THE UNDERLYING PATHOPHYSIOLOGY AND CLINICAL APPEARANCE OF LSS, AND THE AVAILABLE DIAGNOSTIC AND THERAPEUTIC OPTIONS

The term lumbar spinal stenosis (LSS) refers to the narrowing of the spinal canal due to anatomical reasons, and it is linked to a variety of clinical symptoms.The onset of stenosis LSS can be unilateral or bilateral, monosegmental or multisegmental. The stenosis can be characterized as central, lateral, or foraminal anatomically.Neurogenic claudication is the most prevalent symptom of LSS, which is defined as limping or cramping lumbar pain that spreads into the legs primarily during walking.Typical patient symptoms include unilateral or bilateral (exertional) back and leg discomfort that develops over months, if not years.As people live longer and seek a better quality of life, as well as increased knowledge of the condition and the availability of improved imaging techniques, the number of people diagnosed with degenerative LSS has increased.

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Prediction of walking ability following posterior decompression for lumbar spinal stenosis

European Spine Journal ◽

10.1007/s00586-021-06938-6 ◽

2021 ◽

Author(s):

Suzanne McIlroy ◽

Feroz Jadhakhan ◽

David Bell ◽

Alison Rushton

Keyword(s):

Quality Of Life ◽

Higher Education ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Walking Distance ◽

Walking Ability ◽

Poor Outcome ◽

Lumbar Spinal ◽

Reduced Risk

Abstract Purpose Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS. Methods An observational cohort study was conducted using data from the British Spine Registry (2017–2018) of adults (≥ 50 years) with LSS, who underwent ≤ 2 level posterior lumbar decompression. Patients receiving fixation or who had previous lumbar surgery were excluded. Walking ability was assessed by a single item on the Oswestry Disability Index and dichotomised into poor/good outcome. Multivariable regression models were performed. Results 14,485 patients were identified. Pre-operatively 30% patients reported poor walking ability, this decreased to 8% at 12 months follow-up. Predictors associated with poor walking ability at 12 months were: increasing age (≥ 75 years OR 1.54, 95% CI 1.07, 2.18), BMI ≥ 35 kg/m2 (OR 1.52, 95% CI 1.00, 2.30), severity of leg pain (OR 1.10, CI 95% 1.01, 1.21), disability (OR 1.01, 95% CI 1.01, 1.02) and quality of life (OR 0.72, 95% CI 0.56, 0.89). Pre-operative maximum walking distance (OR 1.10, 95% CI 1.05, 1.25) and higher education (OR 0.90, 95% CI 0.80, 0.96) were associated with reduced risk of poor walking ability at 12 months; p < 0.05. Depression, fear of movement and symptom duration were not associated with risk of poor outcome. Conclusion Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.

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Health-related quality of life and comorbidities associated with lumbar spinal stenosis

The Spine Journal ◽

10.1016/j.spinee.2011.11.009 ◽

2012 ◽

Vol 12 (3) ◽

pp. 189-195 ◽

Cited By ~ 33

Author(s):

Michele C. Battié ◽

C. Allyson Jones ◽

Donald P. Schopflocher ◽

Richard W. Hu

Keyword(s):

Quality Of Life ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Lumbar Spinal

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Radiologic Efficacy and Patient Satisfaction after Minimally Invasive Unilateral Laminotomy and Bilateral Decompression in Patients with Lumbar Spinal Stenosis: A Retrospective Analysis

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1701621 ◽

2020 ◽

Vol 81 (06) ◽

pp. 475-483

Author(s):

