scholarly journals Comparative study between functional outcome of lumbar canal stenosis treated with surgical decompression by laminectomy and unilateral partial hemi laminectomy approaches

2018 ◽  
Vol 4 (4) ◽  
pp. 610
Author(s):  
K. Ramesh ◽  
G. Vimalan
Keyword(s):  
Japanese Orthopaedic Association ◽  
Preoperative Assessment ◽  
Japanese Orthopaedic Association Score ◽  
Neurogenic Claudication ◽  
Excellent Outcome ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
Surgical Options ◽  
One Year ◽  
Lumbar Spinal

<p class="abstract"><strong>Background:</strong> Lumbar spinal canal stenosis may eventually cause signs of intermittent neurogenic claudication<strong>. </strong>The surgical options include procedures such as midline decompression by laminectomy and different kinds of unilateral and bilateral fenestrations and partial or full hemi laminectomies. The aim of the study is to unilateral decompressive approach provides the sufficient decompression; less invasive unilateral procedure, which preserves posterior musculoligamentous complex and bony structures reduce associated morbidity.</p><p class="abstract"><strong>Methods:</strong> 41 patients underwent preoperative assessment of Japanese orthopaedic association score (JOA Score), Neurogenic claudication outcome scores (NCOS), visual analogy scale for back pain and neurogenic claudication. Patients were randomized to undergo either unilateral decompression by partial hemi laminectomy or CMD (CMD) by laminectomy. 20 patients was randomized into unilateral decompression by partial hemi laminectomy group and 21 patients into CMD (CMD) by laminectomy group.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean JOA recovery rate was 50.61% for the unilateral decompression group and 52.12% for the CMD group. Notably, 62% of CMD group had good or excellent outcome while 70% of unilateral decompression group had a good or excellent outcome.</p><p><strong>Conclusions:</strong> In our study, unilateral decompression by a partial hemi laminectomy provides minimal exposure for decompression in lumbar canal stenosis while preserving musculoligamentous attachments of the posterior elements of the spine and good postoperative results after one year with favorable outcomes of at least 70%. </p>

scholarly journals Degrees of Canal Stenosis, Levels of Interleukin-6 (IL-6) And C-Reactive Protein (CRP) Preoperative as Predictors of the Output of Neurogenic Claudication Outcome Score (NCOS) 8 Weeks Post-Decompression-Stabilization-Fusion in Degenerative Lumbar Spinal Stenosis Patients

2022 ◽  
Vol 12 (1) ◽  
pp. 137-146
Author(s):  
Nyoman Gede Bimantara ◽  
I Ketut Suyasa ◽  
I Gede Eka Wiratnaya
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Neurogenic Claudication ◽  
C Reactive Protein ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Canal Stenosis ◽  
Reactive Protein ◽  
Canal Stenosis ◽  
Magnetic Resonance Imaging Mri ◽  
Lumbar Spinal

Introduction: Lumbar Spinal Stenosis (LSS) or spinal stenosis is the most common spinal disease in elderly patients. LSS is also one of the leading causes of spinal surgery in the world. The problem that is often encountered is the limited predictor of outcomes that are considered affordable and accurate, so as to provide education to patients about possible output after the surgery process is carried out. Therefore, a predictor is needed that is considered accurate and affordable such as the degree of measurable canal stenosis of Magnetic resonance imaging (MRI), serum levels of C-Reactive Protein (CRP) and Interleukin-6 (IL-6) Method: This study used a prospective cohort design conducted to compare Neurogenic Claudication Outcome Score scores among people with degenerative lumbar canal stenosis whose post-decompression-stabilization-fusion had higher degrees of canal stenosis (measured through Schizas grading of Magnetic resonance Imaging/MRI) examinations), as well as high pre-operative CRP and IL-6 levels with those with normal CRP and IL-6 levels. From the population of lumbar spinal stenosis, the selection of samples was conducted consecutively sampling. After that, statistical tests in the form of descriptor tests, normality tests, risk factor assessments with 2x2 cross tabulation, and proportion comparison analysis using the Fisher Exact test. Result: Severe lumbar canal stenosis degrees resulted in worse NCOS 8 weeks postoperative than mild degrees of lumbar canal stenosis, with statistically significant differences (p=0.008; p < 0.05) and RR 6.4 (0.99-41.08). High CRP levels resulted in worse NCOS 8 weeks postoperative than mild lumbar degrees of canal stenosis, with statistically significantly differences (p=0.008; p < 0.05) and RR 6.4 (0.99-41.08). High pre-operative IL-6 levels resulted in worse NCOS 8 weeks postoperative than normal pre-operative IL-6 levels with statistically significantly differences (p=0.002; p < 0.05) and RR 8 (1.24-51.50). Conclusion: Degrees of preoperative (mild) canal stenosis, high pre-operative CRP levels, and high levels of pre-operative IL-6 were predictors for better 8-week NCOS scores in patients with post-decompression-stabilizing-fusion degenerative LSS disease. Key words: Degenerative lumbar spinal stenosis, IL-6, CRP, canal degree stenosis, NCOS.

