Symptomatic Spinal Stenosis Research Articles

The Change of Lumbar Spinal Stenosis Symptoms over a Six-Year Period in Community-Dwelling People.

Background and Objectives: The high prevalence of lumbar spinal stenosis (LSS) and its negative impact on quality of life in the elderly is well known. However, the longitudinal time course of LSS symptoms remains unclear. The purpose of this study was to clarify the longitudinal time course and associated factors of LSS symptoms over a period of six years in a community. Materials and Methods: This study was conducted with data prospectively collected in 2004 and 2010 under a retrospective design. In 2004, 1578 subjects (age range: 40 to 79 years) were interviewed on LSS symptoms using a specially designed and validated questionnaire. In 2010, a follow-up study was performed by mail, to which 789 subjects of the 2004 study population responded. Considering that the presence of osteoarthritis (OA) of the knee or hip may influence the participants’ answers in the questionnaire, analysis was performed in all 789 subjects with and 513 subjects without either knee or hip OA. Changes in LSS symptoms between the initial and the 6-year survey were investigated. Multiple logistic regression analysis was used for detecting the risk factors for LSS symptom presence at the six-year follow-up. Results: 1. At the six-year follow-up, more than half of the subjects who showed LSS symptoms at the initial analysis became LSS-negative, and 12–15% of those who were LSS-negative became LSS-positive. 2. From the multiple logistic regression analysis, a lower Roland-Morris Disability Questionnaire (RDQ) score and a positive LSS symptom at the initial analysis were detected as predictive factors of the presence of LSS symptoms at the six-year follow-up in the total number of subjects, as well as just in those who did not have either knee or hip OA. Conclusions: More than half of the subjects who were LSS-positive at their initial assessment still experienced improvement in their symptoms even after 6 years. This means that both LSS symptoms and their time course vary from person to person. Predictive factors for the presence of LSS symptoms during the six-year follow-up period were RDQ score and positive LSS symptoms.

Correlation of 18F-FDG PET/CT uptake with severity of MRI findings and epidural steroid injection sites in patients with symptomatic degenerative disease of the lumbar spine: a retrospective study.

We aimed to retrospectively correlate 18F-fluorodeoxyglucose (18F-FDG) metabolic activity with lumbar spine magnetic resonance imaging (MRI) findings and epidural steroid injection sites in patients with symptomatic degenerative disease of the lumbar spine. A database search was conducted for patients receiving epidural injections <12 months after a positron emission tomography/computed tomography (PET/CT). Maximum standard uptake values (SUVmax) were measured at the facet joints, neural foramina, and spinal canal. Severity of facet arthrosis, disc degeneration, neuroforaminal, and canal stenosis was determined on MRI using previously described grading scales. Spearman rank coefficient assessed association between PET/CT FDG uptake and severity of MRI findings. The SUVmax was also compared with injection sites. Twenty-five patients were included, comprising MRI (n=19) and injection (n=22 patients; 18 interlaminar, 8 transforaminal) groups. Injections were performed an average of 2.6 months after PET/CT. The greatest SUVmax occurred at the L5-S1 spinal canal (mean SUVmax = 2.25). A statistically significant, positive correlation between uptake and grade of spinal canal stenosis was seen only at L4-L5 (r=0.60, p = 0.007). No other significant association was found with spinal canal or neuroforaminal stenosis, or grade of facet joint or disc degeneration. All patients reported symptomatic improvement after injections with mean pain score improvement of 4.4 on a 10-point scale (SD, 2.9). There was moderate agreement between sites of epidural injection and highest SUVmax (κ= 0.591, p < 0.001). 18F-FDG metabolic activity on PET/CT corresponds with MRI findings about the lumbar spinal column, but there is no significant correlation between severity of MRI findings and radiotracer uptake. Given the moderate agreement between metabolic activity and levels of symptomatic spinal stenosis, further studies are warranted to fully evaluate the diagnostic potential of FDG PET/CT as a surrogate for guiding epidural injections.

