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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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Ren Y, Nian Y, Sun T. Ultrasonic bone curette-assisted unilateral approach for bilateral decompression with MIS-TLIF for severe lumbar spinal stenosis. BMC Musculoskelet Disord 2024; 25:315. [PMID: 38654251 PMCID: PMC11036630 DOI: 10.1186/s12891-024-07453-7] [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: 02/01/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE We aimed to evaluate the clinical efficacy of bilateral decompression with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) assisted by an ultrasonic bone curette (UBC) for treating severe degenerative lumbar spinal stenosis (DLSS) and traditional tool laminectomy decompression MIS-TLIF for treating severe DLSS. METHODS The clinical data of 128 patients with single-segment severe DLSS who were admitted between January 2017 and December 2021 were retrospectively analyzed. Among them, 67 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using an ultrasonic bone curette (UBC group), whereas 61 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using traditional tools (traditional group, control). A visual analog scale (VAS) was used to evaluate back and lower limb pain before the operation,immediate postoperative, and one week, 3, 6, 12, and 24 months after the operation. Oswestry disability index (ODI) and Zurich claudication score (ZCQ) were employed to evaluate the improvement in low back and lower limb function. At the last follow-up, the Bridwell bone graft fusion standard was utilized to evaluate bone graft fusion. RESULTS The decompression time of laminectomy was significantly shorter in the UBC group than in the traditional group (control group), and the intraoperative blood loss and postoperative drainage volume were significantly less in those in the control group (P < 0.05). The VAS, ODI, and ZCQ scores of the two groups after the operation were significantly improved compared to those before the operation (P < 0.05). The UBC group had better VAS back scores than the control group immediate postoperative and one week after the operation(P < 0.05). The UBC group had better VAS lower limb scores than the control group immediate postoperative (P < 0.05).The incidence of perioperative complications, hospitalization time, dural sac cross-sectional area (CSA), and dural sac CSA improvement rate did not differ significantly between the two groups (P > 0.05). VAS and ODI scores did not differ significantly between the two groups before,three, six months, one year, and two years after surgery (P > 0.05). The ZCQ scores did not differ significantly between the two groups before the operation at one week, six months, one year, and two years after the operation (P > 0.05). According to the Bridwell bone graft fusion standard, bone graft fusion did not occur significantly between the two groups (P > 0.05) at the last follow-up. CONCLUSIONS UBC unilateral fenestration bilateral decompression MIS-TLIF in treating severe DLSS can achieve clinical efficacy as traditional tool unilateral fenestration bilateral decompression MIS-TLIF and reduce intraoperative blood loss and postoperative drainage. It can also shorten the operation time, effectively reduce the work intensity of the operator, and reduce the degree of low back pain during short-term follow-ups. Therefore, this is a safe and effective surgical method.
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Affiliation(s)
- Yuebing Ren
- Department of Spinal Surgery, Dongying People's Hospital(Dongying Hospital of Shandong Provincial Hospital Group), Dongying, Shandong, 257091, China
| | - Ying Nian
- Department of Oncology, Dongying People's Hospital(Dongying Hospital of Shandong Provincial Hospital Group), Dongying, Shandong, 257091, China
| | - Tongxin Sun
- Department of Orthopedics, Dongying People's Hospital(Dongying Hospital of Shandong Provincial Hospital Group), Dongying, Shandong, 257091, China.
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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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Yoshihara T, Morimoto T, Tsukamoto M, Toda Y, Hirata H, Kobayashi T, Takashima S, Mawatari M. Analyzing lumbar vertebral shape and alignment in female patients with degenerative spondylolisthesis: Comparisons with spinal stenosis and risk factor exploration. PLoS One 2024; 19:e0301974. [PMID: 38626167 PMCID: PMC11020370 DOI: 10.1371/journal.pone.0301974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/26/2024] [Indexed: 04/18/2024] Open
Abstract
PURPOSE This study aimed to examine the vertebral body shape characteristics and spondylopelvic alignment in L4 degenerative spondylolisthesis (DS) as well as the risk factors for the development of DS. METHODS This cross-sectional study compared vertebral morphology and sagittal spinopelvic alignment in female patients with lumbar DS and lumbar spinal stenosis (LSS). The degree of lumbar lordosis (LL), pelvic incidence (PI), cross-sectional area (CSA), and vertebral body height ratio (ha/hp) of the lumbar spine were compared using full-length spine radiographs and computed tomography in 60 females with DS and in 60 women with LSS. RESULTS No significant differences in age or body mass index were observed between the two groups; however, the DS and LSS groups significantly differed in PI (mean, 58.9±10.8 vs. 47.2±11.6, P < 0.001), L4 CSA (mean, 1,166.2 m2 vs. 1,242.0 m2, P = 0.002) and ha/hp (mean, 1.134 vs. 1.007, P < 0.001). The L4 ha/hp was significantly higher in the DS group than in the LSS group. Additionally, LL values were negatively correlated with vertebral L5 CSA in the DS group (r = -0.28, P < 0.05). The LSS and DS groups demonstrated positive correlations between LL and L2, L3, and L4 ha/hp (r = 0.331, 0.267, and 0.317; P < 0.01, < 0.05, and < 0.05, respectively) and between LL and L4 and L5 ha/hp (r = 0.333, 0.331; P < 0.01, respectively). Multivariate regression analyses revealed that PI and ha/hp ratio may be independent predictors of DS development. CONCLUSION The DS group had significantly larger LL, PI, and L4 ha/hp and smaller L4 CSA than the LSS group. The lumbar vertebral body shape and sagittal spinopelvic alignment in females might be independent predictors of DS development.
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Affiliation(s)
- Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yu Toda
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Satoshi Takashima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Watanabe K, Otani K, Nikaido T, Kato K, Kobayashi H, Yabuki S, Konno SI, Matsumoto Y. Time Course of Asymptomatic Stenosis in Multiple Lumbar Spinal Stenosis-Five-Year Results of Selective Decompression of Symptomatic Levels. Medicina (Kaunas) 2024; 60:636. [PMID: 38674282 PMCID: PMC11052377 DOI: 10.3390/medicina60040636] [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: 02/26/2024] [Revised: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Background: In the diagnosis of lumbar spinal stenosis (LSS), finding stenosis with magnetic resonance imaging (MRI) does not always correlate with symptoms such as sciatica or intermittent claudication. We perform decompression surgery only for cases where the levels diagnosed from neurological findings are symptomatic, even if multiple stenoses are observed on MRI. The objective of this study was to examine the time course of asymptomatic stenosis in patients with LSS after they underwent decompression surgery for symptomatic stenosis. Materials and Methods: The participants in this study comprised 137 LSS patients who underwent single-level L4-5 decompression surgery from 2003 to 2013. The dural sac cross-sectional area at the L3-4 disc level was calculated based on preoperative MRI. A cross-sectional area less than 50 mm2 was defined as stenosis. The patients were grouped, according to additional spinal stenosis at the L3-4 level, into a double group (16 cases) with L3-4 stenosis, and a single group (121 cases) without L3-4 stenosis. Incidences of new-onset symptoms originating from L3-4 and additional L3-4-level surgery were examined. Results: Five years after surgery, 98 cases (72%) completed follow-up. During follow-up, 2 of 12 patients in the double group (16.7%) and 9 of 86 patients in the single group (10.5%) presented with new-onset symptoms originating from L3-4, showing no significant difference between groups. Additional L3-4 surgery was performed for one patient (8.3%) in the double group and three patients (3.5%) in the single group; again, no significant difference was shown. Conclusion: Patients with asymptomatic L3-4 stenosis on preoperative MRI were not prone to develop new symptoms or need additional L3-4-level surgery within 5 years after surgery when compared to patients without preoperative L3-4 stenosis. These results indicate that prophylactic decompression for asymptomatic levels is unnecessary.
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Affiliation(s)
- Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan; (K.O.); (T.N.); (K.K.); (H.K.); (S.Y.); (Y.M.)
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Kim JK, Chang MC. Convolutional neural network algorithm trained on lumbar spine radiographs to predict outcomes of transforaminal epidural steroid injection for lumbosacral radicular pain from spinal stenosis. Sci Rep 2024; 14:8490. [PMID: 38605170 PMCID: PMC11009393 DOI: 10.1038/s41598-024-59288-w] [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: 10/15/2023] [Accepted: 04/09/2024] [Indexed: 04/13/2024] Open
Abstract
Little is known about the therapeutic outcomes of transforaminal epidural steroid injection (TFESI) in patients with lumbosacral radicular pain due to lumbar spinal stenosis (LSS). Using lumbar spine radiographs as input data, we trained a convolutional neural network (CNN) to predict therapeutic outcomes after lumbar TFESI in patients with lumbosacral radicular pain caused by LSS. We retrospectively recruited 193 patients for this study. The lumbar spine radiographs included anteroposterior, lateral, and bilateral (left and right) oblique views. We cut each lumbar spine radiograph image into a square shape that included the vertebra corresponding to the level at which the TFESI was performed and the vertebrae juxta below and above that level. Output data were divided into "favorable outcome" (≥ 50% reduction in the numeric rating scale [NRS] score at 2 months post-TFESI) and "poor outcome" (< 50% reduction in the NRS score at 2 months post-TFESI). Using these input and output data, we developed a CNN model for predicting TFESI outcomes. The area under the curve of our model was 0.920. Its accuracy was 87.2%. Our CNN model has an excellent capacity for predicting therapeutic outcomes after lumbar TFESI in patients with lumbosacral radicular pain induced by LSS.
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Affiliation(s)
- Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea.
