Surgery For Lumbar Spinal Stenosis Research Articles

Responsiveness and Minimal Clinically Important Difference of the 6-minute Walk Distance in Patients Undergoing Lumbar Spinal Canal Stenosis Surgery.

This was a retrospective review of prospectively collected data. We aimed to evaluate the responsiveness of the 6-minute walk distance (6MWD) and determine the threshold of the minimal clinically important difference (MCID) in the 6MWD in patients who underwent surgery for lumbar spinal canal stenosis (LSS) surgery. The 6MWD rapidly and objectively assesses the walking distance in patients with LSS. To date, no study has assessed the MCID in the 6MWD in patients who underwent LSS surgery. A total of 41 patients (16 women; average age: 69.4 y, SD: 7.8 y) were included and assessed preoperatively and at 6 months postoperatively. We evaluated the 6MWD and Oswestry Disability Index (ODI), which is a health-related patientrReported outcome, used as an anchor to calculate the MCID for in the 6MWD. We used 2 different approaches to examine the responsiveness of the 6MWD: internal and external responsiveness. The external responsiveness was assessed in 2 ways: one based on the anchoring questionnaire and the other based on the scale distribution of the scale. The anchor-based approach was evaluated using the Spearman rank correlation coefficient and the receiver operating characteristic curve. The distribution-based approach was evaluated using the minimal detectable change. The ODI scores and 6MWD for each anchor significantly improved postoperatively. The correlation coefficient between changes in the 6MWD and ODI was r=-0.58. The area under the receiver operating characteristic curve for the ODI anchor was 0.70 (95% confidence interval: 0.52-0.89), and the cutoff value for the ODI anchor was 50 m (sensitivity=0.57, specificity=0.71). In the distribution-based approach, the minimal detectable change for the 6MWD was 105.9 m. Both the internal and the external responsiveness of the 6MWD were validated using the ODI. Therefore, the MCID in the 6MWD in patients undergoing LSS surgery ranges from 50 to 105.9 m. Level III.

Psychological Predictors of Satisfaction after Lumbar Surgery for Lumbar Spinal Stenosis.

Study DesignA retrospective study of prospectively collected clinical data.PurposeTo identify preoperative psychological factors associated with patient satisfaction after surgery for lumbar spinal stenosis (LSS).Overview of LiteratureAssociations between depressive symptoms, anxiety, and worse surgical outcome or patient dissatisfaction have been reported in LSS patients. However, the influence of preoperative pain catastrophizing and fear-avoidance beliefs on postoperative satisfaction is not well understood.MethodsLSS patients who underwent decompression surgery with or without fusion were included. Clinical outcomes were measured before surgery and 6 months postoperatively using the Zurich Claudication Questionnaire (ZCQ); Visual Analog Scale (VAS) of low back pain, leg pain, and leg numbness; Japanese Orthopaedic Association Back Pain Evaluation Questionnaire; and the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36). The Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale, and Pain Anxiety Symptoms Scale were used to evaluate psychological status before surgery. Patients were classified as satisfied or dissatisfied with surgery based on a ZCQ satisfaction subscale cutoff score of 2.5.ResultsThe satisfied and dissatisfied groups contained 128 and 29 patients, respectively. Six months postoperatively, outcome scores for the dissatisfied group were unchanged or worse than preoperative scores (p>0.05). Multivariate logistic regression analysis showed significant associations between dissatisfaction and preoperative low back pain VAS score ≥median (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.10–0.74; p=0.01), preoperative mental health SF-36 score ≥median (OR, 0.26; 95% CI, 0.08–0.89; p=0.03), and preoperative anxiety HADS score ≥median (OR, 3.95; 95% CI, 1.16–13.46; p=0.03).ConclusionsPreoperative less severe low back pain, lower mental health, and higher anxiety are associated with patient dissatisfaction with lumbar surgery, not depression, pain catastrophizing, or fear-avoidance beliefs. Pre- and postoperative psychological status should be assessed carefully and managed appropriately.