A Retrospective, Single-Center, Quantitative Analysis of Adverse Events in Patients Undergoing Spinal Stenosis with Neurogenic Claudication Using a Novel Percutaneous Direct Lumbar Decompression Strategy

IntroductionLow-back pain with accompanying neurogenic claudication is a common diagnosis in pain and spine centers around the world, with an evolving algorithm of treatment. One option for the treatment of neurogenic claudication by decompressive strategies centers on percutaneous direct decompressive techniques. Although commonly employed in clinical practice, there have been no formal investigations looking at safety of percutaneous direct decompression without the use of an epidurogram and relying on osteal landmarks. The purpose of this study was to investigate the safety of percutaneous direct decompression performed without the use of the epidurogram.MethodsAfter an IRB exemption had been obtained from the Western Investigational Review Board, data were retrospectively analyzed from July 2018 to August 2020 on patients that had undergone percutaneous direct decompression using the Mild procedure in a single center by a single physician. Data were analyzed quantitatively for reported complications within 3 months of the procedure, including nerve injury, hematoma, infection, death, or allergic reaction to contrast use.–ResultsChart review yielded 147 individual patients who had undergone percutaneous direct decompression from July 2018 to August 2020. In this data set, women outnumbered men, with an average age of 76 years, with L4–L5 followed by L3–L4 being the most common levels decompressed. Of the 147 patients was performed, utilizing an epidurogram versus no epidurogram for decompression, with no complications. These data are the first to describe the safety of percutaneous direct lumbar decompression without the use of contrast.ConclusionThis study strongly suggests the use of an epidurogram is not necessary for the safe decompression of a patient with symptomatic spinal stenosis and neurogenic claudication utilizing percutaneous direct decompression.

Relationship between Scheuermann disease and symptomatic thoracic spinal stenosis: A retrospective study.

This study aimed to investigate the possible relationship between Scheuermann disease (SD) and the pathophysiological factors of thoracic spinal stenosis (TSS), including ossification of the ligamentum flavum (OLF), ossification of the posterior longitudinal ligament (OPLL), and thoracic disc herniation (TDH) in patients with symptomatic TSS. Demographic and radiological data from 66 consecutive patients diagnosed with symptomatic TSS from 2013 to 2018 were retrospectively collected and divided into 3 groups depending on the underlying pathomechanism of TSS: TDH group (18 patients; 6 women; mean age ± standard deviation [Sd] = 59.89 ± 11.34), OPLL group (12 patients; 8 women; mean age ± Sd = 56.08 ± 14.74), and OLF group (36 patients; 20 women; mean age ± Sd = 58.69 ± 9.77). A total of 41 age-matched healthy individuals (19 women; mean age ± Sd = 54.88 ± 13.63) were designated as the control group. In each group, both typical and atypical SD criteria were radiologically examined. The demographic data and presence of SD between the control group and 3 subgroups of TSS pathomechanisms were evaluated. SD characteristics were identified in 83.33% (15/18) of patients in the TDH group, 44.44% (16/36) in the OLF group, 25% (3/12) in the OPLL group, and 17.07% (7/41) of the control individuals. When analyzed by the chi-squared test and logistic regression analysis, the presence of SD was significantly associated with TDH (P < 0.01) and OLF (P < 0.05) but not OPLL (P > 0.05). Patients with TDH and OLF showed peak involvement of T10/11, and patients with OPLL did not. Furthermore, we determined that age, sex, body-mass index, and smoking status were not the risk factors for TDH, OPLL, and OLF (P > 0.05). SD was found to be a risk factor for TDH (P < 0.01) and OLF (P < 0.05) but not for OPLL (P > 0.05). Evidence from this study indicated that SD might be a risk factor for OLF and TDH but not for OPLL.

Posterior Lumbar Interbody Fusion with Spinal Decompression using Minimally Invasive Spine Surgery in the Treatment of Symptomatic Degenerative Spinal Stenosis