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Li T, Huang J, Zhang H, Lu Z, Liu J, Ding Y. Full endoscopic laminotomy decompression versus anterior cervical discectomy and fusion for the treatment of single-segment cervical spinal stenosis: a retrospective, propensity score-matched study. J Orthop Surg Res 2024; 19:227. [PMID: 38581052 PMCID: PMC10998346 DOI: 10.1186/s13018-024-04710-2] [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: 11/08/2023] [Accepted: 04/01/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is the standard procedure for the treatment of cervical spinal stenosis (CSS), but complications such as adjacent segment degeneration can seriously affect the long-term efficacy. Currently, posterior endoscopic surgery has been increasingly used in the clinical treatment of CSS. The aim of this study was to compare the clinical outcomes of single-segment CSS patients who underwent full endoscopic laminotomy decompression or ACDF. METHODS 138 CSS patients who met the inclusion criteria from June 2018 to August 2020 were retrospectively analyzed and divided into endoscopic and ACDF groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the groups. Then, perioperative data were recorded and clinical outcomes were compared, including functional scores and imaging data. Functional scores included Visual Analog Scale of Arms (A-VAS) and Neck pain (N-VAS), Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), and imaging data included Disc Height Index (DHI), Cervical range of motion (ROM), and Ratio of grey scale (RVG). RESULTS After PSM, 84 patients were included in the study and followed for 24-30 months. The endoscopic group was significantly superior to the ACDF group in terms of operative time, intraoperative blood loss, incision length, and hospital stay (P < 0.001). Postoperative N-VAS, A-VAS, JOA, and NDI were significantly improved in both groups compared with the preoperative period (P < 0.001), and the endoscopic group showed better improvement at 7 days postoperatively (P < 0.05). The ROM changes of adjacent segments were significantly larger in the ACDF group at 12 months postoperatively and at the last follow-up (P < 0.05). The RVG of adjacent segments showed a decreasing trend, and the decrease was more marked in the ACDF group at last follow-up (P < 0.05). According to the modified MacNab criteria, the excellent and good rates in the endoscopic group and ACDF group were 90.48% and 88.10%, respectively, with no statistically significant difference (P > 0.05). CONCLUSION Full endoscopic laminotomy decompression is demonstrated to be an efficacious alternative technique to traditional ACDF for the treatment of single-segment CSS, with the advantages of less trauma, faster recovery, and less impact on cervical spine kinematics and adjacent segmental degeneration.
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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
| | - Jie Huang
- Department of Orthopaedics, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Hanshuo Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Zhengcao Lu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiang Liu
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, 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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Yamahata H, Ijiri K, Tanabe F, Murasumi K, Nagano Y, Makino R, Higa N, Hanaya R. Radiological Analysis of Cerebrospinal Fluid Dynamics at the Craniovertebral Junction Using Time-Spatial Labeling Inversion Pulse Magnetic Resonance Imaging in Patients with Cervical Spinal Canal Stenosis. World Neurosurg 2024; 184:e731-e736. [PMID: 38340799 DOI: 10.1016/j.wneu.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)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Spondylotic changes in the cervical spine cause degeneration, leading to cervical spinal canal stenosis. This stenotic change can affect cerebrospinal fluid (CSF) dynamics by compressing the dural sac and reducing space in the subarachnoid space. We examined CSF dynamics at the craniovertebral junction (CVJ) using time-spatial labeling inversion pulse magnetic resonance imaging (Time-SLIP MRI) in patients with cervical spinal canal stenosis. METHODS The maximum longitudinal movement of the CSF at the CVJ was measured as length of motion (LOM) in the Time-SLIP MRI of 56 patients. The sum of ventral and dorsal LOM was defined as the total LOM. Patients were classified into 3 groups depending on their spinal sagittal magnetic resonance imaging findings: control (n = 27, Kang classification grades 0 and 1), stenosis (n = 14, Kang classification grade 2), and severe stenosis (n = 15, Kang classification grade 3). RESULTS Time-SLIP MRI revealed pulsatile movement of the CSF at the CVJ. The mean total, ventral, and dorsal LOM was 14.2 ± 9, 8.1 ± 5.7, and 3.8 ± 2.9 mm, respectively. The ventral LOM was significantly larger than the dorsal LOM. The total LOM was significantly smaller in the severe stenosis group (6.1 ± 3.4 mm) than in the control (16.0 ± 8.4 mm) or stenosis (11 ± 5.4 mm) groups (P < 0.001, Kruskal-Wallis H-test). In 5 patients, postoperative total LOM was improved after adequate decompression surgery. CONCLUSIONS This study demonstrates that CSF dynamics at the CVJ are influenced by cervical spinal canal stenosis. Time-SLIP MRI is useful for evaluating CSF dynamics at the CVJ in patients with spinal canal stenosis.
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Affiliation(s)
- Hitoshi Yamahata
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | | | | | | | - Yushi Nagano
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryutaro Makino
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Nayuta Higa
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Chen HB, Huang YL, Chen M, Wu HB. Reducing decompression levels by diffusion tensor imaging and conventional magnetic resonance imaging in degenerative lumbar spinal stenosis. Br J Neurosurg 2024; 38:265-271. [PMID: 33538210 DOI: 10.1080/02688697.2020.1861432] [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: 02/10/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The selection of a correct level in lumbar spinal stenosis (LSS) remains a common problem and is critically important to the effectiveness of this surgical treatment. Surgery is invasive, and extended laminectomy may lead to secondary surgical complications. The application of diffuse tensor imagining (DTI) and paraspinal mapping (PM) in addition to conventional magnetic resonance imaging (cMRI) may be helpful in this respect. However, the superiority of cMRI + DTI over cMRI+ (DTI or PM) in reducing decompression has not yet been established. METHODS We compared the surgical levels, determined by cMRI + DTI and cMRI+ (DTI or PM) (self-control). Treatment outcome measurements were performed at two weeks, three months, six months, and twelve months postoperatively. RESULTS The surgical levels determined by cMRI ± DTI showed less than that determined by cMRI± (DTI or PM) with statistically significant differences (p value = 0.0199) and cMRI ± PM with no statistically significant differences (p value = 0.5503). CONCLUSIONS The effectiveness of cMRI ± DTI in the reduction of the surgical levels in degenerative lumbar spinal stenosis is superior than that of cMRI± (DTI or PM).
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Affiliation(s)
- Hua-Biao Chen
- Departments of Orthopaedic Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, People's Republic of China
| | - Yu-Liang Huang
- Departments of Orthopaedic Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, People's Republic of China
| | - Min Chen
- Departments of Orthopaedic Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, People's Republic of China
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Qu Z, Deng B, Sun W, Yang R, Feng H. A Convolutional Neural Network for Automated Detection of Cervical Ossification of the Posterior Longitudinal Ligament using Magnetic Resonance Imaging. Clin Spine Surg 2024; 37:E106-E112. [PMID: 37941120 DOI: 10.1097/bsd.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE We aimed to develop and validate a convolutional neural network (CNN) model to distinguish between cervical ossification of posterior longitudinal ligament (OPLL) and multilevel degenerative spinal stenosis using Magnetic Resonance Imaging (MRI) and to compare the diagnostic ability with spine surgeons. SUMMARY OF BACKGROUND DATA Some artificial intelligence models have been applied in spinal image analysis and many of promising results were obtained; however, there was still no study attempted to develop a deep learning model in detecting cervical OPLL using MRI images. MATERIALS AND METHODS In this retrospective study, 272 cervical OPLL and 412 degenerative patients underwent surgical treatment were enrolled and divided into the training (513 cases) and test dataset (171 cases). CNN models applying ResNet architecture with 34, 50, and 101 layers of residual blocks were constructed and trained with the sagittal MRI images from the training dataset. To evaluate the performance of CNN, the receiver operating characteristic curves of 3 ResNet models were plotted and the area under the curve were calculated on the test dataset. The accuracy, sensitivity, and specificity of the diagnosis by the CNN were calculated and compared with 3 senior spine surgeons. RESULTS The diagnostic accuracies of our ResNet34, ResNet50, and ResNet101 models were 92.98%, 95.32%, and 97.66%, respectively; the area under the curve of receiver operating characteristic curves of these models were 0.914, 0.942, and 0.971, respectively. The accuracies and specificities of ResNet50 and ResNet101 models were significantly higher than all spine surgeons; for the sensitivity, ResNet101 model achieved better values than that of the 2 surgeons. CONCLUSION The performance of our ResNet model in differentiating cervical OPLL from degenerative spinal stenosis using MRI is promising, better results were achieved with more layers of residual blocks applied.
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Affiliation(s)
- Zhe Qu
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University
- Xuzhou Medical University
| | - Bin Deng
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University
- Xuzhou Medical University
| | - Wei Sun
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University
- Xuzhou Medical University
| | - Ranran Yang
- Xuzhou Medical University
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hu Feng
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University
- Xuzhou Medical University
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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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12
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Kishima K, Yagi K, Yamashita K, Tezuka F, Morimoto M, Takata Y, Sakai T, Maeda T, Sairyo K. Transforaminal Full-Endoscopic Ventral Facetectomy: Midterm Results and Factors Associated with Poor Surgical Outcomes. J Neurol Surg A Cent Eur Neurosurg 2024; 85:155-163. [PMID: 36482000 DOI: 10.1055/a-1995-1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Full-endoscopic spine surgery (FESS) is a well-established procedure for herniated nucleus pulposus. It is a minimally invasive surgery that can be performed under local anesthesia through only an 8-mm skin incision. With improvements in surgical equipment such as high-speed drills, the indications for FESS have expanded to include lumbar spinal stenosis (LSS). We perform a transforaminal full-endoscopic ventral facetectomy (TF-FEVF) for unilateral nerve root-type lateral recess stenosis (LRS) using a transforaminal approach under local anesthesia.The aim of this study was to examine the postoperative results of TF-FEVF for LRS and to identify factors associated with poor surgical outcomes. 85 patients who underwent TF-FEVF for LRS under local anesthesia. Clinical outcomes were determined by visual analog scale (VAS) and the modified MacNab criteria. Evaluation was performed using magnetic resonance imaging (MRI), computed tomography (CT), and flexion-extension radiographs. METHODS This study involved 85 patients (47 males and 38 females) who underwent TF-FEVF for LRS. The mean age was 70.5 years and the mean follow-up duration was 14.8 months. Data were collected on sex, age, level of operation, diagnosis, history of spine surgery at the same level, and duration of follow-up. The diagnosis was categorized as LSS with or without disk bulging. Clinical evaluation was performed using the VAS and modified MacNab criteria. MRI was used to evaluate the degree of disk degeneration, vertebral endplate degeneration, disk height, thickening of the ligamentum flavum, and stenosis. Bony stenosis was evaluated using CT. Sagittal translation and sagittal angulation were also measured by flexion-extension radiographs, and the Cobb angle was measured using a standing front view radiograph. All variables were compared between patients with excellent/good outcomes (E/G group) and those with fair/poor outcomes (F/P group) using the modified MacNab criteria. RESULTS Postoperative VAS showed that leg pain decreased from 59.0 ± 28.6 preoperatively to 17.9 ± 27.2 at the final follow-up (p < 0.01) and that lower back pain also decreased from 60.7 ± 26.6 preoperatively to 27.3 ± 28.6 at final follow-up (p < 0.01). According to the modified MacNab criteria, the results during the final follow-up were excellent in 39 cases, good in 21 cases, fair in 13 cases, and poor in 12 cases. There were no significant differences in sex, age, diagnosis, history of spine surgery, and duration of follow-up periods between the 60 cases (70.6%) in the E/G group and the 25 cases (29.4%) in the F/P group. Imaging evaluation revealed statistically significant differences between the E/G group and the F/P group in intervertebral angle flexion (3.2 vs. 0.4 degrees; p < 0.05), sagittal angulation (4.3 vs. 8.1 degrees; p < 0.05), slip in flexion (0.9 vs. 2.8 mm; p < 0.05), sagittal translation (0.7 vs. 1.6 mm; p < 0.05), and Cobb angle (-0.5 vs. -1.9 degrees; p < 0.05). CONCLUSION Midterm results of TF-FEVF were generally favorable; factors contributing to good or poor TF-FEVF outcomes were large sagittal angulation, large sagittal translation, and concave side.
