How Decompression Surgery Improves the Lower Back Pain in Patient With Lumbar Degenerative Stenosis

Abstract Background Previous research and published literature indicate that some patients with spinal diseases who underwent percutaneous transforaminal endoscopic decompression (PTED) still suffer some discomfort in the early recovery stage in the form of pain, stiffness, and swelling. These are usually considered minor residual symptoms or normal postoperative phenomenon (NPF) in the clinic, occur frequently, and are acknowledged by surgeons worldwide. To the best of our knowledge, we report the first case of a patient who had an osteoporotic vertebral fracture (OVF) misdiagnosed as NPF after she underwent PTED as a result of lumbar disc herniation (LDH). Case presentation A 71-year-old female with Parkinson’s disease who presented with lower back pain radiating to the legs was diagnosed as LDH in L4–5, after which a PTED of L4–5 was performed, with temporary alleviation of symptoms. However, severe lower back pain recurred. Unfortunately, the recurred pain initially misdiagnosed as NPF, in fact, was finally confirmed to be OVF by CT-scan. OVF in the early stage of post-PTED seldom occurs and is rarely reported in the literature. With a percutaneous vertebroplasty, the pain was significantly relieved, and she resumed walking. After 36-weeks of follow-up, the pain improved satisfactorily. Conclusion Doctors should not immediately diagnose a relapse of back pain following PTED as NPF, and hands-on careful physical and imaging examinations are necessary to manage recurring pain rightly and timely.

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Minimally Invasive L5 Corpectomy with Navigated Expandable Vertebral Cage: A Technical Note

Brain Sciences ◽

10.3390/brainsci11091241 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1241

Author(s):

Taro Yamauchi ◽

Ashish Jaiswal ◽

Masato Tanaka ◽

Yoshihiro Fujiwara ◽

Yoshiaki Oda ◽

...

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Lower Back Pain ◽

Revision Surgery ◽

Leg Pain ◽

Decompression Surgery ◽

Intraoperative Radiation ◽

Lower Back ◽

Estimated Blood Loss ◽

L5 Corpectomy

Background: Conventional L5 corpectomy requires a large incision and an extended period of intraoperative fluoroscopy. We describe herein a new L5 corpectomy technique. Methods: A 79-year-old woman was referred to our hospital for leg pain and lower back pain due to an L5 vertebral fracture. Her daily life had been affected by severe lower back pain and sciatica for more than 2 months. We initially performed simple decompression surgery, but this proved effective for only 10 months. Results: For revision surgery, the patient underwent minimally invasive L5 corpectomy with a navigated expandable cage without fluoroscopy. The second surgery took 215 min, and estimated blood loss was 750 mL. The revision surgery proved successful, and the patient could then walk using a cane. In terms of clinical outcomes, the Oswestry Disability Index improved from 66% to 24%, and the visual analog scale score for lower back pain improved from 84 to 31 mm at the 1-year follow-up. Conclusions: Minimally invasive L5 corpectomy with a navigated expandable vertebral cage is effective for reducing cage misplacement and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure.

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Improvement of Lower Back Pain in Lumbar Spinal Stenosis After Decompression Surgery and Factors That Predict Residual Lower Back Pain

Global Spine Journal ◽

10.1177/2192568220905617 ◽

2020 ◽

pp. 219256822090561

Author(s):

Takahiro Kitagawa ◽

Yoji Ogura ◽

Yoshiomi Kobayashi ◽

Yoshiyuki Takahashi ◽

Yoshiro Yonezawa ◽

...

Keyword(s):

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lower Back Pain ◽

Decompression Surgery ◽

Thoracolumbar Kyphosis ◽

Lower Back ◽

Group I ◽

Lumbar Spinal

Study Design: Retrospective observational study. Objectives: There is no consensus to predict improvement of lower back pain (LBP) in lumbar spinal stenosis after decompression surgery. The aim of this study was to evaluate the improvement of LBP and analyze the preoperative predicting factors for residual LBP. Methods: We retrospectively reviewed 119 patients who underwent lumbar decompression surgery without fusion and had a minimum follow-up of 1 year. LBP was evaluated using the numerical rating scale (NRS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) LBP score, and Roland-Morris Disability Questionnaire (RMDQ). All patients were divided into LBP improved group (group I) and LBP residual group (group R) according to the NRS score. Radiographic images were examined preoperatively and at the final follow-up. We evaluated spinopelvic radiological parameters and analyzed the differences between group I and group R. Results: LBP was significantly improved after decompression surgery (LBP NRS, 5.7 vs 2.6, P < .001; JOABPEQ LBP score, 41.3 vs 79.6, P < .001; RMDQ, 10.3 vs 3.6, P < .001). Of 119 patients, 94 patients were allocated to group I and 25 was allocated to group R. There was significant difference in preoperative thoracolumbar kyphosis between group I and group R. Conclusions: Most cases of LBP in lumbar spinal stenosis were improved after decompression surgery without fusion. Preoperative thoracolumbar kyphosis predicted residual LBP after decompression surgery.

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