Clinical and Radiographic Correlation (According to CT) in Patients with Degenerative Lumbar Spinal Stenosis

2017 ◽  
pp. 124-130 ◽  
Author(s):  
S. G. Mlyavykh ◽  
A. Y. Aleynik ◽  
A. E. Bokov ◽  
M. V. Rasteryaeva ◽  
M. A. Kutlaeva
Keyword(s):  
Ct Scan ◽  
Spinal Canal ◽  
Clinical Manifestations ◽  
Intervertebral Discs ◽  
Morphometric Parameters ◽  
Neurogenic Claudication ◽  
Clinical Group ◽  
Lumbar Stenosis ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal

Сomputed tomography (CT) is widely used in the diagnosis of  degenerative pathology of the lumbar spine, but the relationship  between clinical manifestations of lumbar stenosis and its anatomical prerequisites has not been sufficiently studied to date.The objective: to determine the significance of the morphometric  parameters of lumbar stenosis according to CT scans and to  establish their relationship with the prevailing symptoms of the disease.Material and methods. Seventy-five consecutive patients with  clinically significant lumbar stenosis who underwent CT scan before  surgery were enrolled in this study. The average values of thirteen  different morphometric parameters were calculated at LIII–SI levels of the intervertebral discs and of the pedicels in the axial and sagittal views. The possibility of classification of clinical observations and the correlation of morphometric parameters with the clinical forms of lumbar stenosis were investigated using discriminant and logistic regression analysis. Results. CT scan with high probability allocates patients with  predominant symptoms of neurogenic claudication or bilateral  radiculopathy. The most significant morphometric predictors of this  clinical group are the depth of the lateral recesses and the cross-sectional area of the spinal canal.Conclusion. CT scan significantly expands the informative value of  magnetic resonance imaging and can be used in planning the  decompressive stage of the surgery intervention in patients with lumbar spinal canal stenosis.

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 Outcome of Surgical Treatment of Degenerative Lumbar Spinal Stenosis.

2016 ◽  
Vol 14 (1) ◽  
pp. 25-28
Author(s):  
Bishnu Babu Thapa ◽  
Sushil Rana Magar ◽  
Pankaj Chand ◽  
Bachhu Ram KC
Keyword(s):  
Conservative Treatment ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Leg Pain ◽  
Walking Distance ◽  
Neurogenic Claudication ◽  
Long Term Outcome ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Vas Score ◽  
Lumbar Spinal

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

scholarly journals Intraoperative Myelography in Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Preliminary Prospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Yang Yang ◽  
Liangming Zhang ◽  
Jianwen Dong ◽  
Zihao Chen ◽  
Peigen Xie ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lateral Lumbar Interbody Fusion ◽  
Radiological Parameters ◽  
One Year ◽  
Lumbar Spinal

Aim. To investigate the feasibility and effectiveness of intraoperative myelography in determining adequacy of indirect spinal canal decompression during transpsoas lateral lumbar interbody fusion (LLIF). Methods. Seven patients diagnosed with degenerative lumbar spinal stenosis (DLSS) were prospectively included to this study. All patients underwent LLIF and subsequently received intraoperative myelography to determine the effect of indirect spinal canal decompression, which was visualized in both anterior-posterior and lateral images. Those patients with insufficient indirect canal decompression were further resolved by microendoscopic canal decompression (MECD). Radiological parameters, including stenosis ratio and dural sac area of operated levels, were measured and compared before and after operation. Besides, all patients were followed up for at least one year using visual analogue scale (VAS) for back and leg, Japanese Orthopaedic Association score (JOA), and Oswestry disability index (ODI). Results. Seven patients with 8 operated levels underwent LLIF safely and demonstrated significant symptom relief postoperatively. Five operated levels showed adequate indirect canal decompression intraoperatively, while the remaining three levels did not achieve the adequacy, and their residual stenosis was resolved following MECD. Radiological parameters were improved statistically when compared with preoperation (P<0.05). Furthermore, neurological symptoms of all patients were also improved significantly (P<0.05), shown by improved VAS (back and leg), JOA, and ODI at both two-week and one-year follow-up. Conclusions. Intraoperative myelography during LLIF is able to assess adequacy of indirect canal decompression for DLSS, thus promising favorable clinical outcomes.

scholarly journals Percutaneous Interspinous Spacer in Spinal-Canal-Stenosis Treatment: Pros and Cons

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 381 ◽  
Author(s):  
Zini ◽  
Bellini ◽  
Masala ◽  
Marcia
Keyword(s):  
Conservative Treatment ◽  
Spinal Canal ◽  
Meta Analysis ◽  
Surgical Decompression ◽  
Spinal Canal Stenosis ◽  
Comprehensive Description ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Canal Stenosis ◽  
Pros And Cons ◽  
Lumbar Spinal

A comprehensive description of the literature regarding interspinous process devices (IPD) mainly focused on comparison with conservative treatment and surgical decompression for the treatment of degenerative lumbar spinal stenosis. Recent meta-analysis and articles are listed in the present article in order to establish IPD pros and cons.

scholarly journals MINIMALLY INVASIVE SPINAL CANAL RECONSTRUCTION FOR DEGENERATIVE LUMBAR SPINAL STENOSIS

2017 ◽  
Vol 14 (3) ◽  
pp. 67-73 ◽  
Author(s):  
Valery Lebedev ◽  
◽  
Dmitry Epifanov ◽  
Gleb Kostenko ◽  
Tousif Ghodivala ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal

Midterm outcome after a microsurgical unilateral approach for bilateral decompression of lumbar degenerative spondylolisthesis