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Affiliation(s)
- Kazuya Kishima
- Department of Orthopaedics, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Kiyoshi Yagi
- Department of Orthopaedic, Nagoya City University, Nagoya, Aichi, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Masatoshi Morimoto
- Department of Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University Hospital, Tokushima, Japan
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Segar AH, Baroncini A, Urban JPG, Fairbank J, Judge A, McCall I. Obesity increases the odds of intervertebral disc herniation and spinal stenosis; an MRI study of 1634 low back pain patients. Eur Spine J 2024; 33:915-923. [PMID: 38363366 DOI: 10.1007/s00586-024-08154-4] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/13/2023] [Accepted: 01/20/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The objective of this study was to examine the relationships between BMI and intervertebral disc degeneration (DD), disc herniation (DH) and spinal stenosis (SS) using a large, prospectively recruited and heterogeneous patient population. METHODS Patients were recruited through the European Genodisc Study. An experienced radiologist scored MRI images for DD, DH and SS. Multivariate linear and logistic regression analyses were used to model the relationship between these variables and BMI with adjustment for patient and MRI confounders. RESULTS We analysed 1684 patients with a mean age of 51 years and BMI of 27.2 kg/m2.
The mean DD score was 2.6 (out of 5) with greater DD severity with increasing age (R2 = 0.44). In the fully adjusted model, a 10-year increase in age and a 5 kg/m2 increase in BMI were associated, respectively, with a 0.31-unit [95% CI 0.29,0.34] and 0.04-unit [CI 0.01,0.07] increase in degeneration. Age (OR 1.23 [CI 1.06,1.43]) and BMI (OR 2.60 [CI 2.28,2.96]) were positively associated with SS. For DH, age was a negative predictor (OR 0.70 [CI 0.64,0.76]) but for BMI (OR 1.19 [CI 1.07,1.33]), the association was positive. BMI was the strongest predictor of all three features in the upper lumbar spine. CONCLUSIONS While an increase in BMI was associated with only a slight increase in DD, it was a stronger predictor for DH and SS, particularly in the upper lumbar discs, suggesting weight loss could be a useful strategy for helping prevent disorders associated with these pathologies.
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Affiliation(s)
- Anand H Segar
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | | | - Jocelyn P G Urban
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Jeremy Fairbank
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrew Judge
- Centre for Statistics in Medicine, Nuffield, Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, UK
| | - Iain McCall
- Department of Radiology, Robert Jones and Agnes Hunt Hospital, Oswestry, UK
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Mubarak M, Murugan C, Iyer RD, Bt P, Shetty AP, Kanna RM, Rajasekaran S. Congenital Stenosis of the Spine-A Cross-Sectional Study of 1019 Whole-Spine Computed Tomography Scans to Determine Prevalence and Association Among Multilevel, Tandem, and Triple Region Stenosis. World Neurosurg 2024; 183:e556-e563. [PMID: 38171480 DOI: 10.1016/j.wneu.2023.12.144] [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: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGOUND Patients with congenital stenosis of the spine (CSS) present with clinical symptoms at an early age and fewer degenerative hypertrophic changes than the more common degenerative cohort. Literature is lacking in the true prevalence of CSS affecting the 3 segments of the spine in isolation, as well as in tandem in the Indian subcontinent. METHODS Anteroposterior spinal canal diameter in axial plane computed tomography at the midvertebral level was measured in asymptomatic patients with whole-spine computed tomography. Spinal canal stenosis was defined as a diameter of <12 mm for the cervical region, <12 mm for the thoracic region, and <13 mm for the lumbar region. Single-level and multilevel stenosis, as well as tandem and triple-region stenosis, were evaluated. RESULTS The results show the prevalence of CSS as 16.6%, 11.5%, and 20.1% involving the cervical, thoracic, and lumbar spine, respectively. Single-level stenosis affected 90.6%, 94%, and 79.8% of the patients with cervical, thoracic, and lumbar CSS, respectively. Tandem stenosis affected 10.4% of the population (n = 104), with cervicolumbar stenosis being the most prevalent (n = 51, 5%). The presence of CSS in any one segment of the spine was significantly associated with the presence of stenosis at one of the other segments (P < 0.05). Triple-region stenosis was seen in 0.3% (n = 3) patients. CONCLUSIONS The prevalence of cervical, thoracic, lumbar and tandem stenosis from our study is established at 16.6%, 11.5%, 20.1%, and 10.4%. Additionally, our study demonstrates the association between stenosis of the different regions of the spine.
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Affiliation(s)
- Mohammed Mubarak
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Chandhan Murugan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - R Dinesh Iyer
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Pushpa Bt
- Department of Radiology, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India.
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - S Rajasekaran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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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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Tomasi SO, Umana GE, Scalia G, Raudino G, Stevanovic V, Krainz H, Kral M, Nicoletti GF, Winkler PA. Lumbar Spinous Process-Splitting Technique for Ligamentum Flavum Cyst Removal. J Neurol Surg A Cent Eur Neurosurg 2024; 85:195-201. [PMID: 34875711 DOI: 10.1055/a-1715-3958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Laminotomy for lumbar stenosis is a well-defined procedure and represents a routine in every neurosurgical department. It is a common experience that the uni- or bilateral paraspinal muscle detachment, together with injury of the supra- and interspinous ligaments, can lead to postoperative pain. In the literature, the application of a minimally invasive technique, the lumbar spinous process-splitting (LSPS) technique, has been reported. METHODS In this study, we present a case series of 12 patients who underwent LSPS from September 2019 to April 2020. Two patients had a cyst of the ligamentum flavum, eight a single-level lumbar canal stenosis (LCS), and two a two-level LCS. Moreover, we propose a novel morphological classification of postoperative muscle atrophy and present volumetric analysis of the decompression achieved. RESULTS There were no complications related to this technique. In all patients, the vertebral canal area was more than doubled by the procedure. The muscle sparing showed grade A, according to our classification. CONCLUSION To our knowledge, this is the first description of this surgical technique and the first LSPSL case series in Europe. Furthermore, cases of ligamentum flavum cyst removal using this safe and effective technique have not yet been reported.
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Affiliation(s)
| | | | - Gianluca Scalia
- Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Italy
| | - Giuseppe Raudino
- Department of Neurosurgery, Humanitas Centre of Oncology of Catania, Catania, Sicilia, Italy
| | - Vlado Stevanovic
- Department of Neuroradiology, Paracelsus Medical Private University, Salzburg, Austria
| | - Herbert Krainz
- Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria
| | - Michael Kral
- Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria
| | | | - Peter A Winkler
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
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Patel K, Harikar MM, Venkataram T, Chavda V, Montemurro N, Assefi M, Hussain N, Yamamoto V, Kateb B, Lewandrowski KU, Umana GE. Is Minimally Invasive Spinal Surgery Superior to Endoscopic Spine Surgery in Postoperative Radiologic Outcomes of Lumbar Spine Degenerative Disease? A Systematic Review. J Neurol Surg A Cent Eur Neurosurg 2024; 85:182-191. [PMID: 36746397 DOI: 10.1055/a-2029-2694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Minimally invasive spinal surgery (ESS) are both well-established surgical techniques for lumbar spinal stenosis; however, there is limited literature comparing the efficacy of the two techniques with respect to radiologic decompression data. METHODS In this review, PubMed, Google Scholar, and Scopus databases were systematically searched from inception until July 2022 for studies that reported the radiologic outcomes of endoscopic and minimally invasive approaches for decompressive spinal surgery, namely, the spinal canal area, neural foraminal area, and neural foraminal heights. RESULTS Of the 378 articles initially retrieved using MeSH and keyword search, 9 studies reporting preoperative and postoperative spinal areas and foraminal areas and heights were finally included in our review. Of the total 581 patients, 391 (67.30%) underwent MISS and 190 (32.70%) underwent ESS. The weighted mean difference between the spinal canal diameter in pre- and postoperative conditions was 56.64 ± 7.11 and 79.52 ± 21.31 mm2 in the MISS and ESS groups, respectively. ESS was also associated with a higher mean difference in the foraminal area postoperatively (72 ± 1 vs. 35.81 ± 11.3 mm2 in the MISS and ESS groups, respectively), but it was comparable to MISS in terms of the foraminal height (0.32 ± 0.037 vs. 0.29 ± 0.03 cm in the MISS and endoscopic groups, respectively). CONCLUSIONS Compared with MISS, ESS was associated with improved radiologic parameters, including spinal canal area and neural foraminal area in the lumbar spinal segments. Both techniques led to the same endpoint of neural decompression when starting with a more severe compression. However, the present data do not allow the correlation of the radiographic results with the related clinical outcomes.
