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Cai H, Kroll M, Annaswamy T. Motor Unit Number Index in Evaluating Patients With Lumbar Spinal Stenosis. Am J Phys Med Rehabil 2021; 100:966-971. [PMID: 33433110 DOI: 10.1097/phm.0000000000001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Motor unit number index is a quantitative electrophysiological measure that provides an index of the number of motor neurons supplying a muscle. The aim of this exploratory study was to assess the utility of motor unit number index in the evaluation of patients with lumbar spinal stenosis. DESIGN Participants were assigned to three groups: clinical and radiological lumbar stenosis (lumbar spinal stenosis with neurogenic intermittent claudication), group A; radiological lumbar spinal stenosis without neurogenic intermittent claudication, group B; and a control group, group C. Patients self-rated their pain and functional disability using the numerical rating scale and a series of functional questionnaires. An electromyographer performed nerve conduction tests, electromyography, and motor unit number index testing. RESULTS Seventeen patients completed the study. There were 9, 5, and 3 patients in groups A, B, and C, respectively. There were no discernable differences in motor unit number index values of any individual muscle or combined motor unit number index score between the three groups. Motor unit number index values did not correlate to pain/functional measures. CONCLUSIONS In this exploratory study, motor unit number index did not demonstrate discriminatory ability between patients with lumbar spinal stenosis and was not correlated with pain and functional measures. Further study is needed to explore motor unit number index's role in longitudinal evaluation of patients with the clinical syndrome of lumbar spinal stenosis.
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Affiliation(s)
- Haibi Cai
- From the Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas (HC); and Physical Medicine and Rehabilitation Service, Dallas VA Medical Center, North Texas Health Care System, Dallas, Texas (MK, TA)
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Son HJ, Jo YH, Ahn HS, You J, Kang CN. Outcomes of lumbar spinal fusion in super-elderly patients aged 80 years and over: Comparison with patients aged 65 years and over, and under 80 years. Medicine (Baltimore) 2021; 100:e26812. [PMID: 34397839 PMCID: PMC8341266 DOI: 10.1097/md.0000000000026812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/13/2021] [Indexed: 01/04/2023] Open
Abstract
Despite the increasing prevalence of spinal surgery in super-elderly (SE) patients, the outcomes and complication rates have not been fully elucidated. The purpose of this study was to compare the outcomes and complications of lumbar spinal fusion for degenerative lumbar spinal stenosis (DLSS) in SE patients aged 80 years and over with those in patients aged 65 years and over, and under 80 years.This study analyzed 160 patients who underwent spinal fusion for DLSS between January 2011 and November 2019. Thirty patients in the SE group (group SE, ≥80 years) and 130 patients in the elderly group (group E, ≥65 years and <80 years) were enrolled. The performance status was evaluated by preoperative American society of anesthesiologists (ASA) score. Visual analog scales for back pain (VAS-BP) and leg pain (VAS-LP), and Korean Oswestry disability index (K-ODI) were used to assess clinical outcomes preoperatively and 1 year postoperatively. Percent changes of VAS-BP, VAS-LP and K-ODI were also analyzed. Fusion rates were evaluated by computed tomography 6 months and 1 year postoperatively. Furthermore, bone mineral density, operative time, estimated blood loss, blood transfusion, hospital days, hospitalization in intensive care unit and postoperative complications were compared.The average age of group SE was 82.0 years and that of group E was 71.6 years. There were no differences in preoperative ASA score, preoperative or postoperative VAS BP and VAS-LP, bone mineral density, operative time, estimated blood loss, blood transfusion, hospital days, hospitalization in intensive care unit and fusion rates between the groups. Preoperative and postoperative K-ODI were higher in group SE than group E (all P < .05). However, percent changes of VAS-BP, VAS-LP and K-ODI showed no significant differences. Overall early and late complications were not significantly different between the groups; however postoperative delirium was more common in group SE than group E (P = .027). SE status was the only risk factor for postoperative delirium with odds ratio of 3.4 (P = .018).Spinal fusion surgery is considerable treatment to improve the quality of life of SE patients with DLSS, however careful perioperative management is needed to prevent postoperative delirium.
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Affiliation(s)
- Hee Jung Son
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Young-Hoon Jo
- Department of Orthopedic Surgery, Hanyang University, College of Medicine, Guri Hospital, Gyeonggi, Korea
| | - Hyung Seob Ahn
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jooyoung You
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Chang-Nam Kang
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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Shin SS, Yoo WG. The effects of differences on sagittal kinematics and muscle coordination during step up and step down in patients with spinal stenosis. J Back Musculoskelet Rehabil 2021; 34:453-459. [PMID: 33492274 DOI: 10.3233/bmr-200118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Lumbar spinal stenosis (LSS) is a common spinal disorder that causes patients to assume a forward-trunk posture. Spinal alignment affects swing limb angles and stance limb muscle activities. Therefore, we investigated the effects of differences in step up (SU) and step down (SD) tasks on the kinematics of the trunk and swing limb as well as stance limb muscle coordination in patients with LSS. METHODS Nine elderly female patients diagnosed with LSS were recruited for this study. The sagittal kinematics of the trunk and swing limb and isolated contraction ratio of the gluteus medius (GMed) and vastus lateralis (VL) during SU and SD tasks were measured using a motion analysis system and surface electromyography system. RESULTS Thoracic (17.71∘± 7.77∘) and spine angles (13.64∘± 11.34∘) as well as swing hip (48.48∘± 12.76∘) and pelvic angles (7.52∘± 10.33∘) were significantly greater during SU than SD (10.14∘± 8.41∘, 10.03∘± 11.03∘, 29.42∘± 10.57∘, 3.21∘± 10.11∘, all P< 0.05, respectively). The isolated contraction ratio of the GMed of the stance limb (34.12% ± 13.28%) was significantly higher during SU than during SD (26.65% ± 10.02%), whereas that of the VL of the stance limb (65.88% ± 13.28%) was significantly lower during SU than during SD (73.35% ± 10.02%, P= 0.011 for both comparisons). CONCLUSIONS Patients with LSS demonstrated trunk compensatory mechanisms to address swing hip and knee angles. Trunk position affected pelvic limb muscle coordination in the standing support limb. These findings demonstrate that SD are more challenging than SU for patients with LSS, possibly due to reduced ability to generate adequate leg extensor muscular output to safely control the motion of the body's center of mass. Therefore, trunk positions must be considered when patients with LSS undergo rehabilitation programs, particularly those involving SD or descending stairs, so that healthcare professionals can better assist patients with LSS. In addition, this study provides a background for further studies.
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Hijikata Y, Kamitani T, Otani K, Konno S, Fukuhara S, Yamamoto Y. Association of Lumbar Spinal Stenosis with Severe Disability and Mortality Among Community-Dwelling Older Adults: The Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study. Spine (Phila Pa 1976) 2021; 46:E784-E790. [PMID: 33394983 DOI: 10.1097/brs.0000000000003912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This prospective cohort study analyzed data from the Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study. OBJECTIVE To investigate the association between lumbar spinal stenosis (LSS) and severe disability and mortality among community-dwelling older adults. SUMMARY OF BACKGROUND DATA Only a few studies have investigated LSS longitudinally, and the study participants were limited to selected patients diagnosed with LSS during a hospital visit. Additionally, the prognosis of LSS remains unclear. METHODS We enrolled independent community-dwelling older adults aged 65 years or older at the time of a baseline health checkup in 2008. LSS was diagnosed using a validated diagnostic support tool for LSS. The primary endpoint was a composite of severe disability (long-term care insurance certification grade 4 or 5) and mortality. We used 1 minus Kaplan-Meier failure estimates and the log-rank test to compare the interval between baseline and the predetermined endpoint as well as a Cox proportional hazards model to estimate hazard ratios (HRs) for the LSS group with adjustment for possible confounders. Multiple imputation by chained equations was performed for sensitivity analysis. RESULTS Of 2058 subjects enrolled, 1560 did not have missing covariates; 269 (17%) were diagnosed with LSS. After a median follow-up of 5.8 years, the rates of severe disability and mortality were 0.022 per year in subjects with LSS and 0.012 per year in those without (P = 0.006). The adjusted HR for the composite endpoint in the LSS group was 1.55 (95% confidence interval [CI], 1.01-2.38). A similar association was observed after multiple imputation of missing covariates (adjusted HR, 1.51 [95% CI, 1.06-2.16]). CONCLUSION LSS was associated with severe disability and mortality in community-dwelling older adults. Detection of adults with LSS in the community may contribute to local health promotion.Level of Evidence: 2.
