scholarly journals 138 Gait Ignition Failure Syndrome Secondary to Spinal Stenosis

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 86-87
Author(s):  
Jasir T. Nayati ◽  
Angela Rekhi ◽  
Alan R. Hirsch
Keyword(s):  
Spinal Stenosis ◽  
Exercise Therapy ◽  
Compression Fracture ◽  
Leg Pain ◽  
Foraminal Stenosis ◽  
Lower Extremity Weakness ◽  
One Year ◽  
The Right ◽  
Lumbar Spinal ◽  
As If

AbstractCase ObjectiveGait ignition failure syndrome, where immobility occurs only upon initiation of ambulation and normal gait ensues once entrained, has been reported with frontal lobe and midbrain locomotor region pathology. However, gait ignition failure syndrome secondary to lumbosacral spinal stenosis has not heretofore been described.MethodsCase Study: A 65-year-old right-handed woman underwent a right frontal parasagittal arteriovenous malformation embolization 25 years prior to presentation. After a fall resulting in a T12 and L1 compression fracture, two kyphoplasties were performed. After the second kyphoplasty, one year prior to presentation, she developed new onset of gait ignition failure, left anterior thigh pain, lower back pain at L5 with radiation to both hips, and bilateral lower extremity weakness. The gait difficulty duration correlates to the duration she is in a seated position. Upon standing, she is unable to move her legs and exhibits basophobia, feeling she may fall due to weakness and she is unable to lift up her left foot to initiate gait, as if it is glued to the floor. She is able to initiate gait after one minute, but has an unsteady scissors-gait for the first few steps. Afterwards, her gaitreturns to baseline. Anteroflexion was noted to eliminate her back and leg pain.ResultsGait examination shows inability to initiate gait after standing, feeling as if frozen. However, she demonstrated scissors-gait after 30 seconds for 3-5 steps, which gradually improved to baseline. Her quadriceps femoris reflex was absent on the right, 3+ on the left. Her Achilles reflex was absent on left. MRI indicated spinal stenosis with broad based osteophytes at T9-T12 and bilateral neural foraminal stenosis at L1-S1. Exercise therapy designed for spinal stenosis was initiated, and resulted in elimination of gaitignition failure.ConclusionGait ignition failure syndrome may not be necessarily due to frontal or midbrain dysfunction, but can be secondary to lumbosacral impairment. In this patient, dysfunctional arachnoid villi in the lumbosacral nerve roots may have led to transient increases in pressure throughout the neural axis, including the brain, and associated NPH-like symptoms, such as magnetic gait. Seeing that posture affects epidural pressure in lumbar spinal stenosis, with a decrease pressure in response to anteroflexion and reduced pain [Takahashi 1995], one can postulate that this may be a mechanism affecting the patient. Furthermore, since her symptoms are episodic and directly associated with the duration of time she is seated, one may deduce gait ignition failure to be a manifestation of cerebrospinal fluid or intracranial pressure changes influenced by posture. In addition, symptom resolution via exercise therapy strongly suggests that gait apraxia can also be a manifestation of lumbosacral dysfunction. Therefore, those with gait ignitionfailure syndrome warrant evaluation for lumbosacral pathology.Funding AcknowledgementsSmell and Taste Treatment and Research Foundation.

Minimally Invasive versus Open Thoracolumbar Surgery for Lumbar Spinal Stenosis in Patients with Diabetes: A CSORN Study

2021 ◽  
pp. 13
Author(s):  
Kalpesh Hathi
Keyword(s):  
Back Pain ◽  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Research Network ◽  
Leg Pain ◽  
Number Of Patients ◽  
Patients With Diabetes ◽  
One Year ◽  
Lumbar Spinal

