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Mubarak M, Murugan C, Iyer RD, Bt P, Shetty AP, Kanna RM, Rajasekaran S. Congenital Stenosis of the Spine-A Cross-Sectional Study of 1019 Whole-Spine Computed Tomography Scans to Determine Prevalence and Association Among Multilevel, Tandem, and Triple Region Stenosis. World Neurosurg 2024; 183:e556-e563. [PMID: 38171480 DOI: 10.1016/j.wneu.2023.12.144] [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: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGOUND Patients with congenital stenosis of the spine (CSS) present with clinical symptoms at an early age and fewer degenerative hypertrophic changes than the more common degenerative cohort. Literature is lacking in the true prevalence of CSS affecting the 3 segments of the spine in isolation, as well as in tandem in the Indian subcontinent. METHODS Anteroposterior spinal canal diameter in axial plane computed tomography at the midvertebral level was measured in asymptomatic patients with whole-spine computed tomography. Spinal canal stenosis was defined as a diameter of <12 mm for the cervical region, <12 mm for the thoracic region, and <13 mm for the lumbar region. Single-level and multilevel stenosis, as well as tandem and triple-region stenosis, were evaluated. RESULTS The results show the prevalence of CSS as 16.6%, 11.5%, and 20.1% involving the cervical, thoracic, and lumbar spine, respectively. Single-level stenosis affected 90.6%, 94%, and 79.8% of the patients with cervical, thoracic, and lumbar CSS, respectively. Tandem stenosis affected 10.4% of the population (n = 104), with cervicolumbar stenosis being the most prevalent (n = 51, 5%). The presence of CSS in any one segment of the spine was significantly associated with the presence of stenosis at one of the other segments (P < 0.05). Triple-region stenosis was seen in 0.3% (n = 3) patients. CONCLUSIONS The prevalence of cervical, thoracic, lumbar and tandem stenosis from our study is established at 16.6%, 11.5%, 20.1%, and 10.4%. Additionally, our study demonstrates the association between stenosis of the different regions of the spine.
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Affiliation(s)
- Mohammed Mubarak
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Chandhan Murugan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - R Dinesh Iyer
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Pushpa Bt
- Department of Radiology, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India.
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - S Rajasekaran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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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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Kawakami M, Takeshita K, Inoue G, Sekiguchi M, Fujiwara Y, Hoshino M, Kaito T, Kawaguchi Y, Minetama M, Orita S, Takahata M, Tsuchiya K, Tsuji T, Yamada H, Watanabe K. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar spinal stenosis, 2021 - Secondary publication. J Orthop Sci 2023; 28:46-91. [PMID: 35597732 DOI: 10.1016/j.jos.2022.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Japanese Orthopaedic Association (JOA) guideline for the management of lumbar spinal stenosis (LSS) was first published in 2011. Since then, the medical care system for LSS has changed and many new articles regarding the epidemiology and diagnostics of LSS, conservative treatments such as new pharmacotherapy and physical therapy, and surgical treatments including minimally invasive surgery have been published. In addition, various issues need to be examined, such as verification of patient-reported outcome measures, and the economic effect of revised medical management of patients with lumbar spinal disorders. Accordingly, in 2019 the JOA clinical guidelines committee decided to update the guideline and consequently established a formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline, incorporating the recent advances of evidence-based medicine. METHODS The JOA LSS guideline formulation committee revised the previous guideline based on the method for preparing clinical guidelines in Japan proposed by the Medical Information Network Distribution Service in 2017. Background and clinical questions were determined followed by a literature search related to each question. Appropriate articles based on keywords were selected from all the searched literature. Using prepared structured abstracts, systematic reviews and meta-analyses were performed. The strength of evidence and recommendations for each clinical question was decided by the committee members. RESULTS Eight background and 15 clinical questions were determined. Answers and explanations were described for the background questions. For each clinical question, the strength of evidence and the recommendation were both decided, and an explanation was provided. CONCLUSIONS The 2021 clinical practice guideline for the management of LSS was completed according to the latest evidence-based medicine. We expect that this guideline will be useful for all medical providers as an index in daily medical care, as well as for patients with LSS.
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Affiliation(s)
| | | | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | - Yasushi Fujiwara
- Department of Orthopaedic Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City General Hospital, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University, Japan
| | | | - Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
| | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University, Japan
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Cheung JPY, Kuang X, Lai MKL, Cheung KMC, Karppinen J, Samartzis D, Wu H, Zhao F, Zheng Z, Zhang T. Learning-based fully automated prediction of lumbar disc degeneration progression with specified clinical parameters and preliminary validation. 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 2022; 31:1960-1968. [PMID: 34657211 DOI: 10.1007/s00586-021-07020-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 09/02/2021] [Accepted: 10/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Lumbar disc degeneration (LDD) may be related to aging, biomechanical and genetic factors. Despite the extensive work on understanding its etiology, there is currently no automated tool for accurate prediction of its progression. PURPOSE We aim to establish a novel deep learning-based pipeline to predict the progression of LDD-related findings using lumbar MRIs. MATERIALS AND METHODS We utilized our dataset with MRIs acquired from 1,343 individual participants (taken at the baseline and the 5-year follow-up timepoint), and progression assessments (the Schneiderman score, disc bulging, and Pfirrmann grading) that were labelled by spine specialists with over ten years clinical experience. Our new pipeline was realized by integrating the MRI-SegFlow and the Visual Geometry Group-Medium (VGG-M) for automated disc region detection and LDD progression prediction correspondingly. The LDD progression was quantified by comparing the Schneiderman score, disc bulging and Pfirrmann grading at the baseline and at follow-up. A fivefold cross-validation was conducted to assess the predictive performance of the new pipeline. RESULTS Our pipeline achieved very good performances on the LDD progression prediction, with high progression prediction accuracy of the Schneiderman score (Accuracy: 90.2 ± 0.9%), disc bulging (Accuracy: 90.4% ± 1.1%), and Pfirrmann grading (Accuracy: 89.9% ± 2.1%). CONCLUSION This is the first attempt of using deep learning to predict LDD progression on a large dataset with 5-year follow-up. Requiring no human interference, our pipeline can potentially achieve similar predictive performances in new settings with minimal efforts.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/F Professorial Block, Pokfulam, Hong Kong.
| | - Xihe Kuang
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/F Professorial Block, Pokfulam, Hong Kong
| | - Marcus Kin Long Lai
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/F Professorial Block, Pokfulam, Hong Kong
| | - Kenneth Man-Chee Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/F Professorial Block, Pokfulam, Hong Kong
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Il, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Honghan Wu
- Institute of Health Informatics, University College London, London, UK
| | - Fengdong Zhao
- Department of Orthopaedics, Faculty of Surgery, Zhejiang University Affiliated Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Zhaomin Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat Sen University, Guangzhou, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/F Professorial Block, Pokfulam, Hong Kong
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, Martínez Barbero JP, García Espinosa J, Martínez Martínez A. The value of magnetic resonance imaging and computed tomography in the study of spinal disorders. Quant Imaging Med Surg 2022; 12:3947-3986. [PMID: 35782254 PMCID: PMC9246762 DOI: 10.21037/qims-2022-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 08/15/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.