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Affiliation(s)
- Yasukazu Hijikata
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Carlesso C, Piva SR, Smith C, Ammendolia C, Schneider MJ. Responsiveness of Outcome Measures in Nonsurgical Patients with Lumbar Spinal Stenosis: A Secondary Analysis From a Randomized Controlled Trial. Spine (Phila Pa 1976) 2021; 46:788-795. [PMID: 33650839 PMCID: PMC8154167 DOI: 10.1097/brs.0000000000003920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 11/02/2020] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Secondary analysis from a randomized controlled trial on nonsurgical interventions for patients with lumbar spinal stenosis (LSS). OBJECTIVE The aim of this study was to assess the responsiveness of the Self-Paced Walking Test (SPWT), Swiss Spinal Stenosis Questionnaire (SSS), and Oswestry Disability Index (ODI) and determine their minimal clinically important differences (MCID) in nonsurgical LSS patients. SUMMARY OF BACKGROUND DATA Limited information is available about the responsiveness of these tests in nonsurgical LSS population. METHODS A total of 180 participants completed the SPWT, SSS, and ODI at baseline, 2, and 6 months. Responsiveness was assessed by distribution-based method, including effect size and standardized response mean, and anchor-based method, using the patient global index of change (PGIC) as the external anchor to distinguish responders and non-responders. Areas under the curve (AUC) were calculated along with MCIDs for "minimal" and "moderate improvement" subgroups. RESULTS The following values represent 2- and 6-month analyses of each outcome measure, respectively. Standard effect sizes: 0.48 and 0.50 for SPWT, -0.42 and -0.36 for SSS, and -0.29 and -0.25 for ODI. Spearman correlation coefficients between PGIC and outcomes were: 0.44 and 0.39 for SPWT, -0.53 and -0.55 for SSS, and -0.46 and -0.54 for ODI. MCIDs for the "minimal improvement" subgroup were: 375.9 and 319.3 ms for SPWT, -5.3 and -5.8 points for SSS, and -9.3 and -10.8 points for ODI. AUCs was 0.68 to 0.76. MCIDs for the "moderate improvement" subgroup were: 344.2 and 538.2 m for SPWT, -5.5 and -7.5 points for SSS, and -9.1 and -13.6 points for ODI. AUCs ranged from 0.68 to 0.76. CONCLUSION The SPWT, SSS, and ODI are responsive outcome measures to assess nonsurgical patients with LSS. This finding, along with the reported MCIDs, can help clinicians to monitor changes in their patients' walking and physical function over time and make clinical decisions. They also provide researchers with reference for future studies in LSS.Level of Evidence: 2.
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Affiliation(s)
- Cristiane Carlesso
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Sara R. Piva
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Clair Smith
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Carlo Ammendolia
- DC, PhD. Institute for Health Policy, Management and Evolution, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
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Ding Y, Lv S, Dong S, Cui J, Cao Z, Chen Y. Relationship between Scheuermann disease and symptomatic thoracic spinal stenosis: A retrospective study. Acta Orthop Traumatol Turc 2021; 55:253-257. [PMID: 34100367 PMCID: PMC10566354 DOI: 10.5152/j.aott.2021.20022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/28/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the possible relationship between Scheuermann disease (SD) and the pathophysiological factors of thoracic spinal stenosis (TSS), including ossification of the ligamentum flavum (OLF), ossification of the posterior longitudinal ligament (OPLL), and thoracic disc herniation (TDH) in patients with symptomatic TSS. METHODS Demographic and radiological data from 66 consecutive patients diagnosed with symptomatic TSS from 2013 to 2018 were retrospectively collected and divided into 3 groups depending on the underlying pathomechanism of TSS: TDH group (18 patients; 6 women; mean age ± standard deviation [Sd] = 59.89 ± 11.34), OPLL group (12 patients; 8 women; mean age ± Sd = 56.08 ± 14.74), and OLF group (36 patients; 20 women; mean age ± Sd = 58.69 ± 9.77). A total of 41 age-matched healthy individuals (19 women; mean age ± Sd = 54.88 ± 13.63) were designated as the control group. In each group, both typical and atypical SD criteria were radiologically examined. The demographic data and presence of SD between the control group and 3 subgroups of TSS pathomechanisms were evaluated. RESULTS SD characteristics were identified in 83.33% (15/18) of patients in the TDH group, 44.44% (16/36) in the OLF group, 25% (3/12) in the OPLL group, and 17.07% (7/41) of the control individuals. When analyzed by the chi-squared test and logistic regression analysis, the presence of SD was significantly associated with TDH (P < 0.01) and OLF (P < 0.05) but not OPLL (P > 0.05). Patients with TDH and OLF showed peak involvement of T10/11, and patients with OPLL did not. Furthermore, we determined that age, sex, body-mass index, and smoking status were not the risk factors for TDH, OPLL, and OLF (P > 0.05). SD was found to be a risk factor for TDH (P < 0.01) and OLF (P < 0.05) but not for OPLL (P > 0.05). CONCLUSION Evidence from this study indicated that SD might be a risk factor for OLF and TDH but not for OPLL.
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Affiliation(s)
- Yan Ding
- Department of Spine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan,
China
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Shiqiao Lv
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Shengjie Dong
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Jinpeng Cui
- Clinical Laboratory, Yantaishan Hospital, Yantai,
China
| | - Zhilin Cao
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Yunzhen Chen
- Department of Spine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan,
China
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Natalia F, Meidia H, Afriliana N, Young JC, Yunus RE, Al-Jumaily M, Al-Kafri A, Sudirman S. Automated measurement of anteroposterior diameter and foraminal widths in MRI images for lumbar spinal stenosis diagnosis. PLoS One 2020; 15:e0241309. [PMID: 33137112 PMCID: PMC7605707 DOI: 10.1371/journal.pone.0241309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
Lumbar Spinal Stenosis causes low back pain through pressures exerted on the spinal nerves. This can be verified by measuring the anteroposterior diameter and foraminal widths of the patient’s lumbar spine. Our goal is to develop a novel strategy for assessing the extent of Lumbar Spinal Stenosis by automatically calculating these distances from the patient’s lumbar spine MRI. Our method starts with a semantic segmentation of T1- and T2-weighted composite axial MRI images using SegNet that partitions the image into six regions of interest. They consist of three main regions-of-interest, namely the Intervertebral Disc, Posterior Element, and Thecal Sac, and three auxiliary regions-of-interest that includes the Area between Anterior and Posterior elements. A novel contour evolution algorithm is then applied to improve the accuracy of the segmentation results along important region boundaries. Nine anatomical landmarks on the image are located by delineating the region boundaries found in the segmented image before the anteroposterior diameter and foraminal widths can be measured. The performance of the proposed algorithm was evaluated through a set of experiments on the Lumbar Spine MRI dataset containing MRI studies of 515 patients. These experiments compare the performance of our contour evolution algorithm with the Geodesic Active Contour and Chan-Vese methods over 22 different setups. We found that our method works best when our contour evolution algorithm is applied to improve the accuracy of both the label images used to train the SegNet model and the automatically segmented image. The average error of the calculated right and left foraminal distances relative to their expert-measured distances are 0.28 mm (p = 0.92) and 0.29 mm (p = 0.97), respectively. The average error of the calculated anteroposterior diameter relative to their expert-measured diameter is 0.90 mm (p = 0.92). The method also achieves 96.7% agreement with an expert opinion on determining the severity of the Intervertebral Disc herniations.
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Affiliation(s)
- Friska Natalia
- Faculty of Engineering and Informatics, Universitas Multimedia Nusantara, Serpong, Indonesia
| | - Hira Meidia
- Faculty of Engineering and Informatics, Universitas Multimedia Nusantara, Serpong, Indonesia
| | - Nunik Afriliana
- Faculty of Engineering and Informatics, Universitas Multimedia Nusantara, Serpong, Indonesia
| | - Julio Christian Young
- Faculty of Engineering and Informatics, Universitas Multimedia Nusantara, Serpong, Indonesia
| | | | | | - Ala Al-Kafri
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
| | - Sud Sudirman
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- * E-mail:
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Abstract
To evaluate the effect of the severity of spinal stenosis on the peripheral nerves of lower extremities by nerve conduction study (NCS).One hundred fifteen patients with lumbar spinal stenosis were recruited retrospectively in this study. The grading system for lumbar stenosis was used based on the degree of separation of the cauda equina. The degree of cauda equina damage caused by lumbar central stenosis was assessed by NCS of peripheral nerves. Multiple regression analysis was used to estimate which factors affect peripheral nerve injury, according to the presence of DM, total grading of lumbar central stenosis, and age.Only age was associated with low amplitude in the tibial and peroneal motor NCS in the multiple regression analysis. The severity of the compression of the cauda equina, caused by spinal stenosis, did not statistically significantly affect the NCS values of nerves on the lower extremities.In conclusion, the cauda equina is resilient against degenerative lumbar central stenosis. Unlike changes caused by peripheral nerve entrapment, lumbar central stenosis did not affect the findings of NCS on the peripheral nerve of lower extremities.
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Abbas J, Peled N, Hershkovitz I, Hamoud K. Facet Tropism and Orientation: Risk Factors for Degenerative Lumbar Spinal Stenosis. Biomed Res Int 2020; 2020:2453503. [PMID: 32685454 PMCID: PMC7341411 DOI: 10.1155/2020/2453503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study is to establish whether facet tropism (FT) and orientation (FO) are associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study including 274 individuals was divided into two groups: control (82 males and 81 females) and stenosis (59 males and 52 females). All participants have undergone high-resolution CT scan of the lumbar spine in the same position. FT and FO were measured at L1-2 to L5-S1. Significant sagittal FO was noted in the stenosis males (L2-3 to L4-5) and females (L2-3 to L5-S1) compared to the controls. The prevalence of FT was remarkably greater in the stenosis males (L4-5, L5-S1) and females (L3-4, L5-S1) compared to their counterparts in the control group. Our results also showed that FT (L3-4 to L5-S1) increases approximately 2.9 times the likelihood for DLSS development. This study indicates that FO and FT in the lower lumbar spine are significantly associated with DLSS.
