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Shemesh S, Laks A, Cohen I, Turjeman A, Blecher R, Kadar A. Diabetes Mellitus and Poor Glycemic Control Are Associated With a Higher Risk of Lumbar Spinal Stenosis: An Analysis of a Large Nationwide Database. Spine (Phila Pa 1976) 2024; 49:595-600. [PMID: 38095111 DOI: 10.1097/brs.0000000000004900] [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] [Received: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 04/11/2024]
Abstract
STUDY DESIGN A large-scale retrospective case-control study. OBJECTIVE Examine diabetes as a risk factor for lumbar spinal stenosis (LSS) development and evaluate the impact of diabetes duration, glycemic control, and associated complications on this risk. SUMMARY OF BACKGROUND DATA Diabetes mellitus, a multiorgan disorder impacting various connective tissues, induces histological changes in spinal structures, particularly the ligamentum flavum. While clinical studies suggest a higher incidence of LSS in diabetic patients, substantial epidemiological research on the likelihood of LSS diagnosis in individuals with diabetes is scarce. MATERIALS AND METHODS Using nationwide data, a total of 49,576 patients diagnosed with LSS based on International Classification of Diseases-10 codes were matched with controls of the same number based on age and sex. Employing a multivariable logistic regression model, the study assessed for the association between spinal stenosis and diabetes, while adjusting for confounders. RESULTS We found a higher likelihood of LSS diagnosis in diabetic patients [odds ratio (OR) 1.39, 95% CI: 1.36 - 1.43, P <0.001]. Those with hemoglobin A1c ≥7% and ≥1 diabetes-related complication also had an elevated likelihood (OR: 1.19, 95% CI: 1.08-1.31, P =0.001). Prolonged diabetes exposure increased the risk. Diabetes diagnosis reduced median survival by around 4.5 years for both stenosis and nonstenosis patients; spinal stenosis diagnosis alone minimally impacted survival. Relative to individuals diagnosed with diabetes mellitus at the age of 65 or older, the OR for developing LSS were 1.22 (95% CI: 1.18-1.27, P <0.001) when DM was diagnosed at 50 to 65 years old and 1.67 (95% CI: 1.56-1.79, P <0.001) for those under 50 years old. Multivariate analysis revealed a significantly increased risk of all-cause mortality in patients with DM and spinal stenosis (hazard ratio: 1.36, 95% CI: 1.29-1.44, P <0.001) and those with DM without stenosis (hazard ratio: 1.49, 95% CI: 1.41-1.57, P <0.001) compared with controls. CONCLUSIONS Diabetic patients with prolonged disease, poor glycemic control, and diabetes-related complications face an elevated risk of developing LSS. Recognizing the reciprocal adverse relationship between these conditions is crucial in clinical practice and designing public health measures for managing both conditions. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Shai Shemesh
- Department of Orthopaedic Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
| | - Asaf Laks
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | | | - Adi Turjeman
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ronen Blecher
- Department of Orthopaedic Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
| | - Assaf Kadar
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Roth | McFarlane Hand & Upper Limb Centre, St. Joseph's Hospital and Western University
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2
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Oh Y, Han CH, Kim Y, Kim J, Yang C, Choi YE, Kang BK, Kim KH, Yang GY, Lee BR, Kim E. Pharmacopuncture Therapy as an Adjunctive Treatment for Patients with Lumbar Spinal Stenosis: A Pragmatic Randomized Controlled Pilot Trial. J Pain Res 2024; 17:837-849. [PMID: 38464904 PMCID: PMC10924935 DOI: 10.2147/jpr.s438219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/28/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose Pharmacopuncture therapy (PPT) combines medicinal extracts with acupuncture and is widely used as an adjunct in clinical practice. This study assessed the safety and feasibility of PPT in addition to conventional Korean Medicine treatment (CKMT), including electroacupuncture, cupping and infra-red, for lumbar spinal stenosis (LSS). Patients and Methods Forty patients diagnosed with LSS were randomly assigned to undergo PPT with CKMT (experimental group) or CKMT alone (control group) at a 1:1 ratio, receiving 10 sessions of each intervention over five weeks. The primary clinical outcome was measured using the 100-mm Visual Analog Scale (VAS) for buttock and leg pain five weeks post-treatment. Secondary outcomes included clinically important difference (CID), Zurich Claudication Questionnaire, self-reported walking capacity, Modified-Modified Schober test, EuroQol 5-dimension 5-level questionnaire, and the patient's global impression of change. The adverse events were assessed at each visit. The analysis of covariance was conducted to compare between two groups. Results Intervention completion rates were 95% and 100% in the experimental and control groups, respectively. No statistically significant differences were found between groups regarding the primary outcome (adjusted mean difference: 8.0; 95% confidence interval: -1.4-17.4). The mean difference in the 100-mm VAS for low back pain at week 5 (adjusted mean difference: 12.9; 95% confidence interval: 2.4-23.4) and the proportion of patients who reached the minimum CID was higher in the experimental group than in the control group. However, no significant differences were observed with other secondary outcomes. One patient in the experimental group experienced a systemic skin rash that resolved the same day, whereas the adverse events in the other group were mild and transient. Conclusion This trial demonstrated the feasibility of add-on effects and the safety of pharmacopuncture in patients with LSS. Further studies are warranted to evaluate the add-on effects of PPT in treating LSS. Trial Registration Clinical Research Information Service (CRIS), KCT0007229; registered on April 26, 2022.
