Underwent Decompression Surgery Research Articles

Decompression Surgery Alone Versus Decompression Plus Fusion in Symptomatic Lumbar Spinal Stenosis: A Swiss Prospective Multicenter Cohort Study With 3 Years of Follow-up.

Retrospective analysis of a prospective, multicenter cohort study. To estimate the added effect of surgical fusion as compared to decompression surgery alone in symptomatic lumbar spinal stenosis patients with spondylolisthesis. The optimal surgical management of lumbar spinal stenosis patients with spondylolisthesis remains controversial. Patients of the Lumbar Stenosis Outcome Study with confirmed DLSS and spondylolisthesis were enrolled in this study. The outcomes of this study were Spinal Stenosis Measure (SSM) symptoms (score range 1-5, best-worst) and function (1-4) over time, measured at baseline, 6, 12, 24, and 36 months follow-up. In order to quantify the effect of fusion surgery as compared to decompression alone and number of decompressed levels, we used mixed effects models and accounted for the repeated observations in main outcomes (SSM symptoms and SSM function) over time. In addition to individual patients' random effects, we also fitted random slopes for follow-up time points and compared these two approaches with Akaike's Information Criterion and the chi-square test. Confounders were adjusted with fixed effects for age, sex, body mass index, diabetes, Cumulative Illness Rating Scale musculoskeletal disorders, and duration of symptoms. One hundred thirty-one patients undergoing decompression surgery alone (n = 85) or decompression with fusion surgery (n = 46) were included in this study. In the multiple mixed effects model the adjusted effect of fusion compared with decompression alone surgery on SSM symptoms was 0.06 (95% confidence interval: -0.16-0.27) and -0.07 (95% confidence interval: -0.25-0.10) on SSM function, respectively. Among the patients with degenerative lumbar spinal stenosis and spondylolisthesis our study confirms that in the two groups, decompression alone and decompression with fusion, patients distinctively benefited from surgical treatment. When adjusted for confounders, fusion surgery was not associated with a more favorable outcome in both SSM scores as compared to decompression alone surgery. 3.

Post-tetanic transcranial motor evoked potentials augment the amplitude of compound muscle action potentials recorded from innervated and non-innervated muscles

Background ContextTranscranial electrical stimulation used to produce motor evoked potentials (TES-MEPs) and subsequent compound muscle action potential (CMAP) recording is widely used to monitor motor function during surgery when there is risk of damaging the spinal cord. Nonetheless, some muscles do not produce CMAP amplitudes sufficient for intraoperative monitoring. PurposeThis study aimed to investigate the utility of tetanic stimulation at single and multiple peripheral nerve sites for augmenting CMAP amplitudes recorded from innervated and non-innervated muscles. Study Design/SettingA retrospective study was carried out. Patient SampleThe study sample comprised 24 patients with cervical myelopathy who underwent decompression surgery at our department between November 2005 and March 2007. Outcome MeasuresCompound muscle action potential amplitude was a physiological measure. MethodsWe used two patterns of tetanic peripheral nerve stimulation for each patient. The first pattern consisted of tetanic stimulation of the left tibial nerve only (Pattern 1), and the second pattern consisted of tetanic stimulation of the bilateral median nerves and left tibial nerve (Pattern 2). ResultsCompound muscle action potential amplitudes from all muscles were augmented by both tetanic stimulation patterns compared with conventional TES-MEP recording; however, Pattern 2 elicited the greatest augmentation of CMAP amplitudes, especially for CMAPs recorded from the bilateral abductor pollicis brevis muscles. ConclusionsAlthough tetanic stimulation of a single peripheral nerve increased CMAP amplitudes recorded from both innervated and non-innervated muscles, CMAP amplitudes were best augmented when the corresponding nerve received tetanic stimulation. Additionally, tetanic stimulation of multiple nerves rather than a single nerve appears to provide better augmentation.

