Activity of genes of matrix metalloproteinases and their inhibitors in the Ligamentum flavum of patients with stenosing processes in spinal canal and dural sac

New data have been obtained for assessing the expression of genes of metalloproteinases and their tissue inhibitors (MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, TIMP-1 and TIMP-2) in the Ligamentum flavum in patients with lumbar stenosis of spinal canal and dural sac. The features of the metabolism of the extracellular matrix (ECM) were revealed, the data obtained were compared with those for previously studied candidate genes. The search for relationships with the features of the ECM metabolic characteristics was carried out.The aim. To study the expression of genes of metalloproteinases and their tissue inhibitors in intraoperative biopsies of the Ligamentum flavum of patients with lumbar stenosis of the spinal canal and dural sac.Materials and methods. A group of 33 people (17 women, 16 men) with lumbar stenosis of the spinal canal and dural sac was studied; the average age is 45.73 ± 1.95 years. RNA was isolated from intraoperative biopsies of the Ligamentum flavum, reverse transcription was performed, and PCR using specific primers was performed.Results. In Ligamentum flavum of patients with stenosing processes of the spinal canal and dural sac, an increased activity of MMP-1 and insufficient response of TIMP-1 and TIMP-2 were found; the expression of MMP-1 increased synchronously with Dio2, and both genes decreased their activity with increasing age of the patient. In patients with Ligamentum flavum ossification, the MMR-8 gene was more actively expressed, and the synthesis of the mRNA of the MMR-9 gene decreased compared to the subgroup without ossification.

Lumbar Stenosis with Necrosis of Foot a Diagnostic Approach

Lumbar stenosis is characterised by decrease in spinal canal, neural foramina, lateral nerve .with the narrowing or compression which results in pain and progressive loss. The main objective of the review was to present etiology, pathogenesis and most importantly its clinical presentation along with the necrosis of foot . Study shows that lumbar stenosis can show its improvement by surgical Lumbar decompression and endoscopy.

Endoscopic decompression for the treatment of lumbar spinal stenosis: an updated systematic review and meta-analysis

OBJECTIVE Lumbar stenosis treatment has evolved with the introduction of minimally invasive surgery (MIS) techniques. Endoscopic methods take the concepts applied to MIS a step further, with multiple studies showing that endoscopic techniques have outcomes that are similar to those of more traditional approaches. The aim of this study was to perform an updated meta-analysis and systematic review of studies comparing the outcomes between endoscopic (uni- and biportal) and microscopic techniques for the treatment of lumbar stenosis. METHODS Following PRISMA guidelines, a systematic search was performed using the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Ovid Embase, and PubMed databases from their dates of inception to December 14, 2020. All identified articles were then systematically screened against the following inclusion criteria: 1) studies comparing endoscopic (either uniportal or biportal) with minimally invasive approaches, 2) patient age ≥ 18 years, and 3) diagnosis of lumbar spinal stenosis. Bias was assessed using quality assessment criteria and funnel plots. Meta-analysis using a random-effects model was used to synthesize the metadata. RESULTS From a total of 470 studies, 14 underwent full-text assessment. Of these 14 studies, 13 comparative studies were included for quantitative analysis, totaling 1406 procedures satisfying all criteria for selection. Regarding postoperative back pain, 9 studies showed that endoscopic methods resulted in significantly lower pain scores compared with MIS (mean difference [MD] −1.0, 95% CI −1.6 to −0.4, p < 0.01). The length of stay data were reported by 7 studies, with endoscopic methods associated with a significantly shorter length of stay versus the MIS technique (MD −2.1 days, 95% CI −2.7 to −1.4, p < 0.01). There was no significant difference with respect to leg visual analog scale scores, Oswestry Disability Index scores, blood loss, surgical time, and complications, and there were not any significant quality or bias concerns. CONCLUSIONS Both endoscopic and MIS techniques are safe and effective methods for treating patients with symptomatic lumbar stenosis. Patients who undergo endoscopic surgery seem to report less postoperative low-back pain and significantly reduced hospital stay with a trend toward less perioperative blood loss. Future large prospective randomized trials are needed to confirm the findings in this study.

Minimally Invasive Interlaminar Decompression with a 10-mm Endoscope and Microscope in Cases of Adult Degenerative Scoliosis

BACKGROUND: Adult degenerative (de novo) scoliosis (ADS) usually occurs due to degenerative changes and is accompanied by progressive low-back pain and/or symptomatic lumbar stenosis. Interlaminar decompression is considered an effective treatment of lumbar stenosis, but some surgical contraindications to traditional open surgery limit its application in elderly patients with many disorders. A 10-mm endoscope has been used in the treatment of stenosis in individuals with ADS and its safety and efficacy should be assessed. OBJECTIVE: The objective was to conduct a retrospective analysis to compare interlaminar decompression with a 10-mm endoscope versus a microscope. STUDY DESIGN: Retrospective study. SETTING: This study took place at the First Affiliated Hospital of Harbin Medical University. METHODS: The data of 34 ADS patients treated in our hospital from January 2018 to December 2019, who underwent decompression with a 10-mm endoscope (ES group, 19 patients) or microscope (MS group, 15 patients) were retrospectively reviewed. The two methods were compared using the visual analog scale (VAS), Japanese orthopedic association (JOA) scale, and Oswestry disability index (ODI). Lumbar stability was also evaluated by the progression of scoliosis. RESULTS: There were no significant differences between the 2 groups in demographic or clinical characteristics. The mean preoperative Cobb angle of all patients was 23.34° ± 6.44°, which indicated degenerative scoliosis. The mean JOA and ODI scores were 8.09 ± 1.44 and 55.47 ± 11.91. The mean preoperative pelvic incidence (PI) and lumbar lordosis (LL) angles were 51.02° ± 7.21 and 38.26° ± 6.98 and the mean PI-LL mismatch was 12.76° ± 5.63. There was no significant difference in the VAS scores for back/leg pain between the groups at 1 week after the operation, but the scores of the ES group were significantly higher than those of the MS group at 3 months and 12 months. There were no significant differences of mean JOA and ODI between the ES and MS groups preoperatively, at 3 months, or at 12 months, but the JOA and ODI scores of the ES group were significantly higher than those of the MS group 1 week after the operation. LIMITATIONS: The study showed that a novel method for the minimally invasive treatment of ADS is feasible; the safety and outcomes of this method should be verified with more cases. CONCLUSIONS: Minimally invasive decompression with a 10-mm endoscope was suggested to be a safe and effective method, as expected, for the treatment of lumbar stenosis in ADS patients. KEY WORDS: Adult degenerative scoliosis, endoscope, lumbar stability, microscopic decompression, minimally invasive