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Affiliation(s)
- Yoona Oh
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Chang-Hyun Han
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Yeonhak Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
| | - Jihun Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Young Eun Choi
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Byoung-Kab Kang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kun Hyung Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Gi Young Yang
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Byung Ryul Lee
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Eunseok Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
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Caprariu R, Oprea MD, Poenaru DV, Andrei D. Correlation between Preoperative MRI Parameters and Oswestry Disability Index in Patients with Lumbar Spinal Stenosis: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2000. [PMID: 38004049 PMCID: PMC10672893 DOI: 10.3390/medicina59112000] [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: 10/04/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Lumbar spinal stenosis (LSS) is a degenerative condition posing significant challenges in clinical management. Despite the use of radiological parameters and patient-reported outcome measures like the Oswestry Disability Index (ODI) for evaluation, there is limited understanding of their interrelationship. This study aimed to investigate the correlation between preoperative MRI parameters and ODI scores in patients with LSS undergoing surgical treatment. Materials and Methods: A retrospective analysis was conducted on 86 patients diagnosed with LSS over a 5-year period. Preoperative MRI measurements, including the cross-sectional area of the psoas muscle, lumbar canal stenosis, neural foramina area, and facet joint osteoarthritis, were assessed. ODI scores were collected preoperatively and at a 1-year follow-up. Statistical analyses were performed using IBM SPSS Statistics software (version 26). Results: Weak to moderate correlations were observed between certain MRI parameters and ODI scores. The initial ODI score had a weak positive correlation with the severity of lumbar canal stenosis according to Schizas criteria (rho = 0.327, p = 0.010) and a moderate negative correlation with the relative cross-sectional area of the psoas muscle (rho = -0.498, p = 0.000). At 1-year follow-up, the ODI had a weak negative correlation with the relative cross-sectional area of the psoas muscle (rho = -0.284, p = 0.026). Conclusions: While the severity of LSS showed a weak correlation with initial ODI, it was not a predictor of 1-year postoperative ODI. Furthermore, although the cross-sectional area of the thecal sac, the sagittal area of the neural foramen, and the grade of facet joint osteoarthritis influence the imagistic severity, none of them correlate with ODI. These findings underscore the need for a comprehensive model that integrates multiple imaging and clinical parameters for a holistic understanding of LSS and its functional outcomes.
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Affiliation(s)
- Radu Caprariu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania;
| | - Manuel D. Oprea
- Department of Traumatology and Orthopedics, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania;
| | - Dan V. Poenaru
- Department of Traumatology and Orthopedics, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania;
| | - Diana Andrei
- Department of Balneology, Medical Rehabilitation and Rheumatology, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania;
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Sekiguchi M. The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 2. Diagnosis and Evaluation. Spine Surg Relat Res 2023; 7:300-305. [PMID: 37636148 PMCID: PMC10447202 DOI: 10.22603/ssrr.2022-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/13/2022] [Indexed: 08/29/2023] Open
Affiliation(s)
- Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Haque MZ, Reesha S, Khan S, Rafique R, Saleem A, Ilyas O, Abdullah L, Hussain A, Husain M. Peripheral Arterial Diseases and Diabetes Mellitus: Associations With Quality of Health Measures in Patients Undergoing Percutaneous Vascular Interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 48:34-38. [PMID: 36379829 DOI: 10.1016/j.carrev.2022.11.003] [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: 10/03/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is more prevalent and severe in patients with diabetes mellitus (DM) compared with those without DM. Peripheral vascular intervention (PVI) is often used in patients failing conservative management. The association of PVI with health status in diabetic patients has yet to be determined. METHODS We analyzed the clinical response to PVI in DM (n = 203, 52 %) compared with non-DM patients (n = 183, 48 %), using the Peripheral Arterial Questionnaire (PAQ) for patients during baseline and a maximum 6 months after PVI. We used the PAQ summary score, which summarized the patients' level of physical and social function, patient symptoms, and overall quality of life. This represented the PAD-related Quality of Health (QOH). Our score range is between 0 (lowest health quality) and 100 (highest health quality). RESULTS Compared with non-DM patients, those with DM were more likely to have a history of prior PVI, an increased prevalence of PAD risk factors, and significantly lower QOH scores at baseline (32.7 ± 20 vs 37.5 ± 20.6, p = 0.02). After adjustment for baseline confounding, neither the baseline, the change, nor the final summary scores were significantly different between groups, suggesting similar symptomatic and functional improvement in non-DM and DM patients post-PVI. CONCLUSIONS Following PVI, PAD-specific health status showed a similar improvement in patients with and without DM, illustrating that use of this strategy among patients with multiple comorbidities or diffuse PAD as useful.
