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Pham T, Butler A, Weideman RA, Annaswamy TM. Phosphodiesterase 5 Inhibitor Use in Patients Undergoing Decompression Surgery for Lumbar Spinal Stenosis. Am J Phys Med Rehabil 2022; 101:341-347. [PMID: 34121069 DOI: 10.1097/phm.0000000000001821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Our objectives were to explore the association between phosphodiesterase 5 inhibitor use and lumbar decompression surgery by evaluating the prevalence of lumbar decompression surgery in a treatment group of patients with lumbar spinal stenosis compared with a control group. DESIGN We performed database review and extracted data including lumbar decompression surgery prevalence, phosphodiesterase 5 inhibitor dosage, and fill dates. Treatment group was defined as those with phosphodiesterase 5 inhibitor fill dates of less than 30 days before surgery, and control group was defined as those with phosphodiesterase 5 inhibitor fill dates at any other time. Lumbar decompression surgery prevalence rates for both groups were calculated. RESULTS Our study found 599 lumbar spinal stenosis patients who were prescribed phosphodiesterase 5 inhibitor. Three hundred thirty-eight underwent lumbar decompression surgery. Of these, 71 (21%) filled their prescription of less than 30 days before surgery, whereas 267 (79%) filled their prescription during a different period. The majority (94.6%) of surgical patients received decompression at two or more spinal levels. CONCLUSIONS Prevalence of lumbar decompression surgery for lumbar spinal stenosis was significantly lower in patients in the treatment group on phosphodiesterase 5 inhibitor therapy compared with the control group. Among many potential explanations, the vasodilatory effect of phosphodiesterase 5 inhibitor may have contributed to a lower surgical rate. This is the first study to explore this novel association. Future prospective studies are necessary to better define the utility of phosphodiesterase 5 inhibitor in lumbar spinal stenosis.
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Affiliation(s)
- Tri Pham
- From the University of Texas Southwestern Medical Center, Dallas, Texas (TP); University of Cincinnati College of Medicine, Cincinnati, Ohio (AB); Pharmacy Service, VA North Texas Health Care System, Dallas, Texas (RAW); Physical Medicine and Rehabilitation Service, VA North Texas Health Care System, Dallas, Texas (TMA); and Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas (TMA)
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Surgical outcomes of single stage surgery for Tandem spinal stenosis (TSS) in elderly and younger patients: A comparative study. J Clin Orthop Trauma 2021; 17:157-162. [PMID: 33854943 PMCID: PMC8022242 DOI: 10.1016/j.jcot.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To evaluate and compare the outcomes of single stage surgery for Tandem Spinal Stenosis (TSS) in elderly (Age ≥65 years) and younger patients (Age <65 years). SUMMARY OF BACKGROUND DATA Tandem spinal stenosis among elderly is common and often missed diagnosed with delayed presentation. Literature evaluating efficacy and safety of single staged surgery for TSS in elderly patients is scanty. METHODS Analysis of 74 patients with TSS managed with single stage posterior surgery from 2007 to 2016 was done. A total of 62 patients who satisfied our inclusion criteria were evaluated and subdivided into two groups based on age; Study group (age ≥65years)] (n = 32) and control group (age <65years) (n = 30). Perioperative, clinical/radiological parameters and postoperative complications and recovery rate were noted. RESULTS The Mean ODI and mJOA showed significant improvement post-operatively in both groups however there was no significant difference between the two groups at final follow-up. There was no statistical difference in operative time, blood loss and hospital stay between the groups. As per Odom's criteria, 78.1% had excellent to good results in study group, while 83.3% had excellent to good results in control group. Postoperative complications were more in elderly group however, there was no significant difference among neurological or cardiopulmonary complications between both groups. CONCLUSIONS Single stage surgery is safe & efficacious modality with less morbidity and optimal results in elderly patients with proper preoperative risk assessment. Our study showed that increased age does not proved to be deterrent in the outcome of single staged surgery in tandem spinal stenosis.
