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Martino Cinnera A, Morone G, Iosa M, Bonomi S, Calabrò RS, Tonin P, Cerasa A, Ricci A, Ciancarelli I. Artificial neural network analysis of factors affecting functional independence recovery in patients with lumbar stenosis after neurosurgery treatment: An observational cohort study. J Orthop 2024; 55:38-43. [PMID: 38638115 PMCID: PMC11021912 DOI: 10.1016/j.jor.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
Background and aim Lumbar spinal stenosis (LSS) is a leading cause of low back pain and lower limbs pain often associated with functional impairment which entails the loss or the impairment of independence in older adults. Conservative treatment is effective in a small percentage of patients, while a significant percentage undergo surgery, even if often without a complete resolution of clinical symptoms and motor deficits. The aim of the study is to identify clinical and demographic prognostic factors characterising the patients who would benefit most from surgical treatment in relation to the functional independence recovery using an innovative approach based on an artificial neural network. Methods Adult patients with LSS and indication of neurosurgical treatment were enrolled in the study. Clinical evaluation was performed in the preoperative-phase (into the 48 h before surgery) and after two months. Clinical battery investigated the motor, functional, cognitive, behavioural, and pain status. Demographics and clinical characteristics were analysed via Artificial Neural Network (ANN) using 24 input variables, 2 hidden layers and a single final output layer to predict the outcome. ANN results were compared with those of a multiple linear regression. Results 108 patients were included in the study and 90 of them [66.5 ± 12.8 years; 27.8 % F] were submitted to surgery treatment and completed longitudinal evaluation. Statistically significant improvement was recorded in all clinical scales comparing pre- and post-surgery. The ANN results showed a prediction ability up to 81 %. Disability, functional limitations, and pain concerning clinical assessment and stature, onset and age about demographic characteristics are the main variables impacting on surgical outcome. Conclusions ANN can support clinical decision making, using clinical and demographic characteristics of patients with LSS identifying the characteristics of those who might benefit more from the surgical treatment in terms of global functional recovery.
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Affiliation(s)
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Marco Iosa
- IRCCS Santa Lucia Foundation Hospital, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Antonio Cerasa
- Sant'Anna Institute, Crotone, Italy
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), Messina, Italy
- Pharmacotechnology Documention and Transfer Unit, Preclinical and Traslation Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Arcavacata, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore Hospital, ASL Avezzano-Sulmona-L’Aquila, L'Aquila, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Territorial Rehabilitation, ASL Avezzano-Sulmona-L’Aquila, L'Aquila, Italy
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Zhang J, Yan R, Xu S, Shao B, Dou Y. Short-term lumbar disc and lumbar stability changes of one-hole split endoscope technique treatment of spinal stenosis. BMC Musculoskelet Disord 2024; 25:325. [PMID: 38659005 PMCID: PMC11040931 DOI: 10.1186/s12891-024-07443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE Investigating the early biomechanical effects of the one-hole split endoscope (OSE) technique on lumbar spine after decompression surgery. METHODS A retrospective analysis was conducted on 66 patients with lumbar spinal stenosis (LSS) who underwent OSE technique surgery at the affiliated hospital of Binzhou Medical University from September 2021 to September 2022. The patients had complete postoperative follow-up records. The mean age was (51.73 ± 12.42) years, including 33 males and 33 females. The preoperative and postoperative imaging data were analyzed, including disc height (DH), foraminal height (FH), lumbar lordosis angle (LLA), changes in disc angle, anterior-posterior translation distance, and lumbar intervertebral disc Pfirrmann grading. The visual analogue scale (VAS) was applied to evaluate the severity of preoperative, postoperative day 1, postoperative 3 months, and final follow-up for back and leg pain. The Oswestry Disability Index (ODI) was applied to assess the functionality at all the listed time points. The modified MacNab criteria were applied to evaluate the clinical efficacy at the final follow-up. RESULTS In 66 patients, there were statistically significant differences (p < 0.05) in DH and FH at the affected segments compared to preoperative values, whereas no significant differences (p > 0.05) were found in DH and FH at the adjacent upper segments compared to preoperative values. There was no statistically significant difference in the LLA compared to preoperative values (p > 0.05). Both the affected segments and adjacent upper segments showed statistically significant differences in Pfirrmann grading compared to preoperative values (p < 0.05). There were no statistically significant differences in the changes in disc angle or anterior-posterior translation distance in the affected or adjacent segments compared to preoperative values (p > 0.05). The VAS scores for back and leg pain, as well as the ODI, significantly improved at all postoperative time points compared to preoperative values. Among the comparisons at different time points, the differences were statistically significant (p < 0.05). The clinical efficacy was evaluated at the final follow-up using the modified MacNab criteria, with 51 cases rated as excellent, 8 cases as good, and 7 cases as fair, resulting in an excellent-good rate of 89.39%. CONCLUSIONS The OSE technique, as a surgical option for decompression in the treatment of LSS, has no significant impact on lumbar spine stability in the early postoperative period. However, it does have some effects on the lumbar intervertebral discs, which may lead to a certain degree of degeneration.
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Affiliation(s)
- Jinghe Zhang
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, Shandong, 256603, China
| | - Ruqi Yan
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, Shandong, 256603, China
| | - Shidong Xu
- Department of Spine Surgery, Central Hospital of Zibo, No.54, Communist Youth League West Road, Zibo, Shandong, 255020, China
| | - Bin Shao
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, Shandong, 256603, China
| | - Yongfeng Dou
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, Shandong, 256603, China.
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Alhaug OK, Dolatowski FC, Kaur S, Lønne G. Postoperative complications after surgery for lumbar spinal stenosis, assessment using two different data sources. Acta Neurochir (Wien) 2024; 166:189. [PMID: 38653826 DOI: 10.1007/s00701-024-06086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/03/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Lumbar spinal stenosis (LSS) is a prevalent disorder, and surgery for LSS is a common procedure. Postoperative complications occur after any surgery and impose costs for society and costs and additional morbidity for patients. Since complications are relatively rare, medical registries of large populations may provide valuable knowledge. However, recording of complications in registries can be incomplete. To better estimate the true prevalence of complications after LSS surgery, we reviewed two different sources of data and recorded complications for a sample of Norwegian LSS patients. METHODS 474 patients treated surgically for LSS during 2015 and 2016 at four hospitals reported to a national spine registry (NORspine). Postoperative complications were recorded by patients in NORspine, and we cross-referenced complications documented in NORspine with the patients´ electronic patient records (EPR) to re-test the complication rates. We performed descriptive statistics of complication rates using the two different data sources above, and analyzed the association between postoperative complications and clinical outcome with logistic regression. RESULTS The mean (95%CI) patient age was 66.3 (65.3-67.2) years, and 254 (53.6%) were females. All patients were treated with decompression, and 51 (10.7%) received an additional fusion during the index surgery. Combining the two data sources, we found a total rate for postoperative complications of 22.4%, the NORspine registry reported a complication rate of 15.6%, and the EPR review resulted in a complication rate of 16.0%. However, the types of complications were inconsistent across the two data sources. According to NORspine, the frequency of reoperation within 90 days was 0.9% and according to EPR 3.4%. The rates of wound infection were for NORspine 3.1% and EPR review 2.1%. There was no association between postoperative complication and patient reported outcome. CONCLUSION Postoperative complications occurred in 22% of LSS patients. The frequency of different postoperative complications differed between the two data sources.
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Affiliation(s)
- Ole Kristian Alhaug
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, PO Box 68, N-2313, Ottestad, Norway.
- Orthopaedic Department, Akershus University Hospital, PO Box 1000, N-1478, Loerenskog, Norway.
| | - Filip C Dolatowski
- Orthopaedic Department, Oslo University Hospital, PO Box 4956, N-0424, Oslo, Norway
| | - Simran Kaur
- Orthopedic Department, Martina Hansens Hospital, Dønskiveien 8, 1346, Gjettum, Norway
| | - Greger Lønne
- Innlandet Hospital Trust, PO Box 104, N-2381, Brumunddal, Norway
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Li T, Jiang Q, Zhong W, Zhu T, Lu Z, Ding Y. One-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis: a retrospective propensity score study. J Orthop Surg Res 2024; 19:254. [PMID: 38649974 PMCID: PMC11034078 DOI: 10.1186/s13018-024-04743-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The one-hole split endoscopy (OSE) was first proposed and clinically applied in China in 2019. The aim of this study was to compare the clinical efficacy of one-hole split endoscopy (OSE) and unilateral biportal endoscopy (UBE) for treating lumbar spinal stenosis (LSS). METHODS One hundred sixty patients with LSS who met the inclusion from November 2020 to August 2022 were analyzed and divided into OSE and UBE groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the two groups. After matching, surgical outcomes were recorded, and clinical data, including functional scores and imaging findings, were compared. Functional scores included the visual analog scale of leg pain (VAS-LP) and back pain (VAS-BP), the Japanese Orthopedic Association score (JOA), and the Oswestry Disability Index (ODI). Imaging data included dural sac cross-sectional area (DCSA), lumbar range of motion (ROM), and sagittal translation (ST). RESULTS After PSM, 104 LSS patients were included in the study, and all covariates were well-balanced between the two groups. Among the matched patients, the OSE showed advantages over the UBE regarding operative time (62.42 ± 4.86 vs. 68.96 ± 4.56) and incision length (2.30 ± 0.14 vs. 2.70 ± 0.15) (P < 0.001). However, differences between the two groups in intraoperative blood loss, hospital length of stay, and complication rates were not statistically significant (P > 0.05). There was no statistically significant difference regarding VAS-BP, VAS-LP, JOA, and ODI between the two groups (P > 0.05). However, all clinical and functional scores significantly improved postoperatively (P < 0.05). Postoperative DCSA of both groups was significantly found to be improved (P < 0.05), ROM and ST remained within the normal range, and no cases of lumbar instability were recorded. According to the modified MacNab criteria, the excellent and good rates in the OSE and UBE groups were 94.23% and 90.38%, respectively, with no statistically significant difference (P = 0.713). CONCLUSION OSE is an alternative technique to UBE for the treatment of LSS, with similar satisfactory clinical outcomes, shorter operative time, and smaller incision length. Further studies are needed for long-term efficacy.
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Affiliation(s)
- Tusheng Li
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Qiang Jiang
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Wei Zhong
- School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Tengyue Zhu
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Zhengcao Lu
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Yu Ding
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
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Zhang Y, Yuan S, Chen X, Zhang Z, Yang X, Wang S, Tian Y, Wang L, Liu X. Risk Factors for Surgical Treatment of Lumbar Degenerative Disc Disease in Middle-aged and Older Women: A Prospective Case-Control Study of 2370 Subjects. Orthop Surg 2024. [PMID: 38637331 DOI: 10.1111/os.14066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE Given the distinct physiological and societal traits between women and men, we propose that there are distinct risk factors for lumbar degenerative disc disease surgeries, including lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS), in middle-aged and older populations. However, few studies have focused on middle-aged and older women. This study aims to identify these risk factors specifically in this population. METHODS In this case-control study, the study group comprised 1202 women aged ≥ 45 years who underwent operative treatment of lumbar degenerative disc disease (LDH, n = 825; LSS, n = 377), and the control group comprised 1168 women without lumbar disease who visited a health examination clinic during the same period. The study factors included demographics (age, body mass index [BMI], smoking, labor intensity, and genetic history), female-specific factors (menopausal status, number of deliveries, cesarean section, and simple hysterectomy), surgical history (number of abdominal surgeries, hip joint surgery, knee joint surgery, and thyroidectomy), and systemic diseases (hypercholesterolemia, hypertriglyceridemia, hyper-low-density lipoprotein cholesterolemia, hypertension, diabetes, cardiovascular disease, and cerebrovascular disease). Multivariate binary logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) of associated factors. RESULTS The risk factors for surgical treatment of LDH in middle-aged and older women included BMI (OR = 1.603), labor intensity (OR = 1.189), genetic history (OR = 2.212), number of deliveries (OR = 1.736), simple hysterectomy (OR = 2.511), hypertriglyceridemia (OR = 1.932), and hyper-low-density lipoprotein cholesterolemia (OR = 2.662). For surgical treatment of LSS, the risk factors were age (OR = 1.889), BMI (OR = 1.671), genetic history (OR = 2.134), number of deliveries (OR = 2.962), simple hysterectomy (OR = 1.968), knee joint surgery (OR = 2.527), hypertriglyceridemia (OR = 1.476), hyper-low-density lipoprotein cholesterolemia (OR = 2.413), and diabetes (OR = 1.643). Cerebrovascular disease was a protective factor against surgery for LDH (OR = 0.267). CONCLUSIONS BMI, genetic history, number of deliveries, simple hysterectomy, hypertriglyceridemia, and hyper-low-density lipoprotein cholesterolemia were independent risk factors for surgical treatment of both LDH and LSS in middle-aged and older women. Two disparities were found: labor intensity was a risk factor for LDH patients, and knee joint surgery and diabetes were risk factors for LSS patients.
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Affiliation(s)
- Yuchen Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Xing Chen
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Zhaoqing Zhang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaorong Yang
- Department of Orthopedics, Zhangqiu District People's Hospital, Jinan, China
| | - Shuo Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
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Park JH, Yeom JS, Park SM, Ryu MW, Kim HJ. Comparative study on the efficacy of pregabalin versus limaprost in patients with lumbar spinal stenosis: A prospective, randomized controlled trial. World Neurosurg 2024:S1878-8750(24)00596-5. [PMID: 38608818 DOI: 10.1016/j.wneu.2024.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Patients with Lumbar Spinal Stenosis (LSS) typically complain of back pain and leg pain. These symptoms reduce the quality of life and also cause sleep disturbances. This study compares pregabalin and limaprost's efficacy in LSS for pain, disability, quality of life, and sleep, aiming to offer insights for medication selection. METHODS This study was designed as a prospective, randomized, single-center, single-blinded, clinical superiority trial targeting patients with LSS. For 6 weeks, 111 patients per group were administered medication following a standard regimen, after which patient-reported outcomes were measured. The primary outcome was the Visual Analogue Scale (VAS) for back and leg pain, and the secondary outcomes included the Oswestry Disability Index (ODI), European Quality of Life 5 Dimensions (EQ-5D), and sleep quality. RESULTS After 6 weeks of medication, there were significant improvements over time in the primary outcome, VAS for back pain and leg pain, in both groups, but no significant difference between the two groups. Similarly, for the secondary outcomes, ODI and EQ-5D, both groups showed significant improvements, yet there was no significant difference between them. In the subgroup analysis targeting poor sleepers (Pittsburgh sleep quality index, PSQI > 5), both groups also exhibited significant improvements in sleep quality, but again, there was no significant difference between the groups. CONCLUSIONS Efficacy of pregabalin, limaprost in back and leg pain, ODI, EQ-5D, and sleep quality, but there was no significant difference between the two groups. Thus, it is advisable to prescribe based on individual drug responses and potential complications.
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Affiliation(s)
- Jin-Ho Park
- Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 18, Cheonho-daero 173-gil, Gangdong-gu, Seoul, Republic of Korea, 05355.
| | - Jin S Yeom
- Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea, 13620.
| | - Sang-Min Park
- Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea, 13620.
| | - Min-Woo Ryu
- Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea, 13620.
| | - Ho-Joong Kim
- Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea, 13620.
