scholarly journals Efficacy and safety of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar spinal stenosis combined with osteoporosis

2019 ◽  
Vol 65 (6) ◽  
pp. 779-785
Author(s):  
Xiaobin Gu ◽  
Wenhui Zhu ◽  
Haiyi He ◽  
Zili Wang ◽  
Shaolong Ding ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Adverse Reactions ◽  
Leg Pain ◽  
Control Group ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
Lumbar Spinal

SUMMARY OBJECTIVE: To investigate the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar spinal stenosis (LSS) combined with osteoporosis. METHODS: Eighty patients with LSS combined with osteoporosis were divided into a control and PTED group, which received conventional transforaminal lumbar interbody fusion and PTED, respectively. The surgical indications, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores, bone mineral density (BMD), and adverse reactions were observed. RESULTS: Compared with the control group, in the PTED group, the operation time, bleeding loss and hospitalization duration, incision VAS scores at postoperative 12, 24 and 48 h and lumbar and leg pain VAS and lumbar ODI scores on postoperative 6 months were significantly decreased (P < 0.01), and the lumbar JOA score on postoperative 6 months was significantly increased (P < 0.05). There was no significant difference in BMD between two groups (P > 0.05). Compared with the control group, in the PTED group, the total effective rate was significantly higher (P < 0.05), and the incidence of adverse reactions was significantly lower (P < 0.05). CONCLUSIONS: PTED is safe and effective in the treatment of LSS combined with osteoporosis.

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>

scholarly journals Treatment for Lumbar Spinal Stenosis Secondary to Ligamentum Flavum Hypertrophy Using Percutaneous Endoscopy through Interlaminar Approach: A Retrospective Study

2020 ◽  
Author(s):  
Yi Liu ◽  
Yingjie Qi ◽  
Diarra Mohamed Diaty ◽  
Guanglei Zheng ◽  
Xiaoqiang Shen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Disease Duration ◽  
Ligamentum Flavum ◽  
Leg Pain ◽  
Control Group ◽  
Interlaminar Approach ◽  
Lumbar Spinal ◽  
Percutaneous Endoscopy

Abstract Background This paper is to first describe percutaneous endoscopy in the treatment of lumbar spinal stenosis secondary to ligamentum flavum hypertrophy targetedly. To investigate the efficacy and safety of percutaneous endoscopy in the treatment of this kind of lumbar spinal stenosis in elderly patients. Method: A retrospective analysis of 40 elderly patients with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy admitted between January 2016 and January 2018 was performed. According to different surgical methods, they were divided into two groups: the control group and the endoscopy group (interlaminar approach), 20 people per group. There were 9 males and 11 females in the control group; the age of patients was 65.65 ± 4.44years, and the average disease duration was 4.55 ± 1.85 years. Besides, There were 10 males and 10 females in the endoscopy group; the age of patients was 67.30 ± 4.23years, and the average disease duration was 4.95 ± 2.04 years. Collect and count surgical-related indicators, preoperative and postoperative radiologic findings, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores of all patients. Result A series of surgical indicators (including the operation time, the quantity of bleeding and postoperative hospital stay) in the endoscopy group was significantly lower than that in the control group (p < 0.05). The incision VAS score in the endoscopy group was also significantly lower than that in the control group at each time after surgery (p < 0.05). Besides, compared with the control group, in the endoscopy group, the leg pain VAS score and lumbar ODI score after surgery were significantly decreased (p < 0.05). Compared with the control group, in the endoscopy group, the lumbar JOA score was significantly higher (p < 0.05). Conclusion Percutaneous endoscopic technique is a small trauma, quick recovery, safe and effective minimally invasive surgery for patients with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy.

scholarly journals Surgical treatment for lumbar spinal stenosis: a single-blinded randomized controlled trial

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Luiz Claudio Lacerda Rodrigues ◽  
Jamil Natour
Keyword(s):  
Surgical Treatment ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Likert Scale ◽  
Control Group ◽  
Walk Test ◽  
Medium Term ◽  
Sf 36 ◽  
Significant Difference ◽  
Lumbar Spinal

