; P=0.01), but the DLS group was comparable to the LSS group (15.8% vs 16.5%; P=0.941). Lumbar lordosis (LL), pelvic tilt and pelvic incidence-LL were significantly improved and maintained for 5 years after surgery, however, sagittal vertical axis improved at 2-year follow-up, but no significantly difference was observed at 5-year follow-up in both the DS and the DLS group. <h3>CONCLUSIONS</h3> Among patients with DS and DLS, the clinical effectiveness and radiological changes after minimally lumbar decompression surgery alone was noninferior to that of LSS without deformity. The less invasive procedure should be considered for most LSS patients. <h3>FDA DEVICE/DRUG STATUS</h3> Unavailable from authors at time of publication.

Wide Laminectomy, Segmental Bilateral Laminotomies, or Unilateral Hemi-Laminectomy for Lumbar Spinal Stenosis: Five-year Patient-reported Outcomes in Propensity-matched Cohorts.

Propensity-matched retrospective study of patients prospectively enrolled in Danespine. The aim of this study was to report 5-year patient reported outcome in lumbar spinal stenosis (LSS) patients who underwent wide laminectomy (WL), segmental bilateral laminotomies (SBL), or unilateral hemilaminectomy (UHL) with bilateral decompression. The optimal procedure for LSS remains controversial. Studies have shown no difference in short term outcomes among micro-laminectomy, hemi-laminotomies, broad laminectomy, and laminectomy with instrumented fusion. Patients with spinal stenosis who were enrolled in DaneSpine at two spine centers from January 2010 until May 2014 and underwent WL0, SBL, or UHL with bilateral decompression were identified. Patients completed standard questionnaires preoperatively and 1, 2, and 5 years after surgery. Patients in the three cohorts were propensity-matched using age, sex, body mass index (BMI), smoking status, number of surgical levels, American Society of Anesthesiologists (ASA) score, and patient-reported outcome measures (PROMs). Propensity matching produced 62 cases in each group. There were no differences in PROM among the three cohorts at five years follow up. Twelve patients were re-operated at the index level. The most frequent indication of reoperation was repeat decompression after SBL. Regression analysis revealed no statistical significant associations between the incidence of reoperation and age, sex, number of operated levels, ASA score, BMI, center, smoking status, or having a dural tear at index operation. This study revealed no significant difference PROMs, reoperation rates or time to reoperation at five years follow up between SBLs, UHL, or WL in patients operated for central LSS.Level of Evidence: 4.

Risk Factors for Reoperation at Same Level after Decompression Surgery for Lumbar Spinal Stenosis in Patients with Diffuse Idiopathic Skeletal Hyperostosis Extended to the Lumbar Segments.

Introduction Diffuse idiopathic skeletal hyperostosis (DISH) extended to the lumbar segments (L-DISH) reportedly has adverse effects on the surgical outcomes of lumbar spinal stenosis (LSS). However, the risk factors in patients with L-DISH have not been clarified. The purpose of this study was to investigate the long-term risk factors for reoperation at the same level after decompression surgery alone for LSS in patients with L-DISH in a retrospective cohort study. Methods A postoperative postal survey was sent to 1,150 consecutive patients who underwent decompression surgery alone for LSS from 2002 to 2010. Among all respondents, patients who exhibited L-DISH by preoperative total spine X-ray were included in this study. We investigated risk factors for reoperation at the same level as the initial surgery among various demographic and radiological parameters, including the lumbar ossification condition and computed tomography (CT) or magnetic resonance imaging findings. Results A total of 57 patients were analyzed. Reoperations at the same level as that of the index surgery were performed in 10 patients (17.5%) and at 11 levels within a mean of 9.2 years. Cox proportional hazard regression analysis indicated that the independent risk factors for reoperation were a sagittal rotation angle ≥10° (adjusted hazard ratio: 5.17) and facet opening on CT (adjusted hazard ratio: 4.82). Neither sagittal translation nor the ossification condition in the lumbar segments affected reoperations. Conclusions A sagittal rotation angle ≥10° and facet opening on preoperative CT were risk factors for reoperation at the same level as that of the index surgery in patients with L-DISH. The surgical strategy should be carefully considered in those patients.

Does country of origin influence research outcomes in operative interventions for lumbar spinal stenosis?

