Anatomical background of low back pain: variability and degeneration of the lumbar spinal canal and intervertebral disc

ABSTRACT Objective: To compare the morphological parameters of magnetic resonance in patients with congenital narrowing of the lumbar spinal canal with patients with low back pain. Methods: A descriptive, retrospective, observational study was conducted with measurements in the axial and sagittal magnetic resonance sections of the vertebral body and canal of the lumbar spine of 64 patients with diagnosis of low back pain, which were compared with resonance images taken from 31 Mexican patients with congenital narrowing of the lumbar spinal canal. Results: The results show that patients with congenital narrowing of the lumbar spinal canal in the axial sections have a difference in diameters, being L2<13.9 mm, L3<13.3 mm, L4<12.9 mm, L5<13.1 mm, compared with controls L2<20.5 mm, L3<20.5 mm, L4<19.3 mm, L5<18.1 mm with p = 0.000. Conclusions: We found different measurements in the Mexican population compared to those found by similar studies. With the parameters obtained, it would be possible to make the proper diagnosis, surgical planning, and treatment.

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Tubular surgery with the assistance of endoscopic surgery via a paramedian or midline approach for lumbar spinal canal stenosis at the L4/5 level

Journal of Orthopaedic Surgery ◽

10.1177/2309499018782546 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901878254 ◽

Cited By ~ 2

Author(s):

Jun Komatsu ◽

Tomoya Muta ◽

Nana Nagura ◽

Masumi Iwabuchi ◽

Hironari Fukuda ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Minimally Invasive ◽

Spinal Canal ◽

Spinal Canal Stenosis ◽

Low Back ◽

Lumbar Spinal Canal Stenosis ◽

Canal Stenosis ◽

Lumbar Spinal Canal ◽

Lumbar Spinal

Background: Lumbar spinal canal stenosis surgery has recently improved with the use of minimally invasive techniques. Less invasive procedures have emerged, and microendoscopic decompression through smaller incisions is frequently performed. Tubular surgery with the assistance of endoscopic surgery procedures has led to particularly remarkable changes in surgery, with reduced tissue trauma and morbidity. Purpose: The purpose of this study was to compare the clinical outcomes of two different minimally invasive decompressive surgical techniques (microendoscopic bilateral decompression surgery using the unilateral approach [microendoscopic laminectomy (MEL)] and microendoscopy-assisted muscle-preserving interlaminar decompression (MILD; ME-MILD)) using spinal endoscopy for lumbar spinal canal stenosis measured using a visual analog scale (VAS), the Japanese Orthopedic Association (JOA) score, and the JOA Back Pain Evaluation Questionnaire (JOABPEQ), which is based on a patient-oriented scoring system. Study design: This study was a retrospective review of prospectively collected surgical data. Methods: The study included 81 patients (MEL 39 patients, 20 men and 19 women, mean age 68.9 years; and ME-MILD 42 patients, 22 men and 20 women, mean age 73.1 years) with lumbar spinal stenosis (LSS). The indications for surgery were moderate-to-severe stenosis, persistent neurological symptoms, and failure of conservative treatment over 3 months, with a JOA score under 15 points or intermittent claudication at 100 m. This study included patients having LSS at a single vertebral level (L4/5). Results: Low back pain, buttock-leg pain, and numbness were significantly improved in terms of the VAS score from 3 months with both MEL and ME-MILD. In all periods, JOA scores over 3 years of follow-up were significantly higher than those obtained before surgery with both MEL and ME-MILD, and there were improvements of low back pain and walking function. Conclusions: These observations demonstrate that ME-MILD is a safe and very effective minimally invasive technique for degenerative LSS, similar to MEL.

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Lumbar Spinal Canal Size of Sciatica Patients

Acta Radiologica ◽

10.1177/028418518903000404 ◽

1989 ◽

Vol 30 (4) ◽

pp. 353-357 ◽

Cited By ~ 3

Author(s):

M. Hurme ◽

H. Alaranta ◽

T. Aalto ◽

L.-R. Knuts ◽

H. Vanharanta ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Spinal Canal ◽

Clinical Manifestations ◽

Disc Height ◽

Low Back ◽

Straight Leg Raising ◽

One Year ◽

Lumbar Spinal ◽

Pain Patients

Seven measures at the three lowest lumbar interspaces were recorded from conventional radiographs of the lumbar spines of 160 consecutive patients with low back pain and sciatica admitted for myelography and possible surgery. Eighty-eight patients were operated upon for disc herniation, and of the conservatively-treated 72 patients, 18 had a pathologic and 54 a normal myelogram. The results were evaluated after one year using the occupational handicap scales of WHO. Correlations of radiographic measures to stature were moderate and to age small. After adjusting for stature and age, only the male interpedicular distances and the antero-posterior diameter of intervertebral foramen at L3 were greater than those of females. The males with a pathologic myelogram had smaller posterior disc height at L3 and a smaller interarticular distance at L3 and L4 than those with normal myelogram, likewise the midsagittal diameter at L3 and L4 in females. In all patients other measures besides posterior disc height were smaller than those for low back pain patients (p<0.001) or for cadavers (p<0.001). The only correlation between measures and clinical manifestations was between pedicular length at L3 and limited straight leg raising. Where the disc material had been extruded into the spinal canal, the interpedicular distance was significantly wider. Only anterior disc height at L3 revealed differences between good and poor outcome one year after surgery, as did the interarticular distance at S1 in patients with normal myelogram after conservative treatment.

