Yellow Ligament Research Articles

Lumbar Foraminal Stenosis: Diagnosis and Microsurgical Decompression

Lumbar foraminal stenosis is a common problem; however, correct diagnosis and appropriate surgical treatment are difficult. This article describes the author's techniques for imaging diagnosis using thin-slice magnetic resonance imaging(MRI) and the microsurgical technique of foraminal decompression through the intermuscular approach. Thin-slice MRI consists of 1-mm thickness continuous images of the lumbar spine using a T2-weighted-image-based sequence. With multiplanar reconstruction in three planes, all nerve roots are carefully observed from the lateral recess to the extraforaminal area. This technique provides the correct diagnosis of subtle nerve root compression in the foramen. The outlet of the intervertebral foramen is exposed using Wiltse's intermuscular approach. To avoid disorientation, several surgical landmarks and two basic routes to reach the outlet of the foramen are established. The foramen is carefully unroofed by using an ultrasonic bone curette. For complete decompression of the nerve root and ganglion, the inferomedial aspect of the pedicle and its medial and lateral limits should be determined. In addition, the yellow ligament must be completely removed, and the intertransverse ligament lateral to the nerve root should be sufficiently decompressed.

Central lumbar stenosis. Recommendations of the Russian Association for the Study of Pain (RASP)

Narrowing of the central spinal canal in the lumbar spine (central lumbar stenosis, CLS) is one of the most common causes of lumbar pain, disability and spinal surgery in the elderly. The most common is acquired degenerative CLS, in which the main role play lumen-narrowing medial intervertebral disc herniating with ossification phenomena and marginal bone proliferation on the sides of the vertebral bodies – osteophytes, hypertrophy of the facet joints with their medial displacement, hypertrophy of the yellow ligament. The development of CLS can also be a consequence of spondylolisthesis, postoperative changes, rheumatic diseases and other causes. Both the compression of the cauda equine roots due to narrowing of the spinal canal and their ischemia, caused by compression of the radicular vessels and venous congestion play an important role in the pathogenesis of CLS. CLS develops in elderly age and occurs predominantly in men. The main clinical manifestation of CLS is neurogenic (caudogenic) intermittent claudication, which manifests as pain, numbness and weakness in the legs when the patient walks or stands for a long time but subsides when the patient sits or stands and bends forwards (flexion in the lumbar spine). The diagnosis of CLS is confirmed by magnetic resonance imaging (MRI), which shows a narrowing of the spinal canal and makes it possible to rule out specific causes of lumbar pain. It is important to note that, according to MRI, CLS often occurs at an older age, so its detection in the absence of clinical manifestations does not require an immediate discussion of the prospects of surgical treatment. Pain in patients with CLS according to MRI may be musculoskeletal in nature. Therefore, the diagnosis of CLS should include specific clinical manifestations and stenosis on MRI. In patients without clinical manifestations of CLS, osteoporosis and severe concomitant somatic diseases, only conservative therapy is recommended. Modern conservative treatment of CLS includes an educational program, therapeutic exercises (kinesiotherapy), psychological therapy methods for emotional disorders (cognitive-behavioral therapy), manual therapy and pharmacotherapy. Complex conservative treatment of CLS can reduce pain, improve the patient's condition and in some cases increase the patient's walking distance.

Ossification of the yellow ligament in the cervical spine – an unusual location

Ossification of the yellow ligament in the cervical spine – an unusual location

Effect of Mutation Type on Ectopic Ossification Among Adult Patients With X-Linked Hypophosphatemia.