Introduction: This study was aimed at comparing outcomes of minimally invasive (MIS) versus OPEN surgery for lumbar spinal stenosis (LSS) in patients with diabetes. Methodology: This retrospective cohort study included patients with diabetes who underwent spinal decompression alone or with fusion for LSS within the Canadian Spine Outcomes and Research Network (CSORN) database. Outcomes of MIS and OPEN approaches were compared for two cohorts: (i) patients with diabetes who underwent decompression alone (N = 116; MIS, n = 58, OPEN, n = 58) and (ii) patients with diabetes who underwent decompression with fusion (N = 108; MIS, n = 54, OPEN, n = 54). Mixed measures analyses of covariance compared modified Oswestry Disability Index (mODI) and back and leg pain at one-year post operation. The number of patients meeting minimum clinically important difference (MCID) or minimum pain/disability at one year were compared. Result: MIS approaches had less blood loss (decompression alone difference 99.66 mL, p = 0.002; with fusion difference 244.23, p < 0.001) and shorter LOS (decompression alone difference 1.15 days, p = 0.008; with fusion difference 1.23 days, p = 0.026). MIS compared to OPEN decompression with fusion had less patients experience an adverse event (difference, 13 patients, p = 0.007). The MIS decompression with fusion group had lower one-year mODI (difference, 14.25, p < 0.001) and back pain (difference, 1.64, p = 0.002) compared to OPEN. More patients in the MIS decompression with fusion group exceeded MCID at one year for mODI (MIS 75.9% vs OPEN 53.7%, p = 0.028) and back pain (MIS 85.2% vs OPEN 70.4%, p = 0.017). Conclusion: MIS approaches were associated with more favorable outcomes for patients with diabetes undergoing decompression with fusion for LSS.

scholarly journals Effects of Transforaminal Balloon Treatment in Patients with Lumbar Foraminal Stenosis: A Randomized, Controlled, Double-Blind Trial

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. 213-224
Author(s):  
Jin-Woo Shin
Keyword(s):  
Pain Relief ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Balloon Catheter ◽  
Additional Treatment ◽  
Leg Pain ◽  
Control Group ◽  
Foraminal Stenosis ◽  
Lumbar Spinal

Background: Lumbar spinal stenosis is a common condition in the elderly. Although balloon treatment is a well-known therapeutic method in specific pain conditions, applying the balloon treatment in patients with lumbar spinal stenosis is not yet well established. Objectives: We tested the therapeutic effect of transforaminal balloon treatment with a Fogarty balloon catheter on body pain and functional performance in patients with severe lumbar spinal stenosis. Study Design: Prospective, randomized, double-blinded, active control trial. Setting: A tertiary, interventional pain management practice, specialty referral center. Methods: Sixty-two patients with refractory unilateral radiculopathy aggravated by walking were enrolled and randomly assigned to receive transforaminal steroid injection after transforaminal balloon treatment using a 3 Fr balloon catheter (n = 32) or the same procedure without balloon treatment (n = 30). The patients were prohibited from making any alterations to their medications during the 12 weeks of their follow-up period. After the first 12 weeks, the patients who had persistent symptoms or unbearable pain were allowed to increase the dose of analgesics or to receive additional interventional treatment. Outcome Assessment: Visual analogue scale (VAS) pain scores for the leg and lower back, Oswestry disability index (ODI), and claudication distance were measured at 2, 4, 8, and 12 weeks post procedure. During the 52 weeks of the overall follow-up period, the patients achieving ≥ 50% leg pain relief without additional treatment or increasing the dose of analgesics were evaluated. Results: Significant improvement occurred compared to baseline in VAS (P < 0.001), ODI (P < 0.001), and claudication distance (P < 0.001) in the balloon group during the overall follow-up period, whereas the improvement in ODI (P < 0.05) and claudication distance (P < 0.05) in the control group persisted for 8 weeks. The balloon group showed better improvement in leg VAS (P < 0.05), ODI (P < 0.05), and claudication distance (P < 0.05) than the control group at all post-procedure assessment points. Kaplan-Meier analysis of the duration of the patients achieving ≥ 50% leg pain relief without additional treatment or increasing the dose of analgesics showed a significant intergroup difference between the balloon and control (P = 0.003) groups. Six patients (18.8%) in balloon group maintained > 50% pain relief for 52 weeks whereas no patient (0%) did in control group. Limitations: Our study is an active-controlled randomized design with a relatively small number of patients. Conclusion: Transforaminal balloon treatment leads to both significant pain relief and functional improvement in a subset of patients with refractory spinal stenosis. Institutional Review: This study was approved by the Institutional Review Board of the Asan Medical Center. Key words: Neurogenic claudication, lumbar foraminal stenosis, transforaminal balloon treatment, Fogarty catheter

scholarly journals Improvement of Back and Leg Pain after Lumbar Spinal Decompression without Fusion