359 Combinatorial Surgical and Neuroprotective Therapy for Cervical Spondylotic Myelopathy Results in Improved Neurological Function

Abstract INTRODUCTION Surgical decompression is an effective treatment for cervical spondylotic myelopathy (CSM). However, a number of patients continue to experience substantial neurological impairment post surgery. Riluzole has neuroprotective effects in injuries of the central nervous system. To determine the efficacy of riluzole for promoting neurological improvement in CSM following decompression, we performed a pre-clinical proof of concept experiment and then we translated our work and established a Phase III multi-center randomized controlled clinical trial (CSM-Protect). METHODS Surgical decompression was performed in a rat CSM model and riluzole, or control, was administered. Spinal cord blood flow (SCBF) was evaluated in all CSM rats, in vivo, before and after decompression using FAIR MRI. The long-term outcomes of decompression with or without riluzole treatment determined using neurobehavioural and neuroanatomical assessments. Our multi-center double-blind randomized CSM-Protect trial includes a total of 300 CSM patients undergoing decompression surgery and randomized 1:1 to receive riluzole (2 × 50 mg daily for 14 days before and 28 days post surgery) or placebo treatment. MJOA score will determine the effectiveness of the combinatorial treatment at 6 months following surgery. Statistical analysis will be performed as a sequential adaptive trial with interim analysis. RESULTS >Rats receiving combinatorial treatment displayed long-term significant neurological improvements associated with preservation of motor neurons and corticospinal tracts compared to rats treated with decompression alone. Riluzole also dramatically reduced the extent of ischemia-reperfusion injury post surgical decompression in our animal model. At present, 285 subjects have been enrolled into the CSM-Protect trial. A planned interim analysis using this sample has commenced. CONCLUSION The proposed combinatorial therapy promotes neurological recovery in CSM rats. Confirmation of this proof of concept has been translated from bench to the bedside and we are currently running the CSM-Protect trial to determine the efficacy of this combinatorial treatment option for use in CSM patients.

Is it safe to perform lumbar spine surgery on patients over eighty five?

The purpose of this study was to evaluate the safety and tolerance of lumbar spine surgery in patients over 85. Patients over 85 years of age with LSS who underwent decompression surgery with or without fusion between February 2011 and July 2014 were included. Comorbidities, autonomy (Activities of Daily Life and Braden scales), surgical parameters and complications (Clavien-Dindo classification) were collected. A telephone survey was performed to assess survival and patients' satisfaction at last follow-up. Mean follow-up was 27.4±7.6months (range, 18-65). Mean age was 87.5±2.7years (range, 85-97). Mean ADLs and Braden scores were, respectively, 4.3±1.2 and 20.2±1.4. Fifteen patients had associated spondylolisthesis. Nineteen minor complications (grade I and II, 38.7%), five moderate complications (grade III, 10.2%) and six major complications (grade IV and V, 12.2%) occurred. The perioperative mortality rate was 0.02%. At last follow-up, 41 patients were very satisfied (83.7%), five patients were satisfied (10.2%) and three patients were not satisfied (6.1%). Fusion did not affect the incidence of complications (p=0.3) nor the average number of complications per patient (p=0.2). Advanced age should not be a contraindication to lumbar spine surgery provided careful preoperative selection is performed. This study reported a high satisfaction rate and a low mortality rate at the price of a high number of complications, most of which being minor.

Prevention of epidural scar adhesion after lumbar surgery by the use of medical cross-linked high-molecular-weight sodium hyaluronate gel

Objective To evaluate the preventive effect of medical cross-linked high-molecular-weight sodium hyaluronate gel for epidural scar adhesion after lumbar surgery. Methods Atotal of 92 patients were divided into 2 groups. Fifty-two patients in group A underwent decompression surgery combined with medical sodium hyaluronate gel. Forty patients in group B underwent only decompression surgery. The patients were given posterolateral fixation with pedicle screw and decompression, interbody fusion through posterior lumbar interbody fusion (TLIF) with or without the use of medical sodium hyaluronate gel. Operating time, blood loss and volume of drainage after operation were compared between two groups. Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) in lower extremity pain were applied to evaluate the therapeutic effect. The radius vector of sagittal spinal canal and the thecal sac cross sectional area were measured by magnetic resonance imaging (MRI). Results All patients underwent surgery safely without severe complications occurred. There was no significant difference in general materials and operation time (t=1.736, P=0.086), blood during operation (t=1.084, P=0.281), volume of drainage after operation (t=0.816, P=0.417) between two groups. As compared with preoperative parameters, the scores of VAS in back pain and lower limb pain and ODI were decreased significantly after surgery and at the final follow-up in both two groups. There was significant difference in lower limb VAS score between two groups, but there was no significant difference between two groups in ODI scores and back pain VAS score. There was no significant difference between Group A [(15.52±0.98) mm] and B [(15.13±1.07) mm] in L4/5 sagittal spinal canal after surgery (t=1.841, P=0.069). There was significant difference between Group A [(181.58±8.19) mm2] and B [(169.03±6.02) mm2] in the thecal sac cross sectional area (t=0.814, P=0.000). Conclusion Lumbar decompression surgery combined with medical sodium hyaluronate gel had a beter effect than simple operation. It can provide better prevention for epidural adhesions and more satisfactory clinical effects. Key words: Lumbar degeneration disease; Surgery; Medical sodium hyaluronate gel; Epidural adhesion; Prevention

