scholarly journals Study of Percutaneous Lumbar Decompression and Treatment Algorithm for Patients Suffering from Neurogenic Claudication

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. 451-460
Author(s):  
Timothy R. Deer
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Radicular Pain ◽  
Neurogenic Claudication ◽  
Lumbar Decompression ◽  
Reduction Of Pain ◽  
One Year ◽  
Lumbar Spinal ◽  
Over Time

Background: Symptomatic lumbar spinal stenosis (LSS) patients often suffer from multiple etiologies, and patient symptoms must be differentiated and identified as either neurogenic claudication, radicular pain, or both. The most common symptom associated with LSS is neurogenic claudication, which has been reported to occur in 91% to 100% of the LSS patient population. Neurogenic claudication symptoms are described as pain radiating to the lower extremities that begins and worsens as the patient ambulates. Neurogenic claudication symptoms worsen over time and can eventually result in significant life-altering functional limitations. Symptomatic LSS patients may also suffer from radicular pain, which is a persistent pain transmitted through neural pathways, and is associated with inflammation of the exiting nerve root. Objective: To assess patient safety, pain reduction, and functional status of patients treated with percutaneous lumbar decompression. Study Design: Single-center, prospective clinical study of 46 consecutive patients with neurogenic claudication symptoms related to lumbar spinal stenosis. Setting: US interventional pain management practice. Methods: From March 2010 to January 2011, 46 LSS patients suffering from neurogenic claudication underwent mild percutaneous lumbar decompression. Of these, 12-week, 6-month and one-year followup was available for 35 patients. Outcome Assessment: Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ). Outcomes were assessed at baseline, 12-week, 6-month and one-year follow-up. Results: One-year follow-up patients in this study experienced statistically and clinically significant improvement in physical function, as well as reduction of pain intensity. The initial improvement in these patients, which was significant, was sustained through one year, with no significant differences among the interim follow-up visit periods. These results demonstrate early improvement following treatment with a high degree of durability over time. There were no serious device or procedure-related complications reported in this study. Limitations: Single-center study with no control group. Conclusions: In this study, the mild procedure was shown to be safe. In addition, patients experienced significant improvement in mobility and reduction of pain one year after the procedure. One-year outcomes were not significantly different from interim results, indicating that the significant improvement following treatment, occurring as early as 12 weeks, was maintained through one year. This high degree of consistency over time indicates the durability of percutaneous lumbar decompression in the treatment of neurogenic claudication in symptomatic LSS. Key words: Spine, lumbar, lumbar spinal stenosis, neurogenic claudication, decompression, ligamentum flavum, mild, percutaneous.

scholarly journals Surgery for Lumbar Spinal Stenosis in Patients With Mild Leg Pain Levels Is Associated With Unsatisfactory Outcome

2020 ◽  
pp. 219256822094251
Author(s):  
Freyr Gauti Sigmundsson ◽  
Anders Möller ◽  
Fredrik Strömqvist
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Rating Scale ◽  
Leg Pain ◽  
Successful Outcome ◽  
Neurogenic Claudication ◽  
Lumbar Spinal ◽  
Outcome Of Surgery

Study Design: Prospective register cohort study. Objectives: The indication for surgery in patients with lumbar spinal stenosis (LSS) is considered to be leg pain and neurogenic claudication (NC). Nevertheless, a significant part of patients operated for LSS have mild leg pain levels defined as leg pain ≤minimally important clinical difference (MICD). Information is lacking on how to inform these patients about the probable outcome of surgery. The objective was to report the outcome of surgery for LSS in patients with a mild preoperative level of leg pain. Methods: A total of 2559 patients operated upon for LSS with preoperative leg pain ≤3 NRS (Numerical Rating Scale) were evaluated for outcome at the 1-year follow-up. NRS for back pain, the Oswestry Disability Index (ODI), and the EuroQol (EQ-5D) were used. Results: In the period 2007 to 2017, we identified 3239 patients (14%) who had mild leg pain (≤3 on the NRS). In this cohort, leg pain increased 0.40 (0.56-0.37) and back pain decreased 1.0 (0.95-1.2) at the 1-year follow up. ODI decreased 11.1 (10.2-11.4) and the EQ-5D increased 0.15 (0.17-0.14). A total of 31% reached successful outcome in terms of back pain, 43% in terms of ODI and 48% in terms of EQ-5D. 63% of the patients were satisfied with the outcome. Conclusion: A minority of patients with mild leg pain levels operated upon for LSS attain MICD for back pain, ODI, and EQ-5D. The results from this study can aid the surgeon in the shared decision-making process before surgery.

