scholarly journals Influence of Handgrip Strength and Paraspinal Muscles’ Volume on Clinical Outcomes in the Patients With Each Sagittal Imbalance and Lumbar Spinal Stenosis

2021 ◽  
pp. 219256822110018
Author(s):  
Feng Shen ◽  
Ho-Joong Kim ◽  
Seung Won Jeon ◽  
Bong-Soon Chang ◽  
Choon-Ki Lee ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Handgrip Strength ◽  
Sagittal Imbalance ◽  
Paraspinal Muscles ◽  
Cross Sectional ◽  
Significant Difference ◽  
Patient Reported ◽  
Patient Reported Measures ◽  
Lumbar Spinal

Study Design: Cross-sectional study. Objective: To compare handgrip strength (HGS), paraspinal muscles’ (PSM) volume, and their effects on clinical symptom severity between the patients with sagittal imbalance (SI) and symptomatic lumbar spinal stenosis (LSS). Methods: A total of 54 paired consecutive patients with SI and LSS were enrolled after propensity score matching. Preoperative HGS, cross-sectional area (CSA) of psoas (PS) and multifidus (MF) muscles, and patient-reported measures, including visual analog scale (VAS) for back/ leg pain, Oswestry Disability Index (ODI), and EuroQOL (EQ-5D) were compared between both groups. Within each SI and LSS group, patient-reported measures were compared between high and low HGS subgroups. The correlation of HGS and CSA of PSMs to patient-reported measures was evaluated. Results: There was no difference in HGS between 2 groups, however, the CSA of PS and MF muscles in SI group was significantly lower than those in LSS group. Patients with low HGS showed inferior results for ODI and EQ-5D, compared to those with high HGS subgroup in both SI and LSS groups. HGS and CSA of MF muscle were correlated with ODI in both groups. Conclusions: There was no significant difference between the SI and LSS groups in HGS, however, PSMs’ volume in SI group were significantly lower than those in LSS group. Therefore SI would be associated with loss of localized muscle mass in back area, rather than global skeletal muscle weakness. HGS and PSMs’ volume were adversely associated with functional status in SI and LSS patients.

scholarly journals Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN study

2021 ◽  
Author(s):  
Jørn Aaen ◽  
Ivar Magne Austevoll ◽  
Christian Hellum ◽  
Kjersti Storheim ◽  
Tor Åge Myklebust ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Patient Characteristics ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Mri Findings ◽  
Multifidus Muscle ◽  
Cross Sectional ◽  
Patient Reported ◽  
Lumbar Spinal

Abstract Purpose The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. Methods The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. Results The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2–4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. Conclusion In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. Trial registration www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.

scholarly journals Relative risk factors of nerve root sedimentation sign (Sedsign) in patients with severe central lumbar spinal stenosis (LSS)

2021 ◽  
Author(s):  
Haiming YU ◽  
Yunfeng HAN ◽  
Rui ZHANG ◽  
Chu SUN ◽  
Mingda WANG ◽  
...  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Nerve Root ◽  
Sectional Area ◽  
Cross Sectional ◽  
Dural Sac ◽  
Significant Difference ◽  
Lumbar Spinal

Abstract Here we evaluated the incidence of positive nerve root sedimentation sign (Sedsign) and its correlation with MRI parameters in patients with severe lumbar spinal stenosis (LSS) to explore its pathogenesis. Among 209 patients with severe LSS, there were 290 levels with intervertebral narrowing, among which 248 had a positive Sedsign (a prevalence of 85.52%). We then analyzed those levels with a positive Sedsign relative to those with a negative Sedsign (42 levels). There was no significant difference between the two groups for the minimum cross-sectional area (CSA) of the dural sac or the minimum posteroanterior diameter (PAD) of the spinal canal. In contrast, there was a significant difference between the groups for the grade of degenerative facet joint (DFJ) (p < 0.05), the maximum thickness of ligamentum flavum (TLF) (p < 0.01), and the maximum cross-sectional area difference (CSAD) of the dural sac (p < 0.01). In addition, receiver operating characteristic (ROC) curves were used to identify associated factors. The area under the ROC curve for PAD was 0.608 (95%CI: 0.55−0.665, p < 0.05), for DFJ was 0.634 (95%CI: 0.576−0.69, p < 0.05), for TLF was 0.74 (95%CI: 0.742−0.839, p < 0.01), and for CSAD was 0.911 (95%CI: 0.875−0.943, p < 0.01). In summary, a positive Sedsign has notable advantages in assisting with the diagnosis of severe LSS. Compression of the dural sac from the rear may be the main cause of a positive Sedsign, and the TLF and DFJ parameters were the main relative risk factors.

