Treatment Of Lumbar Stenosis Research Articles

Decompression Alone vs Decompression and Fusion: Spin in Abstracts of Systematic Reviews and Meta-Analysis.

Cross-sectional. Spin, a prevalent bias, can distort outcomes in well-validated research. Treatment of lumbar stenosis with spondylolisthesis through decompression alone (DA) vs decompression and fusion (DF) remains a controversial topic. We aimed to identify the prevalence of spin in meta-analyses and systematic reviews regarding DA vs DF in the treatment of spinal stenosis with concomitant degenerative spondylolisthesis. MEDLINE, Web of Science, and Google Scholar were searched for meta-analyses and systematic reviews comparing DA vs DF treatment of lumbar spinal stenosis accompanied by degenerative spondylolisthesis. Each study was evaluated for the nine most severe spin types. We also explored the association between spin and methodological quality of a systematic review using the revised A Measurement Tool to Assess Systematic Reviews appraisal tool. The search yielded 1506 articles, of which 13 met inclusion. It was found that 46.2% (6/13) of the articles contained spin within the abstract. Of the nine most severe types, type 5 was found to be the most prevalent (4/13, 30.8%), followed by types 9 (2/13, 15.4%), 3 (1/13, 7.7%), 4 (1/13, 7.7%), and 6 (1/13, 7.7%). Spin types 1, 2, 7 and 8 were not found. According to AMSTAR-2, 53.8% (7/13) of the studies were appraised as "critically low" quality and 46.2% (6/13) as "low" quality. This study demonstrated the presence of spin in 46.2% of abstracts pertaining to the treatment for spinal stenosis with degenerative spondylolisthesis. Spine surgeons should learn to recognize spin as they review articles before implementing them into practice.

Lumbar Decompression With and Without Fusion for Lumbar Stenosis With Spondylolisthesis: A Cost Utility Analysis.

Markov model. To compare the cost-effectiveness of lumbar decompression alone (DA) with lumbar decompression with fusion (DF) for the management of adults undergoing surgery for lumbar stenosis with associated degenerative spondylolisthesis. Rates of lumbar fusion have increased for all indications in the United States over the last 20 years. Recent randomized controlled trial data, however, have suggested comparable functional outcomes and lower reoperation rates for lumbar decompression and fusion as compared with DA in the treatment of lumbar stenosis with degenerative spondylolisthesis. A multistate Markov model was constructed from the US payer perspective of a hypothetical cohort of patients with lumbar stenosis with associated spondylolisthesis requiring surgery. Data regarding clinical improvement, costs, and reoperation were generated from contemporary randomized trial evidence, meta-analyses of recent prospective studies, and large retrospective cohorts. Base case, one-way sensitivity analysis, and probabilistic sensitivity analyses were conducted, and the results were compared with a WTP threshold of $100,000 (in 2022 USD) over a two-year time horizon. A discount rate of 3% was utilized. The incremental cost and utility of DF relative to DA were $12,778 and 0.00529 aggregated quality adjusted life years. The corresponding incremental cost-effectiveness ratio of $2,416,281 far exceeded the willingness to pay threshold of $100,000. In sensitivity analysis, the results varied the most with respect to rate of improvement after DA, rate of improvement after lumbar decompression and fusion, and odds ratio of reoperation between the two groups. Zero percent of one-way and probabilistic sensitivity analyses achieved cost-effectiveness at the willingness-to-pay threshold. Within the context of contemporary surgical data, DF is not cost-effective compared with DA in the surgical management of lumbar stenosis with associated spondylolisthesis over a two-year time horizon.