Correlations Between the SF-36, the Oswestry-Disability Index and Rolland-Morris Disability Questionnaire in Patients Undergoing Lumbar Decompression According to Types of Spine Origin Pain

Cross-sectional study. To determine the correlation between SF-36 (a measure for overall health status in patients) and Oswestry-Disability Index (ODI) or Rolland-Morris Disability Questionnaire (RMDQ) confined to spine according to the type of pain from the spine. Data showed moderate correlation between ODI and SF-36 Physical Component Score (PCS), Physical Functioning (PF) (r=-0.46), Physical Role Functioning (RP) (r=-0.284), Bodily Pain (BP) (r=-0.327), and Mental Component Score (MCS), Emotional Role Functioning (r=-0.250), Social Role Functioning (r=0.254), Vitality (r=0.296). Between January 1, 2008 and December 31, 2013, a total of 69 patients were enrolled in this study. They were diagnosed with lumbar spinal stenosis and underwent decompression surgery such as laminotomy in this hospital. The 3 standardized questionnaires (ODI, RMDQ, and SF-36) were given to these patients, at least 1 year after the surgery. ODI and SF-36 had a statistically significant (P=0.001) and moderate correlation. Small correlations were also seen between Physical Functioning (r=-0.46), Physical Role Functioning (r=-0.284), and Bodily Pain (r=-0.327) of SF-36 PCS and ODI, and between Emotional Role Functioning (r=-0.250), Social Role Functioning (r=-0.254), and Vitality (r=-0.296) of SF-36 Mental Component Score and ODI. Items in ODI for the level of pain while standing and traveling were mostly related to axial back pain, while item of lifting was related to referred buttock pain. Sleeping disturbance section in the ODI was mainly caused by radiated leg pain. In addition, RMDQ was also associated to the 3 types of pain. Moderate correlation was found between ODI or RMDQ as a condition-specific outcome and the SF-36, indicating overall health status. ODI was found to be a more adequate measure to evaluate axial back pain rather than referred pain or radiating pain. RMDQ was adequate to measure the health status and to evaluate the 3 types of spine pain. These 3 instruments could therefore provide the clinician with complementary information about the patient's status.

Lumbar spine surgery in patients with rheumatoid arthritis (RA): what affects the outcomes?