Abstract Objective To evaluate the effectiveness of surgery for the management of patients with symptomatic lumbar spinal stenosis. Methods Sixty-three patients with lumbar canal stenosis were randomized into two groups: the intervention group (IG) and control group (CG). IG patients underwent surgery and both groups participated in the same physical therapy program twice a week for a period of 12 weeks and were followed up at 1 year. The primary endpoint was visual analogue scale for pain, and the secondary endpoints were function (6-min walk test, Roland Morris and Oswestry questionnaires), quality of life (SF-36 questionnaire) and satisfaction with treatment (Likert scale). Results No significant difference between groups was observed for pain over time (p = 0.145). Significant differences between groups, in favor of the IG, were observed for the Oswestry score (p = 0.006) and vitality domain score of the SF-36 (p = 0.047). Function in the Roland Morris and 6-min walk test and the role of the physical domain of SF-36 also showed significant differences between the groups; however, these differences occurred due to a worsening of the IG in the short term, and the medium-term. The Likert scale demonstrated greater satisfaction with the IG treatment compared to control group. Conclusions Lumbar stenosis surgery did not improve pain in short and medium terms. Function and vitality were better in the group that underwent surgery in the medium term, and patients were more satisfied with the surgical treatment. Trial registration Clinicaltrials.gov (NCT02879461).

scholarly journals A comparative study of Lumbar Decompression and Fusion with Internal Fixation versus Simple Decompression in elderly patients with two-segment Lumbar Spinal Stenosis

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Pengfa Tu ◽  
Shuo Cao ◽  
Chenyang Jiang ◽  
Chong-chao Yan
Keyword(s):  
Elderly Patients ◽  
Internal Fixation ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Operation Time ◽  
Leg Pain ◽  
Wound Complications ◽  
Significant Difference ◽  
Lumbar Spinal ◽  
Simple Decompression

Objective: To investigate and compare the effect of decompression and fusion with internal fixation vs. simple decompression in the treatment of elderly patients with two-segment lumbar spinal stenosis (LSS) in perioperative and postoperative follow-up periods. Methods: Twenty-eight elderly patients with two-segment LSS admitted in Baoding First Hospital between Mar. 2017 and Jan. 2018 were retrospectively analyzed. Fifteen patients who underwent simple decompression were included in the simple decompression group, and 13 who underwent decompression and fusion with internal fixation were included in the decompression-fixation group. The general data and perioperative conditions including wound complications, operation time, blood loss, and VAS (legs) and JOA score were analyzed and compared between the two groups. Results: There was no significant difference in postoperative leg pain (VAS) between the two groups, and a statistically significant difference in JOA score was found between the two groups one month after the operation. The operation time, length of stay, and blood loss in the decompression-fixation group were significantly different from those in the simple decompression group and no significant difference in wound complications was observed between the two groups. Conclusion: There is no significant difference in leg pain relief in elderly patients with two-segment LSS when treated with decompression and fusion with internal fixation or simple decompression. Simple decompression is associated with less intraoperative injuries, better postoperative functional recovery, and reduced hospital stay. doi: https://doi.org/10.12669/pjms.37.1.2287 How to cite this:Tu P, Cao S, Jiang C, Yan CC. A comparative study of Lumbar Decompression and Fusion with Internal Fixation versus Simple Decompression in elderly patients with two-segment Lumbar Spinal Stenosis. Pak J Med Sci. 2021;37(1):256-260.  doi: https://doi.org/10.12669/pjms.37.1.2287 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals RADIOFREQUENCY FACILITATED MANUAL SEMI-ENDOSCOPIC DISCECTOMY UTILIZING THE DISC FX® SYSTEM IN THE TREATMENT OF DISC-PREDOMINATE LUMBAR SPINAL STENOSIS

2018 ◽  
pp. 173-181
Author(s):  
George J. Arcos
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Central Canal ◽  
Leg Pain ◽  
Radiographic Evidence ◽  
Canal Stenosis ◽  
Canal Diameter ◽  
Endoscopic Discectomy ◽  
Lumbar Spinal

