Treatment Of Lumbar Spinal Stenosis Research Articles

Unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly

To investigate the clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the Interlaminar Endoscopic Surgical System(iLESSYS) Delta for the treatment of lumbar spinal stenosis (LSS) in the elderly. Total of 29 patients with LSS treated with the iLESSYS Delta from December 2018 to January 2021 were retrospectively analyzed, including 12 males and 17 females with an average age of (71.52±10.82) years old ranging from 63 to 83 years old. All patients had definite intermittent claudication, mainly neurogenic symptoms of both lower limbs. All patients had single-level spinal stenosis, including L3,4 5 cases, L4,5 21 cases, and L5S1 3 cases. Visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified Macnab assessment criteria were used to evaluate pain, low back pain dysfunction index and clinical efficacy, respectively. All 29 cases were successfully completed. The operation time was (73.45±5.89) min, the intraoperative blood loss was (9.93±0.83) ml, the hospital stay was (4.03±0.41) days, and the follow-up was more than 12 months. The VAS scores of low back pain before surgery and 1 day, 1 month, 3 months, 1 year after surgery were 2.31±0.88, 1.45±0.62, 1.21±0.61, 1.10±0.55, 1.03±0.49;VAS of leg pain were 6.48±0.49 0.56, 1.97±0.61, 1.31±0.59, 1.17±0.59, 1.10±0.55;ODI scores were 38.41±2.74, 18.14±1.17, 5.17±0.53, 5.07±0.45, 4.90±0.48;low back and leg pain VAS score and ODI score have statistically significant differences between preoperative and postoperative follow-up time points (P<0.05). The MacNab efficacy evaluation at 1-year follow-up:excellent in 22 cases, good in 5 cases and fair in 2 cases. The clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly is satisfactory, with the advantages of less trauma and less bleeding, large microscopic operation space, sufficient decompression, and ideal post-operative recovery, and at the same time, it can minimize the damage to the stable structure of the lumbar spine, which is an ideal surgical method for the treatment of elderly lumbar spinal stenosis.

Effectiveness and safety of interspinous spacer versus decompressive surgery for lumbar spinal stenosis: A meta-analysis of randomized controlled trials.

A meta-analysis of randomized controlled trials. Our meta-analysis was conducted to investigate whether interspinous spacer (IS) results in better performance for patients with lumbar spinal stenosis (LSS) when compared with decompressive surgery (DS). DS and IS are common surgeries for the treatment of LSS. However, controversy remains as to whether the IS is superior to DS. We comprehensively searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for prospective randomized controlled trials that compared IS versus DS for LSS. The retrieved results were last updated on July 30, 2023. Eight studies involving 852 individuals were included in the meta-analysis. The pooled data indicated that IS was superior to DS considering shorter operation time (P = .003), lower dural violation rate (P = .002), better Zurich Claudication Questionnaire Physical function score (P = .03), and smaller foraminal height decrease (P = .004), but inferior to DS considering the higher rate of reoperation (P < .0001). There was no significant difference between the 2 groups regarding hospital stay (P = .26), blood loss (P = .23), spinous process fracture (P = .09), disc height decrease (P = .87), VAS leg pain score (P = .43), VAS back pain score (P = .26), Oswestry Disability Index score (P = .08), and Zurich Claudication Questionnaire symptom severity (P = .50). In summary, we considered that IS had similar effects with DS in hospital stay, blood loss, spinous process fracture, disc height decrease, VAS score, Oswestry Disability Index score, and Zurich Claudication Questionnaire Symptom severity, and was better in some indices such as operation time, dural violation, Zurich Claudication Questionnaire Physical function, and foraminal height decrease than DS. However, due to the higher rate of reoperation in the IS group, we considered that both IS and DS were acceptable strategies for treating LSS. As a novel technique, further well-designed studies with longer-term follow-up are needed to evaluate the effectiveness and safety of IS.

