Changes in dural sac caliber with standing MRI improve correlation with symptoms of lumbar spinal stenosis

2017 ◽  
Vol 26 (10) ◽  
pp. 2666-2675 ◽  
Author(s):  
Yvonne Yan On Lau ◽  
Ryan Ka Lok Lee ◽  
James Francis Griffith ◽  
Carol Lai Yee Chan ◽  
Sheung Wai Law ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Dural Sac ◽  
Lumbar Spinal ◽  
Improve Correlation

scholarly journals Erratum to: Changes in dural sac caliber with standing MRI improve correlation with symptoms of lumbar spinal stenosis

2017 ◽  
Vol 26 (10) ◽  
pp. 2676-2677
Author(s):  
Yvonne Yan On Lau ◽  
Ryan Ka Lok Lee ◽  
James Francis Griffith ◽  
Carol Lai Yee Chan ◽  
Sheung Wai Law ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Dural Sac ◽  
Lumbar Spinal ◽  
Improve Correlation

scholarly journals Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal stenosis: radiological results from a randomized controlled trial in the NORDSTEN study

2020 ◽  
Vol 29 (9) ◽  
pp. 2254-2261
Author(s):  
Erland Hermansen ◽  
Ivar Magne Austevoll ◽  
Christian Hellum ◽  
Kjersti Storheim ◽  
Tor Åge Myklebust ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Controlled Trial ◽  
Spinous Process ◽  
Surgical Techniques ◽  
Posterior Decompression ◽  
Clinical Trial Registration ◽  
Dural Sac ◽  
Radiological Results ◽  
Lumbar Spinal

Abstract Purpose To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Summary of background data Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. Methods The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. Results No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm2 in the UL-group, 71.9 (SD 37.1) mm2 in the BL-group and 68.1 (SD 41.0) mm2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. Conclusion For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area. Clinical trial registration The study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083.

scholarly journals Comparative Study Between Uniportal Full-Endoscopic Interlaminar and Tubular Approach in the Treatment of Lumbar Spinal Stenosis: A Pilot Study

2020 ◽  
Vol 10 (2_suppl) ◽  
pp. 70S-78S
Author(s):  
Angela Carrascosa-Granada ◽  
Willian Velazquez ◽  
Ralf Wagner ◽  
Anwar Saab Mazzei ◽  
Andrés Vargas-Jimenez ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Endoscopic Approach ◽  
Endoscopic Technique ◽  
Dural Sac ◽  
Lumbar Spinal ◽  
Endoscopic Group

Study Design: Multicenter, prospective, randomized, and double-blinded study. Objectives: To compare tubular and endoscopic interlaminar approach. Methods: Patients with lumbar spinal stenosis and neurogenic claudication of were randomized to tubular or endoscopic technique. Enrollment period was 12 months. Clinical follow up at 1, 3, 6 months after surgery with visual analogue scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) score. Radiologic evaluation with magnetic resonance pre- and postsurgery. Results: Twenty patients were enrolled: 10 in tubular approach (12 levels) and 10 in endoscopic approach (11 levels). The percentage of enlargement of the spinal canal was higher in endoscopic approach (202%) compared with tubular approach (189%) but was not statistically significant ( P = .777). The enlargement of the dural sac was higher in endoscopic group (209%) compared with tubular group (203%) but no difference was found between the 2 groups ( P = .628). A modest significant correlation was found between the percentage of spinal canal decompression and enlargement of the dural sac ( r = 0.5, P = .023). Both groups reported a significant clinical improvement postsurgery. However, no significant association was found between the percentage of enlargement of the spinal canal or the dural sac and clinical improvement as determined by scales scores. Endoscopic group had lower intrasurgical bleeding ( P < .001) and lower disability at 6 months of follow-up than tubular group (p=0.037). Conclusions: In the treatment of lumbar spinal stenosis, endoscopic technique allows similar decompression of the spinal canal and the dural sac, lower intrasurgical bleeding, similar symptoms improvement, and lower disability at 6 months of follow-up, as compared with the tubular technique.

scholarly journals Degenerative central lumbar spinal stenosis: Is endoscopic decompression through bilateral transforaminal approach sufficient?