Bias undermines evidence-based decision making. To counter this, surgeons must be aware of biases that may influence studies' reported outcomes. Lumbar spinal stenosis often requires operative intervention, with multiple available surgical strategies. Our aim was to assess the role that country of origin plays in published surgical outcomes for lumbar spinal stenosis. We performed a search strategy of MEDLINE and EMBASE for all English language primary research papers evaluating operative interventions for lumbar spinal stenosis during the years 2010-2019 inclusive. Small case series and meta-analyses were excluded. Papers were assessed for outcome positivity and country of origin. Data analysis was conducted using GraphPad Prism statistical software. A total of 487 papers met the inclusion criteria. Of these, 419 (86%) reported positive outcomes. Asian studies were the most likely to report positive outcomes, at 93% (220 of 236), followed by US studies at 89% (98 of 110). European studies had the lowest positive publication rate at 69% (84 of 121). Region of origin was an independent predictor of positive study outcome on multivariable analysis when controlling for different study designs and healthcare systems. There is an association between country of origin and positive reported outcome in studies evaluating interventions for lumbar spinal stenosis. Clinicians should consider this when making management decisions based on published evidence. Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Spinal pseudogout is a joker. Commentary on “Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two cases”

In this issue, Moon et al. provide a detailed report on two cases of Calcium pyrophosphate deposition disease (CPDD), causing compression of the spinal cord and conus medullaris requiring surgical decompression and reconstruction [[1]Moon A.S. Mabry S. Pittman J.L. Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: a report of two cases.North American Spine Society J (NASSJ). 2020; 3: 100026https://doi.org/10.1016/j.xnsj.2020.100026Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. Both cases presented on elderly patients, with known advanced degenerative disease of the spine. In both cases the mass was likely forming from the facet joint and both cases presented with a combination of severe pain and symptoms of neural compression (in different degrees, causing alteration of the spinal cord motor tracts in one case and unilateral lower limb pain mimicking radiculopathy in the second one). Both patients gained full resolution of symptoms and neurological function after surgery. A number of cases of CPDD affecting the spine have been described in the literature, but most reports include one or few cases, which suggests that CPDD requiring surgery is relatively unfrequent. This is in contrast with the finding of high prevalence (as high as 25%) of deposits of calcium pyrophosphate in the cervical spine of patients with pseudogout affecting peripheral joints [[2]Moshrif A. Laredo J.D. Bassiouni H. et al.Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: a series of 37 patients.Semin Arthritis Rheum. 2019; 48: 1113-1126https://doi.org/10.1016/j.semarthrit.2018.10.009Crossref PubMed Scopus (31) Google Scholar]. While the association of pseudogout with lumbar and cervical stenosis has been well described, some aspects of this condition deserve some attention. The prognosis of spinal canal decompression in patients with CPDD does not seem to be worse than that on patients with degenerative lumbar stenosis [[3]Ariyawatkul T. Pichaisak W. Chavasiri C. Vamvanij V. Wilartratsami S. Luksanapruksa P. The role of calcium pyrophosphate dihydrate deposition in the postoperative outcome of lumbar spinal stenosis patients.Asian Spine J. 2019; 13: 1001-1009https://doi.org/10.31616/asj.2018.0280Crossref PubMed Scopus (2) Google Scholar]. CPDD can also need to be distinguished from other spinal conditions, such as tumors [[4]Turaga S. Thomas M. Savy L. Schreiber B.E. Pseudogout or pseudolymphoma? Calcium pyrophosphate deposition disease of the cervical spine: a rare presentation and literature review.BMJ Case Rep. 2019; 12 (Published 2019 Dec 2)e231508https://doi.org/10.1136/bcr-2019-231508Crossref PubMed Scopus (6) Google Scholar], spinal infection [[5]Bridges K.J. Bullis C.L. Wanchu A. Than K.D. Pseudogout of the cervical and thoracic spine mimicking infection after lumbar fusion: case report.J Neurosurg Spine. 2017; 27: 145-149Crossref PubMed Scopus (12) Google Scholar], hematoma of the yellow ligament [[6]Cruz-Conde R. Berjano P. Buitron Z. Ligamentum flavum hematoma presenting as progressive root compression in the lumbar spine.Spine. 1995; 20: 1506-1509https://doi.org/10.1097/00007632-199507000-00012Crossref PubMed Scopus (42) Google Scholar]. One of the two cases in this report presented with severe spinal sagittal misalignment that might be related to either the spinal cord compression or inflammation of the facet joints, and resolved after surgery, which suggests that CPDD can also be misinterpreted as spinal deformity of functional nature [[7]Redaelli A. Berjano P. Aebi M. Focal disorders of the spine with compensatory deformities: how to define them.Eur Spine J. 2018; 27: 59-69https://doi.org/10.1007/s00586-018-5501-8Crossref PubMed Scopus (9) Google Scholar]. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Download .pdf (.12 MB) Help with pdf files Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two casesNorth American Spine Society Journal (NASSJ)Vol. 3PreviewSpinal calcium pyrophosphate deposition disease (CPPD) is uncommon, and often resembles more common spine pathologies causing pain and neural compression. Here, we present two unusual cases of CPPD of the cervical and thoracolumbar spines. Full-Text PDF Open Access

