Poster 155 Characteristics of Persons With Clinical Lumbar Stenosis in Comparison With Age-Matched Back Pain and Asymptomatic Volunteers

Using glycosaminoglycan Chemical Exchange Saturation Transfer (gagCEST) magnetic resonance imaging (MRI), this study comparatively evaluated the GAG contents of lumbar intervertebral disks (IVDs) of patients with non-specific low back pain (nsLBP), radiculopathy, and asymptomatic volunteers to elucidate the association of clinical manifestation and compositional correlate. A total of 18 patients (mean age 57.5 ± 22.5 years) with radiculopathy, 16 age-matched patients with chronic nsLBP and 20 age-matched volunteers underwent standard morphologic and compositional gagCEST MRI on a 3T scanner. In all cohorts, GAG contents of lumbar IVDs were determined using gagCEST MRI. An assessment of morphologic IVD degeneration based on the Pfirrmann classification and T2-weighted sequences served as a reference. A linear mixed model adjusted for multiple confounders was used for statistical evaluation. IVDs of patients with nsLBP showed lower gagCEST values than those of volunteers (nsLBP: 1.3% [99% confidence intervals (CI): 1.0; 1.6] vs. volunteers: 1.9% [99% CI: 1.6; 2.2]). Yet, IVDs of patients with radiculopathy (1.8% [99% CI: 1.4; 2.1]) were not different from patients with nsLBP or volunteers. In patients with radiculopathy, IVDs directly adjacent to IVD extrusions demonstrated lower gagCEST values than distant IVDs (adjacent: 0.9% [99% CI: 0.3; 1.5], distant: 2.1% [99% CI: 1.7; 2.5]). Advanced GAG depletion in nsLBP and directly adjacent to IVD extrusions in radiculopathy indicates close interrelatedness of clinical pathology and compositional degeneration.

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Incidence of Iatrogenic Lumbar Spinal Instability after Laminectomy, Discectomy or Facetectomy

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6256 ◽

2021 ◽

Vol 9 (B) ◽

pp. 588-592

Author(s):

Ahmed A. Hafez ◽

Ahmed Hamdy Ashry ◽

Ahmed Elsayed ◽

Amr El Tayeb ◽

Mohamed Badran Abdel Salam ElShenawy

Keyword(s):

Back Pain ◽

Lumbar Spine ◽

Prospective Study ◽

Lumbar Spine Surgery ◽

Spinal Instability ◽

Lumbar Stenosis ◽

University Hospitals ◽

Lumbar Spinal ◽

A Prospective Study ◽

Postoperative Instability

OBJECTIVE: This thesis aim to report the incidence of iatrogenic spinal instability that occurs after laminectomy, discectomy or facetectomy in Lumbar spine surgery. METHODS: This is a prospective study of 50 cases of degenerative lumbar spondylosis complaining of various symptoms of claudication, sciatica and back pain which were surgically managed by laminectomy according to the level of stenosis in the period between October 2018 and October 2020 in the neurosurgery department at Cairo university hospitals. Mesial facetectomy was added according to the degree of stenosis if needed. Some patients needed discectomy if sciatica was an eminent symptom. RESULTS: Out of 50 patients included: 9 patients (18%) developed postoperative instability. The number of levels operated on and the degree of mesial facetectomy were found to be variables that may affect postoperative stability. CONCLUSION: Iatrogenic instability may result from large laminectomy and extensive facetectomy for lumbar stenosis in patients who do not have obvious pre-existing instability. Key words: Iatrogenic spinal instability - Laminectomy - conventional open discectomy - Mesial facetectomy.

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Clinical principles for the diagnosis and treatment of musculoskeletal (non-specific) lower back pain

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2021-3-107-112 ◽

2021 ◽

Vol 13 (3) ◽

pp. 107-112

Author(s):

V. A. Golovacheva ◽

A. A. Golovacheva ◽

T. G. Fateyeva

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Combination Therapy ◽

Interdisciplinary Approach ◽

Interventional Treatment ◽

Low Back ◽

Lumbar Stenosis ◽

Red Flags ◽

Lower Back ◽

Symptoms And Signs

Low back pain (LBP) is one of the most common reasons for a neurologist visit. In 90–95% of cases, LBP is nonspecific (musculoskeletal). The diagnosis of nonspecific LBP based on symptoms, somatic and neurological examination data, the absence of «red flags» (symptoms and signs characteristic of specific causes of back pain, discogenic radiculopathy, or lumbar stenosis). We review the modern principles of acute, subacute, and chronic nonspecific LBP treatment. We also discuss interventional and non-interventional treatment approaches, emphasizing the importance of combination therapy and an interdisciplinary approach.