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Hermansen E, Myklebust TÅ, Austevoll IM, Hellum C, Storheim K, Banitalebi H, Indrekvam K, Brisby H. Dural Sac Cross-sectional area change from preoperatively and up to 2 years after decompressive surgery for central lumbar spinal stenosis: investigation of operated levels, data from the NORDSTEN study. Eur Spine J 2024:10.1007/s00586-024-08251-4. [PMID: 38587545 DOI: 10.1007/s00586-024-08251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/18/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The aim of the present study was to investigate how canal area size changed from before surgery and up to 2 years after decompressive lumbar surgery lumbar spinal stenosis. Further, to investigate if an area change postoperatively (between 3 months to 2 years) was associated with any preoperative demographic, clinical or MRI variables or surgical method used. METHODS The present study is analysis of data from the NORDSTEN- SST trial where 437 patients were randomized to one of three mini-invasive surgical methods for lumbar spinal stenosis. The patients underwent MRI examination of the lumbar spine before surgery, and 3 and 24 months after surgery. For all operated segments the dural sac cross-sectional area (DSCA) was measured in mm2. Baseline factors collected included age, gender, BMI and smoking habits. Furthermore, surgical method, index level, number of levels operated, all levels operated on and baseline Schizas grade were also included in the analysis. RESULTS 437 patients were enrolled in the NORDSTEN-SST trial, whereof 310 (71%) had MRI at 3 months and 2 years. Mean DSCA at index level was 52.0 mm2 (SD 21.2) at baseline, at 3 months it increased to 117.2 mm2 (SD 43.0) and after 2 years the area was 127.7 mm2 (SD 52.5). Surgical method, level operated on or Schizas did not influence change in DSCA from 3 to 24 months follow-up. CONCLUSION The spinal canal area after lumbar decompressive surgery for lumbar spinal stenosis increased from baseline to 3 months after surgery and remained thereafter unchanged 2 years postoperatively.
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Affiliation(s)
- Erland Hermansen
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.
- Institute of Health Sciences, Norwegian University of Technology and Science, Ålesund, Norway.
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Registration, Cancer Registry Norway, Oslo, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital Oslo, Oslo, Norway
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Nordbyhagen, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Helena Brisby
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Takenaka H, Kamiya M, Sugiura H, Nishihama K, Suzuki J, Hanamura S. Recovery of the Japanese orthopedic association back pain evaluation questionnaire score and walking ability following lumbar spinal stenosis surgery. Eur Spine J 2024:10.1007/s00586-024-08238-1. [PMID: 38584242 DOI: 10.1007/s00586-024-08238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE We investigated the recovery of the Japanese orthopedic association back pain evaluation questionnaire (JOABPEQ) scores and 6 min walk distance (6MWD) in patients after surgery for lumbar spinal stenosis and identified the items among 25 questions of JOABPEQ that showed recovery. METHODS A total of 227 patients (average age 71.5 years; SD: 7.5; 121 men) were included from a single center. The outcome measures were JOABPEQ, visual analog scale (VAS), and 6MWD and obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Mixed-model repeated measures were used to compare the variables at each time point between the surgery groups. RESULTS The JOABPEQ, VAS, and 6MWD scores generally improved at 1 month postoperatively compared with those obtained preoperatively, and some parameters further improved at 3 months. However, improvement in the lumbar spine dysfunction item of JOABPEQ was delayed, showing improvement at 3 months postoperatively for decompression surgery (average score: pre, 64.6; 3 months, 78.5) and 6 months postoperatively for fusion surgery (average score: Pre, 64.3; 6 months, 77.1). Responses to the individual JOABPEQ questions generally improved after surgery. No significant changes in lumbar spine dysfunction occurred in the fusion group. CONCLUSION Our results demonstrated the early postoperative recovery course of JOABPEQ and 6MWD. In the fusion group, significant changes in lumbar spine dysfunction started at 6 months postoperatively. These findings could help medical staff explain postoperative recovery to patients after lumbar spinal stenosis surgery and in their decision making regarding surgery.
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Affiliation(s)
- Hiroto Takenaka
- Department of Rehabilitation, Kasugai Orthopedics Asahi Hospital, 2090 Higashino-Cho, Kasugai, Aichi, 486-0819, Japan.
- Department of Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-Ku, Nagoya, Aichi, 461-8673, Japan.
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Shizuoka, 431-2102, Japan.
| | - Mitsuhiro Kamiya
- Department of Orthopedic Surgery, Kasugai Orthopedics Asahi Hospital, 2090 Higashino-Cho, Kasugai, Aichi, 486-0819, Japan
| | - Hideshi Sugiura
- Department of Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-Ku, Nagoya, Aichi, 461-8673, Japan
| | - Kasuri Nishihama
- Department of Rehabilitation, Kasugai Orthopedics Asahi Hospital, 2090 Higashino-Cho, Kasugai, Aichi, 486-0819, Japan
| | - Junya Suzuki
- Department of Rehabilitation, Kasugai Orthopedics Asahi Hospital, 2090 Higashino-Cho, Kasugai, Aichi, 486-0819, Japan
| | - Shuntaro Hanamura
- Department of Orthopedic Surgery, Kasugai Orthopedics Asahi Hospital, 2090 Higashino-Cho, Kasugai, Aichi, 486-0819, Japan
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Friis Pedersen C, Eiskjær S, Østerheden Andersen M, Yacat Carreon L, Doering P. A propensity-matched study of patients with symptomatic lumbar spinal stenosis opting for surgery versus not. Brain Spine 2024; 4:102802. [PMID: 38633292 PMCID: PMC11021904 DOI: 10.1016/j.bas.2024.102802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
Introduction Although most surgeons treating patients with lumbar spinal stenosis (LSS) believe that surgical treatment is superior to conservative measures, systematics reviews have concluded that no solid evidence support this. Research question To compare change at 1-year of walking ability, health-related quality of life, leg and back pain in patients with symptomatic LSS referred to a spine surgery clinic who opted for surgery and those who did not. Material and methods The study included 149 operated and 149 non-operated patients seen by spine surgeons and diagnosed with LSS. The non-operated patients were propensity-matched to a cohort retrieved from the Danish national spine registry. Matching was done on demographics and baseline outcome measures. The outcomes was walking improvement measured by item 4 of the Oswestry Disability Index, EQ-5D-3L, global assessment (GA) of back/leg pain, back and leg pain on the Visual Analogue Scale and the Short Form 36 transition item 2. Results Less than half of the non-operated reached MCID on EQ-5D-3L, VAS pain legs or VAS pain back where 2/3 of the operated did. The largest difference was VAS back pain where 27.5% of the non-operated reached an MCID of 12 points compared to 71.8% in the operated group. Discussion and conclusion Surgical treated patients improved better than non-operated on all outcome measures. However, further research is required to compare the effectiveness of surgical decompression with non-operative care for LSS patients.
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Affiliation(s)
- Casper Friis Pedersen
- Center for Spine Surgery and Research, Spinecenter of Southern Denmark, Lillebaelt Hospital, Oestre Hougvej 55, DK-5500, Middelfart, Denmark
| | - Søren Eiskjær
- Aalborg University, Denmark, Dept. of Orthopedic Surgery, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Mikkel Østerheden Andersen
- University of Southern Denmark, Center for Spine Surgery and Research, Spinecenter of Southern Denmark, Lillebaelt Hospital, Oestre Hougvej 55, DK-5500, Middelfart, Denmark
| | - Leah Yacat Carreon
- University of Southern Denmark, Center for Spine Surgery and Research, Spinecenter of Southern Denmark, Lillebaelt Hospital, Oestre Hougvej 55, DK-5500, Middelfart, Denmark
| | - Peter Doering
- Aalborg University, Denmark, Dept. of Orthopedic Surgery, Hobrovej 18-22, DK-9000, Aalborg, Denmark
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Guo S, Yu Z, Wang C, Zhong M, Wang R, Hu Y, Wang C, Li S. Risk Factors of Hidden Blood Loss in Unilateral Biportal Endoscopic Surgery for Patients with Lumbar Spinal Stenosis. Orthop Surg 2024; 16:842-850. [PMID: 38384164 PMCID: PMC10984805 DOI: 10.1111/os.14009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE Unilateral biportal endoscopic (UBE) surgery has recently been used as a minimally invasive procedure for the treatment of lumbar spinal stenosis and is associated with less perioperative blood loss. However, perioperative hidden blood loss (HBL) may be neglected during UBE. This study aimed to examine the volume of HBL and discuss the influential risk factors for HBL during unilateral biportal endoscopic surgery. METHODS From January 2022 to August 2022, 51 patients underwent percutaneous unilateral biportal endoscopic surgery for lumbar spinal stenosis at the Department of Spinal Surgery of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University and were enrolled in this study. The data included general indicators (age, sex and body mass index [BMI]), underlying disease (hypertension and diabetes), laboratory test results (prothrombin time [PT], activated partial thromboplastin time [APTT], fibrinogen [Fbg]), and preoperative and postoperative hematocrit and hemoglobin), related imaging parameters (severity of intervertebral disc [IVD] degeneration and soft tissue thickness of the interlaminar approach), number of operated vertebrae and operation time. Total blood loss (TBL) and HBL during surgical procedures were measured via the Gross formula. Influential factors were further analyzed by multivariate linear regression analysis and t-tests. RESULTS The mean HBL was 257.89 ± 190.66 mL for single-operation patients and 296.58 ± 269.75 mL for two-operation patients. Patients with lower PT (p = 0.044), deeper tissue thickness (p = 0.047), and diabetes mellitus were determined to have more HBL during UBE. The operation time might also be an important factor (p = 0.047). However, sex (p = 0.265), age (p = 0.771/0.624), BMI (p = 0.655/0.664), APTT (p = 0.545/0.751), degree of degenerated IVD (p = 0.932/0.477), and hypertension (p = 0.356/0.896) were not related to HBL. CONCLUSION This study determined the different influential factors of HBL during UBE. PT, tissue thickness, and diabetes mellitus are the independent risk factors that affect HBL incidence. Long PT may decrease the volume of HBL within a certain range. Tissue thickness and diabetes mellitus can lead to an increased volume of HBL.
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Affiliation(s)
- Sheng Guo
- Department of Foot and Ankle SurgeryXiangyang Hospital of Traditional Chinese Medicine (The Affiliated Orthopedics & Traumatology Hospital of Hubei University of Traditional Chinese Medicine)XiangyangChina
| | - Zhiyong Yu
- Department of Foot and Ankle SurgeryXiangyang Hospital of Traditional Chinese Medicine (The Affiliated Orthopedics & Traumatology Hospital of Hubei University of Traditional Chinese Medicine)XiangyangChina
| | - Chenglong Wang
- Department of Spine SurgeryOrthopedic Hospital of Mianyang CityMianyangChina
| | - Mingqiang Zhong
- Department of Foot and Ankle SurgeryXiangyang Hospital of Traditional Chinese Medicine (The Affiliated Orthopedics & Traumatology Hospital of Hubei University of Traditional Chinese Medicine)XiangyangChina
| | - Rui Wang
- Department of Foot and Ankle SurgeryXiangyang Hospital of Traditional Chinese Medicine (The Affiliated Orthopedics & Traumatology Hospital of Hubei University of Traditional Chinese Medicine)XiangyangChina
| | - Yechang Hu
- Department of Foot and Ankle SurgeryXiangyang Hospital of Traditional Chinese Medicine (The Affiliated Orthopedics & Traumatology Hospital of Hubei University of Traditional Chinese Medicine)XiangyangChina
| | - Chunling Wang
- Department of Foot and Ankle SurgeryXiangyang Hospital of Traditional Chinese Medicine (The Affiliated Orthopedics & Traumatology Hospital of Hubei University of Traditional Chinese Medicine)XiangyangChina
| | - Sen Li
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
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Figuim B, Haman Nassarou O, Mbangtang CB, Ludvine NT, Djientcheu VDP. Long term postoperative results and quality of life after surgery for lumbar spinal stenosis in sub-sahara African countries, the case of Cameroon: A cross-sectional study. World Neurosurg X 2024; 22:100340. [PMID: 38444866 PMCID: PMC10914569 DOI: 10.1016/j.wnsx.2024.100340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
Objectives Lumbar spinal stenosis is a frequent and disabling disease of the elderly. However, the impact of its surgery on the long term (≥5 years) postoperative results and quality of life has not yet been evaluated in our setting. Methods The study population consisted of 224 patients operated between 2010 and 2017 at the Yaounde Central Hospital and the Yaounde General Hospital, of whom 33 were evaluated. Long term postoperative results were defined as reoperations, indication for reoperation, time elapsed to reoperation and control-X ray findings. Quality of life (QOL) was evaluated using the Oswestry Disability Index (ODI) and Numerical Pain Rating Scale (NRS), and compared to reported preoperative values. The one-way analysis of variance and Kruskal-Wallis tests were used for associations between patient characteristics and quality of life outcomes. Results Participants had a mean age of 57.3 years. 21% of participants were reoperated at least once, two years later on average due to reappearance of their clinical pictures. QOL significantly improved from being crippled (mean ODI 67.5%) and having severe pain (mean NRS 8) before surgery, to moderate disability (mean ODI 34.4%, p < 0.01) and moderate pain (means NRS 4, p < 0.01) five years later. Having large family support was the only factor independently associated with improved ODI and NRS (p = 0.01). Conclusion Lumbar spinal stenosis surgery is still beneficial five years later. Large cohort studies need to be conducted in our setting.
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Affiliation(s)
- Bello Figuim
- Neurosurgery Department, Yaounde Central Hospital, Cameroon
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Wada T, Tanishima S, Kitsuda Y, Osaki M, Takeda C, Noma H, Nagashima H, Hagino H. Association between phase angle and clinical outcomes in patients with lumbar spinal stenosis from the preoperative to 12-month postoperative period: A prospective observational study. J Clin Neurosci 2024; 123:41-46. [PMID: 38531193 DOI: 10.1016/j.jocn.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
No reports of longitudinal studies on phase angle (PhA) in lumbar spinal stenosis (LSS) exist, and its association with postoperative clinical outcomes is unclear. We longitudinally investigated PhA in patients with LSS preoperatively to 12 months postoperatively and determined the association between PhA and the Japanese Orthopedic Association (JOA) score. This prospective observational study included patients who underwent consecutive surgical treatments for clinically and radiologically defined LSS. Outcome measures including walking speed, Timed Up and Go test (TUG), JOA score, and PhA based on bioelectrical impedance analysis were measured preoperatively and at 3, 6, and 12 months postoperatively. Correlations between PhA and the JOA score and motor function were analyzed. The effect of PhA on JOA scores was evaluated using mixed-effect models for repeated measurements (MMRM). Eighty-nine patients were included at baseline, and 85, 85, and 78 patients were analyzed at 3, 6, and 12 months postoperatively, respectively. PhA was 3.9 ± 0.8 (p = 0.086), 4.0 ± 0.8 (p = 0.644), and 4.1 ± 0.9 (p = 0.791) at 3, 6, and 12 months postoperatively and 4.2 ± 0.8 at baseline. PhA was significantly correlated with the JOA score (p < 0.01) and walking speed and TUG results (p < 0.01) at all assessment points. In the MMRM, PhA was associated with the JOA score at all assessment points. Changes in postoperative JOA scores after lumbar spine surgery are associated with PhA at each assessment time point. PhA may be a useful postoperative clinical indicator after surgery for LSS.