Hand grip strength can predict clinical outcomes and risk of falls after decompression and instrumented posterolateral fusion for lumbar spinal stenosis

BACKGROUND CONTEXTThere has been limited research on the association between hand grip strength (HGS) as one of the diagnostic criteria for sarcopenia and surgical outcomes of lumbar spinal stenosis (LSS). PURPOSEWe aimed to determine the effect of HGS on surgical outcomes and risk of fall in patients with LSS. STUDY DESIGNThis is a retrospective observational study. PATIENT SAMPLEWe included 200 patients who underwent spinal surgery for LSS. OUTCOME MEASURESWe recorded clinical outcome parameters, including Oswestry Disability Index (ODI), Euro-QOL (EQ-5D), and visual analog scale (VAS) scores for back or leg pain. To assess the risk of fall we used HGS and four functional mobility tests (alternative step test, six-meter walk test, timed up and go test, sit-to-stand test). MATERIALS AND METHODSODI, EQ-5D, and VAS scores for back and leg pain were assessed preoperatively and 1 year after surgery. The four functional mobility tests were assessed at each time point during the 1-year follow-up period to assess the risk of fall in patients with LSS. We divided the patient cohort according to sex and allocated them into two different groups based on HGS: high HGS (≥26 kg for men, n=26; ≥18 kg for women, n=35), and low HGS (<26 kg for men, n=48; <18 kg for women, n=91). The pre- and postoperative ODI, EQ-5D, and VAS scores for back and leg pain, as well as the functional mobility test results, and demographic data were compared between the two groups using independent t tests. Correlations between HGS and clinical outcome parameters were analyzed using Pearson correlation. RESULTSIn women and men, HGS correlated with the preoperative/postoperative ODI (r1=−0.217/r2=−0.345 in women, and r1=−0.384/r2=−0.411 in men) and EQ-5D scores (r1=0.190/r2=0.309 in women, and r1=0.373/r2=0.467 in men). HGS also correlated with the four postoperative results for the functional mobility tests: alternative step test (r=−0.238 in women, r=−0.431 in men), six-meter walk test (r=−0.232 in women, r=−0.282 in men), timed up and go test (r=−0.285 in women, r=−0.359 in men), and sit-to-stand test (r=−0.238 in women, r=−0.251 in men). The preoperative and postoperative ODI and EQ-5D scores in the high HGS group were superior to those in the low HGS group. Among the four functional mobility tests, preoperative and postoperative six-meter walk test results showed improvements in the high HGS group. CONCLUSIONSConsidering the multifactorial nature of falls, HGS may be a useful surrogate marker for predicting the risk of falls and clinical outcomes in patients with LSS.

Correlation between preoperative CT imaging parameters and clinical outcome of lumbar spinal stenosis treated with endoscopic transforaminal decompression

ObjectiveTo evaluate clinical effects, and their correlations with preoperative computed tomography imaging parameters, in cases of lumbar spinal stenosis treated by endoscopic transforaminal decompression.MethodsThis retrospective study included orthopaedic patients who had undergone percutaneous endoscopic lumbar discectomy (PELD) for lumbar spinal stenosis. Clinical symptoms were evaluated by visual analogue scale (VAS), Oswestry Disability Index (ODI) and claudication distance. Overall clinical efficacy was evaluated by Macnab score.ResultsA total of 87 patients were included. Postoperative wound healing was good without complications. Macnab scores following PELD were ‘excellent’ in 41 cases (47.12%), ‘good’ in 30 cases (34.48%), ‘generally good’ in seven cases (8.04%), and ‘poor’ in nine cases (10.34%). The overall rate of optimal surgery was 81.60%. Postoperative pain (VAS) and ODI scores, and claudication distance, were significantly improved versus preoperative values. The soft tissue invasion ratio of the vertebral canal and invasion ratio of the nerve root canal were correlated with clinical efficacy.ConclusionPositive correlations were observed between clinical efficacy of endoscopic transforaminal decompression and preoperative vertebral canal soft tissue invasion ratio and nerve root canal invasion ratio in patients with lumbar spinal stenosis.

