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Karlsson T, Försth P, Öhagen P, Michaëlsson K, Sandén B. Decompression alone or decompression with fusion for lumbar spinal stenosis: five-year clinical results from a randomized clinical trial. Bone Joint J 2024; 106-B:705-712. [PMID: 38945544 DOI: 10.1302/0301-620x.106b7.bjj-2023-1160.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Aims We compared decompression alone to decompression with fusion surgery for lumbar spinal stenosis, with or without degenerative spondylolisthesis (DS). The aim was to evaluate if five-year outcomes differed between the groups. The two-year results from the same trial revealed no differences. Methods The Swedish Spinal Stenosis Study was a multicentre randomized controlled trial with recruitment from September 2006 to February 2012. A total of 247 patients with one- or two-level central lumbar spinal stenosis, stratified by the presence of DS, were randomized to decompression alone or decompression with fusion. The five-year Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were the EuroQol five-dimension questionnaire (EQ-5D), visual analogue scales for back and leg pain, and patient-reported satisfaction, decreased pain, and increased walking distance. The reoperation rate was recorded. Results Five-year follow-up was completed by 213 (95%) of the eligible patients (mean age 67 years; 155 female (67%)). After five years, ODI was similar irrespective of treatment, with a mean of 25 (SD 18) for decompression alone and 28 (SD 22) for decompression with fusion (p = 0.226). Mean EQ-5D was higher for decompression alone than for fusion (0.69 (SD 0.28) vs 0.59 (SD 0.34); p = 0.027). In the no-DS subset, fewer patients reported decreased leg pain after fusion (58%) than with decompression alone (80%) (relative risk (RR) 0.71 (95% confidence interval (CI) 0.53 to 0.97). The frequency of subsequent spinal surgery was 24% for decompression with fusion and 22% for decompression alone (RR 1.1 (95% CI 0.69 to 1.8)). Conclusion Adding fusion to decompression in spinal stenosis surgery, with or without spondylolisthesis, does not improve the five-year ODI, which is consistent with our two-year report. Three secondary outcomes that did not differ at two years favoured decompression alone at five years. Our results support decompression alone as the preferred method for operating on spinal stenosis.
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Affiliation(s)
- Thomas Karlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden
| | - Peter Försth
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Aleris Elisabeth Hospital, Uppsala, Sweden
| | - Patrik Öhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- SDS Life Science, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Sandén
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden
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Baranidharan G, Bretherton B, Feltbower RG, Timothy J, Khan AL, Subramanian A, Ahmed M, Crowther TA, Radford H, Gupta H, Chandramohan M, Beall DP, Deer TR, Hedman T. 24-Month Outcomes of Indirect Decompression Using a Minimally Invasive Interspinous Fixation Device versus Standard Open Direct Decompression for Lumbar Spinal Stenosis: A Prospective Comparison. J Pain Res 2024; 17:2079-2097. [PMID: 38894862 PMCID: PMC11182879 DOI: 10.2147/jpr.s453343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/06/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose An early-stage, multi-centre, prospective, randomised control trial with five-year follow-up was approved by Health Research Authority to compare the efficacy of a minimally invasive, laterally implanted interspinous fixation device (IFD) to open direct surgical decompression in treating lumbar spinal stenosis (LSS). Two-year results are presented. Patients and Methods Forty-eight participants were randomly assigned to IFD or decompression. Primary study endpoints included changes from baseline at 8-weeks, 6, 12 and 24-months follow-ups for leg pain (visual analogue scale, VAS), back pain (VAS), disability (Oswestry Disability Index, ODI), LSS physical function (Zurich Claudication Questionnaire), distance walked in five minutes and number of repetitions of sitting-to-standing in one minute. Secondary study endpoints included patient and clinician global impression of change, adverse events, reoperations, operating parameters, and fusion rate. Results Both treatment groups demonstrated statistically significant improvements in mean leg pain, back pain, ODI disability, LSS physical function, walking distance and sitting-to-standing repetitions compared to baseline over 24 months. Mean reduction of ODI from baseline levels was between 35% and 56% for IFD (p<0.002), and 49% to 55% for decompression (p<0.001) for all follow-up time points. Mean reduction of IFD group leg pain was between 57% and 78% for all time points (p<0.001), with 72% to 94% of participants having at least 30% reduction of leg pain from 8-weeks through 24-months. Walking distance for the IFD group increased from 66% to 94% and sitting-to-standing repetitions increased from 44% to 64% for all follow-up time points. Blood loss was 88% less in the IFD group (p=0.024) and operating time parameters strongly favoured IFD compared to decompression (p<0.001). An 89% fusion rate was assessed in a subset of IFD participants. There were no intraoperative device issues or re-operations in the IFD group, and only one healed and non-symptomatic spinous process fracture observed within 24 months. Conclusion Despite a low number of participants in the IFD group, the study demonstrated successful two-year safety and clinical outcomes for the IFD with significant operation-related advantages compared to surgical decompression.
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Affiliation(s)
- Ganesan Baranidharan
- Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Beatrice Bretherton
- Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Jake Timothy
- Department of Neuroscience, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Almas Latif Khan
- Department of Spine Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Ashok Subramanian
- Somerset Spinal Surgery Service, Musgrove Park Hospital, Taunton, UK
| | - Mushtaq Ahmed
- Department of Trauma and Orthopaedic Surgery, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Tracey A Crowther
- Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Research & Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen Radford
- Research & Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Harun Gupta
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Thomas Hedman
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
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Yin J, Ma T, Gao G, Chen Q, Nong L. Early Clinical and Radiologic Evaluation of Unilateral Biportal Endoscopic Unilateral Laminotomy and Bilateral Decompression in Degenerative Lumbar Spinal Stenosis: A Retrospective Study. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38442912 DOI: 10.1055/a-2281-2135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND The aim of this study is to evaluate the changes in radiologic parameters and clinical outcomes following unilateral biportal endoscopic unilateral laminotomy and bilateral decompression (UBE ULBD) for treatment of central lumbar spinal stenosis. METHODS Forty-one central lumbar spinal stenosis patients who underwent UBE ULBD were enrolled from April 2021 to February 2023. Visual analog scale (VAS) for back pain and leg pain, Oswestry Disability Index (ODI) score, and the modified MacNab criteria were assessed preoperatively and postoperatively. The preoperative and postoperative cross-sectional area of the spinal canal (CSAC), anteroposterior diameter, horizontal width, and ipsilateral and contralateral lateral recess height were calculated from axial computed tomography (CT) scans. Percentage of facet joint preservation measured on axial CT scans was obtained preoperation and postoperation. RESULTS The VAS for back and leg pain improved from 7.24 ± 0.80 and 7.59 ± 0.59 preoperatively to 2.41 ± 0.55 and 2.37 ± 0.62 (p < 0.05) postoperatively and 1.37 ± 0.54 and 1.51 ± 0.55 at the last follow-up (p < 0.05). For ODI, improvement from 60.37 ± 4.44 preoperatively to 18.90 ± 4.66 (p < 0.05) at the last follow-up was observed. CT scans demonstrated that the postoperative CSAC increased significantly from 287.84 ± 87.81 to 232.97 ± 88.42 mm (p < 0.05). The mean postoperative anteroposterior diameter and horizontal width increased significantly from 18.01 ± 3.13 and 19.57 ± 3.80 to 22.19 ± 4.56 and 21.04 ± 3.72 mm, respectively (p < 0.05). The ipsilateral lateral recess height and contralateral lateral recess height were 3.39 ± 1.12 and 3.20 ± 1.14 mm preoperatively and 4.03 ± 1.37 and 3.83 ± 1.32 mm (p < 0.05) postoperatively, with significant differences. The ipsilateral and contralateral facet joint preservations were 88.17 and 93.18%, respectively. CONCLUSION The UBE ULBD surgery is a safe and effective treatment for central lumbar spinal stenosis, associated with significant improvement in clinical outcomes and radiologic parameters. Studies with larger samples and longer follow-up periods are needed for further research.
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Affiliation(s)
- Jianjian Yin
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Tao Ma
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Gongming Gao
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Qi Chen
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Luming Nong
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
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Young I, Dunning J, Butts R, Bliton P, Zacharko N, Garcia J, Mourad F, Charlebois C, Gorby P, Fernández-de-Las-Peñas C. Spinal manipulation and electrical dry needling as an adjunct to conventional physical therapy in patients with lumbar spinal stenosis: a multi-center randomized clinical trial. Spine J 2024; 24:590-600. [PMID: 38103739 DOI: 10.1016/j.spinee.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/10/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND CONTEXT Nonoperative management of lumbar spinal stenosis (LSS) includes activity modification, medication, injections, and physical therapy. Conventional physical therapy includes a multimodal approach of exercise, manual therapy, and electro-thermal modalities. There is a paucity of evidence supporting the use of spinal manipulation and dry needling as an adjunct to conventional physical therapy in patients with LSS. PURPOSE This study aimed to determine the effects of adding thrust spinal manipulation and electrical dry needling to conventional physical therapy in patients with LSS. STUDY DESIGN/SETTING Randomized, single-blinded, multi-center, parallel-group clinical trial. PATIENT SAMPLE One hundred twenty-eight (n=128) patients with LSS from 12 outpatient clinics in 8 states were recruited over a 34-month period. OUTCOME MEASURES The primary outcomes included the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI). Secondary outcomes included the Roland Morris Disability Index (RMDI), Global Rating of Change (GROC), and medication intake. Follow-up assessments were taken at 2 weeks, 6 weeks, and 3 months. METHODS Patients were randomized to receive either spinal manipulation, electrical dry needling, and conventional physical therapy (MEDNCPT group, n=65) or conventional physical therapy alone (CPT group, n=63). RESULTS At 3 months, the MEDNCPT group experienced greater reductions in overall low back, buttock, and leg pain (NPRS: F=5.658; p=.002) and related-disability (ODI: F=9.921; p<.001; RMDI: F=7.263; p<.001) compared to the CPT group. Effect sizes were small at 2 and 6 weeks, and medium at 3 months for the NPRS, ODI, and RMDI. At 3 months, significantly (p=.003) more patients in the MEDNCPT group reported a successful outcome (GROC≥+5) than the CPT group. CONCLUSION Patients with LSS who received electrical dry needling and spinal manipulation in addition to impairment-based exercise, manual therapy and electro-thermal modalities experienced greater improvements in low back, buttock and leg pain and related-disability than those receiving exercise, manual therapy, and electro-thermal modalities alone at 3 months, but not at the 2 or 6 week follow-up.
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Affiliation(s)
- Ian Young
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Tybee Wellness & Osteopractic, Tybee Island, GA, USA.
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Montgomery Osteopractic Physical Therapy & Acupuncture Clinic, Montgomery, AL, USA
| | | | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; William S. Middleton Veterans Memorial Hospital, Madison, WI, USA
| | - Noah Zacharko
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Osteopractic Physical Therapy of the Carolinas, Fort Mill, SC, USA
| | - Jodan Garcia
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Casey Charlebois
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
| | - Patrick Gorby
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Gorby Osteopractic Physiotherapy, Colorado Springs, CO, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra de Clínica, Investigación y Docencia en Fisioterapia: Terapia Manual, Punción Secay Ejercicio, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Peene L, Cohen SP, Kallewaard JW, Wolff A, Huygen F, Gaag AVD, Monique S, Vissers K, Gilligan C, Van Zundert J, Van Boxem K. 1. Lumbosacral radicular pain. Pain Pract 2024; 24:525-552. [PMID: 37985718 DOI: 10.1111/papr.13317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Patients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%. METHODS The literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized. RESULTS Although a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s). In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short-term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in well-selected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers. CONCLUSIONS The diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.
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Affiliation(s)
- Laurens Peene
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium
| | - Steven P Cohen
- Pain Medicine Division, Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jan Willem Kallewaard
- Department of Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andre Wolff
- Department of Anesthesiology UMCG Pain Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank Huygen
- Department of Anesthesiology and Pain Medicine, Erasmusmc, Rotterdam, The Netherlands
- Department of Anesthesiology and Pain Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antal van de Gaag
- Department of Anesthesiology and Pain Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Steegers Monique
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen, The Netherlands
| | - Chris Gilligan
- Department of Anesthesiology and Pain Medicine, Brigham & Women's Spine Center, Boston, Massachusetts, USA
| | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Koen Van Boxem
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Liu C, Geng Y, Li Y. Oblique lateral internal fusion combined with percutaneous pedicle screw fixation in severe lumbar spinal stenosis: clinical and radiographic outcome. J Orthop Surg Res 2023; 18:882. [PMID: 37981677 PMCID: PMC10658976 DOI: 10.1186/s13018-023-04373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Oblique lumbar interbody fusion (OLIF) has been a popular technique for treating lumbar degenerative diseases. Previous studies have shown its efficiency in lumbar spinal stenosis; yet, only a few studies have investigated its application to severe lumbar spinal stenosis. Herein, we investigated the clinical and radiographic outcome of OLIF with percutaneous pedicle screws in the treatment of severe lumbar spinal stenosis. METHODS A total of 15 patients who underwent OLIF with percutaneous pedicle screws were retrospectively analysed. All patients were diagnosed with severe lumbar stenosis (Schizas grade C or D) through preoperative magnetic resonance image (MRI) and received OLIF combined with percutaneous pedicle screw surgery. Clinical outcomes, including visual analogue scale (VAS)-back and VAS-leg scores, and Oswestry Disability Index (ODI), as well as mean disc height (DH), mean foraminal height (FH), segmental lumbar lordosis (SLL) and cross-sectional area (CSA) of the spinal canal, were analysed before and after surgery and at the last follow-up. Intraoperative data, complications and fusion rate were also investigated. RESULTS OLIF combined with percutaneous pedicle screws was performed on 18 segments in 15 patients. Mean follow-up was 23.1 ± 4.6 months (range 15-29 months). VAS-back, VAS-leg, and ODI scores were significantly improved at the last follow-up. DH increased from 8.86 ± 3.06 mm before surgery to 13.31 ± 2.14 mm after; at the last follow-up, DH was 11.69 ± 1.87 mm. FH increased from 17.85 ± 2.26 mm before surgery to 22.09 ± 1.36 mm after; at the last follow-up, FH was 20.41 ± 0.99 mm. CSA of the spinal canal increased from 30.83 ± 21.15 mm2 before surgery to 74.99 ± 33.65 mm2 after the operation and 81.22 ± 35.53 mm2 at the last follow-up. The segmental LL before surgery, after surgery and at last follow-up was 20.27 ± 6.25 degrees, 20.83 ± 6.52 degrees and 19.75 ± 5.87 degrees, respectively. All patients have gained fusion at the last follow-up. CONCLUSION OLIF with percutaneous pedicle screws could achieve satisfactory clinical and radiographic effects through indirect compression by increasing DH, FH and CSA of the spinal canal in severe lumbar stenosis patients.
