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Kgomotso EL, Hellum C, Fagerland MW, Solberg T, Brox JI, Storheim K, Hermansen E, Franssen E, Weber C, Brisby H, Algaard KRH, Furunes H, Banitalebi H, Ljøstad I, Indrekvam K, Austevoll IM. Decompression alone or with fusion for degenerative lumbar spondylolisthesis (Nordsten-DS): five year follow-up of a randomised, multicentre, non-inferiority trial. BMJ 2024; 386:e079771. [PMID: 39111800 PMCID: PMC11304163 DOI: 10.1136/bmj-2024-079771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To assess whether decompression alone is non-inferior to decompression with instrumented fusion five years after primary surgery in patients with degenerative lumbar spondylolisthesis. DESIGN Five year follow-up of a randomised, multicentre, non-inferiority trial (Nordsten-DS). SETTING 16 public orthopaedic and neurosurgical clinics in Norway. PARTICIPANTS Patients aged 18-80 years with symptomatic lumbar spinal stenosis and a spondylolisthesis of 3 mm or more at the stenotic level. INTERVENTIONS Decompression surgery alone and decompression with additional instrumented fusion (1:1). MAIN OUTCOME MEASURES The primary outcome was a 30% or more reduction in Oswestry disability index from baseline to five year follow-up. The predefined non-inferiority margin was a -15 percentage point difference in the proportion of patients who met the primary outcome. Secondary outcomes included the mean change in Oswestry disability index, Zurich claudication questionnaire, numeric rating scale for leg and back pain, and EuroQol Group 5-Dimension (EQ-5D-3L) questionnaire. RESULTS From 12 February 2014 to 18 December 2017, 267 participants were randomly assigned to decompression alone (n=134) and decompression with instrumented fusion (n=133). Of these, 230 (88%) responded to the five year questionnaire: 121 in the decompression group and 109 in the fusion group. Mean age at baseline was 66.2 years (SD 7.6), and 69% were women. In the modified intention-to-treat analysis with multiple imputation of missing data, 84 (63%) of 133 people in the decompression alone group and 81 (63%) of 129 people in the fusion group had a at least a 30% reduction in Oswestry disability index, a difference of 0.4 percentage points. (95% confidence interval (CI) -11.2 to 11.9). The respective results of the per protocol analysis were 65 (65%) of 100 in the decompression alone group and 59 (66%) of 89 in the fusion group, a difference of -1.3 percentage points (95% CI -14.5 to 12.2). Both 95% CIs were higher than the predefined non-inferiority margin of -15%. The mean change in Oswestry disability index from baseline to five years was -17.8 in both groups (mean difference 0.02 (95% CI -3.8 to 3.9)). Results of the other secondary outcomes were in the same direction as the primary outcome. From two to five year follow-up, a new lumbar operation occurred in six (5%) of 123 people in the decompression group and 11 (10%) of 113 people in the fusion group, with a total from baseline to five years of 21 (16%) of 129 people and 23 (18%) of 125, respectively. CONCLUSIONS In participants with degenerative spondylolisthesis, decompression alone was non-inferior to decompression with instrumented fusion five years after primary surgery. Proportions of subsequent surgeries at the index level or an adjacent lumbar level were no different between the groups. TRIAL REGISTRATION ClinicalTrials.gov NCT02051374.
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Affiliation(s)
- Eric Loratang Kgomotso
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
| | - Christian Hellum
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo, Norway
| | - Tore Solberg
- Institute of clinical medicine, The Arctic University of Norway (UiT), Tromsø, Norway
- The Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Medical Faculty, University of Oslo, Oslo, Norway
| | - Kjersti Storheim
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Erland Hermansen
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Institute of Health Sciences, Norwegian University of Technology and Science, Ålesund, Norway
| | - Eric Franssen
- Orthopaedic Department, Stavanger University Hospital, Stavanger, Norway
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Helena Brisby
- Spine Surgery Team, Department of Orthopaedics, Sahlgrenska University Hospital, Gothenborg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Håvard Furunes
- Medical Faculty, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Gjøvik, Norway
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Inger Ljøstad
- Member of the Norwegian Back and Spine Patients Association
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Zhu L, Sun Y, Kang J, Liang J, Su T, Fu W, Zhang W, Dai R, Hou Y, Zhao H, Peng W, Wang W, Zhou J, Jiao R, Sun B, Yan Y, Liu Y, Liu Z. Effect of Acupuncture on Neurogenic Claudication Among Patients With Degenerative Lumbar Spinal Stenosis : A Randomized Clinical Trial. Ann Intern Med 2024; 177:1048-1057. [PMID: 38950397 DOI: 10.7326/m23-2749] [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: 07/03/2024] Open
Abstract
BACKGROUND Acupuncture may improve degenerative lumbar spinal stenosis (DLSS), but evidence is insufficient. OBJECTIVE To investigate the effect of acupuncture for DLSS. DESIGN Multicenter randomized clinical trial. (ClinicalTrials.gov: NCT03784729). SETTING 5 hospitals in China. PARTICIPANTS Patients with DLSS and predominantly neurogenic claudication pain symptoms. INTERVENTION 18 sessions of acupuncture or sham acupuncture (SA) over 6 weeks, with 24-week follow-up after treatment. MEASUREMENTS The primary outcome was change from baseline in the modified Roland-Morris Disability Questionnaire ([RMDQ] score range, 0 to 24; minimal clinically important difference [MCID], 2 to 3). Secondary outcomes were the proportion of participants achieving minimal (30% reduction from baseline) and substantial (50% reduction from baseline) clinically meaningful improvement per the modified RMDQ. RESULTS A total of 196 participants (98 in each group) were enrolled. The mean modified RMDQ score was 12.6 (95% CI, 11.8 to 13.4) in the acupuncture group and 12.7 (CI, 12.0 to 13.3) in the SA group at baseline, and decreased to 8.1 (CI, 7.1 to 9.1) and 9.5 (CI, 8.6 to 10.4) at 6 weeks, with an adjusted difference in mean change of -1.3 (CI, -2.6 to -0.03; P = 0.044), indicating a 43.3% greater improvement compared with SA. The between-group difference in the proportion of participants achieving minimal and substantial clinically meaningful improvement was 16.0% (CI, 1.6% to 30.4%) and 12.6% (CI, -1.0% to 26.2%) at 6 weeks. Three cases of treatment-related adverse events were reported in the acupuncture group, and 3 were reported in the SA group. All events were mild and transient. LIMITATION The SA could produce physiologic effects. CONCLUSION Acupuncture may relieve pain-specific disability among patients with DLSS and predominantly neurogenic claudication pain symptoms, although the difference with SA did not reach MCID. The effects may last 24 weeks after 6-week treatment. PRIMARY FUNDING SOURCE 2019 National Administration of Traditional Chinese Medicine "Project of building evidence-based practice capacity for TCM-Project BEBPC-TCM" (NO. 2019XZZX-ZJ).
