Spinal Stenosis Research Articles

Macrophage polarization and macrophage-related factor expression in hypertrophy of the ligamentum flavum.

Owing to the unknow types of infiltrating macrophages and the corresponded factors, we aimed to investigate the specific types of infiltrating macrophages involved in HLF and the expression of macrophage-related factors. The ligamentum flavum was obtained from patients with lumbar spinal stenosis (HLF group; n = 15) and lumbar disc herniation (non-hypertrophic ligamentum flavum [NLF] group; n = 15). Ligamentum flavum specimens were paraffin embedded, followed by histological and immunohistochemical staining to identify the macrophage type and expression of macrophage-related factors. The HLF group demonstrated CD206 marker expression, while the NLF group did not (P < 0.0001; n = 11). CD68 marker was expressed in both groups (P > 0.05; n = 11). CCR7 was not expressed in either group. The expression levels of the extracellular matrix proteins aggrecan (Agg), type I collagen (Coll1), and type II collagen (Coll2) were higher in the HLF group than in the NLF group (P < 0.0001; n = 11). The aging markers p21, p16, and p53 were expressed in the HLF group, but not in the NLF group (P < 0.0001; n = 11). The expression levels of the inflammatory factors TNF-α and IL-1β were higher in the HLF group than in the NLF group (P < 0.0001; n = 11). Similarly, the expression level of the fibrosis factor TGF-β1 was higher in the HLF group than in the NLF group (P < 0.0001; n = 11). The infiltration of M2 macrophages may be involved in HLF, while involvement of M1 macrophages may only occur early in inflammation. The expression of extracellular matrix proteins and macrophage-related factors was increased. Aging may also be associated with HLF.

6424 From Hyperparathyroidism To Neurologic Crisis: A Tale Of Brown Tumor And Spinal Cord Compression

Abstract Disclosure: A. Kormanis: None. M. Anderson: None. M. McKnight: None. H. Darapu: None. Background/Objective: In this case, we present a rare and severe consequence of secondary hyperparathyroidism, a Brown tumor leading to spinal cord compression, in a young adult with end-stage renal disease. Case Report: A 26-year-old male with a medical history of polycystic kidney disease and IgA Nephropathy complicated by ESRD, history of brown cell tumors (s/p surgery) was admitted for hospitalization due to hypocalcemia after presenting to the Emergency Department with right lower extremity weakness. Examination revealed right hip flexor weakness and right foot clonus. Lab results showed serum calcium of 10.4 mg/dL . MRI displayed a 2.5cm X 3.7 cm soft tissue mass with circumferential encroachment of the epidural space leading to severe spinal canal stenosis of T4-T5 at the site of prior Brown tumor resection. Ultimately, the patient underwent subtotal parathyroidectomy with left cervical thymectomy, leading to an intra-operative PTH drop from &amp;gt;3500 to 247 pg/mL. Discussion: In the context of treating vertebral brown tumors, the consensus suggests that parathyroidectomy plays a crucial role in achieving both clinical and radiographical amelioration of the tumor. However, in cases like ours where paresis is present, surgical decompression of the tumor becomes imperative. Conclusion: The development of Brown tumors is a severe and rare long-term complication for hyperparathyroidism, and the location of a Brown tumor in the thoracic spine causing symptomatic cord compression is even more rare. Presentation: 6/2/2024

Efficacy and Safety of Biportal Endoscopic Decompressive Laminectomy in Octogenarians With Severe Lumbar Spinal Stenosis.

Lumbar spinal stenosis (LSS) is prevalent among octogenarians, causing significant pain and disability. Surgical intervention is often required because of the ineffectiveness of conservative treatments. This study investigates the efficacy and safety of biportal endoscopic decompressive laminectomy (BED) in octogenarians with severe LSS, evaluating its potential as a minimally invasive surgical option. This retrospective study included 107 patients aged 80 years or older who underwent BED for LSS between March 2017 and December 2022. Data were collected from electronic medical records, including demographic information, clinical outcomes, and surgical details. Patients with fractures, infectious spondylitis, herniated discs, and follow-up less than 12 months were excluded. Clinical outcomes were assessed using the visual analog scale, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT at baseline and at 3, 6, and 12 months after surgery. The mean age of the 107 patients was 84.1 years, with 59% being women. Significant improvements were observed in visual analog scale scores for lower back and lower extremities pain, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT scores, indicating reduced pain, decreased disability, and enhanced quality of life. There were no significant differences in outcomes between patients aged 80 to 84 and those 85 or older. Surgery-related outcomes such as operation time, blood loss, and complications were similar in both age groups. BED is a safe and effective treatment for LSS in octogenarians, providing significant pain relief and functional improvement. This minimally invasive technique is also viable for patients older than 85 years, without increased risk of complications, supporting its broader indications in managing LSS in the elderly. This study highlights the efficacy and safety of BED for LSS in octogenarians, demonstrating its potential to improve quality of life and function with low risks, making it a feasible option for elderly patients.

