Reversible prolongation of motor conduction time after transcranial magnetic brain stimulation after neurogenic claudication in spinal stenosis

Effects of minimally invasive decompression surgery on quality of life in older patients with spinal stenosis

OBJECTIVES

Lumbar spinal stenosis (LSS) in the elderly may result in a progressive narrowing of the spinal canal leading to compression of nerve roots in some individuals. The aim of this study was to evaluate the quality of life changes after minimally invasive decompression surgery without instrumentation in geriatric patients with lumbar spinal stenosis.

PATIENTS AND METHODS

This prospective clinical study included 37 patients with American Society of Anesthesiologists (ASA) II-III scores between the ages of 65 and 86 years, who were planned to undergo surgical intervention due to LSS. All patients had neurogenic claudication and pain in the hips, thighs, and legs. Measurements of the osseous spinal canal were evaluated by magnetic resonance imaging. Before the surgical intervention, patient demographics and clinical characteristics were recorded. The Short-Form-36 test, the Oswestry Disability Index, and the Visual Analog Scale were applied to all patients preoperatively and two years postoperatively.

RESULTS

In the study population, 11 patients had single level of spinal stenosis, 20 patients had two levels of spinal stenosis, and six patients had three levels of spinal stenosis. There were significant differences between the preoperative and postoperative ODI and VAS scores. There was a statistically significant difference in all subscales of the SF-36 test with the exception of general health scores. Three patients who had dural damage during the operation were treated with bio glue. Also, no patients were recorded to have any neurological deficits and root injuries postoperatively.

CONCLUSION

Minimally invasive decompression surgery, without instrumentation, for lumbar spinal stenosis in geriatric patients significantly improves the patients' quality of life.

Surgical treatment of degenerative lumbar stenosis: comorbidities and complications

Objectives: To study the characteristics of patients who underwent surgical treatment of degenerative spinal stenosis in the last 10 years (2000â€"2010) at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (USP-HCFMR) and correlate the postoperative complications and preoperative comorbidities found in the study population. Methods: Retrospective review of medical records and radiographs of patients with degenerative lumbar stenosis treated surgically. Descriptive analysis of data was done with SAS 9.0. Results: 92 patients were included, 47 (51.08%) males and 45 (48.91%) females, with ages ranging from 32 to 86 years (mean age of 64.27 years). The most prevalent comorbidities were hypertension (47.82%) and diabetes mellitus (25%). Twenty-three patients (25%) had two or more comorbidities. Postoperative infection was the most common complication found in 12 cases (13%). Patients with only one preoperative comorbidity showed similar complication rates compared to the population without comorbidities. However, patients with two or more comorbid conditions had a higher incidence of postoperative complications (p<0.001). Conclusions: Comorbidities negatively influenced the outcome of surgical treatment of degenerative lumbar stenosis with higher rates of postoperative complications.

Health-related quality of life and expectations of patients before surgical treatment of lumbar stenosis

OBJECTIVE: To evaluate the expectations of patients awaiting surgical treatment of lumbar canal stenosis and the association of Health-Related Quality of Life (HRQoL) with symptoms of anxiety and depression. METHODS: The sample included 49 patients from a university hospital. HRQoL was assessed by the Oswestry Disability Index (ODI) and 36-item Medical Outcomes Survey Short Form (SF-36) and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). Expectations were investigated by means of questions used in international studies. Data were analyzed descriptively and by Student's t test. RESULTS: The mean time of disease progression was 34.5 months, the mean age was 58.8 years and 55.1% of the patients were women. Most patients had the expectation of improving with surgical treatment and 46.9% expected to be "much better" with regard to leg pain, walking ability, independence in activities and mental well being. The scores of anxiety and depression were respectively, 34.7% and 12.2%. We observed statistically significant differences between the groups with and without anxiety in the domains: General Health, Mental Health, and Vitality. Between the groups with and without depression there were statistically significant differences in the General Health and Mental Health domains. CONCLUSION: Patients showed great expectation to surgical treatment and the symptoms of anxiety and depression were related to some domains of HRQoL. Thus, the study contributes to broaden our knowledge and we can therefore guide the patients as to their expectations with respect to the real possibilities arising from surgery.

Motor conduction time along the cauda equina in patients with lumbar spinal stenosis

STUDY DESIGN

Magnetic lumbar stimulation was used to detect spinal nerve degeneration in patients with lumbar spinal stenosis (LSS).

OBJECTIVE

To evaluate delays in the motor conduction time in the cauda equina of patients with LSS.

SUMMARY OF BACKGROUND DATA

Previous studies suggested a bilateral slowing of motor conduction in the cauda equina in LSS. Among several methods, only magnetic stimulation is sufficiently sensitive for detecting potential degeneration in LSS. A recent study demonstrated the direct calculation of the cauda equina motor conduction time using magnetic stimulation at proximal and distal sites of the cauda equina. We used this technique to determine potential degeneration in patients with LSS.

METHODS

Twenty adult subjects and 15 patients with LSS were investigated. Lumbosacral roots were stimulated at intervertebral levels L1-L2 and L5-S1 by magnetic coil stimulation. The muscle responses to stimulation were recorded from the gastrocnemius-soleus, and anterior tibialis muscles on both sides with bipolar surface electrodes. The response latency from stimulations at the L5 spine level were subtracted from those at the L1 level on the same side. This value represented the conduction time from the proximal to distal ends of the cauda equina.

RESULTS

The mean conduction time along the cauda equina was significantly prolonged in patients with LSS compared with controls. The mean cauda equina motor conduction time was 1.97 +/- 0.67 milliseconds in controls and 3.57 +/- 2.22 milliseconds in patients with LSS (P = 0.00).

CONCLUSION

Determining the motor conduction time along the cauda equina using L1 and L5 magnetic stimulation provides an effective alternative method for evaluating the lumbar motor roots in patients with LSS.

Clinical value of motor evoked potentials with transcranial magnetic stimulation in the assessment of lumbar spinal stenosis

The objective of this study was to evaluate the clinical usefulness of assessing motor evoked potentials (MEP) in lumbar spinal stenosis (LSS). Twenty-three LSS patients were enrolled. The preoperative data of MEP latency (MEPLT), clinical symptoms, Japanese Orthopaedic Association (JOA) scores for low back pain, visual analogue scale (VAS) for back pain, leg pain and numbness, walking distance and the minimal cross-sectional area (mCSA) of the dural sac were evaluated. The mean MEPLT was 42.1 +/- 2.8 ms. Fourteen patients had bilateral leg symptoms. The mean walking distance and mCSA were 302.1 +/- 302.8 m and 0.4 +/- 0.2 cm(2), respectively. The mean JOA score and VAS scores for back pain, leg pain and numbness were 15.9 +/- 4.8, 6.0 +/- 2.9, 7.7 +/- 1.9 and 7.3 +/- 3.0, respectively. MEPLT was related to the walking distance, limb symptoms and the VAS for numbness. MEPLT was significantly delayed in patients who showed a walking distance less than 500 m. MEP is useful in LSS assessment. It can reflect the subjective severity of motor disturbance and predict the neurological deficit prior to appearance.