Introduction &#x0D; Lumbar spinal stenosis is often the result of advanced degeneration of motion segments of the lumbar spine. The incidence of this case is 3.57% (3570 per 100,000) population in Southeast Asia. The main symptoms are low back pain, numbness, and weakness in the lower extremity that occur and intensify on walking caused by the load of the body weight on the spine. Loss of disc height, facet displacement and hypertrophy, spondylosis, and spondylolisthesis , all contribute to impact the spinal canal and intervertebral foramen in lumbar stenosis . There is a subgroup of patients with spinal stenosis in whom the spine is unstable preoperatively or become destabilized following decompression who would benefit from fusion procedure.&#x0D; Objective&#x0D; Surgical treatment of lumbar spinal stenosis by posterior lumbar interbody fusion is indicated for patients with symptoms of low back pain and lower limb radicular pain, that are unsuccessful treated with medicines and /or patients with persisting or worsening neurological deficit.However, this procedure may lead to possible complications. This case report study was conducted to show how our hospital handling spinal stenosis case.&#x0D; Case&#x0D; A 67-year-old woman presented with low back pain that has occured for two years, and had been worsening for the past 3 months. She described the pain as an intermitten ache down on her leg, the pain was severe and worsened when the patient is standing, sitting, or walking for a long time , The pain severity was measured by visual analog score (vas), graded between 7/10 to 9/10. She also complained numbness from the bilateral gluteal region to the lateral side of lower extremities, when she feel too tired. On the physical examination, She was found to have limited range of motion for flexion and extension, on the lumbar spine, due to pain. The motoric strength of both lower limbs were decreased, so did the sensory function. The Radiological examination showed a severe stenosis at lumbar spinal bone region on L4-L5 area. After the examination, the patient agreed to undergo the suggested operative procedure and gare the consent at the hospital.

Prevalence of lumbar spinal stenosis symptoms in patients from primary care treated for knee or hip osteoarthritis or low back pain

Purpose: Musculoskeletal multimorbidity is increasingly recognized as an important contributor to patient disability and health system burden. The prevalence of multiple painful joints is well documented in patients with low back pain (LBP), knee osteoarthritis (OA), and hip OA. Emerging evidence suggests patients with lumbar spinal stenosis (LSS) also commonly experience symptoms in peripheral joints, including the hip and knee, in addition to their LSS. Although few prevalence estimates for multimorbid LSS and knee or hip OA are available, evidence from secondary care settings suggests that over one-third of patients with LSS may also have co-occurring knee or hip OA.

Simplified Universal Grading of Lumbar Spine MRI Degenerative Findings: Inter-Reader Agreement of Non-Radiologist Spine Experts.

1) To describe a simplified multidisciplinary grading system for the most clinically relevant lumbar spine degenerative changes. 2) To measure the inter-reader variability among non-radiologist spine experts in their use of the classification system for interpretation of a consecutive series of lumbar spine magnetic resonance imaging (MRI) examinations. ATS multidisciplinary and collaborative standardized grading of spinal stenosis, foraminal stenosis, lateral recess stenosis, and facet arthropathy was developed. Our institution's picture archiving and communication system was searched for 50 consecutive patients who underwent non-contrast MRI of the lumbar spine for chronic back pain, radiculopathy, or symptoms of spinal stenosis. Three fellowship-trained spine subspecialists from neurosurgery, orthopedic surgery, and physiatry interpreted the 50 exams using the classification at the L4-L5 and L5-S1 levels. Inter-reader agreement was assessed with Cohen's kappa coefficient. For spinal stenosis, the readers demonstrated substantial agreement (κ = 0.702). For foraminal stenosis and facet arthropathy, the three readers demonstrated moderate agreement (κ = 0.544, and 0.557, respectively). For lateral recess stenosis, there was fair agreement (κ = 0.323). A simplified universal grading system of lumbar spine MRI degenerative findings is newly described. Use of this multidisciplinary grading system in the assessment of clinically relevant degenerative changes revealed moderate to substantial agreement among non-radiologist spine physicians. This standardized grading system could serve as a foundation for interdisciplinary communication.