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Affiliation(s)
- Chen Liu
- Department of Spine Surgery, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China
- Spine Research Center of Wannan Medical College, No. 22 Wenchang West Road, Wuhu, 241001, Anhui, China
- Key Laboratory of Non-Coding RNA Transformation Research of Anhui Higher Education Institution, Wannan Medical College, Wuhu, 241001, Anhui, China
| | - Yin Geng
- Department of Spine Surgery, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China
- Spine Research Center of Wannan Medical College, No. 22 Wenchang West Road, Wuhu, 241001, Anhui, China
| | - Yifeng Li
- Department of Spine Surgery, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China.
- Spine Research Center of Wannan Medical College, No. 22 Wenchang West Road, Wuhu, 241001, Anhui, China.
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Dimitriou D, Winkler E, Weber S, Haupt S, Betz M, Farshad M. A Simple Preoperative Score Predicting Failure Following Decompression Surgery for Degenerative Lumbar Spinal Stenosis. Spine (Phila Pa 1976) 2023; 48:610-616. [PMID: 36728033 PMCID: PMC10364961 DOI: 10.1097/brs.0000000000004584] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Proper patient selection is crucial for the outcome of surgically treated degenerative lumbar spinal stenosis (DLSS). Nevertheless, there is still not a clear consensus regarding the optimal treatment option for patients with DLSS. PURPOSE To investigate the treatment failure rate and introduce a simple, preoperative score to aid surgical decision-making. STUDY DESIGN/SETTING Retrospective observational study. PATIENT SAMPLE Four hundred forty-five patients who underwent surgical decompression for DLSS. OUTCOME MEASURES Treatment failure (defined as conversion to a fusion of a previously decompressed level) of lumbar decompression. MATERIALS AND METHODS Several risk factors associated with worse outcomes and treatment failures, such as age, body mass index, smoking status, previous surgery, low back pain (LBP), facet joint effusion, disk degeneration, fatty infiltration of the paraspinal muscles, the presence of degenerative spondylolisthesis and the facet angulation, were investigated. RESULTS At a mean follow-up of 44±31 months, 6.5% (29/445) of the patients underwent revision surgery with spinal fusion at an average of 3±9 months following the lumbar decompression due to low back or leg pain. The baseline LBP (≥7) [odds ratio (OR)=5.4, P <0.001], the presence of facet joint effusion (>2 mm) in magnetic resonance imaging (OR=4.2, P <0.001), and disk degeneration (Pfirrmann >4) (OR=3.2, P =0.03) were associated with an increased risk for treatment failure following decompression for DLSS. The receiver operating characteristic curve analysis demonstrated that a score≥6 points yielded a sensitivity of 90% and specificity of 64% for predicting a treatment failure following lumbar decompression for DLSS in the present cohort. CONCLUSIONS The newly introduced score quantifying amounts of LBP, facet effusions, and disk degeneration, could predict treatment failure and the need for revision surgery for DLSS patients undergoing lumbar decompression without fusion. Patients with scores >6 have a high chance of needing fusion following decompression surgery. LEVEL OF EVIDENCE Retrospective observational study, Level III.
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Mandy M, Kamran K, Marian IR, Dutton SJ, Esther W, Lamb SE, Stavros P. Economic costs, health-related quality of life outcomes and cost-utility of a physical and psychological group intervention targeted at older adults with neurogenic claudication. Cost Eff Resour Alloc 2023; 21:14. [PMID: 36755265 PMCID: PMC9906820 DOI: 10.1186/s12962-022-00410-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/16/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Emerging evidence suggests that structured and progressive exercise underpinned by a cognitive behavioural approach can improve functional outcomes in patients with neurogenic claudication (NC). However, evidence surrounding its economic benefits is lacking. OBJECTIVES To estimate the economic costs, health-related quality of life outcomes and cost-effectiveness of a physical and psychological group intervention (BOOST programme) versus best practice advice (BPA) in older adults with NC. METHODS An economic evaluation was conducted based on data from a pragmatic, multicentre, superiority, randomised controlled trial. The base-case economic evaluation took the form of an intention-to-treat analysis conducted from a UK National Health Service (NHS) and personal social services (PSS) perspective and separately from a societal perspective. Costs (£ 2018-2019 prices) were collected prospectively over a 12 month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit (INMB) of the BOOST programme in comparison to BPA. Sensitivity and pre-specified subgroup analyses explored uncertainty and heterogeneity in cost-effectiveness estimates. RESULTS Participants (N = 435) were randomised to the BOOST programme (n = 292) or BPA (n = 143). Mean (standard error [SE]) NHS and PSS costs over 12 months were £1,974 (£118) in the BOOST arm versus £1,827 (£169) in the BPA arm (p = 0.474). Mean (SE) QALY estimates were 0.620 (0.009) versus 0.599 (0.006), respectively (p = 0.093). The probability that the BOOST programme is cost-effective ranged between 67 and 83% (NHS and PSS perspective) and 79-89% (societal perspective) at cost-effectiveness thresholds between £15,000 and £30,000 per QALY gained. INMBs ranged between £145 and £464 at similar cost-effectiveness thresholds. The cost-effectiveness results remained robust to sensitivity analyses. CONCLUSIONS The BOOST programme resulted in modest QALY gains over the 12 month follow-up period. Future studies with longer intervention and follow-up periods are needed to address uncertainty around the health-related quality of life impacts and cost-effectiveness of such programmes. Trial registration This study has been registered in the International Standard Randomised Controlled Trial Number registry, reference number ISRCTN12698674. Registered on 10 November 2015.
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Affiliation(s)
- Maredza Mandy
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
| | - Khan Kamran
- grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Ioana R. Marian
- grid.4991.50000 0004 1936 8948Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Susan J. Dutton
- grid.4991.50000 0004 1936 8948Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Williamson Esther
- grid.4991.50000 0004 1936 8948Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ,grid.8391.30000 0004 1936 8024Exeter Medical School, University of Exeter, Devon, UK
| | - Sarah E. Lamb
- grid.8391.30000 0004 1936 8024Exeter Medical School, University of Exeter, Devon, UK
| | - Petrou Stavros
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Factors associated with an increased risk of developing postoperative symptomatic lumbar spondylolisthesis after decompression surgery: an explorative two-centre international cohort study. 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; 32:462-474. [PMID: 36308544 DOI: 10.1007/s00586-022-07403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/26/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Symptomatic lumbar spinal stenosis can be treated with decompression surgery. A recent review reported that, after decompression surgery, 1.6-32.0% of patients develop postoperative symptomatic spondylolisthesis and may therefore be indicated for lumbar fusion surgery. The latter can be more challenging due to the altered anatomy and scar tissue. It remains unclear why some patients get recurrent neurological complaints due to postoperative symptomatic spondylolisthesis, though some associations have been suggested. This study explores the association between key demographic, biological and radiological factors and postoperative symptomatic spondylolisthesis after lumbar decompression. METHODS This retrospective cohort study included patients who had undergone lumbar spinal decompression surgery between January 2014 and December 2016 at one of two Spine Centres in the Netherlands or Switzerland and had a follow-up of two years. Patient characteristics, details of the surgical procedure and recurrent neurological complaints were retrieved from patient files. Preoperative MRI scans and conventional radiograms (CRs) of the lumbar spine were evaluated for multiple morphological characteristics. Postoperative spondylolisthesis was evaluated on postoperative MRI scans. For variables assessed on a whole patient basis, patients with and without postoperative symptomatic spondylolisthesis were compared. For variables assessed on the basis of the operated segment(s), surgical levels that did or did not develop postoperative spondylolisthesis were compared. Univariable and multivariable logistic regression analyses were used to identify associations with postoperative symptomatic spondylolisthesis. RESULTS Seven hundred and sixteen patients with 1094 surgical levels were included in the analyses. (In total, 300 patients had undergone multilevel surgery.) ICCs for intraobserver and interobserver reliability of CR and MRI variables ranged between 0.81 and 0.99 and 0.67 and 0.97, respectively. In total, 66 of 716 included patients suffered from postoperative symptomatic spondylolisthesis (9.2%). Multivariable regression analyses of patient-basis variables showed that being female [odds ratio (OR) 1.2, 95%CI 1.07-3.09] was associated with postoperative symptomatic spondylolisthesis. Higher BMI (OR 0.93, 95%CI 0.88-0.99) was associated with a lower probability of having postoperative symptomatic spondylolisthesis. Multivariable regression analyses of surgical level-basis variables showed that levels with preoperative spondylolisthesis (OR 17.30, 95%CI 10.27-29.07) and the level of surgery, most importantly level L4L5 compared with levels L1L3 (OR 2.80, 95%CI 0.78-10.08), were associated with postoperative symptomatic spondylolisthesis; greater facet joint angles (i.e. less sagittal-oriented facets) were associated with a lower probability of postoperative symptomatic spondylolisthesis (OR 0.97, 95%CI 0.95-0.99). CONCLUSION Being female was associated with a higher probability of having postoperative symptomatic spondylolisthesis, while having a higher BMI was associated with a lower probability. When looking at factors related to postoperative symptomatic spondylolisthesis at the surgical level, preoperative spondylolisthesis, more sagittal orientated facet angles and surgical level (most significantly level L4L5 compared to levels L1L3) showed significant associations. These associations could be used as a basis for devising patient selection criteria, stratifying patients or performing subgroup analyses in future studies regarding decompression surgery with or without fusion.
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Sun Y, An Y, Fan X, Liu C, Li D, Lei Y, Weng Z, Gong Y, Wang X, Yu C. A Protocol for a Single-Centered, Pragmatic, Randomized, Controlled, Parallel Trial Comparing Comprehensive Nonsurgical Therapy Options for Individuals with Lumbar Spinal Stenosis. J Pain Res 2023; 16:773-784. [PMID: 36923649 PMCID: PMC10010744 DOI: 10.2147/jpr.s398897] [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: 12/03/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
Aim Lumbar spinal stenosis (LSS) is a long-term degenerative disease. Considering the risks and advantages of the patient's age range and the characteristics of the condition, non-surgical treatment is recommended. To determine the best first-line non-surgical therapy for LSS, few studies have examined different non-surgical therapies. Therefore, the main objective of this study is to determine whether the selection of comprehensive Chinese medicine (CM) treatment for LSS is more successful than non-surgical conservative treatment. Patients and Methods In this two-armed, parallel, single-centered, pragmatic randomized controlled study, 94 LSS participants will be randomized to receive 24 sessions of comprehensive CM therapy or conservative treatment for 3 months, with follow-up assessments at 6, 9, 12, and 15 months. The primary outcome will be based on the success rate of the Zurich Claudication Questionnaire (ZCQ) for the most clinical important difference (MCID) at 3 and 15 months. Secondary outcomes include Numerical Rating Scale (NRS) scores for back and leg pain, ZCQ scores, Oswestry Disability Index scores for lumbar dysfunction, and Short-Form 12 scores for health-related quality of life at 3, 6, 9, 12, and 15 months. Adverse events and incidences of surgery will be reported anytime during the trial and follow-up. Conclusion This protocol examines the comparative efficacy of comprehensive CM therapy compared with conventional care through a pragmatic randomized controlled trial to present data to facilitate clinical or policy decision-making. The outcomes will make it easier to decide which patient-centered treatments to prioritize for LSS.
