Most Common MRI finding in Lumbosacral Degenerative changes in Nepal Police

Introduction: Low back pain (LBP) is a common problem that affects about two-thirds of adults sometimes in their life. Magnetic Resonance Imaging (MRI) with excellent tissue contrast is a better modality for assessing it. We aimed to assess the common findings overall, gender-wise and age-wise in lumbosacral degenerative changes in Nepal police personnel. Methods: The 54 Nepalese police with disc degeneration changes in the MRI report were included . The following MRI findings were evaluated: decrease disc height, disc desiccation change, diffuse disc bulge, asymmetrical disc bulge, disc protrusion, disc extrusion, annular tear, central spinal canal stenosis, foraminal stenosis, spinal nerve compromise, lumbar lordosis preserved or not, osteophyte and modic changes. Results: Mostly involved lumbosacral discs were L4-L5 and L5-S1 and the least involved lumbosacral disc was L1-L2. Disc desiccation changes were the most common finding observed. Disc desiccation changes, decreased disc height, lateral recess stenosis, foraminal stenosis was common in L5-S1. Diffuse disc bulge, asymmetric disc bulge, disc protrusion, annular tear, central spinal canal stenosis were common in L4-L5. Modic type II change was the commonest endplate change observed.. Lateral recess stenosis and foraminal stenosis showed an increasing trend with increment in age group. The most common finding in both gender was disc desiccation changes and diffuse disc bulge. However, disc protrusion, disc extrusion, and annular tear were more common in males and asymmetrical disc bulge in females. Conclusion: This study shows L4-L5 and L5-S1 is the most common intervertebral disc involved in degeneration in Nepal police. Disc desiccation change and diffuse disc bulge are the most frequent finding irrespective of age and gender. Degenerative changes have an increasing trend with increasing age. Disc herniation is more common in male police individuals than female police individuals of Nepal.

Revision surgery following minimally invasive decompression for lumbar spinal stenosis with and without stable degenerative spondylolisthesis: a 5- to 15-year reoperation survival analysis

OBJECTIVE Minimally invasive decompression (MID) is an effective procedure for lumbar spinal stenosis (LSS). Long-term follow-up data on reoperation rates are lacking. The objective of this retrospective cohort study was to evaluate reoperation rates in patients with LSS who underwent MID, stratified for degenerative lumbar spondylolisthesis (DLS), with a follow-up between 5 and 15 years. METHODS All consecutive patients with LSS who underwent MID between 2002 and 2011 were included. All patients had neurogenic claudication from central and/or lateral recess stenosis, without or with up to 25% of slippage (grade I spondylolisthesis), and no obvious dynamic instability on imaging (increase in spondylolisthesis by ≥ 5 mm demonstrated on supine-to-standing or flexion-extension imaging). Reoperation rates defined as any operation on the same or adjacent level were assessed. Revision decompression alone was considered if the aforementioned clinical and radiographic criteria were met; otherwise, patients underwent a minimally invasive posterior fusion. RESULTS A total of 246 patients (mean age 66 years) were included. Preoperative spondylolisthesis was present in 56.9%. The mean follow-up period was 8.2 years (range 5.0−14.9 years). The reoperation rates in patients with and without spondylolisthesis were 15.7% and 15.1%, respectively; fusion was required in 7.1% and 7.5%, with no significant difference (redecompression only, p = 0.954; fusion, p = 0.546). For decompression only, the mean times to reoperation were 3.9 years (95% CI 1.8−6.0 years) for patients with DLS and 2.8 years (95% CI 1.3−4.2 years) for patients without DLS; for fusion, the mean times to reoperation were 3.1 years (95% CI 1.0−5.3 years) and 3.1 years (95% CI 1.1−5.1 years), respectively. CONCLUSIONS In highly selected patients with stable DLS and leg-dominant pain from central or lateral recess stenosis, the long-term reoperation rate is similar between DLS and non-DLS patients undergoing MIS decompression.