166. Effectiveness of epidural amniotic fluid injection for low back pain

BACKGROUND CONTEXT Epidural corticosteroid injections have long been used to treat pain and inflammation associated with lumbar HNP, DDD and spinal stenosis symptoms. amniotic fluid, AF, is rich in the components that are believed to contribute to healing by minimizing inflammation. AF injections in nonspinal conditions have been shown to be safe and avoid adverse effects related to steroids. PURPOSE To investigate the efficacy and safety of a single amniotic fluid injection into the epidural space for the treatment of low back pain. Specifically, this pilot study is to define indications for future large-scale comparative studies. Three diagnostic LBP patient groups were evaluated, HNP, stenosis, and DDD. STUDY DESIGN/SETTING IRB approved prospective three cohort clinical study. PATIENT SAMPLE Patients were enrolled who had LBP and leg symptoms for more than 3 months with clinical and MRI findings for HNP, stenosis or DDD. Inclusion criteria necessitated that patients had not responded to medications, physical therapy, and chiropractic. OUTCOME MEASURES Back pain and leg pain VAS, ODI, PROMIS, pain medication usage. METHODS After obtaining consent, 20 patients in each diagnostic group, had 2mls transforaminal epidural AF injected at symptomatic level using fluoroscopy. Pre- and postprocedure outcomes were obtained with follow-up outcomes obtained at 2 weeks, 6 weeks, 3-4 months, 6 months and 1 year. RESULTS The average age (± SD) of HNP, stenosis, and DDD patients was 39±13, 57±10, 44±14 respectively. There were no complications or other adverse effects. HNP patients had the greatest reduction in symptoms with average LBP VAS improvement from 6.5 to 2.4, leg VAS from 5.7 to 1.5, and ODI from 35 to 6. Stenosis patients had LBP VAS from 6.1 to 3.7, leg VAS from 6.0 to 2.2, and ODI from 41 to 29. DDD patients had LBP VAS from 6.8 to 4.6. Within groups, HNP had significant improvement at all follow-ups for VAS back & leg pain, Pain Diagram, ODI, and PROMIS-Phys. Stenosis patients had significant improvement at all FU CONCLUSIONS AF epidural injections are most effective for patients with lumbar HNP and moderately effective for those with stenosis. AF injections for DDD patients gave inconsistent results. Future prospective studies of AF vs steroid injections are warranted for HNP and stenosis patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P136. Clinical and radiographic outcomes after lumber decompression with placement of interlaminar spacers versus decompression alone

BACKGROUND CONTEXT Lumbar decompression is a viable treatment option for spinal stenosis with neurogenic claudication that has failed conservative treatment. However, given the relatively high rates of reoperation with decompression alone (up to 23%) and the increased surgical burden associated with fusion, alternative stabilization techniques such as dynamic interlaminar spacers have been utilized with the goal of providing stabilization while also preserving motion and native biomechanics. PURPOSE The purpose of this study is to evaluate whether interlaminar spacers can effectively augment lumbar decompression in the treatment of symptomatic spinal stenosis. STUDY DESIGN/SETTING Retrospective cohort study at a single institution. PATIENT SAMPLE Ninety-seven patients were included for analysis. Forty-three of these patients underwent lumbar decompression with placement of an interlaminar spacer, and 54 underwent lumbar decompression alone. OUTCOME MEASURES Radiographic parameters: anterior disc height, posterior disc height, segmental alignment, lumbar lordosis, lumbar range of motion, and foraminal height were measured before and after surgery. Outcome measures such as complication rates, and reoperation rates were also compared between the two cohorts. METHODS This is a retrospective cohort study at a single institution between January 2013 and November 2016. Ninety-seven patients were included for analysis. Forty-three of these patients underwent lumbar decompression with placement of an interlaminar spacer, and 54 underwent lumbar decompression alone. Radiographic parameters such as anterior disc height, posterior disc height, segmental alignment, lumbar lordosis, lumbar range of motion, and foraminal height were measured before and after surgery. Outcome measures, complication rates, and reoperation rates were also compared between the two cohorts. RESULTS Patients in the interlaminar spacer cohort had a significant increase in mean posterior disc height (4.5 to 5.1, p = 0.04) and decrease in mean anterior disc height (9.2 to 8.5 mm, p = 0.02). No significant anterior or posterior disc height change occurred in the laminectomy alone cohort. Both groups had a statistically significant decrease in segmental lumbar lordosis, although there was no observed difference in this degree of change between the two groups and no change in overall lumbar lordosis from L1-S1 in either cohort. Both cohorts demonstrated significant improvement in both Visual Analog Scores (VAS) and Oswestry Disability Index (ODI) postoperatively. The two cohorts had similar rates of postoperative complications, and the interlaminar spacer group had a slightly lower rate of reoperation (11.6% vs 20.4%, p = 0.28). CONCLUSIONS These results indicate that lumbar decompression supplemented with interlaminar spacers can lead to substantial improvement in both clinical and radiographic outcomes. We also found that the interlaminar spacer cohort had similar rates of complications and a lower reoperation rate, which deviates from previously published studies that demonstrate a substantially higher complication rate with interlaminar spacers. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Nerve Root Sedimentation Sign: Can It Predict the Success for Surgical Intervention in Patients With Symptomatic Lumbar Spinal Stenosis?