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Affiliation(s)
- Janan Abbas
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Physical Therapy, Zefat Academic College, Zefat, 13206, Israel
| | - Natan Peled
- Department of Radiology, Carmel Medical Center, Haifa 3436212, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Kamal Hamoud
- Department of Physical Therapy, Zefat Academic College, Zefat, 13206, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
- Department of Orthopaedic Surgery, The Baruch Padeh Poriya Medical Center, Tiberias 1520800, Israel
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Ko YJ, Lee E, Lee JW, Park CY, Cho J, Kang Y, Ahn JM. Clinical validity of two different grading systems for lumbar central canal stenosis: Schizas and Lee classification systems. PLoS One 2020; 15:e0233633. [PMID: 32459814 PMCID: PMC7252624 DOI: 10.1371/journal.pone.0233633] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/08/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To assess the learnability of two magnetic resonance imaging (MRI) grading systems for lumbar central canal stenosis based on inter-observer agreement and test-retest reliability of doctors with no prior knowledge of the two systems. MATERIALS AND METHODS Two clinical fellows, one novice radiology resident, one neurosurgeon, and one orthopedic surgeon, who were unaware of the two qualitative MRI grading systems prior to this study, acquainted themselves with the teaching files. All five observers independently assessed the LCCS grade of 70 patients using T2-weighted axial magnetic resonance images at the L2-3, L3-4, L3-4, and L5-S1 disc levels. Analysis was performed twice at an interval of two months. RESULTS The inter-observer agreement among all five readers was excellent and test-retest reliability was moderate to excellent for both the Schizas and Lee systems. Positive percentage agreements were found to be over 0.8 in almost all observers with relatively narrow 95% confidence limits. CONCLUSION Both Schizas and Lee MRI grading systems for LCCS are reliable grading systems, and can be used as a learnable method for both clinicians and radiologists.
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Affiliation(s)
- Yeon-jee Ko
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eugene Lee
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Joon Woo Lee
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chi Young Park
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jungheum Cho
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yusuhn Kang
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joong Mo Ahn
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Fujita N, Michikawa T, Miyamoto A, Sakurai A, Otaka Y, Suzuki S, Tsuji O, Nagoshi N, Okada E, Yagi M, Tsuji T, Kono H, Ishii K, Nakamura M, Matsumoto M, Watanabe K. Lumbar spinal surgery improves locomotive syndrome in elderly patients with lumbar spinal canal stenosis: A multicenter prospective study. J Orthop Sci 2020; 25:213-218. [PMID: 30982707 DOI: 10.1016/j.jos.2019.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/06/2019] [Accepted: 03/24/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Owing to musculoskeletal dysfunction, locomotive syndrome elevates the risk of requiring nursing care. Among degenerative musculoskeletal disorders, lumbar spinal canal stenosis (LSS) associates with locomotive syndrome; however, whether lumbar spinal surgery for LSS improves locomotive syndrome remains unclear. Hence, this study aimed to identify the efficacy of lumbar spinal surgery on locomotive syndrome among elderly patients with LSS. METHODS We prospectively collected the clinical data from multiple institutions of patients (age >65 years) who underwent lumbar spinal surgery. Patients were examined for the locomotive syndrome risk test, including the stand-up Test, the two-step Test, and the 25-question risk assessment, 1-day preoperatively and 6-month and 1-year postoperatively. Using a logistic regression model, we identified factors associated with improvement of locomotive syndrome in the total assessment. RESULTS Overall, we examined the data of 166 patients in this study. Upon converting each score of three tests to the stage of locomotive syndrome, the two-step test and the 25-question risk assessment revealed marked improvement in the postoperative distribution of stages. However, the stand-up test revealed a comparable distribution of stages pre- and postoperatively. In the total assessment, the postoperative distribution of stages was significantly improved than that preoperatively. The multivariable analysis revealed that failed back surgery syndrome [odds ratio (OR), 0.2; 95% confidence interval (CI): 0.04-1.05; P = 0.057)] and preoperative stage of 2 in stand-up test (OR, 0.2; 95% CI: 0.05-1.02; P = 0.054) tended to have inverse association with postoperative improvement of locomotive syndrome in the total assessment. CONCLUSIONS Lumbar spinal surgery improved the stage of locomotive syndrome among elderly patients with LSS. This study suggests that lumbar spinal surgery for LSS could be beneficial in alleviating locomotive syndrome.
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Affiliation(s)
- Nobuyuki Fujita
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | | | - Aiko Sakurai
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, Fujita Health University, Aichi, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Takashi Tsuji
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Hitoshi Kono
- Keiyu Orthopaedic Hospital, Tatebayashi, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan.
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Moon BJ, Ryu DS, Kim B, Ha Y, Yoon SH, Kim KN, Chin DK, Lee JK. Natural history and aggravating factors of sagittal imbalance in marked sagittal deformity compared with mild to moderate sagittal deformity: A prospective cohort study. Medicine (Baltimore) 2020; 99:e19551. [PMID: 32176111 PMCID: PMC7440234 DOI: 10.1097/md.0000000000019551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sagittal imbalance is a multifactorial complex deformity that can arise from a variety of causes such as spinal stenosis, sarcopenia, vertebral fracture, and neuromuscular diseases. Furthermore, there is lack of research regarding spinal and general conditions that precede the development of sagittal imbalance. Our aim was to evaluate aggravating factors, such as natural history, for sagittal imbalance in a cohort comprising elderly individuals by conducting various examinations.We recruited 96 participants who had a sagittal vertical axis (SVA) larger than 50 mm in a sagittal imbalance study. Finally, 69 participants were followed up and enrolled this study after 2 years. We evaluated full spine radiographs, magnetic resonance imaging (MRI), bone mineral density, and health-related quality of life from patients survey and analyzed factors associated with aggravation of sagittal imbalance. Aggravation was defined by an SVA > 30 mm and T1 pelvic angle (T1PA) > 3° in the third year compared to SVA and T1PA values of the first year.Eighteen participants of the follow-up group had a sagittal imbalance aggravation. According to the deformity severity in the first-year evaluations, the marked deformity group (38 participants) defined as Schwab classification had 11 (28.9%) participants presenting with sagittal imbalance aggravation. These participants had larger mean values of Schwab sagittal modifiers and T1PA compared with the nonaggravation participants. Logistic regression analysis showed a higher pelvic incidence (PI) (OR = 1.201, 95% CI = 1.015-1.422, P = .033) and a small multifidus (MF) volume (OR = 0.991, 95% CI = 0.983-1.000, P = .043) correlated with sagittal imbalance aggravation.From the follow-up group, 18 (26%) subjects of total 69 participants presented a deteriorated sagittal imbalance. A higher PI and smaller MF volume correlated with the aggravation of sagittal imbalance. We should consider that high PI and small MF volume are associated with aggravation of sagittal imbalance.
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Affiliation(s)
- Bong Ju Moon
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju
| | - Dal Sung Ryu
- Department of Neurosurgery, Inha University School of Medicine, Inha University Hospital, Incheon
| | | | - Yoon Ha
- Department of Neurosurgery, Severance Hospital
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University School of Medicine, Inha University Hospital, Incheon
| | | | - Dong Kyu Chin
- Departement of Neurosurgery, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju
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Kulkarni AG, Das S, Kunder TS. Are There Differences Between Patients with Extreme Stenosis and Non-extreme Stenosis in Terms of Pain, Function or Complications After Spinal Decompression Using a Tubular Retractor System? Clin Orthop Relat Res 2020; 478:348-356. [PMID: 31633587 PMCID: PMC7438131 DOI: 10.1097/corr.0000000000001004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 10/03/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Micro-tubular decompression in extreme lumbar spinal stenosis is challenging because it is technically difficult to achieve adequate decompression. Whether the results of micro-tubular decompression related to pain, function, and complications in lumbar spinal stenosis of the extreme and non-extreme varieties are different has not yet been conclusively established. QUESTIONS/PURPOSES Are there differences between patients with extreme stenosis and non-extreme stenosis in terms of (1) VAS back or leg pain, (2) Oswestry Disability Index (ODI), or (3) complications when they were treated with spinal decompression using a tubular retractor system? METHODS Between January 2007 and January 2017, one surgeon performed 325 single-level lumbar micro-tubular decompressions without fusion. Of those, 43% (140 of 325) had extreme stenosis (defined as the absence of cerebrospinal fluid signal and a grey homogeneous dural sac with unrecognizable rootlets and posterior epidural fat in T2 weighted axial MRI image) and the rest had non-extreme stenosis. During this time, we used tubular retractors for these procedures in patients with simple lumbar spinal stenosis who had persistent symptoms despite conservative treatment for neurogenic claudication. No alternate form of decompression was performed in the study period. Patients with complex lumbar spinal stenosis associated with a deformity or instability who were treated with instrumented fusion were excluded. A total of 14% (20 of 140) patients in the extreme stenosis group and 15% (28 of 185) patients in the non-extreme stenosis group were lost to follow-up before 2 years; the remaining 120 patients with extreme stenosis and 157 patients with non-extreme stenosis were analyzed at a mean follow-up of 33 ± 5 months in this retrospective, comparative study. The groups were not different at baseline in terms of preoperative VAS score for back pain, age, gender, BMI or the percentage who had diabetes or who smoked. However, patients with extreme stenosis had higher preoperative ODI scores and higher preoperative VAS score for leg pain compared with the non-extreme group. There was a higher proportion of men in the non-extreme stenosis group (56% [104 of 185] versus 50% [71 of 140]; p = 0.324). Study endpoints were VAS score for leg and back pain, ODI, and complications, all of which were ascertained by chart review. With the numbers available, we could detect with 80% power at p < 0.05 a difference of 0.93 cm of 10 cm on a 10-cm VAS scale for VAS leg pain; a difference of 1.00 cm of 10 cm on a 10-cm VAS scale for VAS back pain and a difference of 2.12 cm of 100 cm on a 100-cm ODI scale. RESULTS In terms of pain, both groups improved after surgery, but there was no between-group difference in terms of the VAS scores at the most recent follow-up. VAS back pain improved from a mean of 3 ± 1 to 2 ± 1 in the extreme stenosis group and from 3 ± 1 to 1 ± 1 in the non-extreme stenosis group (p = 0.904); VAS leg pain improved from 7 ± 1 to 1 ± 1 versus 6 ± 1 to 1 ± 1, respectively (p = 0.537). ODI scores likewise improved in both groups, with no between-group difference in the ODI scores at latest follow-up (66 ± 7 to 19 ± 2 in the extreme stenosis group versus 59 ± 5 to 19 ± 2 in the non-extreme stenosis group (p = 0.237). Complications in the group with extreme stenosis occurred in six patients (incidental dural tears in two patients, urinary retention in three patients, and Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH) in one patient); complications in the non-extreme stenosis occurred in two patients (incidental dural tears in two patients). CONCLUSIONS The results in terms of improvement in VAS for leg and back pain and ODI scores were not different between patients with extreme and non-extreme stenosis. Micro-tubular decompression can be thus considered an alternative for patients with extreme stenosis. Future studies, ideally multicentre, comparative trials, are needed to confirm our preliminary results. LEVEL OF EVIDENCE LEVEL III, therapeutic study.