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Affiliation(s)
- Takashi Wada
- Rehabilitation Division, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan.
| | - Shinji Tanishima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Yuki Kitsuda
- Rehabilitation Division, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Mari Osaki
- Rehabilitation Division, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Chikako Takeda
- Rehabilitation Division, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan; Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Hisashi Noma
- Department of Interdisciplinary Statistical Mathematics, The Institute of Statistical Mathematics, 10-3 Midori-cho, Tachikawa, Tokyo 190-8562, Japan
| | - Hideki Nagashima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Hiroshi Hagino
- Department of Rehabilitation, Sanin Rosai Hospital, 1-8-1 Kaikeshinden, Yonago, Tottori 683‑8605, Japan
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Zhang H, Liu D, Fan X. Diagnostic and prognostic significance of miR-486-5p in patients who underwent minimally invasive surgery for lumbar spinal stenosis. Eur Spine J 2024:10.1007/s00586-024-08203-y. [PMID: 38528160 DOI: 10.1007/s00586-024-08203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/29/2024] [Accepted: 02/22/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND This study aimed to investigate the expression and clinical value of microRNA miR-486-5p in diagnosing lumbar spinal stenosis (LSS) patients and predicting the clinical outcomes after minimally invasive spinal surgery (MISS) in LSS patients, and the correlation of miR-486-5p with inflammatory responses in LSS patients. METHODS This study included 52 LSS patients, 46 patients with lumbar intervertebral disk herniation (LDH) and 42 healthy controls. Reverse transcription quantitative PCR was used to detect miR-486-5p expression. The ability of miR-486-5p to discriminate between different groups was evaluated by receiver-operating characteristic analysis. The visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scores at 6 months postoperatively were used to reflect the clinical outcomes of LSS patients. Enzyme-linked immunosorbent assay was used to measure the levels of inflammatory factor [interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α)]. The correlation of miR-486-5p with continuous variables in LSS patients was evaluated by the Pearson correlation coefficient. RESULTS Expression of serum miR-486-5p was upregulated in LSS patients and had high diagnostic value to screen LSS patients. In addition, serum miR-486-5p could predict the 6-month clinical outcomes after MISS therapy in LSS patients. Moreover, serum miR-486-5p was found to be positively correlated with the levels of IL-1β and TNF-α in patients with LSS. CONCLUSION miR-486-5p, increased in LSS patients, can function as an indicator to diagnose LSS and a predictive indicator for the clinical outcomes after MISS therapy in LSS patients. In addition, miR-486-5p may regulate LSS progression by modulating inflammatory responses.
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Affiliation(s)
- Heqing Zhang
- The Second Department of Spine Surgery, Yantaishan Hospital, Yantai, 264003, Shandong, China
| | - Dong Liu
- The Second Department of Spine Surgery, Yantaishan Hospital, Yantai, 264003, Shandong, China
| | - Xiaoguang Fan
- The Second Department of Spine Surgery, Yantaishan Hospital, Yantai, 264003, Shandong, China.
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Akosman I, Shafi K, Subramanian T, Kazarian GS, Kaidi AC, Cunningham M, Kim HJ, Lovecchio F. Left-digit bias in surgical decision-making for lumbar spinal stenosis. Spine J 2024:S1529-9430(24)00116-5. [PMID: 38499062 DOI: 10.1016/j.spinee.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/09/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND CONTEXT Left-digit bias is a behavioral heuristic or cognitive "shortcut" in which the leftmost digit of a number, such as patient age, disproportionately influences surgical decisions. PURPOSE To determine if left-digit bias in patient age influences the decision to perform arthrodesis with instrumentation vs decompression in lumbar spinal stenosis (LSS). DESIGN Retrospective cohort. PATIENT SAMPLE Patients with an ICD-10 diagnosis of lumbar stenosis or spondylolisthesis identified in the 2017-2021 National Surgical Quality Improvement Program (NSQIP) database. OUTCOME MEASURES The primary outcome was the percent of patients who underwent arthrodesis with instrumentation (AwI). Matched age group comparisons without left-digit differences (ie, 76/77 vs 78/79, 80/81 vs 82/83, etc.) were performed to isolate the effect of the heuristic. Secondary outcomes including peri-operative events and complications were also compared within AwI and decompression cohorts. METHODS Using CPT codes, procedures were classified as either AwI or decompression. Patients were grouped into 6 cohorts based on 2-year age windows (74/75, 76/77, 78/79, 80/81, 82/83, 84/85). The cohorts were propensity matched with neighboring age groups based on the presence of spondylolisthesis, demographics, and comorbidities. The primary comparison was between those aged 78/79 vs 80/81. RESULTS After matching, the primary cohort consisted of two groups of 1,550 patients (aged 78/79 and 80/81). Patients aged 80/81 were less likely to undergo AwI than patients aged 78/79 (23.5% vs 27.2%, p=.021). AwI procedures occurred at similar rates between age groups with the same left digit. Within the decompression and AwI cohorts, there were no differences in secondary outcomes between patients aged 78/79 and 80/81. CONCLUSIONS LSS patients aged 80/81 are less likely to undergo AwI than patients aged 78/79, regardless of comorbidities. This was not seen when comparing patients with similar left digits in age. Until objective measures of physiologic capacity are established, left-digit bias may influence clinical decisions.
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Affiliation(s)
- Izzet Akosman
- Weill Cornell Medicine, 1300 York Ave, New York, NY 10021, USA; Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Karim Shafi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Tejas Subramanian
- Weill Cornell Medicine, 1300 York Ave, New York, NY 10021, USA; Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Gregory S Kazarian
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Austin C Kaidi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Matthew Cunningham
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Han Jo Kim
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Francis Lovecchio
- Weill Cornell Medicine, 1300 York Ave, New York, NY 10021, USA; Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Gustafsson MEAK, Schiøttz-Christensen B, Petersen TL, Jepsen R, Wedderkopp N, Brønd JC, O'Neill SFD. Walking performance in individuals with lumbar spinal stenosis- possible outcome measures and assessment of known-group validity. Spine J 2024:S1529-9430(24)00115-3. [PMID: 38499067 DOI: 10.1016/j.spinee.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND CONTEXT One of the primary goals of treatments received by individuals with lumbar spinal stenosis with neurogenic claudication is to improve walking ability. Thus, a thorough and valid assessment of walking ability in patients with lumbar spinal stenosis is needed. Duration of continuous walking and steps per day could be relevant when evaluating walking ability in daily living. PURPOSE To describe and evaluate a method for estimating continuous walking periods in daily living and to evaluate the known-group validity of steps per day in individuals with lumbar spinal stenosis. STUDY DESIGN This is a cross-sectional observational study. PATIENT SAMPLE The study contains three study groups: individuals with lumbar spinal stenosis, individuals with low back pain, and a background population from the Lolland-Falster Health Study (LOFUS). OUTCOME MEASURES Participants in all three study groups wore an accelerometer on the thigh for seven days. METHODS Accelerometer data were processed to summarize the continuous walking periods according to their length: the number of short (4-9 seconds), moderate (10-89 seconds), and extended (≥90 seconds) continuous walking periods per day, and the number of steps per day. Results from the three groups were compared using negative binomial regression with lumbar spinal stenosis as the reference level. RESULTS Continuous walking periods of moderate length were observed 1.48 (95% CI 1.27, 1.72) times more often in individuals from the background population than in individuals with LSS. Continuous walking periods of extended length were observed 1.53 (95% CI 1.13, 2.06) times more often by individuals with low back pain and 1.60 (95% CI 1.29, 1.99) times more often by individuals from the background population. The number of steps per day was 1.22 (95% CI 1.03, 1.46) times larger in individuals with LBP and 1.35 (95% CI 1.20, 1.53) times larger in individuals from background population. CONCLUSIONS The impact of neurogenic claudication on walking ability in daily living seems possible to describe by continuous walking periods along with steps per day. The results support known-group validity of steps per day. This is the next step toward a clinically relevant and comprehensive assessment of walking in daily living in individuals with lumbar spinal stenosis.
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Affiliation(s)
- Malin Eleonora Av Kák Gustafsson
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, 5500 Middelfart, Denmark; Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
| | - Berit Schiøttz-Christensen
- Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Therese Lockenwitz Petersen
- Centre for Epidemiological Research, Nykøbing Falster Hospital, Strandboulevarden 64, 4800 Nykøbing Falster, Denmark
| | - Randi Jepsen
- Centre for Epidemiological Research, Nykøbing Falster Hospital, Strandboulevarden 64, 4800 Nykøbing Falster, Denmark
| | - Niels Wedderkopp
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Jan Christian Brønd
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Søren Francis Dyhrberg O'Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, 5500 Middelfart, Denmark; Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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韩 国, 马 力, 程 永, 郑 科, 祁 家, 董 洲, 张 之, 姚 登. [Comparison of effectiveness between unilateral biportal endoscopic and uniportal interlaminar endoscopic decompression in the treatment of lumbar spinal stenosis]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:324-330. [PMID: 38500426 PMCID: PMC10982040 DOI: 10.7507/1002-1892.202312029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 03/20/2024]
Abstract
Objective To compare the effectiveness between unilateral laminotomy and bilateral decompression (ULBD) with unilateral biportal endoscopy (UBE) and uniportal interlaminar endoscopy (UIE) in the treatment of lumbar spinal stenosis. Methods A clinical data of 52 patients with lumbar spinal stenosis, who met the selection criteria and treated with ULBD between March 2021 and November 2022, was retrospectively analyzed. The patients were allocated into UBE group (23 cases) and UIE group (29 cases) according to the surgical methods. There was no significant difference ( P>0.05) in age, gender, body mass index, surgical segment, type of lumbar stenosis, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of leg pain, Oswestry disability index (ODI), disc height, and dural sac area between the two groups. Perioperative indexes (incision length, operation time, hospital stay, and surgical complications), clinical indicators (VAS score of low back pain, VAS score of leg pain, and ODI before operation and at 3 days, 1 month, 6 months, and 12 months after operation), and imaging indicators (disc height and dural sac area before operation and at 1, 12 months after operation, and dural sac expansion area) were recorded and compared between the two group. Results All operations in both groups were successfully completed. Compared with the UIE group, the UBE group had shorter operation time and longer incision length, with significant differences ( P<0.05). But there was no significant difference in hospital stay and incidence of complications between the two groups ( P>0.05). All patients were followed up 12-20 months (mean, 14 months). The VAS scores of low back pain and leg pain and ODI after operation significantly improved when compared with preoperative values ( P<0.05), and there was no significant difference in the above indicators between different time points after operation ( P>0.05). There was no significant difference between the two groups at different time points ( P>0.05). Imaging examination showed that there was no significant difference in disc height between the two groups at different time points after operation ( P>0.05). However, the dural sac area and dural sac expansion area were significantly larger in the UBE group than in the UIE group ( P<0.05). Conclusion ULBD with UBE and UIE can achieve satisfactory effectiveness in the treatment of lumbar spinal stenosis. But the former has more thorough decompression and better dural sac expansion than the latter.
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Affiliation(s)
- 国嵩 韩
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 力 马
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 永红 程
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 科 郑
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 家龙 祁
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 洲 董
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 之栋 张
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 登攀 姚
- 合肥市第一人民医院脊柱外科(合肥 230061)Department of Spine Surgery, Hefei First People’s Hospital, Hefei Anhui, 230061, P. R. China
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Wang F, Wang R, Zhang C, Song E, Li F. Clinical effects of arthroscopic-assisted uni-portal spinal surgery and unilateral bi-portal endoscopy on unilateral laminotomy for bilateral decompression in patients with lumbar spinal stenosis: a retrospective cohort study. J Orthop Surg Res 2024; 19:167. [PMID: 38444008 PMCID: PMC10916320 DOI: 10.1186/s13018-024-04621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To investigate the clinical effectiveness of Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS) in the treatment of lumbar spinal stenosis. METHODS A total of 475 patients with lumbar spinal stenosis from January 2019 to January 2023 were included in this study. Among them, 240 patients were treated with AUSS (AUSS group); the other 235 patients were treated with unilateral bi-portal endoscopy treatment (UBE group). The differences in surgery-related clinical indicators, pain degree before and after surgery, Oswestry Disability Index (ODI), CT imaging parameters of spinal stenosis, and clinical efficacy were compared between the two groups. RESULTS Patients in the AUSS group had a shorter operative time than those in the UBE group, and the length of incision and surgical bleeding were less than those in the UBE group, with statistically significant differences (P < 0.05). Before operation, there was no significant difference in the VAS score of low back pain and leg pain between the two groups (P > 0. 05). After operation, patients in both groups showed a significant reduction in low back and leg pain, and their VAS scores were significantly lower than before the operation (P < 0.05). Three months after surgery, the results of CT re-examination in both groups showed that the spinal stenosis of the patients was well improved, and the measurements of lumbar spinal interspace APDC, CAC, ICA, CAD and LAC were significantly higher than those before surgery (P < 0. 05). Besides, the lumbar function of patients improved significantly in both groups, and ODI measurements were significantly lower than those before surgery (P < 0.05). CONCLUSION Both AUSS and UBE with unilateral laminotomy for bilateral decompression can achieve good clinical results in the treatment of lumbar spinal stenosis, but the former has the advantages of simpler operation, shorter operation time, shorter incision length, and less surgical blood loss.
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Affiliation(s)
- Fang Wang
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Rui Wang
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Chengyi Zhang
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - En Song
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - Fengtao Li
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China.
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Lu GQ, Zhuang MH, Liu YY, Zhu LG, Gao JH, Wei X, Li LG, Yu J. Effects of calcitonin on lumbar spinal stenosis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05260-2. [PMID: 38436716 DOI: 10.1007/s00402-024-05260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE There is some controversy about the effects of calcitonin (CT) on lumbar spinal stenosis (LSS). This systematic review and meta-analysis is to assess the strength of the evidence supporting the use of CT in the treatment of patients with LSS. MATERIAL AND METHOD We performed an electronic search depicting randomized controlled trials (RCTs) through 4 databases from the date of database creation to January 2023. 3 different researchers conducted independent literature screening, data extractions, and quality assessments. The outcome measures included visual analogue scale (VAS), walking distance, and oswestry disability index (ODI). Meta-analysis and trial sequence analysis (TSA) were carried out using RevMan 5.4, Stata 16.0, and TSA 0.9. GRADE 3.6 was used to evaluate the evidence quality. RESULTS We accepted 9 studies with 496 participants. The meta-analysis revealed that CT offered no significant improvement in VAS, walking distance, or ODI in patients with LSS. CONCLUSION There is no evidence that CT has a benefit in patients with LSS, either alone or in combination with other treatments, or depending on the route of administration, according to the systematic review and meta-analysis of relevant RCTs.
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Affiliation(s)
- Guang-Qi Lu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ming-Hui Zhuang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi-Ying Liu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Li-Guo Zhu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jing-Hua Gao
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xu Wei
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lu-Guang Li
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Jie Yu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Chapon R, Alixant P, Laroche D, Ornetti P, Beaurain J, le Van T, Berhouma M, Ricolfi L. Influence of Posture on Gait Parameters in Severe Symptomatic Lumbar Stenosis Before and After Decompression Surgery. World Neurosurg 2024; 183:e109-e115. [PMID: 38030072 DOI: 10.1016/j.wneu.2023.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND We searched to quantify the influence of sagittal vertical axis (SVA) on the improvement of spatiotemporal gait parameters using a gait motion analysis (GMA) before and after decompression surgery in patients suffering from lumbar spinal stenosis (LSS). METHODS Thirty-nine patients with severe LisSS planned for lumbar decompression underwent a full-body biplanar radiographs (EOS) to quantify the SVA and have benefited from a 3-dimensional GMA 1 month before surgery (M0) and 6 month (M6) after surgery. The first step of this study was to confirm the validation of 3-dimensional sagittal vertical axis (3D SVA) for posture analysis. An analysis of modification of the 3D SVA and spatiotemporal gait parameters was then carried out in order to identify any correlation. RESULTS Decompression surgery did not significantly improve 3D SVA between M0 and M6 (respectively 49.1 [50.3] vs. 49.84 [19.02], P = 0.42). Concerning spatiotemporal parameters, we found significant difference for all parameters between M0 and M6. A strong correlation (R2 > 0.65) between static SVA (EOS) and 3D SVA was demonstrated using a statistical regression equation. There was also a statistically significant correlation between SVA (static and 3-dimension) and improvement in spatiotemporal gait parameters after decompression surgery. CONCLUSIONS This study analyses the relationship between postural change (SVA) and improvement in gait parameters measured during GMA before and after decompression surgery for LSS. This specific analysis of gait parameters may represent a prognostic assessment tool for the recovery of patients undergoing surgery for a LSS.
