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Vavourakis M, Sakellariou E, Galanis A, Karampinas P, Zachariou D, Tsalimas G, Marougklianis V, Argyropoulou E, Rozis M, Kaspiris A, Pneumatikos SG. Comprehensive Insights into Metastasis-Associated Spinal Cord Compression: Pathophysiology, Diagnosis, Treatment, and Prognosis: A State-of-the-Art Systematic Review. J Clin Med 2024; 13:3590. [PMID: 38930119 PMCID: PMC11205147 DOI: 10.3390/jcm13123590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges in terms of diagnosis, management, and prognosis. Metastatic lesions from cancer are a common cause of spinal cord compression, affecting a substantial portion of oncology patients, and only in the US has the percentage risen to 10%. Acute metastasis-correlated spinal cord compression poses a considerable clinical challenge, necessitating timely diagnosis and intervention to prevent neurological deficits. Clinical presentation is often non-specific, emphasizing the importance of thorough evaluation and appropriate differential diagnosis. Diagnostic workup involves various imaging modalities and laboratory studies to confirm the diagnosis and assess the extent of compression. Treatment strategies focus on pain management and preserving spinal cord function without significantly increasing patient life expectancy, while multidisciplinary approaches are often required for optimal outcomes. Prognosis depends on several factors, highlighting the importance of early intervention. We provide an up-to-date overview of acute spinal cord compression in metastases, accentuating the importance of comprehensive management strategies. Objectives: This paper extensively explores the pathophysiology, clinical presentation, diagnostic strategies, treatment modalities, and prognosis associated with spinal cord metastases. Materials and Methods: A systematic literature review was conducted in accordance with the PRISMA guidelines. Conclusions: We aim to help healthcare professionals make informed clinical decisions when treating patients with spinal cord metastases by synthesizing current evidence and clinical insights.
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Affiliation(s)
- Michail Vavourakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14122 Athens, Greece; (E.S.); (A.G.); (P.K.); (D.Z.); (G.T.); (V.M.); (M.R.); (A.K.); (S.G.P.)
| | - Evangelos Sakellariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14122 Athens, Greece; (E.S.); (A.G.); (P.K.); (D.Z.); (G.T.); (V.M.); (M.R.); (A.K.); (S.G.P.)
| | - Athanasios Galanis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14122 Athens, Greece; (E.S.); (A.G.); (P.K.); (D.Z.); (G.T.); (V.M.); (M.R.); (A.K.); (S.G.P.)
| | - Panagiotis Karampinas
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14122 Athens, Greece; (E.S.); (A.G.); (P.K.); (D.Z.); (G.T.); (V.M.); (M.R.); (A.K.); (S.G.P.)
| | - Dimitrios Zachariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14122 Athens, Greece; (E.S.); (A.G.); (P.K.); (D.Z.); (G.T.); (V.M.); (M.R.); (A.K.); (S.G.P.)
| | - Georgios Tsalimas
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14122 Athens, Greece; (E.S.); (A.G.); (P.K.); (D.Z.); (G.T.); (V.M.); (M.R.); (A.K.); (S.G.P.)
| | - Vasileios Marougklianis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14122 Athens, Greece; (E.S.); (A.G.); (P.K.); (D.Z.); (G.T.); (V.M.); (M.R.); (A.K.); (S.G.P.)
| | - Evangelia Argyropoulou
- Department of Orthopaedic Surgery, University General Hospital of Patra, 26504 Patras, Greece;
| | - Meletis Rozis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14122 Athens, Greece; (E.S.); (A.G.); (P.K.); (D.Z.); (G.T.); (V.M.); (M.R.); (A.K.); (S.G.P.)
| | - Angelos Kaspiris
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14122 Athens, Greece; (E.S.); (A.G.); (P.K.); (D.Z.); (G.T.); (V.M.); (M.R.); (A.K.); (S.G.P.)
| | - Spiros G. Pneumatikos
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14122 Athens, Greece; (E.S.); (A.G.); (P.K.); (D.Z.); (G.T.); (V.M.); (M.R.); (A.K.); (S.G.P.)
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Zhu C, Xiao G. Efficacy and safety of interspinous process device compared with alone decompression for lumbar spinal stenosis: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38370. [PMID: 38847722 PMCID: PMC11155552 DOI: 10.1097/md.0000000000038370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/03/2024] [Indexed: 06/10/2024] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. BACKGROUND Interspinous process devices (IPD) were used as a treatment in selected patients with lumbar spinal stenosis (LSS). However, the use of IPD was still debated that it had significantly higher reoperation rates compared to traditional decompression. Therefore, the purpose of the meta-analysis was to evaluate the effectiveness and safety of IPD treatment in comparison to traditional treatment. METHODS The databases were searched of PubMed, Embase and the Cochrane, Chinese National Knowledge Infrastructure, Chongqing VIP Database and Wan Fang Database up to January 2024. Relevant studies were identified by using specific eligibility criteria and data was extracted and analyzed based on primary and secondary endpoints. RESULTS A total of 13 studies were included (5 RCTs and 8 retrospective studies). There was no significant difference of Oswestey Disability Index (ODI) score in the last follow-up (MD = -3.81, 95% CI: -8.91-1.28, P = .14). There was significant difference of Visual Analog Scale (VAS) back pain scoring in the last follow-up (MD = -1.59, 95% CI: -3.09--0.09, P = .04), but there existed no significant difference of leg pain in the last follow-up (MD = -2.35, 95% CI: -6.15-1.45, P = .23). What's more, operation time, bleeding loss, total complications and reoperation rate had no significant difference. However, IPD had higher device problems (odds ratio [OR] = 9.00, 95% CI: 2.39-33.91, P = .001) and lesser dural tears (OR = 0.32, 95% CI: 0.15-0.67, P = .002) compared to traditional decompression. CONCLUSION Although IPD had lower back pain score and lower dural tears compared with traditional decompression, current evidence indicated no superiority for patient-reported outcomes for IPD compared with alone decompression treatment. However, these findings needed to be verified in further by multicenter, double-blind and large sample RCTs.
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Affiliation(s)
- Changjiu Zhu
- Department of Orthopedics, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Guiling Xiao
- Department of Orthopedics, Sichuan Provincial People’s Hospital, Chengdu, China
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Nikoobakht M, Pourmahmoudian M, Gerszten PC, Pourmahmoudian M. Global sagittal angle and spinopelvic sagittal alignment: a step toward investigation of sagittal plane deformity in upper lumbar disc herniation. Br J Neurosurg 2024; 38:551-555. [PMID: 33983097 DOI: 10.1080/02688697.2021.1923651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding the biomechanical relationship between the spine and the pelvis is important for the management of symptomatic lumbar disease. There are several different metrics that may be used to evaluate the spine in the sagittal plane. The aim of this study is to compare spinopelvic parameters and global sagittal angle (GSA) in a cohort of patients with upper lumbar disc herniations (ULDH) to identify a correlation between the pelvic incidence (PI) and GSA with ULDH. MATERIAL AND METHODS Eighty-six patients with ULDH and 86 asymptomatic control group underwent whole body biplanar stereographs- and magnetic resonance imaging. The spinopelvic parameters and GSA were measured. RESULTS PI, sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis (TK) were all significantly lower than in the control group (p < 0.01) but there was no difference in the pelvic tilt (PT). The two groups were divided into subgroups. PI in the T12-L1 and L1-L2 level groups were significantly smaller than in the control group (p < 0.05). Also, there was a significant difference in TK and LL between the L3-L4 level and control group (p < 0.05), but there was no statistically significant difference in PT between all levels and the control group. CONCLUSION This study demonstrated a unique correlation between several spinopelvic parameters and GSA and the occurrence of ULDH. Lower PI, SS, and LL in T12-L1 and L1-L2 levels indicates a flat lumbar spine which may increase mechanical stress at these levels, thereby leading to disc herniation.
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Affiliation(s)
- Mehdi Nikoobakht
- Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Pourmahmoudian
- Firoozgar Clinical Research and Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Peter Carlos Gerszten
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mostafa Pourmahmoudian
- Firoozgar Clinical Research and Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
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Hiyama A, Sakai D, Katoh H, Sato M, Watanabe M. Quantifying Satisfaction of Degenerative Lumbar Spinal Stenosis Patients in Post-lateral Lumbar Interbody Fusion Surgery: Establishing Critical JOABPEQ Cutoff Scores. World Neurosurg 2024; 186:e461-e469. [PMID: 38580092 DOI: 10.1016/j.wneu.2024.03.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE This retrospective study aimed to determine the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) cutoff scores for assessing patient satisfaction postlateral lumbar interbody fusion (LLIF) in degenerative lumbar spinal stenosis (DLSS) patients. METHODS Analyzing 136 DLSS patients (83 males, 53 females), the study evaluated demographics, pain (Numeric Rating Scale), and JOABPEQ outcomes (low back pain, lumbar function, walking ability, social life, mental health). Patient satisfaction was surveyed, and based on their responses, patients were categorized into "Beneficial" and "Nonbeneficial" groups. Statistical analysis encompassed the Kolmogorov-Smirnov test, t-tests, Mann-Whitney U test, and Receiver Operating Characteristic (ROC) curve analysis for JOABPEQ cutoff determination. RESULTS Postoperative improvements in JOABPEQ scores, especially in walking ability, social life function, and mental health, were significant. Pain intensity, assessed using the Numeric Rating Scale, also showed notable reductions. The Δ walking ability cutoff was set at 25.00, indicating substantial mobility improvement. This domain's area under the curve (AUC) was 0.815 (95% CI: 0.726-0.903), demonstrating high effectiveness in assessing patient satisfaction postsurgery. The study also found no significant differences in complication rates between groups for conditions like transient motor weakness, thigh pain/numbness, and revision surgery. CONCLUSIONS This study underscores the value of patient-centered outcomes in evaluating LLIF surgery success for DLSS. The identified JOABPEQ cutoff values provide a quantitative tool for assessing patient satisfaction, emphasizing the necessity of comprehensive postoperative evaluations beyond traditional clinical metrics for improved patient care and life quality.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Chen Y, Lin W, Lei S, You Y, Zhang X, Ma Y, Wang D. Comparing the Efficacy and Safety of Unilateral Biportal Endoscopic Decompression with Percutaneous Endoscopic Lumbar Decompression for Lumbar Degenerative Diseases: A Meta-Analysis. World Neurosurg 2024:S1878-8750(24)00665-X. [PMID: 38657790 DOI: 10.1016/j.wneu.2024.04.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Unilateral biportal endoscopic decompression (UBED) offers the advantages of minimal tissue damage, operational flexibility, and clear visualization, positioning it as an innovative and minimally invasive endoscopic technique. Nevertheless, the clinical evidence supporting the use of UBED in the treatment of degenerative lumbar diseases is limited and conflicting. METHODS As of October 1, 2023, a comprehensive search was conducted across databases including Web of Science, PubMed, Embase, and the Cochrane Library to identify all published studies on minimally invasive UBED for the treatment of degenerative lumbar diseases. Data pertaining to patient demographics, fluoroscopy time, operative duration, intraoperative hemorrhage, hospitalization length, visual analog scale (VAS) score for back and leg pain, MacNab criteria, Oswestry Disability Index (ODI), and complication rates were extracted. The Newcastle-Ottawa scale was utilized to assess the quality. RESULTS Twelve articles were included, involving 816 patients. The back VAS score (95% confidence interval [CI]: -0.09-0.07, P = 0.75), MacNab criteria (95% CI: 0.52-2.3, P = 0.82), fluoroscopy time (95% CI: -7.03 to -0.4, P = 0.08), and the incidence of complications (95% CI: 0.5-1.73, P = 0.82) were not significantly different, while the leg VAS score (95% CI: 0.01-0.18, P = 0.03), ODI score (95% CI: -1.03 to -0.09, P = 0.02), operation time (95% CI: 5.76-20.62, P = 0.0005), hospitalization length (95% CI: 0.41-2.76, P = 0.008), and intraoperative hemorrhage (95% CI: 21.92-72.44, P = 0.0003) were significantly different. CONCLUSIONS UBED offers superiority in ODI, flexibility, and visual field clarity. Conversely, percutaneous endoscopic lumbar decompression presents advantages in terms of operation duration, blood loss, hospitalization length, and leg VAS score. These factors should be thoroughly considered when selecting a surgical approach.
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Affiliation(s)
- Yuxian Chen
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wei Lin
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shenglin Lei
- Shenzhen Clinical Medical School of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Yawen You
- The Fifth Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaoqing Zhang
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yingfei Ma
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Dongping Wang
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
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Shu L, Mu Q, Dai F, Zhao W, Syeda MZ, Wang Y. Contralateral approach using microscope and tubular retractor system for ipsilateral decompression of lumbar degenerative lateral recess stenosis associated with narrow spinal canal. Front Neurol 2024; 15:1387801. [PMID: 38699053 PMCID: PMC11064648 DOI: 10.3389/fneur.2024.1387801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
Objective To summarize the clinical effect of a single-center retrospective analysis of the contralateral approach with a microscope and tubular retractor system for ipsilateral decompression in patients with lumbar lateral recess stenosis and a narrow spinal canal. Methods A total of 25 patients who underwent ipsilateral decompression surgery via a contralateral approach with microscope and tubular retractor system, performed by one surgeon at a single center were retrospectively examined. The width of the lamina fenestration was compared with the preoperative distance from the root of the spinous process to the dorsal articular facet, the bilateral articular facet change in the suprapedicle notch section on CT scan, and with the changes in transverse and sagittal diameters of the canal area on MRI. Clinical efficacy was assessed using the Japanese Orthopedic Association (JOA), Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores. Results In total, 25 patients were treated and the mean intraoperative time was 82.04 ± 12.48 min. There was no nerve injury, cerebrospinal fluid leakage, and infection complications. The postoperative CT revealed that the width of the contralateral laminar fenestration was less than the distance from the root of the spinous process to the dorsal articular facet. The residual widths of the ipsilateral articular facet and contralateral articular facet were greater than 2/3 of the preoperative articular facet width. The transverse and sagittal diameter of canal were significantly increased. The mean follow-up period was 12-16 months, and no recurrence or reoperation incidence were found at the last follow-up. When compared to pre-surgery, the ODI, VAS, and JOA scores were significantly improved after surgery (p < 0.05). Conclusion Based on our single-center retrospective observation of 25 cases and combined with previous literature, the contralateral approach with a microscope and tubular retractor system for ipsilateral decompression in patients with lumbar lateral recess stenosis and a narrow spinal canal can reduce damage to the articular processes, and probably more conducive to the postoperative stability of the lumbar spine. This was a single center retrospective analysis with a small sample size and lacked randomized controlled trials (RCTs). However, larger-scale, multicenter RTCs are required for additional validation.
