Sciatica in degenerative spondylolisthesis of the lumbar spine

Manipulation for treatment of degenerative lumbar spondylolisthesis: A protocol of systematic review and meta-analysis

BACKGROUND

Degenerative lumbar spondylolisthesis (DLS) is one of the common orthopedic diseases which causes low back pain in patients, which seriously affects people's daily life and work. As a method of conservative treatment of this disease, manipulation is widely used in clinical practice. We will summarize the current published evidence of manipulation in the treatment of DLS, and evaluate the effectiveness and safety of manipulation through systematic review and meta-analysis, so as to provide more reliable evidence for future clinical practice.

METHODS

We will conduct a comprehensive search of the following 9 databases until January 2019: PubMed, Embase, Cochrane Library, ClinicalTrials.gov, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technique Journals Database, Wan Fang Database, and Chinese Biomedical Database. The 2 researchers will independently search, screen, extract data, and evaluate the quality of the literatures. The primary outcomes include clinical effectiveness, Japanese Orthopaedic Association scores, and the secondary outcomes include visual analog scale scores, symptom scores, and adverse events. Bias risk tools provided by Cochrane Collaboration will be used for literature quality assessment, and RevMan 5.3 software will be used for meta-analysis.

RESULTS

The results of this study will systematically evaluate the effectiveness and safety of manipulation intervention for people with DLS, especially in improving lumbar function scores and pain scores.

CONCLUSION

The systematic review of this study will summarize the current published evidence of manipulation for the treatment of DLS, which can further guide the promotion and application of it.

ETHICS AND DISSEMINATION

This study does not require ethical approval and the results will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42019139933.

Lumbar intraspinal synovial cysts: conservative management and review of the world's literature

BACKGROUND CONTEXT

Lumbar intraspinal synovial cysts are an important cause of axial and radicular spine pain. Controversy about nonsurgical versus surgical treatment persists.

PURPOSE

To evaluate the efficacy of nonsurgical management of symptomatic lumbar intraspinal synovial cysts (LISCs).

STUDY DESIGN/SETTING

Retrospective review set in outpatient physiatry office.

PATIENT SAMPLE

Ten patients (8 women, 2 men; average age, 60 years) with LISCs and average symptom duration of 7.9 months.

OUTCOME MEASURES

Numerical pain rating scale (NRS-11), Roland-Morris disability outcome measure, patient satisfaction, and surgery.

METHODS

Patients with LISCs were identified and their charts were reviewed. Those patients whose symptoms correlated with the level of LISC-induced extradural compression were eligible. All patients received conservative care and a fluoroscopic-guided lumbar spine injection. The primary author conducted telephone follow-up.

RESULTS

All 10 patients had unilateral radicular pain. Seven had stable neurologic deficits. Magnetic resonance imaging and computed tomography/myelography, respectively, identified a LISC in 8 and 2 patients. Five patients had cyst aspiration followed by steroid instillation; 5 patients had cyst aspiration followed by a transforaminal epidural steroid injection. Average length of follow-up was 50.4 weeks. Only 1 patient had sustained benefit. One patient had no benefit and refused surgery. Eight patients underwent surgery and had a good result.

CONCLUSION

In our opinion, nonsurgical management in patients with LISC-induced radicular pain does not appear to be as successful as surgery.

Patient outcome after resection of lumbar juxtafacet cysts

STUDY DESIGN

Retrospective review of patients who underwent lumbar juxtafacet cyst resection with questionnaire follow-up.

OBJECTIVES

Determine the long-term outcome after resection of lumbar juxtafacet cysts.

SUMMARY OF BACKGROUND DATA

Juxtafacet cysts are uncommon causes of radicular pain and are often associated with significant spinal degenerative disease. Previous studies have not focused on the outcome of patients who have undergone resection.

METHODS

Charts of 29 patients who underwent lumbar juxtafacet resection were reviewed and an outcomes questionnaire was sent to each.

RESULTS

Thirty-three lumbar juxtafacet cysts were resected from 29 patients. Cysts, 31 (94%) from facets and 2 (6%) from the ligamentum flavum, most commonly arose at the L4-L5 level (51%). Twelve patients (41%) were found to have some degree of spondylolisthesis before surgery, while 26 patients (90%) had facet arthropathy. Two patients (7%) underwent concurrent resection and fusion. Recurrence occurred in 3%. Three patients (9%) had subsequent lumbar spine operations, including 2 fusions (6%). Incidental durotomy was the most common surgical complication occurring in 3 cases (9%). Twenty-four patients (83%) responded to follow-up questionnaire or phone interview. Mean length of follow-up was 24 months (4-64 months). Twenty patients (83%) reported improvement in pain, and 16 (67%) reported an improved level of function. All respondents reported some degree of improvement in their condition after surgery.

CONCLUSIONS

Juxtafacet cysts are an uncommon cause of radiculopathy. Surgical resection is the treatment of choice with low rates of complications, recurrences, and residual complaints.

Retrodural cysts bridging a bilateral lumbar spondylolysis: a report of two symptomatic cases

We report the MR features in two patients presenting with symptomatic thecal impingement by posterior epidural cysts linking a bilateral lumbar spondylolysis. Large fluid-filled channels bridging the ruptured partes interarticulares were present in spite of the absence of significant arthritic changes within the adjacent facet joints.

Plain CT of the degenerative lumbar spine

Degenerative processes of the lumbar spine consist of several disorders of various etiologies with different radiological manifestations. Computed tomography (CT) is well suited for evaluation of these processes since contours of soft tissues, subtle bone structure changes and small calcifications are easily demonstrated with this technique. Spiral CT scanning provides fast data acquisitions, and volumes of high quality for multiplanar reformatting. This review article describes the CT scanning techniques and diagnostic findings of the most common degenerative processes of the lumbar spine.