Investigation of lumbar multifidus muscle, pain, and fear of falling in patients with lumbar spinal stenosis with poor balance

BackgroundThis study aimed to compare the muscle thickness and cross-sectional area (CSA), pain, disability, and fear of falling in patients with lumbar spinal stenosis (LSS) with and without balance problems. MethodsSixty-four patients diagnosed with LSS by magnetic resonance imaging (MRI) were included in this cross-sectional study. The patients were divided into poor (n=31) and normal balance (n=33) groups according to the single leg standing test. Low back pain (Numeric rating scale), dynamic balance (Time up and go test), disability (Oswestry disability index) and fear of falling (International fall efficacy scale) in patients with LSS levels were evaluated. Lumbar (L4/5) multifidus muscle thickness and CSA were obtained from MRI images. ResultsThe poor balance group had a lower L4/5 multifidus thickness (p<0.05) and CSA (p<0.05) than the normal balance group. It was determined that an increase in left L4/5 multifidus muscle CSA was associated with decreased impaired balance (p=0.036). Also, a significant correlation was detected between static balance and muscle thickness and CSA (p<0.01). In addition, low back pain, disability, and fear of falling were significantly higher in LSS patients in the poor balance group (p<0.05). ConclusionMuscle atrophy and decrease in CSA are more common in LSS patients with poor balance. Decreased L4/5 multifidus muscle CSA may increase the risk of balance impairment. Also, LSS patients with poor balance are more likely to experience pain, disability, and fear of falling. Strategies to improve lumbar muscle stability, mass, and pain may reduce impaired balance in LSS.

Efficacy of Preoperative Autologous Blood Donation for Surgical Treatment of Thoracic Spinal Stenosis: A Propensity-Matched Cohort Study.

Thoracic spinal stenosis (TSS) surgeries necessitate a substantial amount of allogeneic blood resources. However, the efficacy of preoperative autologous blood donation (PABD) in TSS surgery has not been clearly evaluated. Therefore, we aimed to evaluate the efficacy of PABD for TSS surgery. This study is a retrospective study. Totally 397 patients who underwent TSS surgeries at our institution from January 2019 to June 2023 were included. Propensity score matching (PSM) was used to make the PABD and Non-PABD groups comparable at baseline. Regarding outcome measures, the incidence and amount of allogeneic blood transfusion, changes in postoperative hemoglobin and hematocrit levels, occurrence of postoperative complications, medical costs, drainage time, length of hospital stay, and postoperative neurological function were analyzed. The outcomes were compared between the matched PABD (n = 79) and Non-PABD (n = 79) groups. Univariate analysis methods were used for statistical analysis, including independent samples t-test, Wilcoxon rank-sum test, and chi-square test. The incidence of allogeneic blood transfusion (8.9% vs. 25.3%, p = 0.006) and volume of intraoperative red blood cell (RBC) transfusion (10.12 ± 54.52 vs. 122.78 ± 275.00 mL, p < 0.001) in the PABD group were significantly lower than those in the Non-PABD group. The PABD group had significantly higher average postoperative hemoglobin and hematocrit levels than the Non-PABD group at 1, 3, and 5 days after surgery (p < 0.05). Similarly, the PABD group exhibited a smaller reduction in hemoglobin and hematocrit levels compared with the Non-PABD group on 1, 3, and 5 days postoperatively. There were no significant intergroup differences in terms of transfusion-related complications, medical expenses, neurological function, length of hospital stay, or drainage time. Notably, PABD was an independent protective factor of allogeneic transfusion in the multivariate regression analysis (OR = 0.334, 95%CI = 0.051-0.966). PABD can effectively reduce the incidence of allogeneic blood transfusion and amount of allogeneic blood in TSS surgeries with safety. It also significantly improved the postoperative hemoglobin and hematocrit levels. Under the premise of clear indications, PABD is worth promoting for the surgical treatment of TSS.

