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Canseco JA, Karamian BA, Minetos PD, Paziuk TM, Gabay A, Reyes AA, Bechay J, Xiao KB, Nourie BO, Kaye ID, Woods BI, Rihn JA, Kurd MF, Anderson DG, Hilibrand AS, Kepler CK, Schroeder GD, Vaccaro AR. Risk Factors for 30-day and 90-day Readmission After Lumbar Decompression. Spine (Phila Pa 1976) 2022; 47:672-679. [PMID: 35066538 DOI: 10.1097/brs.0000000000004325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To assess readmission rates and risk factors for 30-day and 90-day readmission after elective lumbar decompression at a single institution. SUMMARY OF BACKGROUND DATA Hospital readmission is an undesirable aspect of interventional treatment. Studies evaluating readmissions after elective lumbar decompression typically analyze national databases, and therefore have several drawbacks inherent to their macroscopic nature that limit their clinical utility. METHODS Patients undergoing primary one- to four-level lumbar decompression surgery were retrospectively identified. Demographic, surgical, and readmission data within "30-days" (0-30 days) and "90-days" (31-90 days) postoperatively were extracted from electronic medical records. Patients were categorized into four groups: (1) no readmission, (2) readmission during the 30-day or 90-day postoperative period, (3) complication related to surgery, and (4) Emergency Department (ED)/Observational (OBs)/Urgent (UC) care. RESULTS A total of 2635 patients were included. Seventy-six (2.9%) were readmitted at some point within the 30- (2.3%) or 90-day (0.3%) postoperative periods. Patients in the pooled readmitted group were older (63.1 yr, P < 0.001), had a higher American Society of Anesthesiologists (ASA) grade (31.2% with ASA of 3, P = 0.03), and more often had liver disease (8.1%, P = 0.004) or rheumatoid arthritis (12.0%, P = 0.02) than other cohorts. A greater proportion of 90-day readmissions and complications had surgical-related diagnoses or a diagnosis of recurrent disc herniation than 30-day readmissions and complications (66.7% vs. 44.5%, P = 0.04 and 33.3% vs. 5.5%, P < 0.001, respectively). Age (Odds ratio [OR]: 1.02, P = 0.01), current smoking status (OR: 2.38, P < 0.001), longer length of stay (OR: 1.14, P < 0.001), and a history of renal failure (OR: 2.59, P = 0.03) were independently associated with readmission or complication. CONCLUSION Increased age, current smoking status, hospital length of stay, and a history of renal failure were found to be significant independent predictors of inpatient readmission or complication after lumbar decompression.
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Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Paul D Minetos
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Taylor M Paziuk
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Alyssa Gabay
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Ariana A Reyes
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Joseph Bechay
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Kevin B Xiao
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Blake O Nourie
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - I David Kaye
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Barrett I Woods
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jeffrey A Rihn
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Mark F Kurd
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - D Greg Anderson
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Alan S Hilibrand
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | | | - Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Home-based cycling using connected ergometric bicycles for people with lumbar spinal stenosis (FLEXCAL): Protocol for a randomised trial. Ann Phys Rehabil Med 2020; 64:101351. [PMID: 31982599 DOI: 10.1016/j.rehab.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/10/2019] [Accepted: 12/25/2019] [Indexed: 11/21/2022]