scholarly journals Results of posterior decompression with non-instrumented lumbar fusion surgery in cases of degenerative lumbar canal stenosis presenting with neurogenic claudication in a tertiary care hospital

2021 ◽  
Author(s):  
Maruti Bhujangrao Lingayat ◽  
Ansari Muqtadeer Abdul Aziz ◽  
Gaurav Balasaheb Mate ◽  
Sourabh Sahebrao Dhamale
Keyword(s):  
Lumbar Fusion ◽  
Tertiary Care ◽  
Long Term Results ◽  
Neurogenic Claudication ◽  
Care Hospital ◽  
Instrumented Fusion ◽  
Lumbar Canal Stenosis ◽  
Vas Score ◽  
Canal Stenosis ◽  
The Masses

<p><strong>Background:</strong> Degenerative lumbar canal stenosis remains an important public health problem in today’s date. With the overall average age of the world’s population rising steadily it is important to have an optimal treatment plan affordable to the masses. Non-instrumented fusion after decompression remains an important treatment option which is affordable to the masses and effectively treats the instability occurring due to degeneration process. This study aims to understand the results of such treatment in a tertiary care center catering to the masses.</p><p><strong>Methods: </strong>The study was conducted in 34 patients with diagnosed degenerative lumbar canal stenosis with neurogenic claudication who underwent decompressive laminectomy with a posterolateral strut graft posterolateral fusion from July 2018 to August 2020. Each patient was followed up for 12 months.</p><p><strong>Results: </strong>In the present study, a total of 34 patients with degenerative lumbar canal stenosis with neurogenic claudication were included. There were 18 male and 16 female patients. The pre-operative Swiss spinal stenosis Score was 61-80 (52.9%) and these scores improved to a majority of patients in the category of 21-40 (82.4%) at 1 year postoperatively. The average VAS score was 4.7±1.8 preoperatively while the average post op VAS score was 0.8±0.77.</p><p><strong>Conclusions: </strong>Non-instrumented fusion of the vertebrae with decompression has significantly improved results at 1 year follow up postoperatively and it is an excellent easy and cost-effective technique if used in a properly selected patient. Further studies are required to assess its long-term results.</p>

scholarly journals Simultaneous Cervical and Lumbar Spine Surgery: Retrospective Analysis of 45 Cases

2019 ◽  
Vol 08 (01) ◽  
pp. 047-052 ◽  
Author(s):  
Amit Aiwale ◽  
Pankajkumar Patel ◽  
Syed Paspala ◽  
T. Murthy
Keyword(s):  
Lumbar Spine ◽  
Spinal Stenosis ◽  
Japanese Orthopaedic Association ◽  
Cost Effective ◽  
Lumbar Spine Surgery ◽  
Neurogenic Claudication ◽  
Cervical Canal ◽  
Canal Stenosis ◽  
Significant Difference ◽  
The Mean