Different lumbar fusion techniques for lumbar spinal stenosis: a Bayesian network meta-analysis

ObjectiveTo comprehensively compare and assess the effects of different lumbar fusion techniques in patients with lumbar spinal stenosis (LSS).MethodsPubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched up to December 24, 2022 in this network meta-analysis. Outcomes were pain (pain, low back pain, and leg pain), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), complications, reoperation, and fusion. Network plots illustrated the direct and indirect comparisons of different fusion techniques for the outcomes. League tables showed the comparisons of any two fusion techniques, based on both direct and indirect evidence. The efficacy of each fusion technique for LSS was ranked by rank probabilities.ResultsTotally 29 studies involving 2,379 patients were eligible. For pain, percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) was most likely to be the best technique, followed by minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), extreme lateral interbody fusion (XLIF), and transforaminal lumbar interbody fusion (TLIF). Percutaneous endoscopic posterior lumbar interbody fusion (Endo-PLIF) had the greatest likelihood to be the optimal technique for low back pain, followed sequentially by MIS-TLIF, minimally invasive posterior lumbar interbody fusion (MIS-PLIF), XLIF, Endo-TLIF, TLIF, oblique lumbar interbody fusion (OLIF), posterior lumbar interbody fusion (PLIF), and posterolateral lumbar fusion (PLF). MIS-PLIF was ranked the most effective technique concerning leg pain, followed by Endo-TLIF, MIS-TLIF, TLIF, Endo-PLIF, PLIF, OLIF, PLF, and XLIF. As regards JOA scores, Endo-TLIF had the maximum probability to be the best technique, followed by MIS-TLIF and TLIF. Endo-PLIF had the greatest likelihood to be the optimum technique for complications, followed by TLIF, MIS-TLIF, Endo-TLIF, OLIF, and XLIF.ConclusionMinimally invasive fusion techniques may be effective in the treatment of LSS, compared with traditional techniques. Minimally invasive techniques were likely non-inferior with regards to postoperative complications.

Incidence of subsequent surgical decompression following minimally invasive approaches to treat lumbar spinal stenosis: A retrospective review.

Surgical decompression is the definitive treatment for managing symptomatic lumbar spinal stenosis; however, select patients are poor surgical candidates. Consequently, minimally invasive procedures have gained popularity, but there exists the potential for failure of therapy necessitating eventual surgical decompression. To evaluate the incidence and characteristics of patients who require surgical decompression following minimally invasive procedures to treat lumbar spinal stenosis. Retrospective review. Patients who underwent minimally invasive procedures for lumbar spinal stenosis (Percutaneous Image-guided Lumbar Decompression [PILD] or interspinous spacer device [ISD]) and progressed to subsequent surgical decompression within 5 years. The primary outcome was the rate of surgical decompression within 5 years following the minimally invasive approach. Secondary outcomes included demographic and comorbid factors associated with increased odds of requiring subsequent surgery. Patient data were collected using the PearlDiver-Mariner database. The rate of subsequent decompression was described as a percentage while univariable and multivariable regression analysis was used for the analysis of predictors. A total of 5278 patients were included, of which 3222 (61.04%) underwent PILD, 1959 (37.12%) underwent ISD placement, and 97 (1.84%) had claims for both procedures. Overall, the incidence of subsequent surgical decompression within 5 years was 6.56% (346 of 5278 patients). Variables associated with a significantly greater odds ratio (OR) [95% confidence interval (CI)] of requiring subsequent surgical decompression included male gender and a prior history of surgical decompression by 1.42 ([1.14, 1.77], p = 0.002) and 2.10 times ([1.39, 3.17], p < 0.001), respectively. In contrast, age 65 years and above, a diagnosis of obesity, and a Charlson Comorbidity Index score of three or greater were associated with a significantly reduced OR [95% CI] by 0.64 ([0.50, 0.81], p < 0.001), 0.62 ([0.48, 0.81], p < 0.001), and 0.71 times ([0.56, 0.91], p = 0.007), respectively. Minimally invasive procedures may provide an additional option to treat symptomatic lumbar spinal stenosis in patients who are poor surgical candidates or who do not desire open decompression; however, there still exists a subset of patients who will require subsequent surgical decompression. Factors such as gender and prior surgical decompression increase the likelihood of subsequent surgery, while older age, obesity, and a higher Charlson Comorbidity Index score reduce it. These findings aid in selecting suitable surgical candidates for better outcomes in the elderly population with lumbar spinal stenosis.

