scholarly journals Revision decompression with fusion as a treatment for same level restenosis after laminotomy for lumbar spinal stenosis

2020 ◽  
Vol 27 (1) ◽  
pp. 3-9
Author(s):  
Zhuohao Chow Liang ◽  
Wing Ngai Yim ◽  
Chung Ting Martin Wong ◽  
Hung On Cheng ◽  
Ka Kin Cheung
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Revision Surgery ◽  
Japanese Orthopaedic Association ◽  
Japanese Orthopaedic Association Score ◽  
Leg Pain ◽  
Complication Rates ◽  
Salvage Procedure ◽  
Lumbar Spinal

Background/Purpose: Laminotomy is an established procedure to relieve symptoms of lumbar spinal stenosis. However, there is a group of patients with symptomatic recurrence. Re-decompression and fusion could be an effective salvage procedure but the results are seldom found in the literature. In this study, we focused on investigating the clinical outcomes and complication rates of revision decompression with fusion in this patient group. Methods: A retrospective study including patients who had undergone revision decompression with fusion for recurrent symptoms due to same level restenosis after primary laminotomy for lumbar spinal stenosis was performed. Patients with recurrent symptoms due to prolapsed intervertebral disc, trauma, infection, and neoplasm were excluded. Demographics, clinical outcomes, and complications were retrieved. Results: Twenty-eight patients with a total number of 42 levels of revision decompression and fusion were included. With a mean follow-up time of 27 months after revision surgery, there were statistically significant improvement of 63, 49, and 13% in Japanese Orthopaedic Association score, visual analog scale for leg pain, and Roland-Morris disability questionnaire score, respectively. There were 6(21%), 2(7%), 0(0%), and 2(7%) cases of dural tear, infection requiring reoperation, new neurological deficit, and other complications, respectively, in these revision cases. Conclusion: Bearing potential complications in mind, re-decompression with fusion is a viable option with reasonable clinical outcomes for patients with recurrent symptoms after laminotomy for lumbar spinal stenosis. As a treatment option for symptomatic lumbar spinal stenosis, primary laminotomy could have the potential benefit of lower complication rates in revision surgery.

scholarly journals Preoperative low muscle mass is a predictor of falls within 12 months of surgery in patients with lumbar spinal stenosis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Takashi Wada ◽  
Shinji Tanishima ◽  
Yuki Kitsuda ◽  
Mari Osaki ◽  
Hideki Nagashima ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Grip Strength ◽  
Muscle Mass ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Japanese Orthopaedic Association ◽  
Depression Scale ◽  
Leg Pain ◽  
Lower Extremity Muscle ◽  
Lumbar Spinal

Abstract Background Patients with lumbar spinal stenosis (LSS) may be at high risk of falls due to various factors. No effective fall risk assessments or fall prevention measures have been performed for patients with LSS because only a few studies have evaluated falls in these patients. This study aimed to evaluate the incidence and preoperative predictors of falls within 12 months of surgery in patients with LSS. Methods In this prospective study of 82 consecutive preoperative patients with LSS, preoperative demographic data, previous fall history, leg pain, low back pain, Japanese Orthopaedic Association (JOA) score, Hospital Anxiety and Depression Scale (HADS) scores, lower extremity muscle strength, walking speed, grip strength, and muscle mass were assessed at baseline. Falls were assessed at 3, 6, 9, and 12 months after surgery. Participants were categorized as fallers and non-fallers and baseline variables were compared. Binomial logistic regression was used to identify predictors of falls within 12 months of surgery. Results Seventy-four patients (90.2%) completed the 12-month follow-up after surgery, of whom 24 patients (32.4%) experienced falls. A higher proportion of fallers were female and had a history of falls compared to non-fallers. Fallers had a significantly lower JOA score and a higher HADS-depression score compared to non-fallers. Fallers had significantly lower tibialis anterior muscle strength, gait speed, grip strength, and skeletal muscle mass index. Fallers had a higher prevalence of low muscle mass compared with non-fallers. The presence of low muscle mass was significantly predictive of falls within 12 months of surgery (odds ratio, 4.46; 95% confidence interval, 1.02–19.63). Conclusions Patients with LSS have a high incidence of falls after surgery and preoperative low muscle mass may be a predictor of postoperative falls.

scholarly journals Pregabalin for Refractory Radicular Leg Pain due to Lumbar Spinal Stenosis: A Preliminary Prospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Sumihisa Orita ◽  
Masaomi Yamashita ◽  
Yawara Eguchi ◽  
Miyako Suzuki ◽  
Gen Inoue ◽  
...  
Keyword(s):  
Back Pain ◽  
Adverse Events ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Japanese Orthopaedic Association ◽  
Leg Pain ◽  
Vas Scores ◽  
Inflammatory Drugs ◽  
Lumbar Spinal