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Affiliation(s)
- Ya'nan Sun
- Traditional Chinese Medicine Department, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China
| | - Yi An
- First Clinical College, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China
| | - Xiran Fan
- First Clinical College, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China
| | - Changxin Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China
| | - Duoduo Li
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China
| | - Yuan Lei
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China
| | - Zhiwen Weng
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China
| | - Yuanyuan Gong
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China
| | - Xiyou Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China
| | - Changhe Yu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China
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Zouch J, Comachio J, Bussières A, Ashton-James CE, dos Reis AHS, Chen Y, Ferreira M, Ferreira P. Influence of Initial Health Care Provider on Subsequent Health Care Utilization for Patients With a New Onset of Low Back Pain: A Scoping Review. Phys Ther 2022; 102:pzac150. [PMID: 36317766 PMCID: PMC10071499 DOI: 10.1093/ptj/pzac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/05/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this research was to examine the scope of evidence for the influence of a nonmedical initial provider on health care utilization and outcomes in people with low back pain (LBP). METHODS Using scoping review methodology, we conducted an electronic search of 4 databases from inception to June 2021. Studies investigating the management of patients with a new onset of LBP by a nonmedical initial health care provider were identified. Pairs of reviewers screened titles, abstracts, and eligible full-text studies. We extracted health care utilization and patient outcomes and assessed the methodological quality of the included studies using the Joanna Briggs Institute checklist. Two reviewers descriptively analyzed the data and categorized findings by outcome measure. RESULTS A total of 26,462 citations were screened, and 11 studies were eligible. Studies were primarily retrospective cohort designs using claims-based data. Four studies had a low risk of bias. Five health care outcomes were identified: medication, imaging, care seeking, cost of care, and health care procedures. Patient outcomes included patient satisfaction and functional recovery. Compared with patients initiating care with medical providers, those initiating care with a nonmedical provider showed associations with reduced opioid prescribing and imaging ordering rates but increased rates of care seeking. Results for cost of care, health care procedures, and patient outcomes were inconsistent. CONCLUSIONS Prioritizing nonmedical providers at the first point of care may decrease the use of low-value care, such as opioid prescribing and imaging referral, but may lead to an increased number of health care visits in the care of people with LBP. High-quality randomized controlled trials are needed to confirm our findings. IMPACT This scoping review provides preliminary evidence that nonmedical practitioners, as initial providers, may help reduce opioid prescription and selective imaging in people with LBP. The trend observed in this scoping review has important implications for pathways of care and the role of nonmedical providers, such as physical therapists, within primary health care systems. LAY SUMMARY This scoping review provides preliminary evidence that nonmedical practitioners, as initial providers, might help reduce opioid prescription and selective imaging in people with LBP. High-quality randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- James Zouch
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Josielli Comachio
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - André Bussières
- Department de Chiropractique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Claire E Ashton-James
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Yanyu Chen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Manuela Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Paulo Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Karlsson T, Försth P, Skorpil M, Pazarlis K, Öhagen P, Michaëlsson K, Sandén B. Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up. Bone Joint J 2022; 104-B:1343-1351. [PMID: 36453045 PMCID: PMC9680197 DOI: 10.1302/0301-620x.104b12.bjj-2022-0340.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
AIMS The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion. METHODS The Swedish Spinal Stenosis Study (SSSS) was conducted between 2006 and 2012 at five public and two private hospitals. Six centres participated in this two-year MRI follow-up. We randomized 222 patients with central lumbar spinal stenosis at one or two adjacent levels into two groups, decompression alone and decompression with fusion. The presence or absence of a preoperative spondylolisthesis was noted. A new stenosis on two-year MRI was used as the primary outcome, defined as a dural sac cross-sectional area ≤ 75 mm2 at the operated level (restenosis) and/or at the level above (proximal adjacent level stenosis). RESULTS A total of 211 patients underwent surgery at a mean age of 66 years (69% female): 103 were treated by decompression with fusion and 108 by decompression alone. A two-year MRI was available for 176 (90%) of the eligible patients. A new stenosis at the operated and/or adjacent level occurred more frequently after decompression and fusion than after decompression alone (47% vs 29%; p = 0.020). The difference remained in the subgroup with a preoperative spondylolisthesis, (48% vs 24%; p = 0.020), but did not reach significance for those without (45% vs 35%; p = 0.488). Proximal adjacent level stenosis was more common after fusion than after decompression alone (44% vs 17%; p < 0.001). Restenosis at the operated level was less frequent after fusion than decompression alone (4% vs 14%; p = 0.036). Vertebral slip increased by 1.1 mm after decompression alone, regardless of whether a preoperative spondylolisthesis was present or not. CONCLUSION Adding fusion to a decompression increased the rate of new stenosis on two-year MRI, even when a spondylolisthesis was present preoperatively. This supports decompression alone as the preferred method of surgery for spinal stenosis, whether or not a degenerative spondylolisthesis is present preoperatively.Cite this article: Bone Joint J 2022;104-B(12):1343-1351.
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Affiliation(s)
- Thomas Karlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden,Correspondence should be sent to Thomas Karlsson. E-mail:
| | - Peter Försth
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden
| | - Mikael Skorpil
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Konstantinos Pazarlis
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Stockholm Spine Center, Upplands Väsby, Sweden
| | - Patrik Öhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Sandén
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden
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Li P, Fei CS, Chen YL, Chen ZS, Lai ZM, Tan RQ, Yu YP, Xiang X, Dong JL, Zhang JX, Wang L, Zhang ZM. Revealing the novel autophagy-related genes for ligamentum flavum hypertrophy in patients and mice model. Front Immunol 2022; 13:973799. [PMID: 36275675 PMCID: PMC9581255 DOI: 10.3389/fimmu.2022.973799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fibrosis is a core pathological factor of ligamentum flavum hypertrophy (LFH) resulting in degenerative lumbar spinal stenosis. Autophagy plays a vital role in multi-organ fibrosis. However, autophagy has not been reported to be involved in the pathogenesis of LFH. Methods The LFH microarray data set GSE113212, derived from Gene Expression Omnibus, was analyzed to obtain differentially expressed genes (DEGs). Potential autophagy-related genes (ARGs) were obtained with the human autophagy regulator database. Functional analyses including Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment, Gene Set Enrichment Analysis (GSEA), and Gene Set Variation Analysis (GSVA) were conducted to elucidate the underlying biological pathways of autophagy regulating LFH. Protein-protein interaction (PPI) network analyses was used to obtain hub ARGs. Using transmission electron microscopy, quantitative RT-PCR, Western blotting, and immunohistochemistry, we identified six hub ARGs in clinical specimens and bipedal standing (BS) mouse model. Results A total of 70 potential differentially expressed ARGs were screened, including 50 up-regulated and 20 down-regulated genes. According to GO enrichment and KEGG analyses, differentially expressed ARGs were mainly enriched in autophagy-related enrichment terms and signaling pathways related to autophagy. GSEA and GSVA results revealed the potential mechanisms by demonstrating the signaling pathways and biological processes closely related to LFH. Based on PPI network analysis, 14 hub ARGs were identified. Using transmission electron microscopy, we observed the autophagy process in LF tissues for the first time. Quantitative RT-PCR, Western blotting, and immunohistochemistry results indicated that the mRNA and protein expression levels of FN1, TGFβ1, NGF, and HMOX1 significantly higher both in human and mouse with LFH, while the mRNA and protein expression levels of CAT and SIRT1 were significantly decreased. Conclusion Based on bioinformatics analysis and further experimental validation in clinical specimens and the BS mouse model, six potential ARGs including FN1, TGFβ1, NGF, HMOX1, CAT, and SIRT1 were found to participate in the fibrosis process of LFH through autophagy and play an essential role in its molecular mechanism. These potential genes may serve as specific therapeutic molecular targets in the treatment of LFH.
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Affiliation(s)
- Peng Li
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cheng-shuo Fei
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan-lin Chen
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ze-sen Chen
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhong-ming Lai
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rui-qian Tan
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yong-peng Yu
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Xiang
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jia-le Dong
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun-xiong Zhang
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liang Wang
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Academy of Orthopedics, Guangzhou, China
- *Correspondence: Liang Wang, ; Zhong-min Zhang,
| | - Zhong-min Zhang
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Liang Wang, ; Zhong-min Zhang,
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Sinclair CF, Bastien AJ, Ho AS. Radiofrequency ablation (RFA) compared to observation for benign thyroid nodules: emerging considerations for judicious use. Curr Opin Endocrinol Diabetes Obes 2022; 29:449-455. [PMID: 35943184 DOI: 10.1097/med.0000000000000739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Radiofrequency ablation (RFA) for thyroid nodules confers tangible advantages over surgery, which include promising outcomes in the context of a minimally invasive procedure and the functional benefits of organ preservation. However, the ubiquity of benign nodules worldwide may spur the risk of misuse in cases where there is negligible gain over conventional surveillance. This review summarizes new developments in RFA and examines its judicious utilization in benign nodules. RECENT FINDINGS RFA appears to be safe and effective for addressing compressive or cosmetic issues caused by benign functional and nonfunctional thyroid nodules. Volume regression occurs over 12 months, with some cases requiring multiple staged RFA procedures to achieve adequate shrinkage or to address regrowth. Complication rates including recurrent laryngeal nerve injury are reportedly low and are mitigated by strategic technical maneuvers, training, and experience. Consensus guidelines across international societies have emerged to better define appropriate patient candidates. Although association of overuse in analogous disciplines has been well established, no evidence of misuse in thyroid RFA has been described thus far. SUMMARY Compelling multi-institutional data support RFA as first-line treatment for select benign thyroid nodules. Defining the nuances of patient selection and long-term surveillance are necessary to substantiate current observed results. Given the high incidence of thyroid nodules worldwide, it is important to emphasize that the majority of benign nodules will not require any intervention. Thorough consideration and careful implementation of recommended guidelines will hopefully lead to measurable benefit and avoid financial misuse.
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Affiliation(s)
- Catherine F Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai
- Department of Surgery, Monash University, Melbourne, Australia
| | - Amanda J Bastien
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center
| | - Allen S Ho
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, USA
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Sajadi K, Azarhomayoun A, Jazayeri SB, Baigi V, Ranjbar Hameghavandi MH, Rostamkhani S, Atlasi R, Faghih Jooybari M, Ghodsi Z, Vaccaro AR, Khorasanizadeh M, Rahimi-Movaghar V. Long-Term Outcomes of Laminectomy in Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. Asian J Neurosurg 2022; 17:141-155. [PMID: 36120620 PMCID: PMC9473837 DOI: 10.1055/s-0042-1756421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Abstract
Objective Lumbar spinal stenosis (LSS) patients suffer from significant pain and disability. To assess long-term safety and efficacy of laminectomy in LSS patients, a systematic review and meta-analysis study was conducted.
Methods Literature review in MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library databases was performed using a predefined search strategy. Articles were included if they met the following characteristics: human studies, LSS, and at least 5 years of follow-up. Outcome measures included patient satisfaction, pain, disability, claudication, reoperation rates, and complications.
Results Twelve articles met the eligibility criteria for our study. Overall, there was low-quality evidence that patients undergoing laminectomy, with at least 5 years of follow-up, have significantly more satisfaction, and less pain and disability, compared with the preoperative baseline. Assessment of neurogenic intermittent claudication showed significant improvement in walking abilities. We also reviewed the postoperative complication and adverse events in the included studies. After meta-analysis was performed, the reoperation rate was found to be 14% (95% confidence interval: 13–16%).
Conclusion Our study provides low-quality evidence suggesting that patients undergoing laminectomy for LSS have less disability and pain and can be more physically active postoperatively.
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Affiliation(s)
- Kiavash Sajadi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Azarhomayoun
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behnam Jazayeri
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sabra Rostamkhani
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasha Atlasi
- Medical Library & Information Science, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Faghih Jooybari
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexander R. Vaccaro
- Department of Orthopedics and Neurosurgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - MirHojjat Khorasanizadeh
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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16
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Chen L, Zhu B, Zhong HZ, Wang YG, Sun YS, Wang QF, Liu JJ, Tian DS, Jing JH. The Learning Curve of Unilateral Biportal Endoscopic (UBE) Spinal Surgery by CUSUM Analysis. Front Surg 2022; 9:873691. [PMID: 35574554 PMCID: PMC9099005 DOI: 10.3389/fsurg.2022.873691] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/30/2022] [Indexed: 01/24/2023] Open
Abstract
ObjectiveTo assess the learning curve of the unilateral biportal endoscopic (UBE) technique for the treatment of single-level lumbar disc herniation by cumulative summation (CUSUM) method analysis.MethodsA retrospective analysis was conducted to assess 97 patients' general condition, operation time, complications, and curative effect of single segmental UBE surgery performed by a spinal surgeon in his early stage of this technique. The learning curve of operation time was studied using a CUSUM method, and the cut-off point of the learning curve was obtained.ResultsThe operation time was 30 – 241(97.9 ± 34.7) min. The visual analog scale score of lower limb pain decreased from 5.75 ± 0.81 before the operation to 0.39 ± 0.28 at the last follow-up (P < 0.05). The Oswestry disability index score decreased from 66.48 ± 4.43 before the operation to 14.57 ± 3.99 at the last follow-up (P < 0.05). The CUSUM assessment of operation time revealed the learning curve was the highest in 24 cases. In the learning stage (1–24 cases), the operation time was 120.3 ± 43.8 min. In the skilled stage (25–97 cases), the operation time was 90.5 ± 27.8 min.ConclusionsAbout 24 cases of single segmental UBE operation are needed to master the UBE technique.
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Decompression and Interlaminar Stabilization for Lumbar Spinal Stenosis: A Cohort Study and Two-Dimensional Operative Video. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040516. [PMID: 35454355 PMCID: PMC9031522 DOI: 10.3390/medicina58040516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Lumbar spinal stenosis is one of the most common causes of disability in the elderly and often necessitates surgical intervention in patients over the age of 65. Our study aimed to evaluate the clinical efficacy of interlaminar stabilization following decompressive laminectomy in patients with lumbar stenosis without instability. Materials and Methods: Twenty patients with lumbar stenosis underwent decompressive laminectomy and interlaminar stabilization at our academic institution. Clinical outcomes were measured using the visual analog scale (VAS) and Oswestry disability index (ODI) at the 2-month, 6-month, and 1-year postoperative visits, and these outcomes were compared to the preoperative scores. Results: The average VAS scores for low back pain significantly improved from 8.8 preoperatively to 4.0, 3.7, and 3.9 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). The average VAS scores for lower extremity pain significantly improved from 9.0 preoperatively to 2.7, 2.5, and 2.5 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). The average ODI scores significantly improved from 66.6 preoperatively to 23.8, 23.3, and 24.5 at 2 months, 6 months, and 1 year postoperatively, respectively (p < 0.001). There was no statistical significance for difference in VAS or ODI scores between 2 months, 6 months, and 1 year. One patient had an intraoperative durotomy that was successfully treated with local repair and lumbar drainage. Another patient had progression of stenosis and had to undergo bilateral facetectomy and fusion. Conclusions: Decompressive laminectomy and interlaminar stabilization in patients with spinal claudication and low back pain is a good surgical option in the absence of instability and may provide significant clinical improvement of pain and functional disability.
