Surgery For Lumbar Spinal Stenosis Research Articles

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

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

The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial

PurposeTo investigate potential associations between preoperative MRI findings and patient reported outcome measures (PROMs) after surgery for lumbar spinal stenosis (LSS).MethodsThe NORDSTEN trial included 437 patients. We investigated the association between preoperative MRI findings such as morphological grade of stenosis (Schizas grade), quantitative grade of stenosis (dural sac cross-sectional area), disc degeneration (Pfirrmann score), facet joint tropism and fatty infiltration of the multifidus muscle, and improvement in patient reported outcome measures (PROMs) 2 years after surgery. We dichotomized each radiological parameter into a moderate or severe category. PROMs i.e., Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) and Numeric rating scale (NRS) for back and leg pain were collected before surgery and at 2 year follow-up. In the primary analysis, we investigated the association between MRI findings and ODI score (dichotomized to ≥ 30% improvement or not). In the secondary analysis, we investigated the association between MRI findings and the mean improvement on the ODI-, ZCQ- and NRS scores. We used multivariable regression models adjusted for patients’ gender, age, smoking status and BMI.ResultsThe primary analysis showed that severe disc degeneration (Pfirrmann score 4–5) was significantly associated with less chance of achieving a 30% improvement on the ODI score (OR 0.54, 95% CI 0.34, 0.88). In the secondary analysis, we detected no clinical relevant associations.ConclusionSevere disc degeneration preoperatively suggest lesser chance of achieving 30% improvement in ODI score after surgery for LSS. Other preoperative MRI findings were not associated with patient reported outcome.

Multilevel Decompression Surgery for Degenerative Lumbar Spinal Canal Stenosis Is Similarly Effective With Single-level Decompression Surgery.

Retrospective case series. The purpose of this study was to investigate the outcome of multilevel posterior decompression surgery for degenerative lumbar spinal stenosis compared with single-level surgery. The clinical outcomes of multilevel decompression surgery are still controversial because previous studies have not been designed to randomize or adjust the patient background. A retrospective review of prospectively collected data from 659 surgically treated lumbar spinal stenosis patients with a minimum 2-year follow-up was performed. Among them, we compared baseline and 2-year postoperative patient-reported outcomes (PROs) including the Visual Analog Scale and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire scores of 122 patients who underwent three or more levels of surgery (M group) and 304 patients who underwent single-level surgery (S group). Further analyses were performed of 116 paired patients from both groups who were propensity score matched by age and baseline PROs. The number of perioperative complications including extradural hematoma, surgical site infection, and spinal fluid leakage [M vs. S: 10 (8%) vs. 19 (6%), P =0.47], and frequency of revision surgery [5 (4%) vs. 23 (8%), P =0.10] were similar between the two groups. In the analysis of propensity score-matched patients, there were comparable improvements in the Visual Analog Scale score for lower back pain (2.6 vs. 2.4, P =0.55), buttock-leg pain (3.1 vs. 3.4, P =0.48), and buttock-leg numbness (2.9 vs. 2.9, P =0.77) in both groups. There were also similar improvements in the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire scores including lower back pain, lumbar function, walking ability, and mental health domains, except for the social life function domain (20.7±26.5 vs. 28.0±27.5, P =0.04). Despite the longer surgical time and a larger volume of estimated blood loss, multilevel decompression surgery showed similar improvement to that of single-level surgery in terms of recovery of PROs and frequency of revision surgery. Multilevel decompression surgery provides good clinical outcomes with acceptable complication and revision rates when selecting appropriate patient and spinal levels.

Relationship between changes in physical function parameters and Roland-Morris disability questionnaire score after decompression surgery for lumbar spinal canal stenosis.