Introduction: The use of interspinous process devices are less invasive surgical methods designed to manage mild to moderate lumbar spinal stenosis symptoms. Symptomatic relief may not be seen in all patients undergoing this procedure. Magnetic resonance imaging (MRI) parameters have been used to predict the success of clinical outcomes in patients with symptomatic lumbar spinal stenosis for decompressive surgeries. The purpose of this study was to determine the feasibility of using nerve root sedimentation sign to predict mid- to long-term clinical outcomes of patients treated with interspinous spacers for lumbar spinal stenosis.Methods: This was a retrospective study using prospective multicenter Food and Drug Administration Investigational Device Exemption (FDA IDE) trial (Superion™ and X-STOP®) data. Inclusion criteria were patients treated with interspinous spacers, aged 45 or older with lumbar spinal stenosis at one or more contiguous levels from L1 to L5 and symptoms of neurogenic claudication. Preoperative axial T2 weighted MRI images were used to determine nerve root sedimentation sign. Preoperative, six-week, one- and two-year postoperative clinical outcomes were measured using Oswestry Disability Index (ODI) scores. Clinical outcomes were compared between positive and negative nerve root sedimentation sign groups; p ≤0.05 was considered significant.Results: This study included n=374 patients; 40 excluded; 334 included (113=positive nerve root sedimentation sign (NRSS) (34%) and 221=negative NRSS (66%)). At six weeks, significant postoperative ODI correction was noted in both groups (p<0.001). No significant differences in ODI scores were identified between groups. A subgroup analysis with MRI image quality grade 3 and certainty determination grade 5, six-week postoperative ODI correction was significant in both groups. Six-week, one- and two-year postoperative ODI scores were greater by 6 points in the positive nerve root sedimentation sign group compared to the negative nerve root sedimentation sign group.Conclusions: Although satisfactory postoperative improvement occurred in both groups, there were statistically significant differences noted in certain sub-categories. The subgroup analysis indicated MRI image quality and nerve root sedimentation sign certainty of determination may be factors that may aid with planning the surgical management of lumbar spinal stenosis.

Symptomatic cervical spinal stenosis in spastic cerebral palsy.

To describe the prevalence of symptomatic cervical spinal stenosis (CSS) in spastic cerebral palsy (CP) and associated characteristics. This cross-sectional study of adults (>18y) with CP (2006-2016) at a single institution compared the patient characteristics (demographics, comorbidities, surgical history, medications, Gross Motor Function Classification System [GMFCS] level, and CP type) of patients with and without CSS. Of 424 patients (mean age 33y 4mo, SD 13y 6mo, range 18-78y; 225 females, 199 males), 32 patients (7.5%) had symptomatic CSS. GMFCS levels in the study cohort were distributed as follows: level I, 25%; level II, 25%; level III, 22%; level IV, 19%; level V, 9%. Twenty-five out of 32 (78.1%) patients had spastic CP, two (6.3%) had dystonic CP, and one (3.1%) had mixed characteristics. Individuals with CSS were older (mean age 54y 6mo, SD 10y 5mo vs mean age 31y 7mo, SD 12y 1mo, p<0.05) and had a higher body mass index (26.1, SD 4.8 vs 23.4, SD 6.2, p<0.05) than those without CSS. Presentations included upper-extremity symptoms (73%), ambulation decline (70%), neck pain (53%), and incontinence (30%). Common stenosis levels were C5-C6 (59%), C4-C5 (56%), and C6-C7 (53%). Symptomatic CSS was identified in 7.5% of this adult cohort during the 2006 to 2016 period. Diagnosis in CP is difficult due to impaired communication and pre-existing gait abnormalities and spasticity. Given the high prevalence of symptomatic CSS in adults, we propose developing screening guidelines. Physicians must maintain a high level of suspicion for CSS if patients present with changes in gait or spasticity.