PROMIS Scores Should Not be Used in Isolation to Measure Outcomes in Lumbar Stenosis Patients

Retrospective cross-sectional analysis. The aim of this study was to establish the strength of relationship between the Patient-reported Outcomes Measurement Information System (PROMIS) Adult Depression (AD), Physical Function (PF), and Pain Interference (PI) with the Swiss Spinal Stenosis Questionnaire (SSSQ) in assessing lumbar spinal stenosis (LSS). In 2009, there were >35,000 surgeries for LSS, which amounted to $1.65 billion in health care cost. By 2021, there will be >2.4 million people in the United States with symptomatic LSS. There is an increasing emphasis on patient-reported outcomes (PROs) to define value in medicine. Therefore, it would be beneficial to compare PROMIS, a universal PRO, against the SSSQ, the "criterion standard" for assessing LSS. Eighty-two patients with LSS completing the PROMIS and SSSQ were enrolled. Per existing institutional protocol, PROMIS AD, PF, and PI were completed at every clinic visit. Linear regression analysis was then performed to evaluate how well the SSSQ and PROMIS scores correlated to each other. When linear regression was performed for pre-treatment values, the R2 value for the SSSQ PF versus PROMIS PF was 0.14 (P = 0.0008), whereas the R2 value for the SSSQ symptom severity versus PROMIS PI was 0.03 (P = 0.13). The R2 value for the combined SSSQ physical function and symptom severity versus PROMIS AD was 0.07 (P = 0.02). When post-treatment SSSQ satisfaction scores were correlated to postoperative PROMIS AD, PI, and PF scores, the R2 values for a good linear fit were 0.13, 0.25, and 0.18 respectively (P values: 0.01, 0.003, and 0.003). Pre-treatment PROMIS scores do not adequately capture the disease-specific impact of spinal stenosis, but postoperative PROMIS scores better reflect outcomes after surgery for LSS. PROMIS scores should not be used in isolation to assess outcomes in patients with LSS.Level of Evidence: 4.

How people with lumbar spinal stenosis make decisions about treatment: A qualitative study using the Health Belief Model

ObjectiveSurgery rates for lumbar spinal stenosis (LSS) have increased despite inherent risks, high reoperation rates, and a lack of evidence for benefit over conservative treatment. Scant research has investigated how people make decisions about treatment, which may help clinicians better support patients during the course of care. The purpose of the present study was to explore the beliefs of people with LSS and how they make decisions about treatment. DesignCross-sectional qualitative study. MethodsSemi-structured individual interviews were conducted with participants who had LSS (based on diagnostic imaging and recent symptoms). Transcribed interview data was analyzed using directed content analysis informed by the Health Belief Model. ResultsTwelve patients (mean age 75.3 years, range 63–87 years, 9 female, 6 with previous LSS surgery) participated. The Health Belief Model appeared useful for explaining decisions about treatment. Perceived threat of LSS was higher in those who had surgery. Patients who decided on surgery perceived themselves as more susceptible to surgery, often because of pathoanatomical beliefs. These patients had lower perceived control over symptoms and the treatment decision itself. Although patients saw benefit in conservative treatment because of its lower risk and ability to foster self-management, many had no or poor education and reported previous experiences with ineffective conservative treatment. ConclusionPatients with LSS make decisions about treatment by weighing the perceived threat of LSS against the perceived barriers and benefits of conservative treatment. Consistent and nonthreatening educational messages from clinicians may help these patients during their decision-making process.

Full-Endoscopic Lumbar Decompression versus Open Decompression and Fusion Surgery for the Lumbar Spinal Stenosis: A 3-Year Follow-Up Study.