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Affiliation(s)
- Longfei Shu
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
| | - Qingchun Mu
- Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Feihu Dai
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
| | - Wei Zhao
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
| | - Madiha Zahra Syeda
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
- Faculty of Medicine, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Yuhai Wang
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
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Tan H, Yamamoto EA, Smith S, Yoo J, Kark J, Lin C, Orina J, Philipp T, Ross DA, Wright C, Wright J, Ryu WHA. Characterizing utilization patterns and reoperation risk factors of interspinous process devices: analysis of a national claims database. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:283-290. [PMID: 38065695 DOI: 10.1093/pm/pnad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Interspinous process devices (IPDs) were developed as minimally invasive alternatives to open decompression surgery for spinal stenosis. However, given high treatment failure and reoperation rates, there has been minimal adoption by spine surgeons. This study leveraged a national claims database to characterize national IPD usage patterns and postoperative outcomes after IPD implantation. METHOD Using the PearlDiver database, we identified all patients who underwent 1- or 2-level IPD implantation between 2010 and 2018. Univariate and multivariable logistic regression was performed to identify predictors of the number of IPD levels implanted and reoperation up to 3 years after the index surgery. Right-censored Kaplan-Meier curves were plotted for duration of reoperation-free survival and compared with log-rank tests. RESULTS Patients (n = 4865) received 1-level (n = 3246) or 2-level (n = 1619) IPDs. Patients who were older (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 1.01-1.03, P < .001), male (aOR 1.31, 95% CI 116-1.50, P < .001), and obese (aOR 1.19, 95% CI 1.05-1.36, P < .01) were significantly more likely to receive a 2-level IPD than to receive a 1-level IPD. The 3-year reoperation rate was 9.3% of patients when mortality was accounted for during the follow-up period. Older age decreased (aOR 0.97, 95% CI 0.97-0.99, P = .0039) likelihood of reoperation, whereas 1-level IPD (aOR 1.37, 95% CI 1.01-1.89, P = .048), Charlson Comorbidity Index (aOR 1.07, 95% CI 1.01-1.14, P = .018), and performing concomitant open decompression increased the likelihood of reoperation (aOR 1.68, 95% CI 1.35-2.09, P = .0014). CONCLUSION Compared with 1-level IPDs, 2-level IPDs were implanted more frequently in older, male, and obese patients. The 3-year reoperation rate was 9.3%. Concomitant open decompression with IPD placement was identified as a significant risk factor for subsequent reoperation and warrants future investigation.
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Affiliation(s)
- Hao Tan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Erin A Yamamoto
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Spencer Smith
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Jung Yoo
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Jonathan Kark
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Clifford Lin
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Josiah Orina
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Travis Philipp
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Donald A Ross
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Christina Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - James Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Won Hyung A Ryu
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
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Tumko V, Kim J, Uspenskaia N, Honig S, Abel F, Lebl DR, Hotalen I, Kolisnyk S, Kochnev M, Rusakov A, Mourad R. A neural network model for detection and classification of lumbar spinal stenosis on MRI. 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 2024; 33:941-948. [PMID: 38150003 DOI: 10.1007/s00586-023-08089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/30/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES To develop a three-stage convolutional neural network (CNN) approach to segment anatomical structures, classify the presence of lumbar spinal stenosis (LSS) for all 3 stenosis types: central, lateral recess and foraminal and assess its severity on spine MRI and to demonstrate its efficacy as an accurate and consistent diagnostic tool. METHODS The three-stage model was trained on 1635 annotated lumbar spine MRI studies consisting of T2-weighted sagittal and axial planes at each vertebral level. Accuracy of the model was evaluated on an external validation set of 150 MRI studies graded on a scale of absent, mild, moderate or severe by a panel of 7 radiologists. The reference standard for all types was determined by majority voting and in case of disagreement, adjudicated by an external radiologist. The radiologists' diagnoses were then compared to the diagnoses of the model. RESULTS The model showed comparable performance to the radiologist average both in terms of the determination of presence/absence of LSS as well as severity classification, for all 3 stenosis types. In the case of central canal stenosis, the sensitivity, specificity and AUROC of the CNN were (0.971, 0.864, 0.963) for binary (presence/absence) classification compared to the radiologist average of (0.786, 0.899, 0.842). For lateral recess stenosis, the sensitivity, specificity and AUROC of the CNN were (0.853, 0.787, 0.907) compared to the radiologist average of (0.713, 0.898, 805). For foraminal stenosis, the sensitivity, specificity and AUROC of the CNN were (0.942, 0.844, 0.950) compared to the radiologist average of (0.879, 0.877, 0.878). Multi-class severity classifications showed similarly comparable statistics. CONCLUSIONS The CNN showed comparable performance to radiologist subspecialists for the detection and classification of LSS. The integration of neural network models in the detection of LSS could bring higher accuracy, efficiency, consistency, and post-hoc interpretability in diagnostic practices.
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Affiliation(s)
- Vladislav Tumko
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Jack Kim
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA.
| | - Natalia Uspenskaia
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Shaun Honig
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Frederik Abel
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Darren R Lebl
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Irene Hotalen
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | | | - Mikhail Kochnev
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Andrej Rusakov
- Remedy Logic, 1177 Avenue of the Americas, 5th Floor, New York, NY, 10036, USA
| | - Raphaël Mourad
- University of Toulouse, 118 Rte de Narbonne, 31062, Toulouse, France.
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Bogdanovic S, Staib M, Schleiniger M, Steiner L, Schwarz L, Germann C, Sutter R, Fritz B. AI-Based Measurement of Lumbar Spinal Stenosis on MRI: External Evaluation of a Fully Automated Model. Invest Radiol 2024:00004424-990000000-00200. [PMID: 38426719 DOI: 10.1097/rli.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES The aim of this study was to clinically validate a fully automated AI model for magnetic resonance imaging (MRI)-based quantifications of lumbar spinal canal stenosis. MATERIALS AND METHODS This retrospective study included lumbar spine MRI of 100 consecutive clinical patients (56 ± 17 years; 43 females, 57 males) performed on clinical 1.5 (51 examinations) and 3 T MRI scanners (49 examinations) with heterogeneous clinical imaging protocols. The AI model performed segmentations of the thecal sac on axial T2-weighted sequences. Based on these segmentations, the anteroposterior (AP) and mediolateral (ML) distance, and the area of the thecal sac were measured in a fully automated manner. For comparison, 2 fellowship-trained musculoskeletal radiologists performed the same segmentations and measurements independently. Statistics included 1-sample t tests, the intraclass correlation coefficient (ICC), Bland-Altman plots, and Dice coefficients. A P value of <0.05 was considered statistically significant. RESULTS The average measurements of the AI model, reader 1, and reader 2 were 194 ± 72 mm2, 181 ± 71 mm2, and 179 ± 70 mm2 for thecal sac area, 13 ± 3.3 mm, 12.6 ± 3.3 mm, and 12.6 ± 3.2 mm for AP distance, and 19.5 ± 3.9 mm, 20 ± 4.3 mm, and 19.4 ± 4 mm for ML distance, respectively. Significant differences existed for all pairwise comparisons, besides reader 1 versus AI model for the ML distance and reader 1 versus reader 2 for the AP distance (P = 0.1 and P = 0.21, respectively). The pairwise mean absolute errors among reader 1, reader 2, and the AI model ranged from 0.59 mm and 0.75 mm for the AP distance, from 1.16 mm to 1.37 mm for the ML distance, and from 7.9 mm2 to 15.54 mm2 for the thecal sac area. Pairwise ICCs among reader 1, reader 2, and the AI model ranged from 0.91 and 0.94 for the AP distance and from 0.86 to 0.9 for the ML distance without significant differences. For the thecal sac area, the pairwise ICC between both readers and the AI model of 0.97 each was slightly, but significantly lower than the ICC between reader 1 and reader 2 of 0.99. Similarly, the Dice coefficient and Hausdorff distance between both readers and the AI model were significantly lower than the values between reader 1 and reader 2, overall ranging from 0.93 to 0.95 for the Dice coefficients and 1.1 to 1.44 for the Hausdorff distances. CONCLUSIONS The investigated AI model is reliable for assessing the AP and the ML thecal sac diameters with human level accuracies. The small differences for measurement and segmentation of the thecal sac area between the AI model and the radiologists are likely within a clinically acceptable range.
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Affiliation(s)
- Sanja Bogdanovic
- From the Radiology, Balgrist University Hospital, Zurich, Switzerland (S.B., C.G., R.S., B.F.); Faculty of Medicine, University of Zurich, Zurich, Switzerland (S.B., C.G., R.S., B.F.); and ScanDiags AG, Zurich, Switzerland (M. Staib, M. Schleiniger, L. Steiner, and L. Schwarz)
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Rahimzadeh P, Imani F, Farahmand Rad R, Faiz SHR. Comparing the Efficacy of Transforaminal and Caudal Epidural Injections of Calcitonin in Treating Degenerative Spinal Canal Stenosis: A Double-Blind Randomized Clinical Trial. Anesth Pain Med 2024; 14:e142822. [PMID: 38725918 PMCID: PMC11078236 DOI: 10.5812/aapm-142822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 05/12/2024] Open
Abstract
Background Lumbar spinal stenosis (LSS) is the most common indication for lumbar surgery in elderly patients. Epidural injections of calcitonin are effective in managing LSS. Objectives This study aimed to compare the efficacy of transforaminal and caudal injections of calcitonin in patients with LSS. Methods In this double-blind randomized clinical trial, LSS patients were divided into two equal groups (N = 20). The first group received 50 IU (international units) of calcitonin via caudal epidural injection (CEI), and the second group received 50 IU of calcitonin via transforaminal epidural injection (TEI). The Visual Analogue Scale (VAS) and Oswestry Low Back Pain Disability Questionnaire (ODI) were used to assess the patient's pain and ability to stand, respectively. Visual Analogue Scale and ODI scores were recorded and analyzed. Results The results showed that caudal and TEIs of calcitonin significantly improved pain and ability to stand during follow-up compared to before intervention (P < 0.05). Additionally, CEI of calcitonin after 6 months significantly reduced pain in LSS patients compared to TEI of calcitonin (P < 0.05). However, no significant difference was observed between the two epidural injection techniques in improving the patient's ability to stand (P > 0.05). Conclusions The results of the study indicate that epidural injection of calcitonin in long-term follow-up (6 months) had a significant effect on improving pain intensity and mobility in patients with LSS, and its effect on pain in the TEI method was significantly greater than that in the CEI method.
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Affiliation(s)
- Poupak Rahimzadeh
- Department of Anesthesiology and Pain Medicine, Pain Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Department of Anesthesiology and Pain Medicine, Pain Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Farahmand Rad
- Department of Anesthesiology and Pain Medicine, Pain Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Department of Anesthesiology and Pain Medicine, Minimally Invasive Surgery Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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He BL, Zhu ZC, Lin LQ, Sun JF, Huang YH, Meng C, Sun Y, Zhang GC. Comparison of biportal endoscopic technique and uniportal endoscopic technique in Unilateral Laminectomy for Bilateral Decomprssion (ULBD) for lumbar spinal stenosis. Asian J Surg 2024; 47:112-117. [PMID: 37331857 DOI: 10.1016/j.asjsur.2023.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/29/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE Unilateral laminotomy for bilateral decompression (ULBD) has been adopted widely to treat lumbar spinal stenosis (LSS). The objective of the study is to investigate clinical and radiological outcomes of the biportal endoscopic ULBD (BE-ULBD) and uniportal endoscopic ULBD (UE-ULBD). METHODS We collected retrospectively 65 patients' data who met the inclusion criteria (July 2019-June 2021). 33 patients underwent BE-ULBD surgery, and 32 patients underwent the UE-ULBD surgery, and were followed up for at least 1 year. The following preoperative and postoperative outcomes were compared between groups: the visual analog scale (VAS) for pain, the Oswestry disability index (ODI) for nerve function, and modified Macnab criteria for satisfaction, the cross-sectional area of the dural sac (DSCSA), the mean angle of facetectomy. RESULTS Age, BMI, gender, levels of involvement and duration of symptoms were not significantly different at baseline in this study. Clinical data showed that postoperative ODI, VAS scores and Modified Macnab Criteria were not statistically different between the two groups. The BE-ULBD group had a shorter operation time than the UE-ULBD group (P < 0.001). Patients in the BE-ULBD group had a larger postoperative expansion of DSCSA expansion postoperatively (85.58 ± 3.16 mm2 VS 71.43 ± 3.35 mm2, P < 0.001) and a larger contralateral facetectomy angle (63.95 ± 3.34° vs 57.80 ± 3.43°, P < 0.001) compared with patients in the UE-ULBD group. There were no statistical differences in the incidence of postoperative complications between the two groups. CONCLUSION Both the BE-ULBD and the UE-ULBD yielded clinical improvement in terms of pain and stenosis symptoms. The BE-ULBD technique has the advantages of the shorter operation time, larger DSCSA expansion and larger contralateral facetectomy angle.
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Affiliation(s)
- Bang-Lin He
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Zhi-Cheng Zhu
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Li-Qun Lin
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Ji-Fu Sun
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China.
| | - Yong-Hui Huang
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Chen Meng
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Yan Sun
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Guang-Cheng Zhang
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
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Mui T, Iwata E, Nakajima H, Sada T, Tanaka M, Okuda A, Kawasaki S, Shigematsu H, Tanaka Y. Central sensitization adversely affects quality of recovery following lumbar decompression surgery. J Orthop Sci 2024; 29:78-82. [PMID: 36526518 DOI: 10.1016/j.jos.2022.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/17/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Central sensitization (CS) is defined as increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input. The CS phenomenon is caused by continuous, intense nociceptor inputs triggering a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in the central nociceptive pathway. Most patients undergoing surgery for lumbar spinal stenosis (LSS) experience symptoms for more than three months; therefore, it is possible that CS is associated with postoperative symptoms of LSS. The aim of this study was to clarify the influence of CS in patients who underwent surgery for LSS. METHODS We used the Central Sensitization Inventory (CSI) to evaluate CS preoperatively. Clinical and neurological symptoms were assessed before surgery and three months after surgery using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI). To evaluate the correlation between the preoperative CSI score and each parameter of the JOA-BPEQ before and three months after surgery, a Pearson correlation coefficient was used. We also evaluated the correlation between preoperative CSI and improvement scores for each parameter of the JOA-BPEQ for surgery. Similarly, the ODI was assessed. RESULTS This study included 118 patients. After surgery, the parameters of lumbar function disorder, social life function disorder, and mental health disorder revealed a statistically significant relationship (r = -0.289, -0.0354, and -0.493, respectively). There was no significant correlation between CSI and improvement scores of the JOA-BPEQ. The ODI assessment after surgery revealed a statistically significant relationship (r = 0.344). There was no significant correlation between the CSI and ODI improvement scores. CONCLUSION This study showed that the severity of the CSI influenced the postoperative outcomes, and that surgical treatment improved the symptoms of LSS regardless of the occurrence of CS preoperatively.