Causative factors for ectopic ossifications in X-linked hypophosphatemia (XLH) remain to be elucidated. This work aimed to investigate the genotype-phenotype correlations between the phosphate-regulating endopeptidase homologue, X-linked gene (PHEX) and ectopic ossifications in XLH. Biochemical data, spinal computed tomography scans, and x-rays of hip/knee joints were retrospectively reviewed. Genetic analysis and the measurement of plasma inorganic pyrophosphate (PPi)-a potent inhibitor of tissue calcification-were performed. The effect of PHEX mutations on protein function was predicted using nonsense-mediated decay (NMD) and 3-dimensional structure modeling. The index of ossification of the anterior/posterior longitudinal ligament and yellow ligament (OA/OP/OY index) and the sum of the OA/OP/OY index (OS index) were used to quantify the severity of spinal ligament ossification. The severity of the hip/knee osteoarthritis was evaluated by the Kellgren-Lawrence classification. We examined 24 distinct pathogenic PHEX variants in 28 patients from a study population of 33 individuals in 27 unrelated, nonconsanguineous families. Among the 31 patients whose plasma samples were analyzed for PPi, 14 patients (45%) showed decreased plasma PPi concentrations; however, PPi concentrations did not correlate with mutation type or ectopic ossification. Fibroblast growth factor 23 levels in women with NMD-insensitive mutations trended lower than in men with NMD-sensitive mutations but failed to reach statistical significance. Both models revealed no correlations between PHEX pathogenic variant and ectopic ossification. Neither modeling found correlates between PHEX pathogenic variants and ectopic ossification. The effects of PPi on ectopic ossifications in adults with XLH revealed trends that should be investigated with a large sample size.

The Quantitative Evaluation of Automatic Segmentation in Lumbar Magnetic Resonance Images.

This study aims to overcome challenges in lumbar spine imaging, particularly lumbar spinal stenosis, by developing an automated segmentation model using advanced techniques. Traditional manual measurement and lesion detection methods are limited by subjectivity and inefficiency. The objective is to create an accurate and automated segmentation model that identifies anatomical structures in lumbar spine magnetic resonance imaging scans. Leveraging a dataset of 539 lumbar spinal stenosis patients, the study utilizes the residual U-Net for semantic segmentation in sagittal and axial lumbar spine magnetic resonance images. The model, trained to recognize specific tissue categories, employs a geometry algorithm for anatomical structure quantification. Validation metrics, like Intersection over Union (IOU) and Dice coefficients, validate the residual U-Net's segmentation accuracy. A novel rotation matrix approach is introduced for detecting bulging discs, assessing dural sac compression, and measuring yellow ligament thickness. The residual U-Net achieves high precision in segmenting lumbar spine structures, with mean IOU values ranging from 0.82 to 0.93 across various tissue categories and views. The automated quantification system provides measurements for intervertebral disc dimensions, dural sac diameter, yellow ligament thickness, and disc hydration. Consistency between training and testing datasets assures the robustness of automated measurements. Automated lumbar spine segmentation with residual U-Net and deep learning exhibits high precision in identifying anatomical structures, facilitating efficient quantification in lumbar spinal stenosis cases. The introduction of a rotation matrix enhances lesion detection, promising improved diagnostic accuracy, and supporting treatment decisions for lumbar spinal stenosis patients.

CERVICAL DEGENERATIVE MYELOPATHY, PANORAMIC REVIEW

Introduction: cervical degenerative myelopathy (DCM) is a general term that entails multiple etiologies. DCM is a group of pathological entities that originate compression of the cervical spinal cord, where spasticity, hyperreflexia, pathological reflexes, loss of manual dexterity, among others, are found. Objective: to detail the current information related to cervical degenerative myelopathy, epidemiology, clinical presentation, role of complementary examinations, pathophysiology, pathogenesis and treatment. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 21 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: cervical degenerative myelopathy, cervical spondylotic myelopathy, cervical pain, ossification of the yellow ligament and degenerative disc disease. Results: cervical myelopathy occurs in almost all individuals with canal stenosis greater than 60%. Spinal cord injury (SCI) is a devastating disorder that influences remarkable neurological morbidity and significant wear and tear on quality of life. The incidence and prevalence of SCI in North America is between 4.1 and 60.5 per 100,000, robust epidemiological data is difficult to obtain because of the multifactorial etiology of the disease process. Conclusions: cervical degenerative myelopathy involves multiple etiologies, all these entities together represent the most common reason for degenerative and non-traumatic alteration of the spinal cord in adult individuals. Degenerative disorders are more common at C5 and C6 or C6 and C7, because of the increased mobility in these sections. It is difficult to obtain solid epidemiological data because of the multifactorial etiology of the disease process. The symptoms and signs presented by the pathology are varied, so an adequate physical examination and a good clinical history should be taken. The pathology can significantly alter neurological function and lead to disability, so early recognition and treatment can prevent further deterioration of affected individuals. Surgical decompression is almost universally indicated with the intention of preventing progression and achieving maximum recovery potential. KEY WORDS: myelopathy, cervical, degenerative, pain, spinal, neuralgia.