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Affiliation(s)
| | | | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - José Pablo Martínez Barbero
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Jade García Espinosa
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Alberto Martínez Martínez
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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Lai MKL, Cheung PWH, Samartzis D, Cheung JPY. Prevalence and Definition of Multilevel Lumbar Developmental Spinal Stenosis. Global Spine J 2022; 12:1084-1090. [PMID: 33222541 PMCID: PMC9210236 DOI: 10.1177/2192568220975384] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To define multilevel lumbar developmental spinal stenosis (DSS) using a composite score model and to determine its prevalence. METHODS This was a cohort study of 2385 openly recruited subjects with lumbosacral (L1-S1) MRIs. All subjects with previous spinal surgery or spinal deformities were excluded. The anteroposterior (AP) vertebral canal diameter was measured by two independent observers. Any associations between level-specific vertebral canal diameter and subject body habitus were analysed with non-parametric tests. Three or more stenotic levels, equivalent to a composite score of 3 or more, were considered as multilevel DSS. The median values of these subjects' AP canal diameters were used to construct the multilevel DSS values. Receiver operating characteristic analysis was utilized to determine the ability of these cut-off values to screen for DSS by presenting their area under curve, sensitivity and specificity. RESULTS Subject body habitus was poorly correlated with AP vertebral canal diameter. Multilevel DSS was identified as L1<19 mm, L2<19 mm, L3<18 mm, L4<18 mm, L5<18 mm, S1<16 mm with 81%-96% sensitivity and 72%-91% specificity. The prevalence of multilevel DSS in this cohort was 7.3%. CONCLUSIONS Utilizing a large homogeneous cohort, the prevalence of multilevel DSS is determined. Our cut-offs provide high diagnostic accuracy. Patients with multiple levels that fulfil these criteria may be at-risk of spinal canal compressions at multiple sites. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marcus Kin Long Lai
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopaedic Surgery, RUSH University Medical Center, Chicago, IL, USA,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,Jason Pui Yin Cheung, Department of Orthopaedics & Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
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7
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Kitab SA, Wakefield AE, Benzel EC. Postlaminectomy lumbopelvic sagittal changes in patients with developmental lumbar spinal stenosis grouped into Roussouly lumbopelvic sagittal profiles: 2- to 10-year prospective follow-up. J Neurosurg Spine 2022; 36:695-703. [PMID: 34826807 DOI: 10.3171/2021.8.spine21797] [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: 06/09/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Roussouly lumbopelvic sagittal profiles are associated with distinct pathologies or distinct natural histories and prognoses. The associations between developmental lumbar spinal stenosis (DLSS) and native lumbopelvic sagittal profiles are unknown. Moreover, the relative effects of multilevel decompression on lumbar sagittal alignment, geometrical parameters of the pelvis, and compensatory mechanisms for each of the Roussouly subtypes are unknown. This study aimed to explore the association between DLSS and native lumbar lordosis (LL) subtypes. It also attempts to understand the natural history of postlaminectomy lumbopelvic sagittal changes and compensatory mechanisms for each of the Roussouly subtypes and to define the critical lumbar segment or specific lordosis arc that is recruited after relief of the stenosis effect. METHODS A total of 418 patients with multilevel DLSS were grouped into various Roussouly subtypes, and lumbopelvic sagittal parameters were prospectively compared at follow-up intervals of preoperative to < 2 years, 2 to < 5 years, and 5 to ≥ 10 years after laminectomy. The variables analyzed included LL, upper lordosis arc from L1 to L4, lower lordosis arc from L4 to S1, and segmental lordosis from L1 to S1. Pelvic parameters included pelvic incidence, sacral slope, pelvic tilt, and pelvic incidence minus LL values. RESULTS Of the 329 patients who were followed up throughout this study, 33.7% had Roussouly type 1 native lordosis, whereas the incidence rates of types 2, 3, and 4 were 33.4%, 21.9%, and 10.9%, respectively. LL was not reduced in any of the Roussouly subtypes after multilevel decompressions. Instead, LL increased by 4.5° (SD 11.9°-from 27.3° [SD 11.5°] to 31.8° [SD 9.8°]) in Roussouly type 1 and by 3.1° (SD 11.6°-from 41.3° [SD 9.5°] to 44.4° [SD = 9.7°]) in Roussouly type 2. The other Roussouly types showed no significant changes. Pelvic tilt decreased significantly-by 2.8°, whereas sacral slope increased significantly-by 2.9° in Roussouly type 1 and by 1.7° in Roussouly type 2. The critical lumbar segment that recruits LL differs between Roussouly subtypes. Increments and changes were sustained until the final follow-up. CONCLUSIONS The study findings are important in predicting patient prognosis, LL evolution, and the need for prophylactic or corrective deformity surgery. Multilevel involvement in DLSS and the high prevalence of Roussouly types 1 and 2 suggest that spinal canal dimensions are closely linked to the developmental evolution of LL.
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Affiliation(s)
| | - Andrew E Wakefield
- 2Connecticut Neurosurgery and Spine Associates, Windsor, Connecticut; and
| | - Edward C Benzel
- 3Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
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Baker JD, Sayari AJ, Harada GK, Tao Y, Louie PK, Basques BA, Galbusera F, Niemeyer F, Wilke HJ, An HS, Samartzis D. The Modic-endplate-complex phenotype in cervical spine patients: Association with symptoms and outcomes. J Orthop Res 2022; 40:449-459. [PMID: 33749924 DOI: 10.1002/jor.25042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 02/04/2023]
Abstract
This study describes a novel, combined Modic changes (MC) and structural endplate abnormality phenotype of the cervical spine, which we have termed the Modic-Endplate-Complex (MEC), and its association with preoperative symptoms and outcomes in anterior cervical discectomy and fusion (ACDF) patients. This was a retrospective study of prospectively collected data at a single institution. Preoperative cervical magnetic resonance imagings were used to assess the presence of MC and endplate abnormalities. Patients were divided into four groups: MC-only, endplate abnormality-only, the MEC and controls. The MEC was defined as the presence of both a MC and endplate abnormality in the cervical spine. Phenotypes were further stratified by location and compared to controls. Associations with patient-reported outcome measures were assessed using regression controlling for baseline characteristics. A total of 628 patients were included, with 84 MC-only, 166 endplate abnormality-only, and 187 MEC patients. Both MC (p < 0.001) and endplate abnormalities (p < 0.001) were independently associated with one another. MC at the adjacent level (p = 0.018), endplate abnormalities (regardless of location) (p = 0.001), and the MEC within the fusion segment (p = 0.027) were all associated with higher Neck Disability Index scores. Both MC within the fusion segment (p = 0.008) and endplate abnormalities within the fusion segment (p = 0.017) associated with lower Veteran's Rand 12-item scores. MC and structural endplate abnormalities commonly manifest concomitantly in patients indicated for ACDF for degenerative pathology. Patients with the endplate pathology, including the MEC phenotype, reported significantly higher levels of postoperative disability following ACDF. These findings add valuable data to the prognostic assessment of degenerative cervical spine patients.