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Bjorefeldt A, Illes S, Zetterberg H, Hanse E. Neuromodulation via the Cerebrospinal Fluid: Insights from Recent in Vitro Studies. Front Neural Circuits 2018; 12:5. [PMID: 29459822 PMCID: PMC5807333 DOI: 10.3389/fncir.2018.00005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/11/2018] [Indexed: 12/11/2022] Open
Abstract
The cerebrospinal fluid (CSF) occupies the brain's ventricles and subarachnoid space and, together with the interstitial fluid (ISF), forms a continuous fluidic network that bathes all cells of the central nervous system (CNS). As such, the CSF is well positioned to actively distribute neuromodulators to neural circuits in vivo via volume transmission. Recent in vitro experimental work in brain slices and neuronal cultures has shown that human CSF indeed contains neuromodulators that strongly influence neuronal activity. Here we briefly summarize these new findings and discuss their potential relevance to neural circuits in health and disease.
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Affiliation(s)
- Andreas Bjorefeldt
- Department of Physiology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Neuroscience, Brown University, Providence, RI, United States
| | - Sebastian Illes
- Department of Physiology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, London, United Kingdom
- United Kingdom Dementia Research Institute, University College London, London, United Kingdom
| | - Eric Hanse
- Department of Physiology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Li H, Chen Z, Li X, Liu T, Shen B, Huang Y, Wu D. Prioritized cervical or lumbar surgery for coexisting cervical and lumbar stenosis: Prognostic analysis of 222 case. Int J Surg 2017; 44:344-349. [PMID: 28711623 DOI: 10.1016/j.ijsu.2017.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/11/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND CONTEXT Single-stage surgery is usually applied to improving the symptoms of coexisting cervical and lumbar stenosis. In most cases, patients' willingness, surgery affordability, surgical trauma, surgical complications and patients' tolerance to surgery all limit the application of single-stage surgery. For patients who cannot receive single-stage surgery, we hope that we can find out by weighing up merits and flaws of the two surgical sites in order to make decision of prioritize one of the two surgery, so as to bring more benefits to the patients. OBJECTIVE To confirm which one of prioritized cervical surgery and prioritized lumbar surgery has a better effect in alleviating the symptoms of patients with coexisting cervical and lumbar stenosis. STUDY DESIGN A retrospective analysis and a cohort study for 15 years. PATIENT SAMPLE The information of 222 patients who were diagnosed with coexisting cervical and lumbar stenosis over the past 15 years was collected, including 144 patients who underwent prioritized cervical surgery and 78 prioritized lumbar surgery, thereafter the changes in the patients' postoperative neurological functions were evaluated. OUTCOME MEASURES Primary outcome variables are the clinical diagnosis event and the event of surgical site positioning. Secondary variables are the event of postoperative function changes and the symptom improvement event. METHODS The information about 222 patients with coexisting cervical and lumbar stenosis who had a follow-up of more than 1 year during January 2000 and December 2014 was collected. The effects of prioritized staged cervical and lumbar surgeries on the prognosis for the above-mentioned patients were respectively evaluated via relevant evaluation indexes. RESULTS The follow-up time was 18-156 months (58.0 ± 36.5). The lumbar reoperation rate after prioritized cervical surgery was lower than the cervical reoperation rate after prioritized lumbar surgery (22.91% < 57.69%) (P < 0.01). The JOA score and Nurick grade significantly improved (P < 0.01) and the ODI score improved (P < 0.05) after prioritized cervical surgery. No obvious improvement in the JOA score and Nurick grade (P > 0.05) was shown but the ODI score markedly improved (P < 0.01) after prioritized lumbar surgery. CONCLUSIONS For patients with coexisting cervical and lumbar stenosis, prioritized cervical surgery is safe and effective and is superior to prioritized lumbar surgery on the improvement of cervical and lumbar symptoms, the postoperative recovery of limb function and the rate of reoperation on another site.
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Affiliation(s)
- Haoxi Li
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai, 200120, China
| | - Zhaoxiong Chen
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai, 200120, China
| | - Xinhua Li
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai, 200120, China
| | - Tao Liu
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai, 200120, China
| | - Bin Shen
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai, 200120, China
| | - Yufeng Huang
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai, 200120, China.
| | - Desheng Wu
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai, 200120, China.
