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Chen G, Shi J. Improvement of Postoperative Quality of Life in Patients Over 80 Years Old With Thoracic Spinal Stenosis. Clin Spine Surg 2024:01933606-990000000-00300. [PMID: 38637918 DOI: 10.1097/bsd.0000000000001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/22/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN A retrospective comparative study was conducted to analyze the outcome of surgical and conservative treatment for patients over 80 years old with thoracic spinal stenosis (TSS). OBJECTIVE To evaluate the safety and efficiency of posterior spinal cord decompression surgery for over 80-year-old patients with TSS. SUMMARY OF BACKGROUND DATA Concerned about the risk of surgery, over 80-year-old patients with TSS are usually treated conservatively, which often leads to a decline in quality of life. So far as we know, no study demonstrates the risk and benefit of spine surgery for these patients. METHODS Over 80 years of age who underwent dorsal decompression surgery or conservative treatment due to TSS between January 2010 and November 2020 were analyzed. Sixty-four patients who completed follow-up PROM (patient-reported outcome measure) data were collected, including the mJOA (modified Japanese Orthopedic Association score) scoring system, VAS (visual analogue scale), questionnaire-based assessment of the ODI (Oswestry disability index), BI (Barthel index), and SF-36v2 (Short Form-36v2) Health Survey. The clinical characteristics, preoperative and postoperative imaging findings, operative records, complications, and individual outcomes were analyzed. RESULTS Of the 64 patients, 38 underwent posterior decompression, pedicle screw fixation, and posterolateral fusion; another 26 chose conservative treatment. The baseline characteristics of the TSS patients in 2 groups show no significant differences. The clinical symptoms and imaging outcomes showed a significant improvement in the surgical group compared with the nonsurgical group, according to mJOA, VAS, ODI, BI, and SF-36v2. Cerebrospinal fluid leakage occurred in 6 patients, and transient neurological impairment occurred in 2 patients. CONCLUSIONS Posterior decompression surgery for over 80-year-old patients with TSS is a safe and effective treatment, it has a good clinical outcome as well as an acceptable complication rate. However, there were no obvious improvements in quality of life or pain with conservative treatment.
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Affiliation(s)
- Guozhao Chen
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou
- Department of Orthopaedics, The First People's Hospital of Zhangjiagang, Zhangjiagang, Jiangsu, China
| | - Jinhui Shi
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou
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Hu Y, Qi J, Dong Y, Zhang H, Zhou Q, Bai J, Wang C, Chen Z, Li W, Tian Y, Sun C. Development and validation of a novel thoracic spinal stenosis surgical invasiveness index: a single-center study based on 989 patients. Spine J 2023; 23:1296-1305. [PMID: 37100245 DOI: 10.1016/j.spinee.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/07/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND CONTEXT Surgical invasiveness indices have been established for general spine surgery (surgical invasiveness index [SII]), spine deformity, and metastatic spine tumors; however, a specific index for thoracic spinal stenosis (TSS) has not been developed. PURPOSE To develop and validate a novel invasiveness index, incorporating TSS-specific factors for open posterior TSS surgery, which may facilitate the prediction of operative duration and intraoperative blood loss, and the stratification of surgical risk. STUDY DESIGN A retrospective observational study. PATIENT SAMPLE Overall, 989 patients who underwent open posterior TSS surgeries at our institution during the past 5 years were included. OUTCOME MEASURES The operation duration, estimated blood loss, transfusion status, major surgical complications, length of hospital stay, and medical expenses. METHODS We retrospectively analyzed the data of 989 consecutive patients who underwent posterior surgery for TSS between March 2017 and February 2022. Among them, 70% (n=692) were randomly placed in a training cohort, and the remaining 30% (n=297) automatically constituted the validation cohort. Multivariate linear regression models of operative time and log-transformed estimated blood loss were created using TSS-specific factors. Beta coefficients derived from these models were used to construct a TSS invasiveness index (TII). The ability of the TII to predict surgical invasiveness was compared with that of the SII and assessed in a validation cohort. RESULTS The TII was more strongly correlated with operative time and estimated blood loss (p<.05) and explained more variability in operative time and estimated blood loss than the SII (p<.05). The TII explained 64.2% of operative time and 34.6% of estimated blood loss variation, whereas the SII explained 38.7% and 22.5%, respectively. In further verification, the TII was more strongly associated with transfusion rate, drainage time, and length of hospital stay than SII (p<.05). CONCLUSIONS By incorporating TSS-specific components, the newly developed TII more accurately predicts the invasiveness of open posterior TSS surgery than the previous index.