Abstract Background The term ‘tandem spinal stenosis’ (TSS) was first introduced by Dagi et al to describe concurrent symptomatic cervical and lumbar spinal stenosis. A typical clinical picture includes intermittent neurogenic claudication, myelopathy, and polyradiculopathy in both the upper and lower extremities. The incidence of TSS ranges from 0.12 to 28%. Methods We studied patients who presented with tandem canal stenosis and operated cervicolumbar decompression with or without fusion procedures by two separate neurosurgical teams simultaneously from June 2015 to 2017 with follow-up period of minimum 6 months. Results We had 30 (66.66%) male and 15 (33.33%) female patients who underwent simultaneous cervical and lumbar spine surgeries. The average age was 57.8 years (male) and 53.9 years (female). Cervical canal stenosis was graded as per magnetic resonance imaging (MRI) morphological grades of stenosis by Kang et al and lumbar grading, was done as per Schizas et al grading system. The mean duration of complaints in cervical and lumbar compression was 29.54 ± 44.99 months and 30.55 ± 38.11 months, respectively. The mean preoperative Japanese Orthopaedic Association (JOA) score of was 10.46 ± 1.39, whereas the postoperative mean JOA score was 11.93 ± 1.28, and mean preoperative (38.59 ± 16.52) and postoperative (29.22 ± 9.38) Oswestry Disability Index (ODI) scores showed a statistically significant difference (p = 0.0001). Conclusion Patients with TSS are elderly and have associated comorbidities, still simultaneous cervical and lumbar surgery is feasible with the good outcome if you have two neurosurgical teams operating simultaneously and having good other super specialty teams’ support. It can be timesaving and cost effective for patients. Also, it avoids patients from undergoing exposure to two separate surgical and anesthetic stress.

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 Successful operative management of an upper lumbar spinal canal stenosis resulting in multilevel lower nerve root radiculopathy

2015 ◽  
Vol 6 (01) ◽  
pp. 108-111 ◽  
Author(s):  
Shearwood McClelland ◽  
Stefan S. Kim
Keyword(s):  
Spinal Canal ◽  
Operative Management ◽  
Spinal Canal Stenosis ◽  
Neurogenic Claudication ◽  
Lumbar Stenosis ◽  
Lumbar Spinal Canal Stenosis ◽  
Nerve Roots ◽  
Canal Stenosis ◽  
Lumbar Spinal ◽  
Sacral Radiculopathy

ABSTRACTLumbar stenosis is a common disorder, usually characterized clinically by neurogenic claudication with or without lumbar/sacral radiculopathy corresponding to the level of stenosis. We present a case of lumbar stenosis manifesting as a multilevel radiculopathy inferior to the nerve roots at the level of the stenosis. A 55-year-old gentleman presented with bilateral lower extremity pain with neurogenic claudication in an L5/S1 distribution (posterior thigh, calf, into the foot) concomitant with dorsiflexion and plantarflexion weakness. Imaging revealed grade I spondylolisthesis of L3 on L4 with severe spinal canal stenosis at L3-L4, mild left L4-L5 disc herniation, no stenosis at L5-S1, and no instability. EMG revealed active and chronic L5 and S1 radiculopathy. The patient underwent bilateral L3-L4 hemilaminotomy with left L4-L5 microdiscectomy for treatment of his L3-L4 stenosis. Postoperatively, he exhibited significant improvement in dorsiflexion and plantarflexion. The L5-S1 level was not involved in the operative decompression. Patients with radiculopathy and normal imaging at the level corresponding to the radiculopathy should not be ruled out for operative intervention should they have imaging evidence of lumbar stenosis superior to the expected affected level.

scholarly journals Techniques of Surgery for Lumbar Spinal Stenosis: A comparative study

2018 ◽  
Vol 32 (2) ◽  
pp. 240-261
Author(s):  
Gabriel Iacob ◽  
Abdul Salam ◽  
Abdul Rahman Hawis
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Study Groups ◽  
Common Type ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
Lateral Recess Stenosis ◽  
Group A ◽  
Group B ◽  
Lumbar Spinal