2018 ◽  
Vol 80 (02) ◽  
pp. 081-087
Author(s):  
Nicola Bongartz ◽  
Christian Blume ◽  
Hans Clusmann ◽  
Christian Müller ◽  
Matthias Geiger
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Leg Pain ◽  
Short Term ◽  
Clear Trend ◽  
Long Term Follow Up ◽  
Lumbar Spinal

Background To evaluate whether decompression in lumbar spinal stenosis without fusion leads to sufficient improvement of back pain and leg pain and whether re-decompression alone is sufficient for recurrent lumbar spinal stenosis for patients without signs of instability. Material and Methods A successive series of 102 patients with lumbar spinal stenosis (with and without previous lumbar surgery) were treated with decompression alone during a 3-year period. Data on pre- and postoperative back pain and leg pain (numerical rating scale [NRS] scale) were retrospectively collected from questionnaires with a return rate of 65% (n = 66). The complete cohort as well as patients with first-time surgery and re-decompression were analyzed separately. Patients were dichotomized to short-term follow-up (< 100 weeks) and long-term follow-up (> 100 weeks) postsurgery. Results Overall, both back pain (NRS 4.59 postoperative versus 7.89 preoperative; p < 0.0001) and leg pain (NRS 4.09 versus 6.75; p < 0.0001) improved postoperatively. The short-term follow-up subgroup (50%, n = 33) showed a significant reduction in back pain (NRS 4.0 versus 6.88; p < 0.0001) and leg pain (NRS 2.49 versus 6.91: p < 0.0001). Similar results could be observed for the long-term follow-up subgroup (50%, n = 33) with significantly less back pain (NRS 3.94 versus 7.0; p < 0.0001) and leg pain (visual analog scale 3.14 versus 5.39; p < 0.002) postoperatively. Patients with previous decompression surgery benefit significantly regarding back pain (NRS 4.82 versus 7.65; p < 0.0024), especially in the long-term follow-up subgroup (NRS 4.75 versus 7.67; p < 0.0148). There was also a clear trend in favor of leg pain in patients with previous surgery; however, it was not significant. Conclusions Decompression of lumbar spinal stenosis without fusion led to a significant and similar reduction of back pain and leg pain in a short-term and a long-term follow-up group. Patients without previous surgery benefited significantly better, whereas patients with previous decompression benefited regarding back pain, especially for long-term follow-up with a clear trend in favor of leg pain.

scholarly journals The Influence of Pain Sensitivity on the Symptom Severity in Patients with Lumbar Spinal Stenosis

2013 ◽  
Vol 2;16 (2;3) ◽  
pp. 135-144
Author(s):  
Jin S. JYeom
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Disc Degeneration ◽  
Lumbar Spinal Stenosis ◽  
Pain Sensitivity ◽  
Leg Pain ◽  
Canal Stenosis ◽  
Sf 36 ◽  
The Individual ◽  
Lumbar Spinal