Clinical and Radiological Outcomes of Spinous Process-Splitting Laminectomy for Lumbar Spinal Stenosis at 1 Year: A Preliminary Report of a Single-Institution Experience

Objective: This study investigated the clinical and radiological outcomes of lumbar spinous process-splitting laminectomy (LSPSL) performed to treat lumbar spinal stenosis at a single institution in Korea. Methods: A retrospective review was conducted of patients who underwent LSPSL for lumbar spinal stenosis between June 2020 and February 2022, with a minimum 1-year follow-up. Clinical outcomes were assessed using the visual analogue scale (VAS), Oswestry Disability Index (ODI), European quality of life - 5 dimensions - 5 levels (EQ-5D-5L), European quality of life VAS (EQ-VAS), and modified MacNab criteria. One year after surgery, radiological outcomes were evaluated through computed tomography scan to assess the spinolaminar bone union rate and patterns.Results: Out of 38 patients, data from 30 patients (male:female = 17:13) and 36 surgical levels were analyzed. The mean age was 67 years (range, 46–88 years). The preoperative mean leg VAS score and ODI significantly decreased at the 1-year postoperative follow-up (leg VAS, 6.6–3.8; p = 0.001; ODI, 19.3–10.9, p = 0.006). The EQ-5D-5L index and EQ-VAS also significantly improved (0.52–0.77, p &lt; 0.001; 50.8–67.1, p = 0.018; respectively). Using the modified MacNab criteria, the study reported excellent and good outcomes in 80% of patients at the 1-year follow-up, with no serious complications observed. The overall spinolaminar union rate was 77.8% (complete union, 58.3%; partial union 19.4%).Conclusion: LSPSL was found to provide favorable clinical outcomes and a satisfactory rate of posterior bony structure restoration for lumbar spinal stenosis, making it a feasible treatment option.

The Unilateral Biportal Endoscopic Technique for Treatment of Lumbar Spinal Stenosis: Early Surgical Results

Objective: Minimally invasive (MI) surgery for the treatment of spinal stenosis is currently a topic of substantial interest. One such technique is the unilateral biportal endoscopic (UBE) method, becoming popular among spine surgeons as a MI alternative to decompressive lumbar laminectomy without fusion. The purpose of this study was to present a description of the surgical technique and early clinical and radiological outcomes following the author's adoption of the UBE surgical technique for decompression of spinal stenosis.Methods: Between 2019 and 2021, surgery was performed on 47 patients with lumbar spinal stenosis. Clinical and radiological data were retrospectively analyzed through electronic medical records and imaging software reviews. Questionnaires and radiologic images were prospectively collected at scheduled times. The surgical technique used two corridors: one for endoscopic viewing and the other for handling surgical instruments during the procedure. Clinical outcomes were measured using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI), while radiological outcomes were evaluated using X-rays to assess instability. Outcomes after UBE surgery were evaluated in terms of changes in clinical and radiological parameters from the baseline. A mixed-effects model with random effects for patients and surgical levels was used to test for differences in repeatedly measured clinical and radiological parameters.Results: During the early postoperative period, there were few complications, and all patients had a smooth recovery. Patients reported minimal postoperative wound discomfort. Back and leg VAS scores improved significantly in the early postoperative period (at 3, 6, and 12 months) compared to the baseline preoperative scores (p&lt;0.001). The ODI also showed significant improvement post-operatively (p&lt;0.001). The X-ray parameters were well maintained and did not show any progression of instability during the follow-up period.Conclusion: UBE surgery is a safe and effective MI technique for treating lumbar stenosis, with good early results and few complications during the early learning curve period.

Consecutive Case Series of Uniportal Full-endoscopic Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis: Relationship between Decompression Range and Functional Outcomes.