PurposeCompare the efficacy of full-endoscopic lumbar decompression surgery (FELDS) and open decompression and fusion surgery (ODFS) for lumbar spinal stenosis (LSS).Patients and MethodsA retrospective analysis of 358 LSS patients treated by FELDS (“FELD” group) or ODFS (“open” group) was undertaken. There were 177 patients in the FELDS group with a mean age of 65.47±9.26 years and 181 patients in the open group with a mean age of 64.18±10.24 years. Duration of follow-up was 38.63±11.88 months in the FELDS group and 38.56±12.29 months in the open group. Visual analog scale (VAS) score, Oswestry Disability Index (ODI), and Modified MacNab criteria were used to access clinical outcomes. Surgical outcomes (duration of surgical procedure, blood loss, complications, duration of postoperative hospital stay (DOPHS), prevalence of revision procedures) were evaluated. Magnetic resonance imaging was used to evaluate the change in the Pfirrmann grade at adjacent segments.ResultsVAS score (leg and back) and ODI improved significantly in both groups (P<0.001). Success rate reached 86.55% and 90.60% in the FELDS group and open group (P>0.05), respectively. Procedure duration (84.12 vs 112.08 min), blood loss (7.97 vs 279.67 mL), and DOPHS (2.68 vs 4.78 days) of the FELDS group were significantly better than those of the open group (P<0.05). Total prevalence of complications and procedure revisions was 14.69% and 10.73% in the FELD group, respectively, but did not show a significant difference with that in the open group (12.15% and 9.39%, respectively). The Pfirrmann grade increased in 13.04% of adjacent segments in the FELDS group, significantly better than that in the open group (32.67%) (P<0.05).ConclusionFELDS had the same efficacy as ODFS for LSS treatment. FELDS had the advantages of minimal invasiveness, less surgical trauma, rapid recovery, and lower risk of degeneration of adjacent segments compared with that of ODFS.

Effectiveness of a Gelatin-Thrombin Matrix Sealant (Floseal®) for Reducing Blood Loss During Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis: A Retrospective Cohort Study.

Retrospective cohort study. To investigate the effectiveness and safety of a gelatin-thrombin matrix sealant (GTMS) during microendoscopic laminectomy (MEL) for lumbar spinal canal stenosis (LSCS). This study included 158 LSCS cases on hemostasis-affecting medication who underwent MEL by a single surgeon between September 2016 and August 2020. Patients were divided into 2 groups depending on whether GTMS was used (37 cases, Group A) or not (121 cases, Group B). Perioperative data related to bleeding or postoperative spinal epidural hematoma (PSEH) was investigated. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score for low back pain. The mean intraoperative blood loss per level was greater in Group A (26.0 ± 20.3 g) than in Group B (13.6 ± 9.0 g), whereas the postoperative drainage volume was smaller in Group A (79.1 ± 42.5 g) than in Group B (97.3 ± 55.6 g). No revision surgeries for PSEH were required in Group A, while 2 (1.7%) revisions were required in Group B (P = .957). The median JOA score improved significantly from the preoperative period to 1-year postoperatively in both Group A and B (total score, 16.0-23.5 and 17.0-25.0 points, respectively). The use of GTMS during MEL for LSCS may be associated with a reduction in postoperative drainage volume. The revision rate for PSEH was not affected significantly by the use of GTMS. Clinical outcomes (represented by the JOA score) were significantly improved after the surgery, regardless of GTMS use during MEL.

Criteria for failure and worsening after surgery for lumbar spinal stenosis: a prospective national spine registry observational study