Gender differences in spine surgery for degenerative lumbar disease: prospective cohort study.

Despite efforts toward achieving gender-based equality in clinical trial enrollment, females are frequently underrepresented and gender-specific data analysis is lacking. Identifying and addressing gender bias in medical decision-making and outcome reporting may facilitate more equitable healthcare delivery. This study aimed to determine if gender differences exist in the clinical evaluation and surgical management of patients with degenerative lumbar conditions. Consecutive adult patients undergoing spinal surgery for degenerative lumbar conditions (disc herniation [DH], spinal canal stenosis [SCS], and degenerative spondylolisthesis [DS]) were prospectively enrolled across 16 tertiary academic centers. Outcome domains included pain, disability, health-related quality of life (HRQOL), expectations of surgery, and satisfaction with surgical outcome. Covariates pertaining to the preoperative use of healthcare resources, diagnostic testing, and visits to healthcare providers were compared between genders before and after propensity score matching for 13 baseline demographic and procedural variables. Data were analyzed for 5038 patients (2396 female, 2642 male) with degenerative spinal pathologies including SCS (40.2%), DS (33.2%), and DH (26.6%). Surgical treatment effect was similar for both genders. For all conditions, female patients had worse pre- and postoperative pain, disability, and HRQOL. Significant gender differences were identified for marital status, education, employment status, exercise activities, and disability claims. Female patients were more likely to use select medications, diagnostic imaging tests, and nonsurgical therapeutic interventions, and access various healthcare providers. Findings were similar following post hoc propensity score matching. In this multicenter, prospective, observational cohort study, male and female patients benefitted similarly from surgery for degenerative lumbar spine disease. However, female patients had worse preoperative clinical assessment scores and were more likely to use select healthcare resources.

A multicenter study of clinical predictors of positive pyrophosphate scintigraphy findings in the diagnosis of transthyretin amyloidosis

BackgroundThe prevalence of wild-type transthyretin (ATTR) amyloidosis is increasing with advancements in diagnostic techniques and growing awareness of the disease worldwide. 99mTc-labeled pyrophosphate (99mTc-PYP) scintigraphy exhibits high performance in diagnosing ATTR cardiac amyloidosis. This study aimed to validate the characteristics of patients with positive 99mTc-PYP scintigraphy results in a multicenter setting to provide more accurate case selection criteria. Methods and resultsIn total, 180 patients with suspected ATTR amyloidosis underwent 99mTc-PYP scintigraphy in participating institutions in Japan between January 2018 and July 2022. Of 135 patients included in the analysis, 62 were 99mTc-PYP-positive. Logistic regression analysis was performed, and the following five factors were adopted to create a scoring system, with each weighted according to its odds ratio value; 1 point was scored for the absence of hypertension, existence of peripheral entrapment neuropathy (carpal tunnel syndrome or spinal canal stenosis), conduction disturbance (the presence of QRS complex ≥120 ms, first-degree atrioventricular block, higher degree of atrioventricular block, or presence of pacemaker implantation), and left ventricular hypertrophy and 2 points for troponin I/T ≥ 0.06 ng/mL. 99mTc-PYP scintigraphy positivity rate in the 0-point group was 0 %, whereas that in the 6-point group was 100 %. The area under the curve of the criteria was 0.820 (95 % confidence interval, 0.752–0.888; P < 0.001). ConclusionsThe combination of clinical information, which is easily available in local clinics, can provide accurate pretest prediction of positive 99mTc-PYP scintigraphy results. This will help clinicians to make an early diagnosis of ATTR amyloidosis.

The impact of smoking on patient-reported outcomes following lumbar decompression: an analysis of the Quality Outcomes Database.

