scholarly journals Lumbar unilateral laminotomy for bilateral decompression in lumbar spinal stenosis

2020 ◽  
pp. 141-146
Author(s):  
Amin Sabry ◽  
Wael Zakarya ◽  
Amr Farid Khalil
Keyword(s):  
Back Pain ◽  
Leg Pain ◽  
Surgical Approaches ◽  
Low Back ◽  
Slight Improvement ◽  
University Hospitals ◽  
Canal Stenosis ◽  
Operative Outcomes ◽  
Lumbar Spinal

Background: Multiple surgical approaches are existing for the management of lumbar canal stenosis.Objective: This study was conducted to assess the outcomes of unilateral laminotomy with bilateral decompression in such cases.Patients and methods: This prospective study was conducted at Mansoura University Hospitals, and we included a total of 12 cases with lumbar canal stenosis. All cases underwent unilateral laminotomy with bilateral canal decompression during the period between July 2017 and July 2018. Post-operative outcomes included ODI, and VAS score for both leg and back pain.Results: The age of the cases ranged between 38 and 62 years. We included 7 males and 5 females. ODI, lower extremity, and back pain showed a significant decrease after the operation (p < 0.05).Conclusion: Unilateral laminotomy with bilateral canal decompression is a safe and feasible approach to managing LSS. Excellent outcomes are expected regarding leg pain and quality of life, while slight improvement is anticipated regarding low back pain.

scholarly journals The influence of preoperative spinal sagittal balance on clinical outcomes after microendoscopic laminotomy in patients with lumbar spinal canal stenosis

2015 ◽  
Vol 23 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Sho Dohzono ◽  
Hiromitsu Toyoda ◽  
Tomiya Matsumoto ◽  
Akinobu Suzuki ◽  
Hidetomi Terai ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Plumb Line ◽  
Leg Pain ◽  
Low Back ◽  
Vas Score ◽  
Canal Stenosis ◽  
Lumbar Spinal

OBJECT More information about the association between preoperative anterior translation of the C-7 plumb line and clinical outcomes after decompression surgery in patients with lumbar spinal canal stenosis (LSS) would help resolve problems for patients with sagittal imbalance. The authors evaluated whether preoperative sagittal alignment of the spine affects low-back pain and clinical outcomes after microendoscopic laminotomy. METHODS This study was a retrospective review of prospectively collected surgical data. The study comprised 88 patients with LSS (47 men and 41 women) who ranged in age from 39 to 86 years (mean age 68.7 years). All patients had undergone microendoscopic laminotomy at Osaka City University Graduate School of Medicine from May 2008 through October 2012. The minimum duration of clinical and radiological follow-up was 6 months. All patients were evaluated by Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low-back pain, leg pain, and leg numbness before and after surgery. The distance between the C-7 plumb line and the posterior corner of the sacrum (sagittal vertical axis [SVA]) was measured on lateral standing radiographs of the entire spine obtained before surgery. Radiological factors and clinical outcomes were compared between patients with a preoperative SVA ≥ 50 mm (forward-bending trunk [F] group) and patients with a preoperative SVA < 50 mm (control [C] group). A total of 35 patients were allocated to the F group (19 male and 16 female) and 53 to the C group (28 male and 25 female). RESULTS The mean SVA was 81.0 mm for patients in the F group and 22.0 mm for those in the C group. At final follow-up evaluation, no significant differences between the groups were found for the JOA score improvement ratio (73.3% vs 77.1%) or the VAS score for leg numbness (23.6 vs 24.0 mm); the VAS score for low-back pain was significantly higher for those in the F group (21.1 mm) than for those in the C group (11.0 mm); and the VAS score for leg pain tended to be higher for those in the F group (18.9 ± 29.1 mm) than for those in the C group (9.4 ± 16.0 mm). CONCLUSIONS Preoperative alignment of the spine in the sagittal plane did not affect JOA scores after microendoscopic laminotomy in patients with LSS. However, low-back pain was worse for patients with preoperative anterior translation of the C-7 plumb line than for those without.