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Affiliation(s)
- Mahfujul Z Haque
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Syeda Reesha
- Downriver Heart and Vascular Specialists, Southgate, MI, USA
| | - Shahrin Khan
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Rumyah Rafique
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Abdulmalik Saleem
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Omar Ilyas
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | | | - Arif Hussain
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Mashkur Husain
- Downriver Heart and Vascular Specialists, Southgate, MI, USA
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Oh Y, Han CH, Kim Y, Kim J, Yang C, Choi YE, Kang BK, Yang GY, Lee BR, Kim E. Add-on Effect and Safety of Pharmacopuncture Therapy in the Treatment of Patients with Lumbar Spinal Stenosis. J Acupunct Meridian Stud 2023; 16:40-48. [PMID: 36804820 DOI: 10.51507/j.jams.2023.16.1.40] [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: 10/27/2022] [Revised: 12/05/2022] [Accepted: 01/24/2023] [Indexed: 02/22/2023] Open
Abstract
Background Recently, Korean Medicine treatment with pharmacopuncture therapy (PPT) has been increasingly used in clinical practice to improve symptoms in patients with lumbar spinal stenosis (LSS). The aim of this study is to evaluate the effectiveness and safety of PPT in addition to conventional Korean Medicine treatment (CKMT) for the treatment of patients with LSS, compared with CKMT alone. Methods This study is designed as a pragmatic, randomized, two-armed, parallel, stratified (by sex), controlled pilot trial. Forty patients diagnosed with LSS will be randomly allocated to the PPT + CKMT group or the CKMT group. Patients in the two groups will receive treatment two times weekly for 5 weeks. The primary outcome will be the mean change in the 100-mm visual analog scale score from the baseline to the end of treatment (week 5). The secondary outcomes will include the clinically important difference, Zurich Claudication Questionnaire score, self-reported walking capacity, Modified-Modified Schober test, EuroQol 5-dimension 5-level questionnaire, and Patients' Global Impression of Change. Adverse events will be assessed at each visit. Discussion The results of this study will provide meaningful data to evaluate the add-on effect and safety of PPT in the medical care of patients with LSS.
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Affiliation(s)
- Yoona Oh
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
| | - Chang-Hyun Han
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea.,Korean Convergence Medicine, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Yeonhak Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
| | - Jihun Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Young Eun Choi
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Byoung-Kab Kang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Gi Young Yang
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea.,Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea
| | - Byung Ryul Lee
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea.,Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea
| | - Eunseok Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea.,Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea
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Kawakami M, Takeshita K, Inoue G, Sekiguchi M, Fujiwara Y, Hoshino M, Kaito T, Kawaguchi Y, Minetama M, Orita S, Takahata M, Tsuchiya K, Tsuji T, Yamada H, Watanabe K. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar spinal stenosis, 2021 - Secondary publication. J Orthop Sci 2023; 28:46-91. [PMID: 35597732 DOI: 10.1016/j.jos.2022.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Japanese Orthopaedic Association (JOA) guideline for the management of lumbar spinal stenosis (LSS) was first published in 2011. Since then, the medical care system for LSS has changed and many new articles regarding the epidemiology and diagnostics of LSS, conservative treatments such as new pharmacotherapy and physical therapy, and surgical treatments including minimally invasive surgery have been published. In addition, various issues need to be examined, such as verification of patient-reported outcome measures, and the economic effect of revised medical management of patients with lumbar spinal disorders. Accordingly, in 2019 the JOA clinical guidelines committee decided to update the guideline and consequently established a formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline, incorporating the recent advances of evidence-based medicine. METHODS The JOA LSS guideline formulation committee revised the previous guideline based on the method for preparing clinical guidelines in Japan proposed by the Medical Information Network Distribution Service in 2017. Background and clinical questions were determined followed by a literature search related to each question. Appropriate articles based on keywords were selected from all the searched literature. Using prepared structured abstracts, systematic reviews and meta-analyses were performed. The strength of evidence and recommendations for each clinical question was decided by the committee members. RESULTS Eight background and 15 clinical questions were determined. Answers and explanations were described for the background questions. For each clinical question, the strength of evidence and the recommendation were both decided, and an explanation was provided. CONCLUSIONS The 2021 clinical practice guideline for the management of LSS was completed according to the latest evidence-based medicine. We expect that this guideline will be useful for all medical providers as an index in daily medical care, as well as for patients with LSS.