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Affiliation(s)
- Arvind G Kulkarni
- A. G. Kulkarni, S. Das, T. S. Kunder, Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Swaroop Das
- A. G. Kulkarni, S. Das, T. S. Kunder, Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Tushar S Kunder
- A. G. Kulkarni, S. Das, T. S. Kunder, Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, India
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Ferretti F, Coluccia A, Gusinu R, Gualtieri G, Muzii VF, Pozza A. Quality of life and objective functional impairment in lumbar spinal stenosis: a protocol for a systematic review and meta-analysis of moderators. BMJ Open 2019; 9:e032314. [PMID: 31753889 PMCID: PMC6886937 DOI: 10.1136/bmjopen-2019-032314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) is a common degenerative spine disease associated with a strong impairment in various quality of life areas, particularly the ability to perform work-related activity. Depression is a condition frequently associated. There is no comprehensive review on quality of life and objective functional impairment in LSS. This paper presents the protocol of the first systematic review and meta-analysis summarising evidence about quality of life and functional impairment in patients with LSS compared with healthy controls. Comorbid depressive disorders, age, gender, LSS duration, disability, pain severity and study methodological quality will be investigated as moderators. METHODS The protocol is reported according to PRISMA-P guidelines. Studies will be included if they were conducted on patients aged 18 years old or older with primary LSS and if they reported data on differences in the levels of quality of life or objective functional impairment between patients with LSS and healthy controls. Independent reviewers will search published/unpublished studies through electronic databases and additional sources, will extract the data and assess the methodological quality. Random-effects meta-analysis will be carried out by calculating effect sizes as Cohen's d indices. Heterogeneity will be examined by the I2 and the Q statistics. Moderators will be investigated through meta-regression. CONCLUSIONS A summary of the evidence on quality of life and functional impairment in LSS may suggest clinical and occupational health medicine strategies aimed to timely detect and prevent these outcomes. Higher percentages of patients with LSS with depression may be expected to be related to poorer quality of life. Depressive comorbidity might impact negatively on quality of life because it is associated with dysfunctional coping, disability and psychophysiological symptoms. ETHICS AND DISSEMINATION The current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals. REVIEW REGISTRATION CRD42019132209.
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Affiliation(s)
- Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Roberto Gusinu
- Health Service Management Board, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Giacomo Gualtieri
- Legal Medicine Unit, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Vitaliano Francesco Muzii
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
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15
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Hebert JJ, Abraham E, Wedderkopp N, Bigney E, Richardson E, Darling M, Hall H, Fisher CG, Rampersaud YR, Thomas KC, Jacobs B, Johnson M, Paquet J, Attabib N, Jarzem P, Wai EK, Rasoulinejad P, Ahn H, Nataraj A, Stratton A, Manson N. Patients undergoing surgery for lumbar spinal stenosis experience unique courses of pain and disability: A group-based trajectory analysis. PLoS One 2019; 14:e0224200. [PMID: 31697714 PMCID: PMC6837529 DOI: 10.1371/journal.pone.0224200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/08/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Identify patient subgroups defined by trajectories of pain and disability following surgery for degenerative lumbar spinal stenosis, and investigate the construct validity of the subgroups by evaluating for meaningful differences in clinical outcomes. Methods We recruited patients with degenerative lumbar spinal stenosis from 13 surgical spine centers who were deemed to be surgical candidates. Study outcomes (leg and back pain numeric rating scales, modified Oswestry disability index) were measured before surgery, and after 3, 12, and 24 months. Group-based trajectory models were developed to identify trajectory subgroups for leg pain, back pain, and pain-related disability. We examined for differences in the proportion of patients achieving minimum clinically important change in pain and disability (30%) and clinical success (50% reduction in disability or Oswestry score ≤22) 12 months from surgery. Results Data from 548 patients (mean[SD] age = 66.7[9.1] years; 46% female) were included. The models estimated 3 unique trajectories for leg pain (excellent outcome = 14.4%, good outcome = 49.5%, poor outcome = 36.1%), back pain (excellent outcome = 13.1%, good outcome = 45.0%, poor outcome = 41.9%), and disability (excellent outcome = 30.8%, fair outcome = 40.1%, poor outcome = 29.1%). The construct validity of the trajectory subgroups was confirmed by between-trajectory group differences in the proportion of patients meeting thresholds for minimum clinically important change and clinical success after 12 postoperative months (p < .001). Conclusion Subgroups of patients with degenerative lumbar spinal stenosis can be identified by their trajectories of pain and disability following surgery. Although most patients experienced important reductions in pain and disability, 29% to 42% of patients were classified as members of an outcome trajectory subgroup that experienced little to no benefit from surgery. These findings may inform appropriate expectation setting for patients and clinicians and highlight the need for better methods of treatment selection for patients with degenerative lumbar spinal stenosis.
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Affiliation(s)
- Jeffrey J. Hebert
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
- School of Psychology and Exercise Science, Murdoch University, Perth, Australia
- * E-mail:
| | - Edward Abraham
- Canada East Spine Centre, Saint John, New Brunswick, Canada
- Division of Orthopaedic Surgery, Zone 2, Horizon Health Network, Saint John, New Brunswick, Canada
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Niels Wedderkopp
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- The Orthopedic Department, Hospital of Southwestern Jutland, Esbjerg, Denmark
| | - Erin Bigney
- Canada East Spine Centre, Saint John, New Brunswick, Canada
| | | | - Mariah Darling
- Canada East Spine Centre, Saint John, New Brunswick, Canada
| | - Hamilton Hall
- University of Toronto, Department of Surgery, Toronto, Canada
| | - Charles G. Fisher
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Y. Raja Rampersaud
- University of Toronto, University Health Network, Arthritis Program, Krembil Research Institute, Toronto, Ontario, Canada
| | - Kenneth C. Thomas
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Bradley Jacobs
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Division of Neurosurgery-Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Michael Johnson
- Department of Surgery, Section of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jerome Paquet
- Division of Neurosurgery, Department of Surgery, CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Najmedden Attabib
- Canada East Spine Centre, Saint John, New Brunswick, Canada
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Division of Neurosurgery, Zone 2, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Peter Jarzem
- McGill Scoliosis and Spine Research Group, Montreal, Quebec, Canada
- Division of Orthopaedics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Eugene K. Wai
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Parham Rasoulinejad
- London Health Sciences Center, Victoria Hospital, London, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Henry Ahn
- University of Toronto Spine Program, Toronto, Ontario, Canada
| | - Andrew Nataraj
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada
| | | | - Neil Manson
- Canada East Spine Centre, Saint John, New Brunswick, Canada
- Division of Orthopaedic Surgery, Zone 2, Horizon Health Network, Saint John, New Brunswick, Canada
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
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16
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Hjaltadottir H, Hebelka H, Molinder C, Brisby H, Baranto A. Axial loading during MRI reveals insufficient effect of percutaneous interspinous implants (Aperius™ PerCLID™) on spinal canal area. Eur Spine J 2019; 29:122-128. [PMID: 31584119 DOI: 10.1007/s00586-019-06159-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/31/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effect on the spinal canal at the treated and adjacent level(s), in patients treated for lumbar spinal stenosis (LSS) with percutaneous interspinous process device (IPD) Aperius™ or open decompressive surgery (ODS), using axial loading of the spine during MRI (alMRI). MATERIALS Nineteen LSS patients (mean age 67 years, range 49-78) treated with IPDs in 29 spine levels and 13 LSS patients (mean age 63 years, range 46-76) operated with ODS in 22 spine levels were examined with alMRI pre- and 3 months postoperatively. Radiological effects were evaluated by measuring the dural sac cross-sectional area (DSCSA) and by morphological grading of nerve root affection. RESULTS For the IPD group, no DSCSA increase was observed at the operated level (p = 0.42); however, a decrease was observed in adjacent levels (p = 0.05). No effect was seen regarding morphological grading (operated level: p = 0.71/adjacent level: p = 0.94). For the ODS group, beneficial effects were seen for the operated level, both regarding DSCSA (p < 0.001) and for morphological grading (p < 0.0001). No changes were seen for adjacent levels (DSCSA; p = 0.47/morphological grading: p = 0.95). Postoperatively, a significant difference between the groups existed at the operated level regarding both evaluated parameters (p < 0.003). CONCLUSIONS With the spine imaged in an axial loaded position, no significant radiological effects of an IPD could be detected postoperatively at the treated level, while increased DSCSA was displayed for the ODS group. In addition, reduced DSCSA in adjacent levels was detected for the IPD group. Thus, the beneficial effects of IPD implants on the spinal canal must be questioned. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | - Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caroline Molinder
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Brisby
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Adad Baranto
- Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
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Fujita N, Sakurai A, Miyamoto A, Michikawa T, Otaka Y, Suzuki S, Tsuji O, Nagoshi N, Okada E, Yagi M, Tsuji T, Kono H, Ishii K, Nakamura M, Matsumoto M, Watanabe K. Stride length of elderly patients with lumbar spinal stenosis: Multi-center study using the Two-Step test. J Orthop Sci 2019; 24:787-792. [PMID: 30737067 DOI: 10.1016/j.jos.2019.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Short stride length is one of clinical symptoms associated with lumbar spinal stenosis (LSS). Short stride is a risk factor for falls; therefore, identification of factors associated with short stride is critical for fall prevention in LSS patients. Although the Two-Step test can conveniently assess maximal stride length, it has not become widely used; therefore, its data are limited. We identified the potential factors associated with short stride of elderly LSS patients using Two-Step test. METHODS Clinical data of patients aged >65 years who planned to undergo surgery for LSS were prospectively collected at multiple institutions. Patients were assessed with the Two-Step test and Timed Up-and-Go Test prior to surgery; 357 consecutive patients were enrolled. We determined the cut-off value of the Two-Step test score for short stride, referring to the Timed Up-and-Go Test score of 13.5 s, used to indicate high risk of falls in elderly individuals. Logistic regression model was constructed to identify factors associated with short stride. RESULTS The Two-Step test score showed moderate-to-strong inverse correlation with that of Timed Up-and-Go Test (r = -0.65, p < 0.001). Using the tentative Two-Step test cut-off value (0.93) for short stride, multivariable analysis showed that age ≥80 years (OR = 2.3, 95% CI:1.1-4.8), a score of <60 for lumbar function in Japanese Orthopedic Association Back Pain Evaluation Questionnaire (OR = 2.7, 95% CI:1.5-4.7), motor deficit (OR = 2.7, 95% CI:1.2-6.1), and sagittal vertical axis ≥50 mm (OR = 2.1, 95% CI:1.2-3.5) were factors significantly associated with short stride in elderly patients with LSS. CONCLUSIONS Using the Two-Step test, we found that 80 years old and over, lumbar dysfunction, motor deficit of the lower extremities, and forward-bent posture were associated with short stride in LSS patients. Therefore, elderly LSS patients with these conditions may have a higher risk for falls.