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Affiliation(s)
- Renan Chapon
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France
| | - Philibert Alixant
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France.
| | - Davy Laroche
- CIC INSERM 1432, Technological Investigation Platform, University Hospital of Dijon Burgundy, University of Burgundy, Dijon, France
| | - Paul Ornetti
- CIC INSERM 1432, Technological Investigation Platform, University Hospital of Dijon Burgundy, University of Burgundy, Dijon, France; Department of Rheumatology, University Hospital of Dijon Burgundy, Dijon, France
| | - Jacques Beaurain
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France
| | - Tuan le Van
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France
| | - Moncef Berhouma
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France; Functional and Molecular Imaging Team (CNRS 6302 - ICMUB), Molecular Chemistry Institute, University of Burgundy, Dijon, France
| | - Louis Ricolfi
- Department of Orthopaedic surgery, University Hospital of Dijon Burgundy, Dijon, France
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Chen J, Zhong G, Qiu M, Ke W, Xue J, Chen J. Exploring lncRNA Expression Patterns in Patients With Hypertrophied Ligamentum Flavum. Neurospine 2024; 21:330-341. [PMID: 38291747 PMCID: PMC10992663 DOI: 10.14245/ns.2346994.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE Hypertrophy ligamentum flavum (LFH) is a common cause of lumbar spinal stenosis, resulting in significant disability and morbidity. Although long noncoding RNAs (lncRNAs) have been associated with various biological processes and disorders, their involvement in LFH remains not fully understood. METHODS Human ligamentum flavum samples were analyzed using lncRNA sequencing followed by validation through quantitative real-time polymerase chain reaction. To explore the potential biological functions of differentially expressed lncRNA-associated genes, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed. We also studied the impact of lncRNA PARD3-AS1 on the progression of LFH in vitro. RESULTS In the LFH tissues when compared to that in the nonhypertrophic ligamentum flavum (LFN) tissues, a total of 1,091 lncRNAs exhibited differential expression, with 645 upregulated and 446 downregulated. Based on GO analysis, the differentially expressed transcripts primarily participated in metabolic processes, organelles, nuclear lumen, cytoplasm, protein binding, nucleic acid binding, and transcription factor activity. Moreover, KEGG pathway analysis indicated that the differentially expressed lncRNAs were associated with the hippo signaling pathway, nucleotide excision repair, and nuclear factor-kappa B signaling pathway. The expression of PARD3-AS1, RP11-430G17.3, RP1-193H18.3, and H19 was confirmed to be consistent with the sequencing analysis. Inhibition of PARD3-AS1 resulted in the suppression of fibrosis in LFH cells, whereas the overexpression of PARD3-AS1 promoted fibrosis in LFH cells in vitro. CONCLUSION This study identified distinct expression patterns of lncRNAs that are linked to LFH, providing insights into its underlying mechanisms and potential prognostic and therapeutic interventions. Notably, PARD3-AS1 appears to play a significant role in the pathophysiology of LFH.
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Affiliation(s)
- Junling Chen
- Department of Orthopedics, Baoshan Branch, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guibin Zhong
- Department of Orthopedics, Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Manle Qiu
- Department of Orthopedics, Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Wei Ke
- Department of Orthopedics, Baoshan Branch, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jingsong Xue
- Department of Orthopedics, Baoshan Branch, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianwei Chen
- Department of Orthopedics, Baoshan Branch, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
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Morales A, El Chamaa A, Mehta S, Rushton A, Battié MC. Depression as a prognostic factor for lumbar spinal stenosis outcomes: a systematic review. Eur Spine J 2024; 33:851-871. [PMID: 37917206 DOI: 10.1007/s00586-023-08002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Lumbar spinal stenosis (LSS) is associated with increased levels of psychological distress, including depression; however, the prognostic value of depression remains unclear. The purpose of this systematic review was to synthesize the evidence on the prognostic value of depression for a range of outcomes in patients with LSS. METHODS Inclusion criteria were prospective cohort studies that investigated depression in patients diagnosed with LSS. Searches were conducted in 7 databases. Critical appraisal, data extraction, and judgement of cumulative evidence were conducted independently by two reviewers. A meta-analysis was not conducted due to a lack of unique cohorts for each outcome, varying follow-up times, and differences in measurements for both prognostic factors and outcomes. RESULTS Twenty-three articles were included. There was evidence for an association between preoperative depression and postoperative disability and symptom severity outcomes for patients with LSS. Odds ratios ranged from 1.15 to 2.94 for postoperative disability and 1.16-1.20 for symptom severity at various follow-up times. Using GRADE, evidence supporting depression as a prognostic factor for these LSS outcomes was deemed to be of moderate quality. Similarly strong evidence suggested depressive symptoms are of no prognostic value for postoperative walking capacity. CONCLUSION Depression appears to have small to moderate prognostic value for LSS outcomes, with the strongest evidence for postoperative disability and symptom severity. The prognostic value of depression for LSS outcomes should be further explored using standardized measures in additional cohorts, including patients managing their condition conservatively, who have been neglected in related research.
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Affiliation(s)
- Ariel Morales
- School of Physical Therapy, Western University, London, ON, Canada
| | - Alaa El Chamaa
- School of Physical Therapy, Western University, London, ON, Canada
| | - Swati Mehta
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences and Western's Bone & Joint Institute, Western University, 1201 Western Road, London, ON, N6A 1H1, Canada
| | - Michele C Battié
- School of Physical Therapy, Faculty of Health Sciences and Western's Bone & Joint Institute, Western University, 1201 Western Road, London, ON, N6A 1H1, Canada.
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Tumko V, Kim J, Uspenskaia N, Honig S, Abel F, Lebl DR, Hotalen I, Kolisnyk S, Kochnev M, Rusakov A, Mourad R. A neural network model for detection and classification of lumbar spinal stenosis on MRI. Eur Spine J 2024; 33:941-948. [PMID: 38150003 DOI: 10.1007/s00586-023-08089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/30/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES To develop a three-stage convolutional neural network (CNN) approach to segment anatomical structures, classify the presence of lumbar spinal stenosis (LSS) for all 3 stenosis types: central, lateral recess and foraminal and assess its severity on spine MRI and to demonstrate its efficacy as an accurate and consistent diagnostic tool. METHODS The three-stage model was trained on 1635 annotated lumbar spine MRI studies consisting of T2-weighted sagittal and axial planes at each vertebral level. Accuracy of the model was evaluated on an external validation set of 150 MRI studies graded on a scale of absent, mild, moderate or severe by a panel of 7 radiologists. The reference standard for all types was determined by majority voting and in case of disagreement, adjudicated by an external radiologist. The radiologists' diagnoses were then compared to the diagnoses of the model. RESULTS The model showed comparable performance to the radiologist average both in terms of the determination of presence/absence of LSS as well as severity classification, for all 3 stenosis types. In the case of central canal stenosis, the sensitivity, specificity and AUROC of the CNN were (0.971, 0.864, 0.963) for binary (presence/absence) classification compared to the radiologist average of (0.786, 0.899, 0.842). For lateral recess stenosis, the sensitivity, specificity and AUROC of the CNN were (0.853, 0.787, 0.907) compared to the radiologist average of (0.713, 0.898, 805). For foraminal stenosis, the sensitivity, specificity and AUROC of the CNN were (0.942, 0.844, 0.950) compared to the radiologist average of (0.879, 0.877, 0.878). Multi-class severity classifications showed similarly comparable statistics. CONCLUSIONS The CNN showed comparable performance to radiologist subspecialists for the detection and classification of LSS. The integration of neural network models in the detection of LSS could bring higher accuracy, efficiency, consistency, and post-hoc interpretability in diagnostic practices.
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Affiliation(s)
- Vladislav Tumko
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Jack Kim
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA.
| | - Natalia Uspenskaia
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Shaun Honig
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Frederik Abel
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Darren R Lebl
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Irene Hotalen
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | | | - Mikhail Kochnev
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Andrej Rusakov
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Raphaël Mourad
- University of Toulouse, 118 Rte de Narbonne, 31062, Toulouse, France.
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23
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Pedersen CF, Andersen MØ, Carreon LY, Skov ST, Doering P, Eiskjær S. PROPOSE. Development and validation of a prediction model for shared decision making for patients with lumbar spinal stenosis. N Am Spine Soc J 2024; 17:100309. [PMID: 38304320 PMCID: PMC10831309 DOI: 10.1016/j.xnsj.2024.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Abstract
Background Decompression for lumbar spinal stenosis (LSS) is the most frequently performed spine surgery in Denmark. According to the Danish spine registry DaneSpine, at 1 year after surgery, about 75% of patients experiences considerable pain relief and around 66% improvement in quality of life. However, 25% do not improve very much. We have developed a predictive decision support tool, PROPOSE. It is intended to be used in the clinical conversation between healthcare providers and LSS patients as a shared decision-making aid presenting pros and cons of surgical intervention. This study presents the development and evaluation of PROPOSE in a clinical setting. Methods For model development, 6.357 LSS patients enrolled in DaneSpine were identified. For model validation, predictor response and predicted outcome was collected via PROPOSE from 228 patients. Observed outcome at 1 year was retrieved from DaneSpine. All participants were treated at 3 Danish spine centers. The outcome measures presented are improvement in walking distance, the Oswestry Disability Index, EQ-5D-3L and leg/back pain on the Visual Analog Scale. Outcome variables were dichotomized into success (1) and failure (0). With the exception of walking distance, a success was defined as reaching minimal clinically important difference at 1-year follow-up. Models were trained using Multivariate Adaptive Regression Splines. Performance was assessed by inspecting confusion matrix, ROC curves and comparing GCV (generalized cross-validation) errors. Final performance of the models was evaluated on independent test data. Results The walking distance model demonstrated excellent performance with an AUC of 0.88 and a Brier score of 0.14. The VAS leg pain model had the lowest discriminatory performance with an AUC of 0.67 and a Brier score of 0.22. Conclusions PROPOSE works in a real-world clinical setting as a proof of concept and demonstrates acceptable performance. It may have the potential of aiding shared decision making.
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Affiliation(s)
- Casper Friis Pedersen
- Center for Spine Surgery and Research, Spinecenter of Southern Denmark, Lillebaelt Hospital, Oestre Hougvej 55, DK-5500, Middelfart, Denmark
| | - Mikkel Østerheden Andersen
- University of Southern Denmark, Center for Spine Surgery and Research, Spinecenter of Southern Denmark, Lillebaelt Hospital, Oestre Hougvej 55, DK-5500, Middelfart, Denmark
| | - Leah Yacat Carreon
- University of Southern Denmark, Center for Spine Surgery and Research, Spinecenter of Southern Denmark, Lillebaelt Hospital, Oestre Hougvej 55, DK-5500, Middelfart, Denmark
| | - Simon Toftgaard Skov
- Aarhus University, Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 3, DK-8600, Silkeborg, Denmark
| | - Peter Doering
- Department of Orthopedic Surgery, Aalborg University, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Søren Eiskjær
- Department of Orthopedic Surgery, Aalborg University, Hobrovej 18-22, DK-9000, Aalborg, Denmark
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Stephens AR, El-Hassan R, Patel RK. Evaluation of Fluoroscopically Guided Transforaminal Selective Nerve Root Sleeve Injections for Lumbar Spinal Stenosis With Radiculopathy Utilizing Patient Reported Outcome Measurement Information System as an Outcome Measure. Arch Phys Med Rehabil 2024:S0003-9993(24)00831-1. [PMID: 38430994 DOI: 10.1016/j.apmr.2024.02.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To evaluate the therapeutic effect of transforaminal selective nerve root sleeve injections (TFSNRIs) in a specific subset of patients with clinical symptoms and presentation consistent with spinal stenosis. DESIGN Retrospective review. SETTING Tertiary academic spine center. PARTICIPANTS A total of 176 patients with radicular leg pain with or without low back pain as well as ≥3 clinical features of spinal stenosis and corroborative radiographic features of spinal stenosis on lumbar spine magnetic resonance imaging without confounding spinal pathology (N=176). INTERVENTIONS Fluoroscopically guided transforaminal selective nerve root sleeve injections. MAIN OUTCOME MEASURES Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) v1.2/v2.0, Pain Interference (PI) v1.1, and PROMIS (D) v1.0 were collected at baseline and post-procedure short term (<3-months) and long-term (6-12 month) follow-up. Statistical analysis comparing baseline and postprocedural PROMIS scores was performed. Differences were compared with previously established minimal clinically important differences in the spine population. RESULTS For patients with spinal stenosis treated with TFSNRI, no statistically significant improvement was observed short- and long-term follow-up in PROMIS PF (P=.97, .77) and PROMIS Depression (P=.86, .85) scores. At short-term follow-up, PROMIS PI scores did significantly improve (P=.01) but the average difference of pre- and post-procedure scores did not reach clinical significance. No significant difference in PROMIS PI was noted at long-term follow-up (.75). CONCLUSIONS Although a statistically significant difference was observed for improvement in pain, in this retrospective study, TFSNRI did not provide clinically significant improvement in patients' function, pain, or depression for lumbar spinal stenosis at short- and long-term follow-up.
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Affiliation(s)
- Andrew R Stephens
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
| | - Ramzi El-Hassan
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Rajeev K Patel
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
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Kang DH, Lee JH, Chang BS, Chang SY, Kim D, Park S, Kim H. Predicting adequate segmental lordosis correction in lumbar spinal stenosis patients undergoing oblique lumbar interbody fusion: a focus on the discontinuous segment. Eur Spine J 2024:10.1007/s00586-024-08146-4. [PMID: 38421447 DOI: 10.1007/s00586-024-08146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To identify the factors associated with a correction of the segmental angle (SA) with a total change greater than 10° in each level following minimally invasive oblique lumbar interbody fusion (MIS-OLIF). METHODS Patients with lumbar spinal stenosis who underwent single- or two-level MIS-OLIF were reviewed. Segments with adequate correction of the SA >10° after MIS-OLIF in immediate postoperative radiograph were categorized as discontinuous segments (D segments), whereas those without such improvement were assigned as continuous segments (C segments). Clinical and radiological parameters were compared, and multivariate logistic regression analysis was performed to identify factors associated with SA correction >10° after MIS-OLIF. RESULTS Of 211 segments included, 38 segments (18.0%) were classified as D segments. Compared with C segments, D segments demonstrated a significantly smaller preoperative SA (mean ± standard deviation [SD], - 1.1° ± 6.7° vs. 6.6° ± 6.3°, p < 0.001), larger change of SA (mean ± SD, 13.5° ± 3.4° vs. 3.1° ± 3.9°, p < 0.001), and a higher rate of presence of facet effusion (76.3% vs. 48.6%, p = 0.002). Logistic regression revealed preoperative SA (odds ratio (OR) [95% confidence interval (CI)]:0.733 [0.639-0.840], p < 0.001) and facet effusion (OR [95% CI]:14.054 [1.758-112.377], p = 0.027) as significant predictors for >10° SA correction after MIS-OLIF. CONCLUSION Preoperative kyphotic SA and facet effusion can predict SA correction >10° following MIS-OLIF. For patients with lordotic SA and no preoperative facet effusion, supplemental procedures, such as anterior column release or posterior osteotomy, should be prepared for additional lumbar lordosis correction required for remnant global sagittal imbalance after MIS-OLIF.
