scholarly journals Qualitative Grading as a Tool in the Management of Multilevel Lumbar Spine Stenosis

2017 ◽  
Vol 11 (2) ◽  
pp. 278-284 ◽  
Author(s):  
Shardul Madhav Soman ◽  
Jimmy Chokshi ◽  
Naitik Chhatrala ◽  
Gulam Haider Tharadara ◽  
Mukund Prabhakar
Keyword(s):  
Decision Making ◽  
Grading System ◽  
Gender Ratio ◽  
Radiological Findings ◽  
Single Centre ◽  
Dural Sac ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Lumbar Spinal ◽  
A Prospective Study

<sec><title>Study Design</title><p>This is a prospective study that was undertaken at a single centre and involved 80 consecutive patients diagnosed with lumbar spinal stenosis (LSS).</p></sec><sec><title>Purpose</title><p>The aim of the study was to assess the efficacy of a qualitative grading system as seen on magnetic resonance imaging (MRI) as a tool in the management of multilevel LSS.</p></sec><sec><title>Overview of Literature</title><p>LSS diagnosis is clinical but is usually radiologically supplemented. However, there are often multilevel radiological findings with non-specific or atypical clinical features. We used a qualitative grading system to help in the decision-making process of the management of patients with multilevel LSS.</p></sec><sec><title>Methods</title><p>80 patients with LSS were treated with decompression and prospectively followed-up for a minimum of 12 months. All had failed conservative treatment. Qualitative grading of LSS severity was based on the dural sac in T2 weighted axial MRI images at all disc levels and was done from L1–2 to L5–S1 (n=400). Functional outcome was assessed using the Oswestry disability index (ODI).</p></sec><sec><title>Results</title><p>The mean patient age was 56.6 years, with a gender ratio of 0.6:1. Forty patients had degenerative LSS and 40 had degenerative spondylolysthesis. A total of 178 levels were decompressed, the majority of which were L4–L5 (43.82%), followed by L5–S1 (41.57%). According to our qualitative grading system, grade D stenosis (53.93%) was decompressed most frequently, followed by grade C stenosis (41.57%). The average preoperative ODI score was 58.55%, which later reduced to 19.15%. Seventy percent of patients achieved excellent results, whereas 30% achieved good results.</p></sec><sec><title>Conclusions</title><p>Morphological grading is a useful tool in decision making in surgery for multilevel LSS. Grade C and D stenosis should be decompressed, whereas A and B should not be, unless clinically justified.</p></sec>

scholarly journals Degenerative central lumbar spinal stenosis: Is endoscopic decompression through bilateral transforaminal approach sufficient?

2020 ◽  
Author(s):  
Bin Zhang ◽  
Qingquan Kong ◽  
Yuqing Yan ◽  
Pin Feng
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Operation Time ◽  
Decompression Surgery ◽  
Cross Sectional ◽  
Endoscopic Decompression ◽  
Dural Sac ◽  
Transforaminal Approach ◽  
The Mean ◽  
Lumbar Spinal

Abstract Background: At present, few percutaneous endoscopic transforaminal decompression surgery has been reported to solve central lumbar spinal stenosis (CLSS). Whether endoscopic decompression through lateral transforaminal approach decompression is sufficient for degenerative CLSS.Methods: This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through a bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively.Results：All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 minutes. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P=0.00), 2.47 (P=0.71), and 19.40 % (P=0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dura tear and 3 cases of transient postoperative dysthesia. The cross sectional area of the dural sac was significantly enlargement at the last fellow up (74.28±13.08 mm2 vs.104.91±12.40 mm2, P=0.00).Conclusions: Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.

Different Patellar Indices and Their Role in Decision-Making: An MRI-Based Study

2020 ◽  
Author(s):  
Sivashanmugam Raju ◽  
Karthikeyan Chinnakkannu ◽  
Balasubramanian Balakumar ◽  
Ramanivas Sundareyan ◽  
Saravanakumar P. Kaliappan ◽  
...  
Keyword(s):  
Decision Making ◽  
Patellofemoral Pain ◽  
Mr Images ◽  
Strong Negative Correlation ◽  
Mean Values ◽  
Patellar Position ◽  
Asymptomatic Patients ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
The Many

AbstractMagnetic resonance imaging (MRI) of knee has become the integral part of knee evaluation, hence any MRI based study adds more value if it helps in the decision-making process, especially for surgery in treating patellofemoral pain. We tried to determine normal patellar indices using knee MR images and the correlation between them and also compared the results with different ethnic population. We analyzed the prospectively collected MR images of 117 knees/patients, and Insall–Salvati (IS) index, modified IS index, patellotrochlear (PT) index, and patellophyseal (PP) index were calculated. Two standard deviations from the mean were used to define the normal and abnormal patellar position. Cohen's kappa values were used to assess the agreement between the indices and the correlation between them was analyzed using Pearson's correlation. The mean values for IS index, modified IS index, PT index, and PP index were 1.00, 1.53, 0.40, and 0.58, respectively. There was very good agreement between PT index and PP index. There was weak correlation between all the indices except the one between PT and PP indices which had a strong negative correlation. Based on commonly used methodology, there were 4% of asymptomatic patients who were outside the standardized cut-off values and different indices classified different knees as abnormal. This indicates patellar position should be one among the many other factors, not as a sole factor when making a surgical decision in patellofemoral pain. We also noted that the indices compared fairly with other populations. Further research is needed to determine the clinical applicability of these indices.