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Hermansen E, Austevoll IM, Hellum C, Storheim K, Myklebust TÅ, Aaen J, Banitalebi H, Anvar M, Rekeland F, Brox JI, Franssen E, Weber C, Solberg TK, Furunes H, Grundnes O, Brisby H, Indrekvam K. Comparison of 3 Different Minimally Invasive Surgical Techniques for Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e224291. [PMID: 35344046 PMCID: PMC8961320 DOI: 10.1001/jamanetworkopen.2022.4291] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE Operations for lumbar spinal stenosis is the most often performed surgical procedure in the adult lumbar spine. This study reports the clinical outcome of the 3 most commonly used minimally invasive posterior decompression techniques. OBJECTIVE To compare the effectiveness of 3 minimally invasive posterior decompression techniques for lumbar spinal stenosis. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial used a parallel group design and included patients with symptomatic and radiologically verified lumbar spinal stenosis without degenerative spondylolisthesis. Patients were enrolled between February 2014 and October 2018 at the orthopedic and neurosurgical departments of 16 Norwegian public hospitals. Statistical analysis was performed in the period from May to June 2021. INTERVENTIONS Patients were randomized to undergo 1 of the 3 minimally invasive posterior decompression techniques: unilateral laminotomy with crossover, bilateral laminotomy, and spinous process osteotomy. MAIN OUTCOMES AND MEASURES Primary outcome was change in disability measured with Oswestry Disability Index (ODI; range 0-100), presented as mean change from baseline to 2-year follow-up and proportions of patients classified as success (>30% reduction in ODI). Secondary outcomes were mean change in quality of life, disease-specific symptom severity measured with Zurich Claudication Questionnaire (ZCQ), back pain and leg pain on a 10-point numeric rating score (NRS), patient perceived benefit of the surgical procedure, duration of the surgical procedure, blood loss, perioperative complications, number of reoperations, and length of hospital stay. RESULTS In total, 437 patients were included with a median (IQR) age of 68 (62-73) years and 230 men (53%). Of the included patients, 146 were randomized to unilateral laminotomy with crossover, 142 to bilateral laminotomy, and 149 to spinous process osteotomy. The unilateral laminotomy with crossover group had a mean change of -17.9 ODI points (95% CI, -20.8 to -14.9), the bilateral laminotomy group had a mean change of -19.7 ODI points (95% CI, -22.7 to -16.8), and the spinous process osteotomy group had a mean change of -19.9 ODI points (95% CI, -22.8 to -17.0). There were no significant differences in primary or secondary outcomes among the 3 surgical procedures, except a longer duration of the surgical procedure in the bilateral laminotomy group. CONCLUSIONS AND RELEVANCE No differences in clinical outcomes or complication rates were found among the 3 minimally invasive posterior decompression techniques used to treat patients with lumbar spinal stenosis. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02007083.
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Affiliation(s)
- Erland Hermansen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Hofseth BioCare, Ålesund, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Registration, Cancer Registry Norway, Oslo, Norway
| | - Jørn Aaen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Eric Franssen
- Department of Orthopedics, Stavanger University Hospital, Stavanger, Norway
| | - Clemens Weber
- Department of Orthopedics, Stavanger University Hospital, Stavanger, Norway
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Tore K. Solberg
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Håvard Furunes
- Department of Surgery, Gjøvik Hospital, Innlandet Hospital Trust, Brumunddal, Norway
- Institute of Health and Society Studies, University of Oslo, Oslo, Norway
| | - Oliver Grundnes
- Department of Orthopedics, Akershus University Hospital, Oslo, Norway
| | - Helena Brisby
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Ammendolia C, Hofkirchner C, Plener J, Bussières A, Schneider MJ, Young JJ, Furlan AD, Stuber K, Ahmed A, Cancelliere C, Adeboyejo A, Ornelas J. Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review. BMJ Open 2022; 12:e057724. [PMID: 35046008 PMCID: PMC8772406 DOI: 10.1136/bmjopen-2021-057724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication. DESIGN A systematic review. DATA SOURCES CENTRAL, MEDLINE, EMBASE, CINAHL and Index to Chiropractic Literature databases were searched and updated up to 22 July 2020. ELIGIBILITY CRITERIA We only included randomised controlled trials published in English where at least one arm provided data on non-operative treatment and included participants diagnosed with neurogenic claudication with imaging confirmed LSS. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias using the Cochrane Risk of Bias Tool 1. Grading of Recommendations Assessment, Development and Evaluation was used for evidence synthesis. RESULTS Of 15 200 citations screened, 156 were assessed and 23 new trials were identified. There is moderate-quality evidence from three trials that: Manual therapy and exercise provides superior and clinically important short-term improvement in symptoms and function compared with medical care or community-based group exercise; manual therapy, education and exercise delivered using a cognitive-behavioural approach demonstrates superior and clinically important improvements in walking distance in the immediate to long term compared with self-directed home exercises and glucocorticoid plus lidocaine injection is more effective than lidocaine alone in improving statistical, but not clinically important improvements in pain and function in the short term. The remaining 20 new trials demonstrated low-quality or very low-quality evidence for all comparisons and outcomes, like the findings of our original review. CONCLUSIONS There is moderate-quality evidence that a multimodal approach which includes manual therapy and exercise, with or without education, is an effective treatment and that epidural steroids are not effective for the management of LSS with neurogenic claudication. All other non-operative interventions provided insufficient quality evidence to make conclusions on their effectiveness. PROSPERO REGISTRATION NUMBER CRD42020191860.
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Affiliation(s)
- Carlo Ammendolia
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rheumatology, Sinai Health System, Toronto, Ontario, Canada
| | - Corey Hofkirchner
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Joshua Plener
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculy of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, boulevard des Forges, Trois-Rivières Québec, Canada
| | | | - James J Young
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Sports Medicine and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Andrea D Furlan
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Kent Stuber
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Aksa Ahmed
- Rheumatology, Sinai Health System, Toronto, Ontario, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Aleisha Adeboyejo
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Joseph Ornelas
- Health Systems Management, Rush University, Chicago, Illinois, USA
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20
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Jiang Y, Yin J, Nong L, Xu N. Uniportal Full-Endoscopic versus Minimally Invasive Decompression for Lumbar Spinal Stenosis: A Meta-analysis. J Neurol Surg A Cent Eur Neurosurg 2022; 83:523-534. [PMID: 34991170 DOI: 10.1055/s-0041-1739208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In this study, we systematically analyze the effectiveness of the uniportal full-endoscopic (UPFE) and minimally invasive (MIS) decompression for treatment of lumbar spinal stenosis patients. METHODS We performed a systematic search in Medline, Embase, Europe PMC, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, China national knowledge infrastructure, and Wanfang Data databases for all relevant studies. All statistical analyses were performed using Review Manager version 5.3. RESULTS A total of 9 articles with 522 patients in the UPFE group and 367 patients in the MIS group were included. The results of the meta-analysis showed that the UPFE group had significantly better results in hospital stay time (mean difference [MD]: -2.05; 95% confidence interval [CI]: -2.87 to -1.23), intraoperative blood loss (MD: -36.56; 95% CI: -54.57 to -18.56), and wound-related complications (MD: -36.56; 95%CI: -54.57 to -18.56) compared with the MIS group, whereas the postoperative clinical scores (MD: -0.66; 95%CI: -1.79 to 0.47; MD: -0.75; 95%CI: -1.86 to 0.36; and MD: -4.58; 95%CI: -16.80 to 7.63), satisfaction rate (odds ratio [OR] = 1.24; 95%CI: 0.70-2.20), operation time (MD: 30.31; 95%CI: -12.55 to 73.18), complication rates for dural injury (OR = 0.60; 95%CI: 0.29-1.26), epidural hematoma (OR = 0.60; 95%CI: 0.29-1.26), and postoperative transient dysesthesia and weakness (OR = 0.73; 95%CI: 0.36-1.51) showed no significant differences between the two groups. CONCLUSIONS The UPFE decompression is associated with shorter hospital stay time and lower intraoperative blood loss and wound-related complications compared with MIS decompression for treatment of lumbar spinal stenosis patients. The postoperative clinical scores, satisfaction rate, operation time, complication rates for dural injury, epidural hematoma, and postoperative transient dysesthesia and weakness did not differ significantly between two groups.
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Affiliation(s)
- Yuqing Jiang
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Jianjian Yin
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Luming Nong
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Nanwei Xu
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
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21
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Pan W, Ruan B. Surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia for treating elderly patients with lumbar central canal stenosis. Neurosurg Focus 2021; 51:E5. [PMID: 34852321 DOI: 10.3171/2021.9.focus21420] [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: 07/10/2021] [Accepted: 09/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical decompression via a posterior interlaminar approach is widely used for treating lumbar central canal stenosis (LCCS). However, this surgical approach poses a challenge for elderly patients with comorbidities. Thus, the authors tried a new surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia to treat such patients. The aim of this study was to evaluate the safety and effectiveness of surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia for patients with LCCS. METHODS Patients with LCCS who underwent surgical decompression, performed by a single surgeon, between January 2016 and March 2019 were retrospectively analyzed. All patients received decompression via the unilateral intervertebral foraminal approach with local anesthesia. Visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, modified Macnab criteria, walking distance, and Schizas classification were used as outcome predictors. Additionally, a decompression evaluation method was designed for use after spinal endoscopic surgery. RESULTS Overall, 23 patients with a mean age of 69 years were included in this study, with a mean follow-up of 28 months. Low-back and leg pain were significantly improved after decompression surgery. Postoperative ODI scores and walking distances were statistically significantly better than before surgery. Postoperatively, the Schizas classification for all patients was improved by at least 1 grade compared with the preoperative grade. No complications occurred during the follow-up period. According to the novel decompression evaluation method, all patients had at least achieved decompression in part 123+B. CONCLUSIONS Surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia showed promising outcomes in the treatment of elderly patients with LCCS. Additionally, a proposed postoperative decompression evaluation method can help guide surgical decompression.
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Affiliation(s)
- Weibo Pan
- 1Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang.,2Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang.,3Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang; and
| | - Boqing Ruan
- 4Department of Orthopedics, Taizhou Orthopedics Hospital, Wenling, Zhejiang, China
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22
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Thread Embedding Acupuncture and Complex Korean Medicine Treatment for Lumbar Spinal Stenosis with Degenerative Scoliosis: A Clinical Case Report. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2021.00108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lumbar spinal stenosis (LSS) is a common degenerative spinal condition that can have unpredictable improvement and worsening of symptoms which include low back pain, radiating pain, claudication, and degenerative lumbar scoliosis affecting quality of life. In this study, thread embedding acupuncture (TEA) was used as a conservative treatment for LSS in combination with complex Korean medicine treatments (acupuncture, herbal medicines, and physical therapy). The treatment was evaluated using the numerical rating scale, walking distance and duration, and inclination of radiological lumbar scoliosis according to antalgic posture. TEA was performed 27 times between June 8, 2020, and March 16, 2021. The patient showed improvement in numerical rating scale score from 7 to 2, pain-free walking distance from 10 m to 900 m, and scoliosis inclination following treatment. The findings of this study suggest that TEA may be helpful in the treatment of LSS.
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23
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Kim HS, Sharma SB, Raorane HD, Kim KR, Jang IT. Early results of full-endoscopic decompression of lumbar central canal stenosis by outside-in technique: A clinical and radiographic study. Medicine (Baltimore) 2021; 100:e27356. [PMID: 34596144 PMCID: PMC8483834 DOI: 10.1097/md.0000000000027356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
Retrospective cohort study.Full-endoscopic decompression of lumbar spinal canal stenosis is being performed by endoscopic surgeons as an alternative to micro-lumbar decompression in the recent years. The outcomes of the procedure are reported by few authors only. The aim of this paper is to report the clinical and radiographic outcomes of full endoscopic lumbar decompression of central canal stenosis by outside-in technique at 1-year follow-up.We reviewed patients operated for lumbar central canal stenosis by full endoscopic decompression from May 2018 to November 2018. We analyzed the visual analogue scale scores for back and leg pain and Oswestry disability index at pre-op, post-op, and 1-year follow-up. At the same periods, we also evaluated disc height, segmental lordosis, whole lumbar lordosis on standing X-rays and canal cross sectional area at the affected level and at the adjacent levels on magnetic resonance imaging and the facet length and facet cross-sectional area on computed tomography scans. The degree of stenosis was judged by Schizas grading and the outcome at final follow-up was evaluated by MacNab criteria.We analyzed 32 patients with 43 levels (M:F = 14:18) with an average age of 63 (±11) years. The visual analogue scale back and leg improved from 5.4 (±1.3) and 7.8 (±2.3) to 1.6 (±0.5) and 1.4 (±1.2), respectively, and Oswestry disability index improved from 58.9 (±11.2) to 28 (±5.4) at 1-year follow-up. The average operative time per level was 50 (±16.2) minutes. The canal cross sectional area, on magnetic resonance imaging, improved from 85.78 mm2 (±28.45) to 150.5 mm2 (±38.66). The lumbar lordosis and segmental lordosis also improved significantly. The disc height was maintained in the postoperative period. All the radiographic improvements were maintained at 1-year follow-up. The MacNab criteria was excellent in 18 (56%), good in 11 (34%), and fair in 3 (9%) patients. None of the patients required conversion to open surgery or a revision surgery at follow-up. There was 1 patient with dural tear that was sealed with fibrin sealant patch endoscopically. There were 10 patients who had grade I stable listhesis preoperatively that did not progress at follow-up. No other complications like infection, hematoma formations etc. were observed in any patient.Full endoscopic outside-in decompression method is a safe and effective option for lumbar central canal stenosis with advantages of minimal invasive technique.