Background ContextAlthough the cervical spine is only occasionally involved in rheumatoid arthritis (RA), involvement of the lumbar spine is even less common. A few reports on lumbar spinal stenosis in patients with RA have appeared. Although disc space narrowing occurs in aging, postoperative adjacent segment disease (ASD) in patients with RA has not been subject to much analysis. PurposeThe objective of this study was to investigate differences in ASD and clinical outcomes between lumbar spinal decompression with and without fusion in patients with RA. Study Design/SettingThis is a retrospective comparative study. Patient SampleA total of 52 patients with RA who underwent surgery for lumbar spinal disorders were included. Twenty-seven patients underwent decompression surgery with fusion and 25 underwent decompression surgery alone. Outcome MeasuresIntervertebral disc space narrowing and spondylolisthesis of the segment immediately cranial to the surgical site were measured using a three-dimensional volume rendering software. Pre- and postoperative evaluation of RA activity and Japanese Orthopaedic Association (JOA) scores were conducted. Materials and MethodsAll patients had preoperative and annual postoperative lumbar radiographs and were followed up for a mean of 5.1 years (range 3.5–10.9 years). Pre- and postoperative (2 years after surgery) JOA scores were recorded and any postoperative complications were investigated. Degrees of intervertebral disc narrowing and spondylolisthesis at the adjacent levels were evaluated on radiographs and were compared between the two groups. Analysis was performed to look for any correlation between ASD and RA disease activities. ResultsPostoperative JOA scores were significantly improved in both groups. The rate of revision surgery was significantly higher in the fusion group than that in the non-fusion group. The rate of ASD was significantly greater in the fusion group than that in the non-fusion group at the final follow-up examination. Both matrix metalloproteinase 3 (MMP-3) and the 28-joint disease activity score incorporating C-reactive protein levels (DAS28-CRP) were significantly associated with the incidence and severity of ASD. ConclusionsAdjacent segment disease and the need for revision surgery were significantly higher in the fusion group than those in the non-fusion group. A preoperative high MMP-3 and DAS28-CRP are likely to be associated with postoperative ASD.

MRI findings of lumbar spine instability in degenerative spondylolisthesis.

To find out the factors suggesting lumbar segmental instability in patients with degenerative spondylolisthesis (DS) on conventional magnetic resonance imaging (MRI). Ninety-four patients with DS who underwent decompression surgery with or without fusion were selected. Patient demographics and findings on simple radiographs and MRI were analyzed. We divided patients into two groups by the presence of lumbar instability on simple standing plain radiographs and measured degeneration status of intervertebral discs and facet joints and distance of facet fluid signal on T2 axial MRI on each groups. The data were analyzed to find out the correlation between facet fluid signal and lumbar instability. Sixty-three patients were confirmed to have lumbar instability (unstable group (UG), 67%), while 31 patients (stable group (SG), 33%) did not have instability on simple radiographs. The mean age was slightly older in SG ( p < 0.05) and SG patients' degeneration status of intervertebral discs and facet joints was advanced than UG patients. Fifty-five of 63 patients had high signal intensity on T2-weighted MR images in the UG, but only 4 of 31 patients had high signal intensity in the SG ( p < 0.001) and UG patients have more larger facet joint distance than SG patients ( p < 0.001). High signal in facet joints on T2 MR images can be a useful factor suggestive of lumbar instability. Thus, the identification of fluid signal in the facet joints on MRI should raise the suspicion for lumbar instability and prompt additional evaluations such as with stress radiographs.

The Influence of Pre- and Postoperative Fear Avoidance Beliefs on Postoperative Pain and Disability in Patients With Lumbar Spinal Stenosis: Analysis of the Lumbar Spinal Outcome Study (LSOS) Data.

Prospective multicenter cohort study. To evaluate the effect of pre- and postoperatively assessed fear avoidance beliefs (FAB) on pain and disability in patients with degenerative lumbar spinal stenosis (LSS) after decompression surgery. To the present, the influence of pre- and postoperative FAB on the prognosis after surgery for LLS is still unclear. Patients of the Swiss Lumbar Stenosis Outcome Study (LSOS) with confirmed LSS undergoing first-time decompression without fusion were enrolled in this study. The main outcome of this study was minimal clinically important difference (MCID) in spinal stenosis measure symptoms (pain) and function (disability) after 12 months. To analyze the influence of pre- and postoperatively assessed FAB on pain and disability we built simple and multiple logistic regression models. In this analysis of 234 patients undergoing decompression surgery for symptomatic degenerative LSS we found baseline FAB measured by the FAB physical activity subscale (FABQ-P) not to be associated with pain (OR 0.95; 95% CI: 0.55-1.67) and disability (OR 1.11; 95% CI: 0.64-1.92) at 12 months' follow-up. In the final multiple logistic regression models patients with high FABQ-P at 6 months (OR 0.46; 95% CI: 0.24-0.91) and high persistent FABQ-P at baseline and 6 months (OR 0.34, 95% CI: 0.16-0.73) were less likely to report a MCID for spinal stenosis measure symptoms at 12 months. Our analysis found a similar trend for disability; however, the results were not statistically significant. In elderly patients undergoing decompression surgery for symptomatic degenerative LSS preoperative fear avoidance beliefs were not a prognostic indicator for the outcome. Patients with FAB at 6 months and persistent FAB were less likely to experience clinically relevant improvement in pain at 12 months. Studies should address the importance of persistent postoperative FAB. 3.

