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

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.

scholarly journals Εμβιομηχανική ανάλυση βάδισης σε ασθενείς με χρόνια οσφυαλγία πριν και μετά την εφαρμογή ειδικών φυσιοθεραπευτικών τεχνικών

2015 ◽  
Author(s):  
Γεώργιος Κρεκούκιας
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Visual Analog Scale ◽  
Oswestry Disability Index ◽  
Degenerative Disease ◽  
Leg Pain ◽  
Low Back ◽  
Greek Version ◽  
Analog Scale ◽  
Disability Questionnaire

Εισαγωγή: οι ασθενείς που πάσχουν από χρόνια οσφυαλγία ως συνέπεια της νόσου του εκφυλισμένου δίσκου, εκτός από πόνο εμφανίζουν επίσης και διαταραχή της βάδισής τους. Ο σκοπός της μελέτης είναι η αξιολόγηση τόσο των κλινικών δεδομένων με την χρήση κλινικών κλιμάκων αξιολόγησης, όπως Oswestry Disability Index Greek version (ODI), Visual Analog Scale for low back pain and leg pain (VAS) και το Roland Morris Disability Questionnaire Greek Version, όσο και των κινητικών και κινηματικών χαρακτηριστικών κατά την ανάλυση βάδισης σε ασθενείς με χρόνια οσφυαλγία συνεπεία της νόσου του εκφυλισμένου δίσκου (Disc Degenerative Disease), πριν και μετά την εφαρμογή των ειδικών φυσιοθεραπευτικών τεχνικών (τεχνικών θεραπείας δια χειρός).Μεθοδολογία: για τις ανάγκες της μελέτης 75 ασθενείς που έπασχαν από χρόνια οσφυαλγία, χωρίστηκαν τυχαία σε 3 ομάδες των 25 η καθεμιά. Η κάθε ομάδα δέχθηκε 5 συνεδρίες που για την πρώτη ομάδα ήταν φυσικοθεραπευτικές τεχνικές δια χειρός, για τη δεύτερη ήταν εικονική θεραπεία και για την τρίτη ήταν κλασική φυσικοθεραπεία (διατατικές ασκήσεις, T.E.N.S. και μάλαξη). Προκειμένου να αξιολογηθεί η αποτελεσματικότητα της κάθε θεραπείας χρησιμοποιήθηκε η οπτική αναλογική κλίμακα του πόνου, 2 ερωτηματολόγια (Oswestry και Roland Morris) και επίσης ένα οπτικοηλεκτρονικό σύστημα καταγραφής και ανάλυσης της βάδισης (κινητικά και κινηματικά δεδομένα)Αποτελέσματα: η ομάδα που δέχθηκε τεχνικές δια χειρός εμφάνισε στατιστικά σημαντική μείωση του πόνου και των επιπέδων δυσλειτουργίας. Σε παρόμοια αποτελέσματα οδήγησε και η εφαρμογή κλασικής φυσικοθεραπείας, αλλά η ελάττωση ήταν σαφώς μικρότερη σε σχέση με την ομάδα των τεχνικών δια χειρός. Η ομάδα που δέχθηκε εικονική θεραπεία, δεν είχε κάποια στατιστικά σημαντική διαφορά στα επίπεδα πόνου και δυσλειτουργίας. Σχετικά με την αξιολόγηση της βάδισης, οι ασθενείς στο σύνολό τους, παρουσίασαν διαταραγμένη βάδιση με διαφορά στα κινητικά και κινηματικά δεδομένα μεταξύ δεξιάς και αριστερής πλευράς. Μετά την εφαρμογή των θεραπειών, μόνο η ομάδα που δέχθηκε τεχνικές δια χειρός έδειξε τάση προς συμμετρία μεταξύ δεξιάς και αριστερής πλευράς.Συμπεράσματα: σε περιπτώσεις ασθενών που πάσχουν από χρόνια οσφυαλγία συνεπεία της νόσου του εκφυλισμένου δίσκου, η εφαρμογή 5 συνεδριών τεχνικών δια χειρός δείχνει να βελτιώνει τόσο τα επίπεδα πόνου όσο και δυσλειτουργίας, καθώς επίσης και παρουσιάζει τάση προς συμμετρία στη βάδιση.