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Affiliation(s)
- Takahiro Mui
- Department of Orthopaedic Surgery, Otemae Hospital, 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan
| | - Eiichiro Iwata
- Department of Orthopaedic Surgery, Nara City Hospital, Nara, Japan.
| | - Hiroshi Nakajima
- Department of Orthopaedic Surgery, Otemae Hospital, 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan
| | - Takuya Sada
- Department of Orthopaedic Surgery, Nara City Hospital, Nara, Japan
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Otemae Hospital, 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Sachiko Kawasaki
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Hideki Shigematsu
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
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Childs S, Bakhsh W, Thirukumaran C, Emery S, Rubery P, Mesfin A. Trends in lumbar interbody fusion: A study of American Board of Orthopedic Surgery (ABOS) candidate data. Surg Neurol Int 2023; 14:426. [PMID: 38213447 PMCID: PMC10783666 DOI: 10.25259/sni_502_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/08/2023] [Indexed: 01/13/2024] Open
Abstract
Background There has been an increase in posterior-based interbody fusions over the past two decades. Our objective was to evaluate trends in interbody fusion use among the American Board of Orthopedic Surgery (ABOS) Part II candidates. Methods The ABOS database from 2003 to 2012 was queried for common procedural terminology (CPT) codes indicating lumbar interbody fusion (22,558 anterior lumbar interbody fusion [ALIF] and 22,630 and 22,633 posterior lumbar interbody fusion [PLIF] or transforaminal lumbar interbody fusion [TLIF]). Trends in the use of interbody fusion technique, associated complications, and geographical variation were evaluated. We also queried utilization of the anterior and posterior interbody fusions by the International Classification of Diseases-9 code. Results 6841 interbody fusion cases were identified (2329 ALIF and 4512 PLIF/TLIF). There was a significantly higher use of PLIF/TLIF than ALIF over the study period (P < 0.001). As compared to patients in the Midwest, those in the Northwest had significantly higher odds of undergoing PLIF/TLIF (odds ratio [OR]: 4.79, 95% confidence interval [CI]: 3.61-6.35, P <0.001), and those in the Southwest had significantly lower odds of PLIF/TLIF (OR: 0.81, 95% CI: 0.69-0.95, P = 0.01). The overall complication rate was 22.2% (n = 1,519). Vascular-related complications were significantly higher among patients undergoing ALIF (31 vs. 1, P <0.001), while those undergoing TLIF/PLIF were more likely to experience unspecified medical complications. On multivariate analysis, patients undergoing PLIF/TLIF had lower odds of experiencing a complication (P = 0.03, OR 0.87, CI 95%). Conclusion Over the 10-year study period, there has been a significantly increased rate of posterior interbody fusion among candidates taking part II ABOS examination.
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Affiliation(s)
- Sean Childs
- Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, United States
| | - Wajeeh Bakhsh
- Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, United States
| | - Caroline Thirukumaran
- Department of Orthopaedics, University of Rochester, Rochester, New York, United States
| | - Sanford Emery
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia, United States
| | - Paul Rubery
- Department of Orthopaedics, University of Rochester, Rochester, New York, United States
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, Medstar Orthopaedic Institute, Washington, DC, United States
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Corazzelli G, Capece M, Meglio V, Leonetti S, Pizzuti V, Ricciardi F, D'Elia A, Santilli M, Innocenzi G. Multiple univariate analysis of radiologic and clinical features on 168 patients with lumbar spinal stenosis: what is the role of the erector spinae in the development of a patient's disability? Acta Neurochir (Wien) 2023; 165:3947-3957. [PMID: 37932635 DOI: 10.1007/s00701-023-05863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The weakening of paraspinal muscles in the paravertebral area may play a role in developing central lumbar spinal stenosis, resulting in lower back discomfort. OBJECTIVE The study thoroughly examined the correlation between the Oswestry Disability Index, Dural Sac cross-sectional area, Schizas grading Scale, Body Mass Index, and the cross-sectional areas of Erector Spinae, Multifidus, and Psoas muscles. The findings were also compared between patients with central Lumbar Spinal Stenosis and healthy individuals. STUDY DESIGN Retrospective monocentric observational study. METHODS The study recruited 168 consecutive patients aged 60 or older diagnosed with central Lumbar Spinal Stenosis between January 2020 and July 2022. The patients' condition was evaluated by administering a preoperative Oswestry Disability Index questionnaire, measuring their Body Mass Index, and performing preoperative Magnetic Resonance Imaging. The analyzed parameters were the cross-sectional area of paraspinal muscles at the L4-L5 level, dural sac cross-sectional area, and Schizas grading Scale at the most stenotic level, using multiple linear univariate analyses. Two groups of healthy individuals were recruited: Group A (under 60 years old) and Group B (over 60 years old). The same data extrapolated from these groups were compared with those of patients with central lumbar stenosis using a two-tailed Mann-Whitney test. RESULTS As the Erector Spinae degenerates, the Oswestry Disability Index tends to increase. Similarly, an increase in Body Mass Index is often accompanied by a decrease in the cross-sectional area of the Erector Spinae. Low dural sac cross-sectional area is statistically linked to a reduced Multifidus cross-sectional area. Interestingly, the Schizas grading scale does not appear to correlate with changes in the cross-sectional area of the paraspinal muscles. Additionally, there is no significant difference in the cross-sectional area of the Psoas muscle between individuals with central lumbar spinal stenosis and healthy individuals. CONCLUSIONS Our study found that degeneration of the Erector Spinae plays a crucial role in the progression of perceived disability in Lumbar Spinal Stenosis. Prospective studies should investigate the long-term evolution of paraspinal muscles in decompressed patients.
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Affiliation(s)
- Giuseppe Corazzelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy.
| | - Mara Capece
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Vincenzo Meglio
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | | | | | | | | | - Marco Santilli
- Department of Neurology, IRCCS Neuromed, (IS), Pozzilli, Italy
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Ogon I, Takashima H, Morita T, Fukushi R, Takebayashi T, Teramoto A. Association of central sensitization, visceral fat, and surgical outcomes in lumbar spinal stenosis. J Orthop Surg Res 2023; 18:886. [PMID: 37990264 PMCID: PMC10662108 DOI: 10.1186/s13018-023-04376-2] [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: 10/02/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Controversy remains regarding predictors of surgical outcomes for patients with lumbar spinal stenosis (LSS). Pain sensitization may be an underlying mechanism contributing to LSS surgical outcomes. Further, obesity is associated with dissatisfaction and poorer outcomes after surgery for LSS. Therefore, this study aimed to examine the relationship between central sensitization (CS), visceral fat, and surgical outcomes in LSS. METHODS Patients with LSS were categorized based on their central sensitization inventory (CSI) scores into low- (CSI < 40) and high- (CSI ≥ 40) CSI subgroups. The participants completed clinical outcome assessments preoperatively and 12 months postoperatively. RESULTS Overall, 60 patients were enrolled in the study (28 men, 32 women; mean age: 62.1 ± 2.8 years). The high-CSI group had significantly higher mean low back pain (LBP), leg pain, and leg numbness visual analogue scale (VAS) scores than the low-CSI group (p < 0.01). The high-CSI group had a significantly higher mean visceral fat area than the low-CSI group (p < 0.01). Postoperatively, LBP VAS score was significantly worse in the high-CSI group. Relative to preoperatively, postoperative leg pain and leg numbness improved significantly in both groups. CONCLUSIONS We believe that neuro decompression can be effective for LSS surgical outcomes in patients with CS; nonetheless, it should be approached with caution owing to the potential for worsening LBP. Additionally, visceral fat is an important indicator suggesting the involvement of CS.
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Affiliation(s)
- Izaya Ogon
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, 291, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Hiroyuki Takashima
- Faculty of Health Sciences, Hokkaido University, North-12, West-5, Kitaku, Sapporo, 060-0812, Japan
| | - Tomonori Morita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, 291, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ryunosuke Fukushi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, 291, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Tsuneo Takebayashi
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, 1-3, North-7, West-27, Chuo-ku, Sapporo, 060-0007, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, 291, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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Yuan H, Yi X. Lumbar Spinal Stenosis and Minimally Invasive Lumbar Decompression: A Narrative Review. J Pain Res 2023; 16:3707-3724. [PMID: 37954472 PMCID: PMC10637222 DOI: 10.2147/jpr.s428112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 11/14/2023] Open
Abstract
Background Lumbar spinal stenosis (LSS) is a common pain condition that causes lumbar back pain, radiating leg pain, and possible functional impairment. MILD is an emerging minimally invasive treatment for LSS. It is an image-guided percutaneous procedure designed to debulk hypertrophied ligamentum flavum. However, the exact short- and long-term efficacy, safety profile, indication criteria, and certain procedure details reported in medical literature vary. Objective This narrative review was to elucidate efficacy, safety profile, certain procedure details, advantages, and limitations of MILD. Study Design This is a narrative review. Setting All included articles are clinic trials including analytic studies and descriptive studies. Methods PubMed, Cochrane Library, and Scopus were searched. Only clinical trials of MILD procedure were included. Information of indications, contraindications, VAS scores, ODI scores, effective rate, efficacy durations, and certain procedure details was focused on. Results According to the literature, for the MILD procedure, the VAS score could be reduced from a pre-treatment level of 6.3-9.6 to a post-treatment level of 2.3-5.8. The ODI score could be reduced from a pre-treatment level of 38.8-55.3 to a post-treatment level of 27.4-39.8. The effective rate of the MILD procedure was reported to be 57.1%-88%. A 2-year postoperative stability of efficacy was also supported. One RCT study testified superior efficacy of MILD over epidural steroid injection. Limitations There is few high-quality literature in the review. Moreover, the long-term efficacy of MILD cannot be revealed according to the current literature. Conclusion Based on the reviewed literature, MILD is an effective and safe procedure. MILD can reduce pain intensity and improve functional status significantly. Therefore, it is a preferable option for LSS patients who failed conservative treatments, but not for those who require immediate invasive decompression surgery.
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Affiliation(s)
- Hongjie Yuan
- Department of Pain Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xiaobin Yi
- Pain Division, Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA
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Koch D, Nüesch C, Ignasiak D, Aghlmandi S, Caimi A, Perrot G, Prüfer F, Harder D, Santini F, Schären S, Ferguson S, Mündermann A, Netzer C. The role of muscle degeneration and spinal balance in the pathophysiology of lumbar spinal stenosis: Study protocol of a translational approach combining in vivo biomechanical experiments with clinical and radiological parameters. PLoS One 2023; 18:e0293435. [PMID: 37889898 PMCID: PMC10610482 DOI: 10.1371/journal.pone.0293435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To describe a study protocol for investigating the functional association between posture, spinal balance, ambulatory biomechanics, paraspinal muscle fatigue, paraspinal muscle quality and symptoms in patients with symptomatic lumbar spinal stenosis (sLSS) before and 1-year after elective surgical intervention. DESIGN Single-centre prospective, experimental, multimodal (clinical, biomechanical, radiological) study with three instances of data collection: baseline (study visit 1), 6-month follow-up (remote) and 1-year follow-up (study visit 2). Both study visits include an in vivo experiment aiming to elicit paraspinal muscle fatigue for postural assessment in a non-fatigued and fatigued state. EXPERIMENTAL PROTOCOL At baseline and 1-year follow-up, 122 patients with sLSS will be assessed clinically, perform the back-performance scale assessment and complete several patient-reported outcome measure (PROMs) questionnaires regarding overall health, disease-related symptoms and kinesiophobia. Posture and biomechanical parameters (joint kinematics, kinetics, surface electromyography, back curvature) will be recorded using an optoelectronic system and retroreflective markers during different tasks including overground walking and movement assessments before and after a modified Biering-Sørensen test, used to elicit paraspinal muscle fatigue. Measurements of muscle size and quality and the severity of spinal stenosis will be obtained using magnetic resonance imaging (MRI) and sagittal postural alignment data from EOS radiographies. After each study visit, physical activity level will be assessed during 9 days using a wrist-worn activity monitor. In addition, physical activity level and PROMs will be assessed remotely at 6-month follow-up. CONCLUSION The multimodal set of data obtained using the study protocol described in this paper will help to expand our current knowledge on the pathophysiology, biomechanics, and treatment outcome of degenerative sLSS. The results of this study may contribute to defining and/or altering patient treatment norms, surgery indication criteria and post-surgery rehabilitation schedules. TRIAL REGISTRATION The protocol was approved by the regional ethics committee and has been registered at clinicaltrials.gov (NCT05523388).
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Affiliation(s)
- David Koch
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | | | - Soheila Aghlmandi
- Division of Clinical Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Alice Caimi
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Guido Perrot
- Department of Physiotherapy, University Hospital Basel, Basel, Switzerland
| | - Friederike Prüfer
- Department of Pediatric Radiology, University Children’s Hospital Basel, Basel, Switzerland
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Francesco Santini
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | | | - Annegret Mündermann
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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Wu Y, Chen Z, Yao C, Sun H, Li H, Du X, Cheng J, Wan X. Effect of systemic lidocaine on postoperative quality of recovery, the gastrointestinal function, inflammatory cytokines of lumbar spinal stenosis surgery: a randomized trial. Sci Rep 2023; 13:17661. [PMID: 37848527 PMCID: PMC10582089 DOI: 10.1038/s41598-023-45022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 10/14/2023] [Indexed: 10/19/2023] Open
Abstract
Surgery is one of the most frequent and effective intervention strategies for lumbar spinal stenosis, however, one-third of patients are not satisfied with postoperative outcomes. It is not clear whether perioperative systemic lidocaine could accelerate the early postoperative quality of recovery in patients undergoing lumbar spinal stenosis surgery. 66 patients were enrolled in this trial. Lidocaine or placebo was administered at a loading dose of 1.5 mg/kg for 10 min and then infused at 2.0 mg/kg/hour till the end of surgery. Continued infusion by postoperative patient-controlled intravenous analgesia with a dose of 40 mg/hour. The primary outcome was the quality of recovery. Secondary outcomes included the time of the patient's first flatus, catheter removal time, underground time from the end of the surgery, pain score, levels of inflammatory factors (IL-6, IL-10, TNF-α), postoperative nausea and vomiting (PONV), sufentanil rescues, patients' satisfaction scores, and complications of lidocaine. Eventually, 56 patients were in the final analysis with similar age, Body Mass Index (BMI), duration of surgery and anesthesia, and median QoR-15 score (a development and Psychometric Evaluation of a Postoperative Quality of Recovery Score). The difference in median QoR-15 score in placebo versus lidocaine patients was statistically significant (IQR, 106 (104-108) versus 114 (108.25-119.25), P < 0.001). The Numeric Rating Scale (NRS) score at the 12th hour, median sufentanil rescue consumption, IL-6, tumor necrosis factor-alpha (TNF-α) of patients treatment with lidocaine were lower. Nevertheless, patients given lidocaine had high satisfaction scores. Suggesting that lidocaine enhanced the postoperative quality of recovery, met early postoperative gastrointestinal function recovery, provided superior pain relief, lessened inflammatory cytokines, etc., indicating it may be a useful intervention to aid recovery following lumbar spinal stenosis surgery.