Background contextCriteria for success after surgical treatment of lumbar spinal stenosis (LSS) have been defined previously; however, there are no clear criteria for failure and worsening after surgery as assessed by patient-reported outcome measures (PROMs). PurposeWe aimed to quantify changes in standard PROMs that most accurately identified failure and worsening after surgery for LSS. Study design /settingRetrospective analysis of prospective national spine registry data with 12-months follow-up. Patient sampleWe analyzed 10,822 patients aged 50 years and older operated in Norway during a decade, and 8,258 (76%) responded 12 months after surgery. Outcome measures (PROMs)We calculated final scores, absolute changes, and percentage changes for Oswestry Disability Index (ODI), Numeric Rating Scale (NRS) for back and leg pain (0-10), and EuroQol-5D (EQ-5D). These 12 PROM derivates were compared to the Global Perceived Effect (GPE), a 7-point Likert scale. MethodsWe used ODI, NRS back and leg pain, and EQ-5D 12 months after surgery to identify patients with failure (no effect) and worsening (clinical deterioration). The corresponding GPE at 12-months was graded as failure (GPE=4-7) and worsening (GPE=6-7) and used as an external criterion. To quantify the most accurate cut-off values corresponding to failure and worsening, we calculated areas under the curves (AUCs) of receiver operating characteristics (ROC) curves for the respective PROM derivates. ResultsMean (95% CI) age was 68.3 (68.1 – 68.5) years, and 52% were females. There were 1,683 (20%) failures, and 476 (6%) patients were worse after surgery. The mean (95% CI) pre- and postoperative ODIs were 39.8 (39.5 – 40.2) and 23.7 (23.3 – 24.1), respectively. At 12 months, the mean difference (95% CI) in ODI was 16.1 (15.7 – 16.4), and the mean (95% CI) percentage improvement 38.8% (37.8 – 38.8).The PROM derivates identified failure and worsening accurately (AUC>0.80), except for the absolute change in EQ-5D. The ODI derivates were most accurate to identify both failure and worsening. We found that less than 20% improvement in ODI most accurately identified failure (AUC=0.89 [95% CI: 0.88 to 0.90]), and an ODI final score of 39 points or more most accurately identified worsening (AUC =0.91 [95% CI: 0.90 – 0.92]). ConclusionsIn this national register study, ODI derivates were most accurate to identify both failure and worsening after surgery for degenerative lumbar spinal stenosis. We recommend use of ODI percentage change and ODI final score for further studies of failure and worsening in elective spine surgery.

Dynamic Stabilization Surgery in Patients with Spinal Stenosis: Long-term Outcomes and the Future.

Retrospective cohort study. The purpose of this study was to analyze the long-term results for patients with lumbar spinal stenosis (LSS) treated with dynamic stabilization (DS) and to consider how we can improve the results. Few studies have reported long-term outcomes of DS surgery for LSS with or without spondylolisthesis. A single-center, single-surgeon consecutive series of LSS patients who underwent DS surgery with at least 5 years of follow-up were retrospectively reviewed. Twenty-seven patients were included in the LSS group and 38 patients in the spondylolisthesis group. Patient characteristics, operative data, radiographic parameters, clinical outcomes, and complications were analyzed at baseline and follow-up. In the LSS group, all radiographic parameters (e.g., disc height, segmental lordosis, segmental range of motion [ROM] at the index level and proximal adjacent level, global lordosis, and global ROM) were maintained well until the last follow-up. In the spondylolisthesis group, global lordosis decreased from 36.5° ± 8.2° to 32.6° ± 6.0° at the last follow-up (P = 0.039), and global ROM decreased from 22.1° ± 6.9° to 18.8° ± 7.1° at the last follow-up (P = 0.012). In both groups, back pain, leg pain, and Oswestry Disability Index scores showed significant and sustained improvements. Screw loosening occurred in three patients (11.1%) in the LSS group and five patients (13.2%) in the spondylolisthesis group. Symptomatic adjacent segment degeneration (ASD) occurred in two patients (7.4%) in the LSS group and three patients (7.9%) in the spondylolisthesis group. Decompression and DS surgery for LSS with or without spondylolisthesis showed favorable long-term surgical outcomes with an acceptable rate of complications and ASD. However, an improved physiological DS system should be developed.Level of Evidence: 4.

Predictors for clinical outcomes of tubular surgery for endoscopic decompression in selected patients with lumbar spinal stenosis.