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Castania V, Issy AC, Silveira JW, Ferreira FR, Titze-de-Almeida SS, Resende FFB, Ferreira NR, Titze-de-Almeida R, Defino HLA, Del Bel E. The Presence of the Neuronal Nitric Oxide Synthase Isoform in the Intervertebral Disk. Neurotox Res 2016; 31:148-161. [PMID: 27761804 DOI: 10.1007/s12640-016-9676-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 01/08/2023]
Abstract
Intervertebral disk degeneration is a progressive and debilitating disease with multifactorial causes. Nitric oxide (NO) might contribute to the cell death pathway. We evaluated the presence of the constitutive form of the neuronal NOS (nNOS) in both health and degenerated intervertebral disk through qPCR and immunohistochemistry. We also analyzed the potential role of nNOS modulation in the tail needle puncture model of intervertebral disk degeneration. Male Wistar rats were submitted to percutaneous disk puncture with a 21-gauge needle of coccygeal vertebras. The selective nNOS pharmacological inhibitor N (ω)-propyl-L-arginine (NPLA) or a nNOS-target siRNA (siRNAnNOShum_4400) was injected immediately after the intervertebral disk puncture with a 30-gauge needle. Signs of disk degeneration were analyzed by in vivo magnetic resonance imaging and histological score. We found that intact intervertebral disks express low levels of nNOS mRNA. Disk injury caused a 4 fold increase in nNOS mRNA content at 5 h post disk lesion. However, NPLA or nNOS-target siRNA slight mitigate the intervertebral disk degenerative progress. Our data show evidence of the nNOS presence in the intervertebral disk and its upregulation during degeneration. Further studies would disclose the nNOS role and its potential therapeutical value in the intervertebral disk degeneration.
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Affiliation(s)
- Vitor Castania
- Department of Morphology, Physiology and Basic Pathology, Dental School, University of São Paulo (USP), Ribeirão Prêto, SP, 14049-904, Brazil
| | - Ana Carolina Issy
- Department of Morphology, Physiology and Basic Pathology, Dental School, University of São Paulo (USP), Ribeirão Prêto, SP, 14049-904, Brazil.,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo (USP), São Paulo, Brazil
| | - João Walter Silveira
- Department of Morphology, Physiology and Basic Pathology, Dental School, University of São Paulo (USP), Ribeirão Prêto, SP, 14049-904, Brazil
| | - Frederico Rogério Ferreira
- Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo (USP), São Paulo, Brazil
| | | | - Fernando F B Resende
- Technology for Gene Therapy Laboratory, University of Brasilia - UnB/FAV, Brasília, DF, Brazil
| | - Nádia Rubia Ferreira
- Department of Morphology, Physiology and Basic Pathology, Dental School, University of São Paulo (USP), Ribeirão Prêto, SP, 14049-904, Brazil
| | | | - Helton L A Defino
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, School of Medicine, University of São Paulo (USP), Ribeirão Prêto, Brazil
| | - Elaine Del Bel
- Department of Morphology, Physiology and Basic Pathology, Dental School, University of São Paulo (USP), Ribeirão Prêto, SP, 14049-904, Brazil. .,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo (USP), São Paulo, Brazil.
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Wang J, Wang X, Rong W, Lv J, Wei F, Liu Z. Alteration in chondroitin sulfate proteoglycan expression at the epicenter of spinal cord is associated with the loss of behavioral function in Tiptoe walking Yoshimura mice. Neurochem Res 2014; 39:2394-406. [PMID: 25273876 DOI: 10.1007/s11064-014-1442-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/08/2014] [Accepted: 09/23/2014] [Indexed: 12/15/2022]
Abstract
The objective of this study was to explore the correlation between the alteration in chondroitin sulfate proteoglycan (CSPG) expression at the epicenter of spinal cord and the loss of behavioral function in tiptoe walking Yoshimura mice. The tiptoe walking Yoshimura mice (twy) and Institute of Cancer Research (ICR) mice, aged 20 and 26 weeks, were used in the present study. The behavior assessment, micro-computed tomography and immunofluorescent staining were performed. The compressed spinal cord was histologically analyzed. The results showed that the expression of CSPG was statistically higher at the compressed spinal cord for twy mice compared with that at the normal spinal cord for ICR mice. At the 26th week, a large ossification block at the posterior longitudinal ligament of C1-3 was obviously observed at the micro-CT image We observed the BMS Score was significantly correlated with the expression of glial fibrillary acidic protein, CSPG and hyaluronan (P < 0.05). These findings suggest that compression injury induces the higher CSPG expression at the compressed spinal cord in the twy mice. Furthermore, the alteration in CSPG expression at the epicenter of spinal cord is associated with the loss of behavioral function in twy mice.