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Affiliation(s)
| | | | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | - Yasushi Fujiwara
- Department of Orthopaedic Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City General Hospital, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University, Japan
| | | | - Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
| | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University, Japan
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Lower Extremity Arterial Disease and Lumbar Spinal Stenosis: A Study of Exercise-Induced Arterial Ischemia in 5197 Patients Complaining of Claudication. J Clin Med 2022; 11:jcm11195550. [PMID: 36233418 PMCID: PMC9572820 DOI: 10.3390/jcm11195550] [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: 08/16/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 12/24/2022] Open
Abstract
Only few studies have analyzed the associations of lower extremity artery disease (LEAD) with lumbar spinal stenosis (LSS), although it is expected to be a frequent association. With exercise-oximetry, we determined the presence of exercise-induced regional blood flow impairment (ischemia) in 5197 different patients complaining of claudication and referred for treadmill testing. We recorded height, weight, age, sex, ongoing treatments, cardiovascular risk factor (diabetes, high blood pressure, current smoking habit), and history of suspected or treated LSS and/or lower limb revascularization. An ankle-brachial index at rest < 0.90 or >1.40 on at least one side was considered indicative of the presence of LEAD (ABI+). Ischemia was defined as a minimal DROP (Limb-changes minus chest-changes from rest) value < −15 mmHg during exercise oximetry. We analyzed the clinical factors associated to the presence of exercise-induced ischemia in patients without a history of LSS, using step-by-step linear regression, and defined a score from these factors. This score was then tested in patients with a history of LSS. In 4690 patients without a history of (suspected, diagnosed, or treated) LSS, we observed that ABI+, male sex, antiplatelet treatment, BMI< 26.5 kg//m2, age ≤ 64 years old, and a history of lower limb arterial revascularization, were associated to the presence of ischemia. The value of the score derived from these factors was associated with the probability of exercise-induced ischemia in the 507 patients with a history of LSS. This score may help to suspect the presence of ischemia as a factor of walking impairment in patients with a history of lumbar spinal stenosis.
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Impact of lumbar spinal stenosis on metabolic syndrome incidence in community-dwelling adults in Aizu cohort study (LOHAS). Sci Rep 2022; 12:11246. [PMID: 35789178 PMCID: PMC9253139 DOI: 10.1038/s41598-022-15173-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/20/2022] [Indexed: 12/14/2022] Open
Abstract
Metabolic syndrome and lumbar spinal stenosis (LSS) are common age-related diseases. However, the causal relationship between them remains unclear. This study aimed to identify the effects of LSS on metabolic syndrome incidence in community-dwelling adults. This prospective cohort study included participants of the Aizu cohort study (LOHAS) aged < 75 years as of 2008. Participants with metabolic syndrome at baseline were excluded. The primary outcome measure was metabolic syndrome incidence, and the main explanatory variable was the presence of LSS, as assessed by a self-reported questionnaire. A multivariate Cox proportional hazard regression model was used to estimate hazard ratios (HRs) for metabolic syndrome incidence during the 6-year follow-up period. Complete-case analyses were compared with the multiple imputation results. Among 1599 participants, 1390 complete cases were analyzed (mean [SD] age 62.3 [9.0] years; females, 734 [52.8%]). Among those participants, 525 (37.8%) developed metabolic syndrome during the follow-up of 3.89 [1.96] years. The presence of LSS was associated with developing metabolic syndrome (HR, 1.41; 95% confidence interval [CI] 1.02–1.95). Multiple imputation results showed similar trends of those having complete-case data (HR, 1.47; 95% CI 1.08–2.00). This finding suggests the importance of prevention and management of LSS in community settings.