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Affiliation(s)
- Lili Zhu
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.)
| | - Yuanjie Sun
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.)
| | - Jing Kang
- The Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (J.K., Y.L.)
| | - Jun Liang
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.)
| | - Tongsheng Su
- Department of Acupuncture and Moxibustion, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an, China (T.S.)
| | - Wenbin Fu
- Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China (W.F.)
| | - Wei Zhang
- Department of Acupuncture and Moxibustion, The First Hospital of Hunan University of Chinese Medicine, Changsha, China (W.Z.)
| | - Rongshui Dai
- Department of Acupuncture and Moxibustion, The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China (R.D.)
| | - Yan Hou
- Peking University Clinical Research Center, Peking University, Beijing, China (Y.H.)
| | - Hong Zhao
- Luohu District Hospital of Traditional Chinese Medicine, Shenzhen, China (H.Z.)
| | - Weina Peng
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.)
| | - Weiming Wang
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.)
| | - Jing Zhou
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.)
| | - Ruimin Jiao
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.)
| | - Biyun Sun
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.)
| | - Yan Yan
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.)
| | - Yan Liu
- The Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (J.K., Y.L.)
| | - Zhishun Liu
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.)
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Li MH, Zheng H, Choi EJ, Nahm FS, Choe GY, Lee PB. Therapeutic effect of epidural dexamethasone palmitate in a rat model of lumbar spinal stenosis. Reg Anesth Pain Med 2024:rapm-2024-105530. [PMID: 38960590 DOI: 10.1136/rapm-2024-105530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/28/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Dexamethasone palmitate (DEP), a prodrug of dexamethasone (DEX), is a synthetic corticosteroid medication distinguished by the inclusion of a fatty acid component known as palmitate. This study introduces DEP as a novel therapeutic option for spinal epidural injection, aiming to provide safer and longer-lasting pain relief as an alternative to for patients with spinal stenosis. METHODS 40 rats were randomly divided into four groups: those receiving epidural administration of normal saline (NS), and DEP in the lumbar spinal stenosis (LSS) model, and non-model rats receiving epidural NS administration. Paw withdrawal thresholds to mechanical stimulation and motor function (neurogenic intermittent claudication) were observed for up to 21 days. Hematology and blood chemistry analyses were performed 1 week after drug therapy. Tissue samples were collected for steroid pathology examination to evaluate adhesion degree, perineural area inflammation, and chromatolysis in the dorsal root ganglion (DRG), and adrenal gland. RESULTS The DEX and DEP groups demonstrated significant recovery from mechanical allodynia and motor dysfunction after 2 weeks of drug therapy (p<0.001). However, by the third week, the effect of DEX started to diminish while the effect of DEP persisted. Furthermore, the DEP group exhibited reduced fibrosis and less chromatolysis than the NS group. No steroid overdose or toxin was observed in any group. CONCLUSION The epidural administration of DEP demonstrated therapeutic efficacy in reducing allodynia and hyperalgesia resulting from chronic DRG compression, thus offering prolonged pain relief. These findings underscore the potential of DEP as a promising treatment alternative for pain associated with LSS, serving as a viable substitute for .
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Affiliation(s)
- Mei Hui Li
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Jongno-gu, Korea (the Republic of)
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Haiyan Zheng
- Department of Anesthesiology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)
| | - Ghee Young Choe
- Pathology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
- Pathology, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)
| | - Pyung Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)
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Jensen RK, Hartvigsen L, Kongsted A. Pain trajectories over 12 months following conservative care consultation in patients with lumbar spinal stenosis. BMC Res Notes 2024; 17:174. [PMID: 38909261 PMCID: PMC11193895 DOI: 10.1186/s13104-024-06840-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024] Open
Abstract
OBJECTIVE To investigate symptom trajectories in chiropractic patients with lumbar spinal stenosis (LSS). METHODS Patients diagnosed with LSS were recruited from chiropractic clinics and self-reported questionnaires were collected at baseline and 1-year follow-up. Patients received weekly text messages about low back pain (LBP) and leg symptoms for 1 year. Group-based trajectory modelling was performed to identify symptom trajectory groups. The groups were compared based on patient characteristics, LBP and leg pain intensity, Oswestry Disability Index (ODI) and Zurich Claudication Questionnaire (ZCQ). RESULTS A total of 90 patients were included in the analysis. A three-group trajectory model was chosen: 'improving' (16%), 'fluctuating/improving' (30%), and 'persistent' (54%). The 'persistent' group had a higher proportion of women [71% (95% CI 57-82%)] than the 'improving' group 29% (95% CI 11-56%), and a higher ODI score at both baseline [34.2 (95% CI 29.7-38.8) vs. 22.8 (16.4-29.1)] and 1-year follow-up [28.1 (95% CI 23.2-33.0) vs. 4.8 (0.1-9.4)]. Similar differences were observed for ZCQ symptom and function scores. CONCLUSIONS Pain symptoms in people with LSS followed distinctly different trajectories. Half of the sample had a pattern of consistently severe symptoms over a year, while the other half either improved rapidly or experienced fluctuating symptoms with some improvement.