Background: The symptom severity of back pain/leg pain is not correlated with the severity of degenerative changes and canal stenosis in lumbar stenosis. Considering the individual pain sensitivity might play an important role in pain perception, this discordance between the radiologic findings and clinical symptoms in degenerative lumbar stenosis might originate from the individual difference of pain sensitivity for back pain and/or leg pain. Objective: To determine the relationship among the clinical symptoms, radiologic findings, and the individual pain sensitivity in the patients with degenerative lumbar spinal stenosis. Study Design: Retrospective analysis of prospectively collected data. Setting: A spine center in the department of orthopedic surgery. Methods: In 94 patients who had chronic back pain and/or leg pain caused by degenerative lumbar spinal stenosis, a medical history, a physical examination, and completion of a series of questionnaires, including pain sensitivity questionnaire (PSQ) [total PSQ and PSQ-minor], Oswestry Disability Index (ODI), Visual Analog Pain Scale (VAS) for back pain, and Short Form36 (SF-36) were recorded on the first visit. Radiologic analysis was performed using the MRI findings. The grading of canal stenosis was based on the method by Schizas, and the degree of disc degeneration was graded from T2-weighted images with the Pfirrmann classification. The correlations among variables were statistically analyzed. Results: Total PSQ and PSQ-minor were not dependent on the grade of canal stenosis after gender adjustment. VAS for leg pain and back pain was highly associated with the total PSQ and the PSQ-minor. Total PSQ and PSQ-minor were also significantly associated with ODI. Among SF36 scales, the PSQ minor had significant correlations with SF-36 such as bodily pain (BP), Roleemotional (RE), and Mental Component Summary (MCS) after control of confounding variables such as body mass index (BMI), age, and the grade of canal stenosis/disc degeneration. Total PSQ was significantly associated with the SF-36 RP, BP, and RE. Furthermore, after adjustment for gender and pain sensitivity, there was no significant association between the grade of canal stenosis and VAS for back pain/leg pain and ODI, and no correlation was found between the grade of disc degeneration and VAS for back pain/leg pain and ODI, either. Limitations: The multiple lesions of canal stenosis and/or disc degeneration and the grade of facet degeneration were not considered as a variable. Conclusion: The current study suggests that the pain sensitivity could be a determining factor for symptom severity in the degenerative spinal disease. Key words: Pain sensitivity, pain sensitivity questionnaire, lumbar spinal stenosis, visual analog pain scale, Oswestry disability index, Short Form-36

scholarly journals Prevalence of Vitamin D Deficiency in Patients with Lumbar Spinal Stenosis and its Relationship with Pain

2013 ◽  
Vol 2;16 (2;3) ◽  
pp. 165-176
Author(s):  
Seong-Hwan Moon
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Back Pain ◽  
Vitamin D Deficiency ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Sunlight Exposure ◽  
Leg Pain ◽  
Mineral Density ◽  
Lumbar Spinal

Background: Patients with lumbar spinal stenosis (LSS) are at a great risk of a fall and fracture, which vitamin D protects against. Vitamin D deficiency is expected to be highly prevalent in LSS patient, and pain is thought to have a profound effect on vitamin D status by limiting activity and sunlight exposure. Objective: To identify the prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D [25-OHD] < 20ng/mL) and its relationship with pain. Study Design: Nonblinded, cross-sectional clinical study. Setting: University-based outpatient clinic of the Department of Orthopedic Surgery, Yonsei University College of Medicine, Korea. Methods: Consecutive patients who visited the orthopedic outpatient clinic for chronic low back pain and leg pain and were diagnosed as LSS between May 2012 and October 2012 were included. Pain was categorized into 4 groups based on location and severity: 1) mild to moderate back or leg pain; 2) severe back pain; 3) severe leg pain; and 4) severe back and leg pain. Covariates for vitamin D deficiency included age, sex, body mass index, level of education, medical history, season, region of residence, sunlight exposure score and functional disability. 25-OHD level was measured by radioimmunoassay, and bone metabolic status including bone mineral density and bone turnover markers was also measured. Multivariable logistic regression modeling was used to adjust all risk estimates for covariates. Results: The study had 350 patients enrolled. Mean serum 25-OHD level was 15.9 ± 7.1 ng/mL (range, 2.5 ~ 36.6). of the 350 patients, 260 patients out of 350 (74.3%) were vitamin D deficient. Univariate logistic regression analysis showed a significantly higher prevalence of vitamin D deficiency in the following patients: 1) medical comorbidity; 2) urban residence rather than rural; 3) lower score for sunlight exposure; and 4) severe leg pain, or severe back and leg pain rather than mild to moderate pain. Pain category was significantly associated with lower sunlight exposure; however, the association between pain category and vitamin D deficiency remained significant even after adjustment for the sunlight exposure. Furthermore, severe back pain, and severe back and leg pain were also associated with higher incidence of osteoporosis and higher level of bone resorption marker (serum CTx). Limitations: The limitation of our study is that due to its cross-sectional design, causal relationships between pain and vitamin D deficiency could not be established. Conclusion: Vitamin D deficiency was highly prevalent in LSS patients (74.3%), and severe pain was associated with higher prevalence of vitamin D deficiency and osteoporosis which could be potential risk factors or a fall and fracture. As evidenced by the present study, assessment of serum 25-OHD and bone mineral density are recommended in LSS patients with severe pain, and active treatment combining vitamin D, calcium, or bisphosphonate should be considered according to the status of the bone metabolism. Key words: Vitamin D, lumbar spinal stenosis, pain, bone mineral density

