Degrees of Canal Stenosis, Levels of Interleukin-6 (IL-6) And C-Reactive Protein (CRP) Preoperative as Predictors of the Output of Neurogenic Claudication Outcome Score (NCOS) 8 Weeks Post-Decompression-Stabilization-Fusion in Degenerative Lumbar Spinal Stenosis Patients

Introduction: Lumbar Spinal Stenosis (LSS) or spinal stenosis is the most common spinal disease in elderly patients. LSS is also one of the leading causes of spinal surgery in the world. The problem that is often encountered is the limited predictor of outcomes that are considered affordable and accurate, so as to provide education to patients about possible output after the surgery process is carried out. Therefore, a predictor is needed that is considered accurate and affordable such as the degree of measurable canal stenosis of Magnetic resonance imaging (MRI), serum levels of C-Reactive Protein (CRP) and Interleukin-6 (IL-6) Method: This study used a prospective cohort design conducted to compare Neurogenic Claudication Outcome Score scores among people with degenerative lumbar canal stenosis whose post-decompression-stabilization-fusion had higher degrees of canal stenosis (measured through Schizas grading of Magnetic resonance Imaging/MRI) examinations), as well as high pre-operative CRP and IL-6 levels with those with normal CRP and IL-6 levels. From the population of lumbar spinal stenosis, the selection of samples was conducted consecutively sampling. After that, statistical tests in the form of descriptor tests, normality tests, risk factor assessments with 2x2 cross tabulation, and proportion comparison analysis using the Fisher Exact test. Result: Severe lumbar canal stenosis degrees resulted in worse NCOS 8 weeks postoperative than mild degrees of lumbar canal stenosis, with statistically significant differences (p=0.008; p < 0.05) and RR 6.4 (0.99-41.08). High CRP levels resulted in worse NCOS 8 weeks postoperative than mild lumbar degrees of canal stenosis, with statistically significantly differences (p=0.008; p < 0.05) and RR 6.4 (0.99-41.08). High pre-operative IL-6 levels resulted in worse NCOS 8 weeks postoperative than normal pre-operative IL-6 levels with statistically significantly differences (p=0.002; p < 0.05) and RR 8 (1.24-51.50). Conclusion: Degrees of preoperative (mild) canal stenosis, high pre-operative CRP levels, and high levels of pre-operative IL-6 were predictors for better 8-week NCOS scores in patients with post-decompression-stabilizing-fusion degenerative LSS disease. Key words: Degenerative lumbar spinal stenosis, IL-6, CRP, canal degree stenosis, NCOS.

Effective of Fusion in the Treatment of Lumbar Spinal Stenosis：A Systematic Review Andmeta-Analysis

Objective: The debate on efficacy of fusion added to decompression for lumbar spinal stenosis (LSS) is ongoing. The primary objective of this systematic review is to compare the outcome after decompression with and without fusion in patients with lumbar spinal stenosis .Methods: A literature search was performed in the Web of Science, EMBASE, Pubmed,and Cochrane Libraryfrom January 1990 to May 2021.The information of screened studies included clinical outcomes, and secondary measures, then data synthesis and meta-analysis were progressed.Data analysis was conducted using the Review Manager 5.0 software.Results: 17 studies were included in the analysis involving 2947 patients in total. In the majority of studies, including seven RCTs and ten observational studies. The pooled data revealed that fusion was associated with signifificantly higher rates of back pain scores when compared with decompression alone in RCT subgroup(SMD=-0.42, 95% CI (–0.60, -0.23), Z=4.31 P<0.0001).However, fusion signifificantly increased the intraoperative blood loss, operative time and hospital stay. Both techniques had similar leg Pain scores , EQ-5D, walking ability，ODI，major complication,clinical satisfactions and reoperation rate.Conclusions: Our studies showed that the additional fusion in the management of LSS yielded no clinical improvements over decompression alone within a 1-year follow-up period. We suggested that the least invasive and least costly procedure, being decompression alone, is preferred in patients with degenerative lumbar spinal stenosis. The appropriate surgical protocol for LSS should be discussed further.