ABSTRACTAlthough decompression surgery for lumbar spinal canal stenosis (LSS) improves leg symptoms, low back pain (LBP), and disability, the factors related to the improvement of subjective disability have not been studied sufficiently. The purpose of the study was to clarify the relationship between subjective disability and objective physical function parameters. A total of 51 patients who underwent decompression were included and evaluated preoperatively and 6 and 12 months postoperatively. Patient-reported outcomes related to activity limitation due to LBP were evaluated using Roland–Morris disability questionnaire (RDQ) and VAS (Visual Analog Scale). Physical function was assessed using 6-min walk distance (6MWD) and trunk muscle strength. Univariate analysis and multivariable linear regression analysis were performed to identify significant factors for RDQ score change. The 6- and 12-month postoperative RDQ scores, VAS scores, and trunk extensor strength significantly improved relative to the preoperative values. In the univariate analysis, age, changes in VAS (LBP, leg pain, and numbness) scores, and change in 6MWD were associated with the RDQ score change (p < 0.05). Multivariable linear regression showed that 6MWD changes were significantly associated with RDQ score changes, explaining 41% of the variance in the RDQ score change. This study showed the change in 6MWD was significantly associated with the RDQ score change. Our results suggest that improving 6MWD may reduce disability in activities of daily living.

Validation of a Model Predicting That Physical Activities Improve Health-Related Quality of Life in Older Japanese Adults with Pain, Dysesthesia, and Kinesiophobia after Lumbar Surgery: Structural Equation Modeling

Objectives This study assessed the validity of a hypothesized model predicting that physical activity improves health-related quality of life (HRQOL) in older Japanese adults with pain, dysesthesia, and kinesiophobia following lumbar surgery. Methods We included 431 elderly patients who underwent surgery for lumbar spinal stenosis at two hospitals. The frequency of physical activity, pain, dysesthesia, kinesiophobia (somatic focus and activity avoidance), and HRQOL were investigated using a questionnaire. Missing values were complemented by the stochastic regression imputation. We constructed the following model. (i) physical activity affects pain, dysesthesia, and kinesiophobia. (ii) pain, dysesthesia, and kinesiophobia separately affect HRQOL. This hypothetical model was tested by structural equation modeling. The model was improved based on a modified index. Results Of the 431 respondents, 297 (median age 72 years, range 65–91 years; 158 men and 139 women) were analyzed (68.9%). The fit of the model improved based on the modification index and was acceptable comparative fit index, 0.948; Tucker–Lewis index, 0.919; root mean square error of approximation, 0.048 (90% confidence interval, 0.026–0.069), and standardized root mean square residual (0.046). The paths by which physical activities reduced pain or dysesthesia (standardized pass coefficients, −0.406) and somatic focus (−0.301) and consequently improved HRQOL were significant (pain/dysesthesia, −0.684; somatic focus, −0.218). Discussion. Our hypothesized model predicting that physical activity improves HRQOL in terms of pain, dysesthesia, and kinesiophobia in older Japanese adults after lumbar surgery was validated using cross-sectional data. Interventional studies on physical activity based on this model are required to establish the model.

Development and validation of machine learning-based predictive model for clinical outcome of decompression surgery for lumbar spinal canal stenosis

BACKGROUND CONTEXTAlthough the results of decompression surgery for lumbar spinal canal stenosis (LSS) are favorable, it is still difficult to predict the postoperative health-related quality of life of patients before surgery. PURPOSEThe purpose of this study was to develop and validate a machine learning model to predict the postoperative outcome of decompression surgery for patients with LSS. STUDY DESIGN/SETTINGA multicentered retrospective study. PATIENT SAMPLEA total of 848 patients who underwent decompression surgery for LSS at an academic hospital, tertiary center, and private hospital were included (age 71±9 years, 68% male, 91% LSS, level treated 1.8±0.8, operation time 69±37 minutes, blood loss 48±113 mL, and length of hospital stay 12±5 days). OUTCOME MEASURESBaseline and 2 years postoperative health-related quality of life. METHODSThe subjects were randomly assigned in a 7:3 ratio to a model building cohort and a testing cohort to test the models’ accuracy. Twelve predictive algorithms using 68 preoperative factors were used to predict each domain of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire and visual analog scale scores at 2 years postoperatively. The final predictive values were generated using an ensemble of the top five algorithms in prediction accuracy. RESULTSThe correlation coefficients of the top algorithms for each domain established using the preoperative factors were excellent (correlation coefficient: 0.95–0.97 [relative error: 0.06–0.14]). The performance evaluation of each Japanese Orthopedic Association Back Pain Evaluation Questionnaire domain and visual analog scale score by the ensemble of the top five algorithms in the testing cohort was favorable (mean absolute error [MAE] 8.9–17.4, median difference [MD] 8.1–15.6/100 points), with the highest accuracy for mental status (MAE 8.9, MD 8.1) and the lowest for buttock and leg numbness (MAE 1.7, MD 1.6/10 points). A strong linear correlation was observed between the predicted and measured values (linear correlation 0.82–0.89), while 4% to 6% of the subjects had predicted values of greater than±3 standard deviations of the MAE. CONCLUSIONSWe successfully developed a machine learning model to predict the postoperative outcomes of decompression surgery for patients with LSS using patient data from three different institutions in three different settings. Thorough analyses for the subjects with deviations from the actual measured values may further improve the predictive probability of this model.