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Affiliation(s)
- Yu Wu
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Zhuoming Chen
- School of Textile and Fashion, Shanghai University of Engineering Science, Shanghai, 201620, China
| | - Caimiao Yao
- Department of Clinical Laboratory, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Houxin Sun
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Hongxia Li
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Xuyang Du
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Jianzheng Cheng
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China.
| | - Xiaojian Wan
- Department of Anesthesiology and Critical Care Medicine, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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Hiyama A, Sakai D, Katoh H, Sato M, Watanabe M. Comprehensive Assessment of Indirect Decompression Through Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Japanese Orthopedic Association Back Pain Evaluation Questionnaire-Based Analysis. Global Spine J 2023:21925682231204254. [PMID: 37750358 DOI: 10.1177/21925682231204254] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE This study aimed to comprehensively evaluate the clinical outcomes of lateral lumbar interbody fusion (LLIF) as an indirect decompression technique for degenerative spondylolisthesis (DS) and concomitant degenerative lumbar spinal stenosis (DLSS) patients. We utilized the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) to assess treatment success and its impact on patient's quality of life (QOL). METHODS We included 124 patients who underwent LLIF. Pre- and postoperative JOABPEQ evaluations indicated treatment success. Subgroup analysis categorized patients' perceptions of surgery as beneficial or non-beneficial. RESULTS 89% of patients (110/124) reported satisfaction with LLIF. Lateral lumbar interbody fusion achieved successful indirect decompression, increasing canal diameter and central canal area. Significant improvements occurred across all JOABPEQ domains, notably for low back pain, lumbar function, walking ability, social life function, and mental health. Patients who perceived the surgery as beneficial experienced fewer postoperative complications, lower numeric rating scale scores for pain relief, and greater functional outcome improvements compared to non-beneficial patients. CONCLUSIONS Our findings highlight the utility of JOABPEQ as a valuable and sensitive tool for assessing treatment effectiveness and patient-reported outcomes in DS and concomitant DLSS patients. Patients undergoing LLIF. The results affirm the favorable outcomes of LLIF as a surgical option for DLSS patients and emphasize the importance of considering patient perspectives when evaluating overall treatment success. The study provides valuable insights into the impact of indirect decompression on patients' QOL, supporting the effectiveness of LLIF as a minimally invasive technique for DLSS and DS management.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Japan
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Baker SA, Billmire DA, Bilodeau RA, Emmett D, Gibbons AK, Mitchell UH, Bowden AE, Fullwood DT. Wearable Nanocomposite Sensor System for Motion Phenotyping Chronic Low Back Pain: A BACPAC Technology Research Site. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S160-S174. [PMID: 36799544 PMCID: PMC10403308 DOI: 10.1093/pm/pnad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
Chronic low back pain (cLBP) is a prevalent and multifactorial ailment. No single treatment has been shown to dramatically improve outcomes for all cLBP patients, and current techniques of linking a patient with their most effective treatment lack validation. It has long been recognized that spinal pathology alters motion. Therefore, one potential method to identify optimal treatments is to evaluate patient movement patterns (ie, motion-based phenotypes). Biomechanists, physical therapists, and surgeons each utilize a variety of tools and techniques to qualitatively assess movement as a critical element in their treatment paradigms. However, objectively characterizing and communicating this information is challenging due to the lack of economical, objective, and accurate clinical tools. In response to that need, we have developed a wearable array of nanocomposite stretch sensors that accurately capture the lumbar spinal kinematics, the SPINE Sense System. Data collected from this device are used to identify movement-based phenotypes and analyze correlations between spinal kinematics and patient-reported outcomes. The purpose of this paper is twofold: first, to describe the design and validity of the SPINE Sense System; and second, to describe the protocol and data analysis toward the application of this equipment to enhance understanding of the relationship between spinal movement patterns and patient metrics, which will facilitate the identification of optimal treatment paradigms for cLBP.
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Affiliation(s)
- Spencer A Baker
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Darci A Billmire
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - R Adam Bilodeau
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Darian Emmett
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Andrew K Gibbons
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Anton E Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - David T Fullwood
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
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21
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Aaen J, Banitalebi H, Austevoll IM, Hellum C, Storheim K, Myklebust TÅ, Anvar M, Weber C, Solberg T, Grundnes O, Brisby H, Indrekvam K, Hermansen E. Is the presence of foraminal stenosis associated with outcome in lumbar spinal stenosis patients treated with posterior microsurgical decompression. Acta Neurochir (Wien) 2023; 165:2121-2129. [PMID: 37407851 PMCID: PMC10409656 DOI: 10.1007/s00701-023-05693-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND We aim to investigate associations between preoperative radiological findings of lumbar foraminal stenosis with clinical outcomes after posterior microsurgical decompression in patients with predominantly central lumbar spinal stenosis (LSS). METHODS The study was an additional analysis in the NORDSTEN Spinal Stenosis Trial. In total, 230 men and 207 women (mean age 66.8 (SD 8.3)) were included. All patients underwent an MRI including T1- and T2-weighted sequences. Grade of foraminal stenosis was dichotomized into none to moderate (0-1) and severe (2-3) category using Lee's classification system. The Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and numeric rating scale (NRS) for back and leg pain were collected at baseline and at 2-year follow-up. Primary outcome was a reduction of 30% or more on the ODI score. Secondary outcomes included the mean improvement on the ODI, ZCQ, and NRS scores. We performed multivariable regression analyses with the radiological variates foraminal stenosis, Pfirrmann grade, Schizas score, dural sac cross-sectional area, and the possible plausible confounders: patients' gender, age, smoking status, and BMI. RESULTS The cohort of 437 patients presented a high degree of degenerative changes at baseline. Of 414 patients with adequate imaging of potential foraminal stenosis, 402 were labeled in the none to moderate category and 12 in the severe category. Of the patients with none to moderate foraminal stenosis, 71% achieved at least 30% improvement in ODI. Among the patients with severe foraminal stenosis, 36% achieved at least 30% improvement in ODI. A significant association between severe foraminal stenosis and less chance of reaching the target of 30% improvement in the ODI score after surgery was detected: OR 0.22 (95% CI 0.06, 0.83), p=0.03. When investigating outcome as continuous variables, a similar association between severe foraminal stenosis and less improved ODI with a mean difference of 9.28 points (95%CI 0.47, 18.09; p=0.04) was found. Significant association between severe foraminal stenosis and less improved NRS pain in the lumbar region was also detected with a mean difference of 1.89 (95% CI 0.30, 3.49; p=0.02). No significant association was suggested between severe foraminal stenosis and ZCQ or NRS leg pain. CONCLUSION In patients operated with posterior microsurgical decompression for LSS, a preoperative severe lumbar foraminal stenosis was associated with higher proportion of patients with less than 30% improvement in ODI. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov (22.11.2013) under the identifier NCT02007083.
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Affiliation(s)
- Jørn Aaen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Nordbyhagen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | | | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Dept. of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Tore Solberg
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Oliver Grundnes
- Department of Orthopedics, Akershus University Hospital, Nordbyhagen, Norway
| | - Helena Brisby
- Dept of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Dept. of Orthopaedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Erland Hermansen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Munesada D, Sakai D, Nakamura Y, Schol J, Matsushita E, Tamagawa S, Sako K, Ogasawara S, Sato M, Watanabe M. Investigation of the Mitigation of DMSO-Induced Cytotoxicity by Hyaluronic Acid following Cryopreservation of Human Nucleus Pulposus Cells. Int J Mol Sci 2023; 24:12289. [PMID: 37569664 PMCID: PMC10419032 DOI: 10.3390/ijms241512289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/26/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
To develop an off-the-shelf therapeutic product for intervertebral disc (IVD) repair using nucleus pulposus cells (NPCs), it is beneficial to mitigate dimethyl sulfoxide (DMSO)-induced cytotoxicity caused by intracellular reactive oxygen species (ROS). Hyaluronic acid (HA) has been shown to protect chondrocytes against ROS. Therefore, we examined the potential of HA on mitigating DMSO-induced cytotoxicity for the enhancement of NPC therapy. Human NPC cryopreserved in DMSO solutions were thawed, mixed with equal amounts of EDTA-PBS (Group E) or HA (Group H), and incubated for 3-5 h. After incubation, DMSO was removed, and the cells were cultured for 5 days. Thereafter, we examined cell viability, cell proliferation rates, Tie2 positivity (a marker of NP progenitor cells), and the estimated numbers of Tie2 positive cells. Fluorescence intensity of DHE and MitoSOX staining, as indicators for oxidative stress, were evaluated by flow cytometry. Group H showed higher rates of cell proliferation and Tie2 expressing cells with a trend toward suppression of oxidative stress compared to Group E. Thus, HA treatment appears to suppress ROS induced by DMSO. These results highlight the ability of HA to maintain NPC functionalities, suggesting that mixing HA at the time of transplantation may be useful in the development of off-the-shelf NPC products.
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Affiliation(s)
- Daiki Munesada
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (D.M.); (J.S.); (S.T.); (K.S.); (S.O.); (M.S.); (M.W.)
| | - Daisuke Sakai
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (D.M.); (J.S.); (S.T.); (K.S.); (S.O.); (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Yoshihiko Nakamura
- Research Center for Regenerative Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.N.); (E.M.)
| | - Jordy Schol
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (D.M.); (J.S.); (S.T.); (K.S.); (S.O.); (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Japan
- Research Center for Regenerative Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.N.); (E.M.)
| | - Erika Matsushita
- Research Center for Regenerative Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (Y.N.); (E.M.)
| | - Shota Tamagawa
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (D.M.); (J.S.); (S.T.); (K.S.); (S.O.); (M.S.); (M.W.)
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku 113-8431, Japan
| | - Kosuke Sako
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (D.M.); (J.S.); (S.T.); (K.S.); (S.O.); (M.S.); (M.W.)
| | - Shota Ogasawara
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (D.M.); (J.S.); (S.T.); (K.S.); (S.O.); (M.S.); (M.W.)
| | - Masato Sato
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (D.M.); (J.S.); (S.T.); (K.S.); (S.O.); (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Masahiko Watanabe
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (D.M.); (J.S.); (S.T.); (K.S.); (S.O.); (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Japan
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Jiang Q, Ding Y, Lu Z, Cui H, Zhang J, Fu B, Du W, Cao S. Comparative Analysis of Non-Full and Full Endoscopic Spine Technique via Interlaminar Approach for the Treatment of Degenerative Lumbar Spinal Stenosis: A Retrospective, Single Institute, Propensity Score-Matched Study. Global Spine J 2023; 13:1509-1521. [PMID: 34530635 PMCID: PMC10448085 DOI: 10.1177/21925682211039181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To compare the clinical efficacy of posterior lumbar laminectomy decompression under full endoscopic technique (Endo-LOVE) and percutaneous endoscopic medial foraminal decompression (PE-MFD) in the treatment of degenerative lumbar spinal stenosis (DLSS). METHODS Between April 2017 and April 2018, 96 patients with DLSS underwent Endo-LOVE or PE-MFD, including 58 with Endo-LOVE and 38 with PE-MFD. After propensity score matching (PSM), patient characteristics, operation time, intraoperative fluoroscopy times, postoperative bedridden time, hospital stay and postoperative complications were recorded and compared. The clinical efficacy was evaluated according to Oswestry disability index (ODI), visual analogue scale (VAS), lumbar disease JOA and modified MacNab criteria. RESULTS A total of 96 patients with DLSS were included in the study. After PSM, the 2 groups were comparable in patient demographic and baseline characteristics. The operation time and intraoperative fluoroscopy times in PE-MFD group were significantly more than those in Endo-LOVE group (P < .05). The operation time in PE-MFD group was significantly less than that in Endo-LOVE group (P < .05).The intraoperative fluoroscopy times in PE-MFD group were significantly more than that in Endo-LOVE group (P < .05). The ODI, VAS and lumbar disease JOA in the 2 groups were significantly improved comparing with those before operation (P < .05). According to the modified MacNab criteria, the excellent and good rates of the 2 groups were 93.5% in Endo-LOVE group and 87.1% in PE-MFD group (P > .05). CONCLUSION Endo-LOVE and PE-MFD technique can both effectively treat DLSS, and the short-term follow-up results are positive. Endo-LOVE technique has the advantages of fast puncture positioning, less radiation exposure and wider indications. However, PE-MFD needs more radiation exposure and has the possibility of incomplete decompression for complex multiplanar spinal stenosis.
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Affiliation(s)
- Qiang Jiang
- Department of TCM Orthopedics, Sixth Medical Center, PLA General Hospital, Beijing, People’s Republic of China
| | - Yu Ding
- Department of TCM Orthopedics, Sixth Medical Center, PLA General Hospital, Beijing, People’s Republic of China
| | - Zhengcao Lu
- Department of TCM Orthopedics, Sixth Medical Center, PLA General Hospital, Beijing, People’s Republic of China
| | - Hongpeng Cui
- Department of TCM Orthopedics, Sixth Medical Center, PLA General Hospital, Beijing, People’s Republic of China
| | - Jianjun Zhang
- Department of TCM Orthopedics, Sixth Medical Center, PLA General Hospital, Beijing, People’s Republic of China
| | - Bensheng Fu
- Department of TCM Orthopedics, Sixth Medical Center, PLA General Hospital, Beijing, People’s Republic of China
| | - Wei Du
- Department of TCM Orthopedics, Sixth Medical Center, PLA General Hospital, Beijing, People’s Republic of China
| | - Shiqi Cao
- Department of TCM Orthopedics, Sixth Medical Center, PLA General Hospital, Beijing, People’s Republic of China
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Cheng X, Wu Y, Chen B, Tang J. A Comparative Study of Unilateral Biportal Endoscopic Decompression and Percutaneous Transforaminal Endoscopic Decompression for Geriatric Patients with Lumbar Lateral Recess Stenosis. J Pain Res 2023; 16:2241-2249. [PMID: 37409162 PMCID: PMC10319288 DOI: 10.2147/jpr.s413502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose The purpose of this research was to compare the efficacy of unilateral biportal endoscopic decompression (UBE) and percutaneous transforaminal endoscopic decompression (PTED) in the treatment of elderly patients with single-level lumbar lateral recess stenosis (LRS). Materials and Methods Data from January 2020 to March 2022 were analyzed. Thirty-eight patients in the PTED group and thirty-nine patients in the UBE group completed the minimum 12-month follow-up. The demographic data and perioperative outcomes were reviewed. Clinical outcomes were evaluated using the VAS for back and leg pain, the Oswestry Disability Index (ODI), and the modified MacNab criteria. Results Both groups of patients completed surgery and a one-year follow-up. There was no significant difference between the two groups in demographics data. UBE has the advantage in operative duration and X-ray time; as far as incision length, blood loss, and drainage volume are concerned, PTED is advantageous. Under the modified MacNab criteria, UBE exhibited a good-to-excellent rate similar to that of PTED (84.6% vs 81.6%, P>0.05). There were no significant differences at any point in time between UBE and PTED with respect to ODI, VAS, or back pain scores (P>0.05). UBE and PTED did not differ significantly in terms of complications. Conclusion Both PTED and UBE achieved favorable outcomes in single-level LRS. For operative time and X-ray times, UBE is more advantageous, while PTED offers better estimates of blood loss, incision length, and drainage volume.