Clinical, radiological, and functional evaluation of surgical treatment in degenerative lumbar canal stenosis

Background: Low-back pain (LBP) is extremely prevalent and is the one of the most common causes for people to seek medical attention. As life expectancy continue to increase, prevalence of symptomatic spinal stenosis will increase. Although lumbar stenosis is not life-threatening, it can cause chronic and sustained pain and can limit activity severely. Early, accurate diagnosis, and treatment of lumbar stenosis is important in preserving activity in elderly population. Aims and Objectives: The study was conducted to find the incidence of degenerative lumbar canal stenosis (LCS) among patients of LBP, to evaluate clinicoradiological profile and to evaluate the outcome and complications in the surgically treated patients of degenerative LCS. Materials and Methods: This prospective study included all patients admitted with LCS under department of neurosurgery, GR medical college and associated J.A. group of Hospitals from December 2021 to December 2022 who underwent surgery. No randomization done. Results: Out of total 48 patients, 58% were males while 42% were females, 62.5% of patients were of more than 40 years of age, all patients were having LBP and 64.5% of patients were having LBP for the past 1 year. After surgical management, 87.5% of patients shows improvement in symptoms in Oswestry disability index and Visual analog scale scales. Conclusion: Overall good surgical outcome is obtained and better surgical results in degenerative LCS compared to other studies. Patients with degenerative LCS presenting with back pain and associated neurological deficit are successfully managed with surgical treatment in this study.

499 Prospective, Randomized and Controlled Multicenter Study of Posterior Lumbar Facet Arthroplasty for the Treatment of Spondylolisthesis

INTRODUCTION: Prospective, Randomized and Controlled Multicenter Study of Posterior Lumbar Facet Arthroplasty for the Treatment of Spondylolisthesis. METHODS: The study was a prospective, randomized, controlled Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trial evaluating the investigational TOPS device to the control, transforaminal interbody fusion (TLIF) and pedicle screw fixation. Follow-up duration was a minimum twenty-four months. RESULTS: A total of 249 patients were evaluated comparing the investigational TOPS group (n = 170) to the control TLIF group (n = 79. There were no statistically significant differences between implanted levels (L4-5 TOPS 95%; L4-5 TLIF 95%) or blood loss. The overall composite measure for clinical success was statistically significantly higher in the TOPS group, 85%, compared to the fusion group, 64% (p = 0.0138). The percentage of subjects reporting minimum 15-point improvement in ODI showed a statistically significant difference (p-value = 0.037) favoring TOPS (94.0%) over TLIF (79.4%). CONCLUSIONS: This study demonstrates that posterior lumbar decompression and dynamic stabilization with the TOPS device is safe and efficacious in the treatment of lumbar stenosis with degenerative spondylolisthesis. Additionally, decompression and dynamic stabilization with the TOPS device maintains segmental motion.

SURGICAL MANAGEMENT OF LUMBAR STENOSIS IN THE PRESENCE OF DEGENERATIVE SPONDYLOLISTHESIS: ARE DECOMPRESSION AND FUSION OR INTERSPINOUS PROCESS DEVICE SUPERIOR TO DECOMPRESSION ALONE? A SYSTEMATIC REVIEW AND META-ANALYSIS

AimsTo compare the efficacy of decompression alone (DA) with i) decompression and fusion (DF) and ii) interspinous process device (IPD) in the treatment of lumbar stenosis with degenerative spondylolisthesis. Outcomes of interest were both patient-reported measures of postoperative pain and function, as well as the perioperative measures of blood loss, operation duration, hospital stay, and reoperation.MethodsData were obtained from electronic searches of five online databases. Included studies were limited to randomised-controlled trials (RCTs) which compared DA with DF or IPD using patient-reported outcomes such as the Oswestry Disability Index (ODI) and Zurich Claudication Questionnaire (ZCQ), or perioperative data.Patient-reported data were reported as part of the systematic review, while meta-analyses were conducted for perioperative outcomes in MATLAB using the DerSimonian and Laird random-effects model. Forest plots were generated for visual interpretation, while heterogeneity was assessed using the I2-statistic.ResultsA total of 13 articles met the eligibility criteria. Of these, eight compared DA with DF and six studies compared DA with IPD. Patient-rated outcomes reported included the ODI and ZCQ, with mixed results for both types of comparisons. Overall, there were few statistically significant and no clinically significant differences in patient-rated outcomes. Study quality varied greatly across the included articles.Meta-analysis of perioperative outcomes revealed DF to result in greater blood loss than DA (MD = 406.74 ml); longer operation duration (MD = 108.91 min); and longer postoperative stay in hospital (MD = 2.84 days). Use of IPD in comparison to DA led to slightly reduced operation times (MD = –25.18 min), but a greater risk of reoperation compared to DA (RR = 2.70).ConclusionCurrently there is no evidence for the use of DF or IPD over DA in both patient-rated and perioperative outcomes. Indeed, both procedures can potentially lead to greater cost and risk of complications, and therefore, a stronger evidence base for their use should be established before they are promoted as routine options in patients with degenerative spondylolisthesis.