Comparison of Postoperative Outcomes Between Percutaneous Endoscopic Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis.

ObjectiveThis study aimed to compare postoperative outcomes in surgical and patient-reported outcomes (PROs) between percutaneous endoscopic lumbar interbody fusion (PE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar spinal stenosis (LSS).MethodsWe reviewed a total of 89 patients undergoing single-level surgery for lumbar spinal stenosis from January 2018 to July 2021. The cases were categorized as PE-LIF (Group PE-LIF, 41 cases) or MIS-TLIF (Group MIS-TLIF, 48 cases) approach. Parameters obtained at baseline through at least six months of follow-up were collected. The surgical outcomes involving the operative time, estimated blood loss, postoperative bed staying time, and length of hospital stays were analyzed. PROs included the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), modified MacNab standard evaluation, intervertebral fusion rate, and postoperative complications.ResultsA total of 89 patients were included in this analysis involving 41 patients who underwent PE-LIF and 48 patients who underwent MIS-TLIF. The 2 groups were similar in gender, age, body mass index, follow-up time and surgery levels (P > 0.05), and were not significantly different in the length of hospital stays (P > 0.05). PE-LIF had a significantly longer operative time, greater fluoroscopy time, lower estimated blood loss and shorter bed rest time than MIS-TLIF. Both groups improved significantly from baseline for the VAS and ODI scores. PE-LIF was associated with a lower VAS score for back pain at three-day after surgery. There were no significant differences between PE-LIF and MIS-TLIF in the excellent or good rates and intervertebral fusion rates at the last follow-up (P > 0.05). As for related complications, there were no significant complications occurred, and no significant differences were seen in the complications between both groups (P > 0.05).ConclusionsTo summarize, PE-LIF and MIS-TLIF are both safe and effective for LSS. PE-LIF has a definite short-term curative effect with less trauma.

Sex Differences in the Mediating Effect of Kinesiophobia on Chronic Pain, Dysesthesia, and Health-Related Quality of Life in Japanese Individuals Aged 65 Years Old and Older Treated with Surgery for Lumbar Spinal Stenosis.

PurposeThis study aimed to determine whether kinesiophobia mediates the relationship between low back pain (LBP), leg pain (LP), and leg dysesthesia (LD) and health-related quality of life (HRQOL) among Japanese individuals aged 65 years old and older treated with surgery for lumbar spinal stenosis (LSS).Patients and MethodsData collection for this study took place between October 2019 and August 2020 at two Japanese medical facilities. Eligibility criteria for participants in this study were individuals aged 65 years or older and those who had undergone surgery for LSS at least more than one year ago. A self-administered questionnaire assessed the intensity of LBP, LP, and LD (numerical rating scale: NRS), HRQOL (EuroQol-5 Dimension-5 Levels: EQ-5D-5L), and kinesiophobia (Tampa Scale for Kinesiophobia-17 items: TSK-17). Mediation analysis using sex as a control variable was conducted.ResultsComplete responses were obtained from 238 of 431 individuals (73.1 ± 5.1 years; 135 males and 103 females). The mediating effect of NRS scores for LBP, LP, and LD to EQ-5D-5L index on TSK-17 score was significant, respectively (LBP: −0.007 [95% confidence interval −0.012, −0.004], p = 0.000; LP and LD: −0.007 [−0.011, −0.004], p = 0.000). The strength of the association between NRS scores and EQ-5D-5L index decreased when the mediating effect of TSK-17 score (LBP: β = −0.698 [−0.792, −0.603], p = 0.000 to β = −0.616 [−0.707, −0.524], p = 0.000; LP: β = −0.629 [−0.729, −0.529], p = 0.000 to β = −0.539 [−0.638, −0.440], p = 0.000; LD: β = −0.568 [−0.675, −0.460], p = 0.000 to β = −0.482 [−0.586, −0.378], p = 0.000). The mediating effect of TSK score was greater in females than males.ConclusionKinophobia partially mediated the relationship between LBP, LP and LD, and HRQOL in Japanese aged 65 years and older after lumbar surgery. The mediating effect differed by sex.