We investigated the efficacy of pregabalin (PGB) for neuropathic leg pain in lumbar spinal stenosis (LSS) patients with disturbed activities of daily living (ADL)/quality of life (QOL) in a prospective observational study. Subjects were a total of 104 LSS patients with neuropathic pain (NeP) in leg and neurological intermittent claudication (IMC) refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) for at least a month. NeP was identified using screening tool, Pain DETECT questionnaire. Visual analog scale (VAS) scores and responses to the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were assessed before and 6 weeks after PGB treatment initiation. Changes in IMC distance and adverse events were also recorded. PGB significantly improved their VAS scores for pain and sleep quality (P<0.001). With respect to JOABPEQ, significant improvements were observed with regard to the following dimensions: pain-related disorders (P<0.01), lumbar spine dysfunction (P=0.031), gait disturbance (P=0.028), and psychological disorders (P=0.014). The IMC distance showed an improvement tendency after PGB treatment, albeit with no significance (P=0.063). Minor adverse events such as dizziness were observed. PGB can be effective for neuropathic leg pain refractory to NSAIDs in LSS patients, resulting in not only pain control but also improving lower back pain-related ADL/QOL scores.

scholarly journals Clinical Outcomes of Selective Single-Level Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression of Multilevel Lumbar Spinal Stenosis and Risk Factors of Reoperation

2021 ◽  
pp. 219256822110335
Author(s):  
Koichi Yoshikane ◽  
Katsuhiko Kikuchi ◽  
Ken Okazaki
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Rating Scale ◽  
Japanese Orthopaedic Association ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Single Level ◽  
Lumbar Spinal

Study Design: Retrospective cohort study. Objectives: To investigate the usefulness of selective single-level lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) in patients with radiological multilevel lumbar spinal stenosis (LSS) and clarify the predictive factors of reoperation. Methods: A total of 128 patients who underwent LE-ULBD of radiological multilevel LSS were retrospectively examined. Single-level decompression was selected clinically and supplemented radiologically. Clinical outcomes were assessed with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), numeric rating scale (NRS), and Macnab criteria (mean follow-up period, 28.6 months [range, 24-63 months]). Stenosis severity was classified as grades M (moderate) and S (severe) based magnetic resonance imaging findings. Multilevel LSS was classified as SS, SM, and MM according to the number of grade S levels. Results: The follow-up rate was 74.2%. All domains of the JOABPEQ and NRS significantly improved during follow-up. The Macnab outcome classification was “excellent” or “good” in 77.9% of the patients. The reoperation rate was 10.2%. None of the patients with unilateral symptoms required reoperation. The SS type was a significant risk factor of reoperation for multilevel LSS with bilateral symptoms. Additional LE-ULBD was performed for all the reoperation with the “excellent” or “good” results of the Macnab criteria in 69% of the patients. Conclusions: Selective single-level LE-ULBD provided favorable results for multilevel LSS. However, information about the risks of reoperation for multilevel severe stenosis with bilateral symptoms should be shared between surgeons and patients.

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 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 relationship between preoperative predictive factors for clinical outcome in patients operated for lumbar spinal stenosis by decompressive laminectomy

2020 ◽  
Vol 11 ◽  
pp. 27 ◽  
Author(s):  
Dobran Mauro ◽  
Davide Nasi ◽  
Riccardo Paracino ◽  
Mara Capece ◽  
Erika Carrassi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Predictive Factors ◽  
Antidepressant Drugs ◽  
Decompressive Laminectomy ◽  
Pain Anxiety ◽  
Pain Medications ◽  
Improved Outcomes ◽  
Lumbar Spinal

Background: Our hypothesis was that by identifying certain preoperative predictive factors, we could favorably impact clinical outcomes in patients undergoing decompressive surgery for lumbar spinal stenosis (LSS). Methods: In this retrospective study, there were 65 patients (2016–2018) with symptomatic LSS who underwent decompressive laminectomy without fusion. Their clinical outcomes were assessed utilizing the Oswestry Disability Index (ODI). Multiple preoperative variables were studied to determine which ones would help predict improved outcomes: gender, age, body mass index (BMI), general/neurological examination, smoking, and drug therapies (anxiolytics and/or antidepressants). Results: All patients demonstrated statistically significant improvement on the ODI. Multivariate analysis revealed that those with higher preoperative BMI had significantly lower ODI on 1-year follow-up examinations, reflecting poorer outcomes. Postoperatively, 44 patients (67%) exhibited lower utilization of anxiolytic medications, 52 patients (80%) showed reduced use of antidepressant drugs, and pain medications utilization was reduced in 33 patients (50%). Conclusion: Decompressive laminectomy without fusion effectively managed LSS. It reduced patients’ use of pain, anxiety, and antidepressant medications. In addition, we found that increased preoperative BMIs contributed to poorer postoperative outcomes (e.g., ODI values).

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.

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