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Affiliation(s)
- James D Baker
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Philip K Louie
- Department of Neurosurgery, Neuroscience Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Fabio Galbusera
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
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9
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Lai MKL, Cheung PWH, Song YQ, Samartzis D, Cheung JPY. Pedigree analysis of lumbar developmental spinal stenosis: Determination of potential inheritance patterns. J Orthop Res 2021; 39:1763-1776. [PMID: 32902878 DOI: 10.1002/jor.24850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/01/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Lumbar developmental spinal stenosis (DSS) refers to multilevel pre-existing narrowed spinal canals, which predispose to neural compromise. The objective of this study is to identify any inheritance pattern of DSS by utilizing pedigree charts. This was a case series of 13 families with a total of 80 subjects having magnetic resonance imaging (MRI) from L1 to S1. Cases (subjects with DSS) or controls (subjects without DSS) were identified by measuring their anteroposterior (AP) vertebral canal diameters. Multilevel model analyses were also performed to evaluate whether there is substantial clustering of observations within the families, and the effect of multilevel DSS. The intraclass correlation coefficient (ICC) and Akaike information criteria (AIC) were compared between models. Correlations between subject demographics and AP vertebral canal diameter were statistically insignificant at all levels. Only vertebral canal cross-sectional area, and axial and sagittal vertebral canal diameter were found to be statistically different between cases and controls at all levels (all p < .05). Both males and females were affected by DSS and there was no skipping of generation, which highly suggested DSS followed an autosomal dominant inheritance pattern. After accounting for multilevel DSS, there was a drop of more than 10 in AIC and some variances were also explained within families. This is the first study that suggests multilevel lumbar DSS to have an autosomal dominant inheritance pattern. Within families with a background of DSS, subjects had a smaller canal size, contributed by shortened axial and sagittal AP vertebral canal diameter, and smaller canal cross-sectional area.
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Affiliation(s)
- Marcus K L Lai
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence W H Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - You-Qiang Song
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopaedic Surgery, RUSH University Medical Center, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, Illinois, USA
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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10
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Lai MKL, Cheung PWH, Samartzis D, Karppinen J, Cheung KMC, Cheung JPY. The profile of the spinal column in subjects with lumbar developmental spinal stenosis. Bone Joint J 2021; 103-B:725-733. [PMID: 33789478 DOI: 10.1302/0301-620x.103b4.bjj-2020-1792.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort. METHODS This was a radiological analysis of 2,387 participants who underwent L1-S1 MRI. Means and ranges were calculated for age, sex, BMI, and MRI measurements. Anteroposterior (AP) vertebral canal diameters were used to differentiate those with DSS from controls. Other imaging parameters included vertebral body dimensions, spinal canal dimensions, disc degeneration scores, and facet joint orientation. Mann-Whitney U and chi-squared tests were conducted to search for measurement differences between those with DSS and controls. In order to identify possible associations between DSS and MRI parameters, those who were statistically significant in the univariate binary logistic regression were included in a multivariate stepwise logistic regression after adjusting for demographics. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported where appropriate. RESULTS Axial AP vertebral canal diameter (p < 0.001), interpedicular distance (p < 0.001), AP dural sac diameter (p < 0.001), lamina angle (p < 0.001), and sagittal mid-vertebral body height (p < 0.001) were significantly different between those identified as having DSS and controls. Narrower interpedicular distance (OR 0.745 (95% CI 0.618 to 0.900); p = 0.002) and AP dural sac diameter (OR 0.506 (95% CI 0.400 to 0.641); p < 0.001) were associated with DSS. Lamina angle (OR 1.127 (95% CI 1.045 to 1.214); p = 0.002) and right facet joint angulation (OR 0.022 (95% CI 0.002 to 0.247); p = 0.002) were also associated with DSS. No association was observed between disc parameters and DSS. CONCLUSION From this large-scale cohort, the canal size is found to be independent of body stature. Other than spinal canal dimensions, abnormal orientations of lamina angle and facet joint angulation may also be a result of developmental variations, leading to increased likelihood of DSS. Other skeletal parameters are spared. There was no relationship between DSS and soft tissue changes of the spinal column, which suggests that DSS is a unique result of bony maldevelopment. These findings require validation in other ethnicities and populations. Level of Evidence: I (diagnostic study) Cite this article: Bone Joint J 2021;103-B(4):725-733.
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Affiliation(s)
- Marcus Kin Long Lai
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, USA
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital, Finnish Institute of Occupational Health, Oulu, Finland
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Lai MKL, Cheung PWH, Samartzis D, Karppinen J, Cheung KMC, Cheung JPY. Clinical implications of lumbar developmental spinal stenosis on back pain, radicular leg pain, and disability. Bone Joint J 2021; 103-B:131-140. [PMID: 33380193 DOI: 10.1302/0301-620x.103b1.bjj-2020-1186.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability. METHODS This was a cross-sectional study of 2,206 subjects along with L1-S1 axial and sagittal MRI. Clinical and radiological information regarding their demographics, workload, smoking habits, anteroposterior (AP) vertebral canal diameter, spondylolisthesis, and MRI changes were evaluated. Mann-Whitney U tests and chi-squared tests were conducted to search for differences between subjects with and without DSS. Associations of LBP and radicular pain reported within one month (30 days) and one year (365 days) of the MRI, with clinical and radiological information, were also investigated by utilizing univariate and multivariate logistic regressions. RESULTS Subjects with DSS had higher prevalence of radicular leg pain, more pain-related disability, and lower quality of life (all p < 0.05). Subjects with DSS had 1.5 (95% confidence interval (CI) 1.0 to 2.1; p = 0.027) and 1.8 (95% CI 1.3 to 2.6; p = 0.001) times higher odds of having radicular leg pain in the past month and the past year, respectively. However, DSS was not associated with LBP. Although, subjects with a spondylolisthesis had 1.7 (95% CI 1.1 to 2.5; p = 0.011) and 2.0 (95% CI 1.2 to 3.2; p = 0.008) times greater odds to experience LBP in the past month and the past year, respectively. CONCLUSION This large-scale study identified DSS as a risk factor of acute and chronic radicular leg pain. DSS was seen in 6.9% of the study cohort and these patients had narrower spinal canals. Subjects with DSS had earlier onset of symptoms, more severe radicular leg pain, which lasted for longer and were more likely to have worse disability and poorer quality of life. In these patients there is an increased likelihood of nerve root compression due to a pre-existing narrowed canal, which is important when planning surgery as patients are likely to require multi-level decompression surgery. Cite this article: Bone Joint J 2021;103-B(1):131-140.
