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.

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 Clinical Features and Efficacy Analysis of Redundant Nerve Roots

2021 ◽  
Vol 8 ◽  
Author(s):  
Jianzhong Xu ◽  
Yong Hu
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Clinical Features ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Leg Pain ◽  
Common Finding ◽  
Nerve Roots ◽  
Standard Deviations ◽  
Lumbar Spinal

Introduction: Redundant nerve roots (RNRs) are common finding in lumbar spinal stenosis patients. Up to now, many relevant studies were carried out on the mechanism, pathogenic factors, and clinical features of redundant nerve roots. However, there are few studies on the surgical methods. In this study, posterior lumbar interbody fusion and internal fixations were used in 30 patients with RNRs in our hospital. Moreover, we also proposed new ideas about different types and subtypes of RNRs using patterns and their corresponding MRI images.Methods: Thirty patients with lumbar spinal stenosis and RNRs were enrolled in this study and underwent surgery between January 2009 and December 2014. Redundant nerve roots are identified as elongated, tortuous, or serpiginous nerve roots present in the subarachnoid space on sagittal T2-weighted magnetic resonance imaging (MRI) studies. Patients were treated with posterior decompression, intervertebral disc resection, and instrumented interbody fusion. The age, sex, disease course, operative time, intraoperative blood loss, operative segments were recorded. Outcome measures recorded to identify symptom improvement included pre-operative and post-operative visual analog scale (VAS), pre-operative and post-operative Oswestry Disability Index (ODI) and pre-operative and post-operative Japanese Orthopedic Association (JOA) scores.Results: VAS back pain, VAS leg pain VAS, ODI, and JOA with standard deviations were 6.4 ± 0.9, 7.1 ± 0.8, 43.0 ± 2.2, and 10.3 ± 2.6, respectively. At 3 months post-operatively, VAS back pain, VAS leg pain VAS, ODI, and JOA with standard deviations were 1.4 ± 0.5, 1.6 ± 0.6, 13.0 ± 1.6, and 25.0 ± 1.8, respectively. Nerve redundancy resolved in all cases on post-operative MRI.Conclusion: Posterior lumbar laminectomy and instrumented interbody fusion relieves low back and leg pain in patients with lumbar spinal stenosis and RNRs and can alleviate the tortuous appearance of the cauda equina in the decompressed segment.

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 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 Minimally invasive direct decompression for lumbar spinal stenosis: impact of multiple prior epidural steroid injections

2021 ◽  
Author(s):  
Peter Pryzbylkowski ◽  
Anjum Bux ◽  
Kailash Chandwani ◽  
Vishal Khemlani ◽  
Shawn Puri ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Ligamentum Flavum ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Vas Scores ◽  
Lumbar Spinal ◽  
Epidural Steroid ◽  
Modified Algorithm

Background: A modified algorithm for the treatment of lumbar spinal stenosis with hypertrophic ligamentum flavum using minimally-invasive lumbar decompression ( mild®)was assessed, with a focus on earlier intervention. Patients & methods: Records of 145 patients treated with mild after receiving 0–1 epidural steroid injections (ESIs) or 2+ ESIs were retrospectively reviewed. Pain assessments as measured by visual analog scale (VAS) scores were recorded at baseline and 1-week and 3-month follow-ups. Results: Improvements in VAS scores at follow-ups compared with baseline were significant in both groups. No statistically significant differences were found between the two groups. Conclusion: Multiple ESIs prior to mild showed no benefit. A modified algorithm to perform mild immediately upon diagnosis or after the failure of the first ESI is recommended.

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.

scholarly journals Radiological Significance of Ligamentum Flavum Hypertrophy in the Occurrence of Redundant Nerve Roots of Central Lumbar Spinal Stenosis

2012 ◽  
Vol 52 (3) ◽  
pp. 215 ◽  
Author(s):  
Junseok W Hur ◽  
Junho K Hur ◽  
Taek-Hyun Kwon ◽  
Youn Kwan Park ◽  
Hung Seob Chung ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Ligamentum Flavum ◽  
Nerve Roots ◽  
Lumbar Spinal

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.

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