The clinical impact of lumbar epidural steroid injections prior to spine surgery for lumbar spinal stenosis

IntroductionLumbar spinal stenosis is a common finding in the adult population. Lumbar Epidural Steroid Injections (ESIs) are often used in management of this condition, with conflicting evidence regarding their efficacy. Previous research has suggested a negative impact of ESIs on the postoperative outcomes when ESIs are administered preoperatively prior to spine surgery in this population. Our retrospective study was performed to gain greater insight into the impact of preoperative ESIs on postoperative outcomes following spine surgery in management of lumbar stenosis. ObjectiveOur objective is to determine how preoperative ESIs impact postoperative outcomes following spine surgery in management of lumbar stenosis. DesignRetrospective cohort involving 95 patients (39 patients who received ESI in the preoperative timeframe and 56 patients who did not) who underwent surgical management of lumbar stenosis. Data for patients with preoperative ESI was compared to those without preoperative ESI administration. SettingInstitutional. InterventionsNot Applicable. Main outcome measuresPROMIS (Patient-Reported Outcomes Measurement Information System) scores, VAS (Visual Analog Scale) pain scores, ODI (Oswestry Disability Index), NDI (Neck Disability Index). ResultsAt baseline (time of surgery), the ESI group had significantly higher ODI, PROMIS pain, PROMIS pain interference, VAS leg and lower PROMIS physical function, but no significant difference in PROMIS satisfaction, VAS back and NDI, compared to the Non-ESI group. At 3 months after surgery, both the ESI and Non-ESI groups demonstrated a significant decrease in VAS back, VAS leg, PROMIS pain and ODI from baseline scores. The improvement in PROMIS pain at 3 months after surgery was larger in the ESI group than the Non-ESI group. ConclusionsPreoperative ESI administration did not lead to worsening of disability, function, or pain symptoms in the short-term postoperative period following surgical management of lumbar stenosis. Patients had short term improvements in radicular pain following surgical management of lumbar stenosis, regardless of preoperative ESI administration.

Surgery rates for lumbar spinal stenosis in Denmark between 2002 and 2018: a registry-based study of 43,454 patients.

Background and purposeOver the last decades, many countries have shown increased surgery rates for lumbar spinal stenosis (LSS), but little information is available from Denmark. We describe the development in diagnosis and surgery of LSS in Denmark between 2002 and 2018.Patients and methodsWe collected diagnostic ICD10-codes and surgical procedure codes from private and public hospitals in Denmark from the Danish National Patient Register. Patients diagnosed with LSS and those with surgical procedure codes for decompression surgery with or without fusion were identified. Annual surgery rates were stratified by age, sex, and type of surgery.ResultsDuring these 17 years, 132,138 patients diagnosed with LSS and 43,454 surgical procedures for LSS were identified. The number of surgical procedures increased by 144%, from 23 to 56 per 100,000 inhabitants. The proportion of patients diagnosed with LSS who received surgery was about 33%, which was almost stable over time. Decompression without fusion increased by 128% from 18 to 40 per 100,000 inhabitants and decompression with fusion increased by 199%, from 5 to 15 per 100,000.InterpretationBoth the prevalence of LSS diagnoses and LSS surgery rates more than doubled in Denmark between 2002 and 2018. However, the proportion of patients diagnosed with LSS who received surgery remained stable. Decompression surgery with fusion increased at a higher rate than decompression without fusion, although recent evidence suggests no advantage of decompression plus fusion over decompression alone.