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Affiliation(s)
- Yuanyu Hu
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Junbo Qi
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Yanlei Dong
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trails Unit, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhong Shan Er Rd, Guangzhou 510080, China
| | - Jvcheng Bai
- Shoulder Surgery Department of the Institute of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Chaoxin Wang
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Zhongqiang Chen
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Weishi Li
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Chuiguo Sun
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China.
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Hu Y, Dong Y, Qi J, Chen Z, Li W, Tian Y, Sun C. Learning Curve and Clinical Outcomes of Ultrasonic Osteotome-based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum. Orthop Surg 2023; 15:2318-2327. [PMID: 37403615 PMCID: PMC10475665 DOI: 10.1111/os.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/13/2023] [Accepted: 05/21/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Despite rapid advances in minimally invasive surgery, en bloc laminectomy remains the most common surgical approach for treating thoracic ossification of the ligamentum flavum (TOLF). However, the learning curve of this risky operation is rarely reported. Therefore, we aimed to describe and analyze the learning curve of ultrasonic osteotome-based en bloc laminectomy for TOLF. METHODS Among 151 consecutive patients with TOLF who underwent en bloc laminectomy performed by one surgeon between January 2012 and December 2017, we retrospectively analyzed their demographic data, surgical parameters, and neurological function. Neurological outcome was evaluated with the modified Japanese Orthopaedic Association (mJOA) scale, and the Hirabayashi method was used to calculate the neurological recovery rate. The learning curve was assessed with logarithmic curve-fitting regression analysis. Univariate analysis methods were used for statistical analysis, including t-test, rank sum test, and chi-square test. RESULTS A total of 50% of learning milestones could be reached in approximately 14 cases, and the asymptote in 76 cases. Therefore, 76 of the 151 enrolled patients were defined as the "early group," and the remaining 75 were delimitated as the "late group" for comparison. There was a significant intergroup difference in the corrected operative time (94.80 ± 27.77 vs 65.93 ± 15.67 min, P < 0.001) and the estimated blood loss (median 240 vs 400 mL, P < 0.001). The overall follow-up was 83.1 ± 18.5 months. The mJOA significantly increased from a median of 5 (IQR: 4-5) before the surgery to 10 (IQR: 9-10) at the last follow-up (P < 0.001). The overall complication rate was 37.1%, and no significant intergroup difference was found, except for the incidence of dural tears (31.6% vs 17.3%, p = 0.042). CONCLUSION Initially, mastering the en bloc laminectomy technique using ultrasonic osteotome for TOLF treatment can be challenging, but the surgeon's experience improves as the operative time and blood loss decrease. Improved surgical experience reduced the risk of dural tears but was not associated with the overall complication rate or long-term neurological function. Despite the relatively long learning curve, en bloc laminectomy is a secure and valid technique for TOLF treatment.
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Affiliation(s)
- Yuanyu Hu
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yanlei Dong
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Junbo Qi
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Zhongqiang Chen
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yun Tian
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Chuiguo Sun
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
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Liu W, Li Y, Qiu J, Shi B, Liu Z, Sun X, Zhu Z, Qiu Y. Intra-Operative Neurophysiological Monitoring in Patients with Thoracic Spinal Stenosis: Its Feasibility and High-Risk Factors for New Neurological Deficit. Orthop Surg 2023; 15:1298-1303. [PMID: 37052070 PMCID: PMC10157703 DOI: 10.1111/os.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE Considering the high risk of postoperative neurological complications for patients with thoracic spinal stenosis (TSS), intra-operative neurophysiological monitoring (IONM) has been used for detecting possible iatrogenic injury timely. However, the IONM waveforms are often unreliable. This article is designed to determine the test performance of somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) during surgical thoracic decompression in patients with TSS, and to investigate the risk factors associated with deteriorated neurologic function at immediate postoperation. METHODS Patients undergoing posterior spinal fusion from February 2009 to December 2020 were retrospectively reviewed. Patients were divided into the deteriorated neurologic function (DNF) group and the improved/intact neurological function (INF) group based on the postoperative neurological status. Demographic parameters such as gender, age, height, weight, etiology and IONM data were compared between groups. Demographics and IONM data between DNF and INF groups were compared by independent t or nonparametric tests. The incidence of abnormal SEP was analyzed by Chi-square test. RESULTS A total of 108 patients (63 males, 45 females) with an average age of 53.5 ± 14.0 years were included. The SEP and MEP records were available in 94 and 98 patients, with the overall success rates being 87.0% and 90.7%, respectively. The sensibilities and specificities were 100% and 88.2% for SEP, 100% and 98.8% for MEP, respectively. There were 17 patients in DNF group and 91 patients in INF group. High weight (79.1 ± 14.6 vs 69.7 ± 15.7 kg, P = 0.024), high inter-side difference of MEP amplitude (899.1 ± 997.5 vs 492.3 ± 512.4 μV, P = 0.013) and high incidence of abnormal SEP (94.1% vs 64.8%, P = 0.024) were observed in the DNF group. Fourteen (82.4%) patients in the DNF group showed improvement in neurological status during follow-up. CONCLUSIONS The overall success rates were 87.0% for SEP and 90.7% for MEP in patients with TSS.
