Is Dynamic Spino-Pelvic Alignment During Gait Associated with Quality of Life in Patients with Degenerative Lumbar Spinal Canal Stenosis?

This study aims to investigate the relationship between dynamic alignment of the spine and pelvis during gait and quality of life (QOL) in lumbar spinal canal stenosis (LSS) patients. We evaluated QOL using the Oswestry Disability Index (ODI), trunk and hip muscle strength as physical function, static spinal alignment, and dynamic spinal/pelvic alignment during gait. The relationship between the ODI score and physical function or static and dynamic alignment were examined. A total of 30 preoperative patients with LSS were participated in this study. ODI score significantly correlated with trunk extension strength (r = -0.559, p = 0.002), hip extension strength (r = -0.473, p = 0.011), maximum flexion angle of spine during gait (r = -0.551, p = 0.002) and maximum anterior tilt angle of pelvis (r = 0.528, p = 0.004). Multiple regression analysis showed that trunk extension strength (standardized β; - 0.35), maximum spinal flexion angle (standardized β; - 0.51) and hip extension strength (standardized β; - 0.40) significantly affected the ODI score, with adjusted coefficient of determination of 0.62. The results of this study showed that the LSS patients with weak hip or trunk extensor muscles, a greater angle of pelvic tilt or a less spinal flexion during gait had a lower QOL.

Hypertrophy of the ligamentum flavum in lumbar spinal canal stenosis is associated with abnormal accumulation of specific lipids

Ligamentum flavum hypertrophy (HLF) is the most important component of lumbar spinal canal stenosis (LSCS). Analysis of hypertrophied ligamentum flavum (HLF) samples from patients with LSCS can be an important que. The current study analyzed the surgical samples of HLF samples in patients with LCSC using quantitative and qualitative high performance-liquid chromatography and mass spectrometry. We collected ligamentum flavum (LF) tissue from twelve patients with LSCS and from four patients with lumbar disk herniation (LDH). We defined LF from LSCS patients as HLF and that from LDH patients as non-hypertrophied ligamentum flavum (NHLF). Total lipids were extracted from the LF samples and evaluated for quantity and quality using liquid chromatography and mass spectrometry. The total lipid amount of the HLF group was 3.6 times higher than that of the NHLF group. Phosphatidylcholines (PCs), ceramides (Cers), O-acyl-ω-hydroxy fatty acids (OAHFAs), and triglycerides (TGs) in the HLF group were more than 32 times higher than those of the NHLF group. PC(26:0)+H+, PC(25:0)+H+, and PC(23:0)+H+ increased in all patients in the HLF group compared to the NHLF group. The thickness of the LF correlated significantly with PC(26:0)+H+ in HLF. We identified the enriched specific PCs, Cers, OAHFAs, and TGs in HLF.

ELECTRODIAGNOSTIC PARAMETERS OF TIBIAL & SURAL NERVE IN LUMBAR SPINAL CANAL STENOSIS.

Background: Lumbar spinal canal stenosis (LSCS) is dened as the narrowing of the lumbar spinal canal due to bulging intervertebral discs and/or hypertrophy of the ligamentum avum and facet joints that results in the compression of nerve root that might affect the nerve conduction studies. Objective: To determine the electrodiagnostic parameters of tibial and sural nerve with and severity of lumbar spinal canal stenosis. Methods: A comparative study was conducted on 51 patients of LSCS diagnosed clinically and canal diameter measured on MRI. All patients were subjected to nerve conduction study by EMG Octopus manufactured by Clarity Medical Pvt. Ltd. Results: The mean age of participants was 49.0±16.77 years ( 22-85 years), out of which 26 (50.98%) were males and 25 (49.02%) were females. They were divided into 3 groups based on antero-posterior lumbar canal diameter for severity of stenosis. LSCS was found at multiple levels in spinal cord with most common site is LSCS in L4-L5. There was a signicant decrease in motor nerve conduction (p=0.01(Rt. & Lt. tibial)) and sensory nerve conduction (p= 0.007(Rt. sural), 0.008 (Lt. sural)) velocities. However, signicant differences in motor and sensory latencies and amplitude were not observed. Conclusion: The signicantly reduced motor and sensory nerve conduction velocities are suggestive of functional impairement of the tibial and sural nerve with the severity of LSC; however, the non signicant changes in latencies and amplitude suggests no evidence of peripheral demyelination or axonal loss.

Hypertrophy of the Ligamentum Flavum in Lumbar Spinal Canal Stenosis is Associated with Abnormal Accumulation of Specific Lipids

Purpose. Ligamentum flavum hypertrophy (HLF) is the most important component of lumbar spinal canal stenosis (LSCS). Analysis of hypertrophied ligamentum flavum (HLF) samples from patients with LSCS can be an important que. The current study analyzed the surgical samples of HLF samples in patients with LCSC using quantitative and qualitative high performance-liquid chromatography and mass spectrometry.Methods. We collected ligamentum flavum (LF) tissue from twelve patients with LSCS and from four patients with lumbar disk herniation (LDH). We defined LF from LSCS patients as HLF and that from LDH patients as non-hypertrophied ligamentum flavum (NHLF). Total lipids were extracted from the LF samples and evaluated for quantity and quality using liquid chromatography and mass spectrometry.Results. The total lipid amount of the HLF group was 3.6 times higher than that of the NHLF group. Phosphatidylcholines (PCs), ceramides (Cers), O-acyl-ω-hydroxy fatty acids (OAHFAs), and triglycerides (TGs) in the HLF group were more than 32 times higher than those of the NHLF group. PC(26:0)+H+, PC(25:0)+H+, and PC(23:0)+H+ increased in all patients in the HLF group compared to the NHLF group. The thickness of the LF correlated significantly with PC(26:0)+H+ in HLF. Conclusion. We identified the enriched specific PCs, Cers, OAHFAs, and TGs in HLF.