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Affiliation(s)
- Kashyap Patel
- Baroda Medical College, India, Vadodara, Gujarat, India
- Society for Brain Mapping & Therapeutics (SBMT), Los Angeles, California, United States
| | | | - Tejas Venkataram
- Society for Brain Mapping & Therapeutics (SBMT), Los Angeles, California, United States
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Vishal Chavda
- Department of Pathology, Stanford School of Medicine, Stanford University Medical Center, San Francisco, California, United States
- Department of Medicine, Multispeciality, Trauma and ICCU Center, Sardar Hospital, Ahmedabad, Gujarat, India
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | - Marjan Assefi
- University of North Carolina at Greensboro, Greensboro, North Carolina, United States
| | - Namath Hussain
- Department of Neurosurgery, Loma Linda University, Loma Linda, California, United States
| | - Vicky Yamamoto
- University of Southern California Keck School of Medicine, The University of Southern California Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, California, United States
- University of Southern California-Norris Comprehensive Cancer Center, Los Angeles, California, United States
- Brain Mapping Foundation (BMF), Los Angeles, California, United States
| | - Babak Kateb
- Brain Mapping Foundation (BMF), Los Angeles, California, United States
- Brain Technology and Innovation Park, Los Angeles, California, United States
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, Arizona, United States
| | - Giuseppe E Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
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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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Yamato Y, Nagata K, Kawamura N, Higashikawa A, Takeshita Y, Tozawa K, Fukushima M, Urayama D, Ono T, Hara N, Okamoto N, Azuma S, Iwai H, Sugita S, Yoshida Y, Hirai S, Masuda K, Jim Y, Ohtomo N, Nakamoto H, Kato S, Taniguchi Y, Tanaka S, Oshima Y. Comparative Analysis of Microendoscopic and Open Laminectomy for Single-Level Lumbar Spinal Stenosis at L1-L2 or L2-L3. World Neurosurg 2024; 183:e408-e414. [PMID: 38143029 DOI: 10.1016/j.wneu.2023.12.109] [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: 08/12/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Several reports have highlighted comparable surgical outcomes between microendoscopic laminectomy (MEL) and open laminectomy (open) for lumbar spinal stenosis. However, the unilateral approach in MEL may present challenges for the upper lumbar levels, where facet joints are located deeper inside. Our objective was to compare surgical outcomes and radiographic evaluations for single-level decompression cases at L1-L2 or L2-L3 between MEL and open laminectomy. METHODS We analyzed patients who underwent single-level decompression for upper lumbar spinal stenosis at 12 distinguished spine centers from April 2017 to September 2021. Baseline demographics, preoperative, and 1-year postoperative patient-reported outcomes, along with imaging parameters, were compared between the MEL and open groups. To account for potential confounding, patients' backgrounds were adjusted using the inverse probability weighting method based on propensity scores. RESULTS Among the 2487 patients undergoing decompression surgery, 118 patients (4.7%) underwent single-level decompression at L1-L2 or L2-L3. Finally, 80 patients (51 in the MEL group, 29 in the open group) with postoperative data were deemed eligible for analysis. The MEL group exhibited significantly improved postoperative EuroQol 5-Dimension values compared to the open group. Additionally, the MEL group showed a lower facet preservation rate according to computed tomography examination, whereas the open group had a higher incidence of retrolisthesis. CONCLUSIONS Although overall surgical outcomes were similar, the MEL group demonstrated potential advantages in enhancing EuroQol 5-Dimension scores. The MEL group's lower facet preservation rate did not translate into a higher postoperative instability rate.
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Affiliation(s)
- Yukimasa Yamato
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Kosei Nagata
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Shibuya City, Tokyo, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Keiichiro Tozawa
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Spine Center, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Masayoshi Fukushima
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Spine Center, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Daiki Urayama
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Shinjuku City, Tokyo, Japan
| | - Takashi Ono
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Shinjuku City, Tokyo, Japan
| | - Nobuhiro Hara
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan
| | - Naoki Okamoto
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Seiichi Azuma
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Hiroki Iwai
- Inanami Spine and Joint Hospital, Shinagawa City, Tokyo, Japan
| | - Shurei Sugita
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo City, Tokyo, Japan
| | - Yuichi Yoshida
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Spine Center, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Shima Hirai
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Spine Center, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Kazuhiro Masuda
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yu Jim
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan.
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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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21
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Abudouaini H, Yang J, Lin K, Meng Y, Zhang H, Wang S. A possible correlation between facet orientation and development of degenerative cervical spinal stenosis. BMC Musculoskelet Disord 2024; 25:181. [PMID: 38413918 PMCID: PMC10900644 DOI: 10.1186/s12891-024-07279-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/13/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Previous studies have demonstrated the relationship between sagittal facet orientation and cervical degenerative spondylolisthesis. However, the associations between facet orientation and cervical spinal stenosis (CSS) have rarely been studied. METHODS One hundred twenty patients with CSS (CSS group) and 120 healthy participants (control group) were consecutively enrolled. The cervical facet angles and anteroposterior diameter (A-P diameter) of spinal canal at each subaxial cervical levels were measured using axial magnetic resonance imaging. The intersection angle of the midsagittal line of the vertebra to the facet line represents the orientation of the facet joint. RESULTS The facet angles on the right side at C2- C3 and C3-C4 in CSS group and at C2- C3 in control group had significantly higher values than those of the other sides. Besides, the facet angles and A-P diameter of spinal canal in CSS group were significantly smaller than those in control group at all levels (p < 0.05). CONCLUSIONS Our study demonstrated that patients with CSS have smaller axial cervical facet joint angles compared to the healthy individuals. Further studies are needed to elicit the specific underlying mechanism between sagittalization of the cervical facet joints and the pathology of CSS.
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Affiliation(s)
- Haimiti Abudouaini
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Junsong Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Kaiyuan Lin
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yibing Meng
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Hong Zhang
- Department of Ultrasound Medical Center, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
| | - Sibo Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
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22
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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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23
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Lu S, Zhu W, Wang Y, Kong C, Wang W, Chen X, Li X. Sagittal imbalance syndrome, a new concept, helps determining a long fusion for patients with degenerative lumbar spinal stenosis and severe global sagittal imbalance. J Orthop Surg Res 2024; 19:138. [PMID: 38351135 PMCID: PMC10865626 DOI: 10.1186/s13018-024-04613-2] [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: 11/29/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE To retrospectively investigate the postoperative clinical and radiographic outcomes in elderly patients with degenerative lumbar spinal stenosis (DLSS) and severe global sagittal imbalance who underwent different fusion levels. METHODS A total of 214 patients with DLSS and severe global sagittal imbalance were included. Sagittal imbalance syndrome was defined as the severe decompensated radiographic global sagittal imbalance accompanied with the following symptoms: severe back pain in naturel posture that disappears or significantly relieves in support position, living disability with ODI score > 40% and dynamic sagittal imbalance. Thereinto, 54 patients were found with sagittal imbalance syndrome and were performed the lumbar decompression with a long thoracolumbar fusion (Group A) or a short lumbar fusion (Group B). Thirty patients without sagittal imbalance syndrome who underwent short lumbar decompression and fusion were selected as the control (Group C). RESULTS Patients with sagittal imbalance syndrome were detected to have more paraspinal muscle degeneration and less compensatory potentials for sagittal imbalance (smaller thoracic kyphosis and larger pelvic tilt) than those without this diagnosis. Postoperative comparisons revealed significant restoration of global sagittal alignment and balance and improvement of living quality in Groups A and C at the final follow-up. Six patients in Group B and one in Group A were found to have proximal junctional complication during follow-up. CONCLUSION Our results indicated that DLSS patients with sagittal imbalance syndrome had inferior surgical outcomes in terms of living quality and proximal junctional complication after lumbar decompression with a short fusion.
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Affiliation(s)
- Shibao Lu
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China.
- National Geriatric Disease Research Center, Beijing, China.
| | - Weiguo Zhu
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Yu Wang
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Chao Kong
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Wei Wang
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Xiaolong Chen
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Xiangyu Li
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
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24
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Jiang Y, Li C, Yuan LT, Luo C, Wu SS, Mao YH, Xu F, Yu Y. Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis. J Vis Exp 2024. [PMID: 38407307 DOI: 10.3791/65456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ligaments. LSS encompasses central canal stenosis (CCS), lateral recess stenosis (LRS), and intervertebral foramen stenosis (IFS). The utilization of lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has gained popularity in the treatment of CCS and LRS. This popularity is attributed to the rapid development of endoscopic instruments and the progress of endoscopic philosophy. In this technical report, a detailed introduction to the steps and key points of LE-ULBD is provided. Simultaneously, a retrospective review of 132 consecutive patients who underwent LE-ULBD for central canal and/or lateral recess stenosis was conducted. The outcomes after more than two years of follow-up were assessed using the visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and the modified MacNab criteria to evaluate surgical efficacy. All 132 patients underwent LE-ULBD successfully. Among them, 119 patients were rated as "excellent," while 13 patients were rated as "good" based on the modified MacNab criteria during the last follow-up. Incidental dural tears occurred in four cases, but there were no post-operative epidural hematomas or infections. The experience demonstrates that LE-ULBD is a less invasive, effective, and safe approach. It can be considered as an alternative option for treating patients with lumbar central canal stenosis and/or lateral recess stenosis.
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Affiliation(s)
- Ye Jiang
- Department of Neurosurgery, Minhang Hospital, Fudan University
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital, Fudan University
| | - Lu-Tao Yuan
- Department of Neurosurgery, Minhang Hospital, Fudan University
| | - Cong Luo
- Department of Neurosurgery, Minhang Hospital, Fudan University
| | - Shao-Shuai Wu
- Department of Neurosurgery, Minhang Hospital, Fudan University
| | - Yu-Hang Mao
- Department of Neurosurgery, Minhang Hospital, Fudan University
| | - Fulin Xu
- Department of Neurosurgery, Minhang Hospital, Fudan University
| | - Yong Yu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University;
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25
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Pesante BD, Paro MR, Nadeem T, Bulsara KR, Choi DB. Lumbar decompression and fusion for symptomatic spinal stenosis in a patient with chronic thoracic sensory level from prior transverse myelitis: a case report. J Med Case Rep 2024; 18:42. [PMID: 38310259 PMCID: PMC10838414 DOI: 10.1186/s13256-024-04367-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/05/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Many patients with transverse myelitis suffer from sensory loss below the spinal level of the lesion. This is commonly associated with chronic neuropathic pain. However, the presence of somatic pain below a complete thoracic sensory level after transverse myelitis is exceptionally rare, and it is unclear if surgical decompression is an effective form of treatment for these patients. CASE PRESENTATION In this report, we describe a 22-year-old Caucasian female who suffered from chronic lumbar back pain despite a complete thoracic sensory level secondary to prior transverse myelitis. Imaging demonstrated multilevel central stenosis below the sensory level, and her pain improved after surgical decompression. To our knowledge, this is the first reported case of symptomatic lumbar stenosis below a sensory level after transverse myelitis successfully treated with surgical decompression. CONCLUSION This is the first reported case of a patient with symptomatic lumbar stenosis after transverse myelitis whose lower back pain and quality of life improved following surgical decompression and fusion. This case provides evidence that typical lumbago is possible in patients with sensory loss from transverse myelitis, and standard lumbar decompression may provide benefit for these patients.