The success rate of decompression surgery for lumbar spinal stenosis (LSS) has been reported to vary from 60 to 80%. The purpose of this study was to analyze the predictors for clinical outcomes after tubular surgery for endoscopic decompression (microendoscopic decompression) for LSS. A total of 100 patients with degenerative LSS (M/F: 61/39, Age: mean 69.7years), who underwent microendoscopic decompression and had a minimum 2-year follow-up (FU) after surgery, were reviewed. All patients suffered from leg-related symptoms predominantly without severe mechanical back pain, preoperatively. The presence of chronic arterial occlusion of the lower limbs was ruled out. The primary outcome measure was clinical evaluation at 2-year FU using the Oswestry Disability Index (ODI). Furthermore, numeric rating scales, Japanese Orthopedic Association (JOA) lumbar score and JOA Back Pain Evaluation Questionnaire were used for secondary outcome measures. Based on findings of univariable analyses, multivariable logistic regression analysis was applied to identify preoperative predictors for the clinical outcomes. Sixty-eight patients (68%) were assessed as good outcomes, on the basis of minimum clinically important difference of the ODI (13 points ≤) and final ODI score (< 30 points). The secondary outcomes were further support for the primary outcome. In multivariable logistic regression analysis, co-existence of intradiscal vacuum phenomenon with LSS (odds ratio [OR] 8.26; 95% confidence interval [95% CI] 2.32-29.34; p = 0.001) and ischemic cardiovascular comorbidities (OR, 13.3; 95% CI, 1.9-92.57; p = 0.009) were significantly associated with poor clinical outcomes. We found co-existence of intradiscal vacuum phenomenon with LSS and ischemic cardiovascular comorbidity to be preoperative predictors of less favorable clinical outcomes after microendoscopic decompression in selected patients of LSS. Although the conclusion obtained from restricted state, the information would be able to help in patient selection of the tubular surgery for endoscopic decompression for LSS.

New Factor Structure of the Tampa Scale for Kinesiophobia in Older Japanese Adults After Lumbar Surgery.

PurposeThe Tampa Scale for Kinesiophobia (TSK) has been used worldwide as a measure of kinesiophobia, but its factor structure in older Japanese adults after lumbar surgery is unknown. The purpose of this study was to fill this research gap by identifying the factors that comprise TSK in older Japanese adults after lumbar surgery.Patients and MethodsParticipants were older Japanese adults who had undergone surgery for lumbar spinal stenosis. Clinicodemographic data, TSK, intensity of low back pain and leg pain, dysesthesia (using an 11-point numerical rating scale), and HRQOL (using the EQ-5D-5L) were collected. After supplementing the missing values by the multiple assignment method, the hypothetical model of TSK was developed by categorical exploratory factor analysis (weighted least squares method, promax rotation). Confirmatory factor analysis (WLSMV method, promax rotation) was used to compare the hypothetical model and the traditional one-factor and two-factor models. Furthermore, we confirmed the relationship between factors extracted from the hypothetical model and HRQOL, pain, and dysesthesia.ResultsQuestionnaires were mailed to 302 individuals, and responses were obtained from 211 (72.4±4.2 years [range: 65–88]; 115 men and 96 women; 804±343.1 [380–1531] days after surgery; 137 who had undergone decompression and fixation surgery, 74 who had undergone decompression surgery) (response rate: 69.9%). The hypothesized model consisted of “somatic focus,” “activity avoidance,” and “efficacy of physical activities,” all of which were highly consistent. The fit of the hypothetical model was slightly inferior to that of the traditional two-factor model, but the hypothetical model met the criteria for fit. Somatic focus in the hypothetical model was significantly associated with HRQOL, pain, and dysesthesia.ConclusionIn older Japanese adults after lumbar surgery, the goodness of fit of the TSK model was maintained by adding efficacy of physical activities as a third factor to the traditional two factors.