Biomarkers related to hypertrophy of the ligamentum flavum: a systematic review of the literature.

Spinal stenosis is one of the most common spinal disorders in the elderly. Hypertrophy of the ligamentum flavum (HLF) can contribute to spinal stenosis. The current literature suggests that various biomarkers may play important roles in the pathogenesis of HLF. However, the connection between these biomarkers and the development of HLF is still not well understood. This systematic review aims to explore the current literature on biomarkers related to the development of HLF. A literature search was conducted using PubMed, Embase, Web of Science, and Cochrane Library. The search strategy looked for the titles, abstracts, and keywords of studies that contained a combination of the following phrases: "ligamentum flavum OR yellow ligament," "biomarkers," and "hypertrophy." Recorded data included study design, demographic characteristics (number of patients of each gender and mean age), study period, country where the study was conducted, biomarkers, and diagnostic modalities used. Risk of bias was assessed using the Newcastle-Ottawa Scale for case-control studies. The authors identified 39 studies. After screening, 26 full-text original articles assessing one or more biomarkers related to HLF were included. The included studies were conducted over a 22-year period. The most popular biomarkers studied, in order of frequency reported, were collagen types I and III (n = 10), transforming growth factor β (TGF-β) (n = 8), and interleukin (IL)-6 (n = 6). The authors found that mechanical stretching forces, tissue inhibitor of metalloproteinases 2 (TIMP-2) induction, and TGF-β were associated with increased amounts of collagen I and III. IL-6 expression was increased by microRNA-21, as well as by leptin, through the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway. Biomarkers such as TGF-β, IL-6, and collagen I and III have been consistently correlated with the development of HLF. However, the pathogenesis of HLF remains unclear due to the heterogeneity of the studies, patient populations, and research at the molecular level. Further studies are necessary to better characterize the pathogenesis of HLF and provide a more comprehensive understanding of how these biomarkers may aid in the diagnosis and treatment of HLF.

Evaluation of differences in expression pattern of three isoforms of the transforming growth factor beta in patients with lumbosacral stenosis

ABSTRACT The study investigates molecular changes in the lumbosacral (L/S) spine’s yellow ligamentum flavum during degenerative stenosis, focusing on the role of transforming growth factor beta 1–3 (TGF-β-1–3). Sixty patients with degenerative stenosis and sixty control participants underwent molecular analysis using real-time quantitative reverse transcription reaction technique (RTqPCR), enzyme-linked immunosorbent assay (ELISA), Western blot, and immunohistochemical analysis (IHC). At the mRNA level, study samples showed reduced expression of TGF-β-1 and TGF-β-3, while TGF-β-2 increased by only 4%. Conversely, at the protein level, the study group exhibited significantly higher concentrations of TGF-β-1, TGF-β-2, and TGF-β-3 compared to controls. On the other hand, at the protein level, a statistically significant higher concentration of TGF-β-1 was observed (2139.33 pg/mL ± 2593.72 pg/mL vs. 252.45 pg/mL ± 83.89 pg/mL; p < 0.0001), TGF-β-2 (3104.34 pg/mL ± 1192.74 pg/mL vs. 258.86 pg/mL ± 82.98 pg/mL; p < 0.0001), TGF-β-3 (512.75 pg/mL ± 107.36 pg/mL vs. 55.06 pg/mL ± 9.83 pg/mL, p < 0.0001) in yellow ligaments obtained from patients of the study group compared to control samples. The study did not establish a significant correlation between TGF-β-1–3 concentrations and pain severity. The findings suggest that molecular therapy aimed at restoring the normal expression pattern of TGF-β-1–3 could be a promising strategy for treating degenerative stenosis of the L/S spine. The study underscores the potential therapeutic significance of addressing molecular changes at the TGF-β isoforms level for better understanding and managing degenerative spinal conditions.