Efficacy of percutaneous transforaminal endoscopic discectomy unilateral and bilateral approach for bilateral decompression in treatment of degenerative lumbar spinal stenosis and their effects on quality of life

This study aimed to explore the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) unilateral and bilateral approach for bilateral decompression in the treatment of degenerative lumbar spinal stenosis (DLSS) and their effects on quality of life. Altogether 119 patients with DLSS admitted to our hospital from May 2012 to February 2014 were enrolled in this study. Patients in Group A (62 cases) were treated with PTED bilateral approach for bilateral decompression, while those in Group B (57 cases) were treated with PTED unilateral approach for bilateral decompression. The therapeutic effect and incidence of complications in the two groups were observed. Visual Analogue Scale (VAS) was used to assess the pain degree of the lower limbs. Oswestry Disability Index (ODI) was used to assess the improvement of neurological function. 36-ltem Short Form Health Survey (SF-36) developed by the Institute of Medicine was used to assess the quality of life. There were no significant differences between Group A and Group B in operative time, intraoperative blood loss, hospitalization time, the effective rate of treatment, and the incidence of complications (P>0.05). The recovery time of lumbar function in Group A was significantly shorter than that in Group B (P<0.01). VAS and ODI scores at 1, 3, and 6 months after operation in Group A were significantly lower than those in Group B (P<0.05). The scores of general health (GH), bodily pain (BP), social function (SF), vitality (VT), and mental health (MH) at 6 months after operation in Group A were significantly higher than those in Group B (P<0.05). In conclusion, PTED bilateral approach for bilateral decompression was effective in the treatment of patients with DLSS. It can promote the recovery of their lumbar function and neurological function, and improve their quality of life.

Activation of Hypoxia-Inducible Factor-1α Signaling Pathway Has the Protective Effect of Intervertebral Disc Degeneration

Intervertebral discs (IVDs) have poor nutrient diffusion, because the nucleus pulposus (NP) lacks direct vascular supply and likely generates adenosine triphosphate by anaerobic glycolysis. Regulation of glycolysis is mediated by hypoxia-inducible factor-1α (HIF-1α), a transcription factor that responds to local oxygen tension. Constitutively active HIF-1α (CA HIF-1α) was created by point mutation and determined the protective role of HIF-1α in IVD degeneration. Under fluoroscopy, rat caudal IVD segments were stabbed by a needle puncture, and pcDNA3- HIF-1α wild-type (WT) or pcDNA3-CA HIF-1α was transfected into NP cell lines. The constitutive activity of CA HIF-1α was analyzed using a luciferase assay after cell lysis. Next, IVD tissue samples were retrieved from five patients with degenerative lumbar spinal stenosis at the time of surgery, and NP cells were cultured. NP cells were transfected with CA HIF-1α, and relevant gene expression was measured. HIF-1α protein levels in the nucleus were significantly higher, and transcriptional activity was 10.3-fold higher in NP cells with CA HIF-1α than in those with HIF-1α WT. Gene transfer of CA HIF-1α into NP cells enhanced the expression of Glut-1, Glut-3, aggrecan, type II collagen, and Sox9. Moreover, CA HIF-1α reduced the apoptosis of NP cells induced by the Fas ligand. The HIF-1α and collagen 2 expression levels were notably increased in the NP cells of the CA HIF-1α transfected segments in histology and immunohistochemistry study. Collectively, these results suggest that activation of HIF-1α signaling pathway may play a protective role against IVD degeneration and could be used as a future therapeutic agent.

Comparative Analysis of Non-Full and Full Endoscopic Spine Technique via Interlaminar Approach for the Treatment of Degenerative Lumbar Spinal Stenosis: A Retrospective, Single Institute, Propensity Score-Matched Study