The effectiveness of vitamin D supplementation in functional outcome and quality of life (QoL) of lumbar spinal stenosis (LSS) requiring surgery

Study designThis is a retrospective cohort comparative study.BackgroundVitamin D supplementation is considered to be associated with good functional outcome. Thus, a few studies have proposed vitamin D supplementation is benefit to the functional outcome in LSS requiring surgery. The purpose of this study is to identify the prevalence of vitamin D deficiency in patients with LSS requiring surgery, and to compare the differences between the cases whether vitamin D is supplemented and vitamin D is not supplemented in terms of a QoL during postoperative 2 year.MethodsAll patients with LSS who underwent surgery from March 1, 2015 to August 31, 2016 were enrolled. Among them, 61 patients with vitamin D deficiency were divided into two groups (supplemented group (A) and non-supplemented group (B)). Functional outcomes using Oswestry Disability Index (ODI) and Rolland Morris Disability Index (RMDQ) and QoL using SF-36 were evaluated at 12-month and 24-month follow-up periods. Differences in functional score and SF-36 between the vitamin D supplemented and non-supplemented group were compared.ResultsAmong the total 102 patients, 78 patients (76.5%) had vitamin D deficiency. Of the 78 patients, 61 patients were included, 27 patients were group A and 27 patients were group B. There was no difference in age and 25-OHD level between the two groups (all 0 > 0.05). Group A were better functional outcomes at 2 years after surgery (p < 0.05). On the QoL, group A were higher score than group B from 12 month later after surgery (p < 0.05).ConclusionsVitamin D deficiency was highly prevalent in LSS patients (76.5%). Assessment of serum 25-hydroxyvitamin D (25(OH)D) is recommended in LSS needing surgical intervention and active treatment vitamin D supplementation and maintenance of normal range should be considered for better postoperative functional outcome and QoL.

Spontaneous correction of sagittal spinopelvic malalignment after decompression surgery without corrective fusion procedure for lumbar spinal stenosis and its impact on clinical outcomes: A systematic review

BackgroundThe impact of a positive sagittal vertical axis (SVA) on the surgical outcome for lumbar spinal stenosis (LSS) remains unclear, because sagittal imbalance in LSS may partly result from the tendency of patients to lean forward to reduce symptoms. Such an abnormality could be normalized by decompression surgery alone without corrective fusion. As this spontaneous correction is not well known, some surgeons perform only neural decompression in patients with positive SVA and decreased lumbar lordosis (LL), unless flatback-related symptoms are present, whereas other surgeons add corrective fusion to restore spinopelvic alignment. We systematically reviewed previous studies on this issue. MethodsPubMed, Cochrane Library, and Embase were searched for English articles on the relationship between SVA and decompression surgery for LSS. The rates of spontaneous correction in spinopelvic parameters and the impact of SVA on clinical outcomes were analyzed. ResultsThe rate of spontaneous SVA correction from >40–50 mm to normal values following decompression surgery alone varied from 25% to 73%. Overall, the spinopelvic parameters tended to improve postoperatively, with statistically significant changes in some series. Postoperative residual sagittal imbalance, rather than preoperative imbalance, more consistently showed a negative impact on clinical outcomes, but not on leg symptoms. For predicting postoperative sagittal imbalance, 2 studies identified the cutoff of >20° for preoperative PI-LL mismatch. Another study suggested SVA >80 mm as a useful value for this purpose. ConclusionIn LSS treated with decompression surgery alone, postoperative rather than preoperative sagittal imbalance more consistently affects clinical outcomes, particularly low back pain. This is probably because decompression usually partly improves preoperative spinopelvic sagittal malalignment. Thus, LSS, if associated with preoperative PI-LL mismatch <20° and SVA <80 mm, may not require additional corrective fusion procedures.