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Yoshida T, Kawakami M, Teraguchi M, Kagotani R, Minetama M, Nakagawa M, Nakagawa Y. A comparative study of gait characteristics associated with and without degenerative lumbar spondylolisthesis in patients with lumbar spinal stenosis. J Orthop Sci 2019; 24:590-595. [PMID: 30573395 DOI: 10.1016/j.jos.2018.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/15/2018] [Accepted: 11/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reported characteristics of DS include forward slippage of the superior lumbar relative to the inferior lumbar, lumbar instability, increased lumbar lordotic angle, and high body mass index (BMI). However, to our knowledge, only static measurements were conducted in previous studies, and no dynamic observations exist. In this crosssectional study, the gait of patients with and without DS in LSS was compared, and their characteristics were examined using a three-dimensional motion analysis system. METHODS In total, 42 patients with LSS were included. Lumbar lordosis angle, sacral tilt angle, lumbar slip rate determined from X-ray images, the Zurich Claudication Questionnaire (ZCQ), the visual analog scale (VAS), and BMI were evaluated. U-COM length was the distance between the upper center of mass (COM) and the body's COM, while L-COM length was the distance between the lower COM and the COM. Each DS and Non-DS group evaluation was compared using the Mann-Whitney U-test. Additionally, multivariate analysis was performed using factors with significant differences as explanatory variables and with or without DS as the target variable. RESULTS Lumbar lordotic angle was significantly higher in the DS group and there was a significant difference between U-COM and L-COM lengths in the sagittal planes at heel contact (HC) and toe-off (TO). L-COM length at HC and TO was a significant variable when the lumbar lordotic angle was adjusted as a confounding factor in multivariate analysis. CONCLUSIONS The U-COM and L-COM lengths in the DS group were both extended and the line connecting each COM was inclined backward on the sagittal plane at HC and TO during gait. Our study showed that L-COM length was associated with or without DS.
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Affiliation(s)
- Takaki Yoshida
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan; Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Japan.
| | - Mamoru Kawakami
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
| | | | - Ryohei Kagotani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
| | - Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
| | - Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
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Matsuwaka ST, Liem BC. The Role of Exercise in Treatment of Lumbar Spinal Stenosis Symptoms. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0171-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Tousignant-Laflamme Y, Longtin C, Brismée JM. How radiological findings can help or hinder patients' recovery in the rehabilitation management of patients with low back pain: what can clinicians do? J Man Manip Ther 2017; 25:63-65. [PMID: 28559664 DOI: 10.1080/10669817.2017.1309345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Yannick Tousignant-Laflamme
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.,Research Center of the Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Canada
| | - Christian Longtin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Jean-Michel Brismée
- Doctor of Science Program in Physical Therapy, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Dobbs R, May S, Hope P. The validity of a clinical test for the diagnosis of lumbar spinal stenosis. ACTA ACUST UNITED AC 2016; 25:27-34. [DOI: 10.1016/j.math.2016.05.332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 11/28/2022]
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Kim ER, Kang MH, Kim YG, Oh JS. Effects of a Home Exercise Program on the Self-report Disability Index and Gait Parameters in Patients with Lumbar Spinal Stenosis. J Phys Ther Sci 2014; 26:305-7. [PMID: 24648654 PMCID: PMC3944311 DOI: 10.1589/jpts.26.305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/22/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The present study was performed to identify the effect of a home exercise
program on the self-reported disability index and gait parameters in patients with lumbar
spinal stenosis (LSS). [Methods] Fifteen patients with LSS were enrolled in this study and
were trained in a 4-week home exercise program (40 min/day). All patients were evaluated
with three self-reported disability indices (Oswestry Disability Index, Roland-Morris
Disability Questionnaire, and Spinal Stenosis Scale), and gait parameters were assessed
using a GAITRite system before and after the home exercise program. [Results] Patients
with LSS showed significant decreases in the self-reported questionnaire scores and pain
intensity after the home exercise program. However, the gait parameters did not
significantly change. [Conclusion] These findings suggest that home exercise programs can
improve self-reported questionnaire scores and decrease pain in patients with LSS.