scholarly journals Nonsurgical Korean Integrative Treatments for Symptomatic Lumbar Spinal Stenosis: A Three-Armed Randomized Controlled Pilot Trial Protocol

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Kiok Kim ◽  
Kyung-Min Shin ◽  
Jun-Hwan Lee ◽  
Bok-Nam Seo ◽  
So-Young Jung ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Treatment Program ◽  
Leg Pain ◽  
Low Back ◽  
Randomized Controlled ◽  
Medicinal Treatment ◽  
Lumbar Spinal

This is a study protocol for a pilot three-armed randomized controlled trial on nonsurgical integrative Korean medicinal treatment for symptomatic lumbar spinal stenosis (LSS). Thirty-six participants who have been diagnosed with (LSS) and recommended for spinal surgery by neurosurgeons or orthopedics and have had spinal symptoms such as severe low back pain and neurological claudication regardless of at least three months of conservative treatments will be recruited. Participants will be randomly assigned to be one of the three intervention groups, including the Mokhuri treatment program group 1 or 2 or usual care group. All treatments will be administered in inpatient units over a period of 4 weeks. The primary outcomes are 0 to 100 Visual Analogue Scales for low back pain and leg pain and the secondary outcomes are Oswestry Disability Index; EQ-5D; Roland-Morris Disability Questionnaire; Oxford Claudication Score; physical function test, including treadmill test, walking duration, and distance assessment for free leg pain; radiologic testing; and adverse events which will be assessed during the 4-week treatment period as well as after 3 and 6 months of follow-up. Then, we will assess the feasibility of the clinical trial design as well as a nonsurgical integrative treatment program. This trial is registered with CRIS registration number: KCT0001218.

scholarly journals Coflex interspinous implant placement leading to synovial cyst development: case report

2018 ◽  
Vol 29 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Seba Ramhmdani ◽  
Marc Comair ◽  
Camilo A. Molina ◽  
Daniel M. Sciubba ◽  
Ali Bydon
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Facet Joint ◽  
Cauda Equina ◽  
Synovial Cyst ◽  
Leg Pain ◽  
Segmental Motion ◽  
Low Back ◽  
The Right ◽  
Lumbar Spinal

Interspinous process devices (IPDs) have been developed as less-invasive alternatives to spinal fusion with the goal of decompressing the spinal canal and preserving segmental motion. IPD implantation is proposed to treat symptoms of lumbar spinal stenosis that improve during flexion. Recent indications of IPD include lumbar facet joint syndrome, which is seen in patients with mainly low-back pain. Long-term outcomes in this subset of patients are largely unknown. The authors present a previously unreported complication of coflex (IPD) placement: the development of a large compressive lumbar synovial cyst. A 64-year-old woman underwent IPD implantation (coflex) at L4–5 at an outside hospital for low-back pain that occasionally radiates to the right leg. Postoperatively, her back and right leg pain persisted and worsened. MRI was repeated and showed a new, large synovial cyst at the previously treated level, severely compressing the patient’s cauda equina. Four months later, she underwent removal of the interspinous process implant, bilateral laminectomy, facetectomy, synovial cyst resection, interbody fusion, and stabilization. At the 3-month follow-up, she reported significant back pain improvement with some residual leg pain. This case suggests that facet arthrosis may not be an appropriate indication for placement of coflex.

scholarly journals The influence of preoperative spinal sagittal balance on clinical outcomes after microendoscopic laminotomy in patients with lumbar spinal canal stenosis

2015 ◽  
Vol 23 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Sho Dohzono ◽  
Hiromitsu Toyoda ◽  
Tomiya Matsumoto ◽  
Akinobu Suzuki ◽  
Hidetomi Terai ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Plumb Line ◽  
Leg Pain ◽  
Low Back ◽  
Vas Score ◽  
Canal Stenosis ◽  
Lumbar Spinal