Study Design: Retrospective study. Objective: To compare the clinical efficacy of posterior lumbar laminectomy decompression under full endoscopic technique (Endo-LOVE) and percutaneous endoscopic medial foraminal decompression (PE-MFD) in the treatment of degenerative lumbar spinal stenosis (DLSS). Methods: Between April 2017 and April 2018, 96 patients with DLSS underwent Endo-LOVE or PE-MFD, including 58 with Endo-LOVE and 38 with PE-MFD. After propensity score matching (PSM), patient characteristics, operation time, intraoperative fluoroscopy times, postoperative bedridden time, hospital stay and postoperative complications were recorded and compared. The clinical efficacy was evaluated according to Oswestry disability index (ODI), visual analogue scale (VAS), lumbar disease JOA and modified MacNab criteria. Results: A total of 96 patients with DLSS were included in the study. After PSM, the 2 groups were comparable in patient demographic and baseline characteristics. The operation time and intraoperative fluoroscopy times in PE-MFD group were significantly more than those in Endo-LOVE group ( P < .05). The operation time in PE-MFD group was significantly less than that in Endo-LOVE group ( P < .05). The intraoperative fluoroscopy times in PE-MFD group were significantly more than that in Endo-LOVE group ( P < .05). The ODI, VAS and lumbar disease JOA in the 2 groups were significantly improved comparing with those before operation ( P < .05). According to the modified MacNab criteria, the excellent and good rates of the 2 groups were 93.5% in Endo-LOVE group and 87.1% in PE-MFD group ( P > .05). Conclusion: Endo-LOVE and PE-MFD technique can both effectively treat DLSS, and the short-term follow-up results are positive. Endo-LOVE technique has the advantages of fast puncture positioning, less radiation exposure and wider indications. However, PE-MFD needs more radiation exposure and has the possibility of incomplete decompression for complex multiplanar spinal stenosis.

The Role of Vertebral Morphometry in the Pathogenesis of Degenerative Lumbar Spinal Stenosis

The aim of the current study was to establish whether the vertebral morphometry (e.g., vertebral body width and spinal canal diameters) is associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study from L1 to L5 for two sample populations was used. The first included 165 participants with symptomatic DLSS (sex ratio 80 M/85F), and the second had 180 individuals from the general population (sex ratio: 90 M/90F). Vertebral body length (VL) and width (VW) were significantly greater in the stenosis males and females compared to their counterparts in the control. The mean VL in the stenosis males was 31.3 mm at L1, 32.6 mm at L2, 34 mm at L3, 34.1 mm at L4, and 34.5 at L5 compared to 29.9 mm, 31.3 mm, 32.6 mm, 32.8 mm, and 32.9, respectively, in the control group ( P ≤ 0.003 ). Additionally, the bony anterior-posterior (AP) canal diameters and cross-sectional area (CSA) were significantly smaller in the stenosis group compared to the control. The mean AP canal values in the stenosis males were 17.8 mm at L1, 16.6 mm at L2, 15.4 mm at L3, 15.6 mm at L4, and 16.1 at L5 compared to 18.7, 17.8, 16.9, 17.6, and 18.8, respectively, in the control group. Vertebral length (OR-1.273 to 1.473; P ≤ 0.002 ), AP canal diameter (OR-0.474 to 0.664; P ≤ 0.007 ), and laminar inclination (OR-0.901 to 0.856; P ≤ 0.025 ) were significantly associated with DLSS. Our study revealed that vertebral morphometry has a role in DLSS development.

The Relation of Surgical Procedures And Diagnosis Groups To Unplanned Readmission In Spinal Neurosurgery. A Retrospective Single Center Study.

PurposeUnplanned readmission has gained increasing interest as a quality marker for inpatient care, as it is associated with patient mortality and higher economic costs. Spinal neurosurgery is characterized by a lack of epidemiologic readmission data. The aim of this study was to identify causes and predictors for unplanned readmissions related to index diagnoses and surgical procedures. MethodsIn this study from 2015-2017, spinal neurosurgical procedures were recorded. The main reasons for an unplanned readmission in between 30 days after discharge were identified. Multivariate logarithmic regression revealed predictors of unplanned readmission. Results1172 patient records were examined, of which 4.27 % disclosed unplanned readmissions. Among the surgical patients the readmission rate was 4.06 % mainly due to surgical site infections, for the non-surgical patients 5.06 % due to uncontrolled pain. A night-time surgery presented as independent predictive factor. ConclusionIn the heterogeneous group of spinal neurosurgical patients, stratification into diagnostic groups is necessary for statistical analysis. Degenerative lumbar spinal stenosis and spinal abscesses are mainly affected by unplanned readmission. The surgical procedure dorsal root ganglion stimulation is an independent predictor of unplanned re-hospitalizations, as is timing of surgery.