Surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia for treating elderly patients with lumbar central canal stenosis

OBJECTIVE Surgical decompression via a posterior interlaminar approach is widely used for treating lumbar central canal stenosis (LCCS). However, this surgical approach poses a challenge for elderly patients with comorbidities. Thus, the authors tried a new surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia to treat such patients. The aim of this study was to evaluate the safety and effectiveness of surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia for patients with LCCS. METHODS Patients with LCCS who underwent surgical decompression, performed by a single surgeon, between January 2016 and March 2019 were retrospectively analyzed. All patients received decompression via the unilateral intervertebral foraminal approach with local anesthesia. Visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, modified Macnab criteria, walking distance, and Schizas classification were used as outcome predictors. Additionally, a decompression evaluation method was designed for use after spinal endoscopic surgery. RESULTS Overall, 23 patients with a mean age of 69 years were included in this study, with a mean follow-up of 28 months. Low-back and leg pain were significantly improved after decompression surgery. Postoperative ODI scores and walking distances were statistically significantly better than before surgery. Postoperatively, the Schizas classification for all patients was improved by at least 1 grade compared with the preoperative grade. No complications occurred during the follow-up period. According to the novel decompression evaluation method, all patients had at least achieved decompression in part 123+B. CONCLUSIONS Surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia showed promising outcomes in the treatment of elderly patients with LCCS. Additionally, a proposed postoperative decompression evaluation method can help guide surgical decompression.

Fatty Infiltration in Multifidus Muscles and its Association With Spinal MRI Findings

Background: The present cross sectional study was conducted to evaluate the relation between fatty infiltration (FI) in multifidus muscles and spinal MRI findings among patients who referred to Sina Athar and Kosar imaging centers of Shahid Beheshti University of Medical Sciences Methods: Discovertebral and facet joint degenerative changes, intervertebral foraminal narrowing, disk herniation and central canal stenosis in all lumbar levels and FI in multifidus muscles at the level of L5 vertebra were assessed on magnetic resonance imaging (MRI) studies of 333 patients, and correlation of these MRI changes with FI was identified. Results: Among 333 patients (174 female), whose data were analyzed, 316 patients mentioned a positive history of back pain. We observed a significant relation between female sex and higher age with degrees of multifidus FI in L5 level. No significant association was found between the existence of back pain and the rate of multifidus FI. There was a significant negative relation between the activity level and the amount of multifidus FI. Considering weekly exercise level and hours of computer use, this association was not observed. Evaluating the relation between end plate and facet joint degenerative process and also neuroforaminal stenosis with multifidus FI, a statistically significant relation was noted. This correlation was not observed for central canal stenosis. Conclusion: We concluded that the degree of multifidus FI was remarkably higher in female gender, older ages and subjects with more sedentary lifestyle. Moreover, a significant correlation existed between abnormal MRI imaging findings (degenerative process, discopathies, foraminal stenosis) and multifidus FI.