Percutaneous Transforaminal Endoscopic Decompression for Lumbar Lateral Recess Stenosis

Objective: The aim of this study was to evaluate the treatment efficacy of lateral spinal stenosis through the decompression of the nerve root under a multiple planar endoscope.Methods: From January 2017 to March 2019, 52 patients with lumbar spinal stenosis or lumbar spinal stenosis combined with intervertebral disc herniation had been treated via transforaminal approach spinal endoscopy. Our study retrospectively analyzed the treatment outcome. All patients experienced complications with different degrees of facet joint hyperplasia and ligamentum flavum hyperplasia and hypertrophy. Some patients suffered disc herniation. All patients were treated with percutaneous transforaminal approach multiple planar endoscopic decompression. The visual analog scale (VAS) and the Oswestry Disability Index (ODI) were compared before and after the operation, as were the horizontal foramen areas of the medial margins of the upper and lower pedicles of the vertebral arch. The treatment effectiveness was evaluated.Results: VAS and ODI scores were significantly improved at postoperative 3 days, 3 months, 6 months, and the last follow-up (P < 0.05). The area of the intervertebral foramen was 422.5 ± 159.2 mm2 preoperatively and 890.8 ± 367.7 mm2 postoperatively, the difference was statistically significant (P < 0.05).Conclusion: Percutaneous transforaminal approach multiple planar endoscopic decompression could achieve an accurate and effective decompression of the lumbar lateral spinal canal. This procedure has good short-term effects, and is especially suitable for elderly patients.

The Transformation of Intracranial Subdural Hygroma to Chronic Subdural Hematoma Following Endoscopic Spinal Surgery: A Case Report

Background We present the case of an intracranial subdural hygroma resulting from intraoperatively undetected dural tear after unilateral biportal endoscopic (UBE) spine surgery for lumbar spinal stenosis. Case Description An 80-year-old woman presented with insidious onset, gradually progressing low back pain, and right leg pain of 1-year duration. The pain radiated to the right L4–L5 dermatomes. Neurogenic intermittent claudication was <300 m. Motor function was normal. Lumbar magnetic resonance imaging showed a lateral recess stenosis at the L3–L4 and L4–L5 levels. These lesions were operated on by the UBE decompression technique.No major complications were encountered during the operation. But soon we found out that there was an undiscovered dura tear. We placed the patient under close observation for 2 weeks. After 30 days, we confirmed that subdural hygroma had changed to chronic subdural hematoma. Conservative treatment was continued. On postoperative day 90), the condition was stable and the symptoms improved completely. Conclusions We concluded that a spinal cerebrospinal fluid leakage can result in an intracranial subdural hygroma. Intracranial subdural hygromas and hematomas after lumbar spinal surgery should be cautiously assessed and treated.

Simplified Universal Grading of Lumbar Spine MRI Degenerative Findings: Inter-Reader Agreement of Non-Radiologist Spine Experts

Objective 1) To describe a simplified multidisciplinary grading system for the most clinically relevant lumbar spine degenerative changes. 2) To measure the inter-reader variability among non-radiologist spine experts in their use of the classification system for interpretation of a consecutive series of lumbar spine magnetic resonance imaging (MRI) examinations. Methods ATS multidisciplinary and collaborative standardized grading of spinal stenosis, foraminal stenosis, lateral recess stenosis, and facet arthropathy was developed. Our institution’s picture archiving and communication system was searched for 50 consecutive patients who underwent non-contrast MRI of the lumbar spine for chronic back pain, radiculopathy, or symptoms of spinal stenosis. Three fellowship-trained spine subspecialists from neurosurgery, orthopedic surgery, and physiatry interpreted the 50 exams using the classification at the L4–L5 and L5–S1 levels. Inter-reader agreement was assessed with Cohen’s kappa coefficient. Results For spinal stenosis, the readers demonstrated substantial agreement (κ = 0.702). For foraminal stenosis and facet arthropathy, the three readers demonstrated moderate agreement (κ = 0.544, and 0.557, respectively). For lateral recess stenosis, there was fair agreement (κ = 0.323). Conclusions A simplified universal grading system of lumbar spine MRI degenerative findings is newly described. Use of this multidisciplinary grading system in the assessment of clinically relevant degenerative changes revealed moderate to substantial agreement among non-radiologist spine physicians. This standardized grading system could serve as a foundation for interdisciplinary communication.