Analysis of morphological changes in liver in obstructive jaundice with special emphasis on fibrosis

Background: Biliary obstruction can present with distressing symptoms and increased morbidity which leads to liver fibrosis, cholestasis, portal inflammation and ductular proliferation. Experimental studies showed reversal of histological findings in liver after biliary decompression surgery; however only a limited data is available regarding the same. Methods: Prospective observational study of 28 liver biopsies from 14 patients of obstructive jaundice, who underwent decompression surgery and showed clinical deterioration at 6 weeks with normal HIDA scan. Patients were clinically evaluated. Both intra (1st bx) and postoperative (2nd bx) liver biopsies were studied for fibrosis, cholestasis, ductular proliferation and portal inflammation.Result: Patient’s age ranged from 24 to 75 years (8 Males and females 6), commonest symptom being jaundice. In 1st bx, most of the patients showed histological evidence of obstruction, which improved at least partially after surgery. There was no definite correlation of fibrosis with etiology. Fibrosis was less commonly seen with shorter duration of symptoms and younger males had higher prevalence. Increase/static grades of fibrosis were seen in 35.71% patients each, while 28.57% showed regression. No correlation of age and etiology with status of fibrosis was observed. Regression was more common in males and with absence of cholangitis while progression was more common in females and with presence of cholangitis.Conclusion: We wonder whether younger males are more prone for fibrosis but males in general have better prognosis regarding the reversal. Also, cholangitis could be an important factor for deciding the further course of fibrosis. However we require larger data with multivariate analysis for the confirmation of the same. DOI: 10.21276/APALM.1223

Geriatric patients are predisposed to strabismus following thyroid-related orbital decompression surgery: A multivariate analysis

ABSTRACTGeriatric patients (age ≥ 65) are prone to complications after surgery and are at risk for severe thyroid eye disease (TED). In this study, we aim to identify preoperative demographic and TED patterns associated with geriatric patients who underwent decompression surgery, to examine the effect of age on postoperative strabismus rates, and to identify factors that may contribute to postoperative strabismus in the geriatric subgroup. We retrospectively reviewed patients who underwent thyroid-related orbital decompression surgery at the Kellogg Eye Center, University of Michigan, between 1999 and 2014. Primary outcome was postoperative strabismus requiring palliation with prisms and/or strabismus surgery. Descriptive, univariate, and multivariable logistic regression analyses were used to define association of geriatric age with postoperative strabismus and determine predictors of postoperative strabismus. Of 241 patients, 41 (17.0%) were geriatric. They were less likely to undergo bilateral decompression (P = 0.012), less likely to be current smokers at time of decompression (P = 0.002), and more likely to have preoperative primary gaze diplopia (P = 0.001). Postoperative strabismus rates for geriatric patients (≥ 65 years of age), ages 50–65, 30–50, and < 30, were 73.2%, 41.3%, 31.9%, and 15.8%, respectively (P = 0.002). On multivariable analysis, geriatric age remained an independent risk factor for postoperative strabismus when compared to each age group (P ≤ 0.001). Among geriatric patients in subgroup multivariable analysis, balanced as opposed to lateral wall decompression (P = 0.038) and shorter TED duration (P = 0.031) were independently predictive of postoperative strabismus.

Reversibility of nerve root sedimentation sign in lumbar spinal stenosis patients after decompression surgery.