Seung-Kook Kim ◽

Sungmo Ryu ◽

Eun-Sang Kim ◽

Sun-Ho Lee ◽

Su-Chan Lee

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Minimally Invasive ◽

Retrospective Analysis ◽

Spinal Stenosis ◽

Surgical Procedure ◽

Lateral Recess ◽

Lateral Recess Stenosis ◽

Lumbar Spinal

Abstract Background and Study Aims Lumbar spinal stenosis (LSS) is the most common spinal disease in older adults. Although surgical modalities are recommended in patients who are unresponsive to conservative treatment, the most appropriate minimally invasive surgical procedure for patients with LSS remains controversial. Moreover, few previous studies have focused on patient-centered outcomes with radiologic correlation. In the present study, we aimed to investigate radiologic efficacy and patient satisfaction following bilateral decompression via unilateral laminotomy. Materials and Methods We performed a retrospective analysis of radiologic efficacy and patient satisfaction in a series of surgical patients treated at our institution. We classified patients into two groups based on the primary pathology (i.e., central or lateral recess stenosis). Medical records were analyzed retrospectively for radiologic outcomes and clinical parameters including pain and changes in quality of life. Data related to outcomes were collected at 2 weeks, 3 months, and 12 months after surgery in the outpatient clinic. Results Among the 122 patients enrolled in this study, 51 had central spinal stenosis; 71 had lateral recess stenosis. Radiologically, we observed significant improvements in the anteroposterior diameter and cross-sectional area of the dural sac (central stenosis) and the lateral width of the central canal and depth of the lateral recess (lateral recess stenosis). Two weeks and 12 months after the surgical procedure, we observed significant improvements in the extent of symptoms, patient satisfaction, and quality of life (including physical function). Conclusion Our findings suggest that bilateral decompression via a unilateral approach shows improved radiologic outcomes, varying based on the type of stenosis. Furthermore, patient satisfaction significantly improved regardless of the type of disease.

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The effectiveness of vitamin D supplementation in functional outcome and quality of life (QoL) of lumbar spinal stenosis (LSS) requiring surgery

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01629-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Sangbong Ko ◽

Seungbum Chae ◽

Wonkee Choi ◽

Jaibum Kwon ◽

Je-Yong Choi

Keyword(s):

Quality Of Life ◽

Vitamin D ◽

Functional Outcome ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Vitamin D Supplementation ◽

Lumbar Spinal

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Efficacy of percutaneous transforaminal endoscopic discectomy unilateral and bilateral approach for bilateral decompression in treatment of degenerative lumbar spinal stenosis and their effects on quality of life

Tobacco Regulatory Science ◽

10.18001/trs.7.6.129 ◽

2021 ◽

Vol 7 (6) ◽

pp. 6540-6554

Author(s):

Xuanhuang Chen ◽

Xiaoqiang Gao ◽

Haibin Lin ◽

Hanhua Cai ◽

Feng Zheng ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Stenosis ◽

Degenerative Lumbar Spinal Stenosis ◽

Endoscopic Discectomy ◽

Percutaneous Transforaminal Endoscopic Discectomy ◽

Bilateral Approach ◽

Group A ◽

Group B ◽

Lumbar Spinal

This study aimed to explore the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) unilateral and bilateral approach for bilateral decompression in the treatment of degenerative lumbar spinal stenosis (DLSS) and their effects on quality of life. Altogether 119 patients with DLSS admitted to our hospital from May 2012 to February 2014 were enrolled in this study. Patients in Group A (62 cases) were treated with PTED bilateral approach for bilateral decompression, while those in Group B (57 cases) were treated with PTED unilateral approach for bilateral decompression. The therapeutic effect and incidence of complications in the two groups were observed. Visual Analogue Scale (VAS) was used to assess the pain degree of the lower limbs. Oswestry Disability Index (ODI) was used to assess the improvement of neurological function. 36-ltem Short Form Health Survey (SF-36) developed by the Institute of Medicine was used to assess the quality of life. There were no significant differences between Group A and Group B in operative time, intraoperative blood loss, hospitalization time, the effective rate of treatment, and the incidence of complications (P>0.05). The recovery time of lumbar function in Group A was significantly shorter than that in Group B (P<0.01). VAS and ODI scores at 1, 3, and 6 months after operation in Group A were significantly lower than those in Group B (P<0.05). The scores of general health (GH), bodily pain (BP), social function (SF), vitality (VT), and mental health (MH) at 6 months after operation in Group A were significantly higher than those in Group B (P<0.05). In conclusion, PTED bilateral approach for bilateral decompression was effective in the treatment of patients with DLSS. It can promote the recovery of their lumbar function and neurological function, and improve their quality of life.

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Long-term Clinical Outcomes and Quality of Life in Elderly Patients Treated with Interspinous Devices for Lumbar Spinal Stenosis

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1604280 ◽

2017 ◽

Vol 79 (02) ◽

pp. 139-144 ◽

Cited By ~ 4

Author(s):

Massimo Miscusi ◽

Stefano Forcato ◽

Alessandro Ramieri ◽

Filippo Polli ◽

Antonino Raco ◽

...