Pain and neurogenic claudication control in lumbar stenosis, which is the most common cause of spinal surgery in the geriatric population.

The authors aim to present when to do physical therapy or surgery in geriatric patients with degenerative lumbar stenosis. The authors retrospectively analyzed 250 patients who underwent physical therapy due to lumbar degenerative stenosis between December 2014 and April 2017. The patients were divided into two groups: Central canal stenosis and lateral recess/foraminal stenosis groups. Visual analogue scale and neurological claudication values of both patient groups were evaluated before and after physical therapy. The association between comorbid diseases and the frequency of surgery was also evaluated. 142 of the patients were female and 108 were male, and the mean age of these patients was 69 years. The mean onset of symptoms was 55 months. In the visual analog scale value of patients after physical therapy, the authors observed decreases of 4-6° in patients with central canal stenosis and 2-3° in patients with lateral recess/foraminal stenosis. In addition, the authors observed that patients with lateral recess/foraminal stenosis together with diabetes mellitus benefit less from physical therapy. Physical therapy and rehabilitation play an important role in the treatment of lumbar stenosis. Physical therapy is the primary treatment option for patients who do not have motor muscle strength losses and incontinence and who have pain control through medications. The authors can consider surgical interventions in patients with lateral recess/foraminal stenosis who do not benefit from physical therapy at a satisfactory level.

Spinal lumbar stenosis (analysis of the literature and own results)

The article is devoted to the issues of etiology, pathophysiology and clinical manifestations of spinal stenosis of the lumbar spine. The possibilities of modern instrumental diagnostics of the disease are described, the differential clinical diagnosis of lumbar stenosis is presented. The paper presents a detailed classification of spinal stenosis. The modern therapeutic tactics of the disease are described, indications for the surgical treatment of the disease are given. Modern methods of surgical treatment of stenosis are briefly and schematically described: decompression (microsurgical and endoscopic), interspinous fixation, stabilization (dorsal and ventral) and epidural stimulation of the spinal cord. The data on the immediate and long-term results of surgical methods of treatment are presented. The authors also presented their experience in the treatment of spinal stenosis of the lumbar spine. The use of differentiated surgical treatment tactics in 85–90 % of cases provides good and excellent results in the treatment of lumbar stenosis.

Experience in the use of dynamic interspinous fixation in the treatment of lumbar spine stenosis

The results of surgical treatment of lumbar stenosis using the dynamic intercostal fixator Coflex in the period from September 2016 to February 2019 were analyzed in 36 patients, 25 of them with monosegmental stenosis, 11 with two levels. Caudogenic intermittent claudication was observed in 27 patients. Dynamic interspinous fixation was performed on38 vertebral-motor segments of the lumbar. Assessment of the quality of life and the intensity of pain in the back and leg before and after the operation, as well as the outcome of the operation in the distant period after the operation, was carried out by validated scales and questionnaires. There were no intraoperative complications. In the distant period after surgery, the results of control functional spondylography of the lumbar revealed a direct dependence of the mobility of the operated vertebral-motor segment on the value of the disk height index. In all observations, a decrease in the mobility of the operated level was noted, which indicated the high-quality functioning of the interspinous implant. An increase in the height of the intervertebral foramen additionally provided indirect decompression of the spinal nerve in all cases. Syndrome of caudogenic intermittent claudication by the time of discharge regressed in all cases. For the period of observation of cases of development of postoperative instability and restenosis at the operated level was not noted. Satisfactory outcomes were obtained in 33 (91,7%), and unsatisfactory outcomes in 3 (8,3%) cases. Unsatisfactory outcomes in two cases were due to chronic pain in the lower back due to symptomatic stenosis of the spinal canal at an adjacent level, and in one observation, severe pain in the right leg due to the formation of sequestered herniated discs at an adjacent level. In general, interspinous dynamic stabilization has proven itself in the treatment of spinal stenosis of the lumbar spine, as the completion of the operation after the decompression phase.