Multiple sclerosis: report on 200 cases from Iran

2003 ◽  
Vol 9 (1) ◽  
pp. 36-38 ◽  
Author(s):  
Hossein Kalanie ◽  
Kurosh Gharagozli ◽  
Amir Reza Kalanie
Keyword(s):  
Multiple Sclerosis ◽  
Age Of Onset ◽  
Positive Family History ◽  
Gender Ratio ◽  
Disability Status ◽  
Definite Multiple Sclerosis ◽  
Relapsing Remitting ◽  
Spinal Form ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

C linical findings of 200 patients in Iran with definite multiple sclerosis (MS) according to Poser et al.’s criteria and positive findings on magnetic resonance imaging (MRI) have been reviewed. The clinical course was relapsing-remitting (RR) for 88%, primary progressive (PP) for 7% and secondary progressive (SP) for 5% of cases. The mean age of onset was 27±7.4 years for the whole group and 37.1±8.8 years for PPMS. The gender ratio was 2.5:1 female:male. Involvement of the pyramidal system was the most common mode of presentation. Five per cent of patients had positive family history for the disease, 14% of patients had benign MS and 12% with disease duration longer than five years had an Expanded Disability Status Scale-2. The optico-spinal form was not a common form of presentation in the group.

scholarly journals Degenerative central lumbar spinal stenosis: is endoscopic decompression through bilateral transforaminal approach sufficient?

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Bin Zhang ◽  
Qingquan Kong ◽  
Yuqing Yan ◽  
Pin Feng
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Operation Time ◽  
Decompression Surgery ◽  
Cross Sectional ◽  
Endoscopic Decompression ◽  
Dural Sac ◽  
Transforaminal Approach ◽  
The Mean ◽  
Lumbar Spinal

Abstract Background At present, few reports of percutaneous endoscopic transforaminal decompression surgery have been reported to solve central lumbar spinal stenosis (CLSS). Is endoscopic decompression through bilateral transforaminal approach decompression sufficient for degenerative CLSS? Methods This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively. Results All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 min. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P = 0.00), 2.47 (P = 0.71), and 19.40% (P = 0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dural tear and 3 cases of transient postoperative dysthesia. The cross-sectional area of the dural sac was significant enlargement at the last fellow up (74.28 ± 13.08 mm2 vs.104.91 ± 12.40 mm2, P = 0.00). Conclusions Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.

scholarly journals Degenerative central lumbar spinal stenosis: Is endoscopic decompression through lateral transforaminal approach sufficient?

2020 ◽  
Author(s):  
Bin Zhang ◽  
Qingquan Kong ◽  
Yuqing Yan ◽  
Pin Feng
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Operation Time ◽  
Decompression Surgery ◽  
Cross Sectional ◽  
Endoscopic Decompression ◽  
Dural Sac ◽  
Transforaminal Approach ◽  
The Mean ◽  
Lumbar Spinal

Abstract Background: At present, no percutaneous endoscopic transforaminal decompression surgery has been reported to solve central lumbar spinal stenosis (CLSS). Whether endoscopic decompression through lateral transforaminal approach decompression is sufficient for degenerative CLSS. Methods: This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through a bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively. Results ： All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 minutes. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P=0.00), 2.47 (P=0.71), and 19.40 % (P=0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dura tear and 3 cases of transient postoperative dysthesia. The cross sectional area of the dural sac was significantly enlargement at the last fellow up (74.28±13.08 mm 2 vs. 104.91±12.40 mm 2 , P=0.00). Conclusions: Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.

scholarly journals Degenerative central lumbar spinal stenosis: Is endoscopic decompression through bilateral transforaminal approach sufficient?