Smoking has been shown to negatively impact spinal health, as well as the outcomes of spinal fusion. Published reports show conflicting data regarding whether smoking negatively impacts patient outcomes following lumbar decompression. The objective of this study was to investigate whether smoking affects the outcomes of patients undergoing lumbar decompression for spinal stenosis or herniated disc. The Quality Outcomes Database was queried for patients with spinal stenosis or lumbar disc herniation who underwent one- or two-level lumbar decompression without fusion. All patients had preoperative and 12-month outcome measures and were divided into groups of nonsmokers and current smokers. Outcomes were compared between the two groups, as well as the percentage of patients reaching the minimal clinically important difference (MCID) threshold for numeric rating scale (NRS) back and leg pain scores and the Oswestry Disability Index (ODI). Of 17,271 patients, 14,233 were nonsmokers and 3038 were current smokers. Smokers had worse baseline NRS back and leg pain, ODI, and EQ-5D scores and experienced slightly less improvement in all measures following lumbar decompression (p ≤ 0.009), although changes were largely similar, and a high percentage of patients achieved the MCID thresholds for NRS back pain (78% nonsmokers vs 75% smokers), NRS leg pain (79% nonsmokers vs 73% smokers), and ODI (74% nonsmokers vs 68% smokers). Comparison of propensity-matched cohorts did not identify any difference in outcomes in smokers versus nonsmokers. In patients undergoing lumbar decompression for spinal stenosis or herniated disc, smokers demonstrated slightly less improvement in outcomes compared with nonsmokers, and a high proportion of both groups achieved meaningful improvement with surgery. While smoking cessation should be strongly encouraged in all patients, lumbar decompression procedures for spinal stenosis and herniated disc should not be denied to smokers.

Comparative analysis of imaging data in sensory and motor disorders in lumbar neurocompressive syndrome

Introduction Lumbar neurocompressive syndrome is a condition characterized by radicular pain, motor, sensory and reflex changes, as well as paresthesia or numbness in the lower limb. These symptoms can be triggered by positions and/or movements of the spine. In lumbar radiculopathy, both mechanical and inflammatory factors play significant roles. Material and methods The study included 102 patients with signs of lumbar neurocompressive syndrome. Of these, 51 (group I) patients were examined using MRI and the other 51 patients (group II) were examined using conventional radiographic investigation of the lumbosacral region of the spine. Results By analyzing the magnetic resonance imaging data of the lumbar spine, a threshold of statistical significance was determined (of 10%, p &lt; 0.10) for patients with sensory disturbances in the lower limb in cases of stenosis of the lumbar spinal canal, and in patients with motor disorders in the lower limb, in the case of disc protrusions. The analysis of the magnetic resonance imaging data determined a significance threshold (of 5%, p &lt; 0.05) in patients with sensory disorders (in the case of disc sequestrations and in the case of disc extrusions) as well as for motor disorders (in the case of disc extrusions, disc sequestrations and static disorders of the spine). The analysis of standard radiographs of the lumbar spine allowed the determination of the threshold of statistical significance (of 5%, p &lt; 0.05) in patients with sensory disorders in the lower limb in cases of coxofemoral osteoarthritis and Schmorl’s hernias. For patients with motor disorders at the level of the lower limb, conventional radiography was informative in the presence of calcification of the intervertebral discs and in coxofemoral osteoarthritis. Conclusion MRI can be considered the first-choice imaging technique for diagnosis of the lumbar spine pathologies characterized by sensory and motor changes in the lower limbs.

Development of Machine Learning Model for Predicting Prolonged Operation Time in Lumbar Stenosis undergoing Posterior Lumbar Interbody Fusion: A Multi-center study