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Ruggiero E, Bonaccio M, Costanzo S, Esposito S, Di Castelnuovo A, Carpineta E, Cerletti C, Donati MB, Paolini S, Esposito V, de Gaetano G, Innocenzi G, Iacoviello L. Dietary factors and the risk of lumbar spinal stenosis: A case-control analysis from the PREFACE study. Nutr Metab Cardiovasc Dis 2022; 32:90-97. [PMID: 34802849 DOI: 10.1016/j.numecd.2021.09.019] [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: 05/17/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS There is a lack of knowledge on the association of dietary factors and Lumbar Spinal Stenosis (LSS). We evaluated the association of a Mediterranean diet (MD), its major food components and ultra-processed food (UPF) with the risk of LSS. METHODS AND RESULTS Participants were recruited from the Neurosurgery Department of the IRCCS Neuromed, Italy. The study sample consisted of 156 cases of LSS, and 312 controls matched 1:2 for sex, age (±6 months) and physical activity, without a history or clinical evidence of LSS who were identified from the general population. Adherence to MD was assessed by the Mediterranean Diet Score based on 9 food groups. UPF was defined according to NOVA classification and calculated as the ratio (%) of UPF (g/d) on total food consumed (g/d). In multivariable-adjusted analysis, a 2-point increase in the MD score was not associated with LSS risk (OR: 1.02, 95% CI: 0.72-1.46). An increment of 10 g/d of fruits and nuts, cereals or fish led to lower odds of LSS (OR: 0.97, 95% CI: 0.95-0.99; OR: 0.88, 95% CI: 0.82-0.94; OR: 0.87, 95% CI: 0.76-0.99, respectively). Additionally, 1% increment in the consumption of UPF in the diet was independently associated with higher LSS risk (OR: 1.09, 95% CI: 1.04-1.14). CONCLUSION A diet rich in fruits, cereals, fish is associated with lower risk of LSS while a large dietary share of UPF increases the risk of this disease. Further studies with a prospective design and larger sample sizes are warranted.
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Affiliation(s)
- Emilia Ruggiero
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Simona Esposito
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | | | | | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | | | - Sergio Paolini
- Neurosurgery Department, IRCCS NEUROMED, Pozzilli, IS, Italy
| | | | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | | | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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11
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Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN 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 2021; 31:1391-1398. [PMID: 34797405 DOI: 10.1007/s00586-021-07051-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. METHODS The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. RESULTS The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2-4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. CONCLUSION In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. TRIAL REGISTRATION www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.
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Koyama K, Wada K, Kumagai G, Kudo H, Tanaka S, Asari T, Jung S, Ando M, Ishibashi Y. Association between mild cognitive impairment and lumbar degenerative disease in a Japanese community: A cross-sectional study. PLoS One 2021; 16:e0258852. [PMID: 34665835 PMCID: PMC8525772 DOI: 10.1371/journal.pone.0258852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
Abstract
Lumbar degenerative disease and dementia are increasing in super-aging societies and are both related to physical dysfunction and pain. However, the relationship between these diseases remains unclear. This cross-sectional study aimed to investigate the comorbidity rates of lumbar spinal canal stenosis (LSS) and mild cognitive impairment (MCI) and clarify the association between LSS presence, lumbar symptoms, and quality of life (QOL) related to low back pain and cognitive impairment in the Japanese population. We enrolled 336 participants (men 124; women 212; mean age 72.2 years) from a medical checkup program. LSS was diagnosed using a self-administered questionnaire, and lumbar symptoms were evaluated using the visual analog scale (low back pain, and pain and numbness of the lower limb). QOL related to low back pain was evaluated using the Japanese Orthopedic Association Back-Pain Evaluation Questionnaire (JOABPEQ: pain, and lumbar, and gait function). Radiological lumbar degeneration was classified using Kellgren-Lawrence grading and lateral radiographs of the lumbar spine. Cognitive function was measured using the Mini Mental State Examination (MMSE), and MCI was defined by a summary score of MMSE ≤27. Logistic and multiple linear regression analyses were performed to analyze the association between MCI, summary score of MMSE, and lumbar degenerative disease. The comorbidity rate of MCI and LSS was 2.1%, and the rate of MCI was 41% in participants with LSS. Lumbar function in JOABPEQ was associated with MCI. The presence of LSS and lumbar function in JOABPEQ were associated with MMSE. Over one-third of the people with LSS had MCI. The presence of LSS and deterioration of QOL due to low back pain were related to cognitive impairment. We recommend evaluating cognitive function for patients with LSS because the rate of MCI was high in LSS participants.