Percutaneous spinal endoscopy with unilateral interlaminar approach to perform bilateral decompression for central lumbar spinal stenosis: radiographic and clinical assessment

BackgroundRecently, a percutaneous spinal endoscopy unilateral posterior interlaminar approach to perform bilateral decompression has been proposed for use in treatment of lumbar spinal stenosis, As a development and supplement to traditional surgery, its advantages regarding therapeutic effects and prognosis, such as minor soft tissue damage, little intraoperative blood loss, and a quick return to daily life. However, there are few analyses of this surgery with a follow-up of more than 1 year,we conducted this study in order to quantitatively investigate radiographic and clinical efficacies of this surgery for central lumbar spinal stenosis.Materials and methodsForty-six patients with central lumbar spinal stenosis were enrolled from January 2017 to July 2018. The visual analog scale (VAS) for back pain and leg pain, Oswestry disability index (ODI), modified MacNab criteria were used to evaluate clinical efficiency at preoperative and postoperative time points. The intervertebral height index (IHI), cross-sectional area of the spinal canal (CSAC), calibrated disc signal (CDS) and spinal stability were examined to assess radiographic decompression efficiency via magnetic resonance imaging and X-ray at preoperative and postoperative time points.ResultsThe VAS score for lower back pain and leg pain improved from 7.50 ± 0.78 to 1.70 ± 0.66 and from 7.30 ± 0.79 to 1.74 ± 0.68, respectively, and the ODI improved from 72.35 ± 8.15 to 16.15 ± 4.51. In terms of modified MacNab criteria, 91.3% of the patients achieved good or excellent outcomes. Furthermore, significant changes after surgery were observed for the percentage of CSAC, increasing from 125.3 ± 53.9 to 201.4 ± 78 mm2; however, no significant differences were observed for the remaining measurement indicators.ConclusionsThe clinical and radiographic efficacies of this surgery for central lumbar spinal stenosis were good in short-term follow-up, and this surgery did not cause meaningful changes in IHI, CDS, and spine stability in short-term follow-up. The effect of long-term follow-up needs further investigation.

Pain During Sex Before and After Decompressive Surgery for Lumbar Spinal Stenosis

Study Design. Observational multicenter study. Objective. The aim of this study was to evaluate changes in pain during sexual activity after surgery for lumbar spinal stenosis (LSS). Summary of Background Data. There are limited data available on sexual function in patients undergoing surgery for LSS. Methods. Data were retrieved from the Norwegian Registry for Spine Surgery. The primary outcome was change in pain during sexual activity at 1 year, assessed by item number eight of the Oswestry disability index questionnaire. Secondary outcome measures included Oswestry Disability Index, EuroQol-5D, and numeric rating scale scores for back and leg pain. Results. Among the 12,954 patients included, 9908 (76.5%) completed 1-year follow-up. At baseline 9579 patients (73.9%) provided information about pain during sexual activity, whereas 7424 (74.9%) among those with complete follow-up completed this item. Preoperatively 2528 of 9579 patients (26.4%) reported a normal sex-life without pain compared with 4294 of 7424 patients (57.8%) at 1 year. Preoperatively 1007 (10.5%) patients reported that pain prevented any sex-life, compared with 393 patients (5.3%) at 1 year. At baseline 7051 of 9579 patients (73.6%) reported that sexual activity caused pain, and among these 3145 of 4768 responders (66%) reported an improvement at 1 year. A multivariable regression analysis showed that having a life partner, college education, and working until time of surgery were predictors of improvement in pain during sexual activity. Current tobacco smoking, pain duration &gt;12 months, previous spine surgery, and complications occurring within 3 months were negative predictors. Conclusion. This study clearly demonstrates that a large proportion of patients undergoing surgery for LSS experienced an improvement in pain during sexual activity at 1 year. Level of Evidence: 2

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

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

Comparison Between Fusion and Non-Fusion Surgery for Lumbar Spinal Stenosis: A Meta-analysis.