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Affiliation(s)
- Dong-Ho Kang
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Ji Han Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Dongook Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Sanghyun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea.
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Fan Z, Wu X, Guo Z, Shen N, Chen B, Xiang H. Unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in the treatment of lumbar spinal stenosis along with intervertebral disc herniation: a retrospective analysis. BMC Musculoskelet Disord 2024; 25:186. [PMID: 38424576 PMCID: PMC10902992 DOI: 10.1186/s12891-024-07287-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE This study aims to compare the clinical effects and imaging data of patients who underwent endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) with those who received unilateral biportal endoscopic lumbar interbody fusion (ULIF). METHODS A retrospective analysis was conducted on the clinical data of 69 patients presenting with typical intermittent claudication and signs and symptoms indicative of unilateral lower extremity nerve root compression, meeting inclusion criteria between April 2022 and June 2022. Among the cohort, 35 patients underwent ULIF group, while 34 patients underwent Endo-TLIF group. We compared perioperative parameters, including intraoperative blood loss, duration of hospital stay, and operation time between the two groups. Pre-operative and post-operative changes in the height and cross-sectional area of the target intervertebral space were also compared between the groups. Finally, we evaluated bone graft size and interbody fusion rates at 6 and 12 months post-surgery using the Brantigan scoring system. RESULTS The ULIF group had significantly shorter operative times compared to the Endo-TLIF group (P < 0.05). Conversely, the Endo-TLIF group exhibited significantly shorter hospital stays compared to the ULIF group (P < 0.05). However, there were no significant differences in intraoperative bleeding between the two groups (P > 0.05). Furthermore, both groups exhibited postoperative increases in vertebral canal volume compared to baseline (P < 0.05), with no significant difference in the change in the cross-sectional area of the target intervertebral space between the two surgical methods (P > 0.05). Interbody fusion rates were comparable between the two groups at both 6 and 12 months after surgery (P > 0.05). Lastly, the ULIF group had a significantly larger area of bone graft than the Endo-TLIF group (P < 0.05). CONCLUSION In summary, the ULIF technique, as a novel spinal endoscopy approach, is a safer and more effective minimally invasive surgical method for addressing lumbar spinal stenosis and intervertebral disc herniation in patients. Both surgical methods have their own advantages and drawbacks. With the development of technology and related instruments, the limitations of both techniques can be mitigated for to a certain extent, and they can be applied by more doctors in diverse medical fields in the future.
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Affiliation(s)
- Zuoran Fan
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China
| | - Xiaolin Wu
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China
| | - Zhu Guo
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China
| | - Nana Shen
- Department of Rehabilitation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China
| | - Bohua Chen
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China.
| | - Hongfei Xiang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China.
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Wänman J, Åkerstedt J, Banitalebi H, Myklebust TÅ, Weber C, Storheim K, Austevoll IM, Hellum C, Indrekvam K, Brisby H, Hermansen E. The association between lumbar lordosis preoperatively and changes in PROMs for lumbar spinal stenosis patients 2 years after spinal surgery: radiological and clinical results from the NORDSTEN-spinal stenosis trial. Eur Spine J 2024:10.1007/s00586-024-08137-5. [PMID: 38386059 DOI: 10.1007/s00586-024-08137-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Patients with lumbar spinal stenosis (LSS) sometimes have lower lumbar lordosis (LL), and the incidence of LSS correlates closely with the loss of LL. The few studies that have evaluated the association between LL and clinical outcomes after non-instrumented surgery for LSS show conflicting results. This study investigates the association between preoperative LL and changes in PROMs 2 years after decompressive surgery. METHOD This prospective cohort study obtained preoperative and postoperative data for 401 patients from the multicenter randomized controlled spinal stenosis trial as part of the NORwegian degenerative spondylolisthesis and spinal STENosis (NORDSTEN) study. Before surgery, the radiological sagittal alignment parameter LL was measured using standing X-rays. The association between LL and 2-year postoperative changes was analyzed using the oswestry disability index (ODI), a numeric rating scale (NRS) for low back and leg pain, the Zurich claudication questionnaire (ZCQ), and the global perceived effect (GPE) score. The changes in PROMs 2 years after surgery for quintiles of lumbar lordosis were adjusted for the respective baseline PROMs: age, sex, smoking, and BMI. The Schizas index and the Pfirrmann index were used to analyze multiple regressions for changes in PROMs. RESULTS There were no associations in the adjusted and unadjusted analyses between preoperative LL and changes in ODI, ZCQ, GPE, and NRS for back and leg pain 2 years after surgery. CONCLUSION LL before surgery was not associated with changes in PROMs 2 years after surgery. Lumbar lordosis should not be a factor when considering decompressive surgery for LSS.
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Affiliation(s)
- Johan Wänman
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.
| | - Josefin Åkerstedt
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Akershus, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Registration, Cancer Registry Norway, Oslo, Norway
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erland Hermansen
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
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Yu H, Zhao Q, Lv J, Liu J, Zhu B, Chen L, Jing J, Tian D. Unintended dural tears during unilateral biportal endoscopic lumbar surgery: incidence and risk factors. Acta Neurochir (Wien) 2024; 166:95. [PMID: 38381267 PMCID: PMC10881605 DOI: 10.1007/s00701-024-05965-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/31/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND An unintended dural tear (DT) is the most common intraoperative complication of lumbar spine surgery. The unilateral biportal endoscopic technique (UBE) has become increasingly popular for treating various degenerative diseases of the lumbar spine; however, the DT incidence and risk factors specific to UBE remain undetermined. Therefore, this study aimed to evaluate the incidence and risk factors of DTs in UBE. METHOD Data from all patients who underwent UBE for degenerative lumbar spinal diseases from November 2018 to December 2021 at our institution were used to assess the effects of demographics, diagnosis, and type of surgery on unintended DT risk. RESULTS Overall, 24/608 patients (3.95%) experienced DTs and were treated with primary suture repair or bed rest. Although several patients experienced mild symptoms of cerebrospinal fluid (CSF) leaks, no serious postoperative sequelae such as nerve root entrapment, meningitis, or intracranial hemorrhage occurred. Additionally, no significant correlations were identified between DT and sex (P = 0.882), body mass index (BMI) (P = 0.758), smoking status (P = 0.506), diabetes (P = 0.672), hypertension (P = 0.187), or surgeon experience (P = 0.442). However, older patients were more likely to experience DT than younger patients (P = 0.034), and patients with lumbar spinal stenosis (LSS) were more likely to experience DT than patients with lumbar disc herniation (LDH) (P = 0.035). Additionally, DT was more common in revision versus primary surgery (P < 0.0001) and in unilateral laminotomy with bilateral decompression (ULBD) versus unilateral decompression (P = 0.031). Univariate logistic regression analysis revealed that age, LSS, ULBD, and revision surgery were significant risk factors for DT. CONCLUSIONS In this UBE cohort, we found that the incidence of DT was 3.95%. Additionally, older age, LSS, ULBD, and revision surgery significantly increased the risk of DT in UBE surgery.
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Affiliation(s)
- Hang Yu
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
- Department of Orthopaedics, Huzhou Central Hospital, 313000, Huzhou, China
| | - Qingzhong Zhao
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Jianwei Lv
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Jianjun Liu
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Bin Zhu
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Lei Chen
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Juehua Jing
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Dasheng Tian
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China.
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Yu R, Cheng X, Chen B. Percutaneous transforaminal endoscopic decompression with removal of the posterosuperior region underneath the slipping vertebral body for lumbar spinal stenosis with degenerative lumbar spondylolisthesis: a retrospective study. BMC Musculoskelet Disord 2024; 25:161. [PMID: 38378495 PMCID: PMC10877792 DOI: 10.1186/s12891-024-07267-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Percutaneous transforaminal endoscopic decompression (PTED) is an ideal minimally invasive decompression technique for the treatment of lumbar spinal stenosis (LSS) with degenerative lumbar spondylolisthesis (DLS). The posterosuperior region underneath the slipping vertebral body (PRSVB) formed by DLS is an important factor exacerbating LSS in patients. Therefore, the necessity of removing the PRSVB during ventral decompression remains to be discussed. This study aimed to describe the procedure of PTED combined with the removal of the PRSVB and to evaluate the clinical outcomes. METHODS LSS with DLS was diagnosed in 44 consecutive patients at our institution from January 2019 to July 2021, and they underwent PTED combined with the removal of the PRSVB. All patients were followed up for at least 12 months. The clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. RESULTS The mean age of the patients was 69.5 ± 7.1 years. The mean preoperative ODI score, VAS score of the low back, and VAS score of the leg were 68.3 ± 10.8, 5.8 ± 1.0, and 7.7 ± 1.1, respectively, which improved to 18.8 ± 5.0, 1.4 ± 0.8, and 1.6 ± 0.7, respectively, at 12 months postoperatively. The proportion of patients presenting "good" and "excellent" ratings according to the modified MacNab criteria was 93.2%. The percent slippage in spondylolisthesis preoperatively (16.0% ± 3.3%) and at the end of follow-up (15.8% ± 3.3%) did not differ significantly (p>0.05). One patient had a dural tear, and one patient had postoperative dysesthesia. CONCLUSIONS Increasing the removal of PRSVB during the PTED process may be a beneficial surgical procedure for alleviating clinical symptoms in patients with LSS and DLS. However, long-term follow-up is needed to study clinical effects.
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Affiliation(s)
- Rongbo Yu
- Department of Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei, China
| | - Xiaokang Cheng
- Department of Orthopedic, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, 100730, China
| | - Bin Chen
- Department of Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei, China.
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Wu M, Tang Q, Gao W, Zhu L. A novel approach to electroacupuncture for postoperative urinary retention following lumbar spinal stenosis treatment: A case report. Asian J Surg 2024:S1015-9584(24)00277-X. [PMID: 38378434 DOI: 10.1016/j.asjsur.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Minmin Wu
- Department of Rehabilitation Medicine, Heilongjiang University of Chinese Medicine, Harbin, 150000, China
| | - Qiang Tang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150000, China
| | - Weibin Gao
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150000, China
| | - Luwen Zhu
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150000, China.
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Schönnagel L, Zhu J, Camino-Willhuber G, Guven AE, Tani S, Caffard T, Haffer H, Muellner M, Chiapparelli E, Arzani A, Amoroso K, Moser M, Shue J, Tan ET, Carrino JA, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Relationship between lumbar spinal stenosis and axial muscle wasting. Spine J 2024; 24:231-238. [PMID: 37788745 DOI: 10.1016/j.spinee.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND CONTEXT Although the effect of lumbar spinal stenosis (LSS) on the lower extremities is well documented, limited research exists on the effect of spinal stenosis on the posterior paraspinal musculature (PPM). Similar to neurogenic claudication, moderate to severe spinal canal compression can also interfere with the innervation of the PPM, which may result in atrophy and increased fatty infiltration (FI). PURPOSE This study aims to assess the association between LSS and atrophy of the PPM. STUDY DESIGN Retrospective cross-sectional study. PATIENT SAMPLE Patients undergoing MRI scans at a tertiary orthopedic center for low back pain or as part of a preoperative evaluation. OUTCOME MEASURES The functional cross-sectional area (fCSA) and percent fatty infiltration (FI) of the PPM at L4. METHODS Lumbar MRIs of patients at a tertiary orthopedic center indicated due to lower back pain (LBP) or as a presurgical workup were analyzed. Patients with previous spinal fusion surgery or scoliosis were excluded. LSS was assessed according to the Schizas classification at all lumbar levels. The cross-sectional area of the PPM was measured on a T2-weighted MRI sequence at the upper endplate of L4. The fCSA and fatty infiltration (FI) were calculated using custom software. Crude differences in FI and fCSA between patients with no stenosis and at least mild stenosis were tested with the Wilcoxon signed-rank test. To account for possible confounders, a multivariable linear regression model was used to adjust for age, sex, body mass index (BMI), and disc degeneration. A subgroup analysis according to MRI indication was performed. RESULTS A total of 522 (55.7% female) patients were included. The median age was 61 years (IQR: 51-71). The greatest degree of moderate and severe stenosis was found at L4/5, 15.7%, and 9.2%, respectively. Stenosis was the least severe at L5/S1 and was found to be 2% for moderate and 0.2% for severe stenosis. The Wilcoxon test showed significantly increased FI of the PPM with stenosis at any lumbar level (p<.001), although no significant decrease in fCSA was observed. The multivariable regression model showed a significant increase in FI with increased LSS at L1/2, L2/3, and L3/4 (p=.013, p<.01 and p=.003). The severity of LSS at L4/5 showed a positive association with the fCSA (p=.019). The subgroup analysis showed, the effect of LSS was more pronounced in nonsurgical patients than in patients undergoing surgery. CONCLUSIONS In this study, we demonstrated a significant and independent association between LSS and the composition of the PPM, which was dependent on the level of LSS relative to the PPM. In addition to neurogenic claudication, patients with LSS might be especially susceptible to axial muscle wasting, which could worsen LSS due to increased spinal instability, leading to a positive feedback loop.
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Affiliation(s)
- Lukas Schönnagel
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | | | - Ali E Guven
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Soji Tani
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Artine Arzani
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA.
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Minetama M, Kawakami M, Teraguchi M, Nakagawa M, Yamamoto Y, Sakon N, Nakatani T, Matsuo S, Nakagawa Y. Minimal clinically important differences in walking capacity and physical activity after nonsurgical treatment in patients with lumbar spinal stenosis: a secondary analysis of a randomized controlled trial. Spine J 2024; 24:256-262. [PMID: 37871657 DOI: 10.1016/j.spinee.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND CONTEXT Little information is available about the minimal clinically important differences (MCIDs) for objective physical measurements in people with lumbar spinal stenosis (LSS). PURPOSE To use disorder-specific anchor and, multiple anchor-, and distribution-based approaches to determine the MCIDs for walking capacity and physical activity in patients with LSS receiving nonsurgical treatment. STUDY DESIGN/SETTING Secondary analysis of a randomized controlled trial. PATIENT SAMPLE Sixty-nine patients with neurogenic claudication caused by LSS receiving outpatient physical therapy. OUTCOME MEASURES Zurich claudication questionnaire (ZCQ), self-paced walking test (SPWT), and number of daily steps measured by pedometry. METHODS All patients completed the ZCQ, SPWT, and pedometry at the baseline and after 6 weeks. For the anchor-based approach, ZCQ symptom severity, physical function, and satisfaction subscales were used as the external anchors. Using the receiver-operating characteristic (ROC) curve, the MCIDs were determined based on the optimal cutoff points for changes in the SPWT or daily steps. For the distribution-based approach, the MCIDs were estimated from the standard deviations (SDs) of the baseline scores of the SPWT and daily steps. RESULTS In the anchor-based approach, only the ZCQ satisfaction subscale for the SPWT (0.73), and ZCQ symptom severity subscale for daily steps (0.71) exceeded the area under the ROC curve value of 0.7, which is considered acceptable. When using these subscales as anchors, the ROC curves and optimal cutoff points indicated MCIDs of 151 m for the SPWT and 1,149 steps for daily steps. The distribution-based approach estimated the MCIDs as 280 m for the SPWT and 1,274 steps for daily steps, and had a moderate effect size (0.5 SD). CONCLUSIONS The anchor-based approach had limited external responsiveness when the ZCQ was used as the anchor. However, this information may be helpful for interpreting walking capacity and physical activity in patients with LSS receiving nonsurgical treatment and for estimating power and sample size when planning new trials.