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Affiliation(s)
- Xiaokang Cheng
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China
- Department of Orthopedics, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, People’s Republic of China
| | - Yuxuan Wu
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China
| | - Bin Chen
- Department of Orthopedics, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, People’s Republic of China
| | - Jiagang Tang
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China
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25
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Xu J, Si H, Zeng Y, Wu Y, Zhang S, Shen B. Transcriptome-wide association study reveals candidate causal genes for lumbar spinal stenosis. Bone Joint Res 2023; 12:387-396. [PMID: 37356815 DOI: 10.1302/2046-3758.126.bjr-2022-0160.r1] [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] [Indexed: 06/27/2023] Open
Abstract
Aims Lumbar spinal stenosis (LSS) is a common skeletal system disease that has been partly attributed to genetic variation. However, the correlation between genetic variation and pathological changes in LSS is insufficient, and it is difficult to provide a reference for the early diagnosis and treatment of the disease. Methods We conducted a transcriptome-wide association study (TWAS) of spinal canal stenosis by integrating genome-wide association study summary statistics (including 661 cases and 178,065 controls) derived from Biobank Japan, and pre-computed gene expression weights of skeletal muscle and whole blood implemented in FUSION software. To verify the TWAS results, the candidate genes were furthered compared with messenger RNA (mRNA) expression profiles of LSS to screen for common genes. Finally, Metascape software was used to perform enrichment analysis of the candidate genes and common genes. Results TWAS identified 295 genes with permutation p-values < 0.05 for skeletal muscle and 79 genes associated for the whole blood, such as RCHY1 (PTWAS = 0.001). Those genes were enriched in 112 gene ontology (GO) terms and five Kyoto Encyclopedia of Genes and Genomes pathways, such as 'chemical carcinogenesis - reactive oxygen species' (LogP value = -2.139). Further comparing the TWAS significant genes with the differentially expressed genes identified by mRNA expression profiles of LSS found 18 overlapped genes, such as interleukin 15 receptor subunit alpha (IL15RA) (PTWAS = 0.040, PmRNA = 0.010). Moreover, 71 common GO terms were detected for the enrichment results of TWAS and mRNA expression profiles, such as negative regulation of cell differentiation (LogP value = -2.811). Conclusion This study revealed the genetic mechanism behind the pathological changes in LSS, and may provide novel insights for the early diagnosis and intervention of LSS.
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Affiliation(s)
- Jiawen Xu
- Orthopedic Research Institute, Department of Orthopedics, Sichuan University West China Hospital, Chengdu, China
| | - Haibo Si
- Orthopedic Research Institute, Department of Orthopedics, Sichuan University West China Hospital, Chengdu, China
| | - Yi Zeng
- Orthopedic Research Institute, Department of Orthopedics, Sichuan University West China Hospital, Chengdu, China
| | - Yuangang Wu
- Orthopedic Research Institute, Department of Orthopedics, Sichuan University West China Hospital, Chengdu, China
| | - Shaoyun Zhang
- Orthopedic Research Institute, Department of Orthopedics, Sichuan University West China Hospital, Chengdu, China
| | - Bin Shen
- Orthopedic Research Institute, Department of Orthopedics, Sichuan University West China Hospital, Chengdu, China
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Miura T, Ito T, Sato K, Endo T, Iwabuchi M, Shirado O. Is dynamic spino-pelvic alignment during gait associated with lumbar function in patients with degenerative lumbar spinal stenosis? Gait Posture 2023; 103:210-214. [PMID: 37262975 DOI: 10.1016/j.gaitpost.2023.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Static spine and pelvic posture has been reported to be associated with symptoms in patients with lumbar spinal stenosis (LSS), but it is unknown whether dynamic alignment of the spine and pelvis is associated with lumbar function in daily life. This study aims to investigate the relationship between dynamic alignment of the spine and pelvis during gait and lumbar function in daily life in patients with LSS. METHODS We evaluated lumbar function in daily life using the Oswestry Disability Index (ODI), trunk and hip muscle strength as physical function, static spinal alignment, and dynamic spinal/pelvic alignment during gait. The relationship between the ODI score and physical function or static and dynamic alignment was examined. RESULTS A total of 35 preoperative patients with LSS participated in this study. ODI score significantly correlated with trunk extension strength (r = -0.578, p = 0.000), hip extension strength (r = -0.472, p = 0.004), maximum spinal flexion angle during gait (r = -0.473, p = 0.004) and maximum pelvic anterior tilt angle (r = 0.510, p = 0.002). Multiple regression analysis showed that trunk extension strength (standardized β; - 0.309), hip extension strength (standardized β; -0.287), maximum spinal flexion angle (standardized β; - 0.306) and maximum pelvic anterior tilt angle (standardized β; 0.271) significantly affected the ODI score, with adjusted coefficient of determination of 0.529. CONCLUSION The results of this study showed that the patients with LSS with weak hip or trunk extensor muscles, a greater angle of pelvic tilt or a less spinal flexion during gait had a lower lumbar function in daily life.
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Affiliation(s)
- Takuya Miura
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center) at Fukushima Medical University, Aizu-wakamatsu, Fukushima 969-3492, Japan.
| | - Toshikazu Ito
- Hokkaido Chitose College of Rehabilitation, Chitose, Hokkaido 066-0055, Japan
| | - Keita Sato
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center) at Fukushima Medical University, Aizu-wakamatsu, Fukushima 969-3492, Japan
| | - Tatsuya Endo
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center) at Fukushima Medical University, Aizu-wakamatsu, Fukushima 969-3492, Japan
| | - Masumi Iwabuchi
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center) at Fukushima Medical University, Aizu-wakamatsu, Fukushima 969-3492, Japan
| | - Osamu Shirado
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center) at Fukushima Medical University, Aizu-wakamatsu, Fukushima 969-3492, Japan
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Holc F, Albani-Forneris A, Kido G, Beltrame S, Petracchi M, Gruenberg M, Sola C, Camino-Willhuber G. Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:175-180. [PMID: 36240990 DOI: 10.1016/j.recot.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. MATERIALS AND METHODS An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. RESULTS Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52-0.63) and 0.69 (0.55-0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46-0.60) for junior residents, 0.61 (0.54-0.67) for senior residents and 0.67 (0.59-0.74) for attendings. Intraobserver agreement was of 0.54 (0.48-0.60) for junior, 0.60 (0.55-0.66) for senior and 0.66 (0.60-0.72) for attendings. CONCLUSION The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.
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Affiliation(s)
- F Holc
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Albani-Forneris
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Kido
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Beltrame
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Petracchi
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Gruenberg
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C Sola
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Department of Orthopaedics, University of California at Irvine, 101 The City Drive South, Orange, CA 92868, USA.
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Wang Y, Zhang P, Yan X, Wang J, Zhu M, Teng H. The correlation between lumbar interlaminar space size on plain radiograph and 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 2023; 32:1721-1728. [PMID: 36941496 DOI: 10.1007/s00586-023-07646-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 03/06/2023] [Indexed: 03/22/2023]
Abstract
PURPOSE Investigating the correlation between the interlaminar space size on plain radiograph and lumbar spinal stenosis (LSS). METHODS 100 Patients with LSS and 100 normal participants without LSS were included in this study. Lumbar interlaminar parameters were measured on plain radiographs. Spinal canal parameters were measure on CT and MRI. These image parameters were compared between LSS and control group. The linear correlation among interlaminar parameters, spinal canal parameters and Oswestry Disability Index (ODI) were analyzed. The cut-off values of interlaminar parameters for diagnosing L3/4 and L4/5 symptomatic LSS were analyzed. RESULTS Excepting for L1/2 interlaminar width, all interlaminar and spinal canal related parameters in LSS group were significantly smaller than those in control group. Excepting for L1/2 interlaminar width and L5/S1 interlaminar height, all interlaminar parameters had significantly positive linear correlation with spinal canal parameters accordingly in each lumbar level. For diagnosis of symptomatic LSS, The cut off values of L4/5 interlaminar width, height and area were 18.46 mm, 11.37 mm and 134.05 mm2 while 15.78 mm, 13.59 mm and 157.98 mm2 in L3/4. Both spinal canal size and interlaminar size had no linear correlation with ODI in cases of L4/5 LSS. CONCLUSIONS Lumbar interlaminar space size on plain radiograph has positive linear correlation with developmental and degenerative LSS, excepting for L1/2 interlaminar width and L5/S1 interlaminar height. Lumbar plain radiograph can be a feasible way for predicting and helping to diagnose LSS through evaluating the interlaminar space size. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yu Wang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
| | - Peng Zhang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Xin Yan
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Jing Wang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Minyu Zhu
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Honglin Teng
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
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Holc F, Albani-Forneris A, Kido G, Beltrame S, Petracchi M, Gruenberg M, Sola C, Camino-Willhuber G. Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T175-T180. [PMID: 36858284 DOI: 10.1016/j.recot.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/01/2022] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. MATERIALS AND METHODS An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. RESULTS Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52-0.63) and 0.69 (0.55-0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46-0.60) for junior residents, 0.61 (0.54-0.67) for senior residents and 0.67 (0.59-0.74) for attendings. Intraobserver agreement was of 0.54 (0.48-0.60) for junior, 0.60 (0.55-0.66) for senior and 0.66 (0.60-0.72) for attendings. CONCLUSION The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.
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Affiliation(s)
- F Holc
- Orthopaedic and Traumatology Department, Institute of Orthopedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Albani-Forneris
- Orthopaedic and Traumatology Department, Institute of Orthopedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Kido
- Orthopaedic and Traumatology Department, Institute of Orthopedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Beltrame
- Orthopaedic and Traumatology Department, Institute of Orthopedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Petracchi
- Orthopaedic and Traumatology Department, Institute of Orthopedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Gruenberg
- Orthopaedic and Traumatology Department, Institute of Orthopedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C Sola
- Orthopaedic and Traumatology Department, Institute of Orthopedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Department of Orthopaedics, University of California at Irvine, Orange, CA, Estados Unidos.
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Ekhator C, Griepp D, Urbi A, Fiani B. Effectiveness of X-stop Interspinous Distractor Device Versus Laminectomy for Treatment of Lumbar Stenosis: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e37535. [PMID: 37077368 PMCID: PMC10110388 DOI: 10.7759/cureus.37535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023] Open
Abstract
Lumbar spinal stenosis refers to the narrowing of the spinal canal in the lumbar region. There is an increasing need to determine the treatment modality for lumbar spinal stenosis by comparing the outcomes of X-stop interspinous distractors and laminectomy. The objective of this study is to determine the effectiveness of the X-stop interspinous distractor compared to laminectomy. This systematic review fundamentally abides by the procedures delineated in the Cochrane methodology while the reporting is done according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Three databases searched generated a total of 943 studies, with PubMed being the source for the bulk of the articles. Six studies were selected for inclusion in this study. The effectiveness of the interspinous distractor devices and laminectomy can be determined through their impact on the quality of life, rates of complications, and the amount of money utilized. This meta-analysis fundamentally emphasizes that laminectomy is a more effective intervention for the treatment of lumbar spinal stenosis as it is more cost-effective and results in fewer complications in the long term.
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Affiliation(s)
- Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Daniel Griepp
- Neurosurgery, St. Barnabas Hospital Health System, Bronx, USA
| | - Alyssa Urbi
- Neuroscience, Brandeis University, Waltham, USA
| | - Brian Fiani
- Neurosurgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, USA
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Eguchi Y, Aoki Y, Yamashita M, Fujimoto K, Sato T, Abe K, Sato M, Yamanaka H, Toyoguchi T, Shimizu K, Orita S, Inage K, Shiga Y, Ohtori S. Clinical Efficacy of Neurotropin for Lumbar Spinal Stenosis with Low Back Pain. Pain Ther 2023; 12:461-473. [PMID: 36645650 PMCID: PMC10036710 DOI: 10.1007/s40122-022-00472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE We compared the clinical effects of Neurotropin, limaprost alfadex, and a combination of both drugs for lumbar spinal stenosis (LSS) with low back pain (LBP). METHODS We conducted a multicenter, randomized, active-controlled, open-label trial from March 2021 to May 2022. Participants were patients diagnosed with LSS by MRI and were randomly assigned to three groups: Neurotropin/limaprost combination (NL group), Neurotropin (N group), and limaprost group (L group). Participants received the drugs administered orally for 12 weeks, and each examination and observation was performed before any drug administration and every 2 weeks thereafter. We recorded age, sex, height, weight, duration of symptoms, intermittent claudication distance, level of stenosis in MRI, and concomitant analgesics as examination items in the trial period. Items measured during the trial were visual analog scale (VAS) score (mm) for LBP, leg pain and numbness, walking activity (walking speed, stride length), standing balance (3 m Timed Up-and-Go (TUG) Test results, Five Times Sit-to-Stand Test (FTSST) results), LBP/Quality of Life (QOL)-related scores (Oswestry Disability Index (ODI), Euro QOL 5-Dimensions 5-Level (EQ-5D-5L), Roland-Morris Disability Questionnaire (RDQ)), psychological factors (Pain catastrophizing scale (PCS) and Pain Self-Efficacy Questionnaire (PSEQ) scores), and adverse events. Each item was evaluated using changes at each visit (weeks 2-12) from baseline value before drug administration (week 0), and changes were considered significant when p < 0.05. RESULTS We included results from 64 patients in the present study; 24 were assigned to the NL group (mean age 71.2 years), 20 to the N group (mean age 76.2 years), and 20 to the L group (mean age 74.4 years). There were no significant differences between the three groups in patient characteristics, concomitant analgesics, or baseline VAS score, gait balance, or QOL-related scores (p ≥ 0.05). The VAS and leg pain scores were significantly improved in Group L, and LBP was improved significantly in Group N. QOL and ODI scores improved significantly in the NL and L groups, EQ-5D score improved significantly in the L group, and RDQ score improved significantly in all groups (p < 0.05). Psychological factor and PCS scores improved significantly in the NL and L groups (p < 0.05). Walking speed and stride length were improved significantly in the NL and N groups (p < 0.05). TUG/FTSST scores were improved significantly in all groups (p < 0.05). Leg pain VAS score was improved significantly (p < 0.05) in the L group compared with the NL group after 6 and 12 weeks of administration, and LBP VAS was improved significantly in the N group after 6 weeks compared with the NL group (p < 0.05). Walking speed was significantly improved in the NL group after 2 weeks compared with the N group and improved significantly in the NL group after 6 weeks (p < 0.05) compared with the L group. RDQ was decreased significantly in the L group compared with the NL group after 8 weeks (p < 0.05). CONCLUSIONS Combined use of Neurotropin and limaprost showed an additional effect on walking speed compared with single drug administration. Neurotropin may contribute to the improvement of low back pain, walking speed/stride length, and standing balance. TRIAL REGISTRATION Japan Registry of Clinical Trials (jRCTs031200282).