A large number of studies have shown that, for severe lumbar spinal stenosis, decompression surgery can often obtain better results than non-surgical treatment. However, whether the lumbar spine is fixed after decompression is still controversial. The results of biomechanical studies indicate that there is a correlation between the range of decompression and postoperative spinal instability. The multiple databases like Pubmed, Embase, Cochrane databases and China National Knowledge database were used to search for the relevant studies, and full-text articles involved in the evaluation of fusion and nonfusion surgery for lumbar spinal stenosis. Review Manager 5.2 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. A total of nine relevant studies were eventually satisfied the included criteria. There were significant differences in length of stay [mean difference (MD)=3.04, 95% CI (2.00, 4.08), P<0.000]1), but there were no differences in Oswestry Disability Index (ODI score) [MD=-1.14, 95% CI (-2.92, 0.63), P=0.21; I2=87%] and complications [RR=1 with 95% CI (0.69, 1.46), P value of overall effect was 0.98]. The study was robust and limited publication bias was observed in this study. Our research supported that fusion and nonfusion surgeries had no differences in clinical effects and complications for lumbar spinal stenosis, while fusion surgery involved a longer length of stay than nonfusion surgery.

Transthyretin amyloid deposits in lumbar spinal stenosis and assessment of signs of systemic amyloidosis.

BackgroundWild‐type transthyretin (ATTRwt) amyloidosis is the most common systemic amyloidosis in Western countries and manifests mainly as progressive restrictive cardiomyopathy.ObjectiveTo study the prevalence of ATTR deposits in ligament tissue in patients undergoing surgery for lumbar spinal stenosis and to assess whether these deposits are associated with cardiac amyloidosis.Materials and methodsA total of 250 patients, aged 50–89 (57% women), none with known cardiovascular disease, were included. Ligaments were investigated microscopically for amyloid. ATTR type was determined by immunohistochemistry and fibril type by Western blot. The amount of amyloid was graded 0‐4. All patients with grade 3‐4 ATTR deposits were offered cardiac investigation including ECG, cardiac ultrasound, plasma NT‐proBNP and cardiac magnetic resonance (CMR), including modern tissue characterization.ResultsAmyloid was identified in 221 of the samples (88.4%). ATTR appeared in 93 samples (37%) of whom 42 (17 women and 25 men) were graded 3‐4; all had fibril type A (mixture of full‐length TTR and fragmented TTR). Twenty‐nine of 42 patients with grade 3‐4 ATTR deposits accepted cardiovascular investigations; none of them had definite signs of cardiac amyloidosis, but five men had a history of carpal tunnel syndrome.ConclusionsThe prevalence of ATTR deposits in ligamentum flavum in patients with lumbar spinal stenosis was high but not associated with manifest ATTR cardiac amyloidosis. However, the findings of fibril type A, the prevalence of previous carpal tunnel syndrome and ATTR amyloid in surrounding adipose and vascular tissue indicate that amyloid deposits in ligamentum flavum may be an early manifestation of systemic ATTR disease.

Ultrasound-Guided Erector Spinae Plane Block for Lumbar Spinal Stenosis Surgery

Background: In this retrospective observational study, we evaluated patients who underwent elective lumbar stenosis surgery between February 1, 2019, and April 1, 2019. Patients who underwent surgery for lumbar spinal stenosis under general anesthesia alone were compared with those who underwent general anesthesia combined with erector spinae plane block. Aims: We aimed to retrospectively evaluate whether erector spinae plane block reduced opioid consumption following surgery for spinal stenosis. Study Design: A retrospective observational study. Methods: We collected data on the pain scores, time for the first requirement for patient-controlled analgesia with tramadol, the cumulative patient-controlled analgesia dose, requirement for rescue analgesia, time to first stand up postoperatively and the incidence of postoperative nausea and vomiting. Results: Sixty patients were included in the study. The numerical rating scale’s pain scores were significantly lower in the erector spinae plane group at 1, 2, 4, 6, 12 and 24 hours than in the general anesthesia group. The cumulative dose of patient-controlled analgesia with tramadol was higher in the general anesthesia group than in the ESP group [212.0 (6.6) mg, vs. 107.3 (36.9 mg), (p Conclusion: ESP block appear to be an effective method to relieve pain after lumbar surgery.

Patterns of physical activity and exercise after lumbar surgery among Japanese patients with lumbar spinal stenosis.