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Affiliation(s)
- Nobuyuki Fujita
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Aiko Sakurai
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Fujita Health University, Aichi, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Takashi Tsuji
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Hitoshi Kono
- Keiyu Orthopaedic Hospital, Tatebayashi, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, International University of Health and Welfare, Chiba, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan.
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18
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Kobayashi Y, Ogura Y, Kitagawa T, Tadokoro T, Yonezawa Y, Takahashi Y, Yasuda A, Shinozaki Y, Ogawa J. The influence of preoperative mental health on clinical outcomes after laminectomy in patients with lumbar spinal stenosis. Clin Neurol Neurosurg 2019; 185:105481. [PMID: 31442743 DOI: 10.1016/j.clineuro.2019.105481] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/22/2019] [Accepted: 08/08/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The influence of preoperative mental health on health-related quality of life (HRQOL) in patients with lumbar spinal stenosis (LSS) remains unclear. This study aims to investigate the influence of preoperative mental health HRQOL after laminectomy in patients with LSS. PATIENTS AND METHODS We retrospectively reviewed 122 patients who had lumbar spinous process splitting laminectomy (LSPSL) for LSS. We assessed clinical information; Japanese Orthopedic Association (JOA) score; numerical rating scale (NRS) for low back pain, for leg pain, and for leg numbness; Zurich Claudication Questionnaire (ZCQ); JOA Back Pain Evaluation Questionnaire (JOABPEQ); Roland-Morris Disability Questionnaire (RMDQ); and Short Form 8 (SF-8) as patient reported outcomes. Patients were divided into two groups (Group L ≤ 36.2 points and Group NL > 36.2 points) based on the results of the preoperative mental health (MH) score in SF-8 to examine the influence of MH in LSS. We compared the HRQOL between the two groups postoperatively. RESULTS The JOA score, NRS, and ZCQ score significantly improved after surgery. HRQOL outcomes including JOABPEQ, RMDQ, and SF-8 showed that the LSPSL improved not only the physical but also the mental function in patients with LSS. All HRQOL outcomes in Group L exhibited significantly worse scores preoperatively; however, no significant differences between two groups were found postoperatively. CONCLUSIONS LSPSL greatly reduced low back pain, leg pain, and leg numbness. LSPSL resulted in a significant improvement based on HRQOL questionnaires even in patients with preoperative depressive mood. Not only the physical status but also the mental health may improve after LSPSL even in patients with LSS with a depressive mood preoperatively.
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Affiliation(s)
| | - Yoji Ogura
- Spine Center, Japanese Red Cross Shizuoka Hospital, Japan
| | | | - Takahiro Tadokoro
- Department of Anesthesiology, University of California San Diego, USA
| | | | - Yohei Takahashi
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Nagoya, Japan
| | - Akimasa Yasuda
- Spine Center, Japanese Red Cross Shizuoka Hospital, Japan
| | | | - Jun Ogawa
- Spine Center, Japanese Red Cross Shizuoka Hospital, Japan
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19
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Yuan T, Zhang J, Yang L, Wu J, Tian H, Wan T, Xu D, Liu Q. Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery: A case report. Medicine (Baltimore) 2019; 98:e16396. [PMID: 31335689 PMCID: PMC6709168 DOI: 10.1097/md.0000000000016396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [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
RATIONALE Cauda equina syndrome (CES) refers to a group of symptoms that occur when the nerves in the cauda equina become compressed or damaged. The most common etiology of CES is lumbar intervertebral disc herniation, but CES following lumbar spinal surgery is rare, especially without motor dysfunction. Herein, we illustrate a case of CES that developed as a complication of spinal surgery and to deduce its possible underlying cause. PATIENT CONCERNS A 46-year-old man experienced lumbago, bilateral shank pain, and numbness with neurogenic claudication for 3 years due to degenerative lumbar disc herniation and spinal cord stenosis. After a thorough examination to diagnose lumbar spinal stenosis, the patient underwent bilateral decompression and pedicle screw system internal fixation with bone graft. Postoperatively, the patient showed regained strength in his bilateral shanks, and he did not complain of lumbago and shank pain, but CES occurred, which manifested as underpants-type numbness in the perineum without bladder, anal, and motor dysfunction. DIAGNOSES CES as a postoperative complication of lumbar stenosis. INTERVENTIONS The patient underwent bilateral laminectomies, partial facetectomies, and pedicle screw system internal fixation and fusion with bone graft. Postoperatively, the patient performed adequate rehabilitation exercises and was expected to recover spontaneously. OUTCOMES The symptoms of pain and claudication resolved after 3 weeks in the hospital, but an underpants-type hypoesthesia in the perineum without motor dysfunction developed. The patient experienced full recovery from CES 6 months after surgery. LESSONS CES as a complication of lumbar spinal surgery is very rare. Excessive sensitivity to the traction of the dural sac was, in our opinion, the most possible cause of postoperative CES in this case. When the nerve root is pulled intraoperatively, it is best not to cross the central line of the spinous process. The plane of the nerve retractor needs to be parallel to the dural sac at the pulling point to reduce the formation of shear force. Most importantly, gentle maneuver is required because sensitivity to the traction of the dural sac varies individually.
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Chen L, H Ferreira P, R Beckenkamp P, L Ferreira M. Comparative efficacy and safety of surgical and invasive treatments for adults with degenerative lumbar spinal stenosis: protocol for a network meta-analysis and systematic review. BMJ Open 2019; 9:e024752. [PMID: 30948574 PMCID: PMC6500367 DOI: 10.1136/bmjopen-2018-024752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Surgical and invasive procedures are widely used in adults with degenerative lumbar spinal stenosis when conservative treatments fail. However, little is known about the comparative efficacy and safety of these interventions. To address this, we will perform a network meta-analysis (NMA) and systematic review to compare the efficacy and safety of surgical and invasive procedures for adults with degenerative lumbar spinal stenosis. METHODS AND ANALYSIS We will include randomised controlled trials assessing surgical and invasive treatments for adults with degenerative lumbar spinal stenosis. We will search AMED, CINAHL, EMBASE, the Cochrane Library and MEDLINE. Only English studies will be included and no restriction will be set for publication status. For efficacy, our primary outcome will be physical function. Secondary outcomes will include pain intensity, health-related quality of life, global impression of recovery, work absenteeism and mobility. For safety, our primary outcome will be all-cause mortality. Secondary outcomes will include adverse events (number of events or number of people with an event) and treatment withdrawal due to adverse effect. Two reviewers will independently select studies, extract data and assess the risk of bias (Revised Cochrane risk-of-bias tool for randomized trials) of included studies. The quality of the evidence will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation framework. Random-effects NMA will be performed to combine all the evidence under the frequentist framework and the ranking results will be presented through the surface under the cumulative ranking curve and mean rank. All analyses will be performed in Stata and R. ETHICS AND DISSEMINATION No ethical approval is required. The research will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018094180.