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Affiliation(s)
- Yawara Eguchi
- Department of Orthopaedic Surgery, Center for Orthopaedic Science Medical Innovation, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan.
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba, 284-0003, Japan.
- Department of Orthopaedic Surgery, Chiba Qiball Clinic, 4-5-1, Chuo-Ku, Chiba, 260-0013, Japan.
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Masaomi Yamashita
- Department of Orthopaedic Surgery, JCHO Funabashi Central Hospital, 6-13-10 Kaijin, Funabashi City, Chiba, 260-8670, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic Surgery, Konodai Hospital, National Center for Global Health and Medicine, Ichikawa, 272-8516, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba, 284-0003, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, JCHO Funabashi Central Hospital, 6-13-10 Kaijin, Funabashi City, Chiba, 260-8670, Japan
| | - Masashi Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Hajime Yamanaka
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba, 284-0003, Japan
| | - Toru Toyoguchi
- Department of Orthopaedic Surgery, Chiba Qiball Clinic, 4-5-1, Chuo-Ku, Chiba, 260-0013, Japan
| | - Keisuke Shimizu
- Future Medicine Education and Research Organization at Chiba University, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Center for Orthopaedic Science Medical Innovation, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Chiba University Center for Frontier Medical Engineering, 1-33 Yayoi-Cho, CFME Room#B201, Inage-Ku, Chiba, 263-8522, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Center for Orthopaedic Science Medical Innovation, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Center for Orthopaedic Science Medical Innovation, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Center for Orthopaedic Science Medical Innovation, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan
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Differentiating Lumbar Spinal Etiology from Peripheral Plexopathies. Biomedicines 2023; 11:biomedicines11030756. [PMID: 36979737 PMCID: PMC10044821 DOI: 10.3390/biomedicines11030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Clinicians have managed and treated lower back pain since the earliest days of practice. Historically, lower back pain and its accompanying symptoms of radiating leg pain and muscle weakness have been recognized to be due to any of the various lumbar spine pathologies that lead to the compression of the lumbar nerves at the root, the most common of which is the radiculopathy known as sciatica. More recently, however, with the increased rise in chronic diseases, the importance of differentially diagnosing a similarly presenting pathology, known as lumbosacral plexopathy, cannot be understated. Given the similar clinical presentation of lumbar spine pathologies and lumbosacral plexopathies, it can be difficult to differentiate these two diagnoses in the clinical setting. Resultingly, the inappropriate diagnosis of either pathology can result in ineffective clinical management. Thus, this review aims to aid in the clinical differentiation between lumbar spine pathology and lumbosacral plexopathy. Specifically, this paper delves into spine and plexus anatomy, delineates the clinical assessment of both pathologies, and highlights powerful diagnostic tools in the hopes of bolstering appropriate diagnosis and treatment. Lastly, this review will describe emerging treatment options for both pathologies in the preclinical and clinical realms, with a special emphasis on regenerative nerve therapies.
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Gagliardi MJ, Guiroy AJ, Camino-Willhuber G, Joaquim AF, Carazzo CA, Yasuda E, Cabrera JP, Morales Ciancio AR. Is Indirect Decompression and Fusion More Effective than Direct Decompression and Fusion for Treating Degenerative Lumbar Spinal Stenosis With Instability? A Systematic Review and meta-Analysis. Global Spine J 2023; 13:499-511. [PMID: 35486409 PMCID: PMC9972259 DOI: 10.1177/21925682221098362] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study design: Systematic Review and Meta-analysis.Objective: Surgical alternatives to treat lumbar spinal stenosis and instability include indirect (ALIF, OLIF, and LLIF) and direct (TLIF or posterior lumbar interbody fusion) decompression and fusion interventions. Although both approaches have proven to be effective in reducing symptoms, it is unknown if there is any difference in effectiveness between them. In this systematic review and meta-analysis, we aimed to evaluate postoperative pain and disability in patients treated whit indirect vs direct decompression and fusion approaches.Methods: We conducted a systematic review of the literature consulting several databases and identified studies that enrolled patients diagnosed with degenerative lumbar spinal stenosis and instability treated with indirect or direct decompression and fusion techniques. Our primary endpoints were the visual analogue scale, Oswestry Disability Index, and the Japanese Orthopedics Association Back Pain Evaluation Questionnaire 1 year after the procedure. Secondary outcomes included complication rate, blood loss, and surgical time.Results: Nine retrospective and comparative studies were included enrolling a total of 1004 participants. Both surgical strategies had satisfactory clinical outcomes with no significant difference at 1 year. Although the complication rate was similar for both groups, the profile of the adverse events was different. In addition, patients treated with indirect decompression and fusion had significantly less blood loss and operative times.Conclusions: Indirect and direct decompression and fusion techniques are similarly effective in treating patients with lumbar spinal stenosis and instability. The ID group had significantly lower intraoperative blood loss and surgical time values.
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Affiliation(s)
- Martin J. Gagliardi
- Department of Neurosurgery, St Michael’s Hospital, University of
Toronto, Toronto, ON, Canada,Department of Orthopedics, Hospital Español de
Mendoza, Mendoza, Argentina,Martin J. Gagliardi, M.D, Department of
Neurosurgery, St Michael’s Hospital, University of Toronto, 36 Queen Street,
Toronto, ON M5B 1W8, Canada.
| | - Alfredo J. Guiroy
- Department of Orthopedics, Hospital Español de
Mendoza, Mendoza, Argentina,The Paley Orthopedics and Spine
Institute, Saint Mary’s Medical
Center, West Palm Beach, FL, USA
| | | | - Andrei F. Joaquim
- Department of Neurosurgery, University of Campinas, Campinas, Brazil
| | - Charles A. Carazzo
- Department of Neurosurgery, São
Vicente de Paulo Hospital, University of Passo
Fundo, Passo Fundo, Brazil
| | - Ezequiel Yasuda
- Department of Neurosurgery,
Hospital de Clinicas, University of Buenos
Aires, Buenos Aires, Argentina
| | - Juan P. Cabrera
- Department of Neurosurgery, Hospital Clinico Regional de
Concepción, Concepción, Chile
| | - Alejandro R. Morales Ciancio
- Department of Orthopedics, Hospital Español de
Mendoza, Mendoza, Argentina,Department of Orthopaedics, Great Ormond Street
Hospital, London, UK
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Oh Y, Han CH, Kim Y, Kim J, Yang C, Choi YE, Kang BK, Yang GY, Lee BR, Kim E. Add-on Effect and Safety of Pharmacopuncture Therapy in the Treatment of Patients with Lumbar Spinal Stenosis. J Acupunct Meridian Stud 2023; 16:40-48. [PMID: 36804820 DOI: 10.51507/j.jams.2023.16.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/05/2022] [Accepted: 01/24/2023] [Indexed: 02/22/2023] Open
Abstract
Background Recently, Korean Medicine treatment with pharmacopuncture therapy (PPT) has been increasingly used in clinical practice to improve symptoms in patients with lumbar spinal stenosis (LSS). The aim of this study is to evaluate the effectiveness and safety of PPT in addition to conventional Korean Medicine treatment (CKMT) for the treatment of patients with LSS, compared with CKMT alone. Methods This study is designed as a pragmatic, randomized, two-armed, parallel, stratified (by sex), controlled pilot trial. Forty patients diagnosed with LSS will be randomly allocated to the PPT + CKMT group or the CKMT group. Patients in the two groups will receive treatment two times weekly for 5 weeks. The primary outcome will be the mean change in the 100-mm visual analog scale score from the baseline to the end of treatment (week 5). The secondary outcomes will include the clinically important difference, Zurich Claudication Questionnaire score, self-reported walking capacity, Modified-Modified Schober test, EuroQol 5-dimension 5-level questionnaire, and Patients' Global Impression of Change. Adverse events will be assessed at each visit. Discussion The results of this study will provide meaningful data to evaluate the add-on effect and safety of PPT in the medical care of patients with LSS.
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Affiliation(s)
- Yoona Oh
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
| | - Chang-Hyun Han
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea.,Korean Convergence Medicine, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Yeonhak Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
| | - Jihun Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Young Eun Choi
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Byoung-Kab Kang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Gi Young Yang
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea.,Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea
| | - Byung Ryul Lee
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea.,Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea
| | - Eunseok Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea.,Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea
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Maeder B, Becce F, Kehtari S, Monier A, Chaboudez E, Rothenfluh DA, Schizas C, Hajdu SD. Evolution of the Cross-Sectional Area of the Osseous Lumbar Spinal Canal across Decades: A CT Study with Reference Ranges in a Swiss Population. Diagnostics (Basel) 2023; 13:diagnostics13040734. [PMID: 36832223 PMCID: PMC9955901 DOI: 10.3390/diagnostics13040734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Spinal canal dimensions may vary according to ethnicity as reported values differ among studies in European and Chinese populations. Here, we studied the change in the cross-sectional area (CSA) of the osseous lumbar spinal canal measured in subjects from three ethnic groups born 70 years apart and established reference values for our local population. This retrospective study included a total of 1050 subjects born between 1930 and 1999 stratified by birth decade. All subjects underwent lumbar spine computed tomography (CT) as a standardized imaging procedure following trauma. Three independent observers measured the CSA of the osseous lumbar spinal canal at the L2 and L4 pedicle levels. Lumbar spine CSA was smaller at both L2 and L4 in subjects born in later generations (p < 0.001; p = 0.001). This difference reached significance for patients born three to five decades apart. This was also true within two of the three ethnic subgroups. Patient height was very weakly correlated with the CSA at both L2 and L4 (r = 0.109, p = 0.005; r = 0.116, p = 0.002). The interobserver reliability of the measurements was good. This study confirms the decrease of osseous lumbar spinal canal dimensions across decades in our local population.
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Affiliation(s)
- Benoit Maeder
- Spine Center, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence:
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Sam Kehtari
- Department of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Arnaud Monier
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Etienne Chaboudez
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
| | - Dominique A. Rothenfluh
- Spine Center, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | | | - Steven D. Hajdu
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
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Less-invasive decompression procedures can reduce risk of reoperation for lumbar spinal stenosis with diffuse idiopathic skeletal hyperostosis extended to the lumbar segment: analysis of two retrospective cohorts. 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 2023; 32:505-516. [PMID: 36567342 DOI: 10.1007/s00586-022-07496-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Clinical outcomes after decompression procedures are reportedly worse for lumbar spinal stenosis (LSS) with diffuse idiopathic skeletal hyperostosis (DISH), especially DISH extended to the lumbar segment (L-DISH). However, no studies have compared the effect of less-invasive surgery versus conventional decompression techniques for LSS with DISH. The purpose of this study was to compare the long-term risk of reoperation after decompression surgery focusing on LSS with L-DISH. METHODS This study compared open procedure cohort (open conventional fenestration) and less-invasive procedure cohort (bilateral decompression via a unilateral approach) with ≥ 5 years of follow-up. After stratified analysis by L-DISH, patients with L-DISH were propensity score-matched by age and sex. RESULTS There were 57 patients with L-DISH among 489 patients in the open procedure cohort and 41 patients with L-DISH among 297 patients in the less-invasive procedure cohort. The reoperation rates in L-DISH were higher in the open than less-invasive procedure cohort for overall reoperations (25% and 7%, p = 0.026) and reoperations at index levels (18% and 5%, p = 0.059). Propensity score-matched analysis in L-DISH demonstrated that open procedures were significantly associated with increased overall reoperations (hazard ratio [HR], 6.18; 95% confidence interval [CI], 1.37-27.93) and reoperations at index levels (HR, 4.80; 95% CI, 1.04-22.23); there was no difference in reoperation at other lumbar levels. CONCLUSIONS Less-invasive procedures had a lower risk of reoperation, especially at index levels for LSS with L-DISH. Preserving midline-lumbar posterior elements could be desirable as a decompression procedure for LSS with L-DISH.
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Kirker K, Masaracchio MF, Loghmani P, Torres-Panchame RE, Mattia M, States R. Management of lumbar spinal stenosis: a systematic review and meta-analysis of rehabilitation, surgical, injection, and medication interventions. Physiother Theory Pract 2023; 39:241-286. [PMID: 34978252 DOI: 10.1080/09593985.2021.2012860] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) has a substantial impact on mobility, autonomy, and quality of life. Previous reviews have demonstrated inconsistent results and/or have not delineated between specific nonsurgical interventions. OBJECTIVE The purpose of this systematic review is to assess the effectiveness of interventions in the management of LSS. METHODS Eligible studies were randomized controlled trials (RCTs) or prospective studies, included patients with LSS, assessed the effectiveness of any interventions (rehabilitation, surgical, injection, medication), included at least two intervention groups, and included at least one measure of pain, disability, ambulation assessment, or LSS-specific symptoms. Eighty-five articles met inclusion criteria. Meta-analyses were conducted across outcomes. Effect sizes were calculated using Hedge's g and reported descriptively. Formal grading of evidence was conducted. RESULTS Meta-analysis comparing rehabilitation to no treatment/placebo demonstrated significant effects on pain favoring rehabilitation (mean difference, MD -1.63; 95% CI: -2.68, -0.57; I2 = 71%; p = .002). All other comparisons to no treatment/placebo revealed nonsignificant findings. The level of evidence ranged from very low to high for rehabilitation and medication versus no treatment/placebo for pain, disability, ambulation ability, and LSS symptoms. CONCLUSIONS Although the findings of this review are inconclusive regarding superiority of interventions, this accentuates the value of multimodal patient-centered care in the management of patients with LSS.