Keyword(s):

Quality Of Life ◽

Elderly Patients ◽

Spinal Stenosis ◽

Local Anesthesia ◽

Lumbar Spinal Stenosis ◽

Short Form ◽

Meaningful Improvement ◽

Lumbar Spinal

Background and Objective Lumbar spinal stenosis (LSS) is a common degenerative condition that occurs in the spine with increasing age. Clinically, LSS causes a progressive reduction in walking autonomy, resulting in a poor quality of life and impaired functional capacity. The aim of this study was to evaluate the clinical outcome and quality of life of elderly patients presenting with LSS and associated comorbidities after a 5-year follow-up who were treated with an interspinous process device (IPD). Material and Methods Sixty patients > 75 years of age presenting with symptomatic degenerative LSS were included. All were treated with an IPD under local anesthesia. American Society of Anesthesiology score, Zurich Claudication Questionnaire, and Short Form 36 were evaluated pre- and postoperatively and at the follow-up visit each year for 5 years. Results The mean surgery time while under local anesthesia was 20 minutes. Forty-eight patients were followed for 5 years. Significant clinical improvements in all outcome scores (p < 0.05) both postoperatively or at follow-up were found. Conclusions IPD seems to be an effective and safe treatment for LSS in elderly patients with general comorbidities. In our study, all followed up patients had a meaningful improvement of their quality of life even at 5 years after surgery.

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Health-related quality of life (EQ-5D) before and one year after surgery for lumbar spinal stenosis

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.91b2.21119 ◽

2009 ◽

Vol 91-B (2) ◽

pp. 210-216 ◽

Cited By ~ 149

Author(s):

K.-å. Jansson ◽

G. Németh ◽

F. Granath ◽

B. Jönsson ◽

P. Blomqvist

Keyword(s):

Quality Of Life ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

One Year ◽

Lumbar Spinal

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Postoperative evaluation of quality of life in lumbar spinal stenosis patients following instrumented posterior decompression

Acta Orthopaedica et Traumatologica Turcica ◽

10.3944/aott.2011.2387 ◽

2011 ◽

Vol 45 (1) ◽

pp. 47-52 ◽

Cited By ~ 4

Author(s):

Bilal Aykac

Keyword(s):

Quality Of Life ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Postoperative Evaluation ◽

Posterior Decompression ◽

Lumbar Spinal

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SURGICAL TREATMENT OF ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE CENTRAL LUMBAR SPINAL STENOSIS

Hirurgiâ pozvonočnika ◽

10.14531/ss2018.3.73-84 ◽

2018 ◽

Vol 15 (3) ◽

pp. 73-84 ◽

Cited By ~ 2

Author(s):

R. V. Khalepa ◽

V. S. Klimov ◽

J. A. Rzaev ◽

I. I. Vasilenko ◽

E. V. Konev ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Spinal Stenosis ◽

Nerve Root ◽

Spinal Canal ◽

Older Age ◽

Age Group ◽

Cross Sectional ◽

Clinically Significant

Objective. To analyze the results of surgical treatment of patients of the older age group with central spinal stenosis at the lumbar level. Material and Methods. A total of 107 patients of elderly and senile age with clinically significant degenerative central stenosis of the spinal canal were treated. They were divided into two groups: patients in Group 1 underwent bilateral decompression of nerve roots through unilateral approach; those in Group 2 - nerve root decompression supplemented with interbody fusion and transpedicular fixation. Results. The surgery resulted in statistically significant reduction in pain, improvement of the quality of life, enlargement of spinal canal dimension parameters, and increase in the distance of walking. Statistical difference in the quality of life between Groups 1 and 2 was revealed for the indicator characterizing the psychological component of the SF-36 questionnaire (p = 0.03); there were no statistical differences for the remaining indicators. The key parameter for assessing central stenosis is the cross-sectional area of the dural sac. Conclusion. Preoperative examination of patients of the older age group should be comprehensive and include CT myelography with 3D reconstruction. The cause of nerve root compression in central stenosis is a combination of various factors in 41.9 % of cases. Differential surgical tactics provides an improvement in the quality of life in 80 % of cases. Excessive decompression does not improve the quality of life of patients. Instrumental fixation does not improve the outcome of surgical intervention and should be used only for clinically significant instability of the spinal motion segment.

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