Background ContextLonger posterior lumbar interbody fusion (PLIF) surgeries for individuals with lumbar spinal stenosis are linked to more complications and negatively affect recovery after the operation. Therefore, there is a critical need for a method to accurately predict patients who are at risk for prolonged operation times. PurposeThis research aimed to develop a clinical model to predict prolonged operation time for patients undergoing PLIF procedures. Study Design/SettingThis study employs a machine-learning approach to analyze data retrospectively collected. Patient Sample3233 patients diagnosed with lumbar spinal stenosis (LSS) had posterior lumbar interbody fusion (PLIF) at 22 hospitals in China from January 2015 to December 2022. Outcome MeasuresThe primary outcome was operation time. Prolonged operation time defined as exceeded 75% of the overall surgical duration, which mean exceeding 240 minutes. MethodsA total of 3233 patients who underwent PLIF surgery with lumbar spinal stenosis (LSS) were divided into one training group and four test groups based on different district areas. The training group included 1569 patients, while Test1 had 541, Test2 had 403, Test3 had 351, and Test4 had 369 patients. Variables consisted of demographics, perioperative details, preoperative laboratory examinations and other Additional factors. Six algorithms were employed for variable screening, and variables identified by more than two screening methods were incorporated into the final model. In the training cohort, a 10-fold cross-validation (CV) and Bayesian hyperparameter optimization techniques were utilized to construct a model using eleven machine learning algorithms. Following this, the model was evaluated using four separate external test sets, and the mean Area Under the Curve (AUC) was computed to determine the best-performing model. Further performance metrics of the best model were evaluated, and SHapley Additive exPlanations(SHAP) were used for interpretability analysis to enhance decision-making transparency. Ultimately, an online calculator was created. ResultsAmong the various machine learning models, the Random Forest achieved the highest performance in the validation set, with AUROC scores of 0.832 in Test1, 0.834 in Test2, 0.816 inTest3, 0.822 in Test4) compared with other machine learning models. The top contributing variables were number of levels fusion, pre-APTT, weight and age. The predictive model was further refined by developing a web-based calculator for clinical application. (https://wenle.shinyapps.io/PPOT_LSS/) ConclusionsThis predictive model can facilitate identification of risk for prolonged operation time following PLIF surgery. Predictive calculators are expected to improve preoperative planning, identify patients with high risk factors, and help clinicians facilitating the improvement of treatment plans and the implementation of clinical intervention.

Spine

The October 2024 Spine Roundup360 looks at: Analysis of risk factors for non-fusion of bone graft in anterior cervical discectomy and fusion: a clinical retrospective study; Does paraspinal muscle mass predict lumbar lordosis before and after decompression for degenerative spinal stenosis?; Return to work after surgery for lumbar disk herniation: a nationwide registry-based study; Can the six-minute walking test assess ambulatory function impairment in patients with cervical spondylotic myelopathy?; Complications after adult deformity surgery: losing more than sleep; Frailty limits how good we can get in adult spine deformity surgery.

CircTMTC1 Mediates Nucleo-cytoplasmic Translocation of DDX3X to Regulate Osteogenic Differentiation of Human Ligamentum Flavum Cells.

This study was aimed to investigate the potential roles of circTMTC1 in the underlying pathophysiological mechanisms of ossification of the ligamentum flavum (OLF). OLF is the primary contributor to thoracic spinal stenosis, which may cause severe neurological symptoms. There is a lack of effective medical therapy for OLF available so far because the exact underlying mechanism of OLF has not been fully elucidated. CircRNAs are a special class of non-coding RNAs and have attracted a growing interest of research in various human diseases recently. Therefore, we explored the potential roles of circRNAs in the underlying pathophysiological mechanisms of OLF. We performed RNA-seq analysis to investigate the differentially expression profile of circRNAs in osteogenic differentiation of human LF cells, and identified a key circular RNA circTMTC1 functioned in OLF. Subsequently, we performed a series of experiments to investigate the exact molecular and cellular mechanisms in osteogenic differentiation of human ligamentum flavum cells. CircTMTC1 is significantly up-regulated during osteogenic differentiation of human LF cells. Mechanistically, we found that circTMTC1 could interact with the RNA binding protein DDX3X and enhance its nucleo-cytoplasmic translocation. An increased cytoplasmic level of DDX3X activated the NLRP3 inflammasome pathway and thus promoted osteogenic differentiation of human ligamentum flavum cells. Our findings suggested the circTMTC1-DDX3X-NLRP3 inflammasome signaling plays a pivotal role in osteogenic differentiation of human ligamentum flavum cells, which may provide novel diagnostic and therapeutic strategies for OLF.

Walking stress-induced changes in gait patterns and muscle activity: patients with lumbar spinal stenosis versus asymptomatic controls

IntroductionPatients with symptomatic lumbar spinal stenosis (sLSS) are often limited in their walking range because of worsening symptoms, which is thought to induce changes in the gait pattern. The aim of this study was to determine whether changes in gait pattern and muscle activity in these patients are elicited by a walking stress and differ from asymptomatic controls. MethodsTwenty patients with sLSS and 19 asymptomatic controls performed a 30-minute walking stress. Gait was assessed using seven inertial sensors and sagittal joint range of motion (ROM) was calculated during different phases of gait. Muscle activation of the gluteus medius, erector spinae and multifidus muscles was measured by surface electromyography (EMG) and integrated EMGs (normalized to the maximum during gait) were calculated. Differences between groups and time points (beginning and end) were assessed using mixed factorial analysis of variance. ResultsPatients had less knee extension ROM in terminal stance, less knee flexion ROM in swing and less overall hip flexion/extension ROM than controls (p≤0.03). There were no functionally relevant changes in these parameters during the walking stress. The integrated EMG was greater in all muscles in patients than in controls and increased in both groups during the walking stress in the paraspinal but not in the gluteus medius muscle. There was no interaction between group and time for any of the parameters. ConclusionDifferences in gait pattern and muscle activity between patients with sLSS and controls are generally present, but are not amplified by a walking stress.