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Affiliation(s)
- Marcus Kin Long Lai
- Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, Hong Kong
| | | | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, Illinois, USA
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | | | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, Hong Kong
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12
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Zhang F, Zhang W, Zhang R, Chen B, Shang X, Han J, Li X. Modified minimally invasive-transforaminal lumbar interbody fusion under microscopic view to achieve bilateral decompression and fusion through a single approach to treat developmental lumbar spinal stenosis. J Clin Neurosci 2021; 84:46-49. [PMID: 33485598 DOI: 10.1016/j.jocn.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/17/2020] [Accepted: 12/06/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a modified minimally invasive spine (MIS) procedure to treat lumbar developmental spinal stenosis (DSS) to achieve complete decompression and fusion. The method preserves the muscles, ligaments, and most of the bony structures. DSS is not considered a good indication for MIS procedures and few reports discuss alternative treatments. Because MIS has the advantages of low blood loss, rapid recovery, and short hospital stay, it would be ideal for DSS. METHODS After confirming the screw positions, we placed a tube retractor in the facet joint on the decompressed side. The inferior facet joint and part of the superior joint of the lower segment were removed, the spinal canal was carefully exposed under a microscopic view, and fusion was performed through Kambin's triangle. Next, the operation table was rotated to the contralateral side and angled to approximately 15-20 degrees. We then tilted the tube retractor in the facet joint toward the operation side by 15-20 degrees, which provided access to the contralateral canal for decompression. The ligament flavum was carefully removed and the dural sac was gently retracted to expose the lateral recess on the other side. We then examined the nerve root on the contralateral side to ensure there was no compression. RESULTS Eight patients with lumbar DSS were treated using this method. Patients' neurological symptoms improved greatly without complications and patients were able to walk the day after surgery. The inner plate of the contralateral lamina and muscle as well as most of the ligaments that contribute to stability were preserved. CONCLUSION This modified MIS decompression procedure successfully treated DSS by providing spinal canal decompression and preserving most of the stabilizing structures.
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Affiliation(s)
- Feng Zhang
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China
| | - Wenzhi Zhang
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China
| | - Rui Zhang
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China
| | - Buzhou Chen
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China
| | - Xifu Shang
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China
| | - Jintao Han
- Peking University Third Hospital Intervention and Vascular Surgery, N0.38 Xueyuan Road, Beijing 100083, China
| | - Xu Li
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China.
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13
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George KM, Hernandez NS, Breton J, Cooper B, Dowd RS, Nail J, Yu A, Mastroianni M, Wang A, Godara A, Zhang D, Arkun K, Patel AR, Varga C, Soto O, Kryzanski J, Comenzo R, Riesenburger R. Increased thickness of lumbar spine ligamentum flavum in wild-type transthyretin amyloidosis. J Clin Neurosci 2020; 84:33-37. [PMID: 33485595 DOI: 10.1016/j.jocn.2020.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/17/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Wild-type transthyretin (ATTRwt) amyloid deposits have been found in the ligamentum flavum of patients undergoing surgery for spinal stenosis. The relationship between ATTRwt and ligamentum flavum thickness is unclear. We used pre-operative magnetic resonance imaging (MRI) to analyze ligamentum flavum thickness in lumbar spinal stenosis patients with and without ATTRwt amyloid. METHODS We retrospectively identified 178 patients who underwent lumbar spine surgery. Ligamentum flavum thickness of 253 specimens was measured on T2-weighted axial MRI. Amyloid presence was confirmed through Congo red staining of specimens, and ATTRwt was confirmed using mass-spectrometry and gene sequencing. RESULTS Twenty four of the 178 patients (13.5%) were found to have ATTRwt in the ligamentum flavum. Forty ATTRwt specimens and 213 non-ATTRwt specimens were measured. Mean ligamentum flavum thickness was 4.92 (±1.27) mm in the ATTRwt group and 4.00 (±1.21) mm in the non-ATTRwt group (p < 0.01). The ligamentum flavum was thickest at L4-L5, with a thickness of 5.15 (±1.27) mm and 4.23 (±1.29) mm in the ATTRwt and non-ATTRwt group, respectively (p = 0.007). There was a significant difference in ligamentum flavum thickness between ATTRwt and non-ATTRwt case for both patients younger than 70 years (p = 0.016) and those older than 70 years (p = 0.004). ATTRwt patients had greater ligamentum flavum thickness by 0.83 mm (95% confidence interval (CI): 0.41-1.25 mm, p < 0.001) when controlled for age and lumbar level. CONCLUSION Patients with ATTRwt had thicker ligamentum flavum compared to patients without ATTRwt. Further studies are needed to investigate the pathophysiology of ATTRwt in ligamentum flavum thickening.
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Affiliation(s)
- Keith M George
- Tufts Medical Center, Department of Neurology, United States; Tufts Medical Center, Department of Neurosurgery, United States
| | - Nicholas S Hernandez
- Tufts Medical Center, Department of Neurology, United States; Tufts Medical Center, Department of Neurosurgery, United States
| | - Jeffrey Breton
- Tufts Medical Center, Department of Neurology, United States; Tufts Medical Center, Department of Neurosurgery, United States
| | - Baillee Cooper
- Tufts Medical Center, Department of Neurology, United States; Tufts Medical Center, Department of Neurosurgery, United States
| | - Richard S Dowd
- Tufts Medical Center, Department of Neurosurgery, United States
| | - Jayde Nail
- Tufts Medical Center, Department of Neurosurgery, United States
| | - Anthony Yu
- Tufts Medical Center, Department of Neurology, United States; Tufts Medical Center, Department of Neurosurgery, United States
| | - Michael Mastroianni
- Tufts Medical Center, Department of Neurology, United States; Tufts Medical Center, Department of Neurosurgery, United States
| | - Andy Wang
- Tufts Medical Center, Department of Neurology, United States; Tufts Medical Center, Department of Neurosurgery, United States
| | - Amandeep Godara
- Tufts Medical Center, Department of Hematology and Oncology, United States
| | - Diana Zhang
- Tufts Medical Center, Department of Internal Medicine, United States
| | - Knarik Arkun
- Tufts Medical Center, Department of Neurosurgery, United States; Tufts Medical Center, Department of Pathology, United States
| | - Ayan R Patel
- Tufts Medical Center, CardioVascular Center, United States
| | - Cindy Varga
- Tufts Medical Center, Department of Hematology and Oncology, United States
| | - Oscar Soto
- Tufts University School of Medicine, United States
| | - James Kryzanski
- Tufts Medical Center, Department of Neurosurgery, United States
| | - Raymond Comenzo
- Tufts Medical Center, Department of Hematology and Oncology, United States
| | - Ron Riesenburger
- Tufts Medical Center, Department of Neurosurgery, United States.