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Affiliation(s)
- Kaitlin Kirker
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | | | - Parisa Loghmani
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | | | - Michael Mattia
- Department of Allied Health, Kingsborough Community College, Brooklyn, NY, USA
| | - Rebecca States
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
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Endovascular Revascularization of Isolated Internal Iliac Artery for symptomatic occlusive atherosclerotic disease is a viable and underutilized option for patients with gluteal muscle claudication. J Vasc Surg Cases Innov Tech 2023; 9:101090. [PMID: 36992706 PMCID: PMC10041555 DOI: 10.1016/j.jvscit.2022.101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/29/2022] [Indexed: 02/19/2023] Open
Abstract
Often confused with pseudoclaudication, gluteal muscle claudication is a difficult condition to diagnose and treat. We present the case of a 67-year-old man with a history of back and buttock claudication. He had undergone lumbosacral decompression with no relief of buttock claudication. Computed tomography angiography of the abdomen and pelvis showed occlusion of the bilateral internal iliac arteries. Exercise transcutaneous oxygen pressure measurements obtained on referral to our institution revealed a significant decrease. He underwent successful recanalization and stenting of the bilateral hypogastric arteries with complete resolution of his symptoms. We also reviewed the reported data to highlight the trend in the management of patients with this condition.
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Sheng Y, Li J, Chen L, Geng M, Fen J, Sun S, Sun J. Delta large-channel technique versus microscopy-assisted laminar fenestration decompression for lumbar spinal stenosis: a one-year prospective cohort study. BMC Musculoskelet Disord 2023; 24:43. [PMID: 36653778 PMCID: PMC9850816 DOI: 10.1186/s12891-023-06143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE When it comes to treating lumbar spinal stenosis (LSS), a procedure known as microscope-assisted fenestration decompression has expediently become the gold standard. With the advancement of spinal endoscopy, the Delta large-channel approach has shown promising clinical outcomes in the management of lumbar spinal stenosis. However, case studies of this method being used to treat lumbar spinal stenosis are still uncommon. The purpose of this research was to examine how well microscopy-assisted laminectomy and the Delta large-channel approach work in treating LSS in the clinic. METHODS From May 2018 to June 2020, 149 patients diagnosed with LSS were divided into 80 patients in Delta large-channel technique groups (FE group) and 69 patients in microscope groups (Micro group). Lower back and lower limb pain were measured using the visual analogue scale (VAS-LBP and VAS-LP), while lower limb numbness was evaluated using the 11-point numerical rating scale (NRS-LN); modified Oswestry Disability Index (ODI) was used to evaluate the quality of life, and modified MacNab criteria were used to assess the clinical efficacy before surgery and at one week, three months, six months, and 12 months after surgery. All patients had single-level lumbar spinal stenosis, and clinical data such as hospital stay, operation time, intraoperative blood loss were statistically analyzed. RESULTS Finally, 111 patients (62 in FE group and 49 in Micro group) completed follow-up. Compared with preoperative results, postoperative VAS-LBP, VAS-LP, NRS-LN score and modified ODI score were significantly improved in 2 groups (P < 0.05), but there was no significant difference in postoperative follow-up at each time point (P > 0.05), Except 1 week after surgery, VAS-LBP in FE group was lower than that in Micro group (P < 0.05). It is noteworthy that the FE group had a shorter hospital stay, less intraoperative blood loss, and a quicker time of getting out of bed when compared with the microscope group,but the operation time was just the opposite (P < 0.05). The excellent and good rate was 83.87% in FE group and 85.71% in Micro group (P > 0.05). CONCLUSIONS Both microscope-assisted laminar fenestration decompression and Delta large-channel procedures provide satisfactory treatment outcomes, however the Delta large-channel approach has some potential advantages for the treatment of LSS, including quicker recovery and sooner reduced VAS-LBP. Long-term consequences, however, will necessitate additional follow-up and research.
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Affiliation(s)
- Yuehang Sheng
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Jing Li
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Lei Chen
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Minghao Geng
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Jing Fen
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Shaodong Sun
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Jianhua Sun
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
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Relationship between lumbar spinal stenosis and cauda equina movement during the Valsalva maneuver. Skeletal Radiol 2023; 52:1349-1358. [PMID: 36609720 DOI: 10.1007/s00256-022-04274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To confirm the relationship between lumbar spinal stenosis (LSS) and cauda equina movement during the Valsalva maneuver. MATERIALS AND METHODS Two radiologists at our institution independently evaluated cauda equina movement on pelvic cine MRI, which was performed for urethrorrhea after prostatectomy or pelvic prolapse in 105 patients (99 males; mean age: 69.0 [range: 50-78] years), who also underwent abdominopelvic CT within 2 years before or after the MRI. The qualitative assessment of the cine MRI involved subjective determination of the cauda equina movement type (non-movement, flutter, and inchworm-manner). The severity of LSS on abdominopelvic CT was quantified using our LSS scoring system and performed between L1/2 and L5/S1. We calculated the average LSS scores of two analysts and extracted the worst scores among all levels. RESULTS Cauda equina movement was observed in 15 patients (14%), inchworm-manner in 10 patients, and flutter in five patients. Participants with cauda equina movement demonstrated significantly higher LSS scores than those without movement (P < 0.001, Wilcoxon's rank-sum test). A significant difference was observed in the worst LSS scores between participants without movement and those with inchworm-manner movement (P < 0.001, Bonferroni's corrected). There were no significant differences between participants without movement and those with flutter movement (P = 0.3156) and between participants with flutter movement and those with inchworm-manner movement (P = 0.4843). CONCLUSION Cauda equina movement in cine MRI during the Valsalva maneuver is occasionally observed in patients with severe LSS, and may be associated with pathogenesis of redundant nerve roots.
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Hu Y, Fu H, Yang D, Xu W. Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis. Front Surg 2023; 9:1061566. [PMID: 36684266 PMCID: PMC9852342 DOI: 10.3389/fsurg.2022.1061566] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/10/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To investigate the clinical efficacy and imaging outcomes of unilateral biportal endoscopy (UBE) with unilateral laminotomy for bilateral decompression (ULBD) in the treatment of severe lumbar spinal stenosis (SLSS). Methods We retrospectively analyzed 50 patients with SLSS treated with UBE-ULBD from October 2018 to March 2021. Visual analog scale (VAS) for back and legs pain, Oswestry disability index (ODI), modified Macnab criteria, complications, hospital stay, preoperative and postoperative dural sac cross-sectional area (DSCA) and Schizas grade, mean angle of facetectomy and osseous lateral recess decompression rate were examined. Results The mean follow-up period was 10.7 months. The mean hospital stay was 2.76 ± 1.02 days. At the final follow-up, VAS for back pain and legs pain decreased from 7.22 ± 0.95 to 1.26 ± 0.44 and from 7.88 ± 0.69 to 1.18 ± 0.39, respectively; ODI decreased from 69.88 ± 6.32% to 14.96 ± 2.75%. According to the modified Macnab criteria, the results were excellent in 24 (48%), good in 22 (44%), and fair in 4 (8%). Excellent or good results (a satisfactory outcome) were obtained in 92% of the patients. There were 2 cases of complications of dural sac tear. The postoperative DSCA was significantly enlarged compared with that before surgery, from 44.74 ± 9.85 to 126.86 ± 14.81 mm2. According to Schizas grade, the stenosis grade changes from preoperative grade C in 16 cases, grade D in 34 cases, to postoperative grade A in 40 cases, and grade B in 10 cases. The mean angle of facetectomy of the ipsilateral facet joint was 70.87 ± 5.68 ∘ , contralateral was 65.07 ± 4.98 ∘ . The decompression rate was 70.81 ± 4.43% (ipsilateral side) and 71.22 ± 3.68% (contralateral). Conclusions UBE-ULBD has a good clinical effect in the treatment of SLSS, and has achieved satisfactory results in spinal canal enlargement, undercutting of facet joints, and decompression effect. It is a safe and effective surgical for SLSS.
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Affiliation(s)
- Yutong Hu
- Graduate School, Dalian Medical University, Dalian, China,Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Hao Fu
- Graduate School, Dalian Medical University, Dalian, China,Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Dongfang Yang
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China,Correspondence: Weibing Xu Dongfang Yang
| | - Weibing Xu
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China,Correspondence: Weibing Xu Dongfang Yang
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Jujjavarapu C, Suri P, Pejaver V, Friedly J, Gold LS, Meier E, Cohen T, Mooney SD, Heagerty PJ, Jarvik JG. Predicting decompression surgery by applying multimodal deep learning to patients' structured and unstructured health data. BMC Med Inform Decis Mak 2023; 23:2. [PMID: 36609379 PMCID: PMC9824905 DOI: 10.1186/s12911-022-02096-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/29/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a common condition made up of a variety of anatomic and clinical subtypes. Lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS) are two subtypes highly associated with LBP. Patients with LDH/LSS are often started with non-surgical treatments and if those are not effective then go on to have decompression surgery. However, recommendation of surgery is complicated as the outcome may depend on the patient's health characteristics. We developed a deep learning (DL) model to predict decompression surgery for patients with LDH/LSS. MATERIALS AND METHOD We used datasets of 8387 and 8620 patients from a prospective study that collected data from four healthcare systems to predict early (within 2 months) and late surgery (within 12 months after a 2 month gap), respectively. We developed a DL model to use patients' demographics, diagnosis and procedure codes, drug names, and diagnostic imaging reports to predict surgery. For each prediction task, we evaluated the model's performance using classical and generalizability evaluation. For classical evaluation, we split the data into training (80%) and testing (20%). For generalizability evaluation, we split the data based on the healthcare system. We used the area under the curve (AUC) to assess performance for each evaluation. We compared results to a benchmark model (i.e. LASSO logistic regression). RESULTS For classical performance, the DL model outperformed the benchmark model for early surgery with an AUC of 0.725 compared to 0.597. For late surgery, the DL model outperformed the benchmark model with an AUC of 0.655 compared to 0.635. For generalizability performance, the DL model outperformed the benchmark model for early surgery. For late surgery, the benchmark model outperformed the DL model. CONCLUSIONS For early surgery, the DL model was preferred for classical and generalizability evaluation. However, for late surgery, the benchmark and DL model had comparable performance. Depending on the prediction task, the balance of performance may shift between DL and a conventional ML method. As a result, thorough assessment is needed to quantify the value of DL, a relatively computationally expensive, time-consuming and less interpretable method.
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Affiliation(s)
- Chethan Jujjavarapu
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Box 358047, Seattle, WA, 98195, USA
| | - Pradeep Suri
- Clinical Learning, Evidence and Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA, 98105, USA
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Vikas Pejaver
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Janna Friedly
- Clinical Learning, Evidence and Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA, 98105, USA
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Laura S Gold
- Clinical Learning, Evidence and Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA, 98105, USA
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Eric Meier
- Clinical Learning, Evidence and Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA, 98105, USA
- Department of Biostatistics, University of Washington, Box 357232, Seattle, WA, 98195-7232, USA
- Center for Biomedical Statistics, University of Washington, Seattle, WA, USA
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Box 358047, Seattle, WA, 98195, USA
| | - Sean D Mooney
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Box 358047, Seattle, WA, 98195, USA
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Box 357232, Seattle, WA, 98195-7232, USA
- Center for Biomedical Statistics, University of Washington, Seattle, WA, USA
| | - Jeffrey G Jarvik
- Clinical Learning, Evidence and Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA, 98105, USA.
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
- Department of Neurological Surgery, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
- Department of Health Services, University of Washington, Box 357660, Seattle, WA, 98195-7660, USA.
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Rho JH, Yoon CD, Kim G, Kang HY. A new technique for controlling intractable pain in lumbar spinal stenosis using steroid injection to ligamentum flavum: A case series. Pain Pract 2023; 23:123-126. [PMID: 35638334 DOI: 10.1111/papr.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Lumbar spinal stenosis is a common degenerative disease that causes low back and lower-extremity pain that increases with age. The treatment of lumbar spinal stenosis is either conservative or surgical. ESI is a commonly performed conservative treatment, but evidence of its effectiveness in lumbar spinal stenosis is limited. CASE SERIES We encountered the three patients with back pain and claudication due to lumbar spinal stenosis, which could not be controlled by conservative therapy including ESIs. Trimacinolone acetonide was injected into the patients' ligamentum flavum. All patients experienced dramatic improvement in their symptoms. CONCLUSIONS Trimacinolone acetonide injection into the ligamentum flavum may be effective for lumbar spinal stenosis that does not improve with ESIs.
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Affiliation(s)
- Jeong Ho Rho
- Spine and Pain Center, Okcheon St. Mary's Hospital, Okcheon, South Korea
| | - Chung Dae Yoon
- Department of Radiology, Okcheon St. Mary's Hospital, Okcheon, South Korea
| | - Gahee Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
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Houle M, Tétreau C, Châtillon CÉ, Marchand AA, Descarreaux M. Effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with lumbar spinal stenosis with neurogenic claudication: a randomized controlled clinical trial protocol. Trials 2022; 23:1046. [PMID: 36572884 PMCID: PMC9793648 DOI: 10.1186/s13063-022-07011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is a leading cause of disability which is intimately related to a decrease in walking capacity. Walking limitation has negative physical and mental impacts on patients. Recent guidelines recommend the use of conservative treatment options such as exercises before considering surgery. Unfortunately, dedicated healthcare resources for the conservative management of patients with LSS causing NC are uncommon. Thus, it is important to develop accessible and specific rehabilitation programs aimed at improving patients' self-management, especially with regard to walking capacity. The aim of this study is to evaluate the effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with LSS causing NC. METHODS/DESIGN This is a prospective randomized controlled parallel-group clinical trial. Sixty-six patients with LSS causing NC will be recruited from identified clinics and local advertisements. The intervention group will receive standardized education and specific exercises while the control group will only receive a standardized education. The program in both groups will last for 6 weeks with 5 evaluation time points (baseline, week 2, week 4, week 6, and week 12). The primary outcome will be walking capacity measured with the Self-Paced Walking Test, and the secondary outcomes will be back and leg pain intensity, LSS-related disability, self-efficacy, level of physical activity, anxiety, depression, gait pattern characteristics, balance, and global perceived change. DISCUSSION This study will assess the effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with LSS causing NC. By measuring objective gait pattern characteristics, the study will also provide new information about the impact of NC on gait pattern that could eventually improve the evaluation and the management of LSS. TRIAL REGISTRATION ClinicalTrials.gov NCT05513326 . Registered on August 22, 2022.