Incidence and Risk Factors for Lumbar Sympathetic Chain Injury After Oblique Lumbar Interbody Fusion.

Oblique lumbar interbody fusion (OLIF), performed using a retroperitoneal approach, can lead to complications related to the approach, such as lumbar sympathetic chain injury (LSCI). Although LSCI is a common complication of OLIF, its reported incidence varies across studies due to an absence of specific diagnostic criteria. Moreover, research on the risk factors of postoperative sympathetic chain injuries after OLIF remains limited. Therefore, this study aimed to describe the incidence, and identify independent risk factors for LSCI, in patients with degenerative lumbar spinal diseases who underwent OLIF. Between October 2020 and August 2023, a retrospective review was conducted at our institute on 200 patients who underwent OLIF at 1 to 4 consecutive spinal levels (L1-5) for degenerative spinal diseases including spinal stenosis, spondylolisthesis, degenerative scoliosis. We excluded those with infections, trauma, tumors, and lower extremity edema/warmth due to other causes. The patients were categorized into 2 groups: those with and without LSCI symptoms. Demographic data, operative data, and pre- and postoperative parameters were evaluated for their association with LSCI using a univariate logistic regression model. Variables with a p-value <0.1 in the univariate analysis were included in a multivariate model to identify the independent risk factors. Thirty-five of 200 patients (17.5%) developed LSCI symptoms after OLIF. Multivariate logistic regression analysis indicated that prolonged retraction time, particularly exceeding 31.5 miniutes, remained an independent risk factor (adjusted odds ratio, 12.59; p<0.001). This study demonstrated that prolonged retraction time was an independent risk factor for LSCI following OLIF, particularly when it exceeded 31.5 minutes. Protecting the lumbar sympathetic chain during surgery and minimizing retraction time are crucial to avoiding LSCI following OLIF.

Hyperreflexia in outpatients with Parkinson’s disease and coexisting cervical spinal stenosis: A retrospective cohort study

Background. Degenerative cervical myelopathy (DCM) is poorly recognized and infrequently diagnosed. Objectives. To identify symptoms and signs in the lower extremities physically and radiologically in outpatients with idiopathic Parkinson’s disease (PD) and coexisting DCM. Methods. In 2023, a retrospective cohort study was performed to review the medical records from 2016 to 2020 at the outpatient clinic of the Department of Internal Medicine. As a result, 8 women with PD were diagnosed based on the presence of cardinal features, asymmetry, and a good response to levodopa. Brain and cervical magnetic resonance imaging (MRI) was conducted in 4 patients (group A): 3 with hyperreflexia of the patellar tendon, and 1 with Babinski’s sign. Results. The motor subtype of the 8 patients aged 69 to 90 was a tremor-dominant type of PD. The Hoehn and Yahr (H&amp;Y) stages were II (1) and III (3) in group A, and III (3) and IV (1) in those without hyperreflexia of the patellar tendon. Hyperreflexia and Babinski’s sign were predominant on the tremor-dominant side in group A. Radiologically, their anteroposterior diameters at the most stenotic level (C5-6) were 6.0, 7.1, 7.1, and 10.4 mm. They developed muscular rigidity and spasticity involving the lower extremities. The gait and balance performance were particularly affected compared with the upper extremity function. Conclusion. Hyperreflexia of the patellar tendon and imbalance of gait performance due to coexisting DCM were the important factors affecting gait in older women with tremor-dominant PD.

Impact of the Disc Vacuum Phenomenon on Surgical Outcomes in Lumbar Spinal Stenosis: A Comparative Study between Endoscopic Decompression and Minimally Invasive Oblique Lateral Interbody Fusion.