2012 ◽  
Vol 16 (1) ◽  
pp. 68-76 ◽  
Author(s):  
Ahmet Murat Müslüman ◽  
Tufan Cansever ◽  
Adem Yılmaz ◽  
Halit Çavuşoğlu ◽  
İsmail Yüce ◽  
...  
Keyword(s):  
Spinal Canal ◽  
Degenerative Spondylolisthesis ◽  
Neurogenic Claudication ◽  
Unilateral Approach ◽  
Midterm Outcome ◽  
Invasive Method ◽  
Lumbar Degenerative Spondylolisthesis ◽  
Lumbar Spinal ◽  
Dynamic Slip

Object The aim of this study was to evaluate the results and effectiveness of bilateral decompression via a unilateral approach in the treatment of lumbar degenerative spondylolisthesis (DS). Methods Operations were performed in 84 selected patients (mean age 62.1 ± 10 years) with lumbar DS between the years 2001 and 2008. The selection criteria included lower back pain with or without sciatica, neurogenic claudication that had not improved after at least 6 months of conservative treatment, and a radiological diagnosis of Grade I DS and lumbar stenosis. Decompression was performed at 3 levels in 15.5%, 2 levels in 54.8%, and 1 level in 29.7% of the patients with 1 level of spondylolisthesis. All patients were followed up for at least 24 months. For clinical evaluations, a visual analog scale, Oswestry Disability Index (ODI), and Neurogenic Claudication Outcome Score (NCOS) were used. Spinal canal size and (neutral and dynamic) slip percentages were measured both pre- and postoperatively. Results Neutral and dynamic slip percentages did not significantly change after surgery (p = 0.67 and p = 0.63, respectively). Spinal canal size increased from 50.6 ± 5.9 to 102.8 ± 9.5 mm2 (p < 0.001). The ODI decreased significantly in both the early and late follow-up evaluations, and good or excellent results were obtained in 64 cases (80%). The NCOS demonstrated significant improvement in the late follow-up results (p < 0.001). One patient (1.2%) required secondary fusion during the follow-up period. Conclusions Postoperative clinical improvement and radiological findings clearly demonstrated that the unilateral approach for treating 1-level and multilevel lumbar spinal stenosis with DS is a safe, effective, and minimally invasive method in terms of reducing the need for stabilization.

scholarly journals “Slalom”: Microsurgical Cross-Over Decompression for Multilevel Degenerative Lumbar Stenosis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
H. Michael Mayer ◽  
Franziska Heider
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Facet Joint ◽  
Leg Pain ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Canal Stenosis ◽  
Microsurgical Decompression ◽  
Lumbar Spinal Canal ◽  
Lumbar Spinal

Objective.Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches.Indications. Two-segmental and multisegmental degenerative central and lateral lumbar spinal stenosis.Contraindications. None.Surgical Technique.Minimally invasive, muscle, and facet joint-sparing bilateral decompression of the lumbar spinal canal through 2 or more alternating microsurgical cross-over approaches from one side.Results.From December 2010 until December 2015 we operated on 202 patients with 2 or multisegmental stenosis (115 f; 87 m; average age 69.3 yrs, range 51–91 yrs). All patients were suffering from symptoms typical of a degenerative lumbar spinal stenosis. All patients complained about back pain; however the leg symptoms were dominant in all cases. Per decompressed segment, the average OR time was 36 min and the blood loss 45.7 cc. Patients were mobilized 6 hrs postop and hospitalization averaged 5.9 days. A total of 116/202 patients did not need submuscular drainage. 27/202 patients suffered from a complication (13.4%). Dural tears occurred in 3.5%, an epidural hematoma in 5.5%, a deep wound infection in 1.98%, and a temporary radiculopathy postop in 1.5%. Postop follow-up ranged from 12 to 24 months. There was a significant improvement of EQ 5 D, Oswestry Disability Index (ODI), VAS for Back and Leg Pain, and preoperative standing times and walking distances.

Obliterative arachnoiditis complicating lumbar spinal stenosis

1978 ◽  
Vol 48 (2) ◽  
pp. 252-258 ◽  
Author(s):  
Joseph A. Epstein ◽  
Bernard S. Epstein ◽  
Leroy S. Lavine ◽  
Alan D. Rosenthal ◽  
Robert E. Decker ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Subarachnoid Space ◽  
Spinal Canal ◽  
Degenerative Spondylolisthesis ◽  
Primary Diagnosis ◽  
Neurogenic Claudication ◽  
Content Type ◽  
Dural Sac ◽  
Lumbar Spinal ◽  
Internal Configuration

✓ The authors report five patients with spinal stenosis who had a total myelographic block at the level of the obliterated subarachnoid space. Arachnoiditis had not been considered as a primary diagnosis until laminectomy revealed a non-pulsating, thickened dural sac that conformed to the internal configuration of the involved spinal canal. Two patients had stenosis complicated by spondyloarthrosis over multiple lumbar levels, one had a previous spinal fusion, another had degenerative spondylolisthesis, and the fifth had a large midline extruded disc at L2–3 that completely blocked the spinal canal. The dura was opened in two patients, confirming the lesion. Despite obliteration of the subarachnoid space, significant relief for approximately 1 year followed decompressive laminectomy, foraminotomy, and discectomy, with disappearance of neurogenic claudication in three patients. Postoperative erect films showed no caudad passage of contrast. While further observations are required, an awareness of this complication of spinal stenosis is important in the diagnosis and management of such patients and in evaluating their ultimate prognosis.

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