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Affiliation(s)
- Lingxiao Chen
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paulo H Ferreira
- University of Sydney, Faculty of Health Sciences, Discipline of Physiotherapy, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- University of Sydney, Faculty of Health Sciences, Discipline of Physiotherapy, Sydney, New South Wales, Australia
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Lee CW, Yoon KJ, Ha SS. Comparative Analysis between Three Different Lumbar Decompression Techniques (Microscopic, Tubular, and Endoscopic) in Lumbar Canal and Lateral Recess Stenosis: Preliminary Report. Biomed Res Int 2019; 2019:6078469. [PMID: 31019969 PMCID: PMC6451825 DOI: 10.1155/2019/6078469] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of our study is to compare the results of spinal decompression using the full-endoscopic interlaminar technique, tubular retractor, and a conventional microsurgical laminotomy technique and evaluate the advantages and clinical feasibility of minimally invasive spinal (MIS) lumbar decompression technique in the lumbar canal and lateral recess stenosis. METHODS The authors retrospectively reviewed clinical and radiological data from 270 patients who received microsurgical (group E: 72 patients), tubular (group T: 34 patients), or full-endoscopic decompression surgery (group E: 164 patients) for their lumbar canal and lateral recess stenosis from June 2016 to August 2017. Clinical (VAS, ODI, and Mcnab criteria), radiologic (spinal canal diameter, segmental dynamic angle, and disc height), and surgical outcome parameters (CPK level, Operative time, blood loss, and hospital stay) were evaluated pre- and postoperatively and compared among the three groups by means of statistical analysis. Failed cases and complications were reviewed in all groups. RESULTS The mean follow-up period was 6.38 months. The Overall clinical success rate was 89.4%. All groups showed favorable clinical outcome. The clinical and radiologic results were similar in all groups. Regarding surgical outcome, group E showed longer operation time than group M and T (group E: 84.17 minutes/level, group M: 52.22 minutes/level, and group T: 66.12 minutes/level) (p<0.05). However, groups E and T showed minimal surgical invasiveness compared with group M. Groups E and T showed less immediate postoperative back pain (VAS) (group E: 3.13, group M: 4.28, group T: 3.54) (p<0.05), less increase of serum CPK enzyme (group E: 66.38 IU/L, group M: 120 IU/L, and group T: 137.5 IU/L) (p<0.05), and shorter hospital stay (group E: 2.12 days, group M: 4.85 days, and group T: 2.83 days) (p<0.05). The rates of complications and revisions were not significantly different among the three groups. CONCLUSIONS MIS decompression technique is clinically feasible and safe to treat the lumbar canal and lateral recess stenosis, and it has many surgical advantages such as less muscle trauma, minimal postoperative back pain, and fast recovery of the patient compared to traditional open microscopic technique.
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Affiliation(s)
- Chul-Woo Lee
- Department of Neurosurgery, St. Peter's Hospital, Seoul 135-809, Republic of Korea
| | - Kang-Jun Yoon
- Department of Neurosurgery, St. Peter's Hospital, Seoul 135-809, Republic of Korea
| | - Sang-Soo Ha
- Department of Neurosurgery, St. Peter's Hospital, Seoul 135-809, Republic of Korea
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Sasani H, Solmaz B, Sasani M, Vural M, Ozer AF. Diagnostic Importance of Axial Loaded Magnetic Resonance Imaging in Patients with Suspected Lumbar Spinal Canal Stenosis. World Neurosurg 2019; 127:e69-e75. [PMID: 30857995 DOI: 10.1016/j.wneu.2019.02.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/08/2019] [Accepted: 02/09/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE AND BACKGROUND To study the efficacy of lumbar (AL) magnetic resonance imaging (MRI) in patients with suspected lumbar spinal stenosis (LSS), with and without AL compression. Supine MRI is used in the assessment of patients with LSS. However, MRI findings may poorly correlate with neurologic findings because of the morphologic changes of the lumbar spinal canal between upright standing and supine positions. In patients without significant stenosis in routine lumbar MRI, by applying AL, MRI can show significant LSS. METHODS This study included 103 consecutive patients (188 disc levels) who presented with neurogenic claudication with and without low back pain. AL was performed using a nonmagnetic compression device for 5 minutes. T1- and T2-weighted axial and sagittal sequences were obtained during AL applied to the spine. The dural sac cross-sectional area (DSCA) appeared to be narrow at each disc level of L4-5 to L5-S1 in all patients and was measured using T2-weighted images in routine supine and AL images. RESULTS The groups included patients with a reduction in the DSCA (>15 mm2) according to patient age and DSCA in routine spine MRI. The mean DSCA of the disc levels without and with AL were 138 mm2 and 123 mm2, with a mean difference of 15 mm2 at L4-5, 134 mm2 and 125 mm2 and a mean difference of 9 mm2 at L5-S1, respectively. CONCLUSIONS The use of AL MRI in patients with clinically suspected LSS could reduce the risk of misdiagnosis of stenosis, leading to inappropriate treatment.
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Affiliation(s)
- Hadi Sasani
- Department of Radiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey.
| | - Bilgehan Solmaz
- Department of Neurosurgery, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, American Hospital, Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
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Lee JH, Sim KC, Kwon HJ, Kim JW, Lee G, Cho SS, Choi SS, Leem JG. Effectiveness of lumbar epidural injection in patients with chronic spinal stenosis accompanying redundant nerve roots. Medicine (Baltimore) 2019; 98:e14490. [PMID: 30817564 PMCID: PMC6831256 DOI: 10.1097/md.0000000000014490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Redundant nerve root syndrome (RNRS) is a phenomenon characterized by the presence of elongated, enlarged, tortuous nerve roots in the lumbar subarachnoid space. It is unclear whether RNRS is caused by spinal stenosis or causes these symptoms.This study evaluated the effects of lumbar epidural steroid injection (LESI) on patients with RNRS and assessed factors associated with RNRS. This retrospective observational cohort study was conducted at a single pain clinic of a university hospital.The medical records of 172 outpatients presenting with low back and/or leg pain from July to December 2014 were analyzed. Pain intensity (numeric rating scale [NRS]) and functional status were assessed at baseline and 2, 4, and 12 weeks after the LESI. Patients were considered moderate responders if they showed a 3-point or >30% reduction in baseline NRS, or said "better than 30%," "a little better," or "I feel an effect." Patients were considered substantial responders if they showed a 5-point or >50% reduction in baseline NRS, or said "better than 50%," "very good," or "much better." Generalized estimating equation (GEE) analysis was performed to identify the factors associated with moderate response to LESI. Factors associated with RNRS were also determined by logistic regression analysis.The proportions of both moderate and substantial responders at 2, 4, and 12 weeks were significantly lower in patients with than without RNRS. GEE analysis showed that RNRS were the only factor significantly associated with moderate response to LESI (OR = 0.400; 95% CI, 0.253-0.632; P < .001). The distance from the conus medullaris to the closest level of stenosis was shorter in patients with than without RNRS (P < .001) and was the only independent factor associated with RNRS on multivariate logistic regression analysis (OR = 0.972; P < .001).LESI was less effective in patients with than without RNRS. The only independent factor significantly associated with RNRS was the distance from the conus medullaris to the nearest moderate stenosis.
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Affiliation(s)
- Jong-Hyuk Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Ki-Choon Sim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul
| | - Hyun-Jung Kwon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae-Won Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Gunn Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Seong-Sik Cho
- Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Jeong-Gil Leem
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
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Abstract
Introduction Acupuncture may have a role in the treatment of intermittent claudication of the cauda equina due to lumbar spinal canal stenosis. The aim of this study was to explore the possible physiological mechanisms. Methods In a laboratory experiment, manual acupuncture was performed at a point adjacent to the sixth lumbar vertebra of 13 animals and its effect on sciatic nerve blood flow was measured using a laser Doppler flowmetry. Simultaneously, changes in blood pressure and cardiac rate were observed. Each animal was stimulated four to eight times, making a total of 58 experiments. Results Acupuncture stimulation did not produce consistent changes in sciatic nerve blood flow, with increased and decreased blood flow as well as no change in blood flow observed. Among the 58 individual experiments, sciatic nerve blood flow was increased in 33, reduced in 12, and unchanged in 13. Approximately half of the stimulations showed a correlation between blood flow and blood pressure change. Conclusion Our results indicate that lumbar acupuncture stimulation can have an influence on sciatic nerve blood flow. The effect is dependent not only on blood pressure but also other factors, for example vasodilator and vasoconstrictor nerve activity. This mechanism may contribute to a clinical effect on intermittent claudication of the cauda equina.