High prevalence of symptomatic spinal stenosis in Norwegian adults with achondroplasia: a population-based study

BackgroundSymptomatic spinal stenosis (SSS) is a well-known medical complication in achondroplasia. The reported prevalence of SSS is 10 to 30%, an estimate based on small studies or selected populations. No population-based studies exist currently. Furthermore, the relationship between SSS and physical functioning has not been investigated in detail. The aims of this study were to describe the prevalence of SSS in Norwegian adults with achondroplasia, and to explore the impact of SSS on physical functioning.MethodsThis was a population-based study on Norwegian community-dwelling adults with genetically confirmed achondroplasia. Prevalence of SSS was defined by clinical symptoms, and confirmed by imaging or surgical reports. Physical functioning was assessed by walking capacity (6-min walk test), hand strength (Grippit), and activities of daily living (the Health Assessment Questionnaire, HAQ). Pain was assessed by pain site locations and intensity (Numeric Rating Scale, NRS).ResultsIn total, 50 participants were included (27 males, 23 females). Median age was 41 years (range 16 to 87 years), 34 (68%) had SSS. The estimated median age at first symptom onset was 33 years (95% confidence interval (CI) 29 to 43 years), range 10 to 67 years. The majority had multiple spinal levels affected. The walking distance was 110 m shorter in the SSS group (95% CI − 172 to − 40 m) as compared with the non-SSS group (p < 0.01). There was no considerable difference in hand strength between the two groups. Mean HAQ scores (0–3) for walking and hygiene were significantly higher in the SSS group, reflecting more activity limitations. Mean differences were 0.9 (95% CI 0.3 to 1.4, p < 0.01) and 0.6 (95% CI 0.2 to 1.0, p < 0.01). Pain intensity (NRS 0–10) was also significantly higher in the SSS group with a mean difference of 3.2 (95% CI 0.6 to 5.6, p = 0.02).ConclusionsSSS was highly prevalent in Norwegian adults with achondroplasia, with symptom onset at young age, and multiple spinal levels affected. The presence of SSS was associated with reduced walking distance, activity limitations, and more pain. The findings underline the importance of thorough assessment and monitoring of SSS in achondroplasia, including a formal assessment of physical functioning.

In patients with symptomatic spinal stenosis, is physical therapy effective in improving pain and function?

Crawford-Bartle, Cara MD; Huffer, Patrick MD; Reinertsen, R. Anne MD; Sweers, Jeffrey MD Author Information

Patient selection protocols for endoscopic transforaminal, interlaminar, and translaminar decompression of lumbar spinal stenosis.

The indications of different endoscopic and endoscopically assisted translaminar approaches for lumbar spinal stenosis are not well-defined, and validated protocols for the use of the transforaminal over the interlaminar approach are lacking. We performed a retrospective study employing an image-based patient stratification protocol of stenosis location (type I-central canal, type II-lateral recess, type III-foraminal, type IV-extraforaminal) and clinical outcomes on 249 patients consisting of 137 (55%) men and 112 (45%) women with an average age of 56.03±16.8 years who underwent endoscopic surgery for symptomatic spinal stenosis from January 2013 to February 2019. The average follow-up of 38.27±27.9 months. The primary clinical outcome measures were the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and modified Macnab criteria. The frequency of stenosis configuration in decreasing order was as follows: type I-121/249; 48.6%, type III-104/249; 41.8%, type II-15/249; 6%, and type IV-9/249; 3.6%. The transforaminal approach (137/249; 55.0%) was used in most type II to IV lesions followed by the interlaminar approach (78/249; 31.3%), and the full endoscopic approach (12/249; 4.8%), and the endoscopically assisted translaminar approach (8/249; 3.2%) which was exclusively used for type I lesions. Macnab outcomes analysis showed Excellent in 47 patients (18.9%), Good in 178 (71.5%), Fair in 18 (7.2%) and Poor in 6 (2.4%), respectively. Paired two-tailed t-test showed statistically significant VAS (5.46±2.1; P<0.0001) and ODI (37.1±16.9; P<0.0001) reductions as a result of the endoscopic decompression surgery. Cross-tabulation of the Macnab outcomes versus the endoscopic approach and surgical technique confirmed beneficial association of the approach selection with Excellent (P=0.001) and Good (P<0.0001) outcomes with statistically significance. This study suggests that in the hands of skilled endoscopic spines surgeon use of an image-based stenosis location protocol may contribute to obtaining Excellent and Good clinical outcomes in a high percentage (93%) of patients suffering from lumbar stenosis related radiculopathy. Additional comparative studies should examine the prognostic value of choosing the endoscopic approach on the basis of the proposed four-type stenosis protocol by correlating its impact on outcomes with preoperative diagnostic injections and intraoperative direct visualization of symptomatic pain generators under local anesthesia and sedation.