Objective: This study investigated the influence of the vacuum phenomenon (VP) on surgical outcomes in patients with lumbar spinal stenosis, comparing minimally invasive oblique lateral interbody fusion (MIS OLIF) and endoscopic decompression. Methods: A cohort of 110 patients diagnosed with lumbar spinal stenosis underwent either endoscopic decompression or MIS OLIF. Patients were classified into two groups based on the presence or absence of the VP on preoperative CT scans, non-VP (n = 42) and VP (n = 68). Radiologic and clinical outcomes, including back and leg pain assessed using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the EuroQol-5 Dimension (Eq5D), were compared pre- and postoperatively over a 2-year follow-up period. Results: Preoperatively, the VP group exhibited significantly greater leg pain (p = 0.010), while no significant differences were observed in back pain or the ODI between the groups. In the non-VP group, decompression and fusion yielded similar outcomes, with decompression showing a better ODI score at 1 month (p = 0.018). In contrast, in the VP group, patients who underwent fusion showed significantly improved long-term leg pain outcomes compared to those who underwent decompression at both 1-year (p = 0.042) and 2-year (p = 0.017) follow-ups. Conclusions: The VP may indicate segmental instability and may play a role in the persistence of radiculopathy. Fusion surgery appears to offer better long-term relief in patients with the VP, whereas decompression alone is a viable option in non-VP cases. These findings suggest that the VP may be a useful factor in guiding surgical decision-making.

External validation of the smartphone-based 6-minute walking test in patients with degenerative lumbar disorders undergoing epidural steroid injection

BackgroundThe 6-minute walking test (6WT) has previously shown to be reliable and valid outcome measure in patients undergoing surgery for degenerative lumbar disorders (DLD). A role of 6WT in conservatively treated patients undergoing epidural steroid injection (ESI) remains unclear. MethodsAbout 50 patients with DLD, scheduled for ESI were assessed by the smartphone-based 6WT and common paper-based patient-reported outcome measures (PROMs), including the Core Outcome Measures Index [COMI] back, Oswestry Disability Index (ODI) and Short Form Survey (SF-12). Pearson correlation coefficient (PCC) was used to define the relationship between 6WT and PROMs. Reliability of the 6WT was determined by intraclass correlation coefficient (ICC). Age- and sex-adjusted objective functional impairment (OFI) z-scores were calculated for each patient. ResultsA total of 50 patients (mean age 52 years, SD 13; 25% female), including 35 patients (70%) with lumbar disc herniation and 15 patients (30%) with lumbar spinal stenosis were included. The mean 6-minute walking distance (6WD) was 454.1 m (SD 89.1); the age- and sex-adjusted mean OFI z-score was −2.1 (SD 4.0). A total of 17 (34%) patients had mild, 8 (16%) moderate, and 4 (8%) severe OFI, while 21 (42%) had 6WT results within the normal population range (no OFI). The PCCs between the 6WD and VAS back pain were r=−0.30, ODI r=−0.43, COMI back r=−0.36, and PCS-12 r=0.51 (all p<.05). The ICC of the 6WT was β=0.92. ConclusionsThis external validation in a patient cohort with DLD, which was managed conservatively, confirms the reliability and content validity of the 6WT with similar PCCs with PROMs compared to the original surgical cohort. The results confirm the 6WT as a valid and useful tool for assessing OFI in patients with DLD and a broad range of functional restrictions in an outpatient setting.

Clinical Importance of Redundant Nerve Roots in Patients with Symptomatic Lumbar Spinal Stenosis: A Secondary Analysis of NORDSTEN Spinal Stenosis Trial Data.