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Affiliation(s)
- Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Hospital Gangnam, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | | | - Harshavardhan D. Raorane
- Department of Neurosurgery, Nanoori Hospital Gangnam, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Kyeong-Rae Kim
- Department of Neurosurgery, Nanoori Hospital Gangnam, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
- Nanoori Gangnam Hospital, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea ZIP-06048
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Hospital Gangnam, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
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24
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Pérez-López JC, Olivella G, Cartagena M, Nieves-Ríos C, Acosta-Julbe J, Ramírez N, Massanet-Volrath J, Montañez-Huertas J, Escobar E. Associated factors of patients with spinal stenosis who undergo reoperation after a posterior lumbar spinal fusion in a Hispanic-American population. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1491-1499. [PMID: 34550474 DOI: 10.1007/s00590-021-03127-5] [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: 06/02/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the associated factors of patients with LSS who undergo reoperation after a PLSF in a Hispanic-American population. METHODS A retrospective single-center review was performed from all non-age-related Hispanic-Americans with LSS who underwent one or two-level PLSF from 2008 to 2018. Baseline characteristics were analyzed between the reoperation and no-reoperation group using a bivariate and multivariate analyses. RESULTS Out of 425 patients who underwent PLSF, 38 patients underwent reoperation. At a two-year follow-up, the reoperation rate was 6.1% (26/425), mostly due to pseudoarthrosis (39.5%), recurrent stenosis (26.3%), new condition (15.8%), infection (10.5%), hematoma (5.3%), and dural tear (2.6%). Patients who underwent reoperation were more likely to have a preoperative history of epidural steroid injection (ESI) (OR 5.18, P = 0.009), four or more comorbidities (OR 2.69, P = 0.028), and operated only with a posterolateral fusion without intervertebral fusion (OR 2.15, P = 0.032). Finally, the multivariable analysis showed that ESI was the only independent associated factor in patients who underwent reoperation after a PLSF in our group. CONCLUSION Among this population who underwent surgery, a reoperation rate at two years of follow-up was less than ten percent. Our study did not find any associated factor inherent to Hispanic-Americans, as ethnic group, who were reoperated after LSS.
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Affiliation(s)
- José C Pérez-López
- Orthopaedic Surgery Department, Medical Sciences Campus, UPR, PO Box 365067, San Juan, PR, 00936-5067, USA
| | - Gerardo Olivella
- Orthopaedic Surgery Department, Medical Sciences Campus, UPR, PO Box 365067, San Juan, PR, 00936-5067, USA.
| | - Miguel Cartagena
- Surgery Department, School of Medicine, Ponce Health Sciences University, Ponce, PR, 00716, USA
| | - Christian Nieves-Ríos
- Surgery Department, School of Medicine, Ponce Health Sciences University, Ponce, PR, 00716, USA
| | - José Acosta-Julbe
- School of Medicine, Medical Sciences Campus, UPR, San Juan, PR, 00936-5067, USA
| | - Norman Ramírez
- Pediatric Orthopaedic Surgery Department, Mayagüez Medical Center, Mayagüez, PR, 00681, USA
| | - José Massanet-Volrath
- Orthopaedic Surgery Department, Medical Sciences Campus, UPR, PO Box 365067, San Juan, PR, 00936-5067, USA
| | - José Montañez-Huertas
- Orthopaedic Surgery Department, Medical Sciences Campus, UPR, PO Box 365067, San Juan, PR, 00936-5067, USA
| | - Enrique Escobar
- Orthopaedic Surgery Department, Medical Sciences Campus, UPR, PO Box 365067, San Juan, PR, 00936-5067, USA
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25
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Cook CE, Garcia AN, Park C, Gottfried O. True Differences in Poor Outcome Risks Between Revision and Primary Lumbar Spine Surgeries. HSS J 2021; 17:192-199. [PMID: 34421430 PMCID: PMC8361594 DOI: 10.1177/1556331621995136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/16/2022]
Abstract
Background: Previous studies have shown that the rates of complications associated with revision spine surgery are higher than those of primary spine surgery. However, there is a lack of research exploring the difference in magnitude of risk of poor outcomes between primary and revision lumbar spine surgeries. Purposes: We sought to compare the risks of poor outcomes for primary and revision lumbar spine surgeries and to analyze different measures of risk to better understand the true differences between the 2 forms of surgery. Methods: This retrospective observational study used data from the Quality Outcomes Database Lumbar Spine Surgical Registry from 2012 to 2018. We included individuals who received primary or revision surgery due to degenerative lumbar disorders. Outcome variables collected were complications within 30 days of surgery and 3 destination variables, specifically, (1) 30-day hospital readmission, (2) 30-day return to operating room, and (3) revision surgery within 3 months. Measures of risk considered were odds ratio (OR), relative risk (RR), relative risk increase (RRI), and absolute risk increase (ARI). Results: There were 31,843 individuals who received primary surgery and 7889 who received revision surgery. After controlling for baseline descriptive variables and comorbidities, revision surgery increased the odds of 4 complications and all 3 destination variables. Risk ratios reflected smaller magnitudes but similar findings as the statistically significant ORs. Conclusion: Revision surgery is related to higher overall risks than primary surgery, but the true magnitudes of these risks are very small. RRI and ARI should be included when reporting ORs to better clarify the significance.
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Affiliation(s)
- Chad E. Cook
- Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University, Durham, NC, USA
| | - Alessandra N. Garcia
- College of Pharmacy & Health Sciences, Division of Physical Therapy, Department of Orthopaedic Surgery, Campbell University, Lillington, NC, USA
| | - Christine Park
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA,Christine Park, BA, Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Oren Gottfried
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Srour R, Gdoura Y, Delaitre M, Mortada J, Benali MA, Millot F, Hritcu D, Timofeev A, Sellal F. Facet Arthrodesis with the FFX Device: One-Year Results from a Prospective Multicenter Study. Int J Spine Surg 2020; 14:996-1002. [PMID: 33560260 PMCID: PMC7872413 DOI: 10.14444/7149] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Facet osteosynthesis can be performed to treat facet syndrome (FS) and reduce spinal instability following laminectomy in patients with lumbar spinal stenosis (LSS). The present study evaluated clinical and radiological outcomes following facet osteosynthesis with the FFX device. METHODS Patients with FS or LSS were prospectively enrolled in a single-arm, multicenter study. The device was placed at affected levels with or without concomitant posterior lumbar interbody fusion (PLIF) procedures. The visual analog scale (VAS) for back and leg pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Computed tomography scans to assess fusion and migration were performed 1 year following surgery. RESULTS Fifty-three patients (26 men/27 women) with a mean age of 65.0 ± 9.6 years (range: 37-83 years) were enrolled. A total of 205 FFX devices were implanted with 15 patients undergoing concurrent PLIF procedures. There were no intraoperative or postoperative surgical complication reported, and no patient required revision surgery. Mean VAS leg and back pain scores significantly improved from 5.57 to 2.09 (P < .001) and 5.74 to 3.13 (P < .001), respectively, between the preoperative and 1 year follow-up assessments. Mean ODI scores also significantly improved from 44.7% to 24.0% (P < .001) during the same time period. Facet fusion occurred with 86.3% of device placements after 12 months. There was 1 (0.5%) asymptomatic device migration. Eight devices (3.9%) were considered misplaced. CONCLUSIONS The use of the FFX device is associated with a significant reduction in both pain and disability following surgery with a high facet joint fusion rate. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE This is the first study reporting clinical experience using the FFX device to facilitate facet osteosynthesis. The ability of the device to relieve pain, reduce disability, and enhance lumbar facet fusion with a low rate of device misplacement and migration was demonstrated.
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Factors associated with the reporting quality of low back pain systematic review abstracts in physical therapy: a methodological study. Braz J Phys Ther 2020; 25:233-241. [PMID: 33246869 DOI: 10.1016/j.bjpt.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/03/2020] [Accepted: 10/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Abstracts of systematic reviews (SR) are frequently used to guide clinical decision-making. However, if the abstract is inadequately reported, key information may be missing and it may not accurately summarize the results of the review. OBJECTIVE We aimed to investigate 1) if abstracts are fully reported; 2) if abstract reporting is associated with review/journal characteristics in physical therapy for low back pain (LBP); and 3) if these abstracts are consistent with the corresponding full texts. METHODS We searched the Physiotherapy Evidence Database for SRs in physical therapy for LBP published between 2015 and 2017. Associations between abstract reporting quality and review/journal characteristics were explored with linear regression. Abstract reporting was assessed with the 12 item Preferred Reporting Items for Systematic Reviews and Meta-Analyses for abstracts (PRISMA-A) checklist. Consistency of reporting between abstracts and the full text was evaluated by comparing responses to each item of the PRISMA-A using Kappa coefficients. Methodological quality of the reviews was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). RESULTS We included 66 SRs, 9 Cochrane and 57 non-Cochrane. Review methodological quality ranged from 'high' (8%) to 'critically low' (76%). The mean ± SD of the "total number of PRISMA-A fully reported items" (range 0-12 points for fully reported items) was 4.1 ± 1.9 points for non-Cochrane review abstracts and 9.9 ± 1.1 points for Cochrane abstracts. Factors associated with reporting quality of abstracts were: journal impact factor (ß 0.20; 95% CI: 0.06, 0.35), number of words in abstract (ß 0.01; 95% CI: 0.00, 0.01) and review methodological quality ('critically low' with ß -3.06; 95% CI: -5.30, -0.82; with 'high' as reference variable). There was typically inconsistent reporting between abstract and full text, with most Kappa values lower than 0.60. CONCLUSIONS The abstracts of SRs in physical therapy for LBP were poorly reported and inconsistent with the full text. The reporting quality of abstracts was higher in journals with a higher impact factor, in abstracts with a greater number of words, and when the review was of higher methodological quality.
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Comer C, Lee H, Williamson E, Lamb S. Understanding the mechanisms of a combined physical and psychological intervention for people with neurogenic claudication: protocol for a causal mediation analysis of the BOOST trial. BMJ Open 2020; 10:e037121. [PMID: 32878759 PMCID: PMC7470505 DOI: 10.1136/bmjopen-2020-037121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Conservative treatments such as exercise are recommended for the management of people with neurogenic claudication from spinal stenosis. However, the effectiveness and mechanisms of effect are unknown. This protocol outlines an a priori plan for a secondary analysis of a multicentre randomised controlled trial of a physiotherapist-delivered, combined physical and psychological intervention (Better Outcomes for Older people with Spinal Trouble (BOOST) programme). METHODS AND ANALYSES We will use causal mediation analysis to estimate the mechanistic effects of the BOOST programme on the primary outcome of disability (measured by the Oswestry Disability Index). The primary mechanism of interest is walking capacity, and secondary mediators include fear-avoidance behaviour, walking self-efficacy, physical function, physical activity and/or symptom severity. All mediators will be measured at 6 months and the outcome will be measured at 12 months from randomisation. Patient characteristics and possible confounders of the mediator-outcome effect will be measured at baseline. Sensitivity analyses will be conducted to evaluate the robustness of the estimated effects to varying levels of residual confounding. ETHICS AND DISSEMINATION Ethical approval was given on 3 March 2016 (National Research Ethics Committee number: 16/LO/0349). The results of this analysis will be disseminated in peer-reviewed journals and at relevant scientific conferences. TRIAL REGISTRATION NUMBER ISRCTN12698674.
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Affiliation(s)
- Christine Comer
- Musculoskeletal and Rehabilitation Services, Leeds Community Healthcare NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Hopin Lee
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
- The Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxfordshire, UK
| | - Esther Williamson
- The Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxfordshire, UK
| | - Sarah Lamb
- The Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxfordshire, UK
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
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Hennemann S, de Abreu MR. Degenerative Lumbar Spinal Stenosis. Rev Bras Ortop 2020; 56:9-17. [PMID: 33627893 PMCID: PMC7895619 DOI: 10.1055/s-0040-1712490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/02/2020] [Indexed: 11/22/2022] Open
Abstract
Degenerative lumbar spinal stenosis is the most frequent cause of low back pain and/or sciatica in the elderly patient. Epidemiology, pathophysiology, clinical manifestations and testing are reviewed in a wide current bibliographic investigation. The importance of the relationship between clinical presentation and imaging study, especially magnetic resonance imaging (MRI), is emphasized. Prior to treatment indication, it is necessary to identify the precise location of pain, as well as the differential diagnosis between neurological and vascular lameness. Conservative treatment combining medications with various physical therapy techniques solves the problem in most cases, while therapeutic testing with injections, whether epidural, foraminal or facetary, is performed when pain does not subside with conservative treatment and before surgery is indicated. Injections usually perform better results in relieving sciatica symptoms and less in neurological lameness. Equine tail and/or root decompression associated or not with fusion is the gold standard when surgical intervention is required. Fusion after decompression is necessary in cases with segmental instability, such as degenerative spondylolisthesis. When canal stenosis occurs at multiple levels and is accompanied by axis deviation, whether coronal and/or sagittal, correction of axis deviations should be performed in addition to decompression and fusion, especially of the sagittal axis, in which a lumbar lordosis correction is required with techniques that correct the rectified lordosis to values close to the pelvic incidence.