2020 ◽  
Author(s):  
Bin Zhang ◽  
Qingquan Kong ◽  
Yuqing Yan ◽  
Pin Feng
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Operation Time ◽  
Decompression Surgery ◽  
Cross Sectional ◽  
Endoscopic Decompression ◽  
Dural Sac ◽  
Transforaminal Approach ◽  
The Mean ◽  
Lumbar Spinal

Abstract Background: At present, few reports of percutaneous endoscopic transforaminal decompression surgery have been reported to solve central lumbar spinal stenosis (CLSS). Is endoscopic decompression through bilateral transforaminal approach decompression sufficient for degenerative CLSS?Methods: This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively.Results：All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 minutes. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P=0.00), 2.47 (P=0.71), and 19.40 % (P=0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dural tear and 3 cases of transient postoperative dysthesia. The cross-sectional area of the dural sac was significant enlargement at the last fellow up (74.28±13.08 mm2 vs.104.91±12.40 mm2, P=0.00).Conclusions: Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.

scholarly journals Thickness of the ligamentum flavum of the spine and its relationship with disc degeneration

2014 ◽  
Vol 13 (2) ◽  
pp. 112-115
Author(s):  
Thiago Mattar ◽  
Alexandre Barros Costa ◽  
Paulo Roberto Appolonio ◽  
André Evaristo Marcondes Cesar ◽  
Luciano Miller Reis Rodrigues
Keyword(s):  
Disc Degeneration ◽  
Spinal Surgery ◽  
Ligamentum Flavum ◽  
Disc Height ◽  
Grading System ◽  
Low Back ◽  
Resonance Imaging ◽  
Spinal Level ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

Objective: This study investigates whether the thickening of the ligamentum flavum (LF) is correlated with disc degeneration. Methods: This retrospective study was conducted with 98 patients with chronic low back pain treated in a spinal surgery service between January 2012 and January 2013. All patients underwent magnetic resonance imaging (MRI) and the images were evaluated by a spinal surgeon to measure the thickness of the LF and evaluate the degree of disc degeneration by the Pfirrmann grading system, according to the spinal levels (L3 -L4, L4-L5, L5-S1). An association was sought between LF hypertrophy and disc degeneration, age, sex and disc height. Results: The mean age of the patients was 53.6 years, and the majority were women (59.2%). The thickness of the LF and disc height varied according to the spinal level, the greatest LF thickness being found between L4-L5, and the greatest disc height at L5-S1. Women had statistically thicker ligaments in L3/L4 than men. The degree of disc degeneration was inversely correlated with the height at all the levels evaluated, i.e., the greater the degree of degeneration, the lower the disc height. Conclusions: The thickening of LF is not related to disc height or degree of disc degeneration. Therefore, there is no deformation of the LF within the spinal canal secondary to disc degeneration.

scholarly journals The Expression of P16 and S100 Associated with Elastin Degradation and Fibrosis of the Ligamentum Flavum Hypertrophy

2019 ◽  
Author(s):  
Wei hu ◽  
Shunli Kan ◽  
Guang Liu ◽  
Zegang Cao ◽  
Rusen Zhu
Keyword(s):  
Ligamentum Flavum ◽  
Lumbar Disc ◽  
Positive Staining ◽  
Elastic Tissue ◽  
Elastin Degradation ◽  
Weighted Magnetic Resonance Imaging ◽  
Correlation Tests ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Lumbar Spinal

Abstract Background: One of the characteristics of lumbar spinal stenosis (LSS) is elastin degradation and fibrosis in the ligamentum flavum (LF). P16 and S100 participate in scar formation and collagen development in wound healing and fibrosis diseases. In this study, we investigate the association between P16 and S100 expression and the fibrosis of the hypertrophic LF in LSS. Methods: The LF specimens were surgically obtained from thirty patients with single-segment LSS (SLSS) and 30 patients with double-segment LSS (DLSS). 30 patients with L4/5 lumbar disc herniation were included as control. The LF thickness was measured by axial T1-weighted Magnetic Resonance Imaging(MRI). The extent of LF elastin degradation and fibrosis were graded based on hematoxylin-eosin (H&E) and Verhoff’s Van Gieson’s (VVG) stain, respectively. The localization of P16 and S100 within the LF tissue was determined by immunohistochemistry. Linear correlation tests between LF thickness, fibrosis, P16 and S100 expression was analyzed. Results: The Absolute and relative LF thickness were greater in the DLSS group compared with the SLSS and LDH groups (p < 0.05). The mean thickness in the DLSS group was 5.658mm (RT = 43.107), compared with 4.924 mm (RT=36.520) and 2.886 mm (RT=21.330), respectively in the SLSS and LDH groups. The amount of collagen deposition is significantly higher in the DLSS group compared with the SLSS and LDH groups (p < 0.05) as shown by the H&E staining. A higher level of elastic tissue was also seen in the DLSS group compared with the SLSS and LDH groups (p < 0.05) though VVG staining. There was a significant correlation between H&E mean rating and relative LF thickness in the DLSS group (r = 0.562; p = 0.010). The specimens in the DLSS group showed positive staining of P16. All the three groups were stained with S100 in the dorsal layer of the LF. Conclusions: Elastin degradation and fibrosis of the LF in the DLSS patients is more severe compared with the SLSS and LDH patients. The expression of P16 may related to LF hypertrophy in the patients who suffer with LSS. LF hypertrophy process may not be associated with S100.

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