The nerve root sedimentation sign (SedSign) is a magnetic resonance imaging (MRI) sign for the diagnosis of lumbar spinal stenosis (LSS). It is included in the assessment of LSS to help determine whether decompression surgery is indicated. Assessment of the reversibility of the SedSign after surgery may also have clinical implications for the decision about whether or not a secondary operation or revision is needed. This study investigated if lumbar decompression leads to a reversal of the SedSign in patients with LSS and a positive SedSign pre-operatively; and if a reversal is associated with more favourable clinical outcomes. If reversal of the SedSign is usual after sufficient decompression surgery, a new positive SedSign could be used as an indicator of new stenosis in previously operated patients. A prospective cohort study of 30 LSS patients with a positive pre-operative SedSign undergoing decompression surgery with or without instrumented fusion was undertaken to assess the presence of nerve root sedimentation (=negative SedSign) on MRI at 3months post-operation. Functional limitation (Oswestry Disability Index, ODI), back and leg pain (Visual Analogue Scale, VAS), and treadmill walking distance were also compared pre- and 3months post-operatively. The short follow-up period was chosen to exclude adjacent segment disease and the potential influence of surgical technique on clinical outcomes at longer follow-up times. 30 patients [median age 73years (interquartile range (IQR) 65-79), 16 males] showed a median pre-operative ODI of 66 (IQR 52-78), a median VAS of 8 (IQR 7-9), and a median walking distance of 0m (IQR 0-100). Three months post-operation 27 patients had a negative SedSign. In this group, we found improved clinical outcomes at follow-up: median post-operative ODI of 21 (IQR 12-26), median VAS of 2 (IQR 2-4), and median walking distance of 1000m (IQR 500-1000). These changes were all statistically significant (p<0.001). Three patients had a positive SedSign at 3-month follow-up due to epidural fat (n=2) or a dural cyst following an intra-operative dural tear (n=1), but also showed improvements in clinical outcomes for ODI, VAS and walking distance. The reversibility of a pre-operative positive SedSign was demonstrated after decompression of the affected segmental level and associated with an improved clinical outcome. A persisting positive SedSign could be the result of incomplete decompression or surgical complications. A new positive SedSign after sufficient decompression surgery could be used as an indicator of new stenosis in previously operated patients.

Acute kidney injury in Ureteric Stones:Single centre short term analysis.

Objective:To analyze acute kidney injury (AKI) frequency, risk factors and outcome in ureteric stone patients.Methods:This is an observational retrospective study performed in a single tertiary care centre in Abu Dhabi from October 2014 till August 2015. Convenient sampling was done on 152 consecutive patients who underwent decompression surgery (Ureterorenoscopy LASER Lithotripsy and DJ Stenting) for ureteric stones. Serum Creatinine was used to calculate creatinine clearance by cock croft Gault formula in all patients before and after procedure. Analysis was done on SPSS version 17.Results:Out of 152 patients who under went decompression surgical procedure for ureteric stones AKI was seen in 49(32.2%). Patients with AKI were found to be more higher age, increasedweight, bilateral stones, lower ureteric stones and with co morbidities in comparison to those who were without acute kidney injury. Patients developing AKI, 89.7% recovered either partially(20.4 %) or completely (69.3%).Conclusion:AKI is seen more in ureteric stone patients with older age, increased weight, bilateral stones, lower ureteric stones and with co morbidities. Recovery is good when obstruction is relieved.

Indications for prophylactic lumbar decompression at the L3/4 level in patients with L4/5 responsible lumbar spinal canal stenosis.

Introduction Lumbar spinal canal stenosis (LSS) is a very common disease. When the responsible level is considered to be L4/5 despite the appearance of double-level (L3/4 and L4/5) stenosis on magnetic resonance imaging (MRI), it is difficult for spinal surgeons to decide whether prophylactic decompression should be performed at the L3/4 level. The purpose of this study was to investigate the relationship between the dural sac cross-sectional area (DCSA) at the L3/4 level and clinical symptoms in patients with double-level stenosis. Methods Thirty-five patients with double-level stenosis were registered in this study. All patients underwent decompression surgery at the L4/5 responsible level. The severity of patients' symptoms was evaluated by the Japanese Orthopaedic Association (JOA) score and its rate of recovery. A measurement program on MRI was used to determine the DCSA. Results The clinical course of LSS according to the JOA score recovery rate at the final follow-up revealed that the good group (≥50%) included 27 patients, and the poor group (<50%) included 8 patients. In the good group, the mean DCSA at the L3/4 level was 72.3 ± 32.1 mm2 preoperatively and 71.3 ± 29.0 mm2 at the final follow-up. In contrast, in the poor group, the mean DCSA at the L3/4 level was 49.1 ± 23.8 mm2 preoperatively and 40.6 ± 14.1 mm2 at the final follow-up. Significant differences were observed in the preoperative and final follow-up DCSAs at the L3/4 level between two groups. Conclusions Considering the present results, prophylactic decompression surgery at the L3/4 level should be performed for patients with double-level stenosis and DCSA <50 mm2 at the L3/4 level.

