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.

Comparison of Plain X-ray and MRI Findings By Determining The Sensitivity and Specificity in the Diagnosis of Lumbar Spinal Stenosis

Background: Lumbar spinal stenosis is the most frequent indication for spine surgery. The X-ray and MRI are the choice of investigation. Justified use of radiography can be cost effective in the management of lumbar spinal stenosis. Objective: To evaluate and compare the sensitivity and specificity of the plain X-ray and MRI in the diagnosis of the lumbar spinal stenosis. Materials and Methods: A multicenter cross sectional analytical study was carried out from January 2014 to December 2015 on 70 patients of both sexes aged more than 25 years with chronic low back pain. Plain x-ray and MRI were done in all patients. The interval between plain x-ray and MRI was less than 3 months. A descriptive analysis was performed for all data. Results: The mean age (+ SD) was 45.1 (+ 5.4) years. Forty two (60%) were male and 28 (40%) were female. In plain x-ray of the lumbosacral spine, 30 (42.9%) had diskogenic spinal canal stenosis and 22 (31.4%) had both diskogenic and non diskogenic spinal canal stenosis. In the MRI, 35 (50.0%) cases had diskogenic spinal canal stenosis and 24 (34.3%) had both diskogenic and non diskogenic spinal canal stenosis. The validity of MRI evaluation for only diskogenic spinal canal stenosis was correlated, where the calculated values of plain x-ray were: sensitivity 80.0%, specificity 60.0%, accuracy 77.5%, positive predictive value 93.3% and negative predictive value 30.0%. The validity of MRI evaluation for both diskogenic and non diskogenic spinal canal stenosis was correlated, where the calculated values of plain x-ray were: sensitivity 83.3%, specificity 66.7%, accuracy 80.0%, positive predictive value 90.9% and negative predictive value 50.0%. Conclusion: Plain x-ray is a useful and reliable diagnostic modality for the evaluation, assessment and the subsequent appropriate management of lumbar spinal stenosis. KYAMC Journal. 2021;12(3): 161-165

Criteria for selection of patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis

Aim – to evaluate clinical and instrumental correlation (MRI data) in patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis for optimizing the indications for differentiated surgical treatment. Materials and methods. Clinical and neurological manifestations and MRI data in 80 patients (men – 36, women – 44), aged 27 to 72 years with a diagnosis of intervertebral disc herniation complicated by spinal canal stenosis were retrospectively analyzed. Depending on the size of the spinal canal, there were 2 groups: the first – with relative spinal canal stenosis (n = 20) – 75–100 mm2, and the second group – with absolute spinal canal stenosis (n = 60) – less than 75 mm2. We examined the correlation between the clinical and neurological presentations and MRI findings. Results. Our retrospective analysis has found that the first group consisted mainly of younger patients (46 years) and with a mean intervertebral disc herniation of 8.35 mm, while the second group included older patients (51.7 years) and the mean size of intervertebral disc herniation was 7.3 mm. The group of relative spinal canal stenosis was dominated by patients with radiculopathy syndrome (70 %) and pain in one lower limb (85 %). Radiculoischemia syndrome (50 %), pain in both lower extremities (33 %), neurogenic intermittent claudication syndrome (46.6 %), knee reflex disorders (58.3 %), pelvic organ dysfunction (11.6 %) were more common in the second group of patients. In addition, the longest disease duration (more than 24 months) was observed among patients of this group. We have found a relationship between pain syndrome (according to VAS), muscle strength, the disease duration and the spinal canal area. Conclusions. The correlation of clinical and instrumental methods of examination in patients with intervertebral disc herniation complicated by spinal canal stenosis allows the indications for differentiated surgery to be optimized.

Efficacy of Posterior Cervical Laminectomy and Decompression plus Lateral Mass Screw-Rod Internal Fixation in the Treatment of Multisegment Cervical Spinal Canal Stenosis and Effects on Cervical Curvature and Range of Motion Parameters