Laminoplasty with tented duraplasty for Hirayama disease.

Hirayama disease (HD) is a characterized by progressive amyotrophy of the upper limbs due to a forward displacement of the cervical dura during neck flexion. Unlike other treatment options aiming at preventing cervical flexion (e.g., collar or arthrodesis), laminoplasty with tented duraplasty addresses dural dysplasia. Technically, the procedure consists in enlarging the dural sac by performing an expansile duraplasty that is secured to the yellow ligaments, in association with an open-book laminoplasty. Laminoplasty with tented duraplasty is a surgical option addressing the cause of HD to prevent further neurological deterioration while preserving cervical motion.

Indirect Decompression in Lumbar Degenerative Pathology: Analysis of Imaging Changes at 48 Hours with One-year Follow-up.

Investigate the immediate resonance magnetic image changes undergone by the lumbar canal after indirect decompression and compare them at one-year post-intervention. We also investigate the clinical outcome of indirect decompression at one-year follow-up. Imaging changes in patients who underwent indirect lumbar decompression and percutaneous posterior fixation were analyzed with one-year follow-up. Radiographic measurements were performed preoperatively and postoperatively (at one year), and the area of lumbar canal occupation and yellow ligament by nuclear magnetic resonance was compared preoperatively, at 48 hours post-surgery, and at one year. Radiographic measurements included disc height, foraminal height, total lumbar lordosis, and segmental lordosis. The VAS lumbar and lower limb scales and the Oswestry Disability Index (ODI) were used to assess clinical outcomes. A total of 21 male and 23 female patients underwent indirect decompression at 64 lumbar levels. A significant improvement was observed in the clinical evaluation of all patients' post-surgery (p < 0.001) in all radiographic parameters. There was an immediate increase in the lumbar canal at 48 hours (p < 0.001), which continued to increase at one year post-intervention (p < 0.05). The yellow ligament occupation area decreased at 48 hours (p < 0.001) and continued to decrease until one year (p < 0.01). Four complications were recorded, one of which was a posterior tract infection requiring open decompression. Indirect decompression for degenerative lumbar disease provided successful clinical outcomes, including indirect expansion of the dural sac at 48 hours post-procedure, with progressive increase in the lumbar canal area at one-year follow-up.

Perspective: Timely diagnosis and repair of intraoperative thoracic/lumbar cerebrospinal fluid (CSF) leaks.

