A Neural Mobilization Treatment Strategy for Patients with Neurogenic Claudication Related to Degenerative Lumbar Spinal Stenosis: A Prospective Case Series

Introduction: Spinal stenosis mostly occur in lumbar spine and causes back pain, leg pain & neurogenic claudication. Although conservative treatment is mainstay, decompression with or without fusion (with or without instrumentation) can be considered in non-responsive cases. However, long term outcome of the surgery is controversial. The aim of our study was to analyze the outcome of surgery in lumbar spinal stenosis in terms of post-operative pain and claudication distance.Methods: A prospective analysis of patients who underwent decompression or decompression with fusion (with or without instrumentation), after failure of 3-6 months conservative treatment, for lumbar spinal stenosis were conducted. Only those who were operated and followed up for at least two years were included.Their preop and postop VAS score and walking distance compared.Results: Of 22 cases enrolled in this study, VAS score was improved in 21 patients and walking distance increased. Only one patient complained of increase in pain score at 24 months.Conclusion: Operative management is a good option for selected patients, 21 out of 22 have improved VAS and claudication distance in our study

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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

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20220120 ◽

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.

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Improvement in Neurogenic Pain with Epidural Injections Following Interspinous Spacer Implantation in Patients with Lumbar Stenosis: A Case Series

Pain Management Case Reports ◽

10.36076/pmcr.2020/4/211 ◽

2020 ◽

pp. 211-215

Author(s):

Steve M. Aydin

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Case Series ◽

Invasive Procedure ◽

Neurogenic Claudication ◽

Lumbar Region ◽

Neurogenic Pain ◽

Interspinous Spacer ◽

Epidural Injections ◽

Lumbar Spinal

Background: Lumbar spinal stenosis with neurogenic claudication can be a debilitating condition, affecting quality of life. Interspinous spacer implantation is a minimally invasive procedure for treatment of lumbar spinal stenosis with neurogenic claudication and associated symptoms by minimizing spinal extension and therefore neural compression. Case Presentation: This case series presents 4 cases of patients with multilevel stenosis, most radiographically severe in the lumbar region, all who received interspinous spacers at L3-4 and L4-5 after minimal improvement in symptoms with conservative management including epidural injections. In all 4 cases, patients reported improved standing and gait but limited improvement in pain and overall function after interspinous spacer implantation. Each patient underwent repeat epidural injections at or below the level of the interspinous spacer with significant improvement in pain for up to 6 months. Conclusion: Our conclusion is that either postspacer epidural injections helped reduce inflammation associated with the implantation procedure, or the spacer maintained an open space to allow the injectate to permeate areas with the most stenosis and help reduce inflammation and therefore pain. Key words: Epidural injection, interspinous process decompression, interspinous spacer, interspinous spacer implant, low back pain, lumbar spinal stenosis, neurogenic claudication, spinal stenosis

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Percutaneous Interspinous Spacer vs Decompression in Patients with Neurogenic Claudication: An Alternative in Selected Patients?

Neurosurgery ◽

10.1093/neuros/nyx326 ◽

2017 ◽

Vol 82 (5) ◽

pp. 621-629 ◽

Cited By ~ 9

Author(s):

Bernhard Meyer ◽

Adad Baranto ◽

Frederic Schils ◽

Frederic Collignon ◽

Bjorn Zoega ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Controlled Trial ◽

Reoperation Rate ◽

Leg Pain ◽

Neurogenic Claudication ◽

Neurogenic Intermittent Claudication ◽

Degenerative Lumbar Spinal Stenosis ◽

Index Level ◽

Lumbar Spinal

Abstract BACKGROUND Standalone interspinous process devices (IPDs) to treat degenerative lumbar spinal stenosis with neurogenic intermittent claudication (NIC) have shown ambiguous results in the literature. OBJECTIVE To show that a minimally invasive percutaneous IPD is safe and noninferior to standalone decompressive surgery (SDS) for patients with degenerative lumbar spinal stenosis with NIC. METHODS A multicenter, international, randomized, controlled trial (RCT) was con- ducted. One hundred sixty-three patients, enrolled at 19 sites, were randomized 1:1 to treatment with IPD or SDS and were followed for 24 mo. RESULTS There was significant improvement in Zurich Claudication Questionnaire physical function, as mean percentage change from baseline, for both the IPD and the SDS groups at 12 mo (primary endpoint) and 24 mo (−32.3 ± 32.1, −37.5 ± 22.8; and −37.9 ± 21.7%, −35.2 ± 22.8, both P < .001). IPD treatment was not significantly noninferior (margin: 10%) to SDS treatment at 12 mo (P = .172) but was significantly noninferior at 24 mo (P = .005). Symptom severity, patient satisfaction, visual analog scale leg pain, and SF-36 improved in both groups over time. IPD showed lower mean surgical time and mean blood loss (24 ± 11 min and 6 ± 11 mL) compared to SDS (70 ± 39 min and 189 ± 148 mL, both P < .001). Reoperations at index level occurred in 18.2% of the patients in the IPD group and in 9.3% in the SDS group. CONCLUSION Confirming 3 recent RCTs, we could show that IPD as well as open decompression achieve similar results in relieving symptoms of NIC in highly selected patients. However, despite some advantages in secondary outcomes, a higher reoperation rate for IPD is confirmed.

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The identification of novel gene mutations for degenerative lumbar spinal stenosis using whole-exome sequencing in a Chinese cohort

BMC Medical Genomics ◽

10.1186/s12920-021-00981-4 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Xin Jiang ◽

Dong Chen

Keyword(s):

Exome Sequencing ◽

Whole Exome Sequencing ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Gene Mutations ◽

Specific Gene ◽

Single Nucleotide ◽

Degenerative Lumbar Spinal Stenosis ◽

Whole Exome ◽

Lumbar Spinal

Abstract Background Degenerative lumbar spinal stenosis (DLSS) is a common lumbar disease that requires surgery. Previous studies have indicated that genetic mutations are implicated in DLSS. However, studies on specific gene mutations are scarce. Whole-exome sequencing (WES) is a valuable research tool that identifies disease-causing genes and could become an effective strategy to investigate DLSS pathogenesis. Methods From January 2016 to December 2017, we recruited 50 unrelated patients with symptoms consistent with DLSS and 25 unrelated healthy controls. We conducted WES and exome data analysis to identify susceptible genes. Allele mutations firstly identified potential DLSS variants in controls to the patients’ group. We conducted a site-based association analysis to identify pathogenic variants using PolyPhen2, SIFT, Mutation Taster, Combined Annotation Dependent Depletion, and Phenolyzer algorithms. Potential variants were further confirmed using manual curation and validated using Sanger sequencing. Results In this cohort, the major classification variant was missense_mutation, the major variant type was single nucleotide polymorphism (SNP), and the major single nucleotide variation was C > T. Multiple SNPs in 34 genes were identified when filtered allele mutations in controls to retain only patient mutations. Pathway enrichment analyses revealed that mutated genes were mainly enriched for immune response-related signaling pathways. Using the Novegene database, site-based associations revealed several novel variants, including HLA-DRB1, PARK2, ACTR8, AOAH, BCORL1, MKRN2, NRG4, NUP205 genes, etc., were DLSS related. Conclusions Our study revealed that deleterious mutations in several genes might contribute to DLSS etiology. By screening and confirming susceptibility genes using WES, we provided more information on disease pathogenesis. Further WES studies incorporating larger DLSS patient cohorts are required to comprehend the genetic landscape of DLSS pathophysiology fully.

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