[Purpose] The purpose of this study was to assess the feasibility of classifying the patterns of physical activity and exercise after surgery for lumbar spinal stenosis in Japanese patients and describe the characteristics of the patient groups. [Participants and Methods] We evaluated Japanese patients diagnosed as having lumbar spinal stenosis and underwent surgery. The frequencies of the 15 types of physical activity and exercise recommended in Kenko Nippon 21 (Japanese policy for health promotion) were investigated by mail. The study included 102 respondents (median age, 69 years [range, 34–88 years]; 55 males and 47 females). A hierarchical cluster analysis was used for grouping according to the physical activity and exercise patterns. The Holm method and residual analysis were used for comparisons of the frequencies of the physical activity and exercise patterns and basic demographics among the groups. [Results] Three clusters, namely clusters A (younger), B (frail older), and C (active older), were identified from the dendrogram. The participants in cluster A frequently performed paid work. In cluster B, the frequencies of all the physical activity and exercise patterns were low. The older people in cluster C regularly performed stretching/light-intensity exercises, walking, muscle-strengthening exercises, and house and garden maintenance tasks. [Conclusion] We found that the physical activity and exercise after lumbar surgery in Japanese patients could be divided into three patterns.

Surgery for lumbar spinal stenosis in consideration of total spinal alignment

Surgery for lumbar spinal stenosis in consideration of total spinal alignment

Evaluation of BMP-2, VEGF, and Vitamin D Receptor Levels in the Ligamentum Flavum of Patients with Lumbar Spinal Stenosis and Disc Herniation.

To histopathologically evaluate and compare bone morphogenetic protein (BMP)-2, vascular endothelial growth factor (VEGF), and vitamin D receptor (VDR) levels in the ligamentum flavum (LF) of patients with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). Surgical specimens of the LF in 25 patients who underwent surgery for LDH and 25 patients who underwent surgery for LSS were examined histopathologically. The prevalence and severity of BMP-2, VEGF, and VDR immunoreactivity were evaluated to create histoscores (prevalence × severity), which were compared between groups. The mean BMP-2 histoscore was similar in both groups. In the LSS group, the mean VEGF histoscore was significantly higher and the mean VDR histoscore was significantly lower. Elevated VEGF and decreased VDR levels in the LF in LSS are associated with more intense inflammation and chronic process of the disease. The prominent expression of BMP-2 in the LF in both diseases suggests that BMP-2 might be affected by inflammation regardless of chronic pressure and degeneration.

Predicting recovery after lumbar spinal stenosis surgery: A protocol for a historical cohort study using data from the Canadian Spine Outcomes Research Network (CSORN)

ABSTRACT Background: Symptomatic lumbar spinal stenosis (SLSS) is a condition in which narrowing of the spinal canal results in entrapment and compression of neurovascular structures. Decompressive surgery, with or without spinal fusion, is recommended for those with severe symptoms for whom conservative management has failed. However, significant persistent pain, functional limitations, and narcotic use can affect up to one third of patients postsurgery. Aims: The aim of this study will be to identify predictors of outcomes 1-year post SLSS surgery with a focus on modifiable predictors. Methods: The Canadian Spine Outcomes Research Network (CSORN) is a large database of prospectively collected data on pre- and postsurgical outcomes among surgical patients. We include participants with a primary diagnosis of SLSS undergoing their first spine surgery. Outcomes are measured at 12 months after surgery and include back and leg pain, disability (Oswestry Disability Index, ODI), walking capacity (ODI item 4), health-related quality of life, and an overall recovery composite outcome (clinically important changes in pain, disability, and quality of life). Predictors include demographics (education level, work status, marital status, age, sex, body mass index), physical activity level, smoking status, previous conservative treatments, medication intake, depression, patient expectations, and other comorbidities. A multivariate partial least squares model is used to identify predictors of outcomes. Conclusion: Study results will inform targeted SLSS interventions, either for the selection of best candidates for surgery or the identification of targets for presurgical rehabilitation programs.