Diagnosing Discogenic Low Back Pain Associated with Degenerative Disc Disease Using a Medical Interview.

PurposesTo evaluate the usefulness of our original five questions in a medical interview for diagnosing discogenic low back pain (LBP), and to establish a support tool for diagnosing discogenic LBP.Materials and MethodsThe degenerative disc disease (DDD) group (n = 42) comprised patients diagnosed with discogenic LBP associated with DDD, on the basis of magnetic resonance imaging findings and response to analgesic discography (discoblock). The control group (n = 30) comprised patients with LBP due to a reason other than DDD. We selected patients from those who had been diagnosed with lumbar spinal stenosis and had undergone decompression surgery without fusion. Of them, those whose postoperative LBP was significantly decreased were included in the control group. We asked patients in both groups whether they experienced LBP after sitting too long, while standing after sitting too long, squirming in a chair after sitting too long, while washing one’s face, and in the standing position with flexion. We analyzed the usefulness of our five questions for diagnosing discogenic LBP, and performed receiver operating characteristic (ROC) curve analysis to develop a diagnostic support tool.ResultsThere were no significant differences in baseline characteristics, except age, between the groups. There were significant differences between the groups for all five questions. In the age-adjusted analyses, the odds ratios of LBP after sitting too long, while standing after sitting too long, squirming in a chair after sitting too long, while washing one’s face, and in standing position with flexion were 10.5, 8.5, 4.0, 10.8, and 11.8, respectively. The integer scores were 11, 9, 4, 11, and 12, respectively, and the sum of the points of the five scores ranged from 0 to 47. Results of the ROC analysis were as follows: cut-off value, 31 points; area under the curve, 0.92302; sensitivity, 100%; and specificity, 71.4%.ConclusionsAll five questions were useful for diagnosing discogenic LBP. We established the scoring system as a support tool for diagnosing discogenic LBP.

Multiple Intramedullary Cavernous Angioma of the Cervicothoracic Spine: Case Report and Review of the Literature

Intramedullary cavernous angioma (ImCA), which was originally thought to be an uncommon vascular lesion, has shown an increased incidence since the advent of magnetic resonance imaging. We present a case of multiple ImCAs in the cervicothoracic region. The patient presented with slow, progressive motor weakness in the upper and lower limbs. Surgical intervention was performed because of misdiagnosis as a spinal cord tumor. The patient underwent decompression surgery because no neoplasm was noted in the course of the operation. The angioma regressed on follow-up magnetic resonance images 3 months later.

Posterior or Single-stage Combined Anterior and Posterior Approach Decompression for Treating Complex Cervical Spondylotic Myelopathy Coincident Multilevel Anterior and Posterior Compression.

Study Design:A single-center, retrospective, longitudinal matched cohort clinical study of prospectively collected outcomes.Objective:To compare retrospectively the clinical outcomes and complications of the posterior approach laminoplasty and single-stage anterior approach laminoplasty combined with anterior cervical corpectomy and fusion and anterior cervical discectomy and fusion for treating patients with cervical spondylotic myelopathy coincident multilevel anterior and posterior compression, known as complex cervical spondylotic myelopathy (cCSM) here.Summary of Background Data:The optimal surgical management of this type of cCSM remains controversial.Methods:Sixty-seven patients with multilevel cCSM underwent decompression surgery from 1996 to 2007. Among these patients, 31 underwent a single-stage combined approach with decompression (combined approach group) and 36 underwent laminoplasty for posterior approach (posterior approach group). Average operative duration, operative estimated blood loss, surgical costs, and cervical alignment were measured.Results:Average operative duration, operative estimated blood loss, and surgical costs were significantly lower in the posterior approach group than those in the combined approach group (P<0.001). Visual analog scale and modified Japanese Orthopedic Association scale were insignificantly different at each data collection period (P>0.05). No statistical difference was observed in the preoperative Cobb angle (P>0.05), whereas a significant statistical difference was observed for the postoperative Cobb angle (P<0.05) and variation of Cobb angle (P<0.05) between the 2 groups. The surgical incidences of complications were 22.2% and 48.4% in the posterior and combined approach groups (P<0.05), respectively.Conclusions:For treating multilevel cCSM, both the posterior approach laminoplasty and single-stage combined approach led to significant neurological improvement and pain reduction in the majority of patients. Both approaches showed similar results in terms of decompression and neurological improvement. The posterior approach was superior to the combined approach in terms of surgical costs, surgical time, blood loss, and complication rate.