Post-hoc analysis of data from a randomized clinical trial. To compare preoperative symptoms of patients with lumbar spinal stenosis (LSS) with and without redundant nerve roots (RNR), and to compare the change in clinical outcomes between those two groups 2 years after decompression surgery. RNR are often seen on MRI in patients with spinal stenosis. Previous studies have reported that patients with RNR are older and have worse symptoms at baseline. A meta-analysis from 2018 concluded that this radiological sign could be seen as a negative predictor of outcome. High quality prospective studies are lacking. Patient characteristics and reported pain and function scores were compared between LSS groups with (RNR+) and without RNR (RNR-) at baseline and after 2 years follow-up. Primary outcome was the mean change in the Oswestry Disability Score (ODI). Secondary outcomes included mean change in scores of the Zurich Claudication Questionnaire (ZCQ) and the numeric rating scale (NRS) for leg and back pain. Out of 416 patients included in the present analysis, 163 (39%) had RNR at baseline. Both groups were similar in regard to patient age, smoking habits, BMI and duration of symptoms. Both groups also showed similar pain and function scores at baseline. The RNR+ group contained a significantly higher proportion of men, patients with severe stenosis and multiple stenotic levels on MRI. At 2-year follow-up the mean change of ODI was -22.1 in the RNR+ group and -17.4 in RNR- group (mean difference 4.7 (95%CI 1.3-8.2) P=0.007). Statistically significant differences were also found for secondary outcomes ZCQ, and NRS leg and back pain favouring the RNR+ group. Patients with RNR had similar baseline characteristics and similar symptoms as patients without. RNR before surgery were associated with better clinical improvement 2 years after decompression.

Correlation between sagittal balance and thoracolumbar elastic energy parameters in 42 spines subject to spondylolisthesis or spinal stenosis and 21 normal spines

The curvature of the lumbar spine plays a critical role in maintaining spinal function, stability, weight distribution, and load transfer. We have developed a mathematical model of the lumbar spine curve by introducing a novel mechanism: minimization of the elastic bending energy of the spine with respect to two biomechanical parameters: dimensionless lumbosacral spinal curvature cLS and dimensionless curvature increment along the spine CI. While most of the biomechanical studies focus on a particular segment of the spine, the distinction of the presented model is that it describes the shape of the thoracolumbar spine by considering it as a whole (non-locally) and thus includes interactions between the different spinal levels in a holistic approach. From radiographs, we have assessed standard geometrical parameters: lumbar lordosis LL, pelvic incidence PI, pelvic tilt PT, sacral slope ψ0 and sagittal balance parameter SB = sagittal vertical axis (SVA)/sacrum-bicoxofemoral distance (SFD) of 42 patients with lumbar spinal stenosis (SS) or degenerative spondylolisthesis (SL) and 21 radiologically normal subjects. SB statistically significantly correlated with model parameters cL5 (r = −0.34, p = 0.009) and −CI (r = 0.33, p = 0.012) but not with standard geometrical parameters. A statistically significant difference with sufficient statistical power between the patients and the normal groups was obtained for cLS, CI, and SB but not for standard geometrical parameters. The model provides a possibility to predict changes in the thoracolumbar spine shape in surgery planning and in assessment of different spine pathologies.

Development and Internal Validation of Machine Learning to Predict Postoperative Worse Functional Status after Surgical Treatment for Thoracic Spinal Stenosis.

BACKGROUND The objective of this study was to develop and validate machine learning (ML) algorithms to predict the 30-day and 6-month risk of deteriorating functional status following surgical treatment for thoracic spinal stenosis (TSS). We aimed to provide surgeons with tools to identify patients with TSS who have a higher risk of postoperative functional decline. MATERIAL AND METHODS The records of 327 patients with TSS who completed both follow-up visits were analyzed. Our primary endpoint was the dichotomized change in the perioperative Japanese Orthopedic Association (JOA) score, categorized based on whether it deteriorated or not. The models were developed using Naïve Bays, LightGBM, XGBoost, logistic regression, and random forest classification models. The model performance was assessed by accuracy and the c-statistic. ML algorithms were trained, optimized, and tested. RESULTS The best-performing algorithms for predicting functional decline at 30 days and 6 months after TSS surgery were XGBoost (accuracy=88.17%, c-statistic=0.83) and Naïve Bays (accuracy=86.03%, c-statistic=0.80). Both algorithms presented good calibration and discrimination in our testing data. We identified several significant predictors, including poor quality of intraoperative SSEP/MEP baseline, poor quality of preoperative SSEP, duration of symptoms, operated level, and motor dysfunction of the lower extremity. CONCLUSIONS The best-performing algorithms for predicting functional decline at 30 days and 6 months after TSS surgery were XGBoost (accuracy=88.17%, c-statistic=0.83) and Naïve Bays (accuracy=86.03%, c-statistic=0.80). Both algorithms presented good calibration and discrimination in our testing data. We identified several significant predictors, including poor quality of intraoperative SSEP/MEP baseline, poor quality of preoperative SSEP, duration of symptoms, operated level, and motor dysfunction of the lower extremity.