Symptomatic Sagittal Imbalance and Severe Degeneration of Paraspinal Muscle Predispose Suboptimal Outcomes After Lumbar Short Fusion Surgery for Degenerative Lumbar Spinal Stenosis

We sought to investigate the risk factors of suboptimal postoperative outcomes after short-segment surgery for degenerative lumbar spinal stenosis and severe sagittal imbalance and to recommend the appropriate candidates for the short fusion. A total of 101 elderly subjects who underwent short-segment surgery were included. Preoperative sagittal vertical axis decreased to ≤50 mm was determined as sagittal compensation; otherwise, it was determined as sagittal decompensation. At the latest follow-up, 64 patients with sagittal decompensation and 14 patients with proximal junctional kyphosis (PJK) were detected. Sagittal imbalance with the related symptoms was named as symptomatic sagittal imbalance. Preoperative clinical data and spinopelvic parameters were collected and compared between different groups. Symptomatic sagittal imbalance and severe degeneration of paravertebral muscle were revealed to be the risk factors for sagittal decompensation and PJK. More sagittal decompensations (100%) and PJKs (60%) were observed in patients with both of these risk factors. On the contrary, postoperative outcomes were superior with less sagittal decompensation (46.9%) and PJK (0%) in those with neither of the 2 factors. Symptomatic sagittal imbalance and severe degeneration of paraspinal muscle are the risk factors predisposing suboptimal surgical outcomes after lumbar short-segment decompression and fusion for degenerative lumbar spinal stenosis. We believe essential spinal function and substantial quality of paraspinal muscle are the keys to long-lasting good outcomes.

Responsiveness of the Zurich Claudication Questionnaire, the Oswestry Disability Index, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, the 8-Item Short Form Health Survey, and the Euroqol 5 dimensions 5 level in the assessment of patients with lumbar spinal stenosis.

To assess the responsiveness of the Zurich Claudication Questionnaire (ZCQ), the Oswestry Disability Index, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, the visual analog scale (VAS), the 8-Item Short Form Health Survey (SF-8), and the EuroQol 5 dimensions 5 level as methods of assessing outcomes of surgery for lumbar spinal stenosis. We analyzed 218 patients who had undergone lumbar surgery for spinal stenosis and completed one year of follow-up. The internal responsiveness of each questionnaire and any domains was assessed by the effect size and standardized response mean. External responsiveness was assessed by the Spearman rank correlation coefficient and the receiver operating characteristics (ROC) curve. The most responsive assessments were "symptom severity" and "physical function" on the ZCQ, "walking ability" on the JOABPEQ, "leg pain" on the VAS, and "social function" on the JOABPEQ. The moderately responsive assessments were the physical component summary on the SF-8, the ODI, the EQ5D-5L, "low back pain" on the JOABPEQ, and "leg numbness" on the VAS. The least responsive assessments were "low back pain" on the VAS, "mental health" and "lumbar function" on the JOABPEQ, and the mental component summary on the SF-8. Because of its high responsiveness, "symptom severity" on the ZCQ is recommended as a primary tool for assessing outcome when designing prospective studies for lumbar spinal stenosis.

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.

Effects of the difference between lumbar lordosis in the supine and standing positions on the clinical outcomes of decompression surgery for lumbar spinal stenosis.

The authors sought to evaluate the relationship between the difference in lumbar lordosis (DiLL) in the preoperative supine and standing positions and spinal sagittal alignment in patients with lumbar spinal stenosis (LSS) and to determine whether this difference affects the clinical outcome of laminectomy. Sixty patients who underwent single-level unilateral laminectomy for bilateral decompression of LSS were evaluated. Spinopelvic parameters in the supine and standing positions were measured preoperatively and at 3 months and 2 years postoperatively. DiLL between the supine and standing positions was determined as follows: DiLL = supine LL - standing LL. On the basis of this determination patients were then categorized into DiLL(+) and DiLL(-) groups. The relationship between DiLL and preoperative spinopelvic parameters was evaluated using Pearson's correlation coefficient. In addition, clinical outcomes such as visual analog scale (VAS) and Oswestry Disability Index (ODI) scores between the two groups were measured, and their relationship to DiLL was evaluated using two-group comparison and multivariate analysis. There were 31 patients in the DiLL(+) group and 29 in the DiLL(-) group. DiLL was not associated with supine LL but was strongly correlated with standing LL and pelvic incidence (PI) - LL (PI - LL). In the preoperative spinopelvic alignment, LL and SS in the standing position were significantly smaller in the DiLL(+) group than in the DiLL(-) group, and PI - LL was significantly higher in the DiLL(+) group than in the DiLL(-) group. There was no difference in the clinical outcomes 3 months postoperatively, but low-back pain, especially in the sitting position, was significantly higher in the DiLL(+) group 2 years postoperatively. DiLL was associated with low-back pain in the sitting position, which was likely to persist in the DiLL(+) group postoperatively. We evaluated the relationship between DiLL and spinal sagittal alignment and the influence of DiLL on postoperative outcomes in patients with LSS. DiLL was strongly correlated with PI - LL, and in the DiLL(+) group, postoperative low-back pain relapsed. DiLL can be useful as a new spinal alignment evaluation method that supports the conventional spinal sagittal alignment evaluation.