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Affiliation(s)
- Rikke K Jensen
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
- Chiropractic Knowledge Hub, Campusvej 55, 5230, Odense M, Denmark.
| | - Lisbeth Hartvigsen
- Private Chiropractic Practice, Hartvigsen & Hein, Vestergade 11, 5000, Odense C, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Chiropractic Knowledge Hub, Campusvej 55, 5230, Odense M, Denmark
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Wang C, Wang Z, Zi Y, Dan X, Xu J, Zhao J, Xu W, Wu Z, Liu W, Ma B. Compensatory upregulation of MT2A alleviates neurogenic intermittent claudication through inhibiting activated p38 MAPK-mediated neuronal apoptosis. Hum Cell 2024; 37:675-688. [PMID: 38546949 DOI: 10.1007/s13577-024-01043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/08/2024] [Indexed: 04/15/2024]
Abstract
Neurogenic intermittent claudication (NIC), a classic symptom of lumbar spinal stenosis (LSS), is associated with neuronal apoptosis. To explore the novel therapeutic target of NIC treatment, we constructed the rat model of NIC by cauda equina compression (CEC) method and collected dorsal root ganglion (DRG) tissues, a region responsible for sensory and motor function, for mRNA sequencing. Bioinformatic analysis of mRNA sequencing indicated that upregulated metallothionein 2A (MT2A), an apoptosis-regulating gene belonging to the metallothionein family, might participate in NIC progression. Activated p38 MAPK mediated motor dysfunction following LSS and it was also found in DRG tissues of rats with NIC. Therefore, we supposed that MT2A might affect NIC progression by regulating p38 MAPK pathway. Then the rat model of NIC was used to explore the exact role of MT2A. Rats at day 7 post-CEC exhibited poorer motor function and had two-fold MT2A expression in DRG tissues compared with rats with sham operation. Co-localization analysis showed that MT2A was highly expressed in neurons, but not in microglia or astrocytes. Subsequently, neurons isolated from DRG tissues of rats were exposed to hypoxia condition (3% O2, 92% N2, 5% CO2) to induce cell damage. Gain of MT2A function in neurons was performed by lentivirus-mediated overexpression. MT2A overexpression inhibited apoptosis by inactivating p38 MAPK in hypoxia-exposed neurons. Our findings indicated that high MT2A expression was related to NIC progression, and MT2A overexpression protected against NIC through inhibiting activated p38 MAPK-mediated neuronal apoptosis in DRG tissues.
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Affiliation(s)
- Chenggang Wang
- Division of Spine, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Zhanchao Wang
- Department of Orthopedics, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Ying Zi
- Department of Orthopedics, Air Force Hospital of the Northern Theater of Chinese People's Liberation Army (PLA), Shenyang, Liaoning, China
| | - Xuejian Dan
- Division of Spine, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Jiahui Xu
- Division of Spine, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Jingwei Zhao
- Division of Spine, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Wei Xu
- Division of Spine, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Zhourui Wu
- Division of Spine, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Wei Liu
- Division of Spine, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Bin Ma
- Division of Spine, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
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Adelhoefer SJ, Berger J, Mykolajtchuk C, Gujral J, Boadi BI, Fiani B, Härtl R. Ten-step minimally invasive slalom unilateral laminotomy for bilateral decompression (sULBD) with navigation. BMC Musculoskelet Disord 2023; 24:860. [PMID: 37919696 PMCID: PMC10621193 DOI: 10.1186/s12891-023-06940-7] [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: 05/21/2023] [Accepted: 10/06/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Unilateral laminotomy for bilateral decompression (ULBD) is a MIS surgical technique that offers safe and effective decompression of lumbar spinal stenosis (LSS) with a long-term resolution of symptoms. Advantages over conventional open laminectomy include reduced expected blood loss, muscle damage, mechanical instability, and less postoperative pain. The slalom technique combined with navigation is used in multi-segmental LSS to improve the workflow and effectiveness of the procedure. METHODS We outline ten technical steps to achieve a slalom unilateral laminotomy for bilateral decompression (sULBD) with navigation. In a retrospective case series, we included patients with multi-segmental LSS operated in our institution using the sULBD between 2020 and 2022. The primary outcome was a reduction in pain measured by Visual Analogue Scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI). RESULTS In our case series (N = 7), all patients reported resolution of initial symptoms on an average follow-up of 20.71 ± 9 months. The average operative time and length of hospital stay were 196.14 min and 1.67 days, respectively. On average, VAS (back pain) was 4.71 pre-operatively and 1.50 on long-term follow-up of an average of 19.05 months. VAS (leg pain) decreased from 4.33 to 1.21. ODI was reported as 33% pre-operatively and 12% on long-term follow-up. CONCLUSION The sULBD with navigation is a safe and effective MIS surgical procedure and achieves the resolution of symptoms in patients presenting with multi-segmental LSS. Herein, we demonstrate the ten key steps required to perform the sULBD technique. Compared to the standard sULBD technique, the incorporation of navigation provides anatomic localization without exposure to radiation to staff for a higher safety profile along with a fast and efficient workflow.
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Affiliation(s)
- Siegfried J Adelhoefer
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Jessica Berger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Catherine Mykolajtchuk
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Jaskeerat Gujral
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Blake I Boadi
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Brian Fiani
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA.