Inter-vertebral Height, Inter-vertebral Foramen Height and Range of Motion are Associated with Redundant Nerve Roots in Lumbar Spinal Stenosis

2020 ◽  
Author(s):  
Deng Bo ◽  
Fan Shao Hua ◽  
Feng Xin Bing ◽  
Zhenghua Hong
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Ligamentum Flavum ◽  
Leg Pain ◽  
Intervertebral Foramen ◽  
Vertebral Height ◽  
Nerve Roots ◽  
Vas Scores ◽  
Lumbar Spinal ◽  
Stenotic Segment

Abstract Background: To analyze the relational factors influencing the formation of cauda equina redundant nerve roots (RNRs) of the lumbar spinal stenosis.Methods: A retrospective study of 116 patients with lumbar spinal stenosis were treated in our department from January 2016 to June 2019. Magnetic resonance imaging (MRI) was performed to observe the shape and morphology of the redundant nerve roots of the cauda equina.We divided patient into (RNRs) group and non-RNRs( NRNRs) group based on the presence or absence of RNRs on sagittal T2-weighted MR. We analyzed the demographic characteristics, preoperative back pain visual analogue scale (VAS) scores ,preoperative leg pain VAS scores, and preoperative Oswestry disability index(ODI) scores, and also analyzed the rate of spondylolisthesis and ligamentum flavum hypertrophy. Simultaneously,the inter-vertebral height, intervertebral foramen height, inter-vertebral height +vertebral height, median sagittal diameter at the inter-vertebral space level(DIW-MSD),median sagittal diameter at the pedicel level(DV-MSD),ROM of the stenotic segment, were statistically analyzed for clinical and radiological significance.Results : Of a total 116 total patients,there were no statistically significant differences in either gender [RNRs group (n = 42, 18/24 female) and NRNR group (n = 74, 38/36 female)], age, BMI index, preoperative back pain VAS score , preoperative leg pain VAS score and preoperative ODI score(p> 0.05);however, there were statistically significant differences regard to the duration of symptoms and the rate of spondylolisthesis and ligamentum flavum hypertrophy (p<0.05);the inter-vertebral height,Intervertebral foramen height, inter-vertebral height+vertebral height, DIW-MSD ,ROM of the stenotic segment were also significantly different between the group (p<0.05).Conclusions:The inter-vertebral height, inter-vertebral foramen height, inter-vertebral height + vertebral height, DIW-MSD and ROM of the stenotic segment were the crucial factors related to RNRs in lumbar spinal stenosis.

scholarly journals Outcome of Surgical Treatment of Degenerative Lumbar Spinal Stenosis.

2016 ◽  
Vol 14 (1) ◽  
pp. 25-28
Author(s):  
Bishnu Babu Thapa ◽  
Sushil Rana Magar ◽  
Pankaj Chand ◽  
Bachhu Ram KC
Keyword(s):  
Conservative Treatment ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Leg Pain ◽  
Walking Distance ◽  
Neurogenic Claudication ◽  
Long Term Outcome ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Vas Score ◽  
Lumbar Spinal

Introduction: Spinal stenosis mostly occur in lumbar spine and causes back pain, leg pain & neurogenic claudication. Although conservative treatment is mainstay, decompression with or without fusion (with or without instrumentation) can be considered in non-responsive cases. However, long term outcome of the surgery is controversial. The aim of our study was to analyze the outcome of surgery in lumbar spinal stenosis in terms of post-operative pain and claudication distance.Methods: A prospective analysis of patients who underwent decompression or decompression with fusion (with or without instrumentation), after failure of 3-6 months conservative treatment, for lumbar spinal stenosis were conducted. Only those who were operated and followed up for at least two years were included.Their preop and postop VAS score and walking distance compared.Results: Of 22 cases enrolled in this study, VAS score was improved in 21 patients and walking distance increased. Only one patient complained of increase in pain score at 24 months.Conclusion: Operative management is a good option for selected patients, 21 out of 22 have improved VAS and claudication distance in our study

scholarly journals Histopathological Analysis of Ligamentum Flavum in Lumbar Spinal Stenosis and Disc Herniation