Abstract Aim: To compare between classic open surgeries and minimally invasive surgeries in Lumbar Spinal Stenosis. Methods: A comparative descriptive study, involved 117 patients suffering from lumbar canal stenosis, aged between 40-70 years; admitted to department of Neurosurgery from March 2011 till august 2016 in King Fahad Hospital in Saudi Arabia. Study groups are consisted of group A as patients managed with classical laminectomy, group B as patients managed with Endoscopic spinal procedures and group C as patients managed with Microscopic decompression facilitated by the Metrex Tubular System. SPSS was used in data entry and analysis, and ethical considerations taken into consideration and participants filled the required inform consents. Results: Age of particaoncet ranged from 45 - 63 Year, Mean +/- 50. The degenerative canal stenosis with acute disc single level (cauda equina syndrome) was the most common type of lumbar canal stenosis encountered in group A, the unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group B, while The unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group C. Classic laminectomy and disectomy used mostly in group A, endoscopic unilateral decompression lamino-foraminotomy without discectomy used mostly in group B and bilateral microscopic laminectomy without discectomy followed by unilateral microscopic lamino-foraminotomy without discectomy used mostly in group C. Mean of operation duration was the highest in both gender of group A, followed by group B, then group C. Unintended durotomy was the most common intra operative complications occurred in the whole study especially in group A. Mean of blood lost was the highest in both gender of group A, followed by group B, then group C. Postop complications in the patients of study Groups was the highest in group A (33.3 %) ,followed by group B (8.5 %) and then group C (2 %). Conclusion: Microscopic decompression facilitated by the Metrex Tubular System is the most effective techniques of Surgery for Lumbar Spinal Stenosis and the least intraoperative and post-operative complications.

scholarly journals Study of Percutaneous Lumbar Decompression and Treatment Algorithm for Patients Suffering from Neurogenic Claudication

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. 451-460
Author(s):  
Timothy R. Deer
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Radicular Pain ◽  
Neurogenic Claudication ◽  
Lumbar Decompression ◽  
Reduction Of Pain ◽  
One Year ◽  
Lumbar Spinal ◽  
Over Time

Background: Symptomatic lumbar spinal stenosis (LSS) patients often suffer from multiple etiologies, and patient symptoms must be differentiated and identified as either neurogenic claudication, radicular pain, or both. The most common symptom associated with LSS is neurogenic claudication, which has been reported to occur in 91% to 100% of the LSS patient population. Neurogenic claudication symptoms are described as pain radiating to the lower extremities that begins and worsens as the patient ambulates. Neurogenic claudication symptoms worsen over time and can eventually result in significant life-altering functional limitations. Symptomatic LSS patients may also suffer from radicular pain, which is a persistent pain transmitted through neural pathways, and is associated with inflammation of the exiting nerve root. Objective: To assess patient safety, pain reduction, and functional status of patients treated with percutaneous lumbar decompression. Study Design: Single-center, prospective clinical study of 46 consecutive patients with neurogenic claudication symptoms related to lumbar spinal stenosis. Setting: US interventional pain management practice. Methods: From March 2010 to January 2011, 46 LSS patients suffering from neurogenic claudication underwent mild percutaneous lumbar decompression. Of these, 12-week, 6-month and one-year followup was available for 35 patients. Outcome Assessment: Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ). Outcomes were assessed at baseline, 12-week, 6-month and one-year follow-up. Results: One-year follow-up patients in this study experienced statistically and clinically significant improvement in physical function, as well as reduction of pain intensity. The initial improvement in these patients, which was significant, was sustained through one year, with no significant differences among the interim follow-up visit periods. These results demonstrate early improvement following treatment with a high degree of durability over time. There were no serious device or procedure-related complications reported in this study. Limitations: Single-center study with no control group. Conclusions: In this study, the mild procedure was shown to be safe. In addition, patients experienced significant improvement in mobility and reduction of pain one year after the procedure. One-year outcomes were not significantly different from interim results, indicating that the significant improvement following treatment, occurring as early as 12 weeks, was maintained through one year. This high degree of consistency over time indicates the durability of percutaneous lumbar decompression in the treatment of neurogenic claudication in symptomatic LSS. Key words: Spine, lumbar, lumbar spinal stenosis, neurogenic claudication, decompression, ligamentum flavum, mild, percutaneous.

scholarly journals Outcome of Surgical Decompression in Simple Degenerative Lumbar Canal Stenosis

2014 ◽  
Vol 3 (2) ◽  
pp. 2-9
Author(s):  
Byapak Paudel ◽  
Harvinder Singh Chhabra ◽  
Rabindra Lal Pradhan ◽  
Mohit Arora
Keyword(s):  
Neurological Deficit ◽  
Recovery Rate ◽  
Surgical Decompression ◽  
Motor Deficit ◽  
Neurogenic Claudication ◽  
Comorbid Conditions ◽  
Outcome Predictor ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
Neurologically Normal