Objective. To investigate the clinical effects of posterior laminectomy and decompression plus lateral mass screw-rod internal fixation for the treatment of multisegment cervical spinal canal stenosis and the improvement of cervical curvature and range of motion in patients. Methods. A total of 68 patients with multisegment cervical spinal stenosis who were treated in our hospital from January 2019 to June 2020 were selected and randomly divided into the control group and the observation group according to the random number table, with 34 patients in each group. The patients in the control group were treated with traditional posterior cervical open-door laminoplasty with silk suture fixation, while those in the observation group were treated with posterior cervical laminectomy and decompression plus lateral mass screw-rod internal fixation. The perioperative index of patients in the two groups was recorded, and the clinical efficacy of patients was evaluated. The patient’s JOA score, cervical physiological curvature, and cervical range of motion were evaluated. The occurrence of complications was recorded during follow-up. Results. The amount of intraoperative bleeding and postoperative rehabilitation training time in the observation group was less than that in the control group ( P < 0.05 ). There was no significant difference in operation time between the two groups ( P > 0.05 ). The total effective rate of the observation group was significantly higher than that of the control group ( P < 0.05 ). The JOA scores at 1 week, 6 months, and 12 months after operation in the observation group were higher than those in the control group ( P < 0.05 ). The physiological curvature of cervical spine in the observation group at 1 week, 6 months, and 12 months after operation was higher than that in the control group ( P < 0.05 ). The cervical range of motion at 12 months after operation in the observation group was significantly higher than that in the control group ( P < 0.05 ). The incidence of postoperative complications in patients of the observation group was significantly lower than that of the control group ( P < 0.05 ). Conclusion. Posterior laminectomy and decompression plus lateral mass screw-rod internal fixation can help patients to improve various clinical symptoms caused by nerve compression and obtain better improvement of cervical curvature and range of motion. It is an ideal surgical method for the treatment of multisegment cervical spinal canal stenosis, and it is conducive to improving the clinical efficacy of patients.

Effect Comparison Of MIS-TLIF Under MED and Quadrant Modes in The Treatment of Lu mbar Spinal Stenosis

Background Lumbar spinal stenosis is one of the common causes of low back and leg pain. Lumbar intervertebral disc degeneration leads to the decrease of intervertebral height, the limitation of vertebral activity, and the biomechanical changes of the lumbar spine, which in turn makes the lumbar anterior convex angle and sacral inclination angle smaller, and the pelvic inclination angle larger, affecting the stress distribution of the lumbar spine aggravating the intervertebral disc degeneration. If the spinal canal stenosis is not corrected for a long time, can cause the cauda equina nerve, nerve root compression, resulting in neurogenic intermittent claudication. If the spinal canal stenosis is not corrected for a long time, can cause the cauda equina nerve, nerve root compression, resulting in neurogenic intermittent claudication. Surgery can correct lumbar stenosis and reconstruct lumbar stability. But the traditional lumbar fusion trauma is huge, even can aggravate pain, spinal canal stenosis. Therefore, more and more patients are more inclined to MIS-TLIF treatment with less surgical trauma. For single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open surgery in restoring lumbar interbody height and improving lumbar-pelvis balance. Objective Discussion on the effect difference of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spinal stenosis by Quadrant and MED methods. Methods A total of 96patients with lumbar spinal stenosis who were scheduled to undergo MIS-TLIF surgery in Our Hospital from January 2017 to October 2020 were selected and divided into group A and group B according to the surgical channel selection scheme, with 48 cases in each group. The patients in group A were treater with MED channel, and the patients in group B were treated with Quadrant channel. The degree of surgical trauma, VAS score before and postoperative, JOA score, lumbar-pelvic imaging parameters and surgical complications were compared between the two methods. Results The operation time of the A group was shorter than that of the group B(P < 0.05). The blood loss, exposure time under X line, drainage flow and down-ground time in A group were lower than those in B group, which had statistical significance (P<0.05) ; A and B groups of patients were compared, the difference was not statistically significant (P>0.05) ; Preoperative, Comparison of VAS scores between A and B groups, the difference was not statistically significant (P>0.05) . On the first day of postoperative, the VAS score of group A was lower than that of groupB, which had statistical significance (P < 0.05). Preoperative, Comparison of JOA scores between A and B groups, the difference was not statistically significant (P>0.05) ; Comparison of JOA scores between 1 month ,3 months and 6 months in Postoperative, the difference was not statistically significant (P>0.05). The JOA scores of the two groups at 1 month, 3 months and 6 months postoperative were significantly lower than those Preoperative (P < 0.05). Six months postoperative, the lumbar anterior convex angle, segmental anterior convex angle and intervertebral height of the two groups were significantly higher than those Preoperative (P<0.05), and the pelvic inclination angle of the two groups was lower than that Preoperative (P<0.05).Conclusion MIS-TLIF in the treatment of patients with lumbar spinal stenosis using MED channel or Quadrant channel operation has curative effect, and there is little difference in the recovery of lumbar-pelvis imaging parameters, but the former has the advantages of less surgical trauma and lower postoperative pain.