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Affiliation(s)
- Jun Wang
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
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Kurt G, Yildirim Z, Cemil B, Celtikci E, Kaplanoglu GT. Effects of curcumin on acute spinal cord ischemia-reperfusion injury in rabbits. J Neurosurg Spine 2014; 20:464-70. [DOI: 10.3171/2013.12.spine1312] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The object of this study was to conduct a prospective, randomized, laboratory investigation of the neuroprotective effects of curcumin functionally, biochemically, and histologically in an experimental acute spinal cord ischemia-reperfusion injury on rabbits.
Methods
Eighteen rabbits were randomly assigned to 1 of 3 groups: the sham group, the ischemia-reperfusion group, or the curcumin group. Spinal cord ischemia was induced by applying an infrarenal aortic cross-clamp for 30 minutes. At 48 hours after ischemia, neurological function was evaluated with modified Tarlov criteria. Biochemical changes in the spinal cord and plasma were observed by measuring levels of malondialdehyde (MDA), advanced oxidation protein products (AOPP), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), nitrite/nitrate, and tumor necrosis factor-α (TNF-α). Histological changes were examined with H & E staining. Immunohistochemical staining with antibodies against caspase-3 was performed to evaluate cell apoptosis after ischemia.
Results
In the curcumin group, neurological outcome scores were statistically significantly better compared with the ischemia-reperfusion group. In the ischemia-reperfusion group, MDA, AOPP, and nitrite/nitrate levels were significantly elevated in the spinal cord tissue and the plasma by the induction of ischemia-reperfusion. The curcumin treatment significantly prevented the ischemia-reperfusion–induced elevation of nitrite/nitrate and TNF-α. In addition, the spinal cord tissue and the plasma SOD, GSH, and CAT levels were found to be preserved in the curcumin group and not statistically different from those of the sham group. Histological evaluation of the tissues also demonstrated a decrease in axonal damage, neuronal degeneration, and glial cell infiltration after curcumin administration.
Conclusions
Although further studies including different dose regimens and time intervals are required, curcumin could attenuate a spinal cord ischemia-reperfusion injury in rabbits via reducing oxidative products and proinflammatory cytokines, as well as increasing activities of antioxidant enzymes and preventing apoptotic cell death.
