Presence Of Spinal Instability Research Articles

How Decompression Surgery Improves the Lower Back Pain in Patient with Lumbar Degenerative Stenosis: A Propensity-score-matched Analysis.

Multicenter retrospective case series of patients treated surgically for lumbar spinal stenosis (LSS). We investigated how laminectomy improves lower back pain (LBP) and the factors associated with poor improvement. Lumbar laminectomy is effective for alleviating neurological symptoms caused by LSS, whereas its effect on LBP is still controversial. A retrospective review of prospectively collected data from 436 patients (age 72 yrs, 69% males) who underwent laminectomy for LSS with 2 years of follow-up. We analyzed the following risk factors for residual LBP by uni- and multivariate analyses: age, sex, smoking, occupation, comorbidities, frailty, joint replacement, vertebral fracture, DISH, HRQOL, complications, and the presence of spinal instability. The LBP of male and female patients was analyzed after propensity score matching of known confounders. Patient-reported outcomes (JOABPEQ and VAS scores) were obtained at baseline and the 2-year postoperative follow-up. LBP was significantly improved at 2 years post operation (VAS change 2.3 [95% CI 2.0-2.6], P < 0.01). Fifty-five percent of the patients achieved an MCID, with 67% having no or mild LBP. In the multivariate analysis, sex and baseline LBP were independent risk factors (female: OR 1.9 [1.2-3.0], baseline LBP [VAS≥7.5]: OR 1.9 [1.2-3.1]). Furthermore, the independent risk factors for severe baseline LBP were sex and mental status (female: OR 1.7 [1.1-2.7], P = 0.03, mental status: OR 3.8 [2.4-6.0], P < 0.01). However, an analysis of 102 pairs of propensity-score-matched male and female patients showed no difference in the improvement of LBP (male vs. female: VAS 3.8 ± 2.8 vs. 4.0 ± 2.9, P = 0.61, VAS change 3.1 ± 2.9 vs. 2.7 ± 3.0, P = 0.38). Decompression surgery for LSS significantly improved LBP. Sex and baseline LBP were risk factors for residual LBP. However, when males and females were matched by confounders, no difference was found in the LBP after surgery. Patients with severe baseline LBP may need further evaluation for their mental status because these patients are likely to have mental problems that potentially contribute to persistent LBP.Level of Evidence: 4.

Comparison of surgery techniques for recurrent lumbar disc herniation: Total and parsiyel laminectomy

Aim: The purpose of this study was to compare different surgical methods; hemi-laminectomy versus facet protective total laminectomy in recurrence lumbar discal hernia(rLDH) patients. Materials and Methods: The patients were categorized into 2 groups:34 patients underwent total laminectomy formed the group 1, and 31 patients underwent hemi-laminectomy formed group 2. Patients were compared in terms of age, sex, body mass index(BMI), duration of surgery, length of hospital stay and complications. After 3 years, visual analogue scale for leg and back pain(VASlp,bp), oswestry disability index(ODI) scores and presence of spinal instability were evaluated. Results: There was no significiantly differences about age, sex, BMI, operation segment, mean operative time and length of hospital stay. Significant improvement was observed in both groups in terms of VAS and ODI values. Dural tear was occurred in 8 patients in group 1 and 1 patient in group 2. Superficial wound infection was seen in 1 patient in group 2. Postop spinal instability was observed in 1 patient in group 2. Conclusion: Total laminectomy increased the duration of the operation, but significantly reduced the complication rates. In recurrent disc hernias facet protective total laminectomy may be used at especially in patients without evidence of spinal instability

The Role of Imaging in the Management of Cystic Formations of the Mobile Spine (CYFMOS).

The purpose of this review is to give a better understanding of the pathogenesis of cystic formations of the mobile spine (CYFMOS) and the correlating imaging findings. This would help with medical decision-making, given the plethora of conservative, interventional, and surgical treatment options. There has been a general understanding that CYFMOS are associated with degenerative spine changes. More recent articles however have suggested that identifying detailed imaging characteristics can assist in determining outcomes when CYFMOS are treated with interventional percutaneous methods or surgical decompression with or without concomitant fusion. CYFMOS although uncommon are not a rare finding seen in the spine when there is a background of degenerative spine changes. These cystic lesions are generally symptomatic by exhibiting mass effect on adjacent structure. Most treatments are aimed at decompression by interventional percutaneous or surgical means. Various imaging characteristics of these CYFMOS described in this article including their signal intensity, presence of spinal instability, particular patterns of adjacent degenerative changes, and imaging changes following interventional treatments can help guide physicians when managing these cases.