Calcitonin treatment in lumbar spinal stenosis: A randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up

1992 ◽  
Vol 50 (5) ◽  
pp. 400-403 ◽  
Author(s):  
Antti Eskola ◽  
Timo Pohjolainen ◽  
Hannu Alaranta ◽  
Juhani Soini ◽  
Kaj Tallroth ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Double Blind ◽  
Calcitonin Treatment ◽  
One Year ◽  
Lumbar Spinal

scholarly journals Neural Decompression by Laminectomy with Spinoplasty for Lumbar Spinal Stenosis

2013 ◽  
Vol 1 (1) ◽  
Author(s):  
RK Pokharel ◽  
K Kafle ◽  
RL Pradhan ◽  
LL Shah
Keyword(s):  
Back Pain ◽  
Conservative Treatment ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinous Process ◽  
Radicular Pain ◽  
Lower Limbs ◽  
Neurogenic Claudication ◽  
Neural Tissues ◽  
Lumbar Spinal

BACKGROUND Lumbar spinal stenosis is one of the common morbid conditions of adult population. Surgical intervention is recommended if conservative treatment is not effective. Aim of the surgery is to decompress neural tissues and it may vary from simple unilateral foraminotomy or laminotomy to multilevel bilateral laminectomy. Conventional laminectomy violates posterior stability and foraminotomy limits access to the neural tissues. Different techniques have been developed for adequate decompression with preservation of posterior stabilizing structures. METHODS Degenerative lumbar spinal stenosis in 22 cases was treated by laminectomy with spinous process osteotomy and re-positioning during October 2007 to August 2009. All cases had back pain with radicular pain and intermittent neurogenic claudication. Average age of the cases was 49.5 years and the average duration of symptom was 7 months. Conservative treatment was tried for 4 months. Average follow up period was 2.5 months. RESULTS Post operatively 82% of the cases were satisfied. There was no radicular pain and intermittent claudication in all cases. Persistence of back pain and numbness in lower limbs was common complaints of majority of the cases. CONCLUSION “Laminectomy with spinous process osteotomy and re-positioning” technique easily decompresses lumbar spinal stenosis with preservation of posterior osteo-ligamentous structure. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8127 Nepal Orthopaedic Association Journal Vol.1(1) 2010

scholarly journals Retrospective Review of Patient Self-Reported Improvement and Post-Procedure Findings for mild® (Minimally Invasive Lumbar Decompression)

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 555-560
Author(s):  
Jay S Grider
Keyword(s):  
Adverse Events ◽  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Ligamentum Flavum ◽  
Neurogenic Claudication ◽  
Lumbar Decompression ◽  
Post Procedure ◽  
Lumbar Spinal ◽  
Major Adverse Events

Background: Lumbar spinal stenosis and neurogenic claudication functionally impact thousands of patients per year. Those who fail conservative therapies and are not surgical candidates due to co-morbid conditions have few interventional options available. The recently described mild® procedure (Minimally Invasive Lumbar Decompression) is a candidate to fill this void. While 2 studies have reported no major adverse events with this procedure, the typical post-procedure patient course has not been previously described. Objective: To examine the minor adverse events and periprocedural course associated with mild. Additionally, to evaluate the efficacy of the procedure with regard to pain relief and functional status. Design: Retrospective evaluation. Methods: Forty-two consecutive patients meeting magnetic resonance imaging (MRI) criteria for mild underwent the procedure performed by 2 interventional pain management physicians working at the same center. The pre and post procedure visual analog scale (VAS) as well as markers of global function were recorded. Major and minor adverse events were tracked and patient outcomes reported. Results: There were no major adverse events reported. Of the minor adverse events, soreness lasting 3.8 days was most frequently reported. No patients required overnight observation and only 5 required postoperative opioid analgesics. Patients self-reported improvement in function as assessed by ability to stand and ambulate for greater than 15 minutes, whereas prior to the procedure 98% reported significant limitations in these markers of global functioning. Visual analog pain scores were significantly decreased by 40% from baseline. Eighty-six percent of the patients reported that they would recommend the mild procedure to others. Conclusions: The mild procedure appears to be a safe and likely effective option for treatment of neruogenic claudication in patients who have failed conservative therapy and have ligamentum flavum hypertrophy as the primary distinguishing component of the stenosis. Key words: Minimally invasive lumbar decompression, lumbar spinal stenosis, neurogenic claudication, fluoroscopy, ligamentum flavum

scholarly journals Percutaneous Epidural Adhesiolysis Using Inflatable Balloon Catheter and Balloon-less Catheter in Central Lumbar Spinal Stenosis with Neurogenic Claudication: A Randomized Controlled Trial

2018 ◽  
Vol 1 (21;1) ◽  
pp. 593-605
Author(s):  
Seong-Soo Choi
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Controlled Trial ◽  
Balloon Catheter ◽  
Controlled Study ◽  
Neurogenic Claudication ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Lumbar Spinal