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Affiliation(s)
- Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan.
| | - Mamoru Kawakami
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan; Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan, 45 Jyunibancho, Wakayama city, Wakayama, 640-8158, Japan
| | - Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Yoshio Yamamoto
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Nana Sakon
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Tomohiro Nakatani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Sachika Matsuo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
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Shi H, Li S, Liu S, Hu W, Chen J, Chen Y, Lin Y, Zhou H, Liao N, Huang D, Gao W, Liang A. Facet joint tropism, pelvic incidence and intervertebral height index: associations with facet joint osteoarthritis in lumbar spinal stenosis. Spine J 2024; 24:317-324. [PMID: 37844628 DOI: 10.1016/j.spinee.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND CONTEXT Facet joint osteoarthritis (FJOA) is associated with lumbar disc degeneration and has a significant role in the development of lumbar spinal stenosis (LSS). The relationship between various radiographic parameters and the grade of FJOA is not well understood. PURPOSE To explore radiographical parameters associated with FJOA in LSS without lumbar dynamic instability. STUDY DESIGN Retrospective study analysis. PATIENT SAMPLE A total of 122 patients diagnosed with LSS who visited our hospital between January 2015 and July 2022. OUTCOME MEASURES We evaluated radiographic parameters of patients at L4-5 including lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), grades of FJOA, facet joint orientation (FO), facet joint tropism (FT), intervertebral height index (IHI) and the relative cross-sectional area (RCSA) of paraspinal muscles. METHODS Patients diagnosed with LSS between January 2015 and July 2022 were enrolled. Demographic characteristics and radiographic parameters were collected. Spinopelvic parameters were measured through the preoperative lateral image of the whole spine, including LL, PI, pelvic tilt, and sacral slope. Lumbar computed tomography scan and magnetic resonance imaging were collected to measure the FO, FT, IHI, and the RCSA of paraspinal muscles respectively. Patients were divided into three groups according to the severity of FJOA graded by the Weishaupt classification: grade 0 and grade 1 were group A, grade 2 were group B, and grade 3 were group C. All variables were compared among the three groups, while the relationship between parameters and grades of FJOA were also analyzed. RESULTS A total of 122 patients were included. PI was significantly greater in group C compared to group A (p = 0.025) and group B (p=0.022). FT was significantly greater in group C compared to group A (p<.001) and group B (p<.001). The RCSA of multifidus in group A were significantly greater than that in group B (p=0.02) and C (p=0.002). Additionally, FO in group C were significantly lower than group A (p<.001) and group B (p=0.028). The IHI in group C was significantly lower than group A (p=0.017). The correlation analysis indicated that grades of FJOA was positively related to Age, BMI (body mass index), PI, LL and FT, while negatively related to IHI, FO, RCSA of multifidus and RCSA of psoas major. Furthermore, the logistics regression showed that FT, PI, and IHI were important influence factors for FJOA. CONCLUSIONS The current study confirmed that FT, PI and IHI were significantly associated with grades of FJOA at L4-5. Additionally, longitudinal studies are needed to understand the causal relationship between these parameters and FJOA.
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Affiliation(s)
- Huihong Shi
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Shaoguang Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Song Liu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Wenjun Hu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Jianan Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Yanbo Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Youxi Lin
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Hang Zhou
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Nianchun Liao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China
| | - Dongsheng Huang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China.
| | - Wenjie Gao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China.
| | - Anjing Liang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Yingfeng Road No. 33, Guangzhou, China.
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Dai M, Liu Q, Chen C, Zhang L. Enhanced recovery after unilateral biportal endoscopic lumbar interbody fusion combined with unilateral biportal endoscopy for the treatment of severe lumbar spinal stenosis. Asian J Surg 2024:S1015-9584(24)00176-3. [PMID: 38296689 DOI: 10.1016/j.asjsur.2024.01.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Affiliation(s)
- Mingjun Dai
- Department of Orthopedic Surgery, Anqiu Traditional Chinese Medicine Hospital of Shandong Province, Anqiu, China, Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University& Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Qibin Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China.
| | - Changjun Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China.
| | - Lei Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China.
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Tronstad S, Haug KJ, Myklebust TÅ, Weber C, Brisby H, Austevoll IM, Hellum C, Storheim K, Aaen J, Banitalebi H, Brox JI, Grundnes O, Franssen E, Indrekvam K, Solberg T, Hermansen E. Do patients with lumbar spinal stenosis benefit from decompression of levels with adjacent moderate stenosis? A prospective cohort study from the NORDSTEN study. Spine J 2024:S1529-9430(24)00017-2. [PMID: 38266826 DOI: 10.1016/j.spinee.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/03/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) is characterized by pain that radiates to the buttocks and/or legs, aggravated by walking and relieved by forward flexion. There is poor correlation between clinical symptoms and severity of stenosis on MRI, and multi-level stenosis has not been described to present worse symptoms or treatment outcomes, compared with patients with single-level stenosis. In patients with one level with severe stenosis combined with an adjacent level with moderate stenosis, the surgeon must decide whether to decompress only the narrowest level or both, to achieve the best possible outcome. The potential benefits of performing surgery on an adjacent moderate stenosis is debated, and the scientific evidence in scarce. PURPOSE The aim of the present study was to investigate whether patients with a level of adjacent moderate stenosis, along with an index stenosis, benefitted from a dual-level decompression (DLD) compared with a single-level decompression (SLD). Furthermore, to investigate whether DLD patients had longer duration of surgery and hospital stay, higher rates of complications and/or lower rate of reoperations compared with SLD patients. STUDY DESIGN Prospective cohort study. PATIENT SAMPLE We analyzed data from the Norwegian Degenerative Spondylisthesis and Spinal Stenosis study- Spinal Stenosis Trial (NORDSTEN-SST). In this randomized multicenter study, 437 patients were included, evaluating clinical outcomes of three different surgical treatment options for LSS. Patients with degenerative spondylolisthesis were excluded. METHOD Based on preoperative MRI, the present analysis included all patients who had a moderate stenosis (defined as Schizas B or C) in addition to a predefined index stenosis (the level with the smallest cross-sectional area). We compared patients who, based on the surgeons` choice, received a dual-level decompression, with those receiving a single-level decompression. OUTCOME MEASURES The primary outcome was mean change in the Oswestry Disability Index (ODI) score from baseline to 2-year follow up. Secondary outcomes were proportion of success (30% reduction in ODI score), the Numeric Rating Scales for back and leg pain (NRS), the EuroQol 5-dimensional questionnaire utility index (EQ-5D), the Zurich Claudication Questionnaire (ZCQ), the Global Perceived Effect (GPE)-scale, duration of surgery, duration of hospital stay, perioperative complications and reoperation rates. RESULTS Among the 222 patients, included in the analysis, 108 underwent DLD and 114 underwent SLD. There was no difference in change scores for any of the investigated patient-reported outcomes between the groups after 2 years. However, the DLD group had longer duration of surgery and longer length of hospital stay. There was no difference in reoperation rates or perioperative complications. CONCLUSION This study, alongside the NORDSTEN-LSS trial on patients with adjacent moderate stenosis as well as an index stenosis, showed no superior clinical effectiveness for dual-level surgery compared with single-level surgery.
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Affiliation(s)
- Sara Tronstad
- Department of Orthopedic Surgery, Skien Hospital, Skien, Norway.
| | | | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway; Department of Registration, Cancer Registry Norway, Oslo, Norway
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway; Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Helena Brisby
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Orthopedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital Oslo, Oslo, Norway
| | - Jørn Aaen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Nordbyhagen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Oliver Grundnes
- Department of Orthopedics, Akershus University Hospital, Norbyhagen, Norway
| | - Eric Franssen
- Department of Orthopedic Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tore Solberg
- Neurosurgical Department, University Hospital of North Norway, Trømsø, Norway
| | - Erland Hermansen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Ikeda N, Yokoyama K, Ito Y, Tanaka H, Yamada M, Sugie A, Takami T, Wanibuchi M, Kawanishi M. Factors influencing slippage after microsurgical single level lumbar spinal decompression surgery - Are the psoas and multifidus muscles involved? Acta Neurochir (Wien) 2024; 166:26. [PMID: 38252278 DOI: 10.1007/s00701-024-05924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE Patients with lumbar spinal stenosis (LSS) require microsurgical decompression (MSD) surgery; however, MSD is often associated with postoperative instability at the operated level. Paraspinal muscles support the spinal column; lately, paraspinal volume has been used as a good indicator of sarcopenia. This study aimed to determine preoperative radiological factors, including paraspinal muscle volume, associated with postoperative slippage progression after MSD in LSS patients. METHODS Patients undergoing single-level (L3/4 or L4/5) MSD for symptomatic LSS and followed-up for ≥ 5 years in our institute were reviewed retrospectively to measure preoperative imaging parameters focused on the operated level. Paraspinal muscle volumes (psoas muscle index [PMI] and multifidus muscle index [MFMI]) defined using the total cross-sectional area of each muscle/L3 vertebral body area in the preoperative lumbar axial CT) were calculated. Postoperative slippage in the form of static translation (ST) ≥ 2 mm was assessed on the last follow-up X-ray. RESULTS We included 95 patients with average age and follow-up periods of 69 ± 8.2 years and 7.51 ± 2.58 years, respectively. PMI and MFMI were significantly correlated with age and significantly larger in male patients. Female sex, preoperative ST, dynamic translation, sagittal rotation angle, facet angle, pelvic incidence, lumbar lordosis, and PMI were correlated with long-term postoperative worsening of ST. However, as per multivariate analysis, no independent factor was associated with postoperative slippage progression. CONCLUSION Lower preoperative psoas muscle volume in LSS patients is an important predictive factor of postoperative slippage progression at the operated level after MSD. The predictors for postoperative slippage progression are multifactorial; however, a well-structured postoperative exercise regimen involving psoas muscle strengthening may be beneficial in LSS patients after MSD.
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Affiliation(s)
- Naokado Ikeda
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan.
| | - Kunio Yokoyama
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Hidekazu Tanaka
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Akira Sugie
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Toshihiro Takami
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masahiro Kawanishi
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
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Xu D, Shu W, Lian L, Jiang W, Hu X, Gan K, Ma W. The clinical effect of unilateral decompressive laminectomy plus fusion with unilateral biportal endoscopic technique for single level lumbar spinal stenosis. Asian J Surg 2024:S1015-9584(24)00065-4. [PMID: 38246788 DOI: 10.1016/j.asjsur.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE This study aimed to compare and analyze the effectiveness of unilateral biportal endoscopic (UBE) decompressive laminectomy plus fusion and microscope-assisted open decompressive laminectomy plus fusion. METHODS A total of 143 patients with lumbar spinal stenosis were enrolled in this study between March 2020 and February 2021 with a minimum 2 years follow-up visit to our hospital. Sixty-five patients underwent the unilateral biportal endoscopic technique and were assigned to the UBE group, and the remaining 78 patients with microscope assistant were assigned to the Microscope group. The baseline characteristics, clinical outcomes, and radiological data were retrospectively collected and analyzed, as well as Clinical outcomes, radiological data and complications. RESULTS There were no significant differences between the two groups in terms of baseline characteristics (P > 0.05). The UBE group was demonstrated to be significantly superior in CRP, drainage, blood loss, treatment cost and Hospital stay than the Microscope group (P < 0.05), whereas a significant longer operation time was observed (P < 0.05). The VAS-B, ODI, and JOA-L scores of the UBE group at 1 year follow-up were significantly greater than those of the Microscope group (P < 0.05). Regarding radiological data, there were no significant differences in the section area of the spinal canal and fusion grade between the two groups (P > 0.05). CONCLUSION In view of the satisfactory clinical outcomes of patients and notable decompression at the stenosed segment, UBE is a feasible, minimally invasive technique for single level lumbar canal stenosis.
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Affiliation(s)
- Dingli Xu
- Medical School, Ningbo University, Ningbo, 315100, Zhejiang, China
| | - Wubin Shu
- Ningbo Yinzhou No. 2 Hospital, Ningbo, 315100, Zhejiang, China
| | - Leidong Lian
- Medical School, Ningbo University, Ningbo, 315100, Zhejiang, China
| | - Weiyu Jiang
- Ningbo No.6 Hospital, Ningbo, 315100, Zhejiang, China
| | - Xudong Hu
- Ningbo No.6 Hospital, Ningbo, 315100, Zhejiang, China
| | - Kaifeng Gan
- The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315100, Zhejiang, China.
| | - Weihu Ma
- Ningbo No.6 Hospital, Ningbo, 315100, Zhejiang, China.
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Chin BZ, Yong JH, Wang E, Sim SI, Lin S, Wu PH, Hey HWD. Full-endoscopic versus microscopic spinal decompression for lumbar spinal stenosis: a systematic review & meta-analysis. Spine J 2024:S1529-9430(24)00005-6. [PMID: 38190892 DOI: 10.1016/j.spinee.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/22/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND CONTEXT Symptomatic lumbar spinal stenosis is routinely treated with spinal decompression surgery, with an increasing trend towards minimally invasive techniques. Endoscopic decompression has emerged as a technique which minimizes approach-related morbidity while achieving similar clinical outcomes to conventional open or microscopic approaches. PURPOSE To assess the safety and efficacy of endoscopic versus microscopic decompression for treatment of lumbar spinal stenosis. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review on randomized and nonrandomized studies comparing endoscopic versus microscopic decompression was conducted, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Treatment effects were computed using pairwise random-effects meta-analysis. Risk of bias was assessed using the Cochrane Risk-of-bias and ROBINS-I tools for randomized and nonrandomized trials respectively. Quality of the overall body of evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS A total of 19 primary references comprising 1,997 patients and 2,132 spinal levels were included. Endoscopic decompression was associated with significantly reduced intraoperative blood-loss (weighted mean differences [WMD]=-33.29 mL, 95% CI:-51.80 to -14.78, p=.0032), shorter duration of hospital stay (WMD=-1.79 days, 95% CI: -2.63 to 0.95, p=.001), rates of incidental durotomy (RR = 0.63, 95% CI: 0.43 to 0.91, p=.0184) and surgical site infections (RR=0.23, 95% CI: 0.10 to-0.51, p=.001), and a nonsignificant trend towards less back pain, leg pain, and better functional outcomes compared to its microscopic counterpart up to 2-year follow up. CONCLUSIONS Endoscopic and microscopic decompression are safe and effective techniques for treatment of symptomatic lumbar spinal stenosis. Prospective studies of larger power considering medium to long-term outcomes and rates of iatrogenic instability are warranted to compare potential alignment changes and destabilization from either techniques.