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Affiliation(s)
- Mariève Houle
- grid.265703.50000 0001 2197 8284Department of Anatomy, Université du Québec à Trois-Rivières, 3351, boul. des Forges, Trois-Rivières, QC G8Z 4M3 Canada
| | - Charles Tétreau
- grid.265703.50000 0001 2197 8284Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Claude-Édouard Châtillon
- Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec (CIUSSS MCQ), Trois-Rivières, Canada ,grid.14848.310000 0001 2292 3357Division of Neurosurgery, Faculty of Medicine, University of Montreal, Montréal, Canada
| | - Andrée-Anne Marchand
- grid.265703.50000 0001 2197 8284Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Martin Descarreaux
- grid.265703.50000 0001 2197 8284Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Miura T, Tominaga R, Sato K, Endo T, Iwabuchi M, Ito T, Shirado O. Relationship between Lower Limb Pain Intensity and Dynamic Lumbopelvic-Hip Alignment in Patients with Degenerative Lumbar Spinal Canal Stenosis: A Cross-Sectional Study. Asian Spine J 2022; 16:918-926. [PMID: 35527537 PMCID: PMC9827212 DOI: 10.31616/asj.2021.0399] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/05/2022] [Indexed: 01/11/2023] Open
Abstract
STUDY DESIGN This cross-sectional study was conducted in a single hospital. PURPOSE To clarify the relationship between lower limb pain intensity and dynamic lumbopelvic-hip alignment in patients with lumbar spinal canal stenosis (LSS), using a three-dimensional (3D) motion analysis system. OVERVIEW OF LITERATURE Although it is well known that leg symptoms have a close relationship with posture in patients with LSS, the relationship under dynamic conditions, such as gait, remain unclear. METHODS Thirty patients with LSS scheduled for spine surgery participated in this study. Lower limb pain was assessed using the Visual Analog Scale (VAS), and the patients were divided into two groups based on the mean scores (patients with scores above and below the mean were classified as the high-VAS and low-VAS groups, respectively). The kinematics of the spine, pelvis, and hip joints during gait were then measured using a 3D motion analysis system. Student paired t -tests were used to compare the angles of the spine, pelvis, and hip during gait between the two groups. RESULTS Compared to those in the low-VAS group, the spine was significantly extended and bent toward the more painful lower limb side, and the pelvis was significantly anteriorly tilted among individuals in the high-VAS group. CONCLUSIONS Patients with LSS experiencing severe pain in their lower limb tend to keep the spine in a more extended position, bend laterally toward the painful side, and have an anteriorly tilted pelvic posture. The dynamic spinal and pelvic alignment was closely related to the intensity of the lower limb pain.
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Affiliation(s)
- Takuya Miura
- Department of Rehabilitation & Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu,
Japan
| | - Ryoji Tominaga
- Department of Rehabilitation & Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu,
Japan
| | - Keita Sato
- Department of Rehabilitation & Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu,
Japan
| | - Tatsuya Endo
- Department of Rehabilitation & Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu,
Japan
| | - Masumi Iwabuchi
- Department of Rehabilitation & Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu,
Japan
| | - Toshikazu Ito
- Department of Rehabilitation & Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu,
Japan,Department of Hokkaido Chitose College of Rehabilitation, Chitose,
Japan
| | - Osamu Shirado
- Department of Rehabilitation & Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu,
Japan
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Kushioka J, Sun R, Zhang W, Muaremi A, Leutheuser H, Odonkor CA, Smuck M. Gait Variability to Phenotype Common Orthopedic Gait Impairments Using Wearable Sensors. SENSORS (BASEL, SWITZERLAND) 2022; 22:9301. [PMID: 36502003 PMCID: PMC9739785 DOI: 10.3390/s22239301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Mobility impairments are a common symptom of age-related degenerative diseases. Gait features can discriminate those with mobility disorders from healthy individuals, yet phenotyping specific pathologies remains challenging. This study aims to identify if gait parameters derived from two foot-mounted inertial measurement units (IMU) during the 6 min walk test (6MWT) can phenotype mobility impairment from different pathologies (Lumbar spinal stenosis (LSS)-neurogenic diseases, and knee osteoarthritis (KOA)-structural joint disease). Bilateral foot-mounted IMU data during the 6MWT were collected from patients with LSS and KOA and matched healthy controls (N = 30, 10 for each group). Eleven gait parameters representing four domains (pace, rhythm, asymmetry, variability) were derived for each minute of the 6MWT. In the entire 6MWT, gait parameters in all four domains distinguished between controls and both disease groups; however, the disease groups demonstrated no statistical differences, with a trend toward higher stride length variability in the LSS group (p = 0.057). Additional minute-by-minute comparisons identified stride length variability as a statistically significant marker between disease groups during the middle portion of 6WMT (3rd min: p ≤ 0.05; 4th min: p = 0.06). These findings demonstrate that gait variability measures are a potential biomarker to phenotype mobility impairment from different pathologies. Increased gait variability indicates loss of gait rhythmicity, a common feature in neurologic impairment of locomotor control, thus reflecting the underlying mechanism for the gait impairment in LSS. Findings from this work also identify the middle portion of the 6MWT as a potential window to detect subtle gait differences between individuals with different origins of gait impairment.
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Affiliation(s)
- Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Ruopeng Sun
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA 94305, USA
| | - Wei Zhang
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Amir Muaremi
- Novartis Institutes for BioMedical Research, 4056 Basel, Switzerland
| | - Heike Leutheuser
- Machine Learning and Data Analytics Lab (MaD Lab), Department Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91052 Erlangen, Germany
| | - Charles A. Odonkor
- Department of Orthopedics and Rehabilitation, Division of Physiatry, Yale School of Medicine, New Haven, CT 06510, USA
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA 94305, USA
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Zou T, Chen H, Wang PC, Sun HH, Feng XM. Predictive factors for residual leg numbness after decompression surgery for lumbar degenerative diseases. BMC Musculoskelet Disord 2022; 23:910. [PMID: 36224568 PMCID: PMC9559037 DOI: 10.1186/s12891-022-05848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study is to evaluate the change patterns of leg numbness (LN) after lumbar decompression surgery (LDS), and to find the predictive factors that affect the recovery of numbness. Methods Patients who underwent LDS in our institution between August 2020 and July 2021 were prospectively enrolled in this study, and were followed by a 12-month follow-up. The degree of LN, leg pain (LP) and the disability were assessed using the visual analog scale (VAS) and oswestry disability index (ODI). Results A total of 314 patients finished the 12-month follow-up. The preoperative mean VAS-LN score was 3.49 ± 2.44, which decreased to 1.91 ± 1.30 at 3 months, to 1.29 ± 0.97 at 6 months and to 1.26 ± 0.96 at 12 months after surgery. The preoperative mean VAS-LP score was 6.05 ± 1.30, which decreased to 2.00 ± 0.86 at 3 months, to 1.02 ± 0.80 at 6 months, and to 0.49 ± 0.71 at 12 months after surgery. The preoperative mean ODI score was 27.90 ± 7.08, which decreased to 9.73 ± 3.09 at 3 months, to 6.72 ± 2.98 at 6 months, and to 4.57 ± 2.76 at 12 months after surgery. Via multivariate logistic regression analysis, only preoperative VAS-LN score (p < 0.001*) was identified as a significantly independent predictive factor for residual LN after operation. Conclusion Clinically significant improvement in LN was observed in the majority of patients within 6 months after LDS, and the improvement of VAS-LN was slower than the VAS-LP. High pre-operative VAS-LN score can independently predict the presence of residual LN after surgery at 12-month follow up.
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Affiliation(s)
- Tao Zou
- Department of Orthopedics, Clinical Medical College of Yangzhou University, No.98 Nantong West Road, 225001, Yangzhou, Jiangsu province, China
| | - Hao Chen
- Department of Orthopedics, Clinical Medical College of Yangzhou University, No.98 Nantong West Road, 225001, Yangzhou, Jiangsu province, China
| | - Ping-Chuan Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, No.98 Nantong West Road, 225001, Yangzhou, Jiangsu province, China
| | - Hui-Hui Sun
- Department of Orthopedics, Clinical Medical College of Yangzhou University, No.98 Nantong West Road, 225001, Yangzhou, Jiangsu province, China.
| | - Xin-Min Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, No.98 Nantong West Road, 225001, Yangzhou, Jiangsu province, China.
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Akar E, Toprak F, Öğrenci A. The relationship between bone canal diameter and facet tropism in cases of lumbar spinal stenosis. J Neurosci Rural Pract 2022; 13:641-646. [PMID: 36743774 PMCID: PMC9894327 DOI: 10.25259/jnrp-2022-7-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Lumbar spinal stenosis (LSS) is a condition that increases in frequency with the aging of the spine and has adverse effects on the quality of life of individuals. Facet tropism (FT) refers to the difference in the orientation of the facet joints relative to each other in the sagittal plane. This situation may be due to a developmental defect or different stimuli. In many biomechanical studies in the literature, the relationship between FT and lumbar degenerative disorders has been investigated. In this study, we aimed to investigate whether there is a relationship between anteroposterior bone canal diameter and FT in LSS cases. Materials and Methods We retrospectively evaluated the CT and T2-weighted axial and sagittal magnetic resonance imaging of the lumbar region of 100 LSS patients who were operated on in our clinic between 2015 and 2017. For each patient, the facet joint angles, the degree of FT, and the AP diameter of the spinal canal were determined. Results The cases were grouped according to FT types and no correlation was found between midsagittal bone spinal canal measurement and FT types. According to the results, no significant difference was found. Conclusion As a result, because of there is no relationship between midsagittal bone canal diameter and FT, we thought that FT may be both a part of the degenerative process and a congenital origin.
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Affiliation(s)
- Ezgi Akar
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fatih Toprak
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Öğrenci
- Department of Neurosurgery, Medicana Ataşehir Hospital, Istanbul, Turkey
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Zhang C, Chen L, Li J, Huang D, Zhang W, Lin J. Should Posterior Midline Structures Be Preserved in Decompression Surgery for Lumbar Spinal Stenosis?: A Systematic Review and Meta-analysis. Clin Spine Surg 2022; 35:341-349. [PMID: 34711752 DOI: 10.1097/bsd.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a systematic review and meta-analysis study. OBJECTIVE The purpose of this study is to evaluate the available evidence on the preservation of posterior midline structures in decompression surgery for lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA The gold-standard treatment for LSS refractory to conservative management is facet-preserving laminectomy. The question remains whether the midline structures should be preserved in decompression surgery for LSS. MATERIALS AND METHODS We performed a systematic review of the Medline, PubMed, Embase, and Cochrane databases in search of published reports comparing midline structure preservation (MSP) and conventional laminectomy (CL) for LSS. The population was divided into 2 groups: (1) MSP group (intervention) and (2) CL group (control). The various outcome parameters including blood loss, operation time, hospital stay, back and leg pain, functional scores including Oswestry Disability Index (ODI) score, Japanese Orthopedic Association score, and 36-Item Short Form Survey (SF-36) scores, satisfaction, and instability rates were analyzed. Data were extracted and aggregated for meta-analysis. RESULTS Of the published reports, 16 met our inclusion criteria with an aggregated 540 in the intervention and 538 in the control groups, respectively. The aggregated data demonstrated patients undergoing MSP had significantly decreased back pain Visual Analog Scale compared with CL, regardless of time after surgery ( P =0.007). The MSP group also showed a significantly lower Oswestry Disability Index score and SF-36 Mental Component Summary score ( P =0.005 and 0.03, respectively) and longer 6-month walking distance ( P <0.00001). The patient satisfaction rate was significantly higher in the MSP group ( P =0.02), and the instability rate was significantly lower in the MSP group compared with the CL group ( P <0.0001). At 3 days after surgery, MSP significantly decreased the level of creatinine phosphokinase ( P <0.00001). Regarding intraoperative blood loss, hospital stay, leg pain Visual Analog Scale score, Japanese Orthopedic Association score, and SF-36 Physical Component Summary score, there were no significant differences between the 2 groups. However, MSP showed significantly higher operation time ( P =0.04). CONCLUSIONS We concluded despite heterogenous and limited data, this study suggests that preservation of midline structure leads to less severe back pain, better functional recovery, and satisfaction rate. Meanwhile, it decreases creatinine phosphokinase level and instability rate. LEVEL OF EVIDENCE Level III-therapeutic.
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Affiliation(s)
- Chaofan Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
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Tamagawa S, Sakai D, Schol J, Sako K, Nakamura Y, Matsushita E, Warita T, Hazuki S, Nojiri H, Sato M, Ishijima M, Watanabe M. N-acetylcysteine attenuates oxidative stress-mediated cell viability loss induced by dimethyl sulfoxide in cryopreservation of human nucleus pulposus cells: A potential solution for mass production. JOR Spine 2022; 5:e1223. [PMID: 36601378 PMCID: PMC9799083 DOI: 10.1002/jsp2.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/13/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background Cell therapy is considered a promising strategy for intervertebral disc (IVD) regeneration. However, cell products often require long-term cryopreservation, which compromises cell viability and potency, thus potentially hindering commercialization and off-the-shelf availability. Dimethyl sulfoxide (DMSO) is a commonly used cryoprotectant, however, DMSO is associated with cytotoxicity and cell viability loss. This study aimed to investigate the effects of DMSO on human nucleus pulposus cells (NPC) and the role of oxidative stress in DMSO-induced cytotoxicity. Furthermore, we examined the potential of antioxidant N-acetylcysteine (NAC) supplementation to mitigate the negative effects of DMSO. Methods NPC were exposed to various concentrations of DMSO with or without a freezing cycle. Cell viability, cell apoptosis and necrosis rates, intracellular reactive oxygen species (ROS) levels, and gene expression of major antioxidant enzymes were evaluated. In addition, NAC was added to cryopreservation medium containing 10% DMSO and its effects on ROS levels and cell viability were assessed. Results DMSO concentrations ≤1% for 24 h did not significantly affect the NPC viability, whereas exposure to 5 and 10% DMSO (most commonly used concentration) caused cell viability loss (loss of 57% and 68% respectively after 24 h) and cell death in a dose- and time-dependent manner. DMSO increased intracellular and mitochondrial ROS (1.9-fold and 3.6-fold respectively after 12 h exposure to 10% DMSO) and downregulated gene expression levels of antioxidant enzymes in a dose-dependent manner. Tempering ROS through NAC treatment significantly attenuated DMSO-induced oxidative stress and supported maintenance of cell viability. Conclusions This study demonstrated dose- and time-dependent cytotoxic effects of DMSO on human NPC. The addition of NAC to the cryopreservation medium ameliorated cell viability loss by reducing DMSO-induced oxidative stress in the freeze-thawing cycle. These findings may be useful for future clinical applications of whole cells and cellular products.
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Affiliation(s)
- Shota Tamagawa
- Department of Medicine for Orthopaedics and Motor OrganJuntendo University Graduate School of MedicineTokyoJapan,Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
| | - Jordy Schol
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
| | - Kosuke Sako
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
| | - Yoshihiko Nakamura
- Research Center for Regenerative MedicineTokai University School of MedicineIseharaJapan
| | - Erika Matsushita
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
| | - Takayuki Warita
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan,TUNZ Pharma Co., Ltd.OsakaJapan
| | - Soma Hazuki
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan,TUNZ Pharma Co., Ltd.OsakaJapan
| | - Hidetoshi Nojiri
- Department of Medicine for Orthopaedics and Motor OrganJuntendo University Graduate School of MedicineTokyoJapan
| | - Masato Sato
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor OrganJuntendo University Graduate School of MedicineTokyoJapan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
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