Background: When conventional interventional procedures fail, percutaneous epidural adhesiolysis (PEA), which has moderate evidence for successful treatment of lumbar spinal stenosis (LSS), has been recommended over surgical treatments. In a previous study, we demonstrated the efficacy of a newly developed inflatable balloon catheter for overcoming the access limitations of pre-existing catheters for patients with severe stenosis or adhesions. Objectives: This study compared the treatment response of combined PEA with balloon decompression and PEA only in patients with central LSS over 6 months of follow-up. Study Design: This study used a randomized, single-blinded, active-controlled trial design. Setting: This study took place in a single-center, academic, outpatient interventional pain management clinic. Methods: This randomized controlled study included 60 patients with refractory central LSS who suffered from chronic lower back pain and/or lumbar radicular pain. Patients failed to maintain improvement for > 1 month with epidural steroid injection or PEA using a balloon-less catheter. Patients were randomly assigned to one of 2 interventions: balloon-less (n = 30) and inflatable balloon catheter (n = 30). The Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), Global Perceived Effect of Satisfaction (GPES), and Medication Quantification Scale III were each measured at 1, 3, and 6 months after PEA. Results: There was a significant difference between groups in NRS-11 reduction ≥ 50% (or 4 points), ODI reduction ≥ 30% (or 10 points), GPES ≥ 6 and ≥ 4 points at 6 months, and NRS11 reduction ≥ 50% (or 4 points) at 3 months after PEA (P < .03). The proportion of successful responders was higher in the balloon group than in the balloon-less group throughout the total follow-up period. Furthermore, there was a statistically significant difference between groups at 6 months after PEA (P = .035). Limitations: The results may vary according to the definition of successful response. Follow-up loss in the present study seemed to be high. Conclusion: PEA using the inflatable balloon catheter leads to significant pain reduction and functional improvement compared to PEA using the balloon-less catheter in patients with central LSS. The study protocol was approved by our institutional review board (2012-0235), and written informed consent was obtained from all patients. The trial was registered with the Clinical Research Information Service (KCT 0002093). Key words: Balloon decompression, central, chronic pain, epidural adhesiolysis, lumbar, percutaneous, radiculopathy, spinal stenosis

scholarly journals Full-Endoscopic Lumbar Decompression versus Open Decompression and Fusion Surgery for the Lumbar Spinal Stenosis: A 3-Year Follow-Up Study

2021 ◽  
Vol Volume 14 ◽  
pp. 1331-1338
Author(s):  
Qingpeng Song ◽  
Bin Zhu ◽  
Wenkui Zhao ◽  
Chen Liang ◽  
Bao Hai ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Fusion Surgery ◽  
Follow Up Study ◽  
Lumbar Decompression ◽  
Lumbar Spinal

scholarly journals Outcomes of decompression without fusion in patients with lumbar spinal stenosis and substantial back pain

2021 ◽  
pp. 1-4
Author(s):  
Rachid Bech-Azeddine ◽  
Søren Fruensgaard ◽  
Mikkel Andersen ◽  
Leah Y. Carreon
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Structural Instability ◽  
Radicular Pain ◽  
Leg Pain ◽  
Neurogenic Claudication ◽  
Vas Score ◽  
The Mean ◽  
Lumbar Spinal

OBJECTIVEThe predominant symptom of lumbar spinal stenosis (LSS) is neurogenic claudication or radicular pain. Some surgeons believe that the presence of substantial back pain is an indication for fusion, and that decompression alone may lead to worsening of back pain from destabilization associated with facet resection. The purpose of this study was to determine if patients with LSS and clinically significant back pain could obtain substantial improvements in back pain after a decompression alone without fusion.METHODSThe DaneSpine database was used to identify 2737 patients with LSS without segmental instability and a baseline back pain visual analog scale (VAS) score ≥ 50 who underwent a decompression procedure alone without fusion. Standard demographic and surgical variables and patient outcomes, including back and leg pain VAS score (0–100), Oswestry Disability Index (ODI), and EQ-5D at baseline and at 12 months postoperatively, were collected.RESULTSA total of 1891 patients (69%) had 12-month follow-up data available for analysis; the mean age was 66.4 years, 860 (46%) were male, the mean BMI was 27.8 kg/m2, and 508 (27%) were current smokers. At 12 months postoperatively, there were statistically significant improvements (p < 0.001) from baseline for back pain (72.1 to 42.1), leg pain (71.2 to 41.3), EQ-5D (0.35 to 0.61), and ODI (44.1 to 27.8).CONCLUSIONSPatients with LSS, clinically substantial back pain, and no structural instability obtain improvement in back pain after decompression-only surgery and do not need a concomitant fusion.

Sign in / Sign up

Export Citation Format

Share Document