OBJECT More information about the association between preoperative anterior translation of the C-7 plumb line and clinical outcomes after decompression surgery in patients with lumbar spinal canal stenosis (LSS) would help resolve problems for patients with sagittal imbalance. The authors evaluated whether preoperative sagittal alignment of the spine affects low-back pain and clinical outcomes after microendoscopic laminotomy. METHODS This study was a retrospective review of prospectively collected surgical data. The study comprised 88 patients with LSS (47 men and 41 women) who ranged in age from 39 to 86 years (mean age 68.7 years). All patients had undergone microendoscopic laminotomy at Osaka City University Graduate School of Medicine from May 2008 through October 2012. The minimum duration of clinical and radiological follow-up was 6 months. All patients were evaluated by Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low-back pain, leg pain, and leg numbness before and after surgery. The distance between the C-7 plumb line and the posterior corner of the sacrum (sagittal vertical axis [SVA]) was measured on lateral standing radiographs of the entire spine obtained before surgery. Radiological factors and clinical outcomes were compared between patients with a preoperative SVA ≥ 50 mm (forward-bending trunk [F] group) and patients with a preoperative SVA < 50 mm (control [C] group). A total of 35 patients were allocated to the F group (19 male and 16 female) and 53 to the C group (28 male and 25 female). RESULTS The mean SVA was 81.0 mm for patients in the F group and 22.0 mm for those in the C group. At final follow-up evaluation, no significant differences between the groups were found for the JOA score improvement ratio (73.3% vs 77.1%) or the VAS score for leg numbness (23.6 vs 24.0 mm); the VAS score for low-back pain was significantly higher for those in the F group (21.1 mm) than for those in the C group (11.0 mm); and the VAS score for leg pain tended to be higher for those in the F group (18.9 ± 29.1 mm) than for those in the C group (9.4 ± 16.0 mm). CONCLUSIONS Preoperative alignment of the spine in the sagittal plane did not affect JOA scores after microendoscopic laminotomy in patients with LSS. However, low-back pain was worse for patients with preoperative anterior translation of the C-7 plumb line than for those without.

scholarly journals Ultrasound-guided caudal epidural steroid injection in chronic radicular low back pain: short-term electrophysiologic benefits

BJR|Open ◽  
2020 ◽  
Vol 2 (1) ◽  
pp. 20190006
Author(s):  
Maha Emad Ibrahim ◽  
Magdy Ahmed Awadalla ◽  
Aziza Sayed Omar ◽  
Mohammad al-Shatouri
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Control Group ◽  
Low Back ◽  
Ultrasound Guided ◽  
Analog Scale ◽  
Short Term ◽  
F Wave ◽  
Epidural Steroid ◽  
Caudal Epidural

Objective: To assess the short-term efficacy of ultrasound-guided caudal epidural steroid injections (ESIs) in improving pain, and nerve function as measured by electrophysiological testing in chronic radicular low back pain. Methods: Patients diagnosed with chronic radicular low back pain were randomized into one of two groups. The injection group (n = 20) underwent a single ultrasound-guided Caudal ESI of 1 ml of 40 mg ml−1 Triamcinolone Acetonide (Kenacort-A), with local anesthetic. The control group (n = 20) underwent a 12-session physiotherapy program. Both groups were evaluated before and 2 weeks after the intervention using visual analog scale for pain and electrophysiological testing comprising peroneal and tibial terminal motor latencies and F-response latencies and chronodispersion. Results: Both groups showed significant pain reduction on the visual analog scale after the intervention. The injection group showed a significant reduction in F wave chronodispersion post-treatment (<0.01). In the control group, there were no significant differences in F wave parameters pre- and post-treatment (p > 0.05). Conclusion: Caudal ESIs were shown to provide short-term improvement of nerve function as evident by improvement in the electrophysiological parameters sensitive to radiculopathy. It was found to be superior to standard physical therapy in this regard. Advances in knowledge: This work shows a novel electrophysiologic evidence of the short-term efficacy ultrasound-guided caudal ESI.

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