Stenosis of the vertebral canal of the lumbar spine

The overall incidence of symptomatic lumbar spinal stenosis is about 1015% among persons aged 5070 years. Due to the aging of the population, the incidence of this pathology is constantly growing. The desire of older patients to preserve their quality of life and their functional abilities, along with the improvement of surgical techniques, leads to an increase in the number of surgical interventions for lumbar stenosis. This publication describes the classification of spinal canal stenosis. The clinical picture of this disease has been studied in detail. A special attention is paid to such diagnostic methods as computed tomography (CT), radiography, CT-myelography, magnetic resonance imaging (MRI). Various methods of surgical treatment decompression and decompression-stabilization are described in detail.. The efficiency of various types of decompression operations are 7280%, the results of surgery not differing statistically between the types of decompression (hemilaminectomy, interlaminectomy). Decompression-stabilization operations are used for progressive degenerative spinal deformity, destabilization after the surgical treatment, and disruption of the vertebral-pelvic relations. Currently, the following types of stabilization are used in the lumbar stenosis surgery: ALIF, PLIF, PLF, TLIF, XLIF, OLIF, and transpedicular fixation. The rate of complications in the stabilizing interventions is 27.6%; after decompression operations 9.7%. The frequency of revision operations is also higher after stabilization 10.3%, while after decompression it is 6.5%, which makes us cautious about these types of interventions. Systems of interosseous fixation are also used in the treatment of lumbar stenosis. In the 14 years of followup after interosseous fixation and decompression in 142 patients, 30 (21.1%) patients underwent revision interventions, with chronic pain (38.5%) and disc herniation (42.3%) being the main indication for repeated surgery in 26 of them.

Randomized trial of 3-drug combination for lumbar nerve root epidural injections with a TNF-α inhibitor in treatment of lumbar stenosis

Background: This study was to assess the clinical efficacy of epidural injections with tumor necrosis factor-alpha (TNF-α) inhibitor in patients with chronic radicular pain caused by lumbar spinal stenosis (LSS).Methods: In a randomized controlled trial (RCT), patients diagnosed with mild-to-moderate LSS underwent epidural intervention with three different drugs and were allocated to TNF-α inhibitor group (Group A), steroid group (Group B) and lidocaine-only group (Group C). All patients were evaluated by visual analog scale (VAS) for leg pain and Oswestry disability index (ODI) to assess function. They all received a 6-month follow-up.Results: Ninety patients were randomly assigned to three groups, for 30 cases in each group. A total of 82 participants (91.1%) completed the follow-up. Pain relief and improvement of movement function after epidural administration in Group A were more significant than those of groups B and C (p < .05) during the 6-month follow-up, while it showed no significant difference between groups B and C (p > .05).Conclusions: Our results indicated that epidural administration with TNF-α inhibitor may be a useful conservative method for the treatment of radicular pain caused by LSS. Trial registration: ClinicalTrials.gov Identifier: NCT04062474.

PRELIMINARY RESULTS OF VERTEBRAL CANAL DECOMPRESSION BY SPINOUS PROCESS SPLITTING

ABSTRACT Objective Considering that the technique of spinous process splitting has been advocated as a less invasive treatment of lumbar stenosis, the objective of this study was to evaluate the preliminary results of this technique in the surgical treatment of lumbar canal stenosis. Methods Twenty patients with lumbar spinal canal stenosis who underwent surgical treatment for lumbar canal decompression with the spinous process splitting technique were assessed in the preoperative period and on postoperative days 1, 7 and 30 for VAS for lower back and lower limbs pain and radiographic evaluation of the operated segment. Results The mean visual analogue scale score for lumbar pain in the preoperative assessment was 4.2 ± 3.37 and 0.85 ± 0.88, 1.05 ± 1.19 and 1.15 ± 1.04 after 1, 7 and 30 postoperative days, respectively. The mean VAS score for lower limb pain was 8 ± 1.72 preoperatively, and 0.7 ± 1.13, 0.85 ± 1.04, and 1.05 ± 1 after 1, 7, and 30 postoperative days, respectively. There were no radiographic signs of instability of the vertebral segment operated in the radiographic evaluation. Conclusions Decompression of the lumbar canal through the spinous process splitting technique in patients with lumbar canal stenosis had good immediate and short-term results in relation to low back and lower limbs pain. Level of evidence IV; Therapeutic Study.