Our review of 12 articles for this perspective showed the frequency of intraoperative thoracic and/or lumbar CSF fistulas/dural tears (DT) ranged from 2.6% - 8% for primary surgical procedures. Delayed postoperative CSF leak/DT were also diagnosed in 0.83% (17/2052 patients) to 14.3% (2/14 patients) of patients undergoing thoracic and/or lumbar procedures. Further, the rate of recurrent postoperative CSF leaks/DT varied from 13.3% (2/15 patients) to 33.3% (4/12 patients). Intraoperative, postoperative delayed, and recurrent postoperative traumatic postsurgical thorac CSF leaks/DT can be limited by performing initially sufficient operative decompressions and/or decompressions/fusions (i.e., utilizing adequate open exposures vs. inadequate minimally invasive (MI) approaches). The incidence of CSF leaks/DT can be further reduced by spine surgeons' utilization of operating microscopes, and their avoiding routine attempts at total synovial cyst excision and/or complete resection of hypertrophied/ossified yellow ligament in the presence of significant dural adhesions. Multiple CSF leak/CT repair techniques included; using interrupted, non-resorbable sutures for direct dural repairs (i.e. 7-0 Gore-Tex sutures where the suture is larger than the needle thus plugging needle holes), and adding where needed muscle patch grafts, microfibrillar collagen, the rotation of Multifidus muscle pedicle flaps, fibrin sealants (FS)/fibrin glues (FG), lumbar drains (LD), and/or lumbo-peritoneal (LP) shunts. Intraoperative, postopertive delayed, and/or recurrent postoperative thorac and/or lumbar traumatic surgical CSF leaks can be reduced by choosing to initially perform the appropriately extensive open operative decompressions and/or decompresssions/fusions. It is critical to use an operating microscope, non-resorbable interrupted sutures, and where necessary, muscle patch grafts, microfibrillar collagen, the rotation of Multifidus Muscle Pedicle Flaps, FS/FG, LD, and/or LP shunts.

Red flags of cardiac amyloidosis in patients with spinal stenosis and yellow ligament hypertrophy

IntroductionStudies addressing the prevalence of cardiac amyloidosis (CA) among patients with spinal stenosis (SS) are lacking. The identification of the red flags (RF) of CA could lead to early detection of cases of CA. The primary objective of this study was to address the prevalence of RF of CA among patients with SS. MethodsTransversal study including consecutive cases with SS and yellow ligament hypertrophy (YLH). A clinical assessment thar included electrocardiogram, echocardiogram anf urine and blood test was performed. A clinical suspicion of CA was defined by the presence of left ventricular hypertrophy plus any RF. Results103 patients with SS and YLH were assessed. The prevalence of RF was high: heart failure: 18.4%; aortic stenosis: 1.9%; carpal tunnel syndrome: 7.8%; bicipital tendon rupture: 1.9%; arterial hypotension: 17.4%; polyneuropathy symptoms: 51.5%; pseudoinfarction patten: 3.9%; low voltages: 15.5%; conduction abnormalities: 15.5%; decreased longitudinal strain: 25.3%; apical sparing pattern: 3.9%. The 57.3% of the cohort met the CA suspicion criteria. ConclusionThe prevalence of RF of CA is high among patients with SS and YLH. A high proportion of patients met the CA suspicion criteria.

«Banderas rojas» de amiloidosis cardiaca en pacientes con estenosis de canal lumbar e hipertrofia de ligamento amarillo

IntroductionStudies addressing the prevalence of cardiac amyloidosis (CA) among patients with spinal stenosis (SS) are lacking. The identification of the red flags (RF) of CA could lead to early detection of cases of CA. The primary objective of this study was to address the prevalence of RF of CA among patients with SS. MethodsTransversal study including consecutive cases with SS and yellow ligament hypertrophy (YLH). A clinical assessment that included electrocardiogram, echocardiogram and urine and blood test was performed. A clinical suspicion of CA was defined by the presence of left ventricular hypertrophy plus any RF. ResultsOne hundred and three patients with SS and YLH were assessed. The prevalence of RF was high: heart failure: 18.4%; aortic stenosis: 1.9%; carpal tunnel syndrome: 7.8%; bicipital tendon rupture: 1.9%; arterial hypotension: 17.4%; polyneuropathy symptoms: 51.5%; pseudoinfarction pattern: 3.9%; low voltages: 15.5%; conduction abnormalities: 15.5%; decreased longitudinal strain: 25.3%; apical sparing pattern: 3.9%. The 57.3% of the cohort met the CA suspicion criteria. ConclusionThe prevalence of RF of CA is high among patients with SS and YLH. A high proportion of patients met the CA suspicion criteria.

Gut-spine axis: a possible correlation between gut microbiota and spinal degenerative diseases.