Uniportal full-endoscopic unilateral laminotomy for bilateral decompression (UFE-ULBD) has been used to treat lumbar spinal stenosis (LSS) with satisfactory outcomes. However, a limited number of studies have investigated the relationship between decompression range and clinical outcomes. This study aimed to investigate the efficacy of UFE-ULBD for single-segment LSS and to explore the relationship between the decompression range and functional outcomes. Single-segment LSS patients who had undergone UFE-ULBD using an interlaminar approach between November 2021 and February 2023 were retrospectively analyzed. Patient demographics, visual analogue scale (VAS) scores for leg and back pain, Oswestry disability index (ODI) scores, modified MacNab grades, and radiological outcomes, including the decompression ratio of the disc-flava ligament space and osseous lateral recess, the enlargement ratio of superior articular process interval, lamina interval dural sac cross-sectional area (DSCA), were collected. The independent sample t-tests, paired sample t-tests, chi-square tests, Fisher's exact tests, and Pearson's and Spearman's correlation analyses were used. Forty patients (23 males, and 17 females) were retrospectively enrolled in this study. The mean follow-up period was 12 months. At the last follow-up, VAS scores for leg pain and back pain decreased from 6.0 ± 0.8 to 1.0 ± 1.9 (p < 0.001), and from 6.0 ± 0.8 to 1.2 ± 1.8 (p < 0.001) respectively; ODI score decreased from 71.7 ± 6.2 to 24.3 ± 21.3 (p < 0.001). According to the modified MacNab criteria, the results were excellent in 28 (70%), good in 5 (12.5%), fair in 6 (15%), and poor in 1 (2.5%), with an excellent-good rate of 82.5%. The postoperative DSCA enlarged from 57.69 ± 21.86 to 150.75 ± 39.33 mm2 (p < 0.001), with an enlargement ratio of 189.43 ± 107.83%. No difference in clinical or radiological parameters was detected between patients with excellent, good, fair, or poor outcomes based on the modified MacNab criteria. UFE-ULBD can provide satisfactory clinical and radiological outcomes in single-segment LSS patients. With sufficient exposure to the dural sac boundary, the functional outcome was not related to the radiological decompression range in LSS patients who had undergone UFE-ULBD.

Development of CORE-CM core outcome domain sets for trials of Chinese medicine for lumbar spinal stenosis

ObjectivesMost Asian countries have employed Chinese medicine (CM) and Western medicine to treat lumbar spinal stenosis (LSS). Evidence synthesis and comparison of effectiveness are difficult since outcomes examined and presented...

Application of Unilateral Double-Channel Endoscopic Lamina Fenestration Decompression in Lumbar Spinal Stenosis

Objective: This paper aims to observe and explore the application effect of unilateral double-channel endoscopic lamina fenestration decompression in the clinical treatment of patients with lumbar spinal stenosis. Methods: The study period is from January 2020 to December 2022, 60 patients with lumbar spinal stenosis were recruited and divided into the control group (traditional interlaminar fenestration) and the study group (unilateral double-channel endoscopic lamina fenestration decompression) according to the method of coin tossing, with 30 cases in each group. The operation time, perioperative blood loss, incision diameter, total hospitalization time, postoperative complications, Japanese Orthopedic Association (JOA), Numerical Rating Scale (NRS) pain score, and excellent rate of lumbar recovery were compared. Results: The operation time of the study group was longer than that of the control group, the amount of perioperative blood loss was lower than that of the control group, the incision diameter was smaller than that of the control group, and the total hospitalization time was shorter than that of the control group (P &lt; 0.05). Postoperative complications such as dural tear, cerebrospinal fluid leakage, infection, and paravertebral muscle injury in the study group were less than those in the control group (P &lt; 0.05). The JOA score of the study group was higher than that of the control group, and the NRS score was lower than that of the control group 6 months after operation (P &lt; 0.05). The operation effect was evaluated according to the modified MacNab standard 6 months after operation, and the excellent rate of lumbar spine recovery in the study group was higher than that in the control group (P &lt; 0.05). Conclusion: Unilateral double-channel endoscopic fenestration decompression of the lamina has a definite application effect, it can significantly reduce postoperative complications of lumbar spinal stenosis, and promote the recovery of lumbar spine function. It has the advantages of mild pain, high safety, less bleeding, small incision, and other advantages, which can be recommended in the treatment of lumbar spinal stenosis.

Efficacy of OLIF combined with pedicle screw internal fixation for lumbar spinal stenosis on spinal canal changes before and after surgery