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Young JJ, Kongsted A, Hartvigsen J, Ammendolia C, Jensen RK. Similar improvements in patient-reported outcomes for non-specific low back pain patients with and without lumbar spinal stenosis symptoms following a structured education and exercise therapy program. BMC Musculoskelet Disord 2023; 24:839. [PMID: 37880624 PMCID: PMC10599001 DOI: 10.1186/s12891-023-06950-5] [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: 06/13/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND People with nonspecific low back pain (NSLBP) can also experience overlapping symptoms of lumbar spinal stenosis (LSS), but the impact on treatment outcomes is unknown. This study investigated differences in treatment outcomes for disability, back pain intensity, and leg pain intensity following an education and exercise therapy program for NSLBP patients with and without comorbid LSS symptoms. METHODS This was a longitudinal analysis of 655 Danish participants in the GLA:D® Back program; an education and exercise therapy program for people with persistent NSLBP. Participants were classified as having comorbid LSS symptoms based on self-report. Linear mixed models were used to assess differences in change in disability (Oswestry Disability Index [0-100]) and back and leg pain intensity (Numeric Rating Scale [0-10]) at 3-, 6-, and 12-months between those with and without LSS symptoms. RESULTS 28% of participants reported LSS symptoms. No certain differences in change in disability or back pain intensity improvement were observed at any time-point between those with and without LSS symptoms. Participants with LSS symptoms had slightly greater improvement in leg pain intensity at 6- (-0.7, 95% CI -1.2 to -0.2) and 12-months (-0.6, 95% CI -1.2 to -0.1). CONCLUSION Compared to those without LSS symptoms, patients with persistent NSLBP and LSS symptoms can expect similar improvements in disability and back pain intensity, and slightly greater improvements in leg pain intensity with treatment. Therefore, education and exercise therapy programs designed for NSLBP are likely helpful for those also experiencing LSS symptoms.
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Affiliation(s)
- James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark.
| | - Alice Kongsted
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
| | - Jan Hartvigsen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
| | - Carlo Ammendolia
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rikke Krüger Jensen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
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Jensen RK, Skovsgaard CV, Ziegler DS, Schiøttz-Christensen B, Mieritz RM, Andresen AK, Hartvigsen J. Surgical trends and regional variation in Danish patients diagnosed with lumbar spinal stenosis between 2002 and 2018: a retrospective registry-based study of 83,783 patients. BMC Health Serv Res 2023; 23:665. [PMID: 37340411 DOI: 10.1186/s12913-023-09638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) is the most common reason for spine surgery in older people. However, surgery rates vary widely both internationally and nationally. This study compared patient and sociodemographic characteristics, geographical location and comorbidity between surgically and non-surgically treated Danish patients diagnosed with LSS from 2002 to 2018 and described variations over time. METHODS Diagnostic ICD-10 codes identifying patients with LSS and surgical procedure codes for decompression with or without fusion were retrieved from the Danish National Patient Register. Patients ≥ 18 years who had been admitted to private or public hospitals in Denmark between 2002 and 2018 were included. Data on age, sex, income, retirement status, geographical region and comorbidity were extracted. A multivariable logistic regression model was used to calculate the relative risk for surgically versus non-surgically treated LSS patients using the total population and subsequently divided into three time periods. Variations over time were displayed graphically. RESULTS A total of 83,783 unique patients with an LSS diagnosis were identified, and of these, 38,362 (46%) underwent decompression surgery. Compared to those who did not receive surgery, the surgically treated patients were more likely to be aged 65-74 years, were less likely to have comorbidities, had higher income and were more likely to reside in the northern part of Denmark. Patients aged 65-74 years remained more likely to receive surgery over time, although the difference between age groups eventually diminished, as older patients (aged ≥ 75) were increasingly more likely to undergo surgery. Large variations and differences in the relative risk of surgery were observed within and between the geographical regions. The likelihood of receiving surgery varied up to threefold between regions. CONCLUSION Danish patients with LSS who receive surgery differ in a number of respects from those not receiving surgery. Patients aged 65 to 74 years were more likely to receive surgery than other age groups, and LSS surgical patients were healthier, more often retired and had higher incomes than those not undergoing surgery. There were considerable variations in the relative risk of surgery between and within geographical regions.
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Affiliation(s)
- Rikke Krüger Jensen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- Chiropractic Knowledge Hub, Odense, Denmark.
| | - Christian Volmar Skovsgaard
- DaCHE - Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorthe Schøler Ziegler
- Medical Spinal Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
| | - Berit Schiøttz-Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Andreas K Andresen
- Spine Surgery and Research, Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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9
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Sun YN, An Y, Zhou YJ, Wang XY, Yu CH. Non-pharmaceutical Chinese medical therapies for degenerative lumbar spinal stenosis: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2023; 74:102949. [PMID: 37062421 DOI: 10.1016/j.ctim.2023.102949] [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: 02/05/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVE The objective of the study was to assess the effectiveness of utilizing Non-Pharmaceutical Chinese Medical (NPCM) therapy singularly or in combination for the treatment of Degenerative Lumbar Spinal Stenosis (DLSS). METHODS The comprehensive search for all randomized controlled trials regarding NPCM therapies for the treatment DLSS was performed through online databases searches, commencing from their inception to January 1st, 2023. The relevant literature underwent a thorough screening process, and the data was meticulously extracted and subjected to analysis through the implementation of RevMan 5.3 software. The Cochrane Risk of Bias tool was employed to assess the potential risk of bias. The synthesis of evidence was performed Grading of Recommendations Assessment, Development, and Evaluation. RESULTS The extensive search procedure produced 5674 records, including data from 37 studies of 38 comparisons (2965 participants). Moderate evidence was obtained demonstrating that the application of acupuncture for a duration of 6-8 weeks was significantly superior to sham acupuncture in terms of intermediate-term (6 months) alleviation of back pain (2 trials, n=128; MD, -1.08; 95% CI, -1.81~-0.34) and improvement in lumbar function (2 trials, n=128; MD, -1.40; 95% CI, -2.93~-0.13). The available low evidence suggested that, as compared to sham acupuncture, acupuncture was effective in reducing short-term (3 months) back pain and enhancing lumbar function but had no impact on leg pain. A trial with low risk of bias found that acupuncture was more effective than sham acupuncture in enhancing disability and walking capabilities. The other studies presented inconsistent evidence with regards to the efficacy of the various interventions employed. CONCLUSIONS Evidence of low-to-moderate quality suggests that for DLSS patients, the implementation of acupuncture in comparison to sham acupuncture presents favorable outcomes in terms of short- and intermediate-term alleviation of back pain, improvement in lumbar function, enhancement of disability and walking capacity. The conclusion regarding the efficacy of other NPCM therapies was not obtained due to the insufficient quality of the available evidence. REGISTRATION PROSPERO CRD42022307631.