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Affiliation(s)
- Benjamin D Pesante
- University of Connecticut School of Medicine, UConn Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Mitch R Paro
- University of Connecticut School of Medicine, UConn Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA
| | | | - Ketan R Bulsara
- Division of Neurosurgery, Department of Surgery, UConn Health, Farmington, CT, USA
| | - David B Choi
- Division of Neurosurgery, Department of Surgery, UConn Health, Farmington, CT, USA
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26
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Jia D, Qiao X, Wang X, Li S, Li Q, Hao Y, Peng X. Early efficacy observation of the unilateral biportal endoscopic technique in the treatment of multi-level lumbar spinal stenosis. J Orthop Surg Res 2024; 19:117. [PMID: 38310279 PMCID: PMC10838451 DOI: 10.1186/s13018-024-04575-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 01/22/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND To explore the early curative effect of unilateral biportal endoscopy (UBE) in the treatment of multi-level lumbar spinal stenosis with the help of multiple small incisions. METHODS A retrospective analysis was performed on 26 patients with multi-level lumbar spinal stenosis treated by UBE in our hospital from August 1, 2021, to March 1, 2022. We collect patients' basic medical records and independently design surgical incisions. The visual analog score (VAS) and Oswestry Disability Index (ODI) were compared before surgery, 7 days after surgery and 6 months after surgery. Spinal canal diameters on CT were compared before surgery and 7 days after surgery. The modified MacNab standard was used to evaluate the efficacy satisfaction at 6 months after operation. RESULTS In this study, 26 patients were operated according to the predetermined surgical plan. The operative time was 145 ± 40.11 min, the intraoperative blood loss was 156.25 ± 44.32 ml, and the postoperative hospital stay was 4.79 ± 1.31 days. The VAS scores of postoperative lumbago and leg pain were lower than those before surgery (P < 0.05). The postoperative ODI score was significantly different from that before surgery (P < 0.05). The postoperative CT sagittal diameter was significantly different from that before surgery (P < 0.05). The curative effect of modified MacNab was 76.92% when followed up 7 days after surgery. The curative effect of modified MacNab was 92.31% when followed up 6 months after surgery, which was significantly improved compared with 7 days after surgery. CONCLUSION Under multiple small incision channels, UBE can effectively treat multi-level lumbar spinal stenosis, significantly relieve the clinical symptoms of patients, and significantly improve the quality of life of patients. It is a safe and feasible minimally invasive surgical treatment method for multi-level lumbar spinal stenosis.
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Affiliation(s)
- Dingding Jia
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Xin Qiao
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Xuepan Wang
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Shaoqing Li
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Qiang Li
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Yunbing Hao
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Xiangping Peng
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China.
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27
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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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Murata S, Takami M, Iwasaki H, Hashizume H, Yukawa Y, Minamide A, Nakagawa Y, Tsutsui S, Okada M, Nagata K, Ishimoto Y, Teraguchi M, Iwahashi H, Murakami K, Taiji R, Kozaki T, Kitano Y, Yoshida M, Yamada H. Outcomes and Vertebral Osteophytes and Bulging Intervertebral Discs Occupancy as a Decision-Making Tool for Surgical Success in Patients Undergoing Microendoscopic Foraminotomy for Lumbar Foraminal Stenosis. World Neurosurg 2024; 182:e570-e578. [PMID: 38052363 DOI: 10.1016/j.wneu.2023.11.150] [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: 10/05/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The objective of this study was to determine the long-term outcomes of microendoscopic foraminotomy in treating lumbar foraminal stenosis and identify the optimal extent of decompression that yields improved results and fewer complications. METHODS A retrospective cohort study reviewed the medical records of 95 consecutive patients who underwent microendoscopic foraminotomy for lumbar foraminal stenosis. Clinical outcomes were assessed using the Japanese Orthopaedic Association scoring system and visual analog scale for low back and leg pain. Surgical success was determined by meeting significant improvement thresholds for back and leg pain at 2 years postoperatively. Multiple regression analysis identified factors associated with improved pain scores. Receiver operating characteristic curve analysis determined the cut-off values for successful surgeries. RESULTS Significant improvements were observed in Japanese Orthopaedic Association and visual analog scale scores for back and leg pain 2 years postoperatively compared with preoperative scores (P < 0.0001) and sustained over a ≥5-year follow-up period. Reoperation rates were low and did not significantly increase over time. Multiple regression analysis identified occupancy of the vertebral osteophytes and bulging intervertebral discs (O/D complex) as surgical success predictors. A 45.0% O/D complex occupancy cutoff value was determined, displaying high sensitivity and specificity for predicting surgical success. CONCLUSIONS This study provides evidence supporting the long-term efficacy of microendoscopic foraminotomy for lumbar foraminal stenosis and predicting surgical success. The 45.0% O/D complex occupancy cut-off value can guide patient selection and outcome prediction. These insights contribute to informed surgical decision-making and underscore the importance of evaluating the O/D complex in preoperative planning and predicting outcomes.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan; Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | | | - Akihito Minamide
- Spine Center, Dokkyo Medical University Nikko Medical Center, Nikko City, Tochigi, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Katsuragi, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Motohiro Okada
- Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yuyu Ishimoto
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masatoshi Teraguchi
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Iwahashi
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Kimihide Murakami
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takuhei Kozaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yoji Kitano
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Munehito Yoshida
- Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, 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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Zhang F, Ye D, Zhang W, Sun Y, Guo L, Li J. Efficacy of lumbar decompression under large-channel spinal endoscope in elderly patients with segmental lumbar spinal stenosis. J Orthop Surg Res 2024; 19:16. [PMID: 38167077 PMCID: PMC10763422 DOI: 10.1186/s13018-023-04389-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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/18/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE The present study was conducted with an attempt to explore the overall efficacy of large-channel spinal endoscopy technology in elderly patients with segmental lumbar spinal stenosis. METHODS We included a total of 68 elderly patients with segmental lumbar spinal stenosis in our hospital from February 2021 to March 2023. The participants were randomly and equally distributed into the study group and the control group using a random number table method. The control group received the open lumbar decompression surgery, and the study group received the lumbar decompression under large-channel spinal endoscopy technology. We compared the surgical conditions of the two groups, including pain level, Oswestry Disability Index (ODI) score, and Japanese Orthopedic Association (JOA) score before surgery, 1 week after surgery, 3 months after surgery, and 1 year after surgery. In addition, we compared the efficacy and adverse reactions 1 year after surgery between the two groups. RESULTS Our findings revealed that the operation time, intraoperative blood loss, postoperative drainage volume, and hospital stay in the study group were significantly lower than those in the control group (p < 0.05). There was no statistically significant difference in the degree of pain between the two groups before surgery (p > 0.05), and the pain intensity of the study group was significantly lower than that of the control group at 1 week, 3 months, and 1 year after surgery (p < 0.05). Similarly, preoperative ODI and JOA scores were not significantly different between the two groups (p > 0.05), while they were significantly lower in the study group than those in the control group at 1 week, 3 months, and 1 year after surgery (p < 0.05). Before surgery, no significant difference was seen in therapeutic efficacy between the two groups (p > 0.05), whereas the efficacy was remarkably improved in the study group comparing to the control group at 1 week, 3 months, and 1 year after surgery (p < 0.05). All patients in this study were followed up for 10 to 16 months, with an average of 13.29 ± 1.28 months. The incidence of adverse reactions in the study group was significantly lower than that in the control group (p < 0.05). CONCLUSIONS Large-channel spinal endoscopy technology exerted promising results in elderly patients with segmental lumbar spinal stenosis, in terms of reducing the surgical time, intraoperative bleeding, postoperative drainage volume, and hospital stay. The approach also alleviated pain, reduced ODI and JOA scores, and restored lumbar function, with decreased incidence of adverse reactions, thereby promoting patient recovery. It is considered valid for wide clinical application.
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Affiliation(s)
- Fei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050000, Hebei, China
| | - Dandan Ye
- Orthopaedic Institute, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050000, Hebei, China.
| | - Yapeng Sun
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050000, Hebei, China
| | - Lei Guo
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050000, Hebei, China
| | - Jiaqi Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050000, Hebei, China
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Park S, Kim JH, Ahn Y, Lee CH, Kim YG, Yuh WT, Hyun SJ, Kim CH, Kim KJ, Chung CK. Multi-pose-based convolutional neural network model for diagnosis of patients with central lumbar spinal stenosis. Sci Rep 2024; 14:203. [PMID: 38168665 PMCID: PMC10761871 DOI: 10.1038/s41598-023-50885-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024] Open
Abstract
Although the role of plain radiographs in diagnosing lumbar spinal stenosis (LSS) has declined in importance since the advent of magnetic resonance imaging (MRI), diagnostic ability of plain radiographs has improved dramatically when combined with deep learning. Previously, we developed a convolutional neural network (CNN) model using a radiograph for diagnosing LSS. In this study, we aimed to improve and generalize the performance of CNN models and overcome the limitation of the single-pose-based CNN (SP-CNN) model using multi-pose radiographs. Individuals with severe or no LSS, confirmed using MRI, were enrolled. Lateral radiographs of patients in three postures were collected. We developed a multi-pose-based CNN (MP-CNN) model using the encoders of the three SP-CNN model (extension, flexion, and neutral postures). We compared the validation results of the MP-CNN model using four algorithms pretrained with ImageNet. The MP-CNN model underwent additional internal and external validations to measure generalization performance. The ResNet50-based MP-CNN model achieved the largest area under the receiver operating characteristic curve (AUROC) of 91.4% (95% confidence interval [CI] 90.9-91.8%) for internal validation. The AUROC of the MP-CNN model were 91.3% (95% CI 90.7-91.9%) and 79.5% (95% CI 78.2-80.8%) for the extra-internal and external validation, respectively. The MP-CNN based heatmap offered a logical decision-making direction through optimized visualization. This model holds potential as a screening tool for LSS diagnosis, offering an explainable rationale for its prediction.
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Affiliation(s)
- Seyeon Park
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Youngbin Ahn
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Young-Gon Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea.
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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Pennisi G, D'Ercole M, Izzo A, Polli FM, Rapisarda A, Papacci F, Olivi A, Montano N. Change of Clinical and Radiologic Parameters after Minimally Invasive Decompression in Patients with Lumbar Spinal Stenosis: A Prospective Study with Long-term Follow-up. J Neurol Surg A Cent Eur Neurosurg 2024; 85:14-20. [PMID: 35901813 DOI: 10.1055/a-1911-8864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The impact of minimally invasive decompression (MID) techniques on spinopelvic parameters and on the sagittal alignment remains a controversial topic. Here we studied the changes in clinical and radiologic parameters and their relationships in a series of lumbar spinal stenosis (LSS) submitted to MID with a minimum follow-up (FU) of 24 months. METHODS We prospectively collected clinical and radiologic data of 20 consecutive patients who were evaluated preoperatively, at the 6-month FU, and at the 24-month FU. Visual analog scale (VAS) for back and leg pain, Oswestry disability index (ODI), neck disability index (NDI), sagittal vertical axis (SVA), C7 slope (C7S), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were assessed for each patient. Moreover, the percentage variation of clinical and radiologic factors at the 24-month FU compared with the preoperative factors was calculated to perform correlation studies among these variables. RESULTS We reported a significant improvement of all clinical parameters. A significant increase of LL and SS and a significant decrease of PT and SVA were observed. The preoperative values of ODI, LL, SS, PT, and SVA significantly affect the 24-month FU values, and the percentage improvement of SVA at the 24-month FU compared with the preoperative values was significantly related to the percentage improvement of LL. CONCLUSIONS MID is clinically effective in patients with LSS and improves the spinopelvic parameters and the global sagittal balance of the spine. The preoperative spinal alignment affects the spinal alignment at FU. The improvement of SVA was strictly related to the improvement of LL.