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Affiliation(s)
- Wanyou Liu
- Department of Spine SurgeryNanjing Drum Tower Hospital Clinical College of Xuzhou Medical UniversityNanjing210008China
- Division of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing210008China
| | - Yinkun Li
- Division of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing210008China
| | - Junyin Qiu
- Division of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing210008China
| | - Benlong Shi
- Department of Spine SurgeryNanjing Drum Tower Hospital Clinical College of Xuzhou Medical UniversityNanjing210008China
- Division of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing210008China
| | - Zhen Liu
- Department of Spine SurgeryNanjing Drum Tower Hospital Clinical College of Xuzhou Medical UniversityNanjing210008China
- Division of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing210008China
| | - Xu Sun
- Department of Spine SurgeryNanjing Drum Tower Hospital Clinical College of Xuzhou Medical UniversityNanjing210008China
- Division of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing210008China
| | - Zezhang Zhu
- Department of Spine SurgeryNanjing Drum Tower Hospital Clinical College of Xuzhou Medical UniversityNanjing210008China
- Division of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing210008China
| | - Yong Qiu
- Department of Spine SurgeryNanjing Drum Tower Hospital Clinical College of Xuzhou Medical UniversityNanjing210008China
- Division of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing210008China
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Liu WZ, Chang ZQ, Bao ZM. Young thoracic vertebra diffuse idiopathic skeletal hyperostosis with Scheuermann disease: A case report. World J Clin Cases 2023; 11:655-661. [PMID: 36793636 PMCID: PMC9923856 DOI: 10.12998/wjcc.v11.i3.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/15/2022] [Accepted: 01/05/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Diffuse idiopathic skeletal hyperostosis (DISH) is a disorder characterised by the calcification and ossification of ligaments and entheses. It is a frequent occurrence in elderly males, but rarely encountered in younger individuals.
CASE SUMMARY A 24-year-old male was admitted to the hospital due to low back pain accompanied with numbness in both lower limbs for 10 d. Upon clinical examination and imaging tests, the patient was diagnosed with DISH with Scheuermann disease and thoracic spinal stenosis. Before the operation and medical treatment, the patient had hypoesthesia of the skin below the xiphoid process. Afterward, a standard laminectomy was conducted using ultrasonic bone curette and internal fixation was applied. Subsequently, the patient was given corticosteroids, neurotrophic drugs, hyperbaric oxygen and electric stimulation. As a result of the treatment, the patient’s sensory level decreased to the navel level and there was no major change in the muscle strength of the lower limbs. During follow-up, the patient’s skin sensation has returned to normal.
CONCLUSION This case is a rare instance of DISH co-existing with Scheuermann’s disease in a young adult. This provides a valuable reference point for spine surgeons, as DISH is more commonly observed in middle-aged and elder adults.
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Affiliation(s)
- Wen-Zheng Liu
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Zheng-Qi Chang
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Zhe-Ming Bao
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
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Ding H, Wang L, Feng GJ, Song YM, Liu LM. Case report: Thoracolumbar spinal stenosis associated with alkaptonuria. Front Surg 2023; 9:1040715. [PMID: 36684124 PMCID: PMC9852044 DOI: 10.3389/fsurg.2022.1040715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/08/2022] [Indexed: 01/07/2023] Open
Abstract
Background Alkaptonuria is a rare autosomal genetic disorder with an incidence of about 1 in 1 million per year. Spinal involvement often manifests in the later stages of the disease. However, this is the first report of the presentation of thoracolumbar spinal stenosis. Case presentation We report the case of a 61-year-old female patient with significant thoracolumbar stenosis symptoms. The patient had obvious kyphosis with preoperative lower extremity muscle strength grade 2/5. Symptoms and imaging signs initially suggested ankylosing spondylitis. This patient was classified into motor incomplete injury (ASIA C). However, the patient was found to have melanin deposits on the sclera and skin, and the urine was darkened at rest. CT and MRI both suggested no bone bridge connection between vertebrae, which was the key difference between ankylosing spondylitis and alkaptonuria in imaging. Most importantly, urine specimen testing and intraoperative pathology demonstrated alkaptonuria. The patient underwent spinal decompression and vertebral body fixation. Postoperative recovery was good: the patient had significantly relieved pain and could stand and walk. Conclusion This case is the first report of thoracolumbar spinal stenosis associated with alkaptonuria involving the spine.