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Affiliation(s)
- Kazushige Koyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
- * E-mail:
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Sunao Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Songee Jung
- Department of Digital Nutrition and Health Sciences, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Masataka Ando
- Department of Diet and Health Sciences, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
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Lee NN, Kramer JS, Stoker AM, Bozynski CC, Cook CR, Stannard JT, Choma TJ, Cook JL. Canine models of spine disorders. JOR Spine 2020; 3:e1109. [PMID: 33392448 PMCID: PMC7770205 DOI: 10.1002/jsp2.1109] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/18/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022] Open
Abstract
Neck and low back pain are common among the adult human population and impose large social and economic burdens on health care and quality of life. Spine-related disorders are also significant health concerns for canine companions with etiopathogeneses, clinical presentations, and diagnostic and therapeutic options that are very similar to their human counterparts. Historically, induced and spontaneous pathology in laboratory rodents, dogs, sheep, goats, pigs, and nonhuman primates have been used for study of human spine disorders. While each of these can serve as useful preclinical models, they all have inherent limitations. Spontaneously occurring spine disorders in dogs provide highly translatable data that overcome many of the limitations of other models and have the added benefit of contributing to veterinary healthcare as well. For this scoping review, peer-reviewed manuscripts were selected from PubMed and Google Scholar searches using keywords: "intervertebral disc," "intervertebral disc degeneration," "biomarkers," "histopathology," "canine," and "mechanism." Additional keywords such as "injury," "induced model," and "nucleus degeneration" were used to further narrow inclusion. The objectives of this review were to (a) outline similarities in key features of spine disorders between dogs and humans; (b) describe relevant canine models; and (c) highlight the applicability of these models for advancing translational research and clinical application for mechanisms of disease, diagnosis, prognosis, prevention, and treatment, with a focus on intervertebral disc degeneration. Best current evidence suggests that dogs share important anatomical, physiological, histological, and molecular components of spinal disorders in humans, such that induced and spontaneous canine models can be very effective for translational research. Taken together, the peer-reviewed literature supports numerous advantages for use of canine models for study of disorders of the spine when the potential limitations and challenges are addressed.
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Affiliation(s)
- Naomi N. Lee
- Department of Orthopaedic SurgeryUniversity of MissouriColumbiaMissouriUSA
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
- Comparative Medicine ProgramUniversity of MissouriColumbiaMissouriUSA
| | - Jacob S. Kramer
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
| | - Aaron M. Stoker
- Department of Orthopaedic SurgeryUniversity of MissouriColumbiaMissouriUSA
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
| | - Chantelle C. Bozynski
- Department of Orthopaedic SurgeryUniversity of MissouriColumbiaMissouriUSA
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
| | - Cristi R. Cook
- Department of Orthopaedic SurgeryUniversity of MissouriColumbiaMissouriUSA
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
| | - James T. Stannard
- Department of Orthopaedic SurgeryUniversity of MissouriColumbiaMissouriUSA
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
| | - Theodore J. Choma
- Department of Orthopaedic SurgeryUniversity of MissouriColumbiaMissouriUSA
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
| | - James L. Cook
- Department of Orthopaedic SurgeryUniversity of MissouriColumbiaMissouriUSA
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
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Azam F, Sharafat S, Khan Z, Ali M. Outcome of modified interlaminar decompression: A conservative decompressive surgery for lumbar spine stenosis. Pak J Med Sci 2020; 36:663-667. [PMID: 32494252 PMCID: PMC7260903 DOI: 10.12669/pjms.36.4.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate the outcomes of modified interlaminar decompression in patients with degenerative lumbar spinal stenosis (LSS). Methods: This descriptive observational study was conducted at the Department of Neurosurgery, Lady Reading Hospital Peshawar from July 2014 to June 2018. All patients with degenerative LSS who underwent modified interlaminar decompression during the study period were included in the study. The patients were followed up to one year after surgery. The data was entered into a structured questionnaire designed according to the study which was then analyzed using SPSS version 21. Results: A total of 182 LSS cases were included in the study and 236 levels were operated during the study period. According to the records increased prevalence of LSS was found among males i.e. 58.8%. The common level with degenerative stenosis involved was L4-5. Good to excellent outcomes were observed in 93.9% patients in the 1st follow-up visit. The most common complication of surgery was dural tear followed by wound infection. Conclusion: Modified interlaminar decompression is a conservative surgical technique, proved to be a potential approach with acceptable complications, satisfactory outcomes and it is easy to learn.