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Endoscopic decompression for the treatment of lumbar spinal stenosis: an updated systematic review and meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2021.8.spine21890 ◽

2021 ◽

pp. 1-9

Author(s):

Roberto J. Perez-Roman ◽

Wendy Gaztanaga ◽

Victor M. Lu ◽

Michael Y. Wang

Keyword(s):

Systematic Review ◽

Back Pain ◽

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Meta Analysis ◽

Lumbar Stenosis ◽

Lumbar Spinal ◽

Endoscopic Methods

OBJECTIVE Lumbar stenosis treatment has evolved with the introduction of minimally invasive surgery (MIS) techniques. Endoscopic methods take the concepts applied to MIS a step further, with multiple studies showing that endoscopic techniques have outcomes that are similar to those of more traditional approaches. The aim of this study was to perform an updated meta-analysis and systematic review of studies comparing the outcomes between endoscopic (uni- and biportal) and microscopic techniques for the treatment of lumbar stenosis. METHODS Following PRISMA guidelines, a systematic search was performed using the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Ovid Embase, and PubMed databases from their dates of inception to December 14, 2020. All identified articles were then systematically screened against the following inclusion criteria: 1) studies comparing endoscopic (either uniportal or biportal) with minimally invasive approaches, 2) patient age ≥ 18 years, and 3) diagnosis of lumbar spinal stenosis. Bias was assessed using quality assessment criteria and funnel plots. Meta-analysis using a random-effects model was used to synthesize the metadata. RESULTS From a total of 470 studies, 14 underwent full-text assessment. Of these 14 studies, 13 comparative studies were included for quantitative analysis, totaling 1406 procedures satisfying all criteria for selection. Regarding postoperative back pain, 9 studies showed that endoscopic methods resulted in significantly lower pain scores compared with MIS (mean difference [MD] −1.0, 95% CI −1.6 to −0.4, p < 0.01). The length of stay data were reported by 7 studies, with endoscopic methods associated with a significantly shorter length of stay versus the MIS technique (MD −2.1 days, 95% CI −2.7 to −1.4, p < 0.01). There was no significant difference with respect to leg visual analog scale scores, Oswestry Disability Index scores, blood loss, surgical time, and complications, and there were not any significant quality or bias concerns. CONCLUSIONS Both endoscopic and MIS techniques are safe and effective methods for treating patients with symptomatic lumbar stenosis. Patients who undergo endoscopic surgery seem to report less postoperative low-back pain and significantly reduced hospital stay with a trend toward less perioperative blood loss. Future large prospective randomized trials are needed to confirm the findings in this study.

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Electromyographic and Magnetic Resonance Imaging to Predict Lumbar Stenosis, Low-Back Pain, and No Back Symptoms

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200702000-00018 ◽

2007 ◽

Vol 89 (2) ◽

pp. 358-366 ◽

Cited By ~ 4

Author(s):

Andrew J. Haig ◽

Michael E. Geisser ◽

Henry C. Tong ◽

Karen S.J. Yamakawa ◽

Douglas J. Quint ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Low Back Pain ◽

Back Pain ◽

Magnetic Resonance ◽

Low Back ◽

Lumbar Stenosis ◽

Resonance Imaging

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Man-in-the-barrel syndrome after thoracoilium fusion

Journal of Neurosurgery Spine ◽

10.3171/spi.2008.8.08485 ◽

2008 ◽

Vol 9 (6) ◽

pp. 566-569 ◽

Cited By ~ 1

Author(s):

Andrei F. Joaquim ◽

Catherine C. Shaffrey ◽

Charles A. Sansur ◽

Christopher I. Shaffrey

Keyword(s):

Back Pain ◽

Cerebral Ischemia ◽

Early Postoperative Period ◽

Sagittal Imbalance ◽

Lumbar Stenosis ◽

Degenerative Scoliosis ◽

Neurological Finding ◽

Brachial Diplegia ◽

Junctional Kyphosis ◽

Difficulty Walking

The authors report a case of man-in-the-barrel (MIB) syndrome occurring after an extensive revision involving thoracoilium instrumentation and fusion for iatrogenic and degenerative scoliosis, progressive kyphosis, and sagittal imbalance. Isolated brachial diplegia is a rare neurological finding often attributed to cerebral ischemia. It has not been previously reported in patients undergoing complex spine surgery. This 70-year-old woman, who had previously undergone T11–S1 fusion for lumbar stenosis and scoliosis, presented with increased difficulty walking and with back pain. She had junctional kyphosis and L5–S1 pseudarthrosis and required revision fusion extending from T-3 to the ilium. In the early postoperative period, she experienced a 30-minute episode of substantial hypotension. She developed delirium and isolated brachial diplegia, consistent with MIB syndrome. Multiple studies were performed to assess the origin of this brachial diplegia. There was no definitive radiological evidence of any causative lesion. After a few days, her cognitive function returned to normal and she regained the ability to move her arms. After several weeks of rehabilitation, she recovered completely. Man-in-the-barrel syndrome is a rare neurological entity. It can result from various mechanisms but most commonly seems to be related to ischemia and is potentially reversible.

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Surgical Approaches for Degenerative Lumbar Stenosis

10.1093/med/9780199350940.003.0018 ◽

2018 ◽

Author(s):

Doniel Drazin ◽

Carlito Lagman ◽

Christine Piper ◽

Ari Kappel ◽

Terrence T. Kim

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Diagnostic Imaging ◽

Surgical Management ◽

Surgical Approaches ◽

Low Back ◽

Lumbar Stenosis ◽

Instrumented Fusion ◽

Common Causes ◽

Ancillary Studies

This chapter discusses the evaluation of patients presenting with low back pain and the surgical management of three common causes of low back pain in adults: stenosis, spondylolisthesis, and scoliosis. Components of the history and physical examination, diagnostic imaging, and ancillary studies are reviewed. Surgical management includes decompression including laminectomy or laminotomy, and instrumented fusion. Indications, contraindications, general procedural steps, and potential complications are covered. Recent published literature is reviewed when appropriate.

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