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Janka M, Handschu R, Merkel A, Schuh A. [Spinal stenosis]. MMW Fortschr Med 2020; 162:58-65. [PMID: 33140362 DOI: 10.1007/s15006-020-1459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Janka
- Klinikum Neumarkt\/Muskuloskelettales Zentrum, Nürnberger Straße 12, 92318, Neumarkt i.d. OPf., Germany.
| | - René Handschu
- Klinikum Neumarkt i.d. Oberpfalz, Nürnberger Str. 12, 92318, Neumarkt i.d.OPf., Germany
| | - Andreas Merkel
- , Nürnberger Straße 12, 92318, Neumarkt i.d. OPf., Germany
| | - Alexander Schuh
- Friedrich-Alexander-Univ. Erlangen-Nürnberg, Nürnberger Str. 12, 92318, Neumarkt i.d.OPf., Germany
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Siller S, Pannenbaecker L, Tonn JC, Zausinger S. Surgery of degenerative thoracic spinal stenosis-long-term outcome with quality-of-life after posterior decompression via an uni- or bilateral approach. Acta Neurochir (Wien) 2020; 162:317-325. [PMID: 31873792 DOI: 10.1007/s00701-019-04191-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rate of degenerative thoracic spinal stenosis (TSS) as underlying pathology for myelopathy is not precisely known, and larger case series are only available for the Asian region. We present one of the largest European series to evaluate rate and clinical outcome after dorsal decompression via a uni- or bilateral approach. METHOD We investigated patients' characteristics, imaging/surgical parameters, and outcomes with quality-of-life (QOL) in all patients who underwent surgical treatment for TSS between 2013 and 2018 in a university neurosurgical clinic. RESULTS From 645 patients with surgery for degenerative spondylotic myelopathy within 6 years, 28 patients (4.3%) suffered from TSS. Median age was 70.4 years with a slight predominance of the female sex (m:f = 1:1.3). The most frequent symptoms (mean duration 7.6 months) were ataxia (61%) and sensory changes (50%). The stenoses (median Naganawa score 3) mostly resulted from a combined osseous/ligamentous hypertrophy and disc prolapse, the majority located below Th8 (75%). Nineteen patients with lateralized compression underwent bilateral decompression via a unilateral approach (fenestration/hemilaminectomy with "undercutting" procedure), and 9 patients with circular pathology underwent bilateral-approached decompression (laminectomy). There were no significant differences of patients' characteristics, blood loss, operation time, and in-patient stay between both surgical groups. Independent from the mode of surgery, the spinal canal was significantly (p < 0.001) widened (median Naganawa score 0), and pain (p = 0.04), myelopathy (mJOA score p = 0.01), and QOL (Oswestry Disability Index, p = 0.03; SF-36-MCS, p = 0.01) were significantly improved at long-term follow-up (mean 35.1 months). CONCLUSIONS Non-tumorous myelopathy is caused in about 4% of patients by TSS and can be effectively treated by surgical decompression via both a uni- or bilateral approach.
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Affiliation(s)
- Sebastian Siller
- Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany.
| | - Laura Pannenbaecker
- Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany
| | - Joerg-Christian Tonn
- Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany
| | - Stefan Zausinger
- Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany
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Na JSD, Dittmar PC. Diabetic amyotrophy, not your typical back pain. BMJ Case Rep 2020; 13:13/1/e231928. [PMID: 31924707 DOI: 10.1136/bcr-2019-231928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old man presented to the hospital for spinal cord decompression surgery with left buttock and left leg pain. The patient described an acute burning pain radiating down from his left buttock to left lateral leg. He also noted a 13.6 kg weight loss in recent months. Physical examination showed decreased muscle bulk of the left thigh, decreased strength of the left hip, left knee flexors and extensors. Recent MRI spine showed mild canal narrowing and cord flattening in the lower thoracic spine. Serologic testing showed an elevated glucose of 17.9 mmol/L and haemoglobin A1c of 9.8%. Electromyography showed denervation of scattered muscles of the left knee flexors, hip flexors and adductors. In the setting of newly diagnosed diabetes mellitus, he was diagnosed with diabetic amyotrophy, started on insulin therapy, and his surgery was cancelled.
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Affiliation(s)
| | - Philip C Dittmar
- Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
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