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Affiliation(s)
- Farooq Azam
- Farooq Azam, Department of Neurosurgery Medical and Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Seema Sharafat
- Seema Sharafat, Department of Neurosurgery Medical and Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Zahid Khan
- Zahid Khan, Department of Neurosurgery Medical and Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Mumtaz Ali
- Mumtaz Ali, Department of Neurosurgery Medical and Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
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Kwon CY, Yoon SH, Lee B, Leem J. Acupotomy for the treatment of lumbar spinal stenosis: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16662. [PMID: 31393365 PMCID: PMC6708781 DOI: 10.1097/md.0000000000016662] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) is caused by neural compression due to narrowing of the lumbar spinal canal or neural foramen. Surgical intervention is a standard treatment for LSS; however, the steep increase in the surgical rate, post-operative complications, and comparatively low long-term satisfaction are considered to be limitations of this surgical approach. Conversely, acupotomy is a minimally invasive technique that combines the effects of conventional acupuncture with micro-incision, which may offer an alternative to surgery for the treatment of LSS. This review was conducted to investigate and critically review the current evidence on the efficacy and safety of acupotomy for LSS. METHODS Eleven databases were searched from their respective inception dates to December 28, 2018. Randomized controlled trials (RCTs) comparing acupotomy and wait-list, sham treatment, or active controls were included. The quality of the included studies was assessed using risk-of-bias tool. RESULTS Seven RCTs were included in this review and meta-analysis. The methodological quality of the included studies was generally poor. The acupotomy treatment group was associated with significantly lower visual analogue scale scores (range 0∼10) (5 RCTs; mean difference [MD] -1.55, 95% confidence interval [CIs] -2.60 to -0.50; I = 94%) and higher Japanese Orthopedic Association Score (3 RCTs; MD 4.70, 95% CI 3.73 to 5.68; I = 0%) compared to the active control group. In subgroup analysis based on the type of active controls, acupotomy retained significant benefits over lumbar traction and acupuncture, as well as over lumbar traction, spinal decompression, and acupuncture. Safety data were reported in only 1 study, and no adverse events occurred in either the acupotomy or the acupuncture control group. CONCLUSION According to current evidence, acupotomy might be beneficial for treating LSS. Acupotomy showed consistent superiority over lumbar traction, but the results were mixed in comparisons with other interventions, such as spinal decompression and acupuncture. However, the findings should be interpreted cautiously, given the poor methodological quality of the included studies, and potential small-study effects. Further larger, high-quality, rigorous RCTs should be conducted on this topic and rigorous reporting of acupotomy procedures and safety data should be encouraged.
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Affiliation(s)
- Chan-Young Kwon
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul
| | - Sang-hoon Yoon
- Chung-Yeon Central Institute
- Chung-Yeon Korean Medicine Hospital, Gwangju
| | - Boram Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul
| | - Jungtae Leem
- Chung-Yeon Central Institute
- Dongshin Korean Medicine Hospital, Seoul, Republic of Korea
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Diabetes mellitus as a risk factor for intervertebral disc degeneration: a critical review. 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 2019; 28:2129-2144. [PMID: 31201565 DOI: 10.1007/s00586-019-06029-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/22/2019] [Accepted: 06/06/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To examine to what extent diabetes mellitus (DM) is implicated as a distinct mechanism in intervertebral disc degeneration (IVDD). METHODS The published clinical and laboratory data relevant to this matter are critically reviewed. A total of 12 clinical studies evaluate the association between DM and degenerative changes such as IVDD, spinal stenosis (SS) and IVD herniation. A total of 34 laboratory research papers evaluate the association between DM and IVDD. RESULTS There are 7 studies that correlate DM with IVDD, 4 of them showing that DM is a significant risk factor for degeneration, and 3 of them failing to establish any association. Three studies demonstrate significant association between DM and SS. However, 2 of these studies also include patients with IVD herniation that failed to demonstrate any correlation with DM. Two other studies indicate a significant association between DM and lumbar disc herniation. Multiple different mechanisms, acting independently or interactively, cause tissue damage leading to IVDD including: microangiopathy of the subchondral vertebral endplate, cellular senescence, cell death (through apoptosis or autophagy), hyperglycaemia, advance glycation end products, adipokines, and cytokines (through oxidative, osmotic, and inflammatory mechanisms). CONCLUSION The clinical evidence is not consistent, but weakly supports the relationship between DM and IVDD. However, the laboratory studies consistently suggest that DM interferes with multipronged aberrant molecular and biochemical pathways that provoke IVDD. Taken as a whole, the strong laboratory evidence and the weak clinical studies implicate DM as a distinct contributing factor for IVDD. These slides can be retrieved under Electronic Supplementary Material.