Microendoscopic Decompression for Lumbar Spinal Stenosis Associated with Adjacent Segment Disease following Lumbar Fusion Surgery: 5-year Follow-up of a Retrospective Case Series

2021 ◽  
Author(s):  
Shizumasa Murata ◽  
Akihito Minamide ◽  
Yukihiro Nakagawa ◽  
Hiroshi Iwasaki ◽  
Hiroshi Taneichi ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Japanese Orthopaedic Association ◽  
Leg Pain ◽  
Adjacent Segment ◽  
Low Back ◽  
Spinal Decompression ◽  
Analog Scale ◽  
Clinically Important Difference ◽  
Lumbar Spinal

Abstract Background and Study Aims Surgical treatment options for lumbar spinal stenosis (LSS) based on adjacent segment disease (ASD) after spinal fusion typically involve decompression, with or without fusion, of the adjacent segment. The clinical benefits of microendoscopic decompression for LSS based on ASD have not yet been fully elucidated. We aimed to investigate the clinical results of microendoscopic spinal decompression surgery for LSS based on ASD. Patients and Methods From 2011 to 2014, consecutive patients who underwent microendoscopic spinal decompression without fusion for LSS based on ASD were enrolled. Data of 32 patients (17 men and 15 women, with a mean age of 70.5 years) were reviewed. Japanese Orthopaedic Association score and low back pain/leg pain visual analog scale score were utilized to measure neurologic and axial pain outcomes, respectively. Additionally, after the surgeries, we analyzed the magnetic resonance imaging (MRI), computed tomography (CT) scans, or radiographs to identify any new instabilities of the decompressed segments or progression of ASD adjacent to the decompressed segments. Results The Japanese Orthopaedic Association recovery rate at the 5-year postoperative visit was 49.2%. The visual analog scale scores for low back pain and leg pain were significantly improved. The minimum clinically important difference for leg pain (decrease by ≥24 mm) and clinically important difference for low back pain (decrease by ≥38 mm) were achieved in 84% (27/32) and 72% (23/32) of cases, respectively. Regarding new instability after microendoscopic decompression, no cases had apparent spinal instability at the decompression segment and adjacent segment to the decompressed segment. Conclusions Microendoscopic spinal decompression is an effective treatment alternative for patients with LSS caused by ASD. The ability to perform neural decompression while maintaining key stabilizing structures minimizes subsequent clinical instability. The substantial clinical and economic benefits of this approach may make it a favorable alternative to performing concurrent fusion in many patients.

scholarly journals The Influence of Pain Sensitivity on the Symptom Severity in Patients with Lumbar Spinal Stenosis

2013 ◽  
Vol 2;16 (2;3) ◽  
pp. 135-144
Author(s):  
Jin S. JYeom
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Disc Degeneration ◽  
Lumbar Spinal Stenosis ◽  
Pain Sensitivity ◽  
Leg Pain ◽  
Canal Stenosis ◽  
Sf 36 ◽  
The Individual ◽  
Lumbar Spinal

Background: The symptom severity of back pain/leg pain is not correlated with the severity of degenerative changes and canal stenosis in lumbar stenosis. Considering the individual pain sensitivity might play an important role in pain perception, this discordance between the radiologic findings and clinical symptoms in degenerative lumbar stenosis might originate from the individual difference of pain sensitivity for back pain and/or leg pain. Objective: To determine the relationship among the clinical symptoms, radiologic findings, and the individual pain sensitivity in the patients with degenerative lumbar spinal stenosis. Study Design: Retrospective analysis of prospectively collected data. Setting: A spine center in the department of orthopedic surgery. Methods: In 94 patients who had chronic back pain and/or leg pain caused by degenerative lumbar spinal stenosis, a medical history, a physical examination, and completion of a series of questionnaires, including pain sensitivity questionnaire (PSQ) [total PSQ and PSQ-minor], Oswestry Disability Index (ODI), Visual Analog Pain Scale (VAS) for back pain, and Short Form36 (SF-36) were recorded on the first visit. Radiologic analysis was performed using the MRI findings. The grading of canal stenosis was based on the method by Schizas, and the degree of disc degeneration was graded from T2-weighted images with the Pfirrmann classification. The correlations among variables were statistically analyzed. Results: Total PSQ and PSQ-minor were not dependent on the grade of canal stenosis after gender adjustment. VAS for leg pain and back pain was highly associated with the total PSQ and the PSQ-minor. Total PSQ and PSQ-minor were also significantly associated with ODI. Among SF36 scales, the PSQ minor had significant correlations with SF-36 such as bodily pain (BP), Roleemotional (RE), and Mental Component Summary (MCS) after control of confounding variables such as body mass index (BMI), age, and the grade of canal stenosis/disc degeneration. Total PSQ was significantly associated with the SF-36 RP, BP, and RE. Furthermore, after adjustment for gender and pain sensitivity, there was no significant association between the grade of canal stenosis and VAS for back pain/leg pain and ODI, and no correlation was found between the grade of disc degeneration and VAS for back pain/leg pain and ODI, either. Limitations: The multiple lesions of canal stenosis and/or disc degeneration and the grade of facet degeneration were not considered as a variable. Conclusion: The current study suggests that the pain sensitivity could be a determining factor for symptom severity in the degenerative spinal disease. Key words: Pain sensitivity, pain sensitivity questionnaire, lumbar spinal stenosis, visual analog pain scale, Oswestry disability index, Short Form-36