Efficacy of Endoscopic Surgery in Management of Patients with Lumbar Canal Stenosis

Background Data: The treatment of lumbar stenosis has originally included extensive resections of posterior neural arch components. Moreover, wide muscular dissection and retraction is generally used to accomplish sufficient visualization. With the advancing noninvasive neuro-imaging modalities; the major component of neurological pressure typically occurs at the level of the interlaminar window. Microendoscopic decompressive laminotomies (MEDL) have now increased popularity among spine specialists for the treatment of lumbar canal stenosis. It has been developed from the unilateral hemilaminotomy technique.Purpose: To evaluate the efficacy of lumbar endoscopic decompression in patients of segmental lumbar canal stenosis from a unilateral skin incision.Study Design: A prospective clinical case study.Patients and Methods: A total of 30 patients 10 males and 20 females were operated in Alexandria Main University Hospital, during the period from January 2013 to June 2015. The degree of pain and disability were assessed pre-operatively using the Visual Analogue Scale (VAS), both for radicular pain and back pain (if present), and the Oswestry Disability Index (ODI). The length of the incision, the duration of surgery, the operative blood loss, and duration of hospital stay were calculated. Mean follow up period for patients was 38.5±18.2 months (Range, 36-48).Results: The mean age was 62.7±6.9 years. All patients had claudicating sciatica; 57% had bilateral sciatica, while 43 % had unilateral sciatica. 60% had low back pain. Only 3 patients (10%) had motor weakness preoperatively. 24 patients (80%) had single level affection, while 6 patients (20%) had double level affection. We operated totally on 36 segmental levels. There was a statistically significant reduction for the mean values of VAS both for radicular pain and back pain in the follow up period (P<0.001). Also, there was a statistically significant reduction for the ODI mean value in the follow up period (P<0.001). Operative blood loss was 109.5±63.2 ML. Mean operative time was 103.8±32.7 minutes. Mean duration of hospital stay was 1.5±0.6 days (Range, 1-3 days). We had two patients of intraoperative dural tears (7%) with no postoperative CSF leak occurred, two patients (7%) had superficial wound infection, no patients had deep wound infection or discitis, and no patients encountered of postoperative instability in the follow up period. Conclusion: Endoscopic surgery for bilateral decompression through a unilateral approach is a useful and effective procedure for treating patients with lumbar canal stenosis with encouraging results. (2018ESJ161)

Comparison of the Minimally Invasive and Conventional Open Surgery Approach in the Treatment of Lumbar Stenosis: A Systematic Review and a Meta-Analysis

Minimally invasive surgery (MIS) is increasingly used in the treatment of lumbar stenosis. However, it is still not clear if the employment of minimally invasive surgical techniques can achieve superior clinical outcomes compared to standard open laminectomy. An extensive literature review regarding the clinical outcome, safety, and efficiency of MIS and standard open surgery (OS) in the treatment of lumbar stenosis was conducted on Medline, Cochrane, EMBASE, and Google Scholar databases up to 19 August 2016. Sixteen studies that enrolled a total of 1580 patients with surgically-indicated lumbar stenosis were identified; 793 patients underwent MIS and 787 patients underwent conventional OS. No significant difference was found in the improvement of Oswestry Disability Index (ODI) (P = 0.718) and operation time (P = 0.322) between patients from different treatment groups. MIS was associated with better visual analogue scale (VAS) for back pain (P = 0.01), shorter length of hospital stay (P <0.001), and lower blood loss (P <0.001). Our findings indicate that both MIS and standard OS can effectively manage patients with lumbar stenosis and lead to comparable clinical outcomes. Further studies are necessary to evaluate MIS with different types of conventional surgery for lumbar stenosis.

Outcome after Surgery of Lumbar Spinal Stenosis: A Randomized Comparison of Bilateral Laminotomy, Trumpet Laminectomy, and Conventional Laminectomy.