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Shin SS, Yoo WG. Stepping over an obstacle in patients with lumbar spinal stenosis: Trunk and lower extremities of kinematic and muscle activation normalized by double limb support. A preliminary study. Technol Health Care 2018; 27:1-11. [PMID: 30452425 DOI: 10.3233/thc-171082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with LSS tend to adopt a flexed lumbar posture and trunk position, particularly when stepping over an obstacle, as this activity alters the biomechanical demands placed on the trunk and lower extremities. OBJECTIVE To investigate the effects of lumbar spinal stenosis (LSS) on patients' trunk and lower-extremity kinematics, and on activities involving the gluteus medius (GMed) and vastus lateralis (VL). METHODS All participants (9 older adult patients with LSS and 11 control subjects) were required to negotiate an obstacle while walking. Trunk and lower-extremity kinematic data and GMed and VL activities were recorded using a synchronized 3D motion capture system and surface electromyography. RESULTS The thoracic (12.01∘± 8.82∘ and 16.45∘± 10.80∘) and spinal (9.92∘± 14.03∘ and 5.99∘± 15.94∘) flexion angles of the leading and trailing swing limbs were higher, and the pelvic anterior tilting angle (2.37∘± 7.76∘ and 10.38∘± 8.07∘) was lower in the LSS group than in the control group (p< 0.05). With the exception of toe-off and normalized GMed activities in the contralateral leading limb (p> 0.05), all GMed (256.73 ± 112.22%, 174.00 ± 75.79%, and 270.57 ± 114.45%, respectively) and VL (208.98 ± 124.81%, 182.97 ± 93.23%, 283.91 ± 154.71%, and 394.42 ± 108.94%, respectively) activities of the contralateral leading and trailing swing limb (heel-strike and toe-off normalized activities) were significantly higher in the LSS group than in the control group (p< 0.05). CONCLUSIONS Patients with LSS exhibited trunk-flexed postures when stepping over an obstacle, and these trunk alignments placed higher demands on the GMed and VL activities normalized by double-limb support during joint loading in the single-leg stance. These findings support clinical recommendations for regulating the physical activity of obstacle negotiation that may be beneficial in the management of patients with LSS.
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Schmidt CT, Ward RE, Suri P, Kiely DK, Goldstein R, Pensheng N, Anderson DE, Bean JF. Which Neuromuscular Attributes Are Associated With Changes in Mobility Among Community-Dwelling Older Adults With Symptomatic Lumbar Spinal Stenosis? Arch Phys Med Rehabil 2018; 99:2190-2197. [PMID: 29753734 PMCID: PMC6640144 DOI: 10.1016/j.apmr.2018.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/31/2018] [Accepted: 04/15/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To identify neuromuscular attributes associated with mobility and changes in mobility over 2 years of follow-up among patients with and without symptomatic lumbar spinal stenosis (SLSS). DESIGN Secondary analysis of a longitudinal cohort study. SETTING Outpatient rehabilitation center. PARTICIPANTS Community-dwelling older adults ≥65 years with self-reported mobility limitations (N=430). SLSS was determined using self-reported symptoms of neurogenic claudication and imaging-detected lumbar spinal stenosis. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Basic and advanced mobility as measured by the Late-Life Function and Disability Instrument (LLFDI). RESULTS Among 430 community-dwelling older adults, 54 (13%) patients met criteria for SLSS, while 246 (57%) did not. On average LLFDI basic and advanced mobility scores decreased significantly from baseline through year 2 for participants with SLSS (basic: P=.04, 95% CI 0.18, 5.21; advanced P=.03, 95% CI 0.39, 7.84). Trunk extensor muscle endurance (trunk endurance) and leg strength were associated with baseline basic mobility (R2=0.27, P<.001) while leg strength and knee flexion range of motion (ROM) were associated with baseline advanced mobility among participants with SLSS (R2=0.47, P<.001). Among participants without SLSS trunk endurance, leg strength and ankle ROM were associated with baseline basic mobility (R2=0.38, P<.001), while trunk endurance, leg strength, leg strength asymmetry, and knee flexion ROM were associated with advanced mobility (R2=0.20, P<.001). Trunk endurance and leg strength were associated with change in basic mobility (R2=0.29, P<.001), while trunk endurance and knee flexion ROM were associated with change in advanced mobility (R2=0.42, P<.001) among participants with SLSS. Among participants without SLSS trunk endurance, leg strength, knee flexion ROM, and ankle ROM were associated with change in basic mobility (R2=0.22, P<.001), while trunk endurance, leg strength, and knee flexion ROM were associated with change in advanced mobility (R2=0.36, P<.001). CONCLUSIONS Patients with SLSS experience greater impairment in the neuromuscular attributes: trunk endurance, leg strength, leg strength asymmetry, knee flexion and extension ROM, and ankle ROM compared to patients without SLSS. Differences exist in the neuromuscular attributes associated with mobility at baseline and decline in mobility over 2 years of follow-up for patients with and without SLSS. These findings may help guide rehabilitative care approaches for patients with SLSS.
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Affiliation(s)
- Catherine T Schmidt
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, MA.
| | - Rachel E Ward
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, GRECC, Boston, MA
| | - Pradeep Suri
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA
| | - Dan K Kiely
- Spaulding Rehabilitation Hospital, Cambridge, MA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Hospital, Charlestown, MA
| | - Ni Pensheng
- Health and Disability Research Institute, Boston University, Boston, MA
| | - Dennis E Anderson
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, GRECC, Boston, MA
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Thornes E, Robinson HS, Vøllestad NK. Dynamic balance in patients with degenerative lumbar spinal stenosis; a cross-sectional study. BMC Musculoskelet Disord 2018; 19:192. [PMID: 29902972 PMCID: PMC6003037 DOI: 10.1186/s12891-018-2111-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/24/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Degenerative lumbar spinal stenosis (LSS) is a prevalent condition in adults over the age of 55 years. The condition is associated with activity limitations that are related to increased pain when engaging in weight-bearing activities, such as walking and standing, and release of pain while sitting down or bending forward. The limitation on ambulation is also associated with impaired balance although the types of balance problems are sparsely described in this patient group. The purpose of this study was to assess dynamic balance in persons with LSS by the Mini-BESTest and explore the associations with self-reported balance and functional disability. METHODS Sixty two participants were included in this cross-sectional study. The main outcome measure was the Mini-BESTest, providing a total score and sub-scores for 4 balance control systems (Anticipatory Adjustment, Reactive Response, Sensory Orientation, Stability of Gait). The Swiss Spinal Stenosis Questionnaire provided sub-scores for self-reported balance problems and walking function (FUNC). RESULTS The participants showed large inter-individual variation in all measures of balance. The Mini-BESTest score ranged from very good to poor and the mean value was 22.8 (SD 3.5). Nineteen participants (31%) reported having frequent balance problems. Logistic regression analyses showed that both the total Mini-BESTest score (OR (95% CI) 1.6 (1.2, 2.0)(P = .001) and 3 of the 4 balance control systems (Anticipatory Adjustment, Sensory Orientation, Stability in Gait) were significantly associated with self-reported balance problems (.001 ≤ P ≤ .01). The strongest association was seen between Sensory Orientation and balance problems, implying that it is 4.4 times more likely that persons would have no or occasional balance problems with each unit of increase in Sensory Orientation. The total score for the Mini-BESTest was significantly associated with FUNC (P = .042). CONCLUSIONS The dynamic balance of persons with LSS showed a large heterogeneity with a large fraction of the participants displaying no balance impairments. The test results were associated with the participants' self-reported balance problems and walking function. The Mini-BESTest thus appears to provide additional information to self-reported disability, and by identifying different kind of balance control impairments, the Mini-BESTest could be useful for physiotherapists working with person-centered rehabilitation in persons with LSS.
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Affiliation(s)
- Elisabeth Thornes
- Department of Physical Therapy, Martina Hansens Hospital, PO.Box 823, 1306 Sandvika, Norway
- Department of Health Sciences, University of Oslo, Oslo, Norway
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Tu J, Hua W, Li W, Liu W, Luo R, Li S, Zhang Y, Kang L, Wang K, Song Y, Yang S, Yang C. Short-term effects of minimally invasive dynamic neutralization system for the treatment of lumbar spinal stenosis: An observational study. Medicine (Baltimore) 2018; 97:e10854. [PMID: 29851799 PMCID: PMC6393126 DOI: 10.1097/md.0000000000010854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The aim of the study was to evaluate the safety and short-term effects of dynamic stabilization via minimally invasive system for degenerative lumbar spinal stenosis. Patients with degenerative lumbar spinal stenosis and treated with Transforaminal Lumbar Interbody Fusion via minimally invasive minimally system (mis-TLIF) were served as the control group.From April 2011 to March 2015, 47 patients (29 male, 18 female; mean age 47.6 [range, 26-52] years) with lumbar spinal stenosis were treated with decompression and excision of herniated disk via the minimally invasive system combined with the dynamic fixation technique, and 42 patients as control group with mis-TLIF. Minimally invasive surgeries were performed via the posterior incision approach. The clinical outcomes were evaluated by comparing the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) scores, and the ROMs of the adjacent segment before and after surgery. The postoperative complications related to the implants were identified.A total of 83 patients (43 of Dynesys group and 40 of mis-TLIF group) were followed for an average duration of >35 months. Dynesys stabilization resulted in significantly higher preservation of motion at the index level (P < .05), and significantly less hypermobility at the adjacent segments. VAS for the back and leg pain and ODI improved significantly (P < .05) in 2 groups; however, there is no significant difference between the groups. In Dynesys group, 3 cases suffered skin flay necrosis, 1 of them had a wound infection that was treated with washing and drainage combined with antibiotic therapy. Skin flay necrosis were also observed in 2 cases of mis-TLIF group. Reoperation was performed in one case of Dynesys group for rupture of the internal fixation. No rupture of internal fixation was observed in mis-TLIF group.The nonfusion fixation system Dynesys may be used to treat degenerative spinal stenosis without posterior element damage. This surgical technique is safe and effective. However, utilizing higher preservation of motion may lead to the failure of internal fixation.