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14
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Cheung PWH, Wong CKH, Lau ST, Cheung JPY. Cost analysis comparison between conventional microsurgical decompression and full-endoscopic interlaminar decompression for lumbar spinal stenosis surgery. JOURNAL OF SPINE SURGERY 2020; 6:721-728. [PMID: 33447674 DOI: 10.21037/jss-20-552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Two of the most commonly used techniques for treatment of lumbar spinal stenosis (LSS) include full-endoscopic interlaminar decompression (MIS) and conventional microsurgical decompression (CD). Although these procedures have proven efficacy for relief of stenotic symptoms, in this age of increased concerns for healthcare cost, weighing the respective accumulative costs is essential for deciding which approach to adopt. The aim of this study is to perform a cost analysis comparison between MIS and CD for LSS. Methods A decision analysis model comparing MIS and CD for patients with LSS over a 1-year time horizon was conducted. Relevant unit costs associated with each surgical procedure and each possible complication treatment were estimated. Regarding the respective complication rates for each procedure, data was retrieved from the literature. Reoperation was considered for epidural hematoma, inadequate decompression or iatrogenic instability requiring fusion. Nonoperative treatment for complications like infection was also considered. Results The average total costs for MIS and CD were found to be HKD$54,863 and HKD$52,748 respectively. Both procedures carried similar costs in terms of hospitalization, radiology and routine follow-up visits. A 3.9% (HKD$2,115) difference in total cost was largely due to the differences in cost of surgery and complications. MIS costs 5.7% more than CD for an operation but was 28.1% less costly than MIS for complications. Conclusions Given the similar clinical effectiveness of either procedure and only a small difference in overall cost, our findings suggest that surgeons should perform the procedure that they are competent with which guarantees adequacy of decompression.
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Affiliation(s)
- Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China.,Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Sin Ting Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
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15
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Lai MKL, Cheung PWH, Cheung JPY. A systematic review of developmental lumbar spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2173-2187. [DOI: 10.1007/s00586-020-06524-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/28/2020] [Accepted: 06/27/2020] [Indexed: 01/14/2023]
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16
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Kitab S, Habboub G, Abdulkareem SB, Alimidhatti MB, Benzel E. Redefining lumbar spinal stenosis as a developmental syndrome: does age matter? J Neurosurg Spine 2019; 31:357-365. [PMID: 31100722 DOI: 10.3171/2019.2.spine181383] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Age is commonly thought to be a risk factor in defining lumbar spinal stenosis (LSS) degenerative or developmental subtypes. This article is a follow-up to a previous article ("Redefining Lumbar Spinal Stenosis as a Developmental Syndrome: An MRI-Based Multivariate Analysis of Findings in 709 Patients Throughout the 16- to 82-Year Age Spectrum") that describes the radiological differences between developmental and degenerative types of LSS. MRI-based analysis of "degeneration" variables and spinal canal morphometric characteristics of LSS segments have been thought to correlate with age at presentation. METHODS The authors performed a re-analysis of data from their previously reported prospective MRI-based study, stratifying data from the 709 cases into 3 age categories of equal size (instead of the original < 60 vs ≥ 60 years). Relative spinal canal dimensions, as well as radiological degenerative variables from L1 to S1, were analyzed across age groups in a multivariate mode. The total degenerative scale score (TDSS) for each lumbar segment from L1 to S1 was calculated for each patient. The relationships between age and qualitative stenosis grades, TDSS, disc degeneration, and facet degeneration were analyzed using Pearson's product-moment correlation and multiple regression. RESULTS Multivariate analysis of TDSS and spinal canal dimensions revealed highly significant differences across the 3 age groups at L2-3 and L3-4 and a weaker, but still significant, association with changes at L5-S1. Age helped to explain only 9.6% and 12.2% of the variance in TDSS at L1-2 and L2-3, respectively, with a moderate positive correlation, and 7.8%, 1.2%, and 1.9% of the variance in TDSS at L3-4, L4-5, and L5-S1, respectively, with weak positive correlation. Age explained 24%, 26%, and 18.4% of the variance in lumbar intervertebral disc (LID) degeneration at L1-2, L2-3, and L3-4, respectively, while it explained only 6.2% and 7.2% of the variance of LID degeneration at L4-5 and L5-S1, respectively. Age explained only 2.5%, 4.0%, 1.2%, 0.8%, and 0.8% of the variance in facet degeneration at L1-2, L2-3, L3-4, L4-5, and L5-S1, respectively. CONCLUSIONS Age at presentation correlated weakly with degeneration variables and spinal canal morphometries in LSS segments. Age correlated with upper lumbar segment (L1-4) degeneration more than with lower segment (L4-S1) degeneration. The actual chronological age of the patients did not significantly correlate with the extent of degenerative pathology of the lumbar stenosis segments. These study results lend support for a developmental contribution to LSS.