Reliability of facet fluid on preoperative MRI for prediction of segmental instability after decompression surgery for degenerative lumbar spinal stenosis.

The purpose of this study is to determine whether preoperative facet fluid on MRI can help predict segmental instability (SI) after decompression surgery. We analyzed 34 patients (14 men and 20 women, a total of 37 segments) who underwent decompression for degenerative lumbar spinal stenosis from June 2011 to August 2019 at a single institution. Mean age at the time of operation was 67.8. Postoperative assessment was performed uniformly 12 months (11~15 months) after the surgery. Preoperative facet fluid on MRI, pre- and postoperative slip percentage and segmental motion on lumbar lateral neutral and flexion-extension (LFE) radiographic images were measured. Visual analog scale (VAS) and necessities of interventional procedure or medication was also assessed for clinical outcomes. No significant association was found between preoperative facet fluid indices and pre- or post-operative slip percentage (P=0.134) and segmental motion (p=0.936). There were no significant association also between facet fluid indices and VAS of back or leg (p=0.997 and p=0.437 respectively). Preoperative facet fluid is not a predictive index of postoperative segmental instability or clinical outcome. Without segmental instability on LFE radiographic images, the presence of facet fluid in MRI is not an absolute indication for fusion.

Comparison of Operative Time and Blood Loss With the FFX® Device Versus Pedicle Screw Fixation During Surgery for Lumbar Spinal Stenosis: A Retrospective Cohort Study.

BackgroundPedicle screw (PS) placement can be associated with soft tissue damage and blood loss. The study objective was to evaluate differences in operative time and blood loss between PS fixation and an implantable facet fusion device in patients undergoing lumbar fusion surgery.Materials and methodsA retrospective analysis was performed on patients undergoing lumbar fusion surgery with PS fixation or the lumbar Facet FiXation (FFX) device. Procedures were performed by the same surgeon at a single institution. The PS group included patients from 2016 and the FFX group included patients from 2018. Variables including age, sex, levels operated on, operative time, and operative blood loss were collected.ResultsA total of 70 patients were included in the study. Twenty-eight in the PS arm and 42 in the FFX arm. The PS group had a mean age of 67.5 ± 9.3 years compared to 70.4 ± 11.5 years for the FFX group. The PS group had a higher percentage of females (57.1%) versus the FFX group (31.0%); p = 0.025. Mean number of levels operated on were similar between the PS and FFX groups (2.3 ± 1 .1 vs. 2.2 ± 1.0, respectively; p = 0.89). Mean operative time was significantly longer for the PS group versus the FFX group (152.5 ± 39.4 vs. 99.4 ± 44.0 minutes; p < 0.001). Mean operative blood loss was significantly greater for the PS group versus the FFX group (446.5 ± 272.0 vs. 251.0 ± 315.9 mL; p < 0.01). Differences were independent of the number of levels operated on.ConclusionPlacement of the FFX device is associated with a significant reduction in operative time and blood loss compared to PS fixation in patients undergoing spinal fusion surgery.

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

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

Relationship between facet joint opening on CT and facet joint effusion on MRI in patients with lumbar spinal stenosis: analysis of a less invasive decompression procedure.