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Affiliation(s)
- Ji Tu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Wentian Li
- Wuhan Institute of Biological Products Co., Ltd
| | - Wei Liu
- Department of Orthopaedics, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Rongjin Luo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Shuai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Yukun Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Liang Kang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Kun Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Yu Song
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Shuahua Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
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Koerner JD, Blatt M, Zielonka T, Sharma J, Kaul S. Blunt Trauma Patients with Cervical Stenosis and No Fracture Are More Likely to Have Neurologic Deficits and Require Surgery Than Those without Stenosis. Am Surg 2018; 84:e188-e191. [PMID: 30454533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Igawa T, Katsuhira J, Hosaka A, Uchikoshi K, Ishihara S, Matsudaira K. Kinetic and kinematic variables affecting trunk flexion during level walking in patients with lumbar spinal stenosis. PLoS One 2018; 13:e0197228. [PMID: 29746537 PMCID: PMC5944950 DOI: 10.1371/journal.pone.0197228] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/28/2018] [Indexed: 11/24/2022] Open
Abstract
Lumbar spinal stenosis causes cauda equina and nerve root compression, resulting in neurological symptoms. Although trunk flexion during level walking may alleviate these symptoms by enabling spinal canal decompression, some patients do not use this strategy. We aimed to identify the kinetic and kinematic variables that affect trunk flexion in patients during level walking. Gait was recorded in 111 patients using a three-dimensional motion capture system and six force plates. From the data recorded, walking velocity, bilateral step length, cycle time, maximum trunk flexion angle, forward pelvic tilt angle, pelvic rotation angle, maximum and minimum joint angles, and moment and power of the lower limb were calculated. Then a step-wise multiple regression analysis was conducted to identify kinetic and kinematic variables affecting trunk flexion. The maximum hip extension angle (β = 0.416), maximum hip flexion moment (β = -0.348), and step length (β = 0.257) were identified as variables significantly affecting the trunk flexion angle. The coefficient of determination adjusted for the degree of freedom was 0.294 (p < 0.05). Our results suggest that patients with lumbar spinal stenosis choose one of two strategies to alleviate symptoms during walking. One strategy is gait with trunk flexion posture to increase step length and hip extension angle. The other strategy is gait with trunk upright posture to decrease step length and hip extension angle.
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Affiliation(s)
- Tatsuya Igawa
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Tokyo, Japan
- * E-mail:
| | - Junji Katsuhira
- Faculty of Medical Technology, Department of Prosthetics and Orthotics and Assistive Technology, Niigata University of Health and Welfare, Niigata, Japan
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, Japan
| | - Akira Hosaka
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Tokyo, Japan
- Faculty of Health Science, Department of Locomotive Rehabilitation Science, Showa University, Tokyo, Japan
| | - Kenta Uchikoshi
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Tokyo, Japan
- Faculty of Health Science, Department of Assistive Technology Science, International University of Health and Welfare, Tokyo, Japan
| | - Shinichi Ishihara
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, Japan
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Herren C, Beckmann A, Meyer S, Pishnamaz M, Mundt M, Sobottke R, Prescher A, Stoffel M, Markert B, Kobbe P, Pape HC, Eysel P, Siewe J. Biomechanical testing of a PEEK-based dynamic instrumentation device in a lumbar spine model. Clin Biomech (Bristol, Avon) 2017; 44:67-74. [PMID: 28342975 DOI: 10.1016/j.clinbiomech.2017.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/06/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the range-of-motion after posterior polyetheretherketone-based rod stabilisation combined with a dynamic silicone hinge in order to compare it with titanium rigid stabilisation. METHODS Five human cadaveric lumbar spines with four vertebra each (L2 to L5) were tested in a temperature adjustable spine-testing set-up in four trials: (1) native measurement; (2) kinematics after rigid monosegmental titanium rod instrumentation with anterior intervertebral bracing of the segment L4/5; (3) kinematics after hybrid posterior polyetheretherketone rod instrumentation combined with a silicone hinge within the adjacent level (L3/4) and (4) kinematics after additional decompression with laminectomy of L4 and bilateral resection of the inferior articular processes (L3). During all steps, the specimens were loaded quasi-statically with 1°/s with pure moment up to 7.5Nm in flexion/extension, lateral bending and axial rotation. FINDINGS In comparison to the native cadaveric spine, both the titanium device and polyetheretherketone-based device reduce the range-of-motion within the level L4/5 significantly (flexion/extension: reduction of 77%, p<0.001; lateral bending: reduction of 62%, p<0.001; axial rotation: reduction of 71%, p<0.001). There was a clear stabilisation effect after hybrid-instrumentation within the level L3/4, especially in flexion/extension (64%, p<0.001) and lateral bending (62%, p<0.001) but without any effect on the axial rotation. Any temperature dependency has not been observed. INTERPRETATION Surprisingly, the hybrid device compensates for laminectomy L4 and destabilising procedure within the level L3/4 in comparison to other implants. Further studies must be performed to show its effectiveness regarding the adjacent segment instability.
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Affiliation(s)
- Christian Herren
- Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Agnes Beckmann
- Institute of General Mechanics, RWTH Aachen, Templergraben 64, 52062 Aachen, Germany
| | - Sabine Meyer
- Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Miguel Pishnamaz
- Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Marion Mundt
- Institute of General Mechanics, RWTH Aachen, Templergraben 64, 52062 Aachen, Germany
| | - Rolf Sobottke
- Department of Orthopaedic and Trauma Surgery, Medizinisches Zentrum StädteRegion Aachen GmbH, Mauerfeldchen 25, 52146 Aachen, Germany; Department of Orthopaedic and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Straße 9, 50924 Cologne, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, University Hospital RWTH Aachen, Wendlingweg 2, 52070 Aachen, Germany
| | - Marcus Stoffel
- Institute of General Mechanics, RWTH Aachen, Templergraben 64, 52062 Aachen, Germany
| | - Bernd Markert
- Institute of General Mechanics, RWTH Aachen, Templergraben 64, 52062 Aachen, Germany
| | - Philipp Kobbe
- Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistr, 100, 8091 Zurich, Switzerland
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Straße 9, 50924 Cologne, Germany
| | - Jan Siewe
- Department of Orthopaedic and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Straße 9, 50924 Cologne, Germany
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Kuwahara W, Deie M, Fujita N, Tanaka N, Nakanishi K, Sunagawa T, Asaeda M, Nakamura H, Kono Y, Ochi M. Characteristics of thoracic and lumbar movements during gait in lumbar spinal stenosis patients before and after decompression surgery. Clin Biomech (Bristol, Avon) 2016; 40:45-51. [PMID: 27821273 DOI: 10.1016/j.clinbiomech.2016.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/25/2016] [Accepted: 10/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although gait analysis has been previously conducted for lumbar spinal stenosis patients, the vertebral segmental movements, such as of the thoracic and lumbar regions, and whether the spinal movement during gait changes after decompression surgery remain unclear. METHODS Ten patients with lumbar spinal stenosis and 10 healthy controls participated. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Visual Analogue Scale. Spinal kinematic data of the participants during gait were acquired using a three-dimensional motion analysis system. The trunk (whole spine), thoracic, and lumbar flexion and pelvic tilting values were calculated. Spinal kinematic data and clinical outcomes were collected preoperatively and 1month postoperatively for the patients. FINDINGS Compared to that observed preoperatively, the clinical outcomes significantly improved at 1month postoperatively. In the standing position, the preoperative lumbar extension of the patients was significantly smaller than that of the controls. Moreover, during gait, the lumbar flexion relative to the standing position of the patients was smaller than that of the controls preoperatively, and increased at 1month postoperatively. The sum of the thoracic and lumbar flexion values during gait negatively correlated with the score for leg pain. INTERPRETATION The epidural pressure of lumbar spinal stenosis patients is known to be higher than that of normal subjects during gait, and to decrease during walking with lumbar flexion. Preoperatively, smaller thoracic and lumbar flexion movements during gait relative to the standing position cannot decrease epidural pressure; as a result, severe leg pain might be induced.
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Affiliation(s)
- Wataru Kuwahara
- Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Aichi, Japan.
| | - Naoto Fujita
- Department of Musculoskeletal Functional Research and Regeneration, Hiroshima University, Hiroshima, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | | | - Toru Sunagawa
- Department of Analysis and Control of Upper Extremity Function, Hiroshima University, Hiroshima, Japan
| | - Makoto Asaeda
- Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Haruka Nakamura
- Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshifumi Kono
- Department of Rehabilitation, Hiroshima University Hospital, Hiroshima, Japan
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
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Hara N, Matsudaira K, Masuda K, Tohnosu J, Takeshita K, Kobayashi A, Murakami M, Kawamura N, Yamakawa K, Terayama S, Ogihara S, Shiono H, Morii J, Hayakawa K, Kato S, Nakamura K, Oka H, Sawada T, Inuzuka K, Kikuchi N. Psychometric Assessment of the Japanese Version of the Zurich Claudication Questionnaire (ZCQ): Reliability and Validity. PLoS One 2016; 11:e0160183. [PMID: 27467254 PMCID: PMC4965020 DOI: 10.1371/journal.pone.0160183] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/14/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose The Zurich Claudication Questionnaire (ZCQ) is a self-administered measure to evaluate symptom severity, physical function, and surgery satisfaction in lumbar spinal stenosis (LSS). The purpose of this study is to assess the psychometric properties of the Japanese ZCQ in LSS patients. Methods LSS patients who are scheduled to undergo surgery were recruited from 12 facilities. Responses to several questionnaires, including the Japanese ZCQ; the visual analogue scale (VAS) to evaluate the degree of pain in the buttocks