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Affiliation(s)
- Eui-Ryong Kim
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Min-Hyeok Kang
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Yang-Gon Kim
- Department of Physical Therapy, Graduate School, Inje University, Republic of Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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Simmerman SM, Sizer PS, Dedrick GS, Apte GG, Brismée JM. Immediate changes in spinal height and pain after aquatic vertical traction in patients with persistent low back symptoms: a crossover clinical trial. PM R 2011; 3:447-57. [PMID: 21570033 DOI: 10.1016/j.pmrj.2011.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 01/20/2011] [Accepted: 01/31/2011] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the effect of aquatic vertical traction on spinal height, pain intensity, and centralization response compared with a land-based supine flexion position for patients with low back pain and signs of nerve root compression. DESIGN Single-blind, repeated-measures crossover design. SETTING Outpatient physical therapy clinic. SUBJECTS Ninety-eight subjects were recruited using consecutive sampling, with 28 men and 32 women of a mean ± standard deviation (SD) age of 59.6 ± 11.6 years completing testing. INTERVENTION Each subject participated in 2 sessions that consisted of loaded walking for 15 minutes, followed by either 15 minutes of land-based supine position or 15 minutes of aquatic vertical traction. MEASUREMENTS Spinal height change, measured using a commercial stadiometer, was determined after completing loaded walking and after each intervention. RESULTS The mean ± SD height change of 4.99 ± 2.88 mm after aquatic vertical traction was similar to that of 4.21 ± 2.53 mm after the land-based supine flexion (P = .0969). Paired t-test indicated that both interventions resulted in significant increased height (P < .0001). Decreases in pain after aquatic intervention (2.7 ± 2.1 cm) were significantly greater than decreases after land intervention (1.7 ± 1.7 cm; P = .0034), and centralization of symptoms was more pronounced after aquatic vertical suspension compared with the supine land-based flexion condition (P < .0001). A significant correlation between height change and both pain reduction (r = 0.39; P = .001) and centralization (r = 0.29; P = .013) was observed for the aquatic intervention only. CONCLUSION Although both the aquatic and land interventions produced significant increases in overall spinal height, the aquatic intervention produced greater pain relief and centralization response in subjects with low back pain and signs of nerve root compression.
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Stuber K, Sajko S, Kristmanson K. Chiropractic treatment of lumbar spinal stenosis: a review of the literature. J Chiropr Med 2011; 8:77-85. [PMID: 19646390 DOI: 10.1016/j.jcm.2009.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 02/18/2009] [Accepted: 02/22/2009] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective of this article was to review the literature on the use of chiropractic for the treatment of lumbar spinal stenosis. METHODS A literature search was conducted on 4 electronic databases (Medline, Index to Chiropractic Literature, Cumulative Index to Nursing and Allied Health Literature, and Allied and Complementary Medicine Database) for clinical research pertaining to chiropractic treatment of lumbar spinal stenosis. Retrieved articles were hand searched for relevant references. Inclusion criteria consisted of any clinical study design (including case reports) using chiropractic care on patients with lumbar spinal stenosis published in English in the past 25 years. RESULTS Six articles on a total of 70 patients met the inclusion criteria for the review. These articles included 4 case studies, a case series, and an observational cohort study. Treatments included spinal manipulation and, most often, flexion-distraction manipulation. Numerous other interventions including exercise, activity of daily living modifications, and various passive care modalities were selectively used in the included studies. CONCLUSIONS There is a paucity of evidence available with respect to chiropractic treatment of spinal stenosis. The limited evidence that is available points toward chiropractic care being potentially beneficial in the treatment of patients with lumbar spinal stenosis, but further clinical investigations are necessary.
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Affiliation(s)
- Kent Stuber
- Private practice of chiropractic, Calgary, Alberta, Canada
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Backstrom KM, Whitman JM, Flynn TW. Lumbar spinal stenosis-diagnosis and management of the aging spine. ACTA ACUST UNITED AC 2011; 16:308-17. [PMID: 21367646 DOI: 10.1016/j.math.2011.01.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/03/2011] [Accepted: 01/22/2011] [Indexed: 11/18/2022]
Abstract
Low back pain and lumbar spinal stenosis (LSS) is an extensive problem in the elderly presenting with pain, disability, fall risk and depression. The incidence of LSS is projected to continue to grow as the population ages. In light of the risks, costs and lack of long-term results associated with surgery, and the positive outcomes in studies utilizing physical therapy interventions for the LSS patient, a non-invasive approach is recommended as a first line of intervention. This Masterclass presents an overview of LSS in terms of clinical examination, diagnosis, and intervention. A focused management approach to the patient with LSS is put forward that emphasizes a defined four-fold approach of patient education, manual physical therapy, mobility and strengthening exercises, and aerobic conditioning.