2017 ◽  
Vol 11 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Idiris Altun ◽  
Kasım Zafer Yüksel
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Disc Herniation ◽  
Ligamentum Flavum ◽  
Elastic Fiber ◽  
Leg Pain ◽  
Histopathological Analysis ◽  
Significant Difference ◽  
Fiber Number ◽  
Lumbar Spinal

<sec><title>Study Design</title><p>Histopathological analyses were performed in ligamentum flavum (LF) hypertrophy patients with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH).</p></sec><sec><title>Purpose</title><p>The aim of the present study was to evaluate histopathological changes in LF patients with LSS and LDH.</p></sec><sec><title>Overview of Literature</title><p>LSS is the most common spinal disorder in elderly patients. This condition causes lower back and leg pain and paresis, and occurs as a result of degenerative changes in the lumbar spine, including bulging of the intervertebral discs, bony proliferation of the facet joints, and LF thickening; among these, LF thickening is considered a major contributor to the development of LSS.</p></sec><sec><title>Methods</title><p>A total of 71 patients operated with the surgical indications of LSS and LDH were included. LF samples were obtained from 31 patients who underwent decompressive laminectomy for symptomatic degenerative LSS (stenotic group) and from 40 patients who underwent lumbar discectomy for LDH (discectomy group). LF materials were examined histopathologically, and other specimens were examined for collagen content, elastic fiber number and array, and presence of calcification.</p></sec><sec><title>Results</title><p>The stenotic and discectomy groups did not differ with regard to mean collagen concentration or mean elastic fiber number (p=0.430 and p=0.457, respectively). Mean elastic fiber alignment was 2.36±0.99 in the stenotic group and 1.38±0.54 in the discectomy group (<italic>p</italic>&lt;0.001). Mean calcification was 0.39±0.50 in the stenotic group, whereas calcification was not detected (0.00±0.00) in the discectomy group; a statistically significant difference was detected (<italic>p</italic>&lt;0.001) between groups.</p></sec><sec><title>Conclusions</title><p>LF hypertrophy in spinal stenosis may occur as a result of elastic fiber misalignment along with the development of calcification over time. Further studies determining the pathogenesis of LSS are needed.</p></sec>

scholarly journals Intraoperative Myelography in Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Preliminary Prospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Yang Yang ◽  
Liangming Zhang ◽  
Jianwen Dong ◽  
Zihao Chen ◽  
Peigen Xie ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lateral Lumbar Interbody Fusion ◽  
Radiological Parameters ◽  
One Year ◽  
Lumbar Spinal

Aim. To investigate the feasibility and effectiveness of intraoperative myelography in determining adequacy of indirect spinal canal decompression during transpsoas lateral lumbar interbody fusion (LLIF). Methods. Seven patients diagnosed with degenerative lumbar spinal stenosis (DLSS) were prospectively included to this study. All patients underwent LLIF and subsequently received intraoperative myelography to determine the effect of indirect spinal canal decompression, which was visualized in both anterior-posterior and lateral images. Those patients with insufficient indirect canal decompression were further resolved by microendoscopic canal decompression (MECD). Radiological parameters, including stenosis ratio and dural sac area of operated levels, were measured and compared before and after operation. Besides, all patients were followed up for at least one year using visual analogue scale (VAS) for back and leg, Japanese Orthopaedic Association score (JOA), and Oswestry disability index (ODI). Results. Seven patients with 8 operated levels underwent LLIF safely and demonstrated significant symptom relief postoperatively. Five operated levels showed adequate indirect canal decompression intraoperatively, while the remaining three levels did not achieve the adequacy, and their residual stenosis was resolved following MECD. Radiological parameters were improved statistically when compared with preoperation (P<0.05). Furthermore, neurological symptoms of all patients were also improved significantly (P<0.05), shown by improved VAS (back and leg), JOA, and ODI at both two-week and one-year follow-up. Conclusions. Intraoperative myelography during LLIF is able to assess adequacy of indirect canal decompression for DLSS, thus promising favorable clinical outcomes.

Sign in / Sign up

Export Citation Format

Share Document