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Affiliation(s)
- Sameer Kitab
- 1Scientific Council of Orthopedics, Baghdad, Iraq
| | - Ghaith Habboub
- 2Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; and
| | | | | | - Edward Benzel
- 2Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; and
- 3Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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17
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Cheung PWH, Hu Y, Cheung JPY. Novel compression rat model for developmental spinal stenosis. J Orthop Res 2019; 37:1090-1100. [PMID: 30644588 DOI: 10.1002/jor.24221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 01/02/2019] [Indexed: 02/04/2023]
Abstract
Developmental spinal stenosis (DSS) is characterized by pre-existing circumferential narrowing of the bony spinal canal which predisposes neural tissue to compression. This study aims to create a reproducible animal model mimicking DSS for investigation of its pathoanatomy. Developmental spinal canal constriction was simulated using circumferential compression. Eighteen female Sprague-Dawley rats (13.0-14.5 weeks-old) underwent circumferential compression at L4-L5 using silicone sheets; or dorsal compression using overlapping silicone sheets; or as controls. A series of outcome scores were used for locomotor function assessment, together with electrophysiological and histological assessment. Assessment time-points were at preoperative, postoperative 1-week, 2-weeks, 3-weeks, 1-month, and pre-sacrifice. Statistical analyses were performed. At all postoperative time-points, circumferential group had the worst mean Basso, Beattie and Bresnahan locomotor scores with significant difference from the control group (p < 0.05), as well as the lowest mean Louisville Swim Scale scores, as compared to the dorsal (p < 0.05) and to the control (p < 0.01) groups. Circumferential group had worse mean foot fault score for both hindlimbs (p < 0.01 to p < 0.05) and highest error rate in foot placement accuracy, especially higher than dorsal (p < 0.05) and control (p < 0.05) groups at pre-sacrifice. Electrophysiological assessment revealed postoperative increase in P1 latency was higher in circumferential than dorsal compression. Highest postoperative mean P1 latency was observed for both paws at all postoperative time-points for circumferential group (except at postoperative 1-week). Circumferential group had lower myelin-to-axonal area ratio and higher g-ratio than both the dorsal and control groups (p < 0.001). For each study group, hindlimb P1 latency and P1-N1 amplitude were each correlated with g-ratio (p < 0.05); and mean myelin-to-axonal area ratio correlated with P1 latency of both hindlimbs (p < 0.05). Based on these more severe axonal demyelination and neurological deficits, a valid DSS rat model is created with somatosensory evoked potential neuro-monitoring technique. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Prudence W H Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
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18
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Cheung PWH, Fong HK, Wong CS, Cheung JPY. The influence of developmental spinal stenosis on the risk of re-operation on an adjacent segment after decompression-only surgery for lumbar spinal stenosis. Bone Joint J 2019; 101-B:154-161. [PMID: 30700115 DOI: 10.1302/0301-620x.101b2.bjj-2018-1136.r2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aims The aim of this study was to determine the influence of developmental spinal stenosis (DSS) on the risk of re-operation at an adjacent level. Patients and Methods This was a retrospective study of 235 consecutive patients who had undergone decompression-only surgery for lumbar spinal stenosis and had a minimum five-year follow-up. There were 106 female patients (45.1%) and 129 male patients (54.9%), with a mean age at surgery of 66.8 years (sd 11.3). We excluded those with adult deformity and spondylolisthesis. Presenting symptoms, levels operated on initially and at re-operation were studied. MRI measurements included the anteroposterior diameter of the bony spinal canal, the degree of disc degeneration, and the thickness of the ligamentum flavum. DSS was defined by comparative measurements of the bony spinal canal. Risk factors for re-operation at the adjacent level were determined and included in a multivariate stepwise logistic regression for prediction modelling. Odds ratios (ORs) with 95% confidence intervals were calculated. Results Of the 235 patients, 21.7% required re-operation at an adjacent segment. Re-operation at an adjacent segment was associated with DSS (p = 0.026), the number of levels decompressed (p = 0.008), and age at surgery (p = 0.013). Multivariate regression model (p < 0.001) controlled for other confounders showed that DSS was a significant predictor of re-operation at an adjacent segment, with an adjusted OR of 3.93. Conclusion Patients with DSS who have undergone lumbar spinal decompression are 3.9 times more likely to undergo future surgery at an adjacent level. This is a poor prognostic indicator that can be identified prior to index decompression surgery.
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Affiliation(s)
- P. W. H. Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - H. K. Fong
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - C. S. Wong
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - J. P. Y. Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Chokshi FH, Kadom N, Dwivedi N, Kundu S, Moussa AY, Tannoury C, Tannoury T. Radiographic Cobb Angle: A Feature of Congenital Lumbar Spine Stenosis. Curr Probl Diagn Radiol 2019; 48:45-49. [PMID: 29422329 DOI: 10.1067/j.cpradiol.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE A low cost, reproducible radiographic method of diagnosing congenital lumbar spinal stenosis (CLSS) is lacking. We hypothesized that the Cobb angle for lumbar lordosis would be smaller in patients with CLSS, based on observations in our spine clinic patient population. Here, we compared lumbar lordosis Cobb angles with the radiographic ratio method in patients with normal spine imaging, degenerative spinal stenosis, and with CLSS. MATERIALS AND METHODS Orthopedic surgeons categorized patients with low back pain as "Normal," "Degenerative spinal stenosis," and "CLSS" based on clinical presentation and findings on lumbar magnetic resonance imaging. We included 30 patients from each cohort who had undergone lateral lumbar spine radiographs and lumbar magnetic resonance imaging. For each lateral radiograph, 2 measurement methods were used (1) 4-line lumbosacral Cobb angle between L2-S1 and (2) the ratio of the anteroposterior vertebral body diameter and spinal canal anteroposterior diameter at the L3 level. We performed logistic regression analyses of CLSS prediction by Cobb angle vs the ratio method in all three cohorts. Covariates included age, gender, and body mass index. RESULTS The radiographic Cobb angles were smaller in CLSS patients when compared to the degenerative disease and normal cohorts: a smaller radiographic Cobb angle showed higher odds ratio (OR) of predicting CLSS diagnosis compared to the radiographic ratio when compared with degenerative disease (OR = 0.28; 95% CI: 0.11-0.78, P = 0.01) and when compared with the normal cohort (OR = 0.46; 95% CI: 0.24-0.92, P = 0.03). Radiographic ratio measurements showed no difference between the three cohorts (P = 0.12). CLSS was associated with male gender (P = 0.04), younger age (P = 0.01), and higher body mass index (P = 0.01). CONCLUSION The radiographic Cobb angle method for lumbar lordosis may be useful for raising the possibility of CLSS as the diagnosis.
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Affiliation(s)
- Falgun H Chokshi
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA.
| | | | - Suprateek Kundu
- Department of Biostatistics and Bioinformatics, Emory University, Rollins School of Public Health, Atlanta, GA
| | - Ahmed Y Moussa
- Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA
| | - Chadi Tannoury
- Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA
| | - Tony Tannoury
- Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA
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20
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Kitab S, Lee BS, Benzel EC. Redefining lumbar spinal stenosis as a developmental syndrome: an MRI-based multivariate analysis of findings in 709 patients throughout the 16- to 82-year age spectrum. J Neurosurg Spine 2018; 29:654-660. [PMID: 30215592 DOI: 10.3171/2018.5.spine18100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/22/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVEUsing an imaging-based prospective comparative study of 709 eligible patients that was designed to assess lumbar spinal stenosis (LSS) in the ages between 16 and 82 years, the authors aimed to determine whether they could formulate radiological structural differences between the developmental and degenerative types of LSS.METHODSMRI structural changes were prospectively reviewed from 2 age cohorts of patients: those who presented clinically before the age of 60 years and those who presented at 60 years or older. Categorical degeneration variables at L1-S1 segments were compared. A multivariate comparative analysis of global radiographic degenerative variables and spinal dimensions was conducted in both cohorts. The age at presentation was correlated as a covariable.RESULTSA multivariate analysis demonstrated no significant between-groups differences in spinal canal dimensions and stenosis grades in any segments after age was adjusted for. There were no significant variances between the 2 cohorts in global degenerative variables, except at the L4-5 and L5-S1 segments, but with only small effect sizes. Age-related degeneration was found in the upper lumbar segments (L1-4) more than the lower lumbar segments (L4-S1). These findings challenge the notion that stenosis at L4-5 and L5-S1 is mainly associated with degenerative LSS.CONCLUSIONSIntegration of all the morphometric and qualitative characteristics of the 2 LSS cohorts provides evidence for a developmental background for LSS. Based on these findings the authors propose the concept of LSS as a developmental syndrome with superimposed degenerative changes. Further studies can be conducted to clarify the clinical definition of LSS and appropriate management approaches.
