“Slalom”: Microsurgical Cross-Over Decompression for Multilevel Degenerative Lumbar Stenosis

Objective.Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches.Indications. Two-segmental and multisegmental degenerative central and lateral lumbar spinal stenosis.Contraindications. None.Surgical Technique.Minimally invasive, muscle, and facet joint-sparing bilateral decompression of the lumbar spinal canal through 2 or more alternating microsurgical cross-over approaches from one side.Results.From December 2010 until December 2015 we operated on 202 patients with 2 or multisegmental stenosis (115 f; 87 m; average age 69.3 yrs, range 51–91 yrs). All patients were suffering from symptoms typical of a degenerative lumbar spinal stenosis. All patients complained about back pain; however the leg symptoms were dominant in all cases. Per decompressed segment, the average OR time was 36 min and the blood loss 45.7 cc. Patients were mobilized 6 hrs postop and hospitalization averaged 5.9 days. A total of 116/202 patients did not need submuscular drainage. 27/202 patients suffered from a complication (13.4%). Dural tears occurred in 3.5%, an epidural hematoma in 5.5%, a deep wound infection in 1.98%, and a temporary radiculopathy postop in 1.5%. Postop follow-up ranged from 12 to 24 months. There was a significant improvement of EQ 5 D, Oswestry Disability Index (ODI), VAS for Back and Leg Pain, and preoperative standing times and walking distances.

Download Full-text

X-RAY AND MAGNETIC RESONANCE IMAGING FEATURES IN PATIENTS WITH ACQUIRED LUMBAR SPINAL STENOSIS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.6.20 ◽

2018 ◽

Vol 8 (6) ◽

pp. 151-156

Author(s):

Trung Hoang Van ◽

Cuong Le Van Ngoc

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Resonance Imaging ◽

X Ray ◽

Canal Stenosis ◽

Lumbar Spinal Canal ◽

Lumbar Spinal

Background: Lumbar spinal stenosis often associates with chronic pain described the abnormal narrowing of the lumbar spinal canal, resulting in compression of neural elements within the central spinal canal or the lateral recesses or the root canals or coordinate with each other. The purpose of this study was to describe and compare the plain X-ray and magnetic resonance imaging features of lumbar canal stenosis. Materials and methods: This was a cross-sectional study of 78 patients with an acquired lumbar spinal canal between October 2017 and May 2018. Results: The X-rays confirmed osteophytes in 92.3%, endplate sclerosis in 88.5% and disc space narrowing 62.8%. On MRI, 213 lumbar levels were lumbar spinal canal stenosis, 181 lumbar levels were evaluated for the grade of central spinal canal stenosis. Conclusions: X-ray examination has limitations in a diagnosis of lumbar spinal stenosis but also serves as a diagnostic aid. MRI is well diagnosed as spinal pathology as well as lumbar spinal stenosis. Key words: Lumbar spinal, Lumbar spinal stenosis, Magnetic resonance imaging (MRI), X-ray, Grading

Download Full-text

Effect of Pedicle Lengthening Screw on Biomechanics of Lumbar Spine

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19358 ◽

2010 ◽

Author(s):

A. Kiapour ◽

V. K. Goel

Keyword(s):

Spinal Stenosis ◽

Spinal Canal ◽

New Technology ◽

Surgical Decompression ◽

Leg Pain ◽

Lumbar Spinal Canal Stenosis ◽

Canal Stenosis ◽

Long Run ◽

Lumbar Spinal Canal ◽

Lumbar Spinal

Lumbar spinal canal stenosis is a common cause of back and leg pain which occurs as the lumbar spinal canal narrows. The current surgical treatment for many patients with spinal stenosis is surgical decompression and spinal fusion with instrumentation. However there are several drawbacks associated with fusion surgeries including degenerative effect at segments adjacent to the fusion in long run [1,2]. Pedicle lengthening device is a new technology which is designed to be applied for treatment of spinal stenosis and replace the traditional fusion techniques.

Download Full-text

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

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/135 ◽

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

Download Full-text

Outcome of Surgical Treatment of Degenerative Lumbar Spinal Stenosis.

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v14i1.14838 ◽

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

Download Full-text

Spinal canal diameter in degenerative lumbar spinal stenosis

Journal of Anatomical Society of India ◽

10.1016/j.jasi.2018.07.005 ◽

2018 ◽

Vol 67 ◽

pp. S25-S28 ◽

Cited By ~ 1

Author(s):

R. Sethi ◽

V. Singh

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Degenerative Lumbar Spinal Stenosis ◽

Canal Diameter ◽

Lumbar Spinal

Download Full-text

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

BioMed Research International ◽

10.1155/2017/3742182 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 2

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.

Download Full-text

The Narrow Lumbar Spinal Canal or Lumbar Spinal Stenosis

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-197601000-00040 ◽

1976 ◽

Vol 1976 (114) ◽

pp. 319???325

Author(s):

L. MERCER McKINLEY ◽

GERALD L. DAVIS

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Lumbar Spinal Canal ◽

Lumbar Spinal

Download Full-text

Effective of Fusion in the Treatment of Lumbar Spinal Stenosis：A Systematic Review Andmeta-Analysis

10.21203/rs.3.rs-868342/v1 ◽

2021 ◽

Author(s):

Yang Yang ◽

Shi-tian Tang ◽

Qian Chen ◽

fang chen

Keyword(s):

Systematic Review ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Major Complication ◽

Primary Objective ◽

Leg Pain ◽

Walking Ability ◽

Degenerative Lumbar Spinal Stenosis ◽

Pain Scores ◽

Lumbar Spinal

Abstract Objective: The debate on efficacy of fusion added to decompression for lumbar spinal stenosis (LSS) is ongoing. The primary objective of this systematic review is to compare the outcome after decompression with and without fusion in patients with lumbar spinal stenosis .Methods: A literature search was performed in the Web of Science, EMBASE, Pubmed,and Cochrane Libraryfrom January 1990 to May 2021.The information of screened studies included clinical outcomes, and secondary measures, then data synthesis and meta-analysis were progressed.Data analysis was conducted using the Review Manager 5.0 software.Results: 17 studies were included in the analysis involving 2947 patients in total. In the majority of studies, including seven RCTs and ten observational studies. The pooled data revealed that fusion was associated with signifificantly higher rates of back pain scores when compared with decompression alone in RCT subgroup(SMD=-0.42, 95% CI (–0.60, -0.23), Z=4.31 P<0.0001).However, fusion signifificantly increased the intraoperative blood loss, operative time and hospital stay. Both techniques had similar leg Pain scores , EQ-5D, walking ability，ODI，major complication,clinical satisfactions and reoperation rate.Conclusions: Our studies showed that the additional fusion in the management of LSS yielded no clinical improvements over decompression alone within a 1-year follow-up period. We suggested that the least invasive and least costly procedure, being decompression alone, is preferred in patients with degenerative lumbar spinal stenosis. The appropriate surgical protocol for LSS should be discussed further.

Download Full-text