scholarly journals Assessing Fatty Infiltration of Paraspinal Muscles in Patients With Lumbar Spinal Stenosis: Goutallier Classification and Quantitative MRI Measurements

2021 ◽  
Vol 12 ◽  
Author(s):  
Filippo Mandelli ◽  
Corina Nüesch ◽  
Yuancheng Zhang ◽  
Florian Halbeisen ◽  
Stefan Schären ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Vertebral Body ◽  
Fatty Infiltration ◽  
Paraspinal Muscle ◽  
Paraspinal Muscles ◽  
Cross Sectional ◽  
Goutallier Classification ◽  
Lumbar Spinal ◽  
Mri Measurements

Objective: Fatty infiltration of paraspinal muscle is associated with spinal disorders. It can be assessed qualitatively (i.e., Goutallier classification) and quantitatively using image processing software. The aims of this study were to compare paraspinal muscle fatty infiltration as assessed using the Goutallier classification vs. quantitative magnetic resonance images (MRI) measurements and to investigate the association between anthropometric parameters and paraspinal muscle morphology and fatty infiltration in patients with symptomatic lumbar spinal stenosis (LSS).Methods: Patients affected by symptomatic LSS scheduled for surgery with available MRI of the lumbar spine were included in this retrospective cross-sectional study. Fatty infiltration at each lumbar level was rated qualitatively according to the Goutallier classification and quantified based on the cross-sectional area (CSA) of the paraspinal muscle, of its lean fraction (LeanCSA), and the ratio between LeanCSA and CSA and the CSA relative to the CSA of vertebral body (RCSA). Considering the muscle as a single unit, overall fatty infiltration according to Goutallier, overall CSA, LeanCSA, LeanCSA/CSA, and RCSA were computed as averages (aGoutallier, aCSA, aLeanCSA, aLeanCSA/aCSA, and aRCSA). Associations among parameters were assessed using Spearman's respective Pearson's correlation coefficients.Results: Eighteen patients, with a mean age of 71.3 years, were included. aGoutallier correlated strongly with aLeanCSA and aLeanCSA/aCSA (R = −0.673 and R = −0.754, both P &lt; 0.001). There was a very strong correlation between values of the left and right sides for CSA (R = 0.956, P &lt; 0.001), LeanCSA (R = 0.900, P &lt; 0.001), and LeanCSA/CSA (R = 0.827, P &lt; 0.001) at all levels. Among all anthropometric measurements, paraspinal muscle CSA correlated the most with height (left: R = 0.737, P &lt; 0.001; right: R = 0.700, P &lt; 0.001), while there was a moderate correlation between vertebral body CSA and paraspinal muscle CSA (left: R = 0.448, P &lt; 0.001; right: R = 0.454, P &lt; 0.001). Paraspinal muscle CSA correlated moderately with body mass index (BMI; left: R = 0.423, P &lt; 0.001; right: R = 0.436, P &lt; 0.001), and there was no significant correlation between aLeanCSA or aLeanCSA/CSA and BMI.Conclusions: The Goutallier classification is a reliable yet efficient tool for assessing fatty infiltration of paraspinal muscles in patients with symptomatic LSS. We suggest taking body height as a reference for normalization in future studies assessing paraspinal muscle atrophy and fatty infiltration.

Association Between Paravertebral Muscle Mass and Improvement in Sagittal Imbalance After Decompression Surgery of Lumbar Spinal Stenosis

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Yuichi Yoshida ◽  
Junichi Ohya ◽  
Taiki Yasukawa ◽  
Yuki Onishi ◽  
Junichi Kunogi ◽  
...  
Keyword(s):  
Muscle Mass ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Sagittal Imbalance ◽  
Decompression Surgery ◽  
Paravertebral Muscle ◽  
Lumbar Spinal

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>

Handgrip strength correlates with walking in lumbar spinal stenosis

2020 ◽  
Vol 29 (9) ◽  
pp. 2198-2204 ◽  
Author(s):  
Hirokazu Inoue ◽  
Hideaki Watanabe ◽  
Hitoshi Okami ◽  
Yasuyuki Shiraishi ◽  
Atsushi Kimura ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Handgrip Strength ◽  
Lumbar Spinal
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