Endoscopic lumbar discectomy, cost effective operative procedure at tertiary care centre

Study design: Retrospective study Background: Endoscopic lumbar discectomy using endoscopic tubular retractor system(METRx-MD) are considered popular minimally invasive surgery (MIS) methods for the treatment of lumbar disc herniation. Our main aim is to apread the benefits related endoscopic technique for lumbar disc herniation at tertiary care centre through which we can reduce the huge patient’s workload and patients are also getting best treatment for their respective disease through minimal invasive surgery. Objective: To evaluate the effectiveness of Endoscopic Lumbar Discectomy as cost effective procedure at tertiary care center where there is huge patient’s workload. Methods: It is a retrospective study of 40 patients were operated during the period between August-2013 to August-2015,at B.J Medical college, civil hospital, ahmedabad out of which 29 were males and 11 females between age group of 17 and 72 years and compared with the standard results of open mini incision discectomy. Inclusion criteria: Single level lumbar disc herniation, Unilateral or bilateral radiculopathy. Exclusion criteria: Multiple level disc bulge, Presence of spinal instability, Presence of gross spinal deformity Results: · In our study out of 40 patients, 29(72.5%) were males and 11(27.5%) were females. · 22 (55%) patients had L4-L5 level disc herniation while 18 (45%) patients had L5-S1 level disc herniation. · Out of 40 patients, only 3 patients presented with complications. · Complications observed in our study were dural tear, infection and recurrence of radiculopathy. · Immediate post-op improvement of VAS, oswestry and SF-12 score was noted in all patients. Conclusion and Summary: Endoscopic Discectomy is a minimally invasive spine surgery which has better outcome (as compared with standard mini incision discectomy) in terms of: · Better Pain Relief · �

Percutaneous posterior stabilisation of L1 to L5 with microsurgical decompression of L3/4, and percutaneous L3 biopsy, in a spinal metastasis

Although guidelines (Harrington [1], Tokuhashi [2], Tomita [3]) for the treatment of spinal metastasis exist, the indication for an operative therapy is still a complex decision. In general, therapeutic decisions should be made in a multidisciplinary setting, taking into account alternatives, the morbidity of the planned surgery as well as the general health condition and life expectancy of the patient. Beside all therapeutic alternatives there are widely accepted indications for operative treatment, which are spinal instability, radio resistant tumours, clinically relevant neural compression, deformity and intractable pain. Especially the percutaneous stabilisation techniques, which evolved over the last years became an important tool for the treatment of spinal metastasis in particular in the presence of spinal instability. Although fusion can seldom be achieved with percutaneous stabilisation, often this is of moderate importance because of the limited life expectancy of the patients. When a neural compression is accompanying the instability, stabilisation can easily be supplemented with a microsurgical decompression.

Positioning and spinal bracing for pain relief in metastatic spinal cord compression in adults.

This is an updated version of the original Cochrane review published in Issue 3 (Lee 2012) on patient positioning (mobilisation) and bracing for pain relief and spinal stability in adults with metastatic spinal cord compression.Many patients with metastatic spinal cord compression (MSCC) have spinal instability, but their clinician has determined that due to their advanced disease they are unsuitable for surgical internal fixation. Mobilising may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (whether a patient should be managed with bed rest or allowed to mobilise) and whether spinal bracing is helpful, is contradictory. To investigate the correct positioning and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC. For this update, we searched for relevant studies from February 2012 to 31 March 2015. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In Process, EMBASE, AMED, CINAHL, TRIP, SIGN, NICE, UK Clinical Research Network, National Guideline Clearinghouse and PEDro database. We also searched the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov, UK Clinical Trials Gateway (UKCTG), WHO International Clinical Trials Registry Platform (ICTRP) and Australia New Zealand Clinical Trials Registry (ANZCTR).For the original version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse, and PEDro database, in February 2012. We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning (mobilisation) and bracing. Two review authors independently assessed each possible study for inclusion and quality. For the original version of the review, we screened 1611 potentially relevant studies. No studies met the inclusion criteria. Many papers identified the importance of mobilisation, but no RCTs of bed rest versus mobilisation have been undertaken. We identified no RCTs of bracing in MSCC.For this update, we identified 347 potential titles. We screened 300 titles and abstracts after removal of duplicates. We did not identify any additional studies for inclusion. Since publication of the original version of this review, no new studies were found and our conclusions remain unchanged.There is a lack of evidence-based guidance around how to correctly position and when to mobilise patients with MSCC or if spinal bracing is an effective technique for reducing pain or improving quality of life. RCTs are required in this important area.

Surgical Outcome if Laminectomy for Cervical Spondylotic Myelopathy

Spondylotic myelopathy is a common spinal cord disorder encountered frequently by neurosuregeons. It can produce a variety of clinical signs and symptoms secondary to neural compromise and biomechanical involvement of the spine. The surgical approach depends on patient's age, the presence of spinal instability, and the pathology of compression. The surgical treatment is still debatable, anterior and posterior approaches have been used with various reported success rates. Thirty consecutive patients with cervical spondylotic myelopathy (CSM) were studied retrospectively. They had extensive laminectomy for the affected levels. The early result of surgical treatment was evaluated. Patient's age ranged between 27 and 70 years (mean 47.8 years). Males constituted %83.3 of the patients. The higher incidence was in the 5th and 6th decades. Limb weakness was the main presenting symptom. The duration of the deterioration of the neurological condition ranged from 1 month t0 2.5 years, with a mean of 6 months. Twenty six patients (%86.7) ahd some degree of improvement post-operatively, Severe radiculopathy (11 patients), wound infection (2 patients), and CSF collection (1 patient) were the main complications. There was no mortality, Although decompressive laminectomy is an indirect procedure in patients with anteriorly located lesions, like osteophytes and herniated discs, it is an effective method to relieve or arrest the progression of myelopathy, Best outcome was associated with shorter duration of symptoms prior to surgery, younger age, and good general condition.