Background: Lumbar spinal stenosis (LSS) occurs with increasing prevalence in the elderly population. The American Academy of Orthopedic Surgeons has estimated that by 2021, 2.4 million adults in the United States (8-11% of the population) will be affected by this condition. Surgical options for LSS are being performed with increased frequency, high cost, and substantial risk of life-threatening complications. While nonsurgical treatment options for LSS are available, they are limited by patient selection (ligamentum flavum hypertrophy) or high rates of reoperation (Interspinous process spacer devices). This study is the first to suggest a minimally invasive treatment option for disc-predominate lumbar central canal stenosis. Objectives: To evaluate the clinical efficacy of radiofrequency facilitated manual semi-endoscopic discectomy utilizing the Disc FX® system in the treatment of disc-predominate lumbar spinal stenosis. Study Design: Single center, prospective, observational study. Setting: Multi-specialty private practice clinic. The Medical Group of South Florida, Jupiter, FL. Methods: This study involved 6 patients with disc-predominant lumbar central spinal stenosis. All patients were treated with the Disc FX® system. Radiographic evidence of central lumbar stenosis was confirmed by measurement of minimum AP canal diameter (mm) performed by 1 board-certified neuroradiologist. Inclusion criteria included absence of lumbar surgery, physical therapy within the previous 6 months, failure of epidural steroid injections (3) within the previous 8 months, spondylolisthesis limited to Grade I, disc height > 50%, presence of low back axial pain + leg pain exacerbated by walking, and relieved with sitting or forward flexion, absence of dermatomal radicular leg pain, radiographic evidence of disc displacement > 4 mm from disc endplate. Zurich claudication (symptom severity and physical function scale was administered 1 week preoperatively, and again 6 months postoperatively. There were no patients lost to follow up. Results: All patients in the study demonstrated moderate-severe or severe central canal stenosis, with an average AP canal diameter of 6.63 mm for all treated disc levels and 5.5 mm for the most severe levels. There was a mean improvement of 57% in a symptom severity scale and 56% in the physical function scale at 6 months. This exceeds the improvement reported with interspinous spacer devices. Limitations: Limitations include very small sample size, observational design, non-randomization, absence of share controls, short follow-up period. Conclusion: For patients suffering from discpredominant lumbar spinal stenosis, The Disc FX® System provides an effective, low-cost alternative to surgical intervention. Key words: Spinal, stenosis, claudication, disc, Disc FX®, operative, minimally invasive, Zürich claudication score

scholarly journals Effects of Nasal Calcitonin vs. Oral Gabapentin on Pain and Symptoms of Lumbar Spinal Stenosis: A Clinical Trial Study

2016 ◽  
Vol 9 ◽  
pp. CMAMD.S39938 ◽  
Author(s):  
Kaveh Haddadi ◽  
Leila Asadian ◽  
Ahdie Isazade
Keyword(s):  
Clinical Trial ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Salmon Calcitonin ◽  
Control Group ◽  
Neurogenic Claudication ◽  
Nasal Calcitonin ◽  
Significant Difference ◽  
Nasal Salmon Calcitonin ◽  
Lumbar Spinal

Lumbar spinal stenosis (LSS) is a chronic and prevalent disease that occurs in 10.8% of the general population, mostly in old age. We designed the first clinical trial study to compare the effects of administering the nasal salmon calcitonin spray and gabapentin in patients with LSS. In this clinical trial, 90 patients with symptoms of neurogenic claudication and magnetic resonance imaging-proven LSS were randomly assigned to nasal salmon calcitonin, gabapentin, or placebo treatments for eight weeks (30 participants in each group). This was followed by a washout period of four weeks. After three months of study and after four weeks off the prescription, mean values of Oswestry Disability Index in the calcitonin, gabapentin, and control groups were 23 ± 12.05, 32 ± 16.08, and 38 ± 22.09, respectively ( P ≤ 0.05, calcitonin group vs. gabapentin group, and P ≤ 0. 001, calcitonin group vs. control group with respect to pretreatment scores). Thus, three months after the treatment, although most of the patients in the control group had a satisfactory period of improvement, the improvement in the calcitonin group was more than the other two groups with a significant difference ( P ≤ 0.05 when compared to gabapentin group and P ≤ 0.01 when compared to placebo group). We revealed that the 200 International Unit (IU) and nasal calcitonin spray daily are more effective compared to 300 mg gabapentin three times per day and the placebo effect for eight weeks of treatment of symptoms of patients with LSS.

scholarly journals Radiological Analysis of Sagittal and Cross-sectional Morphology of Congenital Lumbar Spinal Stenosis

2021 ◽  
Author(s):  
Qihui Cheng ◽  
Ganghui Yin ◽  
Minjun Huang ◽  
Haojie Mi ◽  
Junwei Guan ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Disc Degeneration ◽  
Lumbar Spinal Stenosis ◽  
Ligamentum Flavum ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Control Group ◽  
Lumbar Disc Degeneration ◽  
Lumbar Spinal ◽  
And Control