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Affiliation(s)
- Ya-Nan Sun
- Traditional Chinese medicine department, Xuanwu Hospital Capital Medical University, Beijing, China.
| | - Yi An
- First clinical college, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China.
| | - Yan-Ji Zhou
- Health Management Department, Aerospace Central Hospital, Beijing.
| | - Xi-You Wang
- Tuina and pain management department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Haiyuncang Road 5, Dongcheng, Beijing, China.
| | - Chang-He Yu
- Tuina and pain management department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Haiyuncang Road 5, Dongcheng, Beijing, China.
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10
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Young JJ, Kongsted A, Jensen RK, Roos EM, Ammendolia C, Skou ST, Grønne DT, Hartvigsen J. Characteristics associated with comorbid lumbar spinal stenosis symptoms in people with knee or hip osteoarthritis: an analysis of 9,136 good life with osteoArthritis in Denmark (GLA:D®) participants. BMC Musculoskelet Disord 2023; 24:250. [PMID: 37005607 PMCID: PMC10067254 DOI: 10.1186/s12891-023-06356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Previous studies have found that lumbar spinal stenosis (LSS) often co-occurs with knee or hip OA and can impact treatment response. However, it is unclear what participant characteristics may be helpful in identifying individuals with these co-occurring conditions. The aim of this cross-sectional study was to explore characteristics associated with comorbid symptoms of lumbar spinal stenosis (LSS) in people with knee or hip osteoarthritis (OA) enrolled in a primary care education and exercise program. METHODS Sociodemographic, clinical characteristics, health status measures, and a self-report questionnaire on the presence of LSS symptoms was collected at baseline from the Good Life with osteoArthritis in Denmark primary care program for knee and hip OA. Cross-sectional associations between characteristics and the presence of comorbid LSS symptoms were assessed separately in participants with primary complaint of knee and hip OA, using domain-specific logistic models and a logistic model including all characteristics. RESULTS A total of 6,541 participants with a primary complaint of knee OA and 2,595 participants with a primary complaint of hip OA were included, of which 40% and 50% reported comorbid LSS symptoms, respectively. LSS symptoms were associated with similar characteristics in knee and hip OA. Sick leave was the only sociodemographic variable consistently associated with LSS symptoms. For clinical characteristics, back pain, longer symptom duration and bilateral or comorbid knee or hip symptoms were also consistently associated. Health status measures were not consistently related to LSS symptoms. CONCLUSION Comorbid LSS symptoms in people with knee or hip OA undergoing a primary care treatment program of group-based education and exercise were common and associated with a similar set of characteristics. These characteristics may help to identify people with co-occurring LSS and knee or hip OA, which can be used to help guide clinical decision-making.
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Affiliation(s)
- James J Young
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark.
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada.
| | - Alice Kongsted
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
| | - Rikke Krüger Jensen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
| | - Ewa M Roos
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
| | - Carlo Ammendolia
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Søren T Skou
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, 4200, Denmark
| | - Dorte T Grønne
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
| | - Jan Hartvigsen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
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Maeder B, Becce F, Kehtari S, Monier A, Chaboudez E, Rothenfluh DA, Schizas C, Hajdu SD. Evolution of the Cross-Sectional Area of the Osseous Lumbar Spinal Canal across Decades: A CT Study with Reference Ranges in a Swiss Population. Diagnostics (Basel) 2023; 13:diagnostics13040734. [PMID: 36832223 PMCID: PMC9955901 DOI: 10.3390/diagnostics13040734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Spinal canal dimensions may vary according to ethnicity as reported values differ among studies in European and Chinese populations. Here, we studied the change in the cross-sectional area (CSA) of the osseous lumbar spinal canal measured in subjects from three ethnic groups born 70 years apart and established reference values for our local population. This retrospective study included a total of 1050 subjects born between 1930 and 1999 stratified by birth decade. All subjects underwent lumbar spine computed tomography (CT) as a standardized imaging procedure following trauma. Three independent observers measured the CSA of the osseous lumbar spinal canal at the L2 and L4 pedicle levels. Lumbar spine CSA was smaller at both L2 and L4 in subjects born in later generations (p < 0.001; p = 0.001). This difference reached significance for patients born three to five decades apart. This was also true within two of the three ethnic subgroups. Patient height was very weakly correlated with the CSA at both L2 and L4 (r = 0.109, p = 0.005; r = 0.116, p = 0.002). The interobserver reliability of the measurements was good. This study confirms the decrease of osseous lumbar spinal canal dimensions across decades in our local population.