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Affiliation(s)
- Giovanni Pennisi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Papacci
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
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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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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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Taniwaki H, Hoshino M, Kinoshita Y, Matsumura A, Namikawa T, Kato M, Takahashi S, Nakamura H. Lower preoperative Hounsfield unit values as a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. Eur Spine J 2024; 33:11-18. [PMID: 37882830 DOI: 10.1007/s00586-023-07995-9] [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] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Hounsfield Unit (HU) value has been associated with future osteoporotic fractures and postoperative complications. However, no studies on the impact of low HU values on mid-term clinical outcomes following lumbar spine surgery have been reported. We aimed to evaluate the usefulness of preoperative HU values for 5-year clinical outcomes following lumbar spine surgery. METHODS We enrolled 200 patients who underwent lumbar surgery (≤ 3-disc levels) for lumbar spinal stenosis. HU values were assessed using preoperative lumbar computed tomography as part of routine preoperative planning for lumbar surgery. Patients were divided into two groups based on the cutoff value of the HU values obtained from the receiver operating characteristic curve for the incidence of vertebral fractures within five years postoperatively. Clinical scores preoperatively and 1, 2, and 5 years postoperatively, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were compared using a mixed-effects model. RESULTS Comparative analysis indicated that all domains of JOABPEQ, except for lumbar function, and the physical component summary of the SF-36 were significantly worse in the low HU group than in the high HU group. Using multiple regression analysis, low HU values were significantly correlated with worse 5-year postoperative scores in all domains of JOABPEQ and SF-36. CONCLUSION Low preoperative HU values are a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. HU values are not only a valuable tool for analyzing bone mineral density but also may be a valuable poor prognostic factor of postoperative clinical outcomes.
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Affiliation(s)
- Hiroshi Taniwaki
- Department of Orthopedic Surgery, Osaka City General Hospital, 2-13-22, Miyakojima Hon-Dori, Miyakojima-Ku, Osaka City, Osaka, 534-0021, Japan.
| | - Masatoshi Hoshino
- Department of Orthopedic Surgery, Osaka City General Hospital, 2-13-22, Miyakojima Hon-Dori, Miyakojima-Ku, Osaka City, Osaka, 534-0021, Japan
| | - Yuki Kinoshita
- Department of Orthopedic Surgery, Osaka City General Hospital, 2-13-22, Miyakojima Hon-Dori, Miyakojima-Ku, Osaka City, Osaka, 534-0021, Japan
| | - Akira Matsumura
- Department of Orthopedic Surgery, Osaka City General Hospital, 2-13-22, Miyakojima Hon-Dori, Miyakojima-Ku, Osaka City, Osaka, 534-0021, Japan
| | - Takashi Namikawa
- Department of Orthopedic Surgery, Osaka City General Hospital, 2-13-22, Miyakojima Hon-Dori, Miyakojima-Ku, Osaka City, Osaka, 534-0021, Japan
| | - Minori Kato
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Bednar DA. Postoperative Dural Sac Cross-Sectional Area as an Association for Outcome After Surgery for Lumbar Spinal Stenosis: Clinical and Radiologic Results From the NORDSTEN-Spinal Stenosis Trial ( Spine , May 15, 2023). Spine (Phila Pa 1976) 2024; 49:E8-E9. [PMID: 37737670 DOI: 10.1097/brs.0000000000004835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Drew A Bednar
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Hermansen E, Indrekvam K, Weber C, Brisby H. Postoperative Dural Sac Cross-Sectional Area as an Association for Outcome After Surgery for Lumbar Spinal Stenosis: Clinical and Radiologic Results From the NORDSTEN-Spinal Stenosis Trial (Spine, May 15, 2023). Spine (Phila Pa 1976) 2024; 49:E10. [PMID: 37823287 DOI: 10.1097/brs.0000000000004850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Erland Hermansen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Norway
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Norway
- Department of Quality and Health Technology, University of Stavanger, Norway
| | - Helena Brisby
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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Ashida Y, Miki T, Kondo Y, Takebayashi T. Influence of radiological factors, psychosocial factors, and central sensitization-related symptoms on clinical symptoms in patients with lumbar spinal canal stenosis. J Back Musculoskelet Rehabil 2024; 37:369-377. [PMID: 37955077 DOI: 10.3233/bmr-230093] [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] [Indexed: 11/14/2023]
Abstract
BACKGROUND No study to date has concurrently evaluated the impact of radiological factors, psychosocial factors, and central sensitization (CS) related symptoms in a single lumbar spinal canal stenosis (LSS) patient cohort. OBJECTIVE To investigate the associations between these factors and clinical symptoms in LSS patients. METHODS We recruited 154 patients with LSS scheduled for surgery. Patient-reported outcome measures and imaging evaluation including clinical symptoms, psychosocial factors, CS-related symptoms, and radiological classifications. Spearman's rank correlation coefficient and multiple regression analyses were employed. RESULTS Spearman's correlation revealed CS-related symptoms positively correlated with low back pain (r= 0.25, p< 0.01), leg pain (r= 0.26, p< 0.01), and disability (r= 0.32, p< 0.01). Pain catastrophizing positively correlated with leg pain (r= 0.23, p< 0.01) and disability (r= 0.36, p< 0.01). Regression analysis showed that pain catastrophizing was associated with disability (β= 0.24, 95%CI = 0.03-0.18), and CS-related symptoms with low back pain (β= 0.28, 95%CI = 0.01-0.09). Radiological classifications were not associated with clinical symptoms. CONCLUSION Our findings suggest that psychosocial factors and CS-related symptoms, rather than radiological factors, seem to contribute to clinical symptoms in patients with LSS.
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Affiliation(s)
- Yuzo Ashida
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Takahiro Miki
- PREVENT Inc., Nagoya, Japan
- Graduate School, Hokkaido University, Sapporo, Japan
| | - Yu Kondo
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Tsuneo Takebayashi
- Department of Orthopedic, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
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Han G, Zhou S, Qiu W, Fan Z, Yue L, Li W, Wang W, Sun Z, Li W. Role of the Paraspinal Muscles in the Sagittal Imbalance Cascade: The Effects of Their Endurance and of Their Morphology on Sagittal Spinopelvic Alignment. J Bone Joint Surg Am 2023; 105:1954-1961. [PMID: 37856573 DOI: 10.2106/jbjs.22.01175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND The role of paraspinal muscle degeneration in the cascade of sagittal imbalance is still unclear. This study aimed to compare paraspinal muscle degeneration in the 4 stages of sagittal imbalance: sagittal balance (SB), compensated sagittal balance (CSB), decompensated sagittal imbalance (DSI), and sagittal imbalance with failure of pelvic compensation (SI-FPC). In addition, it aimed to compare the effects paraspinal muscle endurance and morphology on sagittal spinopelvic alignment in patients with lumbar spinal stenosis. METHODS A cross-sectional study of 219 patients hospitalized with lumbar spinal stenosis was performed. The isometric paraspinal extensor endurance test and evaluation of atrophy and fat infiltration of the paraspinal extensor muscles and psoas major on magnetic resonance imaging were performed at baseline. Spinopelvic parameters including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and the sagittal vertical axis were measured. RESULTS The patients with lumbar spinal stenosis were divided into 67 with SB, 85 with CSB, 49 with DSI, and 17 with SI-FPC. There were significant differences in paraspinal muscle endurance and morphology among the 4 groups. Furthermore, the SI-FPC group had poorer paraspinal muscle endurance than either the SB or the CSB group. In multiple linear regression analysis, paraspinal muscle endurance and the relative functional cross-sectional area of the paraspinal extensor muscles were the independent predictors of the sagittal vertical axis, and the relative functional cross-sectional area of the psoas major was the independent predictor of relative pelvic version. CONCLUSIONS This study indicated that paraspinal muscle degeneration is not only an initiating factor in pelvic retroversion but also a risk factor for progression from a compensated to a decompensated stage. Specifically, the impairment of muscle endurance in the CSB stage may be the reason why patients experience failure of pelvic compensation. In addition, paraspinal muscle endurance and muscle morphology (relative functional cross-sectional area of the paraspinal extensor muscles and psoas major) had different clinical consequences. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Siyu Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Weipeng Qiu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Zheyu Fan
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Lihao Yue
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wei Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wei Wang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, People's Republic of China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
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Li C, Wang Y, Fan S, Liu Y, Chen Y, Wang J, He X. Cervical Spondylosis as a Potential Cause of Venous Hypertensive Myelopathy: A Case Report. Am J Case Rep 2023; 24:e942149. [PMID: 38104238 PMCID: PMC10740335 DOI: 10.12659/ajcr.942149] [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: 08/13/2023] [Revised: 11/11/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Venous hypertensive myelopathy (VHM) is generally closely related to spinal vascular malformations, but a small number of other causes of VHM have been reported. CASE REPORT This rare case report describes a 74-year-old man with a C3 to C7 disc herniation, posterior spondylolisthesis (degree I) with spinal stenosis, exhibiting comparatively swift decline in neurological function as well as abnormal expansion of the high-signal intensity region on T2-weighted magnetic resonance imaging (MRI), which progressed to the medulla oblongata. Whether spinal cord degeneration is caused by cervical spondylotic myelopathy remains uncertain. Lumbar puncture was not performed because of spinal stenosis. An acute inflammatory process was also considered and the patient received hormone therapy. However, the effect was not significant, and his symptoms worsened after his hormone levels decreased. Repeat cervical MRI demonstrated interval development of diffuse intramedullary increased T2 signal in the spinal cord, which gradually increased to the pons, with cord swelling and degeneration more apparent. His medical history, negative laboratory results, evoked potential examination results, and poor effects of hormone therapy indicated a low probability of spinal inflammatory disease. Posterior C3-C6 expansive open-door cervical laminoplasty with lateral mass screw insertion and C2 and C7 decompression surgeries were performed. The neurological symptoms and abnormal T2-weighted MRI signals significantly improved after the operation. CONCLUSIONS VHM can be caused by spondylotic cord compression, leading to spinal cord injury. Therefore, an accurate diagnosis and timely surgery are essential.