The impact of sagittal imbalance on walking in patients with lumbar spinal canal stenosis

Purpose: Gait and posture disorder severely impedes the quality of life of affected patients with lumbar spinal canal stenosis (LSCS). Despite the major health concern, there is a paucity of literature about the relationships among spatiotemporal gait parameters and spinal sagittal parameters. This is a cross sectional study performed in a single tertiary referral center to determine the relationships among spatiotemporal gait parameters and spinal sagittal parameters in patients with LSCS. Methods: A total of 164 consecutive patients with LSCS, 87 men and 77 women with mean age of 70.7 years, were enrolled. Spatiotemporal gait parameters were studied using a gait analysis system. Spinal sagittal parameters were studied including sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic inclination (PI), and pelvic tilt (PT) both in the neutral and stepped positions. Results: SVA was significantly larger in the stepped position than in the neutral position (neutral position, 72.5 mm; stepped position, 96.8 mm; p = 0.003). Parameters regarding the pelvis exhibited significant differences, which could represent pelvic anteversion in the stepped position. By stepwise multiple regression analysis, the prediction models, containing SVA (neutral) and PT (stepped) for double supporting phase, exhibited statistical significance, and accounted for approximately 50% of the variance. Conclusions: The present study provides statistically established evidence of correlation among spatiotemporal gait parameters and spinal sagittal parameters. Differences between sagittal parameters in neutral and stepped position may stand for the postural control during gait cycle, and increased SVA in neutral position and increased PT in stepped position may correlate with prolonged double supporting phase.

Effectiveness of a Gelatin–Thrombin Matrix Sealant (Floseal®) for Reducing Blood Loss During Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis: A Retrospective Cohort Study

Study Design: Retrospective cohort study. Objectives: To investigate the effectiveness and safety of a gelatin–thrombin matrix sealant (GTMS) during microendoscopic laminectomy (MEL) for lumbar spinal canal stenosis (LSCS). Methods: This study included 158 LSCS cases on hemostasis-affecting medication who underwent MEL by a single surgeon between September 2016 and August 2020. Patients were divided into 2 groups depending on whether GTMS was used (37 cases, Group A) or not (121 cases, Group B). Perioperative data related to bleeding or postoperative spinal epidural hematoma (PSEH) was investigated. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score for low back pain. Results: The mean intraoperative blood loss per level was greater in Group A (26.0 ± 20.3 g) than in Group B (13.6 ± 9.0 g), whereas the postoperative drainage volume was smaller in Group A (79.1 ± 42.5 g) than in Group B (97.3 ± 55.6 g). No revision surgeries for PSEH were required in Group A, while 2 (1.7%) revisions were required in Group B ( P = .957). The median JOA score improved significantly from the preoperative period to 1-year postoperatively in both Group A and B (total score, 16.0-23.5 and 17.0-25.0 points, respectively). Conclusions: The use of GTMS during MEL for LSCS may be associated with a reduction in postoperative drainage volume. The revision rate for PSEH was not affected significantly by the use of GTMS. Clinical outcomes (represented by the JOA score) were significantly improved after the surgery, regardless of GTMS use during MEL.

STUDY THE FIBROSIS AND HYPERTROPHY OF LIGAMENTUM FLAVUM IN LUMBAR SPINAL CANAL STENOSIS DUE TO LEPTIN INDUCED INFLAMMATIO

Lumbar spinal stenosis (LSS) is defined as the narrowing of the spinal canal with cord or nerve root impingement and as consequences the symptoms of radiculopathy or pseudoclaudication are developed. Hypertrophy of the ligamentum flavum (LF) is often involved in the pathogenesis of LSS, resulting in the reduction of diameter of the spinal canal and compression of the dural sac and nerve roots.Leptin's important role in various biological functions further than appetite regulation and energy metabolism.Interestingly collective evidence suggests it has a critical role in the fibrosis process in multiple organ systems, including the liver, kidney, and lung. The aim of this study was to establish a relationship between serum leptin levels and the fibrosis and hypertrophy of ligamentum flavum in lumbar spinal canal stenosis. METHOD: Our study include 100 patient with ligamentum flavum hypertrophy with lumbar canal stenosis to evaluate co-relation with increased serum leptin levels. Demographic data, clinical, radiological and laboratory investigation done to find a co-relation between increased serum leptins levels with the fibrosis and hypertrophy of ligamentum flavum in lumbar canal stenosis.RESULT:In our study,LF thickness was also measured with a T1weighted axial MRI.The mean thickness in the high vas scores (> 5) group was signicantly thicker than that in the low vas (< 5) group. Serum leptin values were positively correlated to LF Thickness at L4-L5 (r=0.228) and L5-S1 (r=0.198) level and the correlation was significant (p>0.05). CONCLUSION: Our study has shown strong correlation between serum levels of leptin and hypertrophy of ligamentum flavum.VAS score in low VAS group (< 5) as well as high VAS score group (> 5) are positively correlated with serum levels of leptin