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Affiliation(s)
- Benoit Maeder
- Spine Center, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence:
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Sam Kehtari
- Department of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Arnaud Monier
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Etienne Chaboudez
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
| | - Dominique A. Rothenfluh
- Spine Center, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | | | - Steven D. Hajdu
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
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12
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Li T, Yan J, Ren Q, Hu J, Wang F, Liu X. Efficacy and Safety of Lumbar Dynamic Stabilization Device Coflex for Lumbar Spinal Stenosis: A Systematic Review and Meta-analysis. World Neurosurg 2023; 170:7-20. [PMID: 36481444 DOI: 10.1016/j.wneu.2022.11.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND This systematic review and meta-analysis were performed to investigate evidence for the comparison of lumbar dynamic stabilization device Coflex (Surgalign, Deerfield, IL) with posterior lumbar fusion for lumbar spinal stenosis). METHODS Relational databases were searched to October 2022. The main outcome measures included operation time, Japanese Orthopedic Association score (JOA), visual analog scale (VAS), Oswestry disability index (ODI), total complications, and adjacent segment degeneration (ASD). Statistical analysis was performed with Review Manager 5.3 (Cochrane Collaboration). RESULTS A total of 26 studies were included. The main results of this meta-analysis showed lumbar dynamic stabilization device Coflex had shorter operation time (mean difference [MD] -50.77 min, 95% CI -57.24 to -44.30, P < 0.00001), less intraoperative blood loss (MD -122.21 mL, 95% CI -129.68 to -94.74, P < 0.00001), and shorter hospital stays (MD -3.21 days, 95% CI -4.04 to -2.37, P < 0.00001). What's more, the JOA score and ODI score were higher in the Coflex group during early follow-up. Yet, there was no significant difference between the 2 groups with the extension of follow-up time. Moreover, the Coflex group had a lower VAS score than fusion treatment (P < 0.00001). Finally, the Coflex group had lower total complications rate (P = 0.03), lower ASD rate (P = 0.001), and higher range of motion (P < 0.00001), but there was no significant difference in reoperation rate and internal fixation problems rate. CONCLUSIONS Current evidence suggests that lumbar dynamic stabilization device Coflex is superior to posterior lumbar fusion in early follow-up. However, considering that the dynamic stabilization device group also has its limitations, these findings need to be further verified by multicenter, double-blind, and large-sample randomized controlled trials.
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Affiliation(s)
- Ting Li
- Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China; Department of Postgraduate, Chengdu Medical College, Chengdu, China
| | - Jingxin Yan
- Department of Interventional Therapy, Affiliated Hospital of Qinghai University, Xining, China
| | - Qiuyu Ren
- Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China; Department of Postgraduate, Chengdu Medical College, Chengdu, China
| | - Jiang Hu
- Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Fei Wang
- Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Xilin Liu
- Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.
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13
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Wan B, Ma N, Lu W. Evaluating the causal relationship between five modifiable factors and the risk of spinal stenosis: a multivariable Mendelian randomization analysis. PeerJ 2023; 11:e15087. [PMID: 36967997 PMCID: PMC10038083 DOI: 10.7717/peerj.15087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/26/2023] [Indexed: 03/29/2023] Open
Abstract
Background Spinal stenosis is a neurological disorder related to the compression of the spinal cord or nerve roots, and its incidence increases yearly. We aimed to use Mendelian randomization (MR) to investigate the causal relationship between several modifiable risk factors and the risk of spinal stenosis. Methods We obtained genome-wide association study summary data of large-sample projects (more than 100,000 individuals) from public databases. The data were associated with traits, including years of schooling (educational attainment) from the IEU OpenGWAS Project, smoking behavior (never vs. initiation) from the IEU OpenGWAS Project, body mass index (BMI) from the UK Biobank, length of mobile phone use from the UK Biobank, time spent watching television (TV) from the UK Biobank, and spinal stenosis from FinnGen biobank. Spinal stenosis was used as the outcome, whereas the other four traits were used as exposures. Inverse variance weighted (IVW) regressions were used as a primary to estimate the causal-effect size. Several sensitive analyses (including consistency, heterogenicity, and pleiotropy analyses) were conducted to test the stability and reliability of causal estimates. Results Univariable MR analyses showed that genetically predicted higher educational attainment (IVW; odds ratio (OR) = 0.606; 95% confidence interval (CI): 0.507-0.724; P = 3.37 × 10-8) and never smoking (IVW; OR = 1.388; 95% CI [1.135-1.697]; P = 0.001) were negatively correlated with the risk of spinal stenosis. Meanwhile, a higher BMI (IVW; OR = 1.569; 95% CI [1.403-1.754]; P = 2.35 × 10-8), longer time spent using a mobile phone (IVW; OR = 1.895; 95% CI [1.306-2.750]; P = 0.001), and watching TV (IVW; OR = 1.776; 95% CI [1.245-2.532]; P = 0.002) were positively associated with the risk of spinal stenosis. Multivariable MR analysis indicated that educational attainment (IVW; OR = 0.670; 95% CI [0.465-0.967]; P = 0.032) and BMI (IVW; OR = 1.365; 95% CI [1.179-1.580]; P = 3.12 × 10-5) were independently causally related to the risk of spinal stenosis. Conclusion Our findings supported the potential causal associations of the five factors (educational attainment, smoking behavior, BMI, length of mobile phone use, and watching TV) with the risk for spinal stenosis. While replication studies are essential, these findings may provide a new perspective on prevention and intervention strategies directed toward spinal stenosis.
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Affiliation(s)
- Bangbei Wan
- Reproductive Medical Center, Hainan Women and Children’s Medical Center, Haikou, Hainan, China
- Department of Urology, Haikou Affiliated Hospital of Central South University, Xiangya School of Medicine, Haikou, Hainan, China
| | - Ning Ma
- Reproductive Medical Center, Hainan Women and Children’s Medical Center, Haikou, Hainan, China
| | - Weiying Lu
- Reproductive Medical Center, Hainan Women and Children’s Medical Center, Haikou, Hainan, China
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14
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Young JJ, Kongsted A, Hartvigsen J, Roos EM, Ammendolia C, Skou ST, Grønne DT, Jensen RK. Associations between comorbid lumbar spinal stenosis symptoms and treatment outcomes in 6,813 patients with knee or hip osteoarthritis following a patient education and exercise therapy program. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100324. [PMID: 36561495 PMCID: PMC9763512 DOI: 10.1016/j.ocarto.2022.100324] [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: 08/29/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Objective People with knee or hip osteoarthritis (OA) can experience comorbid lumbar spinal stenosis (LSS), but the impact on treatment outcomes is unknown. The aim of this study was to investigate associations between comorbid LSS symptoms and changes in pain, function, and quality of life following a patient education and exercise therapy program. Design This was a longitudinal analysis of 6813 participants in the Good Life with osteoArthritis in Denmark (GLA:D®) program; a structured patient education and exercise therapy program for knee and hip OA. Participants were classified as having comorbid LSS symptoms based on self-report symptom items. Linear mixed models were used to assess differences in change in pain, function, and quality of life outcomes (0 worst to 100 best) at 3- and 12-month follow-up. Results 15% and 23% of knee and hip OA participants had comorbid LSS symptoms, respectively. Knee participants with comorbid LSS symptoms had smaller improvement in pain at 3-months (-1.7, 95% CI -3.3 to -0.1) and hip participants with comorbid LSS symptoms had greater improvement in function at 3- (2.5, 95% CI 0.5 to 5.0) and 12-months (3.8, 95% CI 0.9 to 6.6), when compared to those without LSS symptoms. These differences were not clinically significant and no differences in other outcomes were observed. Conclusion Knee or hip OA patients with comorbid LSS symptoms should expect similar improvements in knee- or hip-related pain, function, and quality of life outcomes when undergoing a patient education and exercise therapy program compared to those without LSS symptoms.