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Affiliation(s)
- Cai Li
- Department of Neurology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, Zhejiang, PR China
| | - Ying Wang
- Department of Neurology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, Zhejiang, PR China
| | - ShaoHua Fan
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, Zhejiang, PR China
| | - Yuchen Liu
- Department of Neurology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, Zhejiang, PR China
| | - Ying Chen
- Department of Radiology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, Zhejiang, PR China
| | - Jianfeng Wang
- Department of Neurosurgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, Zhejiang, PR China
| | - Xinwei He
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, PR China
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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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Guo W, Li T, Feng C, Yu Y, Hu Y, Fan X. Clinical comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion verse 3D microscope-assisted transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis: a retrospective study with 24-month follow-up. J Orthop Surg Res 2023; 18:943. [PMID: 38066527 PMCID: PMC10709901 DOI: 10.1186/s13018-023-04401-4] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To explore the safety and the mid-term efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and 3D microscope-assisted transforaminal lumbar interbody fusion (MMIS-TLIF) for treating single-segment lumbar spondylolisthesis with lumbar spinal stenosis (DLS-LSS). METHODS The clinical data of 49 patients who underwent UBE-TLIF or MMIS-TLIF in our hospital were retrospectively analyzed, including 26 patients who underwent the UBE-TLIF and 23 patients who underwent the MMIS-TLIF. The demographic and perioperative outcomes of patients before and after surgery were reviewed. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes of patients before surgery and at 1, 3, 6, 12 and 24 months after surgery. The lumbar lordosis angle (LL), disc height (DH) and lumbar intervertebral fusion rate were assessed before surgery and at the last follow-up. RESULTS The VAS and ODI scores of the two groups were improved compared with those before surgery. The ODI of UBE-TLIF group was lower than that of MMIS-TLIF group at 1, 3, 6, and 12 months after surgery, and there were no significant differences between the two groups at other time points (P > 0.05). There were no significant differences in VAS between the two groups at each time point (P > 0.05). However, the UBE-TLIF group had more advantages in blood loss and hospital stay. The complications between the UBE-TLIF group (11.54%) and the MMIS-TLIF group (17.39%) were comparable (P > 0.05). Radiographic outcomes showed that the LL and DH of the two groups were improved compared with those before surgery, and the difference before and after surgery was not significant (P > 0.05). The fusion rate was 96.2% in the UBE-TLIF group and 95.7% in the MMIS-TLIF group. There was no significant difference in the fusion rate between the two groups (P > 0.05). CONCLUSIONS Both UBE-TLIF and MMIS-TLIF have favorable outcomes for treating single-segment DLS-LSS. Both groups have the advantages of clear surgical vision, high surgical efficiency, and favorable mid-term efficacy. In addition, compared with MMIS-TLIF, UBE-TLIF causes less intraoperative bleeding and faster postoperative recovery.
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Affiliation(s)
- Wenlong Guo
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China.
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| | - Tong Li
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Chaoqun Feng
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yang Yu
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Youpeng Hu
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Xiaohong Fan
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
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Pérez EG, Santander XA, Llinás Amengual P, Choi DJ. Biportal Endoscopic Spine Surgery: Clinical Results for 163 Patients. World Neurosurg 2023; 180:e676-e685. [PMID: 37813335 DOI: 10.1016/j.wneu.2023.10.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Biportal endoscopy spine surgery is an endoscopic procedure that uses 2 portals, 1 for the endoscope and 1 for the instruments. It provides an excellent and very versatile field of view, with the advantage of another portal to approach the most common degenerative lumbar pathologies. METHODS We evaluated a retrospective series of patients who underwent biportal endoscopy with ≥1 year of follow-up. Relevant epidemiological and clinical data, such as the Oswestry disability index and visual analog scale for pain, were also considered. Complications and the effects of the learning curve are also discussed. RESULTS We included 163 patients treated within a 5-year period with ≥1 year of follow-up available. The main pathologies were disc herniation (53.4%), foraminal stenosis (19%), and central canal stenosis (16.6%). The outcomes regarding disability and pain scores after surgery were very good, with a redistribution of the patient sample to the mild categories of disability. Inferential analysis showed relative and absolute improvements for both disc herniation and canal stenosis in terms of the Oswestry disability index and visual analog scale for pain, especially for disc herniation. The incidence of complications was approximately 7%. The most common approach was interlaminar (89%), and the most common pathology was disc herniation (54.9%). The duration of surgery overall and for the different stages had improved at the end of the learning curve with a reduction of almost 58 minutes. CONCLUSIONS Biportal endoscopy is a minimally invasive procedure that is safe and effective, with a low rate of complications. It has a reproducible learning curve and provides very good outcomes regarding functionality and pain scores.
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Affiliation(s)
- Elsa González Pérez
- Department of Neurosurgery, Policlínica Nuestra Señora del Rosario, Ibiza, Spain
| | | | | | - Dae-Jung Choi
- Department of Neurosurgery, Himnaera Hospital, Pusan, South Korea
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Udby PM, Vestergaard T, Ohrt-Nissen S, Carreon LY. The impact of Diabetes in patients with lumbar stenosis - A propensity-score matched study on patient-reported outcomes after surgery. Clin Neurol Neurosurg 2023; 235:108038. [PMID: 37949041 DOI: 10.1016/j.clineuro.2023.108038] [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: 09/04/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
STUDY DESIGN Registry-based cohort study. OBJECTIVE To evaluate the impact of Diabetes (DM) on Patient-reported Outcomes (PROs) after surgery for lumbar spinal stenosis (LSS). METHOD Patients from the Danish national spine registry, DaneSpine, scheduled for LSS surgery were identified. MRI of patients with and without DM was graded in regards to lumbar stenosis, disc degeneration (DD), muscular fat infiltration, and Modic changes. In addition, preoperative and two-year postoperative data were collected including PROs. Patients with DM were propensity-score matched (PSM) to non-DM patients. RESULTS In total, 296 patients were included, 41 DM and 255 non-DM. Of these, 27 patients from each group were successfully matched. The PSM DM group had less improvement and worse leg pain at two-year follow-up compared to the non-DM group, VAS 58 vs. 36 (p = 0.004). Physical disability was significantly worse at two-year follow-up in the DM group compared to the non-DM group, Oswestry Disability Index score of 38 vs. 29 (p = 0.05). On the preoperative MRI, the number of patients with severe grade LSS and severe fat infiltration in Multifidus muscles was significantly higher in the PSM DM group compared to the non-DM group, (p < 0.01). CONCLUSION Patients with concomitant LSS and DM have a significantly reduced improvement in leg pain, more physical disability, and worse leg pain scores at two-year follow-up post-surgery compared to patients without DM. In elderly patients with LSS, there should be an increased focus on DM and the clinically relevant threshold for spine surgery.
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Affiliation(s)
- Peter Muhareb Udby
- Department of Orthopedic Surgery, Spine Unit, Zealand University Hospital, Koege, Denmark; Department of Orthopedic Surgery, Spine Unit, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Thomas Vestergaard
- Department of Orthopedic Surgery, Spine Unit, Zealand University Hospital, Koege, Denmark
| | - Søren Ohrt-Nissen
- Department of Orthopedic Surgery, Spine Unit, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Leah Y Carreon
- Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
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Nakajima Y, Hachiya K, Michikawa T, Nagai S, Takeda H, Kawabata S, Yoshioka A, Kimata H, Ikeda D, Kaneko S, Ohno Y, Hachiya Y, Fujita N. Impact of surgical treatment on lipid metabolism in patients with lumbar spinal disorders: Prospective observational study. Eur Spine J 2023; 32:4153-4161. [PMID: 37837558 DOI: 10.1007/s00586-023-07976-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] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/02/2023] [Accepted: 09/26/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE It is still unclear how lumbar spinal surgery affects the lipid metabolism of patients with lumbar spinal disorders (LSDs) such as lumbar spinal canal stenosis and lumbar disk herniation. The present study aimed to assess the impact of lumbar spinal surgery on lipid metabolism in patients with LSDs and clarify the factors associated with changes in visceral fat (VF) accumulation before and after lumbar spinal surgery. METHODS Consecutive patients with lumbar spinal surgery for LSDs were prospectively included. Abdominal computed tomography images and blood examination of the participants were evaluated before surgery and at 6 months and 1 year after surgery. The cross-sectional VF area (VFA) was measured at the level of the navel using computed tomography images. Blood examination items included triglycerides and high-density lipoprotein (HDL). RESULTS The study enrolled a total of 138 patients. Female patients with LSDs had significantly increased VFA and serum triglyceride levels after lumbar spinal surgery. On multivariable analysis, the group with > 100 cm2 of preoperative VFA and a postoperative decrease in VFA had a significantly worse preoperative walking ability based on the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (relative risk 2.1; 95% confidence intervals 1.1-4.1). CONCLUSIONS The present study demonstrated that patients with LSDs did not necessarily improve their lipid metabolism after lumbar spinal surgery. Instead, female patients with LSDs had significantly deteriorated lipid metabolism after lumbar spinal surgery. Finally, a worse preoperative walking ability was associated with the improvement in excess VF accumulation after lumbar spinal surgery.
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Affiliation(s)
- Yukio Nakajima
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Kurenai Hachiya
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, 2-4, Nagoya, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Sota Nagai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroki Takeda
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Atsushi Yoshioka
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, 2-4, Nagoya, Japan
| | | | - Daiki Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Yoshiharu Ohno
- Department of Radiology, School of Medicine, Fujita Health University, Toyoake, Japan
- Joint Research Laboratory of Advanced Medical Imaging, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yudo Hachiya
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, 2-4, Nagoya, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.