Abstract Background Purpose This retrospective study was applied to investigate the morphology characteristics of the spine and pelvis in patients with congenital spinal stenosis, to explore the effect of morphological parameters in the pathogenesis and development of the disease.Methods The analysis is based on data of a case-control study, including 40 patients (19 females/21 males) with congenital lumbar spinal stenosis, 40 patients (17females/23males) with age-、Sex- and the waist and leg pain score-matched acquired lumbar spinal stenosis and 40 age-、Sex-matched normal volunteers(controls). Lumbar MRI, lumbar computerized tomography（CT）and full-length radiographs were used to obtain sagittal and cross-sectional parameters. Parameters including pelvic incidence（PI）, sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis（SVA）, and thoracic kyphosis（TK）on the sagittal plane were measured on full-length radiographs and analyzed. The anteroposterior (AP) bone canal diameter and spinal canal area of L4 were collected and analyzed on Lumbar CT. Lumbar MRI was taken to evaluate the angle of the ligamentum flavum at the level of L4/5 intervertebral space，and the Lumbar disc degeneration degree was calculated.Results Total scores for lumbar disc degeneration and the angle of the ligamentum flavum were significantly lower in the congenital group than in the acquired group（P= 0.02 and P= 0.012，respectively ； P＜0.05）. The differences of LL, PT, SVA and TK values were statistically significant ， while the differences of SS and PI were not significant among the acquired, congenital, and control groups. TK values were significantly lower in the congenital group than in the acquired and control groups（P=0.024 and P=0.006，respectively； P＜0.05）. Patients in the congenital and acquired groups had significantly lower LL values than patients in the control group (p = 0.000 and 0.041, respectively； P＜0.05). The mean value of LL was 30.31°±13.42° in the congenital group, while 41.10°±12.51° in the acquired group. And the difference of LL between these two groups was statistically significant（p=0.000＜0.05）. The SVA values of the congenital group, acquired group, and control group increased respectively(all P＜0.05). The PT in the congenital group showed significantly lower values than the acquired group (p = 0.041＜0.05). There is no statistically significant difference in other parameters.The correlations between LL and PI are well in the congenital group（r=0.336；P=0.034）, acquired group（r=0.464；P=0.003） and control group（r=0.584；P=0.000）. However, the trend line of LL/PI in the acquired group was drawn below the control population. Also, the trend line of LL/PI in the congenital group was below the waist and leg pain score-matched acquired group with lower lumbar degeneration.Conclusion In addition to bony structural stenosis, the smaller angle of the ligamentum flavum may be an anatomical factor that causes the smaller effective area of the spinal canal in patients with congenital lumbar spinal stenosis. Patients with congenital lumbar spinal stenosis show a significant reduction in the physiological curvature of the thoracic and lumbar spine, and the trunk leans forward. In addition to intervertebral disc degeneration and pain factors, bony spinal stenosis is also a possible factor leading to smaller LL in patients with congenital lumbar spinal stenosis. LL less than 41° can be used as the initial screening standard for congenital lumbar spinal stenosis among patients with lumbar spinal stenosis.

scholarly journals Treatment for Lumbar Spinal Stenosis Secondary to Ligamentum Flavum Hypertrophy Using Percutaneous Endoscopy through Interlaminar Approach: A Retrospective Study

2020 ◽  
Author(s):  
Yi Liu ◽  
Yingjie Qi ◽  
Diarra Mohamed Diaty ◽  
Guanglei Zheng ◽  
Xiaoqiang Shen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Disease Duration ◽  
Ligamentum Flavum ◽  
Leg Pain ◽  
Control Group ◽  
Interlaminar Approach ◽  
Lumbar Spinal ◽  
Percutaneous Endoscopy

Abstract Background: This paper is to describe percutaneous endoscopy in the treatment of lumbar spinal stenosis secondary to ligamentum flavum hypertrophy targeted. To investigate the efficacy and safety of percutaneous endoscopy in the treatment of this kind of lumbar spinal stenosis in elderly patients.Method: A retrospective analysis of 40 elderly patients with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy admitted between January 2016 and January 2018 was performed. According to different surgical methods, they were divided into two groups: the control group and the endoscopy group (interlaminar approach), 20 people per group. There were 9 males and 11 females in the control group; the age of patients was 65.65±4.44years, and the average disease duration was 4.55±1.85 years. Besides, There were 10 males and 10 females in the endoscopy group; the age of patients was 67.30±4.23years, and the average disease duration was 4.95±2.04 years. Collect and count surgical-related indicators, preoperative and postoperative radiologic findings, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores of all patients.Result: A series of surgical indicators (including the operation time, the quantity of bleeding and postoperative hospital stay) in the endoscopy group was significantly lower than that in the control group (p < 0.05). The incision VAS score in the endoscopy group was also significantly lower than that in the control group at each time after surgery (p < 0.05). Besides, compared with the control group, in the endoscopy group, the leg pain VAS score and lumbar ODI score after surgery were significantly decreased (p < 0.05). Compared with the control group, in the endoscopy group, the lumbar JOA score was significantly higher (p < 0.05).Conclusion: Percutaneous endoscopic technique is a small trauma, quick recovery, safe and effective minimally invasive surgery for patients with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy.

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