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Affiliation(s)
- Sameer Kitab
- 1Scientific Council of Orthopedics, Baghdad, Iraq
| | - Bryan S Lee
- 2Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic; and
- 3Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward C Benzel
- 2Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic; and
- 3Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Cheung JPY, Kao PYP, Sham P, Cheah KSE, Chan D, Cheung KMC, Samartzis D. Etiology of developmental spinal stenosis: A genome-wide association study. J Orthop Res 2018; 36:1262-1268. [PMID: 28983962 DOI: 10.1002/jor.23746] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 09/06/2017] [Indexed: 02/04/2023]
Abstract
Our study aimed to identify possible single nucleotide polymorphisms (SNPs) via a genome-wide association study (GWAS) approach and a candidate gene platform that were associated with lumbar developmental spinal stenosis (DSS). Southern Chinese population-based study volunteers were assessed (age range: 18-55 years). DSS was defined as the anteroposterior bony spinal canal diameter on T1-weighted axial MRI of L1 to S1. Genotyping was performed using the Illumina HumanOmniZhongHua-8 BeadChip. Using the canal diameter as the quantitative trait, genomic statistical analyses was performed. A total of 469 subjects were recruited. The mean axial AP measurements noted were: L1: 21.8 mm, L2: 21.9 mm, L3: 22.4 mm, L4: 20.2 mm, L5: 19.6 mm, and S1: 17.3 mm. Q-Q plots of genome-wide associations found significant differences in L4 and L5 measurements. More significant SNPs were found on chromosomes 8, 11, and 18. Low-density lipoprotein receptor-related protein 5 on chromosome 11 was found to be an important functional gene in canal bony development via candidate gene approach. We found two clusters in the findings with one including the upper levels (L1-L4) and the other the lower levels (L5 and S1). This is the first GWAS addressing DSS. The presence of multiple SNPs suggests a multi-factorial origin of DSS. Further analyses noted region-specific genetic predisposition, delineating distinct upper to lower lumbar regions of DSS. With better understanding of the DSS phenotype and genetic markers, the at-risk population can be identified early, preventative measures can be initiated, lifestyle/activity modification can be implemented, and more novel and precision-based therapeutics can be developed. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1262-1268, 2018.
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Affiliation(s)
- Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Patrick Y P Kao
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Pak Sham
- Genome Research Centre, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Kathryn S E Cheah
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Danny Chan
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Fishchenko IV, Kravchuk LD, Perepechay OA. Lumbar spinal stenosis: symptoms, diagnosis and treatment (meta-analysis of literature data). PAIN MEDICINE 2018. [DOI: 10.31636/pmjua.v3i1.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lumbar spinal stenosis is a disease in which degenerated discs, ligamentum flavum, facet joints, while aging, lead to a narrowing of the space around the neurovascular structures of the spine. This article presents a meta-analysis of literature data on epidemiology, causes, pathogenesis, diagnosis and various types of treatment of lumbar spinal stenosis.
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Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients. PLoS One 2017; 12:e0186148. [PMID: 29023556 PMCID: PMC5638415 DOI: 10.1371/journal.pone.0186148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/26/2017] [Indexed: 12/03/2022] Open
Abstract
Introduction Correlation between magnetic resonance imaging (MRI) and clinical features in cauda equina syndrome (CES) is unknown; nor is known whether there are differences in MRI spinal canal size between lumbar herniated disc patients with CES versus lumbar herniated discs patients without CES, operated for sciatica. The aims of this study are 1) evaluating the association of MRI features with clinical presentation and outcome of CES and 2) comparing lumbar spinal canal diameters of lumbar herniated disc patients with CES versus lumbar herniated disc patients without CES, operated because of sciatica. Methods MRIs of CES patients were assessed for the following features: level of disc lesion, type (uni- or bilateral) and severity of caudal compression. Pre- and postoperative clinical features (micturition dysfunction, defecation dysfunction, altered sensation of the saddle area) were retrieved from the medical files. In addition, anteroposterior (AP) lumbar spinal canal diameters of CES patients were measured at MRI. AP diameters of lumbar herniated disc patients without CES, operated for sciatica, were measured for comparison. Results 48 CES patients were included. At MRI, bilateral compression was seen in 82%; complete caudal compression in 29%. MRI features were not associated with clinical presentation nor outcome. AP diameter was measured for 26 CES patients and for 31 lumbar herniated disc patients without CES, operated for sciatica. Comparison displayed a significant smaller AP diameter of the lumbar spinal canal in CES patients (largest p = 0.002). Compared to average diameters in literature, diameters of CES patients were significantly more often below average than that of the sciatica patients (largest p = 0.021). Conclusion This is the first study demonstrating differences in lumbar spinal canal size between lumbar herniated disc patients with CES and lumbar herniated disc patients without CES, operated for sciatica. This finding might imply that lumbar herniated disc patients with a relative small lumbar spinal canal might need to be approached differently in managing complaints of herniated disc. Since the number of studied patients is relatively small, further research should be conducted before clinical consequences are considered.