Laminectomy is the traditional operating method for the decompression of spinal canal stenosis. New partial decompression processes have been suggested in the treatment of lumbar stenosis. The benefit of a micro surgical approach is the chance of an extensive bilateral decompression of the spinal canal or foramen at one or numerous levels, through a minimal para-spinal muscular separation. To match the safety and the clinical consequences after a bilateral laminotomy, laminectomy and trumpet laminectomy in patients with lumbar spinal stenosis who were randomized to one of three treatment groups. Prospective study. One hundred twenty consecutive patients with 227 levels of lumbar stenosis without significant herniated discs or instability were randomized to three treatment groups [bilateral laminotomy (Group 1), laminectomy (Group 2), and trumpet laminectomy (Group 3)]. Perioperative parameters and complications were documented. Symptoms and scores, such as a visual analog scale (VAS), Oswestry Disability Index, and patient satisfaction, were assessed preoperatively at 3, 6, and 12 months after surgery. Adequate decompression was achieved in all patients on the basis of surgeon satisfaction. The global complication rate was lowest in patients who had undertaken bilateral laminotomy (Group 1). The minimum follow-up of 12 months was achieved in 100% of patients. Matched with that experience in Group 1, but, with more remaining back and leg pain was found in Group 2, 3.85 ± 0.28 and 1.60 ± 0.44, respectively and 3.24 ± 0.22 and 2.44 ± 0.26 in Group 3, respectively compared with 1.84 ± 0.28 and 1.25 ± 0.12 (Group 1) at the 1-year follow-up assessment (p < 0.05). It was the same for the ODI scores, which reached 14 ± 8% (Group 1), 28 ± 12% (Group 2), and 26 ± 16 after 12 months of surgery (Group 3) (significant, p < 0.01 compared with preoperative scores). Patient satisfaction was higher in Group 1, with 7.5, 20, and 25% of patients displeased (in Groups 1, 2, and 3, respectively; p < 0.01). Bilateral Laminotomy is certified acceptable and harmless in decompression of lumbar stenosis, causing a highly significant decrease of symptoms and disability.

Decompression versus decompression and fusion for degenerative lumbar stenosis: analysis of the factors influencing the outcome of back pain and disability

The objective of this study is to evaluate the factors influencing the outcome of back pain and disability in patients operated for lumbar stenosis without instability and deformity using two classical surgical techniques: decompression alone and decompression plus fusion. This is a retrospective cohort study of patients who underwent lumbar surgery with standard posterior decompression or standard posterior decompression plus pedicle screw fixation for degenerative lumbar stenosis without deformity, spondylolisthesis or instability at our department from June 2010 to January 2014. They were divided into two groups: decompression group (D) and decompression-fusion group (F). We analyzed the following factors: age, gender, levels of stenosis, pre-surgical "micro-instability", and post-surgical "micro-instability". A total of 174 patients were enrolled in the study. Both Graphic Rating Scale (GRS) and Oswestry Disability Index (ODI) scores were significantly decreased after surgery (P<0.001). Female patients appeared to have lesser improvements from surgery, for both D and F groups. An analysis of variance using the decrease of pain (GRS pre-post) as dependent variable and type of surgery, age, gender and their interaction as factors showed that the main effects of type of surgery and gender were significant. The analysis of variance for the decrease of pain (GRS) and disability (ODI) according to the levels of stenosis showed a significant interaction for GRS scores. Female patients that underwent fixation surgery reported the least improvement in disability. A significant interaction was found on the one-way analysis of variance for the D group without pre-surgical micro-instability using post-surgical micro-instability as factor. Our study supports posterior decompression alone as the gold standard option as treatment for lumbar stenosis without instability and deformity. Additional fusion should be considered only to prevent post-surgical instability. The "micro-instability" is a radiological finding that has its clinical surrogate but is not able to guide the choice of the type of surgery. Moreover the significance of "micro-instability" is still unclear. We suggest a prospective study following patients with asymptomatic micro-instability to definitively understand the clinical history.