Sacral plexus disorder caused by a wooden toothpick in the rectum

A 67-year-old man presented with a 2-month history of pain in his right buttock and lower limb. MRI depicted right L5/S1 lateral recess stenosis requiring surgical treatment; however, preoperative CT showed an approximately 7 cm long, thin, rod-shaped structure in the rectum, which was ultimately determined to be an accidentally ingested toothpick. It was removed surgically 6 days after diagnosis, because right leg pain worsened rapidly. The pain disappeared thereafter, and the symptoms have not recurred since. The pain might have been localised to the right buttock and posterior thigh in the early stages because the fine tip of the toothpick was positioned to the right of the anterior ramus of the S2 spinal nerve. Although sacral plexus disorder caused by a rectal foreign body is extremely rare, physicians should be mindful to avoid misdiagnosis.

Prompt Return to Work after Bilateral Transforaminal Full-endoscopic Lateral Recess Decompression under Local Anesthesia: A Case Report

Transforaminal full-endoscopic lumbar diskectomy became established early in the 21st century. It can be performed under local anesthesia and requires only an 8-mm skin incision, making it the least invasive disk surgery method available. The full-endoscopic technique has recently been used to treat lumbar spinal canal stenosis. Here, we describe the outcome of simultaneous bilateral decompression of lumbar lateral recess stenosis via a transforaminal approach under local anesthesia in a 60-year-old man. The patient presented with a complaint of bilateral leg pain that was preventing him from standing and walking, and he had been able to continue his work as a dentist by treating patients while seated. Imaging studies revealed bilateral lumbar lateral recess stenosis with central herniated nucleus pulposus at L4/5. We performed simultaneous bilateral transforaminal full-endoscopic lumbar lateral recess decompression (TE-LRD) under local anesthesia. Both decompression and diskectomy were successfully completed without complications. Five days after TE-LRD, he was able to return to work, and 3 months after the surgery, he resumed playing golf. Full-endoscopic surgery under local anesthesia can be very effective in patients who need to return to work as soon as possible after surgery.

Hybrid Interlaminar Endoscopic Lumbar Decompression in Disc Herniation Combined With Spinal Stenosis

BACKGROUND Endoscopic spine surgery is an alternative to the traditional treatment of lumbar disc herniation. However, the traditional technique of interlaminar endoscopic approach is challenging and risky in patients with concomitant spinal stenosis. OBJECTIVE To report a modified technique called hybrid interlaminar endoscopic lumbar decompression as an effective treatment. METHODS Patients with combined lumbar disc herniation and lateral recess stenosis undergoing full-endoscopic interlaminar lumbar discectomy were retrospectively studied. The hybrid interlaminar endoscopic discectomy technique, as well as the use of 2 endoscopes with different diameters, is described in detail. The large endoscope is used for the laminotomy procedure, while the small endoscope is used for the discectomy procedure. The demographics and clinical outcomes of the patients are presented. RESULTS A total of 19 patients were included in this study. The mean age was 46.7 yr. The visual analog scale for back and leg pain improved from 5.6 ± 3.4 and 7.5 ± 2.3 to 1.8 ± 1.3 and 1.8 ± 1.6, respectively (P &lt; .001). The mean Oswestry Disability Index improved from 59.9 ± 21.2 preoperatively to 18.2 ± 8.5 postoperatively (P &lt; .001). The follow-up was 8.2 mo on average. No major complications occurred, but 2 patients reported mild postoperative paresthesia. One patient had an early recurrence and underwent repeat endoscopic discectomy. CONCLUSION Full-endoscopic lumbar discectomy provides excellent access to the intracanalicular herniation site of an intervertebral disc. By using the endoscopic technique presented here, surgeons can safely and efficiently achieve adequate decompression in patients with lumbar disc herniation combined with spinal stenosis.