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Affiliation(s)
- Gokhan Kurt
- 1Department of Neurosurgery, Gazi University Faculty of Medicine, Beşevler
| | | | - Berker Cemil
- 3Department of Neurosurgery, Fatih University Faculty of Medicine, Emek; and
| | - Emrah Celtikci
- 1Department of Neurosurgery, Gazi University Faculty of Medicine, Beşevler
| | - Gulnur Take Kaplanoglu
- 4Department of Histology and Embryology, Gazi University Faculty of Medicine, Beşevler, Ankara, Turkey
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Krishnan A, Dave BR, Kambar AK, Ram H. Coexisting lumbar and cervical stenosis (tandem spinal stenosis): an infrequent presentation. Retrospective analysis of single-stage surgery (53 cases). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:64-73. [PMID: 23793607 PMCID: PMC3897818 DOI: 10.1007/s00586-013-2868-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 05/07/2013] [Accepted: 06/07/2013] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Retrospective analysis of 53 patients who underwent single stage simultaneous surgery for tandem spinal stenosis (TSS) at single centre. OBJECTIVE To discuss the presentation of combined cervical and lumbar (tandem) stenosis and to evaluate the safety and efficacy of single-stage simultaneous surgery. Combined stenosis is an infrequent presentation with mixed presentation of upper motor neuron and lower motor neuron signs. Scarce literature on its presentation and management is available. There is a controversy in the surgical strategy of these patients. Staged surgeries are frequently recommended and only few single-stage surgeries reported. METHODS All the patients were clinico-radiologically diagnosed TSS. Surgeries were performed in single stage by two teams. Results were evaluated with Nurick grade, modified Japanese Orthopedic Association score (mJOA), oswestry disability index (ODI), patient satisfaction index, mJOA recovery rate, blood loss and complication. RESULTS The mJOA cervical and ODI score improved from a mean 8.86 and 68.15 preoperatively to 13.00 and 30.11, respectively, at 12 months and to 14.52 and 24.03 at final follow-up. The average mJOA recovery rate was 48.23 ± 26.90 %. Patient satisfaction index was 2.13 ± 0.91 at final follow-up. Estimated blood loss of ≤400 ml and operating room time of <150 min showed improvement of scores and lessened the complications. In the age group below 60 years, the improvement was statistically significant in ODI (p = 0.02) and Nurick's grade (p = 0.03) with average improvement in mJOA score. CONCLUSION Short-lasting surgery, single anaesthesia, reduced morbidity and hospital stay as well as costs, an early return to function, high patient satisfaction rate with encouraging results justify single-stage surgery in TSS. Age, blood loss and duration of surgery decide the complication rate and outcome of surgery. Staged surgery is recommended in patients above the age of 60 years.
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Affiliation(s)
- Ajay Krishnan
- "STAVYA" Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, 380006, Gujarat, India,
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Adamova BM, Vohanka S, Hnojcikova M, Okacova I, Dusek L, Bednarik J. Neurological impairment score in lumbar spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1897-906. [PMID: 23483310 DOI: 10.1007/s00586-013-2731-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 02/20/2013] [Accepted: 02/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM The Oswestry Disability Index (ODI) is an interview-based instrument generally accepted as a measure of disability in patients with lumbar spinal stenosis (LSS). There is, however, no generally accepted measure for neurological impairment in LSS. We therefore developed a scoring system [neurological impairment score in lumbar spinal stenosis (NIS-LSS)] for the assessment of neurological impairment in the lower limbs of patients with LSS, then performed a validation study to facilitate its implementation in the routine clinical evaluation of patients with LSS. METHODS The NIS-LSS is based on the combined evaluation of tendon reflexes, tactile and vibratory sensation, pareses, and the ability to walk and run; the total score ranges from 0 (inability to walk) to 33 points (no impairment). A group of 117 patients with LSS and a control group of 63 age- and sex-matched healthy volunteers were assessed with the NIS-LSS to evaluate capacity to discriminate between LSS patients and controls. A correlation with the ODI was performed for assessment of construct validity. RESULTS The median NIS-LSS was 27 points in LSS patients compared with 33 points in controls. The NIS-LSS discriminated LSS patients from healthy controls to a high degree of significance: the optimum NIS-LSS cut-off value was 32 points with a sensitivity of 85.5% and a specificity of 81.3% (p < 0.001). Overall NIS-LSS correlated significantly with the ODI score (p < 0.001). Vibratory sensation (p = 0.04), presence of paresis (p = 0.01) and especially the ability to walk and run (p < 0.001) were the NIS-LSS elements that correlated most closely with the degree of disability assessed by the ODI. CONCLUSIONS The NIS-LSS is a simple and valid measure of neurological impairment in the lower limbs of patients with LSS (without comorbidity), discriminating them from healthy controls to a high degree of sensitivity and specificity and correlating closely with the degree of disability. It extends our ability to quantify neurological status and to follow changes arising out of the natural course of the disease or the effects of treatment.
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Affiliation(s)
- B Micankova Adamova
- Department of Neurology, University Hospital and Masaryk University Brno, Jihlavska 20, 62500 Brno, Czech Republic.
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