239. Prospective analysis of functional outcome of single stage surgical treatment for symptomatic tandem spinal stenosis

BACKGROUND CONTEXT Tandem spinal stenosis (TSS) is a rare presentation leading to combined clinical features of upper motor neuron and lower motor neuron lesion which includes intermittent neurogenic claudication with or without neurological deficit, progressive gait imbalance and gait disturbances. Such presentation was usually treated with staged surgery in past and few studies have reported single stage surgical intervention. PURPOSE To discuss safety, efficacy and evaluate the outcome of single stage surgical intervention for TSS. STUDY DESIGN/SETTING A total of 82 patients with TSS were prospectively analysed in our study for clinical and functional outcome after single stage surgical intervention. PATIENT SAMPLE From June 2009 to November 2016 in a series of 1,381 patients who underwent surgery for various degenerative spinal conditions, 82 patients were diagnosed as having symptomatic OUTCOME MEASURES All patients were evaluated pre- and postoperatively at each follow-up with mJOA score, Nurick's grading, Oswestry Disability index (ODI) and Cooper scale. METHODS From June 2009 to November 2016 in a series of 1,381 patients who underwent surgery for various degenerative spinal conditions, 82 patients were diagnosed as having symptomatic TSS with an incidence of 5.93 %. All patients diagnosed with TSS underwent single stage surgical intervention by one surgical team. The peri-operative factors were recorded for each patient. All patients were evaluated pre- and postoperatively at each follow-up with mJOA score, Nurick's grading, ODI and Cooper scale. RESULTS In our study 82 patients including 70 males and 12 females underwent simultaneous surgical intervention for symptomatic TSS. The mean age of patients was 61.78 ± 10.48 years. There was significant improvement in mJOA score, nuricks grading, ODI and Coopers scale post-operatively as compared to preoperative values (p value CONCLUSIONS Symptomatic TSS can be safely managed by single stage surgical intervention with good post-operative results and without significant increase in complication rates. This helps in reducing the cost for hospitalisation, avoid need for repeated intubation as well as reducing patients morbidity by avoiding the need for second surgical procedure. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

LLIF as a Less Invasive Adjunct for Deformity Surgery

Adult spinal deformity is a complex spectrum of disorders that commonly results in symptomatic spinal stenosis and decreased quality of life in patients over 60. Correction of severe deformity remains a challenge for even the most experienced surgeons. This challenge is amplified in patients over 60, where traditional open approaches are associated with significant intraoperative blood loss and postoperative complications. Newer, minimally invasive techniques for interbody fusion and posterior spinal fixation have sought to decrease these complications. Lateral lumbar interbody fusion (LLIF) utilizes a lateral, retroperitoneal corridor to access the intervertebral disk spaces of the lumbar spine. This approach allows for placement of large diameter interbody cages and indirect decompression of neural elements without the associated risks of open anterior and posterior approaches. However, LLIF is not without its own unique complications secondary to violation of the psoas muscle during the approach, and anatomical variations in vascular and neural structures make the approach dangerous in some patients. Despite these challenges, LLIF remains a promising adjunct to posterior spinal fixation. This review will focus on the surgical technique, outcomes, and complication rates of LLIF in adult spinal deformity, as well as compare these parameters to alternative techniques including anterior lumbar interbody fusion, posterior lumbar interbody fusion, and stand-alone posterior spinal fixation.

Lumbar Spinal Stenosis Severity by CT or MRI Does Not Predict Response to Epidural Corticosteroid versus Lidocaine Injections.