Surgical management of vertebral column metastatic disease

The spine is the most frequent site of skeletal metastases. Among all spinal malignancies metastatic disease is most frequent and indicative of disseminating tumor disease. Depending on primary tumor entity, estimated survival time, general health status of the patient, presence of spinal instability and neurological deficits an oncological useful and patient-specific therapeutic intervention should be performed. New anterior approaches, resections and reconstruction techniques are making surgery a preferred method over radiation therapy. For differential indication of the multiple surgical treatment modalities prognostic scores are available to assist individual decision making. Indications for surgery include survival prognosis of minimum 3 months, intractable pain, progress of myelon compression and/or neurological deficits under radiochemotherapy, spinal instability and necessity for histological diagnosis. Resulting quality of life depends on efficient decompression of the spinal cord and restoration of spinal stability. To achieve these ultimate goals there are different anterior and posterior approaches, instrumentations and vertebral body replacement implants available. Preoperative embolization should be performed in hypervascular tumors, e.g., renal cell cancer. Vertebro-/Kyphoplasty as a percutaneous intervention should be considered for painful multisegmental disease and symptomatic osteolysis without epidural tumor compression to reach analgesia and stability. A multidisciplinary approach in patient selection, decision making and management is an essential precondition for complication avoidance and acceptable quality of life.

Radiology of Lumbar Instability

In an era of increasing use of spinal hardware whether for fusion or to preserve segmental motion, radiologic determination of spinal instability plays a prominent role in the treatment algorithm for practically all disorders affecting the spine. Although the presence of spinal instability does not always equate to symptoms directly related to the instability, spinal imaging in combination with clinical history and physical examination can provide valuable insights into the preoperative evaluation of patients, the selection of treatment options, and the subsequent postoperative follow-up. For instance, patients with confirmed instability are currently contraindicated for total disc replacements because of concerns with the long-term survival of the discs, while the presence of instability at the segment above a fusion or disc prosthesis is indicative of adjacent level disease. This article reviews the radiology of spinal instability in patients with degenerative disc disease. Instability secondary to other common causes such as trauma, congenital anomalies, deformity, inflammatory disorders, and prior surgery are outside the scope of this review.

Management of spinal brucellosis and outcome of rehabilitation.

Review of cases. To review cases of brucellosis in order to clarify diagnostic guidelines, treatment regimes and prognosis. University Hospital, Turkey. Study of 11 patients (9 male, 2 female) with either brucellar spondylitis or epidural brucellar abscess. Diagnosis made on clinical presentation, laboratory findings, radiographic evidence and a minimum brucellar anti body of 1 : 160, a positive bacteriological culture and/or histological finding of inflammation of granulomatous tissue. All patients were treated with a combination of oral antibiotics. Surgery was performed in 8 patients. At least 6 months antibiotic therapy using Rifampicin and Doxycycline is recommended. Surgery is indicated in the presence of spinal instability, cord compression or radiculopathy. In our series eight patients required surgery. The patients complaining of back pain, particularly in endemic areas should be investigated as possible cases of brucellosis.

Current considerations in the management of neoplastic spinal cord compression.

Nearly 20% of patients with neoplastic involvement of the vertebral column develop spinal cord compression, and in 8% this is the initial manifestation of cancer. Important determinants of functional prognosis are: 1) tumor biology, 2) pretreatment neurologic status, and 3) tumor location within the spinal canal and the therapy employed. Future efforts should be invested in manipulation of the last two determinants. Delay in neurologic deterioration may be achieved by pharmacologic manipulation of the deleterious pathophysiologic processes operating in the compressed spinal cord, as recently demonstrated in experimental animal models. Use of modern neuro-imaging techniques (metrizamide myelography combined with computed tomography, and/or magnetic resonance imaging) will accurately define tumor extent and location. Radiotherapy is indicated in highly or moderately radiosensitive tumors. Surgery is reserved for the following situations: diagnosis in doubt, previous radiation exposure, radioresistant tumors, neurologic deterioration during irradiation, and the presence of spinal instability or bone compression of the neural structures. The location of the compressing tumor will dictate the surgical approach--a vertebral body resection in an anterior or anterolateral tumor and a laminectomy in a posterior or posterolateral deposit. Modern instrumentation techniques for spinal column stabilization or vertebral body replacement will allow immediate painless ambulation and a better quality of life for these patients.