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

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.

Expression of Estrogen Receptor Alpha and Evaluation of Histological Degeneration Scores in Fibroblasts of Hypertrophied Ligamentum Flavum: A Qualitative Study

The most common spinal disorder in elderly is lumbar spinal stenosis (LSS), resulting partly from ligamentum flavum (LF) hypertrophy. Its pathophysiology is not completely understood. The present study wants to elucidate the role of estrogen receptor α (ER α) in fibroblasts of hypertrophied LF. LF samples of 38 patients with LSS were obtained during spinal decompression. Twelve LF samples from patients with disk herniation served as controls. Hematoxylin & Eosin (H&E) and Elastica stains and immunohistochemistry for ER α were performed. The proportions of fibrosis, loss and/or degeneration of elastic fibers and proliferation of collagen fibers were assessed according to the scores of Sairyo and Okuda. Group differences in the ER α and Sairyo and Okuda scores between patients and controls, male and female sex and absence and presence of additional orthopedic diagnoses were assessed with the Mann–Whitney U test. There was a tendency towards higher expression of ER α in LF fibroblasts in the hypertrophy group (p = 0.065). The Sairyo and Okuda scores were more severe for the hypertrophy group but, in general, not statistically relevant. There was no statistically relevant correlation between the expression of ER α and sex (p = 0.326). ER α expression was higher in patients with osteochondrosis but not statistically significant (p = 0.113). In patients with scoliosis, ER α expression was significantly lower (p = 0.044). LF hypertrophy may be accompanied by a higher expression of ER α in fibroblasts. No difference in ER α expression was observed regarding sex. Further studies are needed to clarify the biological and clinical significance of these findings.

Embolisasi Preoperatif pada Operasi Dekompresi Tulang Belakang

Embolization is an effective way of controlling bleeding. This study was aimed to provide some information about preoperative spinal embolization, embolization materials, and complications. This was a literature review study using an online journal database and Google Scholar. The keywords used were Preoperative Spinal Embolization. The feasibility of the selected studies were case reports. The results showed that all studies used the same technique and approach to achieve different goals. The difference among them was the choice of embolan material. The complications that arose were few and could be managed. In conclusion, preoperative spinal embolization is the choice of therapy that give more benefit and safety.Keywords: preoperative spinal embolization; spinal decompression surgery; embolan Abstrak: Embolisasi merupakan cara yang efektif dalam mengontrol perdarahan. Penelitian ini bertujuan memberikan informasi mengenai embolisasi tulang belakang, bahan embolan, dan komplikasi yang ditimbulkan. Jenis penelitian ialah suatu literature review menggunakan database jurnal online dan Google Scholar. Pencarian data menggunakan kata kunci Preoperative Spinal Embolization. Kelayakan penelitian yang dipilih bersifat case report. Hasil penelitian mendapatkan bahwa semua penelitian menggunakan teknik dan pendekatan yang sama untuk mencapai tujuan yang berbeda. Perbedaannya ialah dalam hal pemilihan bahan embolan. Komplikasi yang terjadi hanya sedikit dan dapat diatasi. Simpulan penelitian ini ialah preoperative spinal embolization merupakan terapi pilihan yang menguntungkan dan aman.Kata kunci: embolisasi preoperatif; operasi dekompresi tulang belakang; embolan

Effect Of Cupping Massage and Modified Spinal Decompression Therapy With Exercise Therapy in Neck Radiculopathy Syndrome

Cervical radiculopathy Syndrome (CRS) is a common neuro-musculo-skeletal disorder causing pain and disability. Manual therapy interventions including cervical traction with other treatment modalities have been advocated to decrease pain and disability caused by cervical radiculopathy (CR). Al-Qudah & AL-Jazzazi (2021) conducted a new method of Spinal Decompression Therapy (SDT) in patients with Chronic Lumbar Disc Herniation (CLDH) which includes Combination of Lumbar Traction With Cervical Traction (CLTCT) as one intervention. Despite of that this new method clinically reduces pain and disability more effectively than the conventional types of Traction, CLTCT method was not previously used in CR patients nor with Cervical Disc Herniation (CDH). The clinical effectiveness of this new method with other treatment modalities in patients with CRS was not approved yet. OBJECTIVE: The purpose of the presented work is to identify the effectiveness of rehabilitative program on patients with Cervical Radiculopathy, by (15) sessions for (4) Weeks. The suggested Rehabilitative program consisted of: 1.Supine Soft Full Back, Shoulders and Neck Cupping Massage (CM) for (10) minutes, 2.CLTCT: Combined Lumbar Traction with Cervical Traction as one intervention for (20) minutes, 3.Gradual Therapeutic Exercise Package of Neck Stretching and Strengthening Exercise for approximately (15) minutes. METHODS: In this study, Five outdoor male patients had accepted to participate and were randomly chosen from Al-Karak Governmental Hospital, All subjects applied the proposed rehabilitative program. The results were analyzed using the SPSS system. RESULTS: indicates that there was statistically significant difference between the pre and post measurements in favor of the post measurements in terms of Pain, Disability. CONCLUSIONS: The present study demonstrated that the use of proposed rehabilitative program has a positive effect on patients with Cervical Radiculopathy.