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Kwon CY, Yoon SH, Lee B, Leem J. Acupotomy for the treatment of lumbar spinal stenosis: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14160. [PMID: 30653158 PMCID: PMC6370031 DOI: 10.1097/md.0000000000014160] [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: 11/25/2022] Open
Abstract
INTRODUCTION This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of acupotomy for the treatment of lumbar spinal stenosis. METHODS AND ANALYSIS The following electronic databases will be searched until December 2018 without language or publication status restrictions: five English databases, that is Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Allied and Complementary Medicine Database (AMED), and Cumulative Index to Nursing and Allied Health Literature (CINAHL); three Korean databases, that is Oriental Medicine Advanced Searching Integrated System (OASIS), Research Information Service System (RISS), and Korea Citation Index (KCI); and three Chinese databases, that is China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP. Any clinical, randomized controlled trials using acupotomy for lumbar spinal stenosis treatment will be included. Changes in the degrees of pain and function will be assessed as primary outcomes. The total effective rate, changes in quality of life, adverse events, and amount of rescue medication used will be evaluated as secondary outcomes. Two independent researchers will perform study selection, data extraction, and risk of bias assessment. If applicable, a meta-analysis will be performed using RevMan version 5.3, with the results expressed as risk ratios or mean differences with 95% confidence intervals. According to a heterogeneity test or the number of studies included, fixed effects or random effects model will be used. The risk of bias tool from the Cochrane group will be used to evaluate the methodological quality of the included studies. ETHICS AND DISSEMINATION Ethical approval is not required because individual patient data will not be included in this study. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentations. PROSPERO REGISTRATION NUMBER CRD42018116567.
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Affiliation(s)
- Chan-Young Kwon
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sang-hoon Yoon
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
- Chung-Yeon Korean Medicine Hospital, Gwangju, Republic of Korea
| | - Boram Lee
- Department of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, Republic of Korea
| | - Jungtae Leem
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
- Dongshin Korean Medicine Hospital, Seoul, Republic of Korea
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Kapetanakis S, Gkantsinikoudis N, Papathanasiou JV, Charitoudis G, Thomaidis T. Percutaneous endoscopic ventral facetectomy: An innovative substitute of open decompression surgery for lateral recess stenosis surgical treatment? JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:188-195. [PMID: 30443139 PMCID: PMC6187905 DOI: 10.4103/jcvjs.jcvjs_76_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Percutaneous transforaminal endoscopic surgery (PTES) constitutes an innovative method principally recruited for the treatment of lumbar disc herniation. Indication spectrum of PTES is constantly widened in current years. Hence, PTES has been proposed to represent a satisfactory alternative for the treatment of lateral recess stenosis (LRS), being defined as percutaneous endoscopic ventral facetectomy (PEVF) in these cases. The aim of this original study is to determine, for the first time in the literature, the outcomes of PEVF, especially in otherwise healthy nonelderly patients with LRS, alongside with special focus in health-related quality of life (HRQoL) assessment. Materials and Methods: Eighty-five otherwise healthy individuals from 58 to 64 years were diagnosed with LRS, being subjected to successful PEVF. Patients were prospectively evaluated in 6 weeks, in 3, 6, and 12 months, and in 2 years postoperatively. Visual analog scales (VASs) were separately utilized for leg and low back pain evaluation (VAS-LP and VAS-BP, respectively), whereas Short Form-36 (SF-36) questionnaire was sequentially implemented for HRQoL assessment. Results: All indexes of SF-36 as well as VAS-LP featured maximal amelioration in 6 weeks postoperatively, with subsequent further enhancement until 3 months and successor stabilization until 2 years. In contrast, VAS-BP presented minimal quantitative amelioration in 6 weeks, featuring no additional alterations. Values of all indexes in all follow-up intervals were demonstrated to be statistically significant in comparison with preoperative values (P < 0.05). No remarkable differentiation was observed between distinct parameters of SF-36. Conclusions: PEVF implementation in nonelderly patients with LRS was displayed to be safe and effective, providing alongside considerable improvement in HRQoL 2 years postoperatively.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Jannis V Papathanasiou
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Tryfon Thomaidis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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