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Corazzelli G, Capece M, Meglio V, Leonetti S, Pizzuti V, Ricciardi F, D'Elia A, Santilli M, Innocenzi G. Multiple univariate analysis of radiologic and clinical features on 168 patients with lumbar spinal stenosis: what is the role of the erector spinae in the development of a patient's disability? Acta Neurochir (Wien) 2023; 165:3947-3957. [PMID: 37932635 DOI: 10.1007/s00701-023-05863-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The weakening of paraspinal muscles in the paravertebral area may play a role in developing central lumbar spinal stenosis, resulting in lower back discomfort. OBJECTIVE The study thoroughly examined the correlation between the Oswestry Disability Index, Dural Sac cross-sectional area, Schizas grading Scale, Body Mass Index, and the cross-sectional areas of Erector Spinae, Multifidus, and Psoas muscles. The findings were also compared between patients with central Lumbar Spinal Stenosis and healthy individuals. STUDY DESIGN Retrospective monocentric observational study. METHODS The study recruited 168 consecutive patients aged 60 or older diagnosed with central Lumbar Spinal Stenosis between January 2020 and July 2022. The patients' condition was evaluated by administering a preoperative Oswestry Disability Index questionnaire, measuring their Body Mass Index, and performing preoperative Magnetic Resonance Imaging. The analyzed parameters were the cross-sectional area of paraspinal muscles at the L4-L5 level, dural sac cross-sectional area, and Schizas grading Scale at the most stenotic level, using multiple linear univariate analyses. Two groups of healthy individuals were recruited: Group A (under 60 years old) and Group B (over 60 years old). The same data extrapolated from these groups were compared with those of patients with central lumbar stenosis using a two-tailed Mann-Whitney test. RESULTS As the Erector Spinae degenerates, the Oswestry Disability Index tends to increase. Similarly, an increase in Body Mass Index is often accompanied by a decrease in the cross-sectional area of the Erector Spinae. Low dural sac cross-sectional area is statistically linked to a reduced Multifidus cross-sectional area. Interestingly, the Schizas grading scale does not appear to correlate with changes in the cross-sectional area of the paraspinal muscles. Additionally, there is no significant difference in the cross-sectional area of the Psoas muscle between individuals with central lumbar spinal stenosis and healthy individuals. CONCLUSIONS Our study found that degeneration of the Erector Spinae plays a crucial role in the progression of perceived disability in Lumbar Spinal Stenosis. Prospective studies should investigate the long-term evolution of paraspinal muscles in decompressed patients.
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Affiliation(s)
- Giuseppe Corazzelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy.
| | - Mara Capece
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Vincenzo Meglio
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | | | | | | | | | - Marco Santilli
- Department of Neurology, IRCCS Neuromed, (IS), Pozzilli, Italy
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Akar E, Öğrenci A, Koban O, Yilmaz M, Dalbayrak S. Three region spinal decompression in the same session: a case report. Br J Neurosurg 2023; 37:1898-1900. [PMID: 33629635 DOI: 10.1080/02688697.2021.1887449] [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: 03/22/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND IMPORTANCE Multiregional spinal stenosis [tandem spinal stenosis (TSS)] is not rare but operating on multiple regions at the same sitting is. Decompression of cervical and lumbar spine in the same session has a frequency of 5-25% all TSS cases, the most frequent one is TSS. Decompression in three different regions is so rare that there is only one case in the literature. We report the second. CLINICAL PRESENTATION A 72-year-old man with pain in legs and arms, neurogenic claudication, progressive loss of balance, radiculopathy and myelopathy in lower and upper extremities whose cervical-thoracic and lumbar spinal stenosis were treated with decompressive surgery in the same session. Total time of surgery for three regions was 330 min. No complications were observed. The patient was mobilized on day 1 postoperative and was discharged from the hospital on day 3. By month 3, motor function had improved almost completely, and pyramidal findings have decreased. CONCLUSION Multiregional spinal stenosis of three spinal regions at the same time is a rare case and these cases, surgery of three regions can be carried out in the same session respectively.
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Affiliation(s)
- Ezgi Akar
- Department of Neurosurgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Öğrenci
- Department of Neurosurgery, Okan University, Istanbul, Turkey
| | - Orkun Koban
- Department of Neurosurgery, Okan University, Istanbul, Turkey
| | - Mesut Yilmaz
- Department of Neurosurgery, Neurospinal Academia, Istanbul, Turkey
| | - Sedat Dalbayrak
- Department of Neurosurgery, Okan University, Istanbul, Turkey
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Marchi F, Kessler C, Distefano D, Terzi di Bergamo L, Fumagalli L, Averaimo M, Crupi E, Bergamini F, Melli G, Stussi G, Rossi D, Gobbi C, Ripellino P, Pravatà E, Kuhlen DE, Röcken C, Scarone P, Gerber B, Condoluci A. Prevalence of amyloid in ligamentum flavum of patients with lumbar spinal stenosis. Amyloid 2023; 30:416-423. [PMID: 37431662 DOI: 10.1080/13506129.2023.2230516] [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: 01/24/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Transthyretin (ATTR) amyloidosis is often diagnosed in an advanced stage, when irreversible cardiac damage has occurred. Lumbar spinal stenosis (LSS) may precede cardiac ATTR amyloidosis by many years, offering the opportunity to detect ATTR already at the time of LSS surgery. We prospectively assessed the prevalence of ATTR in the ligamentum flavum by tissue biopsy in patients aged >50 years undergoing surgery for LSS. METHODS Ligamentum flavum thickness was assessed pre-operatively on axial T2 magnetic resonance imaging (MRI) slices. Tissue samples from ligamentum flavum were screened centrally by Congo red staining and immunohistochemistry (IHC). RESULTS Amyloid in the ligamentum flavum was detected in 74/94 patients (78.7%). IHC revealed ATTR in 61 (64.9%), whereas amyloid subtyping was inconclusive in 13 (13.8%). Mean thickness of ligamentum flavum was significantly higher at all levels in patients with amyloid (p < .05). Patients with amyloid deposits were older (73.1 ± 9.2 vs. 64.6 ± 10.1 years, p = .01). No differences in sex, comorbidities, previous surgery for carpal tunnel syndrome or LSS were observed. CONCLUSIONS Amyloid, mostly of the ATTR subtype, was found in four out of five patients with LSS and is associated with age and ligamentum flavum thickness. Histopathological work-up of ligamentum flavum might inform future decision making.
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Affiliation(s)
- Francesco Marchi
- Neurosurgical Service, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Chiara Kessler
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Luca Fumagalli
- Neurosurgical Service, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Manuela Averaimo
- Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Emanuele Crupi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Fabio Bergamini
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Giorgia Melli
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Georg Stussi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Davide Rossi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Claudio Gobbi
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Paolo Ripellino
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Emanuele Pravatà
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Dominique E Kuhlen
- Neurosurgical Service, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Pietro Scarone
- Neurosurgical Service, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Adalgisa Condoluci
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
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Indrekvam K, Bånerud IF, Hermansen E, Austevoll IM, Rekeland F, Guddal MH, Solberg TK, Brox JI, Hellum C, Storheim K. The Norwegian degenerative spondylolisthesis and spinal stenosis (NORDSTEN) study: study overview, organization structure and study population. Eur Spine J 2023; 32:4162-4173. [PMID: 37395780 DOI: 10.1007/s00586-023-07827-w] [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: 01/11/2023] [Revised: 05/10/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To provide an overview of the The Norwegian Degenerative spondylolisthesis and spinal stenosis (NORDSTEN)-study and the organizational structure, and to evaluate the study population. METHODS The NORDSTEN is a multicentre study with 10 year follow-up, conducted at 18 public hospitals. NORDSTEN includes three studies: (1) The randomized spinal stenosis trial comparing the impact of three different decompression techniques; (2) the randomized degenerative spondylolisthesis trial investigating whether decompression surgery alone is as good as decompression with instrumented fusion; (3) the observational cohort tracking the natural course of LSS in patients without planned surgical treatment. A range of clinical and radiological data are collected at defined time points. To administer, guide, monitor and assist the surgical units and the researchers involved, the NORDSTEN national project organization was established. Corresponding clinical data from the Norwegian Registry for Spine Surgery (NORspine) were used to assess if the randomized NORDSTEN-population at baseline was representative for LSS patients treated in routine surgical practice. RESULTS A total of 988 LSS patients with or without spondylolistheses were included from 2014 to 2018. The clinical trials did not find any difference in the efficacy of the surgical methods evaluated. The NORDSTEN patients were similar to those being consecutively operated at the same hospitals and reported to the NORspine during the same time period. CONCLUSION The NORDSTEN study provides opportunity to investigate clinical course of LSS with or without surgical interventions. The NORDSTEN-study population were similar to LSS patients treated in routine surgical practice, supporting the external validity of previously published results. TRIAL REGISTRATION ClinicalTrials.gov; NCT02007083 10/12/2013, NCT02051374 31/01/2014 and NCT03562936 20/06/2018.
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Affiliation(s)
- Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Ingrid Fjeldheim Bånerud
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Erland Hermansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Maren Hjelle Guddal
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Tore K Solberg
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway
- Institute of Clinical Medicine, The Arctic University of Norway (UiT), Tromsø, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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Kim SY, Jang JN, Choi YS, Park S, Yi J, Song Y, Kim JW, Kang KN, Kim YU. The cervical ligamentum flavum area: A new sensitive morphological parameter for identifying the cervical spinal stenosis. Medicine (Baltimore) 2023; 102:e36259. [PMID: 38013374 PMCID: PMC10681602 DOI: 10.1097/md.0000000000036259] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
Thickening of the cervical ligamentum flavum (CLF) has been considered as a main cause of cervical spinal stenosis (CSS). A previous study reported that cervical ligamentum flavum thickness (CLFT) is correlated with CSS. However, the whole hypertrophy is different from focal thickness. Therefore, to analyze hypertrophy of the CLF, we created a new morphological parameter, called the cervical ligamentum flavum area (CLFA). We hypothesized that the CLFA is an important morphological parameter in the diagnosis of CSS. CLF samples were acquired from 83 patients with CSS, and from 84 controls who underwent cervical magnetic resonance imaging (C-MRI). T2-weighted axial C-MRI images were acquired. We measured the CLFA and CLFT at the C6-C7 intervertebral level on C-MRI using appropriate image analysis software. The CLFA was measured as the cross-sectional area of the entire CLF at the level of C6-C7 stenosis. The CLFT was measured by drawing a straight line along the ligament side towards the spinal canal at the C6-C7 level. Mean CLFA was 25.24 ± 6.43 mm2 in the control group and 45.34 ± 9.09 mm2 in the CSS group. The average CLFT was 1.48 ± 0.28 mm in the control group and 2.09 ± 0.35 mm in the CSS group. CSS patients had significantly higher CLFA (P < .01) and CLFT (P < .01). For the validity of both CLFA and CLFT as predictors of CSS, a receiver operating characteristic curve analysis revealed an optimal cutoff point for the CLFA was 31.66 mm2, a sensitivity of 92.8%, specificity of 88.4%, and an area under the curve of 0.97 (95% CI, 0.94-0.99). The optimal cut off-point of the CLFT was 1.79 mm, with a sensitivity of 83.5%, specificity of 84.5%, and an area under the curve of 0.92 (95% CI, 0.87-0.96). Both CLFT and CLFA were significantly related to CSS, but CLFA was the more sensitive measurement parameter. Therefore, to evaluate patients with CSS, treating physicians should test for CLFA.
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Affiliation(s)
- So Yeon Kim
- Department of Neurosurgery, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Yumin Song
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jae Won Kim
- Catholic Kwandong University of Korea College of Medicine, Gangneung, Republic of Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
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