Effect of preoperative symptom duration on outcome in lumbar spinal stenosis: a Canadian Spine Outcomes and Research Network registry study

BACKGROUND CONTEXTLumbar degenerative stenosis is one of the most common spine pathologies for which surgical intervention is indicated. There is some evidence that a prolonged duration of neurological compression could lead to a failure of surgery to alleviate symptoms. PURPOSEDetermination of whether longer symptom duration was associated with worse postoperative disability outcomes after decompressive surgery for lumbar degenerative stenosis. STUDY DESIGN/SETTINGThe Canadian Spine Outcomes and Research Network (CSORN) prospective database includes pre- and postoperative data from 18 tertiary care hospitals. PATIENT SAMPLEThe CSORN database was queried for all cases of degenerative lumbar stenosis receiving surgical decompression for neurogenic claudication or radiculopathy. Patients with tumor, infection, fracture, or previous surgery were excluded. Patients were divided into groups based on symptom duration (<6 weeks, 6–12 weeks, 3–6 months, 6–12 months, 1–2 years, and >2 years). OUTCOME MEASURESChange between preoperative and 12-month postoperative Oswestry Disability Index (ODI) was compared between symptom duration groups. Secondary outcomes included SF12 physical component score (PCS), and numeric rating scales for leg and back pain. Outcomes were also assessed at 3 months and 24 months postoperatively. METHODSChange in ODI, and secondary outcome measures, were compared between different symptom duration groups. Multiple regression analysis was used to identify factors interacting with symptom duration to predict change in ODI. RESULTSFour hundred and seventy-eight cases of lumbar stenosis with 12-month postoperative data were identified. Longer symptom duration correlated with less improvement in ODI (p<.001). Patients with >1 year of symptoms were less likely to achieve a Minimal Clinically Significant Difference in ODI (54.4% vs. 66.1%; p=.03) and were more likely to experience no improvement or worse disability, postoperatively (22.1% vs. 11.3%; p=.008). Similar results were found at 3- and 24-month timepoints. Smaller postoperative improvements in SF12 PCS and leg pain scales were also correlated with longer symptom duration (p<.05). CONCLUSIONSMulticenter registry data provides important real-world evidence to guide consent, surgical planning, and health resource management. Longer symptom duration was found to correlate with less improvement in pain and disability after lumbar stenosis surgery suggesting that these patients may benefit from earlier treatment.

Influence of Skeletal Muscle Mass and Spinal Alignment on Surgical Outcomes for Lumbar Spinal Stenosis.

Study Design Retrospective observational study.Purpose We considered the relationship between spinal alignment and skeletal muscle mass on clinical outcomes following a surgery for lumbar spinal stenosis (LSS).Overview of Literature There are no reports of preoperative factors predicting residual low back pain following surgery for LSS.Methods Our target population included 34 women (mean age, 74.4 years) who underwent surgery for LSS. Prior to and 6 months after the surgery, systemic bone mineral density and lean soft tissue mass were measured using dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was calculated as the sum of the arm and leg lean mass in kilograms divided by height in meters squared. The spinal alignment was also measured. Clinical outcomes were evaluated using the Japanese Orthopedic Association scoring system, leg and low back pain Visual Analog Scale, and Roland–Morris Disability Questionnaire (RDQ). Additionally, we examined the bone mineral density, skeletal muscle mass, and spinal alignment before and after the surgery. We used the Spearman correlation coefficient to examine the associations among clinical outcomes, preoperative muscle mass, and spinal alignment.Results Sarcopenia (SMI <5.46) was observed in nine subjects (26.5%). Compared with normal subjects (SMI >6.12), RDQ was significantly higher in subjects with sarcopenia (p =0.04). RDQ was significantly negatively correlated with SMI (r =−0.42, p <0.05). There was a significant positive correlation between postoperative RDQ and pelvic tilt (PT; r =0.41, p <0.05). SMI and PT were significantly negatively correlated (r =−0.39, r <0.05).Conclusions Good postoperative outcomes were negatively correlated with low preoperative appendicular muscle mass, suggesting that postoperative outcomes were inferior in cases of decreased appendicular muscle mass (sarcopenia). Posterior PT due to decreased limb muscle mass may contribute to postoperative back pain, showing that preoperatively reduced limb muscle mass and posterior PT are predictive factors in the persistence of postoperative low back pain.