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Affiliation(s)
- James J. Young
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada,Corresponding author. Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark.
| | - Alice Kongsted
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Chiropractic Knowledge Hub, 5230, Odense, Denmark
| | - Jan Hartvigsen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Chiropractic Knowledge Hub, 5230, Odense, Denmark
| | - Ewa M. Roos
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark
| | - Carlo Ammendolia
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Søren T. Skou
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
| | - Dorte T. Grønne
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark
| | - Rikke Krüger Jensen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Chiropractic Knowledge Hub, 5230, Odense, Denmark
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Li D, Wang L, Wang Z, Li C, Yuan S, Tian Y, Yu X, Liu X. Age-related radiographic parameters difference between the degenerative lumbar spinal stenosis patients and healthy people and correlation analysis. J Orthop Surg Res 2022; 17:475. [PMID: 36329488 PMCID: PMC9632108 DOI: 10.1186/s13018-022-03374-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To identify age-related radiographic risk factors for degenerative lumbar spinal stenosis (DLSS) and analyze correlations among them. METHODS A total of 180 cases were enrolled in this study, and lumbar magnetic resonance was performed. Among them, 93 cases suffered DLSS and lumbar dynamic X-ray was examined. And following parameters were measured and evaluated: intervertebral disk height (IDH), the ratio of IDH(IDHL4-5/L3-4), initial IDH of L4-5(iIDHL4-5) in the DLSS group, disk degeneration (DD), cartilaginous endplate failure (CEF), Modic changes, the thickness of ligamentum flavum (LF), range of intervertebral motion (ROM), facet joint opening (FJO), facet joint angle (FJA), the standard cross-sectional area (SCSA) of the multifidus, erector spinae, and psoas major muscles. The data of two groups were compared, and the possible risk factors of DLSS were analyzed. RESULTS Compared with the control group, the DLSS group had higher IDH except for L4-5 and larger iIDHL4-5 (P < 0.05). Significant differences were shown in CEF and the thickness of LF at L1-S1 and DD at L4-5 (P < 0.05). The DLSS group had smaller SCSA of multifidus, erector spinae, and psoas major muscles but greater FJA, FJO (P < 0.05). And the risk of DLSS increased when iIDHL4-5 ≥ 10.73 mm, FJA ≥ 52.03° , or FJO ≥ 3.75 mm. IDH positively correlated with SCSA of multifidus and psoas major muscles and ROM at L1-S1 (P < 0.05). DD showed negative linear relations with SCSA of multifidus and psoas muscle and positive linear relation with CEF at L1-2, L2-3, and L5-S1 (P < 0.05). CONCLUSION Larger initial disk height and excessive CEF may induce DLSS by increasing intervertebral mobility to promote DD, and atrophied paravertebral muscles by weakening the stability of lumbar spine.
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Affiliation(s)
- Donglai Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Zheng Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Chao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Xuguang Yu
- School of Physical Education, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
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Gadjradj PS, Sommer F. Letter to the editor regarding a recent article "The MOTION Study" Putting a Mild Brake on the MOTION. PAIN MEDICINE 2022; 23:1812-1813. [PMID: 35567487 DOI: 10.1093/pm/pnac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/11/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Pravesh S Gadjradj
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, U.S.A
| | - Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, U.S.A
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17
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Gadjradj PS, Arjun Sharma JRJ, Harhangi BS. Quality of conscious sedation using dexmedetomidine during full-endoscopic transforaminal discectomy for sciatica: a prospective case series. Acta Neurochir (Wien) 2022; 164:1209-1216. [PMID: 35098351 DOI: 10.1007/s00701-021-05100-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/18/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Percutaneous transforaminal endoscopic discectomy (PTED) is increasing in popularity as a minimally invasive procedure to treat sciatica caused by lumbar disc herniation. The objective of the current study is to evaluate safety of and satisfaction with the use of local anesthesia and conscious sedation during PTED. METHODS During a 12-month inclusion period, patients were prospectively included in this single center case series. Inclusion criteria consisted of sciatica lasting for at least 6 weeks, which was not responsive to conservative treatment. PTED was performed using dexmedetomidine as sedative and lidocaine as local anesthesia. Measurements included the numeric rating scale (NRS, from 0 to 10) for leg pain, back pain, COMI-back, and NRS for anxiety of anesthesia and perioperative continuously monitored hemodynamics. Furthermore, satisfaction with the sedation was scored by patients, surgeons, and anesthesiologists. RESULTS Ninety-two consecutive patients were enrolled. Of all patients, 18.5% had anxiety for undergoing surgery under local anesthesia. All but one patient underwent PTED successfully. There was one case of conversion due to severe, uncontrollable back pain during surgery. Throughout the procedure, hemodynamic parameters showed no clinically relevant change compared to baseline. Anesthesiologic complications were three cases (3.4%) of self-limiting hypoxia and five cases (8.6%) of nausea and/or vomiting. Surgeons and anesthesiologists had a high satisfaction rate (> 87%) with the conscious sedation during the procedure, while satisfaction with sedation was scored 8.4 ± 2.2 by patients. CONCLUSIONS PTED performed under local anesthesia and conscious sedation is safe and effective to treat sciatica and yields high satisfaction rates from surgeons, anesthesiologists, and patients.