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Affiliation(s)
- Karen Maloney Backstrom
- Rehabilitation Department, University of Colorado Hospital, 1635 Aurora Court Mail Stop F712, Aurora, CO 80045, USA.
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Kay E, Deutsch A, Chen D, Semik P, Rowles D. Effects of gender on inpatient rehabilitation outcomes in the elderly with incomplete paraplegia from nontraumatic spinal cord injury. J Spinal Cord Med 2010; 33:379-86. [PMID: 21061897 PMCID: PMC2964026 DOI: 10.1080/10790268.2010.11689716] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To examine gender differences in rehabilitation outcomes for patients with nontraumatic spinal cord injury. RESEARCH DESIGN Secondary analysis was conducted on Medicare beneficiary data from 65 to 74 year olds with incomplete paraplegia discharged from inpatient rehabilitation facilities in 2002 through 2005. MAIN OUTCOME MEASURES Length of stay, Functional Independence Measure instrument motor item and subscale scores on discharge, and discharge destination. RESULTS Among patients with degenerative spinal disease, men had significantly longer rehabilitation stays than women (P < 0.001). Men with degenerative spinal disease had significantly lower discharge Functional Independence Measure scores than women, indicating more dependence in self-care (P < 0.001) and mobility (P < 0.001). Among patients with degenerative spinal disease, men were less likely to walk (odds ratio = 0.58; 95% CI = 0.38-0.87) and less likely to be independent with bladder management (odds ratio = 0.44; 95% CI = 0.31-0.62). Among patients with vascular ischemia, men were more independent (B = 2.59; 99% CI = 0.42-4.76) in mobility than women. There were no gender differences in the malignant spinal tumors group. There were no gender differences in being discharged to a community-based residence. CONCLUSIONS Gender distributions varied by etiology. Gender differences were found in demographics, length of stay, and functional outcomes but not discharge destination. Men were more dependent than women at discharge in the etiology group with the least overall disability (degenerative spinal disease) and more independent in mobility than women at discharge in the etiology group with the most overall disability (vascular ischemia).
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Affiliation(s)
- Elizabeth Kay
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, Illinois 60611, USA.
| | - Anne Deutsch
- Center for Rehabilitation Outcomes Research
,Department of Physical Medicine and Rehabilitation
,Institute for Health Care Studies, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David Chen
- Spinal Cord Injury Program, Rehabilitation Institute of Chicago, Chicago, Illinois
,Spinal Cord Injury Program, Northwestern Memorial Hospital, Chicago, Illinois
,Department of Physical Medicine and Rehabilitation
| | | | - Diane Rowles
- Spinal Cord Injury Program, Rehabilitation Institute of Chicago, Chicago, Illinois
,Department of Physical Medicine and Rehabilitation
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Effects of etiology on inpatient rehabilitation outcomes in 65- to 74-year-old patients with incomplete paraplegia from a nontraumatic spinal cord injury. PM R 2010; 2:504-13. [PMID: 20630437 DOI: 10.1016/j.pmrj.2010.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 02/17/2010] [Accepted: 03/05/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine differences in rehabilitation outcomes for older patients with a nontraumatic spinal cord injury (NT-SCI) for 5 etiologic diagnoses: degenerative spinal disease (DSD), malignant spinal tumor, benign spinal tumor, vascular ischemia, and spinal abscess. DESIGN Retrospective cohort study that used Medicare claims and assessment data. SETTING A total of 479 inpatient rehabilitation hospitals and units. PATIENTS A total of 1780 Medicare beneficiaries (65-74 years old) with incomplete paraplegia attributable to NT-SCI who were discharged from inpatient rehabilitation facilities from 2002 through 2005. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Length of stay, discharge Functional Independence Measure (FIM) instrument motor item and subscale scores, and discharge destination. RESULTS Demographic characteristics varied by etiology group. Mean +/- SD rehabilitation stays ranged from 13.3 +/- 7.7 days for DSD to 26.4 +/- 13.4 days for vascular ischemia. Adjusted data showed stays differed (P < .001) across etiology groups. Adjusted discharge mean self-care and mobility subscores revealed that patients with DSD and benign tumor were more independent (P < .001) than patients with a malignant tumor or spinal abscess. Patients with vascular ischemia were more dependent (P < .01) in mobility than the DSD and benign tumor groups. Etiologic differences (P < .01) in independence in discharge FIM modifiers for walking (FIM > or = 4), bladder (FIM > or = 6) and bowel management (FIM > or = 6) and bowel accidents/continence (FIM > or = 6), but not bladder accidents (FIM > or = 6), were present. The percent of patients discharged to a community residence ranged from 59.3% to 92.6%. Adjusted data showed that significantly larger percentages (P < .01) of patients in the DSD and malignant tumor groups than in the spinal abscess group were discharged to a community residence (versus nursing home). CONCLUSION There are etiologic differences in demographics, rehabilitation length of stay, functional outcomes, and discharge destination in elderly patients with NT-SCI.
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Iversen MD, Choudhary VR, Patel SC. Therapeutic exercise and manual therapy for persons with lumbar spinal stenosis. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/ijr.10.29] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Goren A, Yildiz N, Topuz O, Findikoglu G, Ardic F. Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: a prospective randomized controlled trial. Clin Rehabil 2010; 24:623-31. [DOI: 10.1177/0269215510367539] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To assess the effectiveness of therapeutic exercises alone and in combination with a single physical agent — ultrasound — in patients with lumbar spinal stenosis. Design: Randomized, prospective, controlled trial. Setting: Department of Physical Medicine and Rehabilitation, University Hospital. Subjects: Forty-five patients presenting with symptoms of neurological claudication and magnetic resonance image-proven lumbar spinal stenosis were assigned to one of three groups: ultrasound plus exercise group (group 1, n =15), sham ultrasound plus exercise group (group 2, n= 15) and no exercise — no treatment group (control group, n = 15). Interventions: Stretching and strengthening exercises for lumbar, abdominal, leg muscles as well as low-intensity cycling exercises were given as therapeutic exercises. Ultrasound was applied with 1 mHz, 1.5 W/cm2 intensity, in continuous mode on the back muscle for 10 minutes in group 1 while ultrasound on/off mode was applied in group 2. Main outcome measures: Before and after a three-week period, all subjects were evaluated by pain, disability, functional capacity and consumption of analgesic. Results: Thirty-two of the participants were women and 13 were men, with an average age of 53.2 ± 12.68 years (range 25—82 years). After a three-week treatment period, leg pain decreased in group 1 (—1.47 ± 3.02) and group 2 (—2.47 ± 3.75) compared with the control group (P<0.05). Disability score decreased in group 1 (—3.94 ± 7.20) and group 2 (—7.80 ± 10.26) compared with control group (P<0.05). We did not find any statistically significant difference between groups 1 and 2 (P>0.05). The amount of analgesic consumption is significantly less in the group with ultrasound application compared to that in the control group (P<0.05). Conclusion: The results of our study suggest that therapeutic exercises are effective for pain and disability in patients with lumbar spinal stenosis and that addition of ultrasound to exercise therapy lowers the analgesic intake substantially.