PurposeThe purpose of the study was to evaluate the efficacy of OLIF combined with pedicle screw internal fixation in the treatment of lumbar spinal stenosis by assessing the changes in spinal canal before and after surgery.MethodsIn this retrospective study, we included sixteen patients who underwent a combination of single-segment OLIF and pedicle screw internal fixation for the treatment of lumbar spinal stenosis at the Affiliated Hospital of Jiangxi University of Chinese Medicine between February 2018 and August 2022. The patients' pre- and post-operative data were compared. Intraoperative bleeding, duration of surgery, visual analogue score (VAS), Oswestry Disability Index (ODI), disc height (DH), cross-sectional area of vertebral canal (CSAVC), cross-sectional area of dural sac (CSADS), cross-sectional area of intervertebral foramen (CSAIF), spinal canal volume (SCV), spinal canal volume expansion rate, lumbar lordosis, and sagittal vertical axis were observed and recorded. The efficacy of OLIF combined with pedicle screw internal fixation for lumbar spinal stenosis on spinal canal changes before and after surgery was summarized.ResultsThe results showed that OLIF combined with pedicle screw internal fixation effectively restored disc height and increased the cross-sectional area of the spinal canal. It also had an indirect decompression effect. The intraoperative bleeding and duration of surgery were within acceptable ranges. The VAS and ODI scores significantly improved after surgery, indicating a reduction in pain and improvement in functional disability. The CSAVC, CSADS, CSAIF, SCV, and spinal canal volume expansion rate were all increased postoperatively. Additionally, there was improvement in lumbar lordosis and sagittal vertical axis. We conducted a follow-up of all patients at 1 year after the surgery. The results revealed that the parameter values at 1 year post-surgery showed varying degrees of decrease or increase compared to the immediate postoperative values. However, these values remained statistically significant when compared to the preoperative parameter values (P < 0.05).ConclusionsOLIF combined with pedicle screw internal fixation effectively restores disc height and increases the cross-sectional area of the vertebral canal in patients with LSS, reflecting the indirect decompression effect. Measuring parameters such as DH, CSAVC, CSADS, CSAIF, SCV, and SCV expansion rate before and after surgery provides valuable information for evaluating the efficacy and functional recovery of the lumbar spine in LSS patients treated with OLIF surgery.

Exercise treatments for lumbar spinal stenosis: A systematic review and intervention component analysis of randomised controlled trials

Objective To analyse the components used in exercise interventions for people with symptoms of neurogenic claudication due to lumbar spinal stenosis and identify components associated with successful interventions. Data sources Eligible papers published up to April 2023 from MEDLINE, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and trial registry websites. Review methods Literature searches were performed by an Information Specialist. We searched for randomised trials evaluating exercise interventions for people with neurogenic claudication symptoms (the primary symptom of lumbar spinal stenosis). Two authors independently performed study selection, data extraction, and quality assessments using the Cochrane Risk of Bias tool Version 2 and the TIDieR checklist for intervention reporting. Details of intervention components were extracted, tabulated, and synthesised using an intervention component analysis approach. Results We found thirteen trials reporting 23 exercise interventions delivered to 1440 participants. These featured 60 different components. Most exercise interventions included supervision and flexion-based exercises. Balance exercises were rarely included. Exercise components featured more frequently in successful interventions included stretches, strength or trunk muscle exercises, fitness exercises, especially cycling, and psychologically informed approaches. Interpretation is limited by low study numbers and heterogeneity. No conclusions could be drawn about exercise supervision or dose. Discussion Exercise interventions for people with neurogenic claudication typically feature multiple components. Common features such as supervision, lumbar flexion, and aerobic fitness exercises and also less common features such as stretches, strengthening exercises, and psychologically informed approaches warrant consideration for inclusion when designing and optimising exercise interventions for people with lumbar spinal stenosis.

Comparison of effectiveness between unilateral biportal endoscopic lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis combined with intervertebral disc herniation

To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation. A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score). Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences ( P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). And there was no significant difference between the two groups at each time point after operation ( P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months ( P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group ( P<0.05). For the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.

Complications and radiographic changes after implantation of interspinous process devices: average eight-year follow-up

PurposeThis study aims to evaluate complications, clinical outcomes, and radiographic results following Coflex implantation.MethodsWe retrospectively studied 66 patients who had decompressive surgery combined with Coflex implantation to treat lumbar spinal stenosis. All imaging data were collected and examined for imaging changes. Clinical outcomes, included Oswestry Disability Index (ODI), back and leg visual analog scale (VAS) scores, were evaluated before surgery, six months after surgery and at the last follow-up. The number of complications occurring after five years of follow-up was counted. All reoperation cases were meticulously recorded.Results66 patients were followed up for 5–14 years. The VAS and ODI scores were significantly improved compared with baseline. Heterotopic Ossification (HO) was detectable in 59 (89.4%). 26 (39.4%) patients had osteolysis at the contact site of Coflex with the spinous process. Coflex loosening was detected in 39 (60%) patients. Spinous process anastomosis was found in 34 (51.5%) patients. There was a statistically significant difference in the VAS score of back pain between patients with and without spinous process anastomosis. Nine cases of lumbar spinal restenosis were observed, and prosthesis fracture was observed in one case.ConclusionOur study identified various imaging changes after Coflex implantation, and majority of them did not affect clinical outcomes. The majority of patients had HO, but osteolysis and Coflex loosening were relatively rare. The VAS score for back pain of these patients was higher if they have spinous process anastomosis. After five-year follow-up, we found lumbar spinal restenosis and prosthesis fracture cases.