As society ages, the number of patients with spinal degenerative diseases (SDD) is increasing, posing a major socioeconomic problem for patients and their families. SDD refers to a generic term for degenerative diseases of spinal structures, including osteoporosis (bone), facet osteoarthritis (joint), intervertebral disk degeneration (disk), lumbar spinal canal stenosis (yellow ligament), and spinal sarcopenia (muscle). We propose the term "gut-spine axis" for the first time, given the influence of gut microbiota (GM) on the metabolic, immune, and endocrine environment in hosts through various potential mechanisms. A close cross-talk is noted between the aforementioned spinal components and degenerative diseases. This review outlines the nature and role of GM, highlighting GM abnormalities associated with the degeneration of spinal components. It also summarizes the evidence linking GM to various SDD. The gut-spine axis perspective can provide novel insights into the pathogenesis and treatment of SDD.

Injury of the Lumbard in Degenerative Diseases of the Lumbar Spine

In this study, the pathomorphological changes that develop in the yellow ligament of the spinal canal in all types of degenerative diseases of the lumbar region of the spine were studied. As a material, fragments of corpus luteum covering the back border of the spinal canal were taken. The results show that in some degenerative diseases of the lumbar region, the yellow ligament is only hypertrophied, while in others, dystrophy, calcification develop, and ossification and deformation are observed in others. Hypertrophy and thickening of the yellow ligament of the spine develops after degenerative and inflammatory diseases and begins with the increase of histitic cells around the blood vessels and in the interstitial tissue. The hypertrophy of the yellow ligament is manifested by a sharp increase in collagen fibers, the development of the fibroelastosis process, the breakdown and destruction of elastic fibers, and a decrease in their quantity.

Cardiac amyloidosis in patients with spinal stenosis and yellow ligament hypertrophy

BackgroundSpinal stenosis (SS) is a manifestation associated with cardiac amyloidosis (CA). However, there is a lack of studies assessing the prevalence of CA among patients with SS. We aimed to address the prevalence of CA among patients with SS and YLH. MethodsWe performed a cross-sectional study of consecutive patients older than 65 years with SS and yellow ligament hypertrophy (YLH). All the patients were assessed with an electrocardiogram, echocardiogram and biohumoral evaluation. Patients with CA red flags was further studied with cardiac magnetic resonance and 99mTc-DPD scintigraphy. A cohort of patients with confirmed CA and SS was used to assess clinical features associated with CA. Results105 patients (75.0 ± 6.6 years old; 45.7% males) with SS and YLH [5.5 [5–7] mm] were screened. Prevalence of red flags of CA was high and 58 patients presented clinical suspicion of CA. One patient (0.95%) was finally diagnosed of CA.Patients with confirmed CA presented a more expressive phenotype than the screened population.Patients with suspected CA had greater YLH than patients without suspicion of CA (6.4 ± 1.3 vs. 5.0 ± 0.8 mm; p < 0.001) and patients with confirmed CA presented greater YLH than the screening population (6.7 ± 1.8 vs. 5.7 ± 1.2 mm; p = 0.018). ConclusionDespite red flags of CA are common among patients with SS, the prevalence of confirmed CA was low in our sample of screened patients.

Ossification of the Ligamentum Flavum of the Cervical Spine in an Iranian Woman: Report of a Case With Myelopathy and Review of the Literature

Background and Importance: Ossification of the ligamentum flavum (OLF) is a pathological condition that affects the yellow ligaments, mostly in adult males between the ages of 45 to 70. Ossification is more common in the thoracolumbar region with an accompanying progressive neurological deficit, and its occurrence within the cervical spine is quite rare. Ossification of the yellow ligament is so common in East Asian countries that it is regarded as a frequently occurring aging pathology in the people of this region. Its existence in other ethnic groups is significantly lower. Case Presentation: A 68-year-old Iranian woman with progressive quadriparesis is presented. Cervical computerized tomography and MRI scans revealed two-level, bilateral, posteriorly located, ossified masses occurring at the C4-C5 and C5-C6 levels, which coincided with the ossification of the yellow ligament. Cervical laminectomy and excision of both masses were undertaken and the patient gradually recovered from his resultant neurological symptoms. Conclusion: Symptomatic cervical OLF is a markedly rare pathological finding and is typically illustrated as a medical case report. In a careful review of the literature including the presented patient, we could uncover only 77 cases involving a documented symptomatic cervical OLF.