Introduction: A sensory or motor deficit occurs in about half of patients with symptomatic lumbar canal stenosis. There is no study evaluating neurologically deficient patients with simple degenerative lumbar canal stenosis using validated measures and there are no consensus about outcome predictor of surgical decompression is available in literature. Only one study assessed outcome of patients with neurological deficit but it had not excluded either patients with comorbid conditions that affect outcome or those with lumbar canal stenosis secondary to spondylolisthesis and scoliosis. The aim of this study was to assess overall result and to compare the surgically treated patients of simple degenerative lumbar canal stenosis using validated outcome measures like Oswestry Disability Scale (ODS), Neurogenic Claudication Score (NCS), Visual Analogue Scale (VAS) and Satisfaction, this study also aimed to find outcome predictor of surgical decompression. Methods: This was a retrospective comparative study with homogenous cohorts with control of comorbid conditions that affect outcome. Each cohort ( Those with neurological deficit and without neurological deficit) had 11 patients who had adequate decompression with laminectomy and foraminotomies. Outcome was evaluated using validated ODS, NCS, VAS and Satisfaction in overall and also evaluated by each section of ODS, NCS with appropriate statistical analysis of both cohorts. Results: Neurologically deficient patients had more back pain, tingling, numbness, weakness and heaviness preoperatively. In neurologically deficient patients there was a trend to have poorer outcome, but overall recovery rate was higher than neurologically normal patients. Sensory deficit did not recover. The index surgery may not have effect on sitting and sleeping in both cohorts and may not have effect on lifting in neurologically normal patients and may not have effect on social life in neurological deficient patients. Additionally the index surgery may not have effect in relieving symptoms of numbness, tingling and heaviness and weakness in neurologically normal patients and may not have effect on standing in both cohorts. Recovery according to VAS was higher in neurologically normal patients. Preoperative NCS and preoperative heaviness and weakness severity contributed up to 43 % in ODS recovery rate. Conclusion: Overall there is a trend to have poorer outcome in neurologically deficient patients though recovery rate is better than neurologically normal patients. Recovery in term of VAS is better in neurologically normal patients. Preoperative NCS and preoperative heaviness and weakness severity score predict or contribute up to 43 % in ODS recovery rate. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9512   NOAJ July-December 2013, Vol 3, Issue 2, 2-9

scholarly journals Role of redundant nerve roots in clinical manifestations of lumbar spine stenosis

2021 ◽  
Vol 12 ◽  
pp. 218
Author(s):  
Karim Rizwan Nathani ◽  
Komal Naeem ◽  
Hamid Hussain Rai ◽  
Muhammad Danish Barakzai ◽  
Haissan Iftikhar ◽  
...  
Keyword(s):  
Japanese Orthopaedic Association ◽  
Radiological Finding ◽  
Cauda Equina ◽  
Clinical Manifestations ◽  
Nerve Roots ◽  
Duration Of Symptoms ◽  
Canal Stenosis ◽  
Clinical Presentations ◽  
Preoperative Magnetic Resonance ◽  
Lumbar Spinal

Background: Redundant nerve roots (RNRs) are defined as elongated, thickened, and tortious appearing roots of the cauda equina secondary to lumbar spinal canal stenosis (LSCS). The study compared the clinical and radiological features of patients with LSCS with versus without RNR. Methods: This retrospective study was performed on 55 patients who underwent decompressive surgery for degenerative LSCS. Patients were divided into two groups based on the presence of RNR in their preoperative magnetic resonance imaging, as evaluated by a radiologist blinded to the study design. Medical records were reviewed for basic demographic, clinical MR presentation, and outcomes utilizing Japanese Orthopaedic Association (JOA) scores. Results: The mean age of enrolled patients was 57.1, with mean follow-up of 4.0 months. RNR was found in 22 (40%) of patients with LSCS. These patients were older than those patients without RNR (62.2 vs. 53.7). Interestingly, there were no statistically significant differences in clinical presentations, duration of symptoms, and outcomes using JOA scores between the two groups. Conclusion: RNR is a relatively common radiological finding (i.e., 40%) in patients with LSCS. It is more likely to be observed in older patients. However, no significant differences were noted in clinical presentation and functional outcomes with respect to the presence or absence of RNR.

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