Surgical outcome of lumbar spinal stenosis with lumbar spinal lipomatosis

Surgical outcome of lumbar spinal stenosis with lumbar spinal lipomatosis

Scoping review to develop common data elements for lumbar spinal stenosis

Background ContextCommon data elements (CDE) represent an important tool for understanding and classifying health outcomes across settings. Although CDEs have been developed for a number of disorders, to date CDEs for lumbar spinal stenosis (LSS) have not been fully developed. To facilitate the identification of CDEs and measures to assess them, this technical study leverages the International Classification of Functioning, Disability and Health (ICF), peer-reviewed research, and a panel of experts to identify CDEs specific to LSS. PurposeThe study aimed to define CDEs for disease characteristics and outcomes of LSS using the World Health Organization's ICF taxonomy, and to facilitate the selection of assessment instruments for research and clinical care. DesignThis is a scoping review using a modified Delphi approach with a technical expert panel composed of clinicians and scientists representing the academia, policy and advocacy stakeholders, and professional associations with expertise in LSS. MethodsThis is a scoping review to identify measures that assess LSS symptoms. Thirty-one subject matter experts (SMEs) prioritized ICF codes and evaluated instruments measuring specific domains. We used a modified Delphi technique to evaluate item-level content and achieve consensus. ResultsSMEs prioritized 53 ICF codes; 3 received 100% endorsement, 27 received ≥90% endorsement, whereas the remaining 23 received ≥80% endorsement. Prioritized ICF codes represent diverse domains, including pain, activities and participation, and emotional well-being. The review yielded 58 instruments; we retained 24 for content analysis. ConclusionsThe retained instruments adequately represent the ICFs activities and participation, and body function domains. Body structure and environmental factors were assessed infrequently. Adoption of these CDEs may guide clinical decision making and facilitate comparative effectiveness trials for interventions focused on LSS.

Life dissatisfaction is associated with depression and poorer surgical outcomes among lumbar spinal stenosis patients: a 10-year follow-up study

Life satisfaction is associated with overall somatic health and the short-term surgical outcome in lumbar spinal stenosis (LSS) patients. In this study, the long-term relationship between life satisfaction and the surgical outcome in LSS patients was investigated in a 10-year follow-up. This prospective clinical study included 102 LSS patients who underwent decompressive surgery. They completed a set of questionnaires first preoperatively and then 6 times postoperatively (at 3 and 6 months, and at 1, 2, 5 and 10 years). The final study population at the 10-year follow-up comprised 72 patients. A four-item life satisfaction scale was used to measure global life satisfaction. The sum of all seven life satisfaction scores provided a measure of the life dissatisfaction burden over the entire 10-year follow-up. Depression was measured using the Beck Depression Inventory. The surgical outcome was evaluated using the Oswestry Disability Index, pain evaluation (visual analogue scale), self-reported walking capacity and overall satisfaction with the surgery. Both preoperative life dissatisfaction and the long-term life dissatisfaction burden were associated with poorer 10-year surgical outcomes (i.e. Oswestry Disability Index and visual analogue scale) in logistic regression analyses. Life dissatisfaction was also associated with symptoms of depression. Monitoring subjective well-being, especially life satisfaction and mood, in LSS patients before and after surgery may help in detecting those at risk of a poorer long-term surgical outcome.

Clinical outcome of lumbar spinal stenosis based on new classification according to hypertrophied ligamentum flavum.

The ligamentum flavum hypertrophy is considered to be one of the important causes of development of lumbar spinal stenosis (LSS). Several histologic and biologic mechanisms in hypertrophied flavum have proposed. However, no study that investigated the relationship between clinical outcome and ligamentum flavum hypertrophy has been published. The purpose of this study was to identify a new classification of LSS, in ligamentous and nonligamentous stenosis, according to the cutoff value of the area proportion of the ligamentum flavum in the spinal canal, and to assess the value of surgical and conservative treatments for LSS based on the classification of the ligamentous stenosis. A total of 230 surgical patients with LSS were evaluated based on the cross-sectional area and intraoperative findings of the ligamentum flavum. LSS was classified as ligamentous or nonligamentous stenosis, according to the cutoff value of the proportion of the ligamentum flavum in the spinal canal. Based on the classification, the results of 234 surgical patients (103 patients with spinal fusion surgery and 131 patients with spinal decompression) and 191 patients under conservative treatment with prostaglandin E1 were evaluated, 1 year after treatments. ROC analysis revealed that the area under the curve for the cutoff value of the proportion of the ligamentum flavum in the spinal canal was 0.4275 (sensitivity=0.861, specificity=0.854). Based on these criteria, ligamentous and nonligamentous stenoses were 115 and 119 in surgical patients, 97 and 94 in conservative patients, respectively. In the surgical treatment group, no significant difference was found in any of the evaluations conducted for the group with ligamentous and nonligamentous stenosis. However, in the conservative treatment group, the patients with ligamentous stenosis showed significant improvement compared with patients with nonligamentous stenosis. Ligamentous stenosis in LSS patients had favorable outcome on conservative treatment with prostaglandin E1 derivative.