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Affiliation(s)
- Sergio Hennemann
- Serviço de Ortopedia, Grupo da coluna, Hospital Mãe de Deus, Porto Alegre, RS, Brasil
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Iwai H, Inanami H, Koga H. Comparative study between full-endoscopic laminectomy and microendoscopic laminectomy for the treatment of lumbar spinal canal stenosis. JOURNAL OF SPINE SURGERY 2020; 6:E3-E11. [PMID: 32656392 DOI: 10.21037/jss-20-620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Lumbar spinal canal stenosis (LSCS) is a common disease in the elderly. Although surgical decompression using a posterior approach is commonly used to treat LSCS, there are several different strategies. We compared the outcomes of uniportal full-endoscopic laminectomy (FEL) and microendoscopic laminectomy (MEL) for treating LSCS. Methods FEL was performed using a 6.4-mm working channel endoscope and MEL was performed using a 16-mm diameter tubular retractor and endoscope. Patients with LSCS treated with FEL (n=60) and MEL (n=54) in our hospital during the same period were retrospectively reviewed. Patient background information and operative data were collected. The satisfaction score was also recorded at discharge and 3 months postoperatively. Results The mean operation time for FEL and MEL was 77.8 min and 54.6 min, respectively. The mean hospital stay after FEL and MEL surgery was 2.1 days and 4.7 days, respectively. These outcomes were significantly different between the two approaches. The satisfaction scores at both stages were not significantly different between the two groups. A dural tear occurred in one patient who underwent FEL and three patients who underwent MEL, but no symptoms resulted from the tear. Although postoperative hematoma occurred in seven who underwent FEL and two who underwent MEL, only one patient who underwent FEL required operative evacuation of the hematoma. Conclusions FEL using a 6.4-mm working channel endoscope can be used to treat patients with LSCS. Shortening of the operation time and prevention of postoperative hematoma are essential for this approach to be completely superior to MEL.
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Affiliation(s)
- Hiroki Iwai
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
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Patients With Persistent Low Back Pain and Nerve Root Involvement: To Operate, or Not to Operate, That Is the Question. Spine (Phila Pa 1976) 2020; 45:483-490. [PMID: 31658235 DOI: 10.1097/brs.0000000000003304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE The aims of this study were to evaluate the outcome of surgical and nonsurgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after 2 years and to identify predictors for nonsuccess. SUMMARY OF BACKGROUND DATA Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted. METHODS This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Nonsuccess was defined as a Roland-Morris Disability score above 4 (0-23) or a Numeric Rating Scale back and leg pain score above 20 (0-60). Uni- and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and magnetic resonance imaging findings. RESULTS Rates of nonsuccess at 2 years were approximately 30% in surgically treated patients with LHD, approximately about 60% in patients with LSS for disability, and 30% and 40%, respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, nonsuccess after surgery was associated with male sex (odds ratio [OR] 2.04, 95% confidence interval [CI]: 1.02-4.11, P = 0.04), low level of education (OR 2.60, 95% CI: 1.28-5.29, P = 0.01), high pain intensity (OR 3.06, 95% CI: 1.51-6.21, P < 0.01), and widespread pain (OR 3.59, 95% CI: 1.36-9.46, P = 0.01). CONCLUSION The results indicate that the prognosis for patients referred for surgery with persistent LHD or LSS and unsuccessful conservative treatment is substantially better when surgery is performed as opposed to not performed. The predictive value of the variables male sex, low level of education, high pain intensity, and widespread pain location found in our study are partly in accordance with results of previous studies. Thus, our results warrant further investigation until firm conclusions can be made. LEVEL OF EVIDENCE 3.
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Winebrake JP, Lovecchio F, Steinhaus M, Farmer J, Sama A. Wide Variability in Patient-Reported Outcomes Measures After Fusion for Lumbar Spinal Stenosis: A Systematic Review. Global Spine J 2020; 10:209-215. [PMID: 32206520 PMCID: PMC7076598 DOI: 10.1177/2192568219832853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The purpose of this study is to review outcomes reporting methodology in studies evaluating fusion for lumbar spinal stenosis. METHODS A systematic review of PubMed and Embase databases was conducted from January 2007 to June 2017 for English language studies with minimum of 2 years postoperative follow-up reporting outcomes after fusion for lumbar spinal stenosis. Two reviewers assessed each study; those meeting inclusion criteria were examined for pertinent data. Outcome measures were categorized into relevant domains: pain/symptomatology, function/disability, and surgical satisfaction. Return to work reporting was also recorded. RESULTS Of 123 studies meeting inclusion criteria, 76% included posterior-only fusion, 32% included posterior/transforaminal interbody fusion, and 5% included anterior/lateral interbody fusion (non-mutually exclusive). There was significant variation in patient-reported outcomes (PROs) used-studies reported 31 unique PROs assessing at least one domain: 22 evaluating pain, 23 evaluating function, and 3 evaluating surgical satisfaction. Most commonly utilized PROs were the Oswestry Disability Index (73% of studies), Visual Analog Scale (55%), and 36-Item Short Form Survey (32%). The remaining 28 measures were used in 14% of studies or fewer. PROs specific to symptoms of lumbar spinal stenosis, such as the Zurich Claudication Questionnaire, were only used rarely (7/123 studies). Only 14% of studies reported on time to return to work. CONCLUSIONS The literature surrounding fusion in the setting of lumbar stenosis is characterized by substantial variability in outcomes reporting. Very few studies utilized measures specific to lumbar spinal stenosis. Efforts to standardize outcomes reporting would facilitate comparisons of surgical interventions.
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Affiliation(s)
- James P. Winebrake
- Weill Cornell Medicine, New York, NY, USA,James P. Winebrake, Cornell University Joan and Sanford I Weill Medical College, 420 East 70th Street, 13K-2, New York, NY 10021, USA.
| | | | | | - James Farmer
- The Hospital for Special Surgery, New York, NY, USA
| | - Andrew Sama
- The Hospital for Special Surgery, New York, NY, USA
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Eight in Every 10 Abstracts of Low Back Pain Systematic Reviews Presented Spin and Inconsistencies With the Full Text: An Analysis of 66 Systematic Reviews. J Orthop Sports Phys Ther 2020; 50:17-23. [PMID: 31443622 DOI: 10.2519/jospt.2020.8962] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Overview study. BACKGROUND Abstracts of systematic reviews have presented 'spin' (i.e. overstated interpretation of study results) and inconsistency with the full text. OBJECTIVES 1. Do abstracts of low back pain reviews contain spin? 2. Do these abstracts consistently represent the full text? 3. Is abstract spin associated with the type of conclusion? METHODS We searched the Physiotherapy Evidence Database (PEDro) on 10th January 2018. Data were extracted from systematic reviews of physiotherapy interventions for low back pain, published between 2015 and 2017. Spin was assessed using a 7-item checklist. We evaluated consistency by comparing information contained in the abstract and the full text using the 7-item checklist with Kappa coefficient analysis. We used logistic regression analysis to evaluate the association between spin in the abstract and type of conclusion. We evaluated methodological quality using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). RESULTS We included 66 eligible systematic reviews, subdivided into Cochrane (n=9) and non-Cochrane (n=57) reviews. There was some form of spin in 80% of abstracts. Abstracts of non-Cochrane reviews were not consistent with the full text (fair to moderate agreement). Cochrane review abstracts had substantial to almost perfect agreement with the full text. Spin was not associated with the type of conclusion in all systematic reviews (P < 0.05). The methodological quality ranged from 'high' to 'critically low'. CONCLUSIONS The abstracts of systematic reviews evaluating physiotherapy interventions for low back pain need improvement. J Orthop Sports Phys Ther, Epub 23 Aug 2019. doi:10.2519/jospt.2020.8962.
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Bumann H, Nüesch C, Loske S, Byrnes SK, Kovacs B, Janssen R, Schären S, Mündermann A, Netzer C. Severity of degenerative lumbar spinal stenosis affects pelvic rigidity during walking. Spine J 2020; 20:112-120. [PMID: 31479778 DOI: 10.1016/j.spinee.2019.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT To understand the role of compensation mechanisms in the development and treatment of symptomatic degenerative lumbar spinal stenosis (DLSS), pelvic stability during walking should be objectively assessed in the context of clinical parameters. PURPOSE To determine the association among duration of symptoms, lumbar muscle atrophy, disease severity, pelvic stability during walking, and surgical outcome in patients with DLSS scheduled for decompression surgery. STUDY DESIGN/SETTING Prospective observational study with intervention. PATIENT SAMPLE Patients with symptomatic DLSS. OUTCOME MEASURES Oswestry Disability Index score; duration of symptoms; lumbar muscle atrophy; severity grade; pelvis rigidity during walking. METHODS Patients with symptomatic DLSS were analyzed on the day before surgery and 10 weeks and 12 months postoperatively. Duration of symptoms was categorized as: <2years, <5years, and >5years. Muscle atrophy at the stenosis level was categorized according to Goutallier. Bilateral cross-sectional areas of the erector spinae and psoas muscles were quantified from magnetic resonance imaging. Stenosis grade was assessed using the Schizas classification. Pelvic tilt was measured in standing radiographs. Pelvic rigidity during walking was assessed as root mean square of the pelvic acceleration in each direction (anteroposterior, mediolateral, and vertical) normalized to walking speed measured using an inertial sensor attached to the skin between the posterior superior iliac spine. RESULTS Body mass index but not duration of symptoms, lumbar muscle atrophy, pelvic rigidity, and stenosis grade explained changes in Oswestry Disability Index from before to after surgery. Patients with greater stenosis grade had greater pelvic rigidity during walking. Lumbar muscle atrophy did not correlate with pelvic rigidity during walking. Patients with lower stenosis grade had greater muscle atrophy and patients with smaller erector spinae and psoas muscle cross-sectional areas had a greater pelvis tilt. CONCLUSIONS Greater pelvic rigidity during walking may represent a compensatory mechanism of adopting a protective body position to keep the spinal canal more open during walking and hence reduce pain. Pelvic rigidity during walking may be a useful screening parameter for identifying early compensating mechanisms. Whether it can be used as a parameter for personalized treatment planning or outcome prognosis necessitates further evaluation.
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Affiliation(s)
- Helen Bumann
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Corina Nüesch
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stefan Loske
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - S Kimberly Byrnes
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland; Faculty for Sport and Health Science, Technische Universität München, Munich, Germany
| | - Balázs Kovacs
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Ruben Janssen
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Annegret Mündermann
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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Standaert CJ, Li JW, Glassman SJ, Manolov NE, Thomas SA, Lee AA, Dolak MA, Stinneford MK. Costs Associated with the Treatment of Low Back Disorders: A Comparison of Surgeons and Physiatrists. PM R 2019; 12:551-562. [PMID: 31628773 DOI: 10.1002/pmrj.12266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Spine care is costly and subject to wide variability. Defining costs and patterns of care for different specialties is critical to improving value. OBJECTIVE Determine costs, utilization, and differences therein for nonoperative and operative specialists in treating low back disorders. We hypothesized costs associated with nonoperative specialists would be lower. DESIGN Retrospective cohort. SETTING Medicare Limited Data Set (5% sample), 2011 to 2014. PARTICIPANTS A total of 170 011 patients saw a primary care provider for a low back disorder between 1 July 2011, and 1 January 2013. Excluding those seen for a low back disorder in the preceding 6 months, final cohorts totaled 11 829 patients subsequently evaluated by a physiatrist (specialist in physical medicine and rehabilitation; 3183 patients) or surgeon (orthopedic or neurosurgeon; 8646 patients) within the following 6 months. MAIN OUTCOME MEASURES Total Medicare expenditures, spine-specific costs, spine surgical rates over 24 months. RESULTS Cohorts had comparable demographics, initial diagnoses, and baseline mean per-member per-month (PMPM) total spending. Mean 2-year spine-specific spending was $3978 for the physiatrist cohort and $7387 for the surgeon cohort. Comparatively, the physiatrist cohort had lower total mean 2-year spine-specific spending (-$3409; 95% confidence interval [CI] -$3824 to -$2994), mean PMPM total spending (-$122/mo; CI -$184 to -$60), and surgical rate (7.8% vs. 18.9%, risk ratio [RR] = 0.41; CI 0.36-0.47). Surgery predominantly drove cost differential. Mean PMPM total spending for both cohorts remained elevated at 24 months compared to baseline mean spending (physiatrist: +$293; CI $447 to $138; surgeon: +$325; CI $425 to $225). CONCLUSIONS Following a new episode of a low back disorder, substantial costs were seen for those subsequently evaluated by a physiatrist or surgeon. Costs were considerably lower for those first seen by a physiatrist. Patients in both cohorts displayed long-term increases in health care costs. Our data suggest that early engagement in nonoperative care, when appropriate, may improve value.
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Affiliation(s)
- Christopher J Standaert
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Stuart J Glassman
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | | | | | - Anthony A Lee
- Synergy Rehabilitation and Wellness Center, Scottsdale, AR
| | - Melanie A Dolak
- American Academy of Physical Medicine and Rehabilitation, Rosemont, IL
| | - M Kate Stinneford
- American Academy of Physical Medicine and Rehabilitation, Rosemont, IL
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Yoo Y, Moon JY, Yoon S, Kwon SM, Sim SE. Clinical outcome of percutaneous lumbar foraminoplasty using a safety-improved device in patients with lumbar foraminal spinal stenosis. Medicine (Baltimore) 2019; 98:e15169. [PMID: 30985699 PMCID: PMC6485750 DOI: 10.1097/md.0000000000015169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Lumbar foraminal spinal stenosis (LFSS) is defined as the narrowing of the nerve root exit associated with a herniated intervertebral disc, osteoarthritic changes in the facet joints, or a hypertrophied ligamentum flavum, which can provoke neurogenic claudication. To achieve effective and safe decompression of the lumbar spinal foramen, a specially designed instrument (Claudicare, SEAWON Meditech, Bucheon-si, Gyeonggi-do, Republic of Korea) for percutaneous lumbar foraminoplasty (PLF) was invented. The purpose of this study was to evaluate the clinical efficacy and safety of the newly devised instrument in patients with LFSS.PLF was performed for LFSS by a single pain physician. For each patient, an 11-point numerical rating scale (NRS) pain score-the Oswestry Disability Index (ODI)-and the duration of walking without radicular pain were evaluated at the 3-month follow-up. The successful responder percentage was defined as ≥50% reduction from the baseline NRS score with improvement in ODI and duration of walking.Among 24 patients who underwent PLF, 15 patients showed successful responses. The NRS pain score and duration of walking without radicular pain were improved significantly from baseline at the 3-month follow-up (P < .01). The ODI was also decreased, but the difference was not statistically significant (P = .09). The NRS pain score and walking duration without pain at 3 months were statistically significantly different between the groups (P < .001 and P = .01, respectively), whereas there was no statistically significant difference in improvement in ODI between the groups (P = .23). No serious adverse events occurred in the study.In conclusion, PLF using the Claudicare device may be an optimal and safe option for managing intractable LFSS on an outpatient basis.