2020 ◽  
Author(s):  
Bin Zhang ◽  
Qingquan Kong ◽  
Yuqing Yan ◽  
Pin Feng
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Operation Time ◽  
Decompression Surgery ◽  
Cross Sectional ◽  
Endoscopic Decompression ◽  
Dural Sac ◽  
Transforaminal Approach ◽  
The Mean ◽  
Lumbar Spinal

Abstract Background: At present, few percutaneous endoscopic transforaminal decompression surgery has been reported to solve central lumbar spinal stenosis (CLSS). Whether endoscopic decompression through lateral transforaminal approach decompression is sufficient for degenerative CLSS.Methods: This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through a bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively.Results：All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 minutes. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P=0.00), 2.47 (P=0.71), and 19.40 % (P=0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dura tear and 3 cases of transient postoperative dysthesia. The cross sectional area of the dural sac was significantly enlargement at the last fellow up (74.28±13.08 mm2 vs.104.91±12.40 mm2, P=0.00).Conclusions: Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.

Evaluation of postoperative spinal epidural hematoma after microendoscopic posterior decompression for lumbar spinal stenosis: a clinical and magnetic resonance imaging study

2006 ◽  
Vol 5 (5) ◽  
pp. 404-409 ◽  
Author(s):  
Ko Ikuta ◽  
Osamu Tono ◽  
Takayuki Tanaka ◽  
Junichi Arima ◽  
Soichiro Nakano ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Epidural Hematoma ◽  
Posterior Decompression ◽  
Dural Sac ◽  
Group 2 ◽  
Lumbar Spinal ◽  
Spinal Epidural ◽  
Group 1

Object The incidence of postoperative spinal epidural hematoma (SEH) is low, and to the best of the authors’ knowledge, no researchers have evaluated its actual incidence and clinical features. The purpose of this study was to investigate the clinical consequences of SEH after microendoscopic posterior decompression (MEPD) in patients with lumbar spinal stenosis. Methods Data obtained in 30 patients undergoing MEPD for lumbar spinal stenosis were reviewed. At 1 week after surgery, magnetic resonance (MR) imaging documented SEHs in 10 patients (33% [Group 1]) and no evidence of SEHs in 20 patients (67% [Group 2]). The authors compared MR imaging findings, postoperative morbidities, and clinical outcomes between the groups. Three Group 1 patients had symptomatic SEHs. All symptoms were mild without associated neurological deterioration and spontaneously subsided within 3 weeks of surgery. Magnetic resonance imaging demonstrated spontaneous regression of the SEH in all patients at 3 months after surgery. In Group 1 patients, however, the authors observed less expansion of the dural sac after 1 year despite sufficient widening of the osseous spinal canal. Low-back pain within 1 week of surgery was moderate in Group 1 and mild in Group 2. Improvements at the final follow up were greater in Group 2 patients. Conclusions The incidence of postoperative SEHs may be greater than reported. Postoperative SEHs caused poor expansion of the dural sac despite its spontaneous regression. In addition, postoperative SEHs caused a delay in the patient’s recovery and led to a poor clinical improvement. The prevention of postoperative SEHs might be required to prevent not only neurological deterioration but also a delay in the patient’s recovery.

scholarly journals Topping Phenomenon with Recurrent Spinal Stenosis and Epidural Fibrosis Prevented with Oxidized Cellulose – a Case Report

2018 ◽  
Vol 61 (2) ◽  
pp. 69-73 ◽  
Author(s):  
Radek Hart
Keyword(s):  
Case Report ◽  
Lumbar Spine ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Oxidized Cellulose ◽  
Epidural Fibrosis ◽  
Nerve Roots ◽  
Failed Back Syndrome ◽  
Dural Sac ◽  
Lumbar Spinal

Lumbar spinal stenosis is a condition where the neural structures are compressed in the narrowed spinal canal and often situated only within a single specific segment of the spine, most frequently in the lumbar spine. A case report demonstrates a surgical solution of lumbar spinal stenosis with using oxidized cellulose as a prevention of post-operative adhesions and failed back syndrome. A female patient (68) with a significant pain of the lumbar spine lasting for a number of months due to advanced spondylosis, failing to respond to conservative treatment underwent instrumented, posterolateral fusion of affected segments. The patient re-arrived with pain due to spinal stenosis in another segments after 4 and then after 3 years. We repeatedly performed spinal fusion of the affected segments and applied an antiadhesive gel to the dural sac and the decompressed nerve roots to prevent the development of post-operative adhesions and the “failed back syndrome”. Last surgical solution included mobilisation of the simultaneously constricted dural sac through laminectomy. This time we covered the sac using a haemostat made of oxidized cellulose (Traumacel FAM). After this treatment, the patient was again without significant difficulties.

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