scholarly journals Nonsurgical Korean Integrative Treatments for Symptomatic Lumbar Spinal Stenosis: A Three-Armed Randomized Controlled Pilot Trial Protocol

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Kiok Kim ◽  
Kyung-Min Shin ◽  
Jun-Hwan Lee ◽  
Bok-Nam Seo ◽  
So-Young Jung ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Treatment Program ◽  
Leg Pain ◽  
Low Back ◽  
Randomized Controlled ◽  
Medicinal Treatment ◽  
Lumbar Spinal

This is a study protocol for a pilot three-armed randomized controlled trial on nonsurgical integrative Korean medicinal treatment for symptomatic lumbar spinal stenosis (LSS). Thirty-six participants who have been diagnosed with (LSS) and recommended for spinal surgery by neurosurgeons or orthopedics and have had spinal symptoms such as severe low back pain and neurological claudication regardless of at least three months of conservative treatments will be recruited. Participants will be randomly assigned to be one of the three intervention groups, including the Mokhuri treatment program group 1 or 2 or usual care group. All treatments will be administered in inpatient units over a period of 4 weeks. The primary outcomes are 0 to 100 Visual Analogue Scales for low back pain and leg pain and the secondary outcomes are Oswestry Disability Index; EQ-5D; Roland-Morris Disability Questionnaire; Oxford Claudication Score; physical function test, including treadmill test, walking duration, and distance assessment for free leg pain; radiologic testing; and adverse events which will be assessed during the 4-week treatment period as well as after 3 and 6 months of follow-up. Then, we will assess the feasibility of the clinical trial design as well as a nonsurgical integrative treatment program. This trial is registered with CRIS registration number: KCT0001218.

Radiographic Predictors of Residual Low Back Pain After Laminectomy for Lumbar Spinal Canal Stenosis

2008 ◽  
Vol 21 (3) ◽  
pp. 153-158 ◽  
Author(s):  
Yingpeng Xia ◽  
Ken Ishii ◽  
Morio Matsumoto ◽  
Masaya Nakamura ◽  
Yoshiaki Toyama ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
Low Back ◽  
Lumbar Spinal Canal Stenosis ◽  
Canal Stenosis ◽  
Lumbar Spinal Canal ◽  
Lumbar Spinal

scholarly journals CLINICAL ASSESSMENT OF BASTI KARMA AND RASARAJ RASA IN THE MANAGEMENT OF GRIDHRASI (SCIATICA)

2020 ◽  
Vol 8 (10) ◽  
pp. 4684-4693
Author(s):  
Mishra Meenu ◽  
Shivhare Shwetal ◽  
Sharma Vivek
Keyword(s):  
Quality Of Life ◽  
Low Back Pain ◽  
Back Pain ◽  
Symptomatic Relief ◽  
Leg Pain ◽  
Low Back ◽  
Nerve Roots ◽  
Pain Prevalence ◽  
Treatment Observation