Both facet joint opening (FJO) on CT and facet joint effusion (FJE) on MRI are reportedly indicators of segmental instability in the lumbar facet joints of patients with lumbar spinal stenosis (LSS). However, no study has investigated both parameters simultaneously. Therefore, the association between these findings and which parameter is better for predicting clinical outcomes after surgical treatment remains unclear. The purpose of this study was to investigate the relationship between FJO and FJE in patients who underwent less invasive decompression procedures for LSS and to investigate the impact of these findings on clinical outcomes. This study included 1465 lumbar levels (L1-2 to L5-S1) in 293 patients who underwent less invasive surgery for LSS and had ≥ 5 years of follow-up. FJO was defined as joint space widening ≥ 2 mm on preoperative axial CT images. FJE was defined as fluid effusion in the facet joint on preoperative axial T2-weighted MR images. The characteristics and distributions of FJO and FJE were investigated with other preoperative radiological findings. The association between need for further surgery and FJO/FJE was analyzed according to intervertebral level. FJO was observed at 402 levels (27%), and FJE was found at 306 levels (21%). The correspondence rate between FJO and FJE was 70% (kappa 0.195, p < 0.01). One hundred thirty-seven levels (9%) had both FJO and FJE. Levels with both FJO and FJE more commonly had lateral olisthesis, lateral wedging, and axial intervertebral rotation than other levels (p < 0.001). Levels with both FJO and FJE were more likely than other levels to need further surgery (OR 2.42, p = 0.027). The correspondence rate between FJO and FJE was not high. However, multivariate analysis showed that levels with both FJO and FJE had a higher risk of requiring further surgery than those with other radiological findings, such as lateral olisthesis, lateral wedging, and axial intervertebral rotation. Patients with levels with both FJO and FJE need careful long-term follow-up after undergoing a less invasive decompression procedure.

Locomotive Syndrome and Lumbar Spine Disease: A Systematic Review.

Locomotive syndrome (LS) is defined based on the Loco-Check, 25-question Geriatric Locomotive Function Scale (GLFS-25), 5-question Geriatric Locomotive Function Scale (GLFS-5), Stand-Up Test, Two-Step Test, or a total assessment (i.e., positive for one or more of the GLFS-25, Stand-Up Test, and Two-Step Test). Lumbar spine disease has been reported to be one of the most common musculoskeletal disorders leading to LS. We therefore conducted a systematic review via PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 studies were considered to be eligible for inclusion in this systematic review. The GLFS-25 showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis but not vertebral fracture. The GLFS-5 showed an association with low back pain and lumbar spinal stenosis. The Loco-Check and Two-Step Test showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis. The Stand-Up Test showed no association with lumbar spinal stenosis. The total assessment showed an association with low back pain and lumbar spinal stenosis. Furthermore, the GLFS-25, Two-Step Test, and total assessment were improved by spinal surgery for lumbar spinal stenosis. The current evidence concerning the relationship between LS and lumbar spine disease still seems insufficient, so further investigations are required on this topic.

Association between depression and anxiety on symptom and function after surgery for lumbar spinal stenosis

Evidence on the role of depression and anxiety in patients undergoing surgical treatment for symptomatic degenerative lumbar spinal stenosis (DLSS) is conflicting. We aimed to assess the association between depression and anxiety with symptoms and function in patients undergoing surgery for DLSS. Included were patients with symptomatic DLSS participating in a prospective multicentre cohort study who underwent surgery and completed the 24-month follow-up. We used the hospital anxiety and depression scale (HADS) to assess depression/anxiety. We used mixed-effects models to quantify the impact on the primary outcome change in the spinal stenosis measure (SSM) symptoms/function subscale from baseline to 12- and 24-months. Logistic regression analysis was used to quantify the odds of the SSM to reach a minimal clinically important difference (MCID) at 24 months follow-up. The robustness of the results in the presence of unmeasured confounding was quantified using a benchmarking method based on a multiple linear model. Out of 401 patients 72 (17.95%) were depressed and 80 anxious (19.05%). Depression was associated with more symptoms (β = 0.36, 95% confidence interval (CI) 0.20 to 0.51, p < 0.001) and worse function (β = 0.37, 95% CI 0.24 to 0.50, p < 0.001) at 12- and 24-months. Only the association between baseline depression and SSM symptoms/function was robust at 12 and 24 months. There was no evidence for baseline depression/anxiety decreasing odds for a MCID in SSM symptoms and function over time. In patients undergoing surgery for symptomatic DLSS, preoperative depression but not anxiety was associated with more severe symptoms and disability at 12 and 24 months.