Epidural steroid injections may offer little-to-no short-term benefit in the overall population of patients with symptomatic spinal stenosis compared with lidocaine alone. We investigated whether imaging could identify subgroups of patients who might benefit most. A secondary analysis of the Lumbar Epidural Steroid Injections for Spinal Stenosis prospective, double-blind trial was performed, and patients were randomized to receive an epidural injection of lidocaine with or without corticosteroids. Patients (n = 350) were evaluated for qualitative and quantitative MR imaging or CT measures of lumbar spinal stenosis. The primary clinical end points were the Roland-Morris Disability Questionnaire and the leg pain numeric rating scale at 3 weeks following injection. ANCOVA was used to assess the significance of interaction terms between imaging measures of spinal stenosis and injectate type on clinical improvement. There was no difference in the improvement of disability or leg pain scores at 3 weeks between patients injected with epidural lidocaine alone compared with corticosteroid and lidocaine when accounting for the primary imaging measures of qualitative spinal stenosis assessment (interaction coefficients for disability score, -0.1; 95% CI, -1.3 to 1.2; P = .90; and for the leg pain score, 0.1; 95% CI, -0.6 to 0.8; P = .81) or the quantitative minimum thecal sac cross-sectional area (interaction coefficients for disability score, 0.01; 95% CI, -0.01 to 0.03; P = .40; and for the leg pain score, 0.01; 95% CI, -0.01 to 0.03; P = .33). Imaging measures of spinal stenosis are not associated with differential clinical responses following epidural corticosteroid injection.

Prospective Analysis of Functional Outcome of Single-Stage Surgical Treatment for Symptomatic Tandem Spinal Stenosis.

Background:Tandem spinal stenosis (TSS) is a rare presentation leading to combined clinical features of upper motor neuron and lower motor neuron lesion which includes intermittent neurogenic claudication with or without neurological deficit, progressive gait imbalance and gait disturbances. In literature, there is controversy whether stage surgery or single-stage surgery should be done.Materials and Methods:From June 2009 to November 2016 in a series of 1381 patients who underwent surgery for various degenerative spinal conditions, 82 patients were diagnosed with having symptomatic TSS with an incidence of 5.93%. All patients diagnosed with TSS underwent single-stage surgical intervention by one surgical team. The perioperative factors were recorded for each patient. All patients were evaluated preoperatively and postoperatively at each followup with the modified Japanese Orthopaedic Association (mJOA) score, Nurick's grading, Oswestry disability index (ODI) and Cooper scale.Results:In this study, 82 patients including 70 males and 12 females underwent simultaneous surgical intervention for symptomatic TSS. The mean age of patients was 61.78 ± 10.48 years. There was a significant improvement in mJOA score, Nuricks grading, ODI and Coopers scale postoperatively as compared to preoperative values (P < 0.05).Conclusion:Symptomatic TSS can be safely managed by single-stage surgical intervention with good postoperative results or without a significant increase in complication rates. Single-stage surgical intervention helps to relieve the symptoms of both cervical and lumbar spinal cord compression, avoids the risk of repeated anesthesia, reduce the duration of surgery, repeated hospitalization hence, reducing the cost for hospitalization and also reducing the rehabilitation, recuperation time and early functional recovery justifies single-stage surgical intervention.

I097 Low Back and Radicular pain including Symptomatic Spinal Stenosis.

I097 Low Back and Radicular pain including Symptomatic Spinal Stenosis.

Fusion rate following three- and four-level ACDF using allograft and segmental instrumentation: A radiographic study

Cervical spine degenerative pathologies remain one of the most common spinal conditions treated by spine surgeons worldwide. Surgery is recommended in all patients with symptomatic cervical spinal stenosis with either moderate to severe myelopathy, degeneration, or refractory radiculopathy. As the number of levels increases the potential for complications associated with anterior surgery can be significant, especially dysphagia and pseudarthrosis. The objective of this study was to analyze the fusion rate following three- or more level anterior cervical discectomy and fusion (ACDF). A retrospective review was performed analyzing patients who underwent three or more level ACDF. Fusion was evaluated using post-operative dynamic upright radiographs Relevant post-operative complications especially dysphagia requiring dietary modifications or placement of feeding tube was also noted. A total of 72 patients were included in the study. Of the 232 levels fused, pseudarthrosis occurred at 47 (14%) levels. Overall 45.8% of patients (33/72) had a pseudarthrosis. The incidence of pseudarthrosis was higher in patients with 4 level ACDF as compared to those with 3 level ACDF [56% (9/16) versus 42% (24/56)]. At last follow up, the number of patients that were symptomatic from their pseudarthrosis and required posterior spinal instrumentation was 8/72 (11.1%). Fusion rates in a large cohort of patients with three- and four-level ACDF performed utilizing allograft and segmental instrumentation is reported. The study demonstrates that 3–4 level, stand-alone anterior cervical arthrodeses result in at least one level of pseudarthrosis in almost half of patients, especially at the caudal level of the construct.