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Smith DL, Olding K, Malaya CA, McCarty M, Haworth J, Pohlman KA. The influence of flexion distraction spinal manipulation on patients with lumbar spinal stenosis: A prospective, open-label, single-arm, pilot study. J Bodyw Mov Ther 2022; 32:60-67. [DOI: 10.1016/j.jbmt.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/08/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
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Williamson E, Boniface G, Marian IR, Dutton SJ, Garrett A, Morris A, Hansen Z, Ward L, Nicolson PJA, Rogers D, Barker KL, Fairbank J, Fitch J, French DP, Comer C, Mallen CD, Lamb SE. The clinical effectiveness of a physiotherapy delivered physical and psychological group intervention for older adults with neurogenic claudication: the BOOST randomised controlled trial. J Gerontol A Biol Sci Med Sci 2022; 77:1654-1664. [PMID: 35279025 PMCID: PMC9373932 DOI: 10.1093/gerona/glac063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Neurogenic claudication (NC) is a debilitating spinal condition affecting older adults’ mobility and quality of life. Methods A randomized controlled trial of 438 participants evaluated the effectiveness of a physical and psychological group intervention (BOOST program) compared to physiotherapy assessment and tailored advice (best practice advice [BPA]) for older adults with NC. Participants were identified from spinal clinics (community and secondary care) and general practice records and randomized 2:1 to the BOOST program or BPA. The primary outcome was the Oswestry Disability Index (ODI) at 12 months. Data were also collected at 6 months. Other outcomes included ODI walking item, 6-minute walk test (6MWT), and falls. The primary analysis was intention-to-treat. Results The average age of participants was 74.9 years (standard deviation [SD] 6.0) and 57% (246/435) were female. There was no significant difference in ODI scores between treatment groups at 12 months (adjusted mean difference [MD]: −1.4 [95% confidence intervals (CI) −4.03, 1.17]), but, at 6 months, ODI scores favored the BOOST program (adjusted MD: −3.7 [95% CI −6.27, −1.06]). At 12 months, the BOOST program resulted in greater improvements in walking capacity (6MWT MD: 21.7m [95% CI 5.96, 37.38]) and ODI walking item (MD: −0.2 [95% CI −0.45, −0.01]) and reduced falls risk (odds ratio: 0.6 [95% CI 0.40, 0.98]) compared to BPA. No serious adverse events were related to either treatment. Conclusions The BOOST program substantially improved mobility for older adults with NC. Future iterations of the program will consider ways to improve long-term pain-related disability. Clinical Trials Registration Number: ISRCTN12698674
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Affiliation(s)
- Esther Williamson
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK.,College of Medicine and Health, University of Exeter
| | - Graham Boniface
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | - Ioana R Marian
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Susan J Dutton
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Angela Garrett
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | - Alana Morris
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | - Zara Hansen
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | - Lesley Ward
- Department of Sport, Exercise and Rehabilitation, Northumbria University, UK
| | - Philippa J A Nicolson
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | - David Rogers
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Karen L Barker
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK.,Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jeremy Fairbank
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, UK
| | - Christine Comer
- University of Leeds, Leeds, UK.,Leeds Community Healthcare NHS Trust, Otley, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter
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Jensen RK, Ris I, Linnebjerg E, Christensen HW, Myburgh C. The utilisation of regulated standardised care packages by Danish chiropractors: a mixed methods study. Chiropr Man Therap 2022; 30:14. [PMID: 35260181 PMCID: PMC8903550 DOI: 10.1186/s12998-022-00423-7] [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: 09/06/2021] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background In Denmark, chiropractors in primary care work as independent private contractors regulated by the Danish National Health Authorities. The regulation includes partial reimbursement intended for standardised care packages for lumbar and cervical radiculopathy and lumbar spinal stenosis. Random checks have shown lower use than expected. This study aimed to describe and explore the utilisation of standardised chiropractic care packages and identify barriers to uptake. Methods A convergent mixed-method design was conceptualised. The use of standardised care packages was collected by register data. Potential determinants of difference in utilisation were assessed using a modified version of the Determinants of Implementation Behaviour Questionnaire (DIBQ) divided into 13 domains and sent to chiropractors in private clinics in Denmark in 2019. An open-ended question was added to the questionnaire, and thematic content analysis was applied. Qualitative findings were used to expand on the DIBQ data providing further insight into the clinicians’ perspective on standardised care packages. Results Registry data of 244 included chiropractic clinics showed limited and inconsistent use of the standardised chiropractic care packages. A total of 269 chiropractors (44%) answered the DIBQ, and 45 provided data for the qualitative analyses. At least 60% of the clinicians answered ‘Strongly agree’ or ‘Agree’ in 10 out of 13 DIBQ domains suggesting a positive attitude towards using the standardised care packages. Three domains were identified as ‘problematic’ as more than 20% of clinicians disagreed or strongly disagreed: ‘Socio-political context’, ‘Goals’ and ‘Innovation’. Qualitative findings indicated that lack of usage of the standardised care packages was mainly related to the practical organization of standardised care, the chiropractor’s role when managing patients, and the patient population of interest to the clinic (e.g., children, athletes). Conclusion In general, Danish chiropractors displayed positive attitudes towards standardised packages of care. However, considerable variation in the use of the standardised care programs was observed. Low utilisation seemed mainly related to logistics, the chiropractor’s role, collaboration with GPs, and the patient population of interest to the clinic. These findings should be further explored in more extensive qualitative studies to inform implementation initiatives to increase and rectify utility. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00423-7.
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Affiliation(s)
- Rikke Krüger Jensen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. .,Chiropractic Knowledge Hub, Campusvej 55, 5230, Odense M, Denmark.
| | - Inge Ris
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Univerity College Lillebaelt, Niels Bohrs Allé 1, 5230, Odense M, Denmark
| | | | | | - Corrie Myburgh
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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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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