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Affiliation(s)
| | - Necmettin Yildiz
- Department of Physical Medicine and Rehabilitation, Pamukkale University Medical School, Denizli, Turkey,
| | - Oya Topuz
- Department of Physical Medicine and Rehabilitation, Pamukkale University Medical School, Denizli, Turkey
| | - Gulin Findikoglu
- Department of Physical Medicine and Rehabilitation, Pamukkale University Medical School, Denizli, Turkey
| | - Fusun Ardic
- Department of Physical Medicine and Rehabilitation, Pamukkale University Medical School, Denizli, Turkey
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Abstract
Lumbar spinal stenosis (LSS) is most commonly due to degenerative changes in older individuals. LSS is being more commonly diagnosed and may relate to better access to advanced imaging and to an ageing population. This review focusses on radicular symptoms related to degenerative central and lateral stenosis and updates knowledge of LSS pathophysiology, diagnosis and management. Since patients with anatomic LSS can range from asymptomatic to severely disabled, the clinical diagnosis focusses on symptoms and examination findings associated with LSS. Imaging findings are helpful for patients with persistent, bothersome symptoms in whom invasive treatments are being considered. There is limited information from high-quality studies about the relative merits and demerits of commonly used treatments. Interpreting and comparing results of available research are limited by a lack of consensus about the definition of LSS. Nevertheless, evidence supports decompressive laminectomy for patients with persistent and bothersome symptoms. Recommendations favour a shared decision-making approach due to important trade-offs between alternative therapies and differences among patients in their preferences and values.
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Affiliation(s)
- Stephane Genevay
- Division of Rheumatology, University Hospitals of Geneva, Switzerland, Tel: 0041 22 382 36 73, Fax: 0041 22 382 35 35
| | - Steven J Atlas
- General Medicine Division, Massachusetts General Hospital, Boston MA, USA, Tel: 617-724-4736, Fax: 617-724-3544
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Abstract
Lumbar spinal stenosis (LSS) comprises narrowing of the spinal canal with subsequent neural compression, and is frequently associated with symptoms of neurogenic claudication. To establish a diagnosis of LSS, clinical history, physical examination results and radiological changes all need to be considered. Patients who exhibit mild to moderate symptoms of LSS should undergo multimodal conservative treatment, such as patient education, pain medication, delordosing physiotherapy and epidural injections. In patients with severe symptoms, surgery is indicated if conservative treatment proves ineffective after 3-6 months. Clinically relevant motor deficits or symptoms of cauda equina syndrome remain absolute indications for surgery. The first randomized, prospective studies have provided class I-II evidence that supports a more rapid and profound decline of LSS symptoms after decompressive surgery than with conservative therapy. In the absence of a valid paraclinical diagnostic marker, however, more evidence-based data are needed to identify those patients for whom the benefit of surgery would outweigh the risk of developing complications. In this Review, we briefly survey the underlying pathophysiology and clinical appearance of LSS, and explore the available diagnostic and therapeutic options, with particular emphasis on neuroradiological findings and outcome predictors.
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Sahin F, Yilmaz F, Kotevoglu N, Kuran B. The efficacy of physical therapy and physical therapy plus calcitonin in the treatment of lumbar spinal stenosis. Yonsei Med J 2009; 50:683-8. [PMID: 19881973 PMCID: PMC2768244 DOI: 10.3349/ymj.2009.50.5.683] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 10/05/2007] [Accepted: 10/05/2007] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of our study was to compare the efficacy of physical therapy alone and in combination with calcitonin in patients with neurogenic claudication (NC). MATERIALS AND METHODS In this single blind, and randomized study, patients with lumbar spinal canal stenosis who were diagnosed by clinical findings and MRI and having NC were included. Patients were observed for 8 weeks and evaluated before and after treatment. Patients were randomized between the salmon calcitonin 200 U/day + physical therapy (n = 23) (Group 1) and paracetamol 1,500 mg/day + physical therapy (n = 22) (Group 2) treatment groups. Both groups received the same physical therapy (interferential current + hot pack + short wave diathermy) and exercise protocol. The association of various clinical and functional parameters was assessed statistically by using paired and unpaired t test, chi square test and McNemar's test. p < 0.05 indicated statistical significant. RESULTS Mean age of the patients in Group 1 was 57.6 +/- 11.2 and in Group 2 54.5 +/- 10.6 years. Before treatment, there were no significant differences between groups with respect to age, body mass index, spinal axial diameter, Visual Analogue Scale (VAS), spinal mobility, functional status and walking distance (p > 0.05). After 8 weeks of treatment, both groups benefited significantly with respect to VAS, functional status and walking distance (p < 0.001). There was no statistically significant difference between groups (p > 0.05). CONCLUSION In 45 patients with lumbar spinal stenosis who received 8 weeks of treatment, concomitant use of calcitonin with physical therapy and exercise did not have any benefical effect on the patient's pain, functional status, lumbar mobility and walking distance.