Biomechanics and Management of Lumbar Spinal Stenosis Neurodegenerative Disease: Mini-Review

Lumbar stenosis is an increasingly common pathology, which causes significant symptoms affecting quality of life, especially in the aging population. The mainstays of treatment employ both conservative and surgical management. Should surgery be required decompression of the lumbar spine via laminectomy or laminotomy has been shown to be effective. The addition of fusion may only benefit in cases with spinal instability. The treatment of lumbar stenosis should include a multifactorial and multidisciplinary approach. Lumbar fusion may lead to an adjacent segment disease as a result of endplate failure by promoting a lumbar alignment with parallel endplates. Upright MRI could be a useful adjunct objective diagnostic option in the future to differentiate symptomatic from asymptomatic patients by evaluating their foraminal geometry.

Depression Predicts Worse Quality of Life Outcomes Following Nonoperative Treatment for Lumbar Stenosis

Depression Predicts Worse Quality of Life Outcomes Following Nonoperative Treatment for Lumbar Stenosis

Controversies about Interspinous Process Devices in the Treatment of Degenerative Lumbar Spine Diseases: Past, Present, and Future

A large number of interspinous process devices (IPD) have been recently introduced to the lumbar spine market as an alternative to conventional decompressive surgery in managing symptomatic lumbar spinal pathology, especially in the older population. Despite the fact that they are composed of a wide range of different materials including titanium, polyetheretherketone, and elastomeric compounds, the aim of these devices is to unload spine, restoring foraminal height, and stabilize the spine by distracting the spinous processes. Although the initial reports represented the IPD as a safe, effective, and minimally invasive surgical alternative for relief of neurological symptoms in patients with low back degenerative diseases, recent studies have demonstrated less impressive clinical results and higher rate of failure than initially reported. The purpose of this paper is to provide a comprehensive overview on interspinous implants, their mechanisms of action, safety, cost, and effectiveness in the treatment of lumbar stenosis and degenerative disc diseases.

A morphometric study of the lumbar interspinous space in 100 stanford university medical center patients.

ObjectiveWith the increased use of interspinous spacers in the treatment of lumbar stenosis, knowledge of the geometry of the interspinous space is important. To prevent dislodgment of an interspinous spacer, the accurate depth and width of the interspinous space needs to be established to facilitate the best intraoperative selection of correct spacer size.MethodsTo determine the depth and width of the interspinous space, two methods are available which utilize plain film and magnetic resonance imaging (MRI). Data analysis of the interspinous depth and width was undertaken in 100 patients.ResultsThe standard deviations were variable, since skin thickness (zone 1) was altered by sex and age. The difference in the zone 1 distance between adjacent interspinous processes varied according to gender (p<0.05), but was not influenced by age [p=0.32 by analysis of variance between groups (ANOVA)]. Zone 2, the supraspinous, and zone 3, the interspinous ligament depths, comprise the operative working area during insertion of an interspinous spacer. There were no differences with regard to gender or age (p>0.05). For zones 6 and 7, the interspinous distances at the narrowest and widest points, respectively, were found to decrease with the aging process, but the decrease was not statistically significant. There were no differences with regard to gender (p>0.05).ConclusionThis study provides additional information on the interspinous space. This statistical data are valuable for use in the design of interspinous spacers.

Study on the health-related quality of life after surgical treatment for lumbar stenosis

Lumbar stenosis (LS) affected middle-aged people and may cause severe symptoms and functional impairment at lower limbs. We conducted a study in China to assess the HRQoL in patients operated on for LS, and investigate the possible determinants of HRQoL. From June 2008 to June 2010, 60 patients have been surgically treated for lunbar stenosis in our Hospital. The medical outcomes study short Form 36 (SF-36) was used to measure the quality of life before and after surgery. With regard to the results of the general quality of life tool (SF-36), we observed a significant improvement of HRQoL, JOY score and improvement rate of LS patients after surgery for 3 months (p 11) was related to both lower MCS and PCS scores (For MCS, OR=1.8, 95% CI=1.1-2.3; for PCS, OR=1.7, 95% CI=1.1-2.2). A significant dose-respondence relationship was found between the JOY score and HRQoL. In conclusion, our study showed the surgery for lumbar stenosis could greatly improve the HRQoL of patients. Age, sex and JOY score were associated with physical or mental HRQoL after surgery for LS. Key words: Health-related quality of life (HRQoL), surgical treatment, lumbar stenosis, outcome assessment, JOY score.