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Cheung JPY, Ng KKM, Cheung PWH, Samartzis D, Cheung KMC. Radiographic indices for lumbar developmental spinal stenosis. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:3. [PMID: 28239663 PMCID: PMC5317052 DOI: 10.1186/s13013-017-0113-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/14/2017] [Indexed: 12/04/2022]
Abstract
Background Patients with developmental spinal stenosis (DSS) are susceptible to developing symptomatic stenosis due to pre-existing narrowed spinal canals. DSS has been previously defined by MRI via the axial anteroposterior (AP) bony spinal canal diameter. However, MRI is hardly a cost-efficient tool for screening patients. X-rays are superior due to its availability and cost, but currently, there is no definition of DSS based on plain radiographs. Thus, the aim of this study is to develop radiographic indices for diagnosing DSS. Methods This was a prospective cohort of 148 subjects consisting of patients undergoing surgery for lumbar spinal stenosis (patient group) and asymptomatic subjects recruited openly from the general population (control group). Ethics approval was obtained from the local institutional review board. All subjects underwent MRI for diagnosing DSS and radiographs for measuring parameters used for creating the indices. All measurements were performed by two independent investigators, blinded to patient details. Intra- and interobserver reliability analyses were conducted, and only parameters with near perfect intraclass correlation underwent receiver operating characteristic (ROC) analysis to determine the cutoff values for diagnosing DSS using radiographs. Results Imaging parameters from a total of 66 subjects from the patient group and 82 asymptomatic subjects in the control group were used for analysis. ROC analysis suggested sagittal vertebral body width to pedicle width ratio (SBW:PW) as having the strongest sensitivity and specificity for diagnosing DSS. Cutoff indices for SBW:PW were level-specific: L1 (2.0), L2 (2.0), L3 (2.2), L4 (2.2), L5 (2.5), and S1 (2.8). Conclusions This is the first study to define DSS on plain radiographs based on comparisons between a clinically relevant patient group and a control group. Individuals with DSS can be identified by a simple radiograph using a screening tool allowing for better cost-saving means for clinical diagnosis or research purposes.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, SAR China
| | - Karen Ka Man Ng
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, SAR China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, SAR China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, SAR China
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, SAR China
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MORALES-RANGEL ELIUHAZAEL, ESPINOZA-CHOQUE FERNANDO, MOHENO-GALLARDO ALFREDOJAVIER, SAAVEDRA-BADILLO LUISANTONIO, ELIZALDE-MARTÍNEZ EULALIO, FUENTE-ZUNO JUANCARLOSDELA, PÉREZ-ATANASIO JOSÉMANUEL. PARAMETERS OF NUCLEAR MAGNETIC RESONANCE IN PATIENTS WITH CONGENITAL NARROWING OF THE LUMBAR SPINAL CANAL. COLUNA/COLUMNA 2016. [DOI: 10.1590/s1808-185120161504167174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT Objective: To compare the morphological parameters of magnetic resonance in patients with congenital narrowing of the lumbar spinal canal with patients with low back pain. Methods: A descriptive, retrospective, observational study was conducted with measurements in the axial and sagittal magnetic resonance sections of the vertebral body and canal of the lumbar spine of 64 patients with diagnosis of low back pain, which were compared with resonance images taken from 31 Mexican patients with congenital narrowing of the lumbar spinal canal. Results: The results show that patients with congenital narrowing of the lumbar spinal canal in the axial sections have a difference in diameters, being L2<13.9 mm, L3<13.3 mm, L4<12.9 mm, L5<13.1 mm, compared with controls L2<20.5 mm, L3<20.5 mm, L4<19.3 mm, L5<18.1 mm with p = 0.000. Conclusions: We found different measurements in the Mexican population compared to those found by similar studies. With the parameters obtained, it would be possible to make the proper diagnosis, surgical planning, and treatment.
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Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The aim of the study was to evaluate clinical outcomes and to clarify the potential risks of cervical laminoplasty by a long-term follow-up of more than 20 years. SUMMARY OF BACKGROUND DATA There is no follow-up report exceeding 20 years after cervical laminoplasty. METHODS Two hundred sixteen patients underwent en bloc cervical laminoplasty for the treatment of cervical compressive myelopathy due to cervical spondylosis or ossification of the posterior longitudinal ligament between 1981 and 1994. Of these, 148 patients with a follow-up of more than 20 years were retrospectively studied (68 survived patients and 80 dead patients). The neurological evaluation was graded using Japanese Orthopaedic Association (JOA) score and the recovery rate. Neurological recovery was defined by the increase in JOA score. Radiological examinations were carried out using pre- and postoperative radiographs. As for the dead patients, the cause and age of death were reviewed. RESULTS The JOA score and recovery rate increased to 14.2 ± 2.7% and 64.9 ± 28.6%, respectively, at 5 years. The JOA score and recovery rate were maintained at 13.9 ± 3.2% and 61.6 ± 34.6% at 10 years. The JOA score decreased to 11.4 ± 5.1 at the last follow-up. In 32 out of 65 patients (49.2%), the JOA scores worsened mainly due to other spinal lesions. Cervical alignment became kyphotic when comparing preoperatively and at the last follow-up (ossification of the posterior longitudinal ligament: 15.7 ± 12.2° and 6.9 ± 17.8°, cervical spondylosis: 11.0 ± 8.9° and 3.3 ± 9.4°). Range of motion (ROM) decreased and one of the causes of ROM reduction was interlaminar fusion. The mean age at death was 78.2 years. The most frequent cause of death was malignant tumor. CONCLUSION Spine surgeons must be aware that patients have a long postoperative lifetime when cervical laminoplasty is performed. A long postoperative follow-up should be carried out after laminoplasty. LEVEL OF EVIDENCE 4.
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Cheung PWH, Tam V, Leung VYL, Samartzis D, Cheung KMC, Luk KDK, Cheung JPY. The paradoxical relationship between ligamentum flavum hypertrophy and developmental lumbar spinal stenosis. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:26. [PMID: 27635416 PMCID: PMC5011336 DOI: 10.1186/s13013-016-0088-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 08/22/2016] [Indexed: 01/25/2023]
Abstract
Background Ligamentum flavum (LF) hypertrophy is a common cause of lumbar spinal stenosis and is thought to be degeneration-driven. Developmental spinal stenosis (DSS) is characterized by pre-existing narrowed spinal canals and is likely a developmental problem that occurs in childhood. In these cases, the LF may demonstrate different characteristics as compared to degeneration-driven stenosis. Thus, this study aimed to investigate the relationship between histological changes of LF and canal size. Methods Patients who had surgical decompression for lumbar spinal stenosis were prospectively recruited and divided into three groups (critical DSS, relative DSS and non-DSS) based on previously defined anteroposterior bony spinal canal diameter measurements on MRI. The degree of disc degeneration and LF thickness were also measured from L1 to S1. Surgical LF specimens were retrieved for histological assessment of fibrotic grade and area of fibrosis. Results A total of 19 females and 15 males (110 LF specimens) with an overall mean age of 65.9 years (SD ± 9.8 years) were recruited. DSS was found to have a significant negative correlation (p < 0.001) with LF thickness, its fibrotic grade and area of fibrosis (%). Non-DSS exhibited a significant positive relationship with the degree of LF fibrosis. Disc degeneration and LF thickness had no correlation with LF histology. Conclusions Our study is the first to definitively note that degeneration is the cause of LF fibrosis in non-DSS patients; however, in contrast, an inverse relationship exists between canal size and LF fibrosis in DSS patients, suggesting a different pathomechanism. Hence, despite a similar degree of LF thickness, DSS patients have LF with less fibrosis compared with non-DSS patients. Further investigation of the cause of LF changes in DSS is necessary to understand this relationship.
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Affiliation(s)
| | - Vivian Tam
- School of Biological Sciences, The University of Hong Kong, Hong Kong, SAR China
| | - Victor Yu Leong Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR China
| | - Kenneth Man-Chee Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR China
| | - Keith Dip-Kei Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR China
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Abstract
Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.
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Affiliation(s)
- Jon Lurie
- Department of Medicine, Dartmouth Medical School, Dartmouth Hitchock Medical Center, NH, USA
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
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