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Affiliation(s)
- Fusun Sahin
- Department of Physical and Rehabilitation Medicine, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
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Pua YH, Cai CC, Lim KC. Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial. ACTA ACUST UNITED AC 2007; 53:83-9. [PMID: 17535143 DOI: 10.1016/s0004-9514(07)70040-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
QUESTION Is 6 weeks of treadmill walking with body weight support more effective than cycling in people with lumbar spinal stenosis when added to an exercise program? DESIGN Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS Sixty-eight patients aged 58 (SD 8) with symptoms of lumbar spinal stenosis for 12 weeks (SD 49). INTERVENTION Participants performed either treadmill with body weight support or cycling, twice weekly, for 6 weeks. Both groups also received an exercise program consisting of heat, lumbar traction, and flexion exercises. OUTCOME MEASURES The primary outcome was disability measured using the modified Oswestry Disability Index. Secondary outcomes were disability, measured using the Roland-Morris Disability Questionnaire, pain severity, and patient perceived benefit. Measures were collected midway through intervention at 3 weeks and after intervention at 6 weeks. RESULTS There was no difference between the groups in reduction in disability or pain over the 6-week intervention period. The between-group difference in the modified Oswestry Disability Index was 3.2 points (95% CI -3.1 to 7.7) at 6 weeks, and in pain severity was 2 mm on a 100 visual analogue scale (95% CI -5 to 10). Furthermore, the wide confidence intervals associated with estimates of patient benefit are consistent with no difference between the two groups. However, both groups did improve. CONCLUSION Treadmill with body weight support and cycling may be equally effective in the conservative management of people with lumbar spinal stenosis. However, the improvement observed in both groups was probably a combination of the intervention and the natural course of recovery of lumbar spinal stenosis.
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Schulte TL, Bullmann V, Lerner T, Schneider M, Marquardt B, Liljenqvist U, Pietilä TA, Hackenberg L. Lumbale Spinalkanalstenose. DER ORTHOPADE 2006; 35:675-92; quiz 693-4. [PMID: 16770609 DOI: 10.1007/s00132-006-0971-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lumbal spinal stenosis is gaining more and more clinical relevance because of changing population structure and increasing demand on lifequality in the elderly. Current treatment recommendations are based on clinical experience, expert opinions and single studies rather than on proven evidence. The radiologic degree of stenosis does not correlate with the patients' clinical situation. It is not the main factor indicating surgery but rather the typical history and spinal claudication. Symptomatic patients with light to moderate complaints should undergo multimodal conservative treatment. Epidural injections, delordosating physiotherapy and medication are useful. In patients with severe symptomatic stenosis surgery is indicated after a conservative treatment of 3 months. Relevant pareses or a cauda equina syndrome are absolute indications for surgery. The general aim is to decompress sufficiently while maintaining or restoring segmental stability. A laminectomy is not necessarily required. In patients with accompanying degenerative Meyerding grade I-II spondylolisthesis or instability in functional radiographs, fusion or dynamic stabilisation are recommended in addition to decompression, depending on the patient's age and activity level.
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Affiliation(s)
- T L Schulte
- Klinik und Poliklinik für Allgemeine Orthopädie, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48149 , Münster, Germany.
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