Lumbar Spinal Canal Stenosis in Acromegaly: A Case Report and Literature Review

A 60-year-old Japanese man diagnosed with acromegaly at 28 years old had difficulty walking due to worsening back pain. He had been treated with somatostatin analog since 57 years old, but his pain and numbness continued to worsen. Lumbar magnetic resonance imaging showed disc bulging at L3/4 and L4/5, and he was diagnosed with lumbar spinal canal stenosis due to hypertrophy of the yellow ligament. Patients with acromegaly may complain of osteoarthropathy, so we must pay attention to the symptoms of spinal canal stenosis in collaboration with orthopedic specialists.

Ossification of yellow ligament-lesser known common cause of thoracic myelopathy in Indian subcontinent treated surgically

Background: To undertake a study which outlines the clinical and radiological features of ossification of yellow ligament (OYL) causing thoracic myelopathy (TM) in Indian subcontinent, to assess the outcomes of surgical resection of yellow ligament and compare different preoperative factors that contribute to be a risk factor in the overall post-surgical recovery rates (RR). Methods: A retrospective analysis of prospectively collected data from a cohort of 45 patients who visited our spine OPD from January 2012 to December 2019 who underwent surgical decompression for TM due to OYL was studied. The surgical outcomes and RR were calculated, compared and pre operative risk factors which could possibly be involved in giving poorer RR were analysed. Results: Our study included 45 patients who underwent surgical resection of OYL for TM. On comparison of post operative improvement in myelopathic symptoms, pre-operative mJOA score of 4.56 had increased significantly to 7.83 at 2 years follow up. While the majority (80%) of patients had an excellent and good recovery rate while 16% of patients had a fair recovery rate and 4% had no change at all in comparison to pre-operative mJOA scores. Preoperative risk factors for poor outcomes were also analysed. Conclusions: Early and timely before the onset or progression of any neurologic involvement. The pre operative risk factors which could give guarded prognosis and lower RR are, the presence of intramedullary signal changes (myelomalacia), &gt;6-10 months of progressive pre operative symptoms and an mJOA&lt;5.

Decompression for lumbar spinal stenosis at the intrathecal catheter insertion site during intrathecal baclofen therapy: a case report

BackgroundIntrathecal baclofen therapy can substantially improve symptoms in most patients with severe spasticity due to traumatic spinal cord injury, multiple sclerosis, or cerebral paresis. To the best of our knowledge, decompression surgeries at the intrathecal catheter insertion site in patients with a preexisting intrathecal pump for drug delivery have not been reported.Case presentationWe report the case of a 61-year-old Japanese man with lumbar spinal stenosis who underwent intrathecal baclofen therapy. We performed decompression for lumbar spinal stenosis at the intrathecal catheter insertion site during intrathecal baclofen therapy. The yellow ligament was removed by partial resection of the lamina under a microscope to avoid damage to the intrathecal catheter. The dura mater was distended. No obvious cerebrospinal fluid leakage was observed. Postoperatively, lumbar spinal stenosis symptoms improved, and spasticity remained well controlled with intrathecal baclofen therapy.ConclusionsThis is the first reported case of lumbar spinal stenosis decompression at an intrathecal catheter insertion site during intrathecal baclofen therapy. Preoperative preparation is necessary, as the intrathecal catheter may be replaced during surgery. We performed surgery without removing or replacing the intrathecal catheter, taking care not to damage the spinal cord by migrating the intrathecal catheter.