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Affiliation(s)
- Brian Zhaojie Chin
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Rd, 119228, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore.
| | - Jung Hahn Yong
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore
| | - Eugene Wang
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore
| | - Seth Ian Sim
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Rd, 119228, Singapore
| | - Shuxun Lin
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, 1 Jurong East St 21, 609606, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore
| | - Pang Hung Wu
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, 1 Jurong East St 21, 609606, Singapore
| | - Hwee Weng Dennis Hey
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Rd, 119228, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore
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Takaoka H, Eguchi Y, Koroki J, Orita S, Inage K, Shiga Y, Furuya T, Maki S, Norimoto M, Umimura T, Suzuki-Narita M, Sato T, Sato M, Hozumi T, Kim G, Mizuki N, Tsuchiya R, Otagiri T, Mukaihata T, Hishiya T, Nakamura J, Hagiwara S, Iwata S, Ataka H, Tanno T, Watanabe A, Aoki Y, Inoue M, Koda M, Takahashi H, Akazawa T, Ohtori S. Quantitative evaluation of the lumbar ligamentum flavum using MRI T2-mapping: Efficacy of its clinical application in patients with lumbar spinal stenosis. J Orthop Sci 2024; 29:101-108. [PMID: 36621375 DOI: 10.1016/j.jos.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 01/07/2023]
Abstract
OBEJECTIVE To perform a magnetic resonance imaging T2-mapping of the ligamentum flavum in healthy individuals and patients with lumbar spinal stenosis scheduled for surgery and compare the T2 relaxation times. SUBJECTS AND METHODS The T2 relaxation time of the ligamentum flavum was compared among 3 groups, healthy young individuals (H group (age< 50)), healthy middle-aged and older individuals (H group (age≥50)), and patients with lumbar spinal stenosis (L group). Additionally, the thickness of the ligament was measured in the axial image plane, and the occupied area ratio of each fiber was measured by staining the surgically obtained ligament, and each was correlated with the T2 relaxation time. We also evaluated the adhesion of the ligamentum flavum with the dura mater during the surgery. RESULTS The T2 relaxation times were significantly prolonged in H group (age ≥50) and L group (P < 0.001) compared to H group (age<50). The relationship between collagen fiber and T2 relaxation times was significantly positive (r = 0.720, P < 0.001). Moreover, the relaxation times were significantly prolonged in those with adhesion of the ligamentum flavum with the dura mater (P < 0.05). The cut-off for the relaxation time was 50 ms (sensitivity: 62.50%, false positive rate: 10.8%). CONCLUSION Healthy middle-aged and older individuals and patients with lumbar spinal stenosis and adhesion of the ligamentum flavum with the dura mater have prolonged T2 relaxation times. Hence, the adhesion between the ligamentum flavum and dura mater should be considered in cases with a relaxation time ≥50 ms.
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Affiliation(s)
- Hiromitsu Takaoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba, 284-0003, Japan.
| | - Junya Koroki
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba, 284-0003, Japan.
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan; Chiba University Center for Frontier Medical Engineering 1-33 Yayoi-cho, CFME Room#B201, Inage-ku, Chiba, 263-8522, Japan.
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Miyako Suzuki-Narita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Takashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Masashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Takashi Hozumi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Geundong Kim
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Norichika Mizuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Ryuto Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Takuma Otagiri
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Tomohito Mukaihata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Takahisa Hishiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Shuhei Iwata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Hiromi Ataka
- Department of Orthopaedic Surgery, Matsudo Orthopaedic Hospital, 1-161 Asahi-cho Matsudo, Chiba, 271-0043, Japan.
| | - Takaaki Tanno
- Department of Orthopaedic Surgery, Matsudo Orthopaedic Hospital, 1-161 Asahi-cho Matsudo, Chiba, 271-0043, Japan.
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba, 283-8686, Japan.
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba, 283-8686, Japan.
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba, 283-8686, Japan.
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-City, Ibaraki 305-8575, Japan.
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-City, Ibaraki 305-8575, Japan.
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
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Wang L, Wang T, Fan N, Yuan S, Du P, Si F, Wang A, Zang L. Clinical outcome of percutaneous endoscopic lumbar decompression in treatment of elderly patients with lumbar spinal stenosis: a matched retrospective study. Int Orthop 2024; 48:201-209. [PMID: 37632530 DOI: 10.1007/s00264-023-05947-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE This retrospective cohort study aimed to evaluate the efficacy and safety of percutaneous endoscopic lumbar decompression (PELD) in elderly patients with lumbar spinal stenosis (LSS). STUDY DESIGN A matched retrospective study. SETTING The research was conducted in Beijing Chaoyang Hospital, Capital Medical University, China. METHODS This study included patients treated with PELD for LSS from September 2016 to September 2020. Patients with LSS aged ≥ 80 years were screened according to the inclusion and exclusion criteria as the study group, and then the same number of patients with LSS aged 50-80 years were matched according to gender, stenosis type, and surgical segment as the control group. Preoperative patient status was assessed using the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) physical status classification score. Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI) scores, modified Macnab criteria, radiological parameters and complication rates. RESULTS A total of 624 LSS patients met the screening criteria between September 2016 and September 2020, with 47 LSS patients ≥ 80 years old serving as the study group. Forty-seven LSS patients aged 50-80 years were matched to the study group according to gender, stenosis type, and stenosis segment. The CCI score (1.77 ± 1.67) and ASA classification (2.62 ± 0.74) of the study group were significantly higher than the CCI score (0.66 ± 0.96) and ASA classification (1.28 ± 0.54) of the control group, and the difference was statistically significant. Compared with preoperative data, postoperative ODI, leg pain VAS scores and back pain VAS scores were significantly improved in both groups (p < 0.05). However, no significant difference was found between two groups in preoperative and postoperative ODI, leg pain VAS scores and back pain VAS scores (p > 0.05). The operation time and postoperative hospital stay in control group were significantly lower than those in study (p < 0.05), but there was no significant difference in blood loss between the two groups (p > 0.05). Besides, overall radiological parameters were comparable in elder and younger patients (p > 0.05), and disc height (DH), lumbar lordosis and segmental lordosis decreased after two year follow-up in both groups (p < 0.05). In addition, complication rates were similar between the two groups (p > 0.05), and no serious complications and deaths were found. LIMITATIONS Single-centre retrospective design, non-randomized sample, small sample size. CONCLUSION Although elderly LSS patients (≥ 80 years old) are less fit and have more comorbidities, satisfactory outcomes can be achieved with PELD, comparable to those of LSS patients < 80 years old, and without increased complications.
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Affiliation(s)
- Lei Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
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He BL, Zhu ZC, Lin LQ, Sun JF, Huang YH, Meng C, Sun Y, Zhang GC. Comparison of biportal endoscopic technique and uniportal endoscopic technique in Unilateral Laminectomy for Bilateral Decomprssion (ULBD) for lumbar spinal stenosis. Asian J Surg 2024; 47:112-117. [PMID: 37331857 DOI: 10.1016/j.asjsur.2023.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/29/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE Unilateral laminotomy for bilateral decompression (ULBD) has been adopted widely to treat lumbar spinal stenosis (LSS). The objective of the study is to investigate clinical and radiological outcomes of the biportal endoscopic ULBD (BE-ULBD) and uniportal endoscopic ULBD (UE-ULBD). METHODS We collected retrospectively 65 patients' data who met the inclusion criteria (July 2019-June 2021). 33 patients underwent BE-ULBD surgery, and 32 patients underwent the UE-ULBD surgery, and were followed up for at least 1 year. The following preoperative and postoperative outcomes were compared between groups: the visual analog scale (VAS) for pain, the Oswestry disability index (ODI) for nerve function, and modified Macnab criteria for satisfaction, the cross-sectional area of the dural sac (DSCSA), the mean angle of facetectomy. RESULTS Age, BMI, gender, levels of involvement and duration of symptoms were not significantly different at baseline in this study. Clinical data showed that postoperative ODI, VAS scores and Modified Macnab Criteria were not statistically different between the two groups. The BE-ULBD group had a shorter operation time than the UE-ULBD group (P < 0.001). Patients in the BE-ULBD group had a larger postoperative expansion of DSCSA expansion postoperatively (85.58 ± 3.16 mm2 VS 71.43 ± 3.35 mm2, P < 0.001) and a larger contralateral facetectomy angle (63.95 ± 3.34° vs 57.80 ± 3.43°, P < 0.001) compared with patients in the UE-ULBD group. There were no statistical differences in the incidence of postoperative complications between the two groups. CONCLUSION Both the BE-ULBD and the UE-ULBD yielded clinical improvement in terms of pain and stenosis symptoms. The BE-ULBD technique has the advantages of the shorter operation time, larger DSCSA expansion and larger contralateral facetectomy angle.
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Affiliation(s)
- Bang-Lin He
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Zhi-Cheng Zhu
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Li-Qun Lin
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Ji-Fu Sun
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China.
| | - Yong-Hui Huang
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Chen Meng
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Yan Sun
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Guang-Cheng Zhang
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
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Abel F, Garcia E, Andreeva V, Nikolaev NS, Kolisnyk S, Sarbaev R, Novikov I, Kozinchenko E, Kim J, Rusakov A, Mourad R, Lebl DR. An Artificial Intelligence-Based Support Tool for Lumbar Spinal Stenosis Diagnosis from Self-Reported History Questionnaire. World Neurosurg 2024; 181:e953-e962. [PMID: 37952887 DOI: 10.1016/j.wneu.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Symptomatic lumbar spinal stenosis (LSS) leads to functional impairment and pain. While radiologic characterization of the morphological stenosis grade can aid in the diagnosis, it may not always correlate with patient symptoms. Artificial intelligence (AI) may diagnose symptomatic LSS in patients solely based on self-reported history questionnaires. METHODS We evaluated multiple machine learning (ML) models to determine the likelihood of LSS using a self-reported questionnaire in patients experiencing low back pain and/or numbness in the legs. The questionnaire was built from peer-reviewed literature and a multidisciplinary panel of experts. Random forest, lasso logistic regression, support vector machine, gradient boosting trees, deep neural networks, and automated machine learning models were trained and performance metrics were compared. RESULTS Data from 4827 patients (4690 patients without LSS: mean age 62.44, range 27-84 years, 62.8% females, and 137 patients with LSS: mean age 50.59, range 30-71 years, 59.9% females) were retrospectively collected. Among the evaluated models, the random forest model demonstrated the highest predictive accuracy with an area under the receiver operating characteristic curve (AUROC) between model prediction and LSS diagnosis of 0.96, a sensitivity of 0.94, a specificity of 0.88, a balanced accuracy of 0.91, and a Cohen's kappa of 0.85. CONCLUSIONS Our results indicate that ML can automate the diagnosis of LSS based on self-reported questionnaires with high accuracy. Implementation of standardized and intelligence-automated workflow may serve as a supportive diagnostic tool to streamline patient management and potentially lower health care costs.
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Affiliation(s)
- Frederik Abel
- Department of Spine Surgery, Hospital for Special Surgery, New York, New York, USA
| | | | - Vera Andreeva
- Federal State Budgetary Institution, Federal Center for Traumatology, Orthopedics and Arthroplasty, Ministry of Health of the Russian Federation, Cheboksary, Russia
| | - Nikolai S Nikolaev
- Federal State Budgetary Institution, Federal Center for Traumatology, Orthopedics and Arthroplasty, Ministry of Health of the Russian Federation, Cheboksary, Russia; Federal State Budgetary Educational Institution of Higher Education, Chuvash State University named after I.N. Ulyanov, Cheboksary, Russia
| | - Serhii Kolisnyk
- Department of Physical and Rehabilitation Medicine, Vinnitsa National Medical University, Vinnytsia, Ukraine
| | | | | | | | - Jack Kim
- Remedy Logic, New York, New York, USA
| | | | - Raphael Mourad
- University of Toulouse, CNRS, UPS, Toulouse, France; Remedy Logic, New York, New York, USA.
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, New York, New York, USA
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Beyer F, Prasse T, Eysel P, Bredow J. Quality of life in lumbar spinal stenosis: Does it correlate with magnetic resonance imaging and spinopelvic parameters? J Orthop 2024; 47:67-71. [PMID: 38022842 PMCID: PMC10679525 DOI: 10.1016/j.jor.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/15/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Degenerative lumbar spinal stenosis (LSS) is a common degenerative spinal disorder with debilitating symptoms that can impact quality of life (QoL). However, the anatomical basis for typical complaints has been poorly quantified. This study aims to correlate QoL assessments of patients with LSS with radiographic spinopelvic parameters and magnetic resonance imaging (MRI) measurements. Methods We screened 371 patients hospitalized for LSS and excluded those with a history of spine surgery. Ultimately, we analyzed the data of 34 patients retrospectively. Two independent members of our research group evaluated the alignment parameters on preoperative spinal radiographs, MRI, and classified the images according to the Pfirrmann grading. The spinopelvic alignment was then compared with the clinical QoL scores Core Outcome Measures Index (COMI) and the Oswestry Disability Index (ODI) as collected by the Spine Tango registry. In addition, the interobserver reliability was analyzed. Results The individual MRI measurements correlated significantly. This correlation could not be found when compared with the spinopelvic parameters on radiographs. Neither the COMI nor the ODI scores showed a significant correlation with the MRI or radiographic imaging. Conclusions The severity of LSS related disability according to QoL questionnaires could not be quantified by any MRI or spinopelvic parameter that was measured. There was also no correlation of the MRI and spinopelvic parameters among themselves. Consequently, treatment recommendations for symptomatic LSS should never be based on radiological data only.
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Affiliation(s)
- Frank Beyer
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Urbacher Weg 19, 51149, Cologne, Germany
| | - Tobias Prasse
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Urbacher Weg 19, 51149, Cologne, Germany
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Mui T, Iwata E, Nakajima H, Sada T, Tanaka M, Okuda A, Kawasaki S, Shigematsu H, Tanaka Y. Central sensitization adversely affects quality of recovery following lumbar decompression surgery. J Orthop Sci 2024; 29:78-82. [PMID: 36526518 DOI: 10.1016/j.jos.2022.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/17/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Central sensitization (CS) is defined as increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input. The CS phenomenon is caused by continuous, intense nociceptor inputs triggering a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in the central nociceptive pathway. Most patients undergoing surgery for lumbar spinal stenosis (LSS) experience symptoms for more than three months; therefore, it is possible that CS is associated with postoperative symptoms of LSS. The aim of this study was to clarify the influence of CS in patients who underwent surgery for LSS. METHODS We used the Central Sensitization Inventory (CSI) to evaluate CS preoperatively. Clinical and neurological symptoms were assessed before surgery and three months after surgery using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI). To evaluate the correlation between the preoperative CSI score and each parameter of the JOA-BPEQ before and three months after surgery, a Pearson correlation coefficient was used. We also evaluated the correlation between preoperative CSI and improvement scores for each parameter of the JOA-BPEQ for surgery. Similarly, the ODI was assessed. RESULTS This study included 118 patients. After surgery, the parameters of lumbar function disorder, social life function disorder, and mental health disorder revealed a statistically significant relationship (r = -0.289, -0.0354, and -0.493, respectively). There was no significant correlation between CSI and improvement scores of the JOA-BPEQ. The ODI assessment after surgery revealed a statistically significant relationship (r = 0.344). There was no significant correlation between the CSI and ODI improvement scores. CONCLUSION This study showed that the severity of the CSI influenced the postoperative outcomes, and that surgical treatment improved the symptoms of LSS regardless of the occurrence of CS preoperatively.