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A study of the effects of chiropractic therapy on the diameter of the spinal canal of patients with low back pain and radiculopathy

10.51415/10321/2847 ◽

1996 ◽

Author(s):

◽

Bradley Stuart Beira

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Intervertebral Disc ◽

Spinal Canal ◽

Low Back ◽

Lumbar Intervertebral Disc ◽

Chiropractic Therapy

Focus during this investigation was directed towards determining alterations in the size of the lumbar intervertebral disc in patients symptomatic with low back pain and sciatic distribution pain, in response to chiropractic management of this condition. The efficacy of chiropractic management for low back pain with associated radiculopathy has been examined. Flexion distraction technique and side posture rotatory adjustment technique of the lumbar spine have been used during this trial.

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Faculty Opinions recommendation of The anatomical basis for low back pain. Studies on the presence of sensory nerve endings in ligamentous, capsular and intervertebral disc structures in the human lumbar spine.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726427730.793519836 ◽

2016 ◽

Author(s):

Massimo Allegri

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Intervertebral Disc ◽

Sensory Nerve ◽

Nerve Endings ◽

Low Back ◽

Sensory Nerve Endings ◽

Anatomical Basis ◽

Human Lumbar Spine

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Intervertebral disc therapies for non-specific chronic low back pain: a systematic review and meta-analysis

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x211028001 ◽

2021 ◽

Vol 13 ◽

pp. 1759720X2110280

Author(s):

Camille Daste ◽

Stéphanie Laclau ◽

Margaux Boisson ◽

François Segretin ◽

Antoine Feydy ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Activity Limitations ◽

Low Back ◽

Short Term

Objectives: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). Methods: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week–3 months), intermediate term (3–6 months) and long term (after 6 months). Results: Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept ( n = 2), tocilizumab ( n = 1), methylene blue ( n = 2), ozone ( n = 2), chymopapaine ( n = 1), glycerol ( n = 1), stem cells ( n = 1), platelet-rich plasma ( n = 1) and recombinant human growth and differentiation factor-5 ( n = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were −1.33 (−2.34; −0.32) and −0.76 (−1.85; 0.34) at short term, −2.22 (−5.34; 0.90) and −1.60 (−3.51; 0.32) at intermediate term and −1.11 (−2.91; 0.70) and −0.63 (−1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91). Conclusion: GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies. Registration PROSPERO: CRD42019106336.

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Microendoscopic Decompression for Lumbar Spinal Stenosis Associated with Adjacent Segment Disease following Lumbar Fusion Surgery: 5-year Follow-up of a Retrospective Case Series

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1739206 ◽

2021 ◽

Author(s):

Shizumasa Murata ◽

Akihito Minamide ◽

Yukihiro Nakagawa ◽

Hiroshi Iwasaki ◽

Hiroshi Taneichi ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Japanese Orthopaedic Association ◽

Leg Pain ◽

Adjacent Segment ◽

Low Back ◽

Spinal Decompression ◽

Analog Scale ◽

Clinically Important Difference ◽

Lumbar Spinal

Abstract Background and Study Aims Surgical treatment options for lumbar spinal stenosis (LSS) based on adjacent segment disease (ASD) after spinal fusion typically involve decompression, with or without fusion, of the adjacent segment. The clinical benefits of microendoscopic decompression for LSS based on ASD have not yet been fully elucidated. We aimed to investigate the clinical results of microendoscopic spinal decompression surgery for LSS based on ASD. Patients and Methods From 2011 to 2014, consecutive patients who underwent microendoscopic spinal decompression without fusion for LSS based on ASD were enrolled. Data of 32 patients (17 men and 15 women, with a mean age of 70.5 years) were reviewed. Japanese Orthopaedic Association score and low back pain/leg pain visual analog scale score were utilized to measure neurologic and axial pain outcomes, respectively. Additionally, after the surgeries, we analyzed the magnetic resonance imaging (MRI), computed tomography (CT) scans, or radiographs to identify any new instabilities of the decompressed segments or progression of ASD adjacent to the decompressed segments. Results The Japanese Orthopaedic Association recovery rate at the 5-year postoperative visit was 49.2%. The visual analog scale scores for low back pain and leg pain were significantly improved. The minimum clinically important difference for leg pain (decrease by ≥24 mm) and clinically important difference for low back pain (decrease by ≥38 mm) were achieved in 84% (27/32) and 72% (23/32) of cases, respectively. Regarding new instability after microendoscopic decompression, no cases had apparent spinal instability at the decompression segment and adjacent segment to the decompressed segment. Conclusions Microendoscopic spinal decompression is an effective treatment alternative for patients with LSS caused by ASD. The ability to perform neural decompression while maintaining key stabilizing structures minimizes subsequent clinical instability. The substantial clinical and economic benefits of this approach may make it a favorable alternative to performing concurrent fusion in many patients.

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