Background: Sciatica is the most common disorder which affects the quality of life of individual. Sciatica is the set of symptoms which is caused by a pinching and /or irritation of one of the three lowest nerve roots that make up the giant sciatic nerve and causing a low back pain and leg pain. Prevalence of sciatica ranges from 2% to 40% worldwide. In Ayurveda sciatica has a high resemblance with Gridhrasi, which comes under Samanyaja Vikara and Nanatmaja Vatavikara. Aim & Objectives: To study the effect of Dashmooladi Niruha Basti with Rasaraj Rasa in the management of Gridhrasi (Sciatica) and to find out an effective Ayurvedic management for Gridhrasi (Sciatica). Material and Methods: An open clinical study with Dasmooladi Niruha Basti with Rasaraj Rasa was done in 10 patients of Gridhrasi (sciatica). 10 clini-cally diagnosed patients of Gridhrasi (sciatica), registered at the Kayachikitsa OPD of Pt. Khushilal Sharma Govt. Ayurvedic Hospital Bhopal. The patients were treated with Dasmooladi Niruha Basti along with Rasaraj Rasa. Duration of study is 30 days. Assessment was done on the basis of symptomatic relief and change in the degree of SLR test after treatment. Observation: Dasmooladi Niruha Basti and Rasaraj Rasa yielded symptomatic relief and increased the degree of SLR test after treatment. The overall effect of the treatment in all patients suggested that, complete cure was not in any patient. Three patients were markedly improved, and seven patients were moderately improved. None of patients remained unchanged. Conclu-sion: On the basis of result obtained, it can be concluded that Dasmooladi Niruha Basti and Rasaraj Rasa can be used as an effective treatment in the management of Gridhrasi (sciatica).

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 Atypical variant of Baastrup’s disease with lumbar stenosis and cauda equina syndrome

2019 ◽  
Vol 10 ◽  
pp. 198
Author(s):  
Kartikeya Shukla ◽  
Jaskaran Singh Gosal ◽  
Mayank Garg ◽  
Suryanarayanan Bhaskar ◽  
Deepak Kumar Jha ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Neurological Deficits ◽  
Low Back ◽  
Canal Stenosis ◽  
Baastrup’S Disease ◽  
Degenerative Disorder ◽  
Lumbar Spinal

Background: Classical Baastrup’s disease is a degenerative disorder of the lumbar spine characterized by the approximation of adjacent spinous processes due to excessive lordosis. This results in edema, sclerosis, cyst, bursitis, and midline epidural fibrosis and is often overlooked as a cause of low back pain. Here, we report a patient with atypical Baastrup’s disease and lumbar spinal stenosis who presented with a cauda equina syndrome. Case Description: A 67-year-old male presented with low back pain of 1 year’s duration. This exacerbated over the past 3 weeks, becoming associated with the left lower limb numbness/weakness and bladder dysfunction. The lumbar magnetic resonance (MR) showed atypical Baastrup’s disease characterized by multiple ill-defined areas of contrast enhancement in the paraspinal region in conjunction with lumbar canal stenosis. The patient underwent lumbar decompression and exhibited improvement in his neurological deficits postoperatively. Conclusion: This case highlights the atypical MR features of lumbar Baastrup’s disease in conjunction with stenosis. Atypical Baastrup’s disease should be differentiated from classical Baastrup’s disease or other infectious pathologies (e.g., Pott’s disease of the spine) and appropriately treated with timely spinal decompression.

scholarly journals Coflex interspinous implant placement leading to synovial cyst development: case report

2018 ◽  
Vol 29 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Seba Ramhmdani ◽  
Marc Comair ◽  
Camilo A. Molina ◽  
Daniel M. Sciubba ◽  
Ali Bydon
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Facet Joint ◽  
Cauda Equina ◽  
Synovial Cyst ◽  
Leg Pain ◽  
Segmental Motion ◽  
Low Back ◽  
The Right ◽  
Lumbar Spinal

Interspinous process devices (IPDs) have been developed as less-invasive alternatives to spinal fusion with the goal of decompressing the spinal canal and preserving segmental motion. IPD implantation is proposed to treat symptoms of lumbar spinal stenosis that improve during flexion. Recent indications of IPD include lumbar facet joint syndrome, which is seen in patients with mainly low-back pain. Long-term outcomes in this subset of patients are largely unknown. The authors present a previously unreported complication of coflex (IPD) placement: the development of a large compressive lumbar synovial cyst. A 64-year-old woman underwent IPD implantation (coflex) at L4–5 at an outside hospital for low-back pain that occasionally radiates to the right leg. Postoperatively, her back and right leg pain persisted and worsened. MRI was repeated and showed a new, large synovial cyst at the previously treated level, severely compressing the patient’s cauda equina. Four months later, she underwent removal of the interspinous process implant, bilateral laminectomy, facetectomy, synovial cyst resection, interbody fusion, and stabilization. At the 3-month follow-up, she reported significant back pain improvement with some residual leg pain. This case suggests that facet arthrosis may not be an appropriate indication for placement of coflex.

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