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Affiliation(s)
- Takahiro Mui
- Department of Orthopaedic Surgery, Otemae Hospital, 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan
| | - Eiichiro Iwata
- Department of Orthopaedic Surgery, Nara City Hospital, Nara, Japan.
| | - Hiroshi Nakajima
- Department of Orthopaedic Surgery, Otemae Hospital, 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan
| | - Takuya Sada
- Department of Orthopaedic Surgery, Nara City Hospital, Nara, Japan
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Otemae Hospital, 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Sachiko Kawasaki
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Hideki Shigematsu
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
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He Y, Wang H, Yu Z, Yin J, Jiang Y, Zhou D. Unilateral biportal endoscopic versus uniportal full-endoscopic for lumbar degenerative disease: A meta-analysis. J Orthop Sci 2024; 29:49-58. [PMID: 36437152 DOI: 10.1016/j.jos.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/31/2022] [Accepted: 10/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the increasing use of unilateral biportal endoscopic (UBE) and uniportal full-endoscopic (UPFE) techniques in lumbar degenerative disease (LDD), few comprehensive and systematic studies have been published comparing UBE and UPFE. Therefore, we conducted a meta-analysis to compare the surgical outcomes of the two procedures. METHODS We searched all studies that compared operative outcomes of UBE and UPFE for lumbar disc degeneration disease from PubMed, Google Scholar, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang and other databases up to March 30, 2022. RESULTS This meta-analysis, which included nine articles, showed that in operative time, (mean difference [MD]: 17.14; 95% confidence intervals [CI]: 6.52 to 27.76), intraoperative bleeding (MD: 59.01; 95% CI: 21.29 to 96.73) and hospital stay (MD: 2.12; 95% CI: 0.35 to 3.90), the UPFE group was more advantageous. UBE had an advantage in terms of postoperative dural expansion area (MD: 59.01; 95% CI: 21.29 to 96.73). These aspects included postoperative clinical score (MD: 0.48; 95% CI: -0.27 to 1.24; MD: -0.07; 95% CI: -0.30 to 0.16; MD: 0.09; 95% CI: -0.09 to 0.26; MD: 0.11; 95% CI: -0.04 to 0.26; MD: -0.81; 95% CI: -3.03 to 1.41; MD: -0.38; 95% CI: -1.02 to 0.26), excellent and good rate (odds ratio [OR] = 1.08; 95% CI: 0.34 to 3.44), complications (OR = 0.82; 95% CI: 0.31 to 2.12), postoperative hospital stay (MD: 1.63; 95% CI: -0.81 to 4.07) and mean number of fluoroscopies (MD: -7.18; 95% CI: -22.84 to 8.48), with no significant difference between the two groups. Meanwhile, the lumbar disc herniation (LDH) subgroup of UPFE had a significantly shorter operation time (MD: 31.67; 95% CI: 12.44 to 50.90) than that of UBE. CONCLUSION Our study showed that UPFE was associated with shorter operative time, less intraoperative bleeding and shorter hospital stay, whereas UBE was associated with a greater increase in postoperative dural sac area. Postoperative visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, satisfaction rates, complications, and mean number of fluoroscopic views were not dramatically dissimilar in UBE and UPFE for LDD. In the LDH subgroup, postoperative hospital stay and operative time were significantly lower in the UPFE group than in the UBE group.
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Affiliation(s)
- Yanxing He
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China; Dalian Medical University, Liaoning, China.
| | - Hao Wang
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China; Dalian Medical University, Liaoning, China.
| | - Zhentang Yu
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China; Dalian Medical University, Liaoning, China.
| | - Jianjian Yin
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China.
| | - Yuqing Jiang
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China.
| | - Dong Zhou
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China.
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Kim J, Han CH, Kim Y, Lee T, Yang C, Choi YE, Kang BK, Kim KH, Yang GY, Kim E. Effect and Safety of Combining Pharmacopuncture Therapy and Acupotomy in the Treatment of Patients with Degenerative Lumbar Spinal Stenosis: a Study Protocol for a Pragmatic, Assessor-Blinded, Randomized, Controlled Trial. J Acupunct Meridian Stud 2023; 16:268-278. [PMID: 38115593 DOI: 10.51507/j.jams.2023.16.6.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 12/21/2023] Open
Abstract
Background : Pharmacopuncture therapy and acupotomy are commonly used in combination for Conventional Korean Medicine Treatments (CKMT) for the treatment of patients with lumbar spinal stenosis (LSS). The aim of this study is to evaluate the effect and safety of combining pharmacopuncture therapy and acupotomy in the treatment of LSS. Methods : This study is designed as a pragmatic, assessor-blinded, randomized controlled trial with two parallel arms in a 1:1 ratio. A total of 104 participants diagnosed with LSS will be randomly assigned to an experimental group (pharmacopuncture therapy and acupotomy in addition to CKMT) or a control group (only CKMT). Patients in both groups will receive treatment two times weekly for 6 weeks. The primary outcome will be the mean change on the 100-mm visual analog scale (VAS) from the baseline to the end of the treatment (week 6). The secondary outcomes will include the mean change in the 100-mm VAS from baseline to week 10 and week 14, respectively. Proportion of patients who achieve the clinically important difference, Zurich Claudication Questionnaire, Roland-Morris disability questionnaire, self-reported maxium walking distance, EuroQol 5-dimension 5-level, and Patients' Global Impression of Change will also be assessed. Adverse events will be assessed at each visit. The outcomes will be measured for a total of 14 weeks, including a treatment period of 6 weeks and follow-up of 4, 8 weeks. Discussion : The results of this trial will confirm the effect and safety of combining pharmacopuncture therapy and acupotomy in the treatment of patients with LSS.
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Affiliation(s)
- Jihun Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
| | - Chang-Hyun Han
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
- Korean Convergence Medicine, University of Science and Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Yeonhak Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
| | - Taewook Lee
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Young Eun Choi
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Byoung-Kab Kang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Kun Hyung Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea
| | - Gi Young Yang
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea
| | - Eunseok Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea
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Uri O, Alfandari L, Folman Y, Keren A, Smith W, Paz I, Behrbalk E. Acute disc herniation following surgical decompression of lumbar spinal stenosis: a retrospective comparison of mini-open and minimally invasive techniques. J Orthop Surg Res 2023; 18:974. [PMID: 38111077 PMCID: PMC10726635 DOI: 10.1186/s13018-023-04457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Disc herniation following decompression of lumbar spinal stenosis is a less familiar surgical complication. Previous studies suggested that open lumbar decompression techniques, associated with relative segmental instability especially in the presence of degenerated disc in older patients, are more likely to result in disc herniation compared to minimally invasive techniques. The current study compares the incidence of acute disc herniation following mini-open and minimally invasive decompression of lumbar spinal stenosis. METHODS This was a retrospective study reviewing 563 patients who underwent spinal decompression for symptomatic lumbar stenosis by mini-open bilateral partial laminectomy technique or minimally invasive laminotomy utilizing a tubular system. Demographic and clinical data were collected and compared between the groups. RESULTS Postoperative disc herniation rate was significantly lower in the minimally invasive group with 2 of 237 cases (0.8%) versus 19 of 326 cases (5.8%) in the mini-open group (p = 0.002). This finding was more noticeable following multi-level procedures with no case of postdecompression disc herniation in the minimally invasive group compared to 8 of 39 cases (20.5%) in the mini-open group (p = 0.003). CONCLUSION The incidence of postoperative disc herniation following spinal decompression for symptomatic lumbar stenosis was 5.8% following mini-open bilateral partial laminectomy compared to only 0.8% after minimally invasive laminotomy (p = 0.002). These findings highlight the more extensive nature of mini-open surgery associated with relative segmental instability that poses a greater risk for postoperative disc herniation.
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Affiliation(s)
- Ofir Uri
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Liad Alfandari
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel.
| | - Yoram Folman
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Amit Keren
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - William Smith
- Department of Neurosurgery, University Medical Center, Las Vegas, NV, USA
| | - Inbar Paz
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Eyal Behrbalk
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
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48
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Sun H, Xiong S, Zhang Y, Zhao Q, Wu Z, Xiao L. Clinical significance of redundant nerve roots in patients with lumbar spinal stenosis undergoing oblique lumbar interbody fusion combined with percutaneous internal fixation. J Orthop Surg Res 2023; 18:958. [PMID: 38087350 PMCID: PMC10717461 DOI: 10.1186/s13018-023-04449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND While there have been previous studies on the surgical efficacy of patients with redundant nerve roots (RNRs), a persistent issue is that some patients continue to experience redundancy even after surgery. Furthermore, the clinical significance of RNRs remains unclear. Notably, there is a lack of research regarding RNRs within the context of oblique lumbar interbody fusion (OLIF) combined with percutaneous internal fixation. Therefore, the primary objective of this study is to investigate the correlation between RNRs and clinical outcomes following OLIF combined with percutaneous internal fixation. METHODS Eighty-seven patients diagnosed with lumbar spinal stenosis (LSS) who underwent single-segment OLIF combined with percutaneous internal fixation were categorized into three groups. Group 1 comprised patients with positive RNRs both before and after the operation. Group 2 included patients with positive RNRs preoperatively but negative RNRs postoperatively. Group 3 consisted of patients with consistently negative RNRs before and after the operation. Comprehensive patient data were collected, including operation time, intraoperative blood loss, and any recorded complications. Radiographic parameters, both pre- and post-operative, were assessed, encompassing the number of stenosis segments, disc height (DH), lumbar lordotic angle, dural sac cross-sectional area, and the placement of the fusion cage. Furthermore, the Visual Analogue Scale was applied to gauge back and leg pain, while the Oswestry Disability Index was employed to appraise daily living activities. A comparative analysis was carried out among the three patient groups. RESULTS In this study, all 87 LSS patients successfully underwent surgery. Among them, 35 patients (40.2%) showed preoperative MRI assessment indicating positive RNRs. In the postoperative MRI assessment, 14 of these patients maintained positive RNRs status, and they were grouped into Group 1. The remaining 21 patients saw a transition to negative RNRs status and were included in Group 2. Among the 52 patients who had preoperative MRI assessments showing negative RNRs, their postoperative RNRs status remained negative, forming Group 3. All patients received follow-up, which ranged from 8 to 18 months, and no complications occurred during this period. In this study, the postoperative efficacy and parameters such as DH and Dural Sac CSA significantly improved compared to preoperative values for all 87 patients. Patients with preoperative RNRs had more stenosis segments, smaller dural sac CSA, and more severe symptoms. In all three groups, postoperative efficacy scores significantly improved compared to preoperative scores. Group 2 patients had their fusion cages placed more in the middle, while Group 1 patients had their fusion cages more anteriorly located. Group 2 patients exhibited greater recovery in dural sac CSA postoperatively compared to Group 1 patients. Additionally, Group 2 patients had better ODI efficacy scores compared to Group 1 patients. CONCLUSIONS Irrespective of the presence or absence of RNRs, patients experienced improvement after undergoing OLIF combined with percutaneous internal fixation. Preoperative RNRs appear to be linked to multi-segmental lumbar spinal stenosis, a reduction in dural sac CSA, and symptom severity. Patients with negative postoperative RNRs demonstrated better treatment efficacy. Furthermore, the placement of the fusion cage appears to have a significant impact on postoperative efficacy and RNRs outcomes.
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Affiliation(s)
- Hongzhou Sun
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu, China
| | - Shouliang Xiong
- Department of Joint Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu, China
| | - Yu Zhang
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu, China
| | - Quanlai Zhao
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu, China
| | - Zhongxuan Wu
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu, China
| | - Liang Xiao
- Spine Research Center of Wannan Medical College, No. 22 Wenchang West Road, Wuhu, 241001, China.
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Ujigo S, Kamei N, Yamada K, Nakamae T, Imada H, Adachi N, Fujimoto Y. Balancing ability of patients with lumbar spinal canal stenosis. Eur Spine J 2023; 32:4174-4183. [PMID: 37217822 DOI: 10.1007/s00586-023-07782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/04/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE To determine the relationship between postural sway and the severity of lumbar spinal canal stenosis as well as the effect on postoperative improvement. METHODS Stabilometry was performed before and 6 months after surgery in 52 patients (29 men and 23 women; mean age, 74.1 ± 7.8 years) who underwent decompression surgery for lumbar spinal canal stenosis. The environmental area (EA; the area surrounding the circumference of the stabilogram) and locus length per EA (L/EA) were evaluated. The patients were divided into moderate (n = 22) and severe (n = 30) groups according to the severity of canal stenosis. Patient characteristics and parameters were compared between the groups before and after surgery, including the visual analog scale (VAS) score for leg pain, Oswestry Disability Index (ODI), EA, and L/EA. In addition, factors affecting EA and L/EA were evaluated using multiple regression analysis. RESULTS Age (p = 0.031), preoperative EA (p < 0.001), preoperative L/EA (p = 0.032), and sagittal vertical axis (p = 0.033) were significantly different between groups. The VAS score and ODI significantly improved postoperatively in both groups (p < 0.001). The EA significantly improved postoperatively only in the severe group (p < 0.001), whereas the L/EA did not significantly improve in either group. Multiple regression analysis showed that only the severity of canal stenosis was significantly associated with preoperative EA (p = 0.030), whereas age (p = 0.040) and severity of canal stenosis (p = 0.030) were significantly associated with preoperative L/EA. Diabetes was significantly associated with postoperative EA (p = 0.046) and L/EA (p = 0.030). CONCLUSION The severity of canal stenosis affected abnormal postural sway, which improved after decompression surgery.
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Affiliation(s)
- Satoshi Ujigo
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Kiyotaka Yamada
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideaki Imada
- Department of Orthopaedic Surgery, Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshinori Fujimoto
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
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Hayashi H, Hashikata H, Sawada M, Toda H. Low back pain improvement after cervical laminoplasty in patients without tandem lumbar stenosis. Eur Spine J 2023; 32:4437-4443. [PMID: 37736774 DOI: 10.1007/s00586-023-07951-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE This study aimed to demonstrate the impact of lumbar spinal stenosis (LSS) on LBP after cervical laminoplasty for cervical spinal stenosis by analyzing the clinical characteristics and surgical outcomes. METHODS This retrospective cohort study analyzed 56 consecutive patients with cervical spinal stenosis who underwent cervical laminoplasty. Data on age, sex, Japanese Orthopaedic Association (JOA) scores, JOA Back Pain Evaluation Questionnaire (BPEQ), and visual analog scale (VAS) were collected. The patients with VAS for LBP ≥ 30 or more were included and divided into two groups: without LSS [LSS (-)]or with LSS [LSS (+)]. Preoperative clinical characteristics and postoperative changes were compared between the groups. RESULTS Preoperative VAS for LBP were 50.7 ± 16.2 mm and 59.8 ± 19.5 mm in the LSS (+) and LSS (-), respectively (p = 0.09). Patients in the LSS (-) were younger (57.6 ± 11.2 vs. 70.7 ± 8.6, p < 0.001) and showed significantly milder preoperative lumbar symptoms in terms of JOA and BPEQ. Patients in the LSS (-) group showed more postoperative changes in low back pain (18.3 ± 26.4 vs. - 8.3 ± 37.6, p = 0.005) and lumbar function (10.8 ± 25.7 vs. - 2.0 ± 22.5, p = 0.04) at BPEQ, and higher recovery in terms of VAS of LBP (23.0 ± 23.8 mm vs. 5.3 ± 25.9 mm, p = 0.008) and buttocks and low limbs (12.5 ± 35.0 mm vs. - 4.3 ± 24.4 mm, p = 0.029). Nine patients in the LSS (+) group underwent lumbar surgery at 12.8 ± 8.5 months after cervical laminoplasty. CONCLUSION LBP improved after cervical laminoplasty in patients without lumbar stenosis.
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Affiliation(s)
- Hideki Hayashi
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan.
| | - Hirokuni Hashikata
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Masahiro Sawada
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Hiroki Toda
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
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