Severity of spinal degeneration does not affect the pain reduction under continuous epidural analgesia

PurposeTo outline clinical effectiveness of continuous epidural analgesia (CEA) in patients with failed back surgery syndrome (FBSS) or lumbar spinal stenosis (LSS) depending on severity of spinal degeneration.MethodsIn this retrospective cohort study, all patients with FBSS or LSS who underwent CEA within an inpatient rehabilitation program were evaluated. The pain reduction was measured by VAS on an hourly basis. Substantial pain reduction was defined as a minimal clinically important difference (MCID) > 50%. Severity of spinal degeneration, side effects and patient-specific characteristics were documented.ResultWe included a total of 148 patients with 105 patients suffering from FBSS and 48 with LSS. The average pain reduction was − 37.6 ± 19.2 in FBSS and − 38.1 ± 17.8 in LSS group (p < .001 and p < .001, respectively). In the FBSS group, sensory deficits (p = .047) and numbness (p = .002), and in the LSS group, a severe disability measured by ODI (38.2 ± 15.4 vs. 57.3 ± 11.3, p < .001) significantly contributed to a worse outcome. The severity of the spinal degeneration and psychological disorders did not affect the pain reduction in terms of MCID.ConclusionsThis study provides new evidence about CEA in the treatment of FBSS and LSS. CEA provides a significant pain reduction even under intensified physiotherapeutic exercising in patients with severe spinal degeneration and a broad variety of secondary diagnoses. Neurologic deficits in case of FBSS and severe disability in case of LSS may be risk factors for less favorable outcome.

ChatGPT and its Role in the Decision-Making for the Diagnosis and Treatment of Lumbar Spinal Stenosis: A Comparative Analysis and Narrative Review.

Comparative Analysis and Narrative Review. To assess and compare ChatGPT's responses to the clinical questions and recommendations proposed by The 2011 North American Spine Society (NASS) Clinical Guideline for the Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis (LSS). We explore the advantages and disadvantages of ChatGPT's responses through an updated literature review on spinal stenosis. We prompted ChatGPT with questions from the NASS Evidence-based Clinical Guidelines for LSS and compared its generated responses with the recommendations provided by the guidelines. A review of the literature was performed via PubMed, OVID, and Cochrane on the diagnosis and treatment of lumbar spinal stenosis between January 2012 and April 2023. 14 questions proposed by the NASS guidelines for LSS were uploaded into ChatGPT and directly compared to the responses offered by NASS. Three questions were on the definition and history of LSS, one on diagnostic tests, seven on non-surgical interventions and three on surgical interventions. The review process found 40 articles that were selected for inclusion that helped corroborate or contradict the responses that were generated by ChatGPT. ChatGPT's responses were similar to findings in the current literature on LSS. These results demonstrate the potential for implementing ChatGPT into the spine surgeon's workplace as a means of supporting the decision-making process for LSS diagnosis and treatment. However, our narrative summary only provides a limited literature review and additional research is needed to standardize our findings as means of validating ChatGPT's use in the clinical space.

Research progress of different minimally invasive spinal decompression in lumbar spinal stenosis

To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS). The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized. At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs. The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.

Prolotherapy at Multifidus Muscle versus Mechanical Needling and Sterile Water Injection in Lumbar Spinal Stenosis.