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Affiliation(s)
- Yongjae Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
- Integrated Cancer Management Center, Seoul National University Cancer Hospital
| | - Sojeong Yoon
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center
| | - Seok Min Kwon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center
| | - Sung Eun Sim
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, Seoul ST. Mary's Hospital, Seoul, Republic of Korea
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Kim K, Shin KM, Hunt CL, Wang Z, Bauer BA, Kwon O, Lee JH, Seo BN, Jung SY, Youn Y, Lee SH, Choi JC, Jung JE, Kim J, Qu W, Kim TH, Eldrige JS. Nonsurgical integrative inpatient treatments for symptomatic lumbar spinal stenosis: a multi-arm randomized controlled pilot trial. J Pain Res 2019; 12:1103-1113. [PMID: 30992679 PMCID: PMC6445233 DOI: 10.2147/jpr.s173178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Lumbar spinal stenosis (LSS) is a chronic condition that causes low back pain and neurogenic claudication, often resulting in significant limitation of daily activities. In this open-label randomized controlled pilot study, we assessed the safety and feasibility of 4-week novel integrative inpatient treatments for LSS. Methods Thirty-six symptomatic LSS patients were randomly and equally allocated to one of the three groups: Mokhuri Chuna treatment 1 (MT1) group, Mokhuri Chuna treatment 2 (MT2) group, or conventional management treatment (CMT) group. MT1 patients were treated with herbal medication, Mokhuri Chuna, and acupuncture, and received daily physician consultation; MT2 patients were treated with Mokhuri Chuna and acupuncture without any herbal medication, and received daily physician consultation; and CMT patients received conventional pain management therapy that included epidural steroid injection, oral NSAID, and muscle relaxant medication, along with daily physiotherapy. The primary outcome of this pilot study was safety as measured by the type and incidence of adverse events (AEs). The secondary outcome measures included VAS score for low back pain and leg pain, Oswestry Disability Index, Oxford Claudication Score (OCS), walking capacity on a 50 m flat track and treadmill, and EuroQol-5D score. Magnetic resonance imaging was also performed up to 6 months after treatment cessation. Results Thirty-four treated patients were included in the analysis, based on the modified intention-to-treat principle. No serious AEs were observed or reported. Compared to the CMT group, the MT1 and MT2 groups did show significant improvement at 3 and 6 months in various domains, including pain (VAS score for leg and back pain) and function (OCS and treadmill walking). Conclusion These novel multimodal integrative treatments for LSS are both clinically safe and logistically feasible. Larger, adequately powered randomized controlled trials will be necessary to assess comparative efficacy and thoroughly analyze the cost-effectiveness of each treatment approach. Clinical trial registration number (CRIS) KCT0001218.
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Affiliation(s)
- Kiok Kim
- Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, South Korea
| | - Kyung-Min Shin
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Christy L Hunt
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Brent A Bauer
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ojin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea.,Korean Medicine Life Science, Campus of Korea Institute of Oriental Medicine, University of Science & Technology (UST), Daejeon, South Korea
| | - Bok-Nam Seo
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - So-Young Jung
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Yousuk Youn
- Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, South Korea
| | - Sang Ho Lee
- Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, South Korea
| | - Jung Chul Choi
- Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, South Korea
| | - Jae Eun Jung
- Hongik Neurosurgery Hospital, Seongnam, South Korea
| | - Jaehong Kim
- Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, South Korea
| | - Wenchun Qu
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.,Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, South Korea
| | - Jason S Eldrige
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA,
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Abstract
PURPOSE OF REVIEW With an aging population and increased prevalence of the disease, we set out to evaluate the validity of current diagnostic criteria for neurogenic claudication as well as the efficacy of the treatment options for the main cause, lumbar spinal stenosis (LSS). RECENT FINDINGS Epidural steroid injections (ESI) were most efficacious when the injectate is a steroid combined with lidocaine or lidocaine only. There are promising results regarding the efficacy of the minimally invasive lumbar decompression (MILD) procedure as well as interspinous process spacers (IPS) compared to surgical alternatives. Spinal cord stimulators are gaining ground as an effective alternative to surgery in patients with lumbar spinal stenosis that is not responsive to conservative measures or epidural injections. We found that there continues to be a lack of consensus on the diagnostic criteria, management, and treatment options for patients with LSS. The Delphi consensus is the most current recommendation to assist clinicians with making the diagnosis. Physical therapy, NSAIDs, gabapentin, and other conservative therapy measures are unproven in providing long-lasting relief. In patients with radicular symptoms, an ESI may be indicated when a combination of lidocaine with steroids is used or using lidocaine alone. In addition, there is not enough high-quality evidence to make a recommendation regarding the use of MILD versus interspinous spacers for neurogenic claudication. There remains a need for high-quality evidence regarding the efficacy of different conservative treatments, interventional procedures, and surgical outcomes in patients with neurogenic claudication in LSS.
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Koltsov JCB, Smuck MW, Zagel A, Alamin TF, Wood KB, Cheng I, Hu SS. Lumbar epidural steroid injections for herniation and stenosis: incidence and risk factors of subsequent surgery. Spine J 2019; 19:199-205. [PMID: 29959098 DOI: 10.1016/j.spinee.2018.05.034] [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: 02/15/2018] [Revised: 05/09/2018] [Accepted: 05/24/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbosacral epidural steroid injections (ESIs) have increased dramatically despite a narrowing of the clinical indications for use. One potential indication is to avoid or delay surgery, yet little information exists regarding surgery rates after ESI. PURPOSE The purpose of this research was to determine the proportion of patients having surgery after lumbar ESI for disc herniation or stenosis and to identify the timing and factors associated with this progression. STUDY DESIGN/SETTING This study was a retrospective review of nationally representative administrative claims data from the Truven Health MarketScan databases from 2007 to 2014. PATIENT SAMPLE The study cohort was comprised of 179,025 patients (54±15 years, 48% women) having lumbar ESIs for diagnoses of stenosis and/or herniation. OUTCOME MEASURES The primary outcome measure was the time from ESI to surgery. METHODS Inclusion criteria were ESI for stenosis and/or herniation, age ≥18 years, and health plan enrollment for 1 year before ESI to screen for exclusions. Patients were followed longitudinally until they progressed to surgery or had a lapse in enrollment, at which time they were censored. Rates of surgery were assessed with the Kaplan-Meier survival curves. Demographic and treatment factors associated with surgery were assessed with multivariable Cox proportional hazard models. No external funding was procured for this research and the authors' conflicts of interest are not pertinent to the present work. RESULTS Within 6 months, 12.5% of ESI patients underwent lumbar surgery. By 1 year, 16.9% had surgery, and by 5 years, 26.1% had surgery. Patients with herniation had surgery at rates of up to five-fold to seven-fold higher, with the highest rates of surgery in younger patients and those with both herniation and stenosis. Other concomitant spine diagnoses, male sex, previous tobacco use, and residence a rural areas or regions other than the Northeastern United States were associated with higher surgery rates. Medical comorbidities (previous treatment for drug use, congestive heart failure, obesity, chronic obstructive pulmonary disease, hypercholesterolemia, and other cardiac complications) were associated with lower surgery rates. CONCLUSIONS In the long term, more than one out of every four patients undergoing ESI for lumbar herniation or stenosis subsequently had surgery, and nearly one of six had surgery within the first year. After adjusting for other patient demographics and comorbidities, patients with herniation were more likely have surgery than those with stenosis. The improved understanding of the progression from lumbar ESI to surgery will help to better inform discussions regarding the value of ESI and aid in the shared decision-making process.
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Affiliation(s)
- Jayme C B Koltsov
- Stanford University School of Medicine, 450 Broadway St, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA 94063, USA.
| | - Matthew W Smuck
- Stanford University School of Medicine, 450 Broadway St, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA 94063, USA.
| | - Alicia Zagel
- Research Institute, Children's Minnesota, 2525 Chicago Ave South, Minneapolis, MN 55404, USA.
| | - Todd F Alamin
- Stanford University School of Medicine, 450 Broadway St, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA 94063, USA.
| | - Kirkham B Wood
- Stanford University School of Medicine, 450 Broadway St, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA 94063, USA.
| | - Ivan Cheng
- Stanford University School of Medicine, 450 Broadway St, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA 94063, USA.
| | - Serena S Hu
- Stanford University School of Medicine, 450 Broadway St, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA 94063, USA.
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Hermansen E, Myklebust TÅ, Austevoll IM, Rekeland F, Solberg T, Storheim K, Grundnes O, Aaen J, Brox JI, Hellum C, Indrekvam K. Clinical outcome after surgery for lumbar spinal stenosis in patients with insignificant lower extremity pain. A prospective cohort study from the Norwegian registry for spine surgery. BMC Musculoskelet Disord 2019; 20:36. [PMID: 30669998 PMCID: PMC6343340 DOI: 10.1186/s12891-019-2407-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 01/08/2019] [Indexed: 01/25/2023] Open
Abstract
Background Spinal stenosis is a clinical diagnosis in which the main symptom is pain radiating to the lower extremities, or neurogenic claudication. Radiological spinal stenosis is commonly observed in the population and it is debated whether patients with no lower extremity pain should be labelled as having spinal stenosis. However, these patients is found in the Norwegian Registry for Spine Surgery, the main object of the present study was to compare the clinical outcomes after decompressive surgery in patients with insignificant lower extremity pain, with those with more severe pain. Methods This study is based on data from the Norwegian Registry for Spine Surgery (NORspine). Patients who had decompressive surgery in the period from 7/1–2007 to 11/3–2013 at 31 hospitals were included. The patients was divided into four groups based on preoperative Numeric Rating Scale (NRS)-score for lower extremity pain. Patients in group 1 had insignificant pain, group 2 had mild or moderate pain, group 3 severe pain and group 4 extremely severe pain. The primary outcome was change in the Oswestry Disability Index (ODI). Successfully treated patients were defined as patients reporting at least 30% reduction of baseline ODI, and the number of successfully treated patients in each group were recorded. Results In total, 3181 patients were eligible; 154 patients in group 1; 753 in group 2; 1766 in group 3; and 528 in group 4. Group 1 had significantly less improvement from baseline in all the clinical scores 12 months after surgery compared to the other groups. However, with a mean reduction of 8 ODI points and 56% of patients showing a reduction of at least 30% in their ODI score, the proportion of patients defined as successfully treated in group 1, was not significantly different from that of other groups. Conclusion This national register study shows that patients with insignificant lower extremity pain had less improvement in primary and secondary outcome parameters from baseline to follow-up compared to patients with more severe lower extremity pain.
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Affiliation(s)
- Erland Hermansen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway. .,Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Tor Åge Myklebust
- Department of Research, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tore Solberg
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway.,Department of Clinical Medicine, University of Tromsø The Arctic University of Norway, Tromsø, Norway.,University Hospital of North, Norwegian National Registry for spine surgery, Tromsø, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Oliver Grundnes
- Department of Orthopedics, Akershus University Hospital, Oslo, Norway
| | - Jørn Aaen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, University of Oslo, Oslo, Norway
| | - Christian Hellum
- Department of Orthopedics, Oslo University Hospital, Oslo, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Schneider MJ, Ammendolia C, Murphy DR, Glick RM, Hile E, Tudorascu DL, Morton SC, Smith C, Patterson CG, Piva SR. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e186828. [PMID: 30646197 PMCID: PMC6324321 DOI: 10.1001/jamanetworkopen.2018.6828] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Lumbar spinal stenosis (LSS) is the most common reason for spine surgery in older US adults. There is an evidence gap about nonsurgical LSS treatment options. OBJECTIVE To explore the comparative clinical effectiveness of 3 nonsurgical interventions for patients with LSS. DESIGN, SETTING, AND PARTICIPANTS Three-arm randomized clinical trial of 3 years' duration (November 2013 to June 2016). Analysis began in August 2016. All interventions were delivered during 6 weeks with follow-up at 2 months and 6 months at an outpatient research clinic. Patients older than 60 years with LSS were recruited from the general public. Eligibility required anatomical evidence of central canal and/or lateral recess stenosis (magnetic resonance imaging/computed tomography) and clinical symptoms associated with LSS (neurogenic claudication; less symptoms with flexion). Analysis was intention to treat. INTERVENTIONS Medical care, group exercise, and manual therapy/individualized exercise. Medical care consisted of medications and/or epidural injections provided by a physiatrist. Group exercise classes were supervised by fitness instructors in senior community centers. Manual therapy/individualized exercise consisted of spinal mobilization, stretches, and strength training provided by chiropractors and physical therapists. MAIN OUTCOMES AND MEASURES Primary outcomes were between-group differences at 2 months in self-reported symptoms and physical function measured by the Swiss Spinal Stenosis questionnaire (score range, 12-55) and a measure of walking capacity using the self-paced walking test (meters walked for 0 to 30 minutes). RESULTS A total of 259 participants (mean [SD] age, 72.4 [7.8] years; 137 women [52.9%]) were allocated to medical care (88 [34.0%]), group exercise (84 [32.4%]), or manual therapy/individualized exercise (87 [33.6%]). Adjusted between-group analyses at 2 months showed manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care (-2.0; 95% CI, -3.6 to -0.4) or group exercise (-2.4; 95% CI, -4.1 to -0.8). Manual therapy/individualized exercise had a greater proportion of responders (≥30% improvement) in symptoms and physical function (20%) and walking capacity (65.3%) at 2 months compared with medical care (7.6% and 48.7%, respectively) or group exercise (3.0% and 46.2%, respectively). At 6 months, there were no between-group differences in mean outcome scores or responder rates. CONCLUSIONS AND RELEVANCE A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01943435.