Who will operate on you?

A late change of surgeon may invalidate a patient’s consent Kathleen Jones had terrible back pain. Following the advice of Daniel Chan, a highly regarded and experienced spinal surgeon, in 2010 she agreed to undergo decompression surgery. She believed that Chan would perform the operation and had waited for his return from leave so that he could undertake it. Six days before the operation Mr Sundaram, a fellow in trauma and orthopaedics, asked for her consent to the procedure. She signed the consent form, which included the statement, “I understand that you cannot give me a guarantee that a particular person will perform the procedure. The person will, however, have appropriate experience.” On the morning of the operation a nurse told Jones that Chan was …

Changes of posture and muscle activities in the trunk and legs during walking in patients with lumbar spinal stenosis after decompression surgery. A preliminary report

Neurogenic intermittent claudication is a main symptom in lumbar spinal stenosis (LSS), and postural change is often observed during walking. This study aimed to identify the changes in posture and muscle activity in the trunk and legs during walking in patients with LSS by examining 6 patients who had undergone decompression surgery. None of them had significant paralysis. Gait analysis using Vicon motion capture system® with electromyographic recordings of the paravertebral muscles (PVM) and vastus lateralis muscle (VL) was performed preoperatively and 2 weeks postoperatively. Results showed that the thorax angle indicating the degree of trunk flexion after walking decreased significantly and the pelvic angle tended to decrease after surgery. However, there were no difference in the spine angle, which is a measure of the motion of the thoraco-lumbar spine among the evaluations. The knee angle increased significantly after surgery both at the beginning and at the end of walking, but the angles of the hip and ankle did not change significantly after surgery. Knee torques increased significantly after surgery both at the beginning and at the end of walking. The activity of the PVM decreased and that of the VL increased after surgery. The results indicate that patients with LSS walk in a forward-bending position without flexing the spine, which can be one of the neurologic symptoms. Increases in knee torque and VL activity seemed to reflect the increase of walking speed, and the decrease of PVM activity appeared to be caused by postural improvement after surgery.

Outcome of laminoplasty in cervical spinal cord injury with stable spine.

Background and Objective:Cervical spinal cord injury (CSCI) with a stable spine has been increasing as the elderly population is dramatically increasing all over the world. In this study, we evaluated the neurological outcome of decompression surgery (laminoplasty) for these patients.Materials and Methods:Forty-one patients with CSCI with stable spine who underwent decompression surgery (laminoplasty) were retrospectively studied. Inclusion criteria were as follows: CSCI without instability, spinal cord contusion in magnetic resonance image (MRI), spinal cord compression rate more than 20%, neurologic deficit American Spinal Cord Injury Association ([ASIA] scale from A to D), and follow-up of at least 12 months. Preoperative neurological state, clinical outcome, and neurological function were measured using the ASIA impairment scale, Japanese Orthopaedic Association (JOA) grading scale, and Hirabayashi recovering rate, respectively.Results:Thirty-three (80.4%) patients showed improvement in ASIA grade at 12-month follow-up. Four (9.7%) patients in ASIA Grade A and 4 (9.7%) patients in ASIA Grade D remain unchanged. The mean JOA score improved from 8.4 ± 6.1 points preoperatively to 11.2 ± 5.4 points at 12 months postoperatively. Improvement in JOA was statistically significant (P < 0.05). The mean Hirabayashi recovery rate was 37.4 ± 25.3%.Conclusion:Surgical decompression (laminoplasty) is helpful in relieving cord compromise and neurological deficit in CSCI with stable spine.