This observational study aimed to compare ultrasound-guided (USG) prolotherapy with 5% dextrose in water (D5W) in the multifidus muscle to USG mechanical needling and sterile water injections for the treatment of lumbar spinal stenosis (LSS). The data was extracted from the medical records of ageing patients with LSS who received USG D5W in the multifidus muscle or USG mechanical needling and sterile water injections for the treatment of LSS by the first author. Low back pain or axial pain and leg pain or radicular pain were assessed by the visual analogue scale, and gait ability with walking distance were obtained at six different time points. Among the 211 older people who were diagnosed with LSS, 104 got USG mechanical needling and sterile water injections over the course of four weeks, while the other 107 got D5W at the multifidus muscles in a single session. Chronic low back pain, radiating pain, and the ability to walk all got much better at 1 and 3 months after the intervention, compared to VAS measures taken at the start. Patients who underwent mechanical needling with injections of sterile water performed consistently and significantly better than those who received prolotherapy in the multifidus muscles on all measures at 1, 3, and 6 months. After receiving USG mechanical needling and sterile water, LSS patients reported significant improvements in low back pain, radicular pain, and ability to walk for at least 6 months. Prolotherapy with D5W in the multifidus muscle has a moderate effect for only three months.

Effectiveness of non-surgical treatment combined with supervised exercise for lumbar spinal stenosis: A systematic review and meta-analysis.

The benefits of combining supervised exercise in the non-surgical treatment of lumbar spinal stenosis (LSS) is unclear. To compare the effectiveness of non-surgical treatments with and without supervised exercise for pain intensity, symptom severity, functional impairment/disability, walking distance, and quality of life (QOL) in LSS patients. Randomized controlled trials (RCTs) evaluating combinations of supervised exercises were searched using four electronic databases up to August 13, 2020. Meta-analysis was conducted for immediate and long-term results. Three studies were identified, including 244 participants. Immediate-term results showed that leg pain intensity (mean distance [MD]: -0.94, 95% confidence intervals [95% CI]: -1.60 to -0.29, p< 0.01) and symptom severity (MD: -0.29, 95% CI: -0.50 to -0.08, p< 0.01) were lower in the study group than in the control group, and walking distance (MD: 415.83, 95% CI: 298.15-533.50, p< 0.001) and QOL were higher in the study group. Long-term results showed that functional disability/impairment (MD: 0.27, 95% CI: -0.49 to -0.04, p< 0.05) was lower in the study group than in the control group, and walking distance and QOL were higher in the study group. The number of studies on this topic was small and limited. Combinations of non-surgical treatment and supervised exercise may not provide significant benefits.

Comparison of biportal endoscopic technique and uniportal endoscopic technique in Unilateral Laminectomy for Bilateral Decomprssion (ULBD) for lumbar spinal stenosis

ObjectiveUnilateral laminotomy for bilateral decompression (ULBD) has been adopted widely to treat lumbar spinal stenosis (LSS). The objective of the study is to investigate clinical and radiological outcomes of the biportal endoscopic ULBD (BE-ULBD) and uniportal endoscopic ULBD (UE-ULBD). MethodsWe collected retrospectively 65 patients’ data who met the inclusion criteria (July 2019–June 2021). 33 patients underwent BE-ULBD surgery, and 32 patients underwent the UE-ULBD surgery, and were followed up for at least 1 year. The following preoperative and postoperative outcomes were compared between groups: the visual analog scale (VAS) for pain, the Oswestry disability index (ODI) for nerve function, and modified Macnab criteria for satisfaction, the cross-sectional area of the dural sac (DSCSA), the mean angle of facetectomy. ResultsAge, BMI, gender, levels of involvement and duration of symptoms were not significantly different at baseline in this study. Clinical data showed that postoperative ODI, VAS scores and Modified Macnab Criteria were not statistically different between the two groups. The BE-ULBD group had a shorter operation time than the UE-ULBD group (P < 0.001). Patients in the BE-ULBD group had a larger postoperative expansion of DSCSA expansion postoperatively (85.58 ± 3.16 mm2 VS 71.43 ± 3.35 mm2, P < 0.001) and a larger contralateral facetectomy angle (63.95 ± 3.34° vs 57.80 ± 3.43°, P < 0.001) compared with patients in the UE-ULBD group. There were no statistical differences in the incidence of postoperative complications between the two groups. ConclusionBoth the BE-ULBD and the UE-ULBD yielded clinical improvement in terms of pain and stenosis symptoms. The BE-ULBD technique has the advantages of the shorter operation time, larger DSCSA expansion and larger contralateral facetectomy angle.

Analysis of the efficacy of percutaneous spinal endoscopic surgery in the treatment of lumbar spinal stenosis.

Analysis of the efficacy of percutaneous spinal endoscopic surgery in the treatment of lumbar spinal stenosis.