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Affiliation(s)
- Michael J. Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donald R. Murphy
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ronald M. Glick
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Physical Medicine Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Hile
- College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Dana L. Tudorascu
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sally C. Morton
- Department of Statistics, College of Science, Virginia Polytechnic Institute and State University, Blacksburg
| | - Clair Smith
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charity G. Patterson
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sara R. Piva
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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42
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Deer TR, Grider JS, Pope JE, Falowski S, Lamer TJ, Calodney A, Provenzano DA, Sayed D, Lee E, Wahezi SE, Kim C, Hunter C, Gupta M, Benyamin R, Chopko B, Demesmin D, Diwan S, Gharibo C, Kapural L, Kloth D, Klagges BD, Harned M, Simopoulos T, McJunkin T, Carlson JD, Rosenquist RW, Lubenow TR, Mekhail N. The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment. Pain Pract 2018; 19:250-274. [PMID: 30369003 DOI: 10.1111/papr.12744] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. METHODS The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer-reviewed literature as the basis for making minimally invasive spine treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using U.S. Preventive Services Task Force criteria. The Consensus Group also created a treatment algorithm. Literature searches yielded 9 studies (2 randomized controlled trials [RCTs]; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. RESULTS The LSS treatment choice is dependent on the degree of stenosis; spinal or anatomic level; architecture of the stenosis; severity of the symptoms; failed, past, less invasive treatments; previous fusions or other open surgical approaches; and patient comorbidities. There is Level I evidence for percutaneous image-guided lumbar decompression as superior to lumbar epidural steroid injection, and 1 RCT supported spacer use in a noninferiority study comparing 2 spacer products currently available. CONCLUSIONS MISTs should be used in a judicious and algorithmic fashion to treat LSS, based on the evidence of efficacy and safety in the peer-reviewed literature. The MIST Consensus Group recommend that these procedures be used in a multimodal fashion as part of an evidence-based decision algorithm.
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Affiliation(s)
- Timothy R Deer
- Center for Pain Relief, Charleston, West Virginia, U.S.A
| | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A
| | - Jason E Pope
- Evolve Restorative Clinic, Santa Rosa, California, U.S.A
| | - Steven Falowski
- Functional Neurosurgery, St. Lukes University Health Network, Bethlehem, Pennsylvania, U.S.A
| | - Tim J Lamer
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - David A Provenzano
- Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, U.S.A
| | - Dawood Sayed
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Eric Lee
- Summit Pain Alliance, Sonoma, California, U.S.A
| | - Sayed E Wahezi
- Montefiore Medical Center, SUNY-Buffalo, Buffalo, New York, U.S.A
| | - Chong Kim
- Center for Pain Relief, Charleston, West Virginia, U.S.A
| | - Corey Hunter
- Ainsworth Institute of Pain Management, New York, New York, U.S.A
| | - Mayank Gupta
- Anesthesiology and Pain Medicine, HCA Midwest Health, Overland Park, Kansas, U.S.A
| | - Rasmin Benyamin
- Millennium Pain Center, Bloomington, Illinois, U.S.A.,College of Medicine, University of Illinois, Urbana-Champaign, Illinois, U.S.A
| | | | - Didier Demesmin
- Rutgers Robert Wood Johnson Medical School, Department of Pain Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, U.S.A
| | - Sudhir Diwan
- Manhattan Spine and Pain Medicine, Lenox Hill Hospital, New York, New York, U.S.A
| | - Christopher Gharibo
- Pain Medicine and Orthopedics, NYU Langone Hospitals Center, New York, New York, U.S.A
| | - Leo Kapural
- Carolina's Pain Institute at Brookstown, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - David Kloth
- Department of Anesthesiology, Danbury Hospital, Danbury, Connecticut, U.S.A
| | - Brian D Klagges
- Anesthesiology and Pain Medicine, Amoskeag Anesthesiology, Manchester, New Hampshire, U.S.A
| | - Michael Harned
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Tom Simopoulos
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | | | | | | | | | - Nagy Mekhail
- Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, Ohio, U.S.A
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Ravindra VM, Ghogawala Z. Is There Still a Role for Interspinous Spacers in the Management of Neurogenic Claudication? Neurosurg Clin N Am 2018; 28:321-330. [PMID: 28600006 DOI: 10.1016/j.nec.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lumbar spinal stenosis with neurogenic claudication is prevalent in the elderly population. Decompression for this condition is the operation most commonly used to treat older patients. Because of the risks associated with open decompression procedures, particularly in older patients with comorbidities, minimally invasive procedures with implantation of interspinous process devices have been developed. This article reviews the current role of interspinous spacers in the treatment of lumbar spinal stenosis with neurogenic claudication and discusses the body of literature surrounding this treatment alternative.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT 84132, USA; Department of Neurosurgery, Alan and Jacqueline Stuart Spine Research Center, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA
| | - Zoher Ghogawala
- Department of Neurosurgery, Alan and Jacqueline Stuart Spine Research Center, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA; Department of Neurosurgery, Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, USA.
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The Timing of Surgery Affects Return to Work Rates in Patients With Degenerative Lumbar Stenosis in a Workers' Compensation Setting. Clin Spine Surg 2017; 30:E1444-E1449. [PMID: 28857967 DOI: 10.1097/bsd.0000000000000573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE The objective of this study is to determine how time to surgery affects outcomes for degenerative lumbar stenosis (DLS) in a workers' compensation (WC) setting. SUMMARY OF BACKGROUND DATA WC subjects are known to be a clinically distinct population with variable outcomes following lumbar surgery. No study has examined the effect of time to surgery in this clinically distinct population. MATERIALS AND METHODS A total of 227 Ohio WC subjects were identified who underwent primary decompression for DLS between 1993 and 2013. We allocated patients into 2 groups: those that received operative decompression before and after 1 year of symptom onset. Our primary outcome was, if patients were able to make a stable return to work (RTW). The authors classified subjects as RTW if they returned within 2 years after surgery and remained working for >6 months. RESULTS The early cohort had a significantly higher RTW rate [50% (25/50) vs. 30% (53/117); P=0.01]. A logistic regression was performed to identify independent variables that predicted RTW status. Our regression model showed that time to surgery remained a significant negative predictor of RTW status (P=0.04; odds ratio, 0.48; 95% confidence interval, 0.23-0.91). Patients within the early surgery cohort cost on average, $37,332 less in total medical costs than those who opted for surgery after 1 year (P=0.01). Furthermore, total medical costs accrued over 3 years after index surgery was on average, $13,299 less when patients received their operation within 1 year after symptom onset (P=0.01). CONCLUSIONS Overall, time to surgery had a significant impact on clinical outcomes in WC subjects receiving lumbar decompression for DLS. Patients who received their operation within 1 year had a higher RTW rate, lower medical costs, and lower costs accrued over 3 years after index surgery. The results presented can perhaps be used to guide surgical decision-making and provide predictive value for the WC population.
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Effects of Traditional Korean Medicine Treatment On Lumbar Spinal Stenosis and Assessing Improvement by Radiological Criteria: An Observational Study. JOURNAL OF ACUPUNCTURE RESEARCH 2017. [DOI: 10.13045/jar.2017.02215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Traeger A, Buchbinder R, Harris I, Maher C. Diagnosis and management of low-back pain in primary care. CMAJ 2017; 189:E1386-E1395. [PMID: 29133540 PMCID: PMC5687927 DOI: 10.1503/cmaj.170527] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Adrian Traeger
- School of Public Health (Traeger, Maher), Sydney Medical School, University of Sydney, Sydney, Australia; Monash Department of Clinical Epidemiology (Buchbinder), Cabrini Institute, Malvern, Australia; Department of Epidemiology and Preventive Medicine (Buchbinder), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Whitlam Orthopaedic Research Centre (Harris), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
| | - Rachelle Buchbinder
- School of Public Health (Traeger, Maher), Sydney Medical School, University of Sydney, Sydney, Australia; Monash Department of Clinical Epidemiology (Buchbinder), Cabrini Institute, Malvern, Australia; Department of Epidemiology and Preventive Medicine (Buchbinder), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Whitlam Orthopaedic Research Centre (Harris), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
| | - Ian Harris
- School of Public Health (Traeger, Maher), Sydney Medical School, University of Sydney, Sydney, Australia; Monash Department of Clinical Epidemiology (Buchbinder), Cabrini Institute, Malvern, Australia; Department of Epidemiology and Preventive Medicine (Buchbinder), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Whitlam Orthopaedic Research Centre (Harris), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
| | - Chris Maher
- School of Public Health (Traeger, Maher), Sydney Medical School, University of Sydney, Sydney, Australia; Monash Department of Clinical Epidemiology (Buchbinder), Cabrini Institute, Malvern, Australia; Department of Epidemiology and Preventive Medicine (Buchbinder), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Whitlam Orthopaedic Research Centre (Harris), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
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Paulsen RT, Bouknaitir JB, Fruensgaard S, Carreon L, Andersen M. Prognostic Factors for Satisfaction After Decompression Surgery for Lumbar Spinal Stenosis. Neurosurgery 2017; 82:645-651. [DOI: 10.1093/neuros/nyx298] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 05/01/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Surgical treatment for lumbar spinal stenosis is associated with both short- and long-term benefits with improvements in patient function and pain. Even though most patients are satisfied postoperatively, some studies report that up to one-third of patients are dissatisfied.
OBJECTIVE
To present clinical outcome data and identify prognostic factors related to patient satisfaction 1 yr after posterior decompression surgery for lumbar spinal stenosis.
METHODS
This multicenter register study included 2562 patients. Patients were treated with various types of posterior decompression. Patients with previous spine surgery or concomitant fusion were excluded. Patient satisfaction was analyzed for associations with age, sex, body mass index, smoking status, duration of pain, number of decompressed vertebral levels, comorbidities, and patient-reported outcome measures, which were used to quantify the effect of the surgical intervention.
RESULTS
At 1-yr follow-up, 62.4% of patients were satisfied but 15.1% reported dissatisfaction. The satisfied patients showed significantly greater improvement in all outcome measures compared to the dissatisfied patients. The outcome scores for the dissatisfied patients were relatively unchanged or worse compared to baseline. Association was seen between dissatisfaction, duration of leg pain, smoking status, and patient comorbidities. Patients with good walking capacity at baseline were less prone to be dissatisfied compared to patients with poor walking capacity.
CONCLUSION
This study found smoking, long duration of leg pain, and cancerous and neurological disease to be associated with patient dissatisfaction, whereas good walking capacity at baseline was positively associated with satisfaction after 1 yr.
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48
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Kim HS, Paudel B, Jang JS, Oh SH, Lee S, Park JE, Jang IT. Percutaneous Full Endoscopic Bilateral Lumbar Decompression of Spinal Stenosis Through Uniportal-Contralateral Approach: Techniques and Preliminary Results. World Neurosurg 2017; 103:201-209. [PMID: 28389410 DOI: 10.1016/j.wneu.2017.03.130] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/25/2017] [Accepted: 03/27/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND When considering various risk factors such as age, comorbidities, and complications related to the surgical procedure itself, open surgery in degenerative spinal stenosis is likely to cause more complications. Here, we report the surgical procedure and preliminary clinical results of percutaneous endoscopic stenosis lumbar decompression (PESLD) technique using a uniportal-contralateral approach for bilateral decompression of degenerative spinal stenosis. MATERIALS AND METHODS Electronic medical records of 48 consecutive patients who were treated between January 2016 and August 2016 were reviewed retrospectively. All patient received PESLD through the uniportal-contralateral approach. We analyzed the outcomes using the visual analogue scale, Macnab criteria, Oswestry Disability Index, and complication rate. RESULTS There were 48 cases (15 men, 33 women). Mean age of patients was 62.44 ± 8.68 years. Mean symptom duration was 20.13 ± 16.87 months. Neurogenic intermittent claudication was 550 m on average. Follow-up period was 7.75 ± 2.28 months (range, 5-13 months). Visual analogue scale and Oswestry Disability Index decreased significantly (P < 0.001) and decreased by 1.073 and 5.795 odds ratio, respectively, in contralateral foraminotomy cases. Macnab outcome grade was good to excellent in 96% of patients. Dural tear occurred in 3 cases (6.25%), and 2 cases (4.17%) required transforaminal lumbar interbody fusion operation after this procedure. CONCLUSIONS The preliminary result of this uniportal-contralateral PESLD technique is encouraging (96% demonstrated a good-to-excellent outcome), and the procedure is safe. However, we need long-term follow-up and a more detailed study for more accurate results of this technique.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Byapak Paudel
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon-si, Gyeonggi-do, Republic of Korea.
| | - Ji Soo Jang
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Bupyeong-gu, Incheon, Republic of Korea
| | - Sol Lee
- Department of Neurosurgery, Nanoori Seoul Hospital, Gangnam-gu, Seoul, Republic of Korea
| | - Jae Eun Park
- Department of Neurosurgery, Nanoori Seoul Hospital, Gangnam-gu, Seoul, Republic of Korea
| | - Il Tae Jang
- Department of Neurosurgery, Nanoori Seoul Hospital, Gangnam-gu, Seoul, Republic of Korea
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