Association between Redundant Nerve Root and Clinical Outcome after Fusion for Lumbar Spinal Stenosis

Objective: This study aimed to determine the association between redundant nerve root and clinical outcome after fusion for lumbar spinal stenosis by comparing outcomes in patients with or without redundant nerve root.Methods: A total of 163 patients who underwent spinal fusion surgery between January 1, 2014, and December 31, 2018, were enrolled. Patients were divided into two groups: with a redundant nerve root (R group) and without a redundant nerve root (N group). The clinical outcome of the two groups was compared using VAS and claudication distance.Results: A total of 46 patients had a redundant nerve root, while the remaining 117 did not. Symptom duration was significantly different between the two groups (R=41.0±25.0, N=24.1±12.2, p<0.001). Changes in the VAS score for lower extremity pain between the two groups at 1 year after surgery showed that patients without a redundant nerve root had significantly better outcomes than those with a redundant nerve root (R: 4.2±1.3 vs. N: 5.5±1.4; p<0.001). Conclusion: Redundant nerve root on MRI is associated with clinical outcome after fusion for lumbar spinal stenosis. Patients with a redundant nerve root had poor outcomes after fusion surgery for lumbar spinal stenosis than those without a redundant nerve root.

Endoscopic Third Ventriculostomy for an Idiopathic Disproportionately Large Communicating Fourth Ventricle: A Case Report

A disproportionately large communicating fourth ventricle (DLCFV) is a rare condition. A 34-year-old man experienced severe headaches, nausea, vomiting, and gait disturbance. Initial brain computed tomography (CT) showed markedly dilated ventricles with prepontine cistern shrinkage. Following extraventricular drain (EVD) insertion, approximately 400 mL/d of cerebrospinal fluid (CSF) was removed over 8 days. During this time, no significant changes in ventricle size were observed on CT images or the facial pain scale (FPS). We then performed an endoscopic third ventriculostomy and changed the drainage catheter. Immediately after surgery, the patient’s symptoms were relieved, and the drainage volume gradually decreased. EVD was successfully removed on the eighth postoperative day. Our experiences suggest that neurosurgeons should consider the importance of a third ventriculostomy for the diagnosis and treatment of DLCFV.

Early Clinical Outcome of Comparative Study between Revision Operation and Radiofrequency Treatment for Management of Failed Back Surgery Syndrome

Objective: Intractable back pain and radicular pain after lumbosacral spine surgery are challenges for surgeons because the pathophysiology of failed back surgery syndrome (FBSS) remains unknown. Various medications, exercise, reoperation, spinal cord stimulation, and various interventional treatments, such as epidural injection, and radiofrequency treatment, have been suggested as treatment options. However, the clinical outcomes for each treatment are unclear. Methods: We retrospectively evaluated clinical outcomes of consecutive FBSS patients who underwent revision operation or radiofrequency treatment from 2014 to 2017, who previously showed response to nerve block. Pain was analyzed preoperatively and 1 month, 6 months, and 12 months postoperatively using a visual analogue scale (VAS). Short Form 36 (SF-36) health survey and Oswestry Disability Index (ODI) scores were assessed preoperatively and 12 months postoperatively. Results: A total of 70 patients was included in the present study (33 males, 37 females). When comparing preoperative and postoperative 12-month results, back pain VAS score decreased from 5.5 to 4.2 for revision operation and from 5.1 to 4.7 for radiofrequency treatment. Leg pain VAS score decreased from 6.5 to 4.02 for revision operation and 6.2 to 4.3 for radiofrequency treatment. ODI score decreased from 70.9 to 36.1 for revision operation and 70.2 to 36.1 for radiofrequency treatment. SF-36 score increased from 28.9 to 64.1 for revision operation and from 29.6 to 59.6 for radiofrequency treatment. Differences between treatments were not statistically significant after 12 months (p>0.05) but were at 1 month (p=0.01). Conclusion: Compared with revision operation, radiofrequency treatment is not inferior on early clinical outcome (up to 1 year following the treatment) in terms of pain relief, functional capacity, patient satisfaction, and quality of life in patients with FBSS. Radiofrequency treatment can be considered in patients who are not good candidates for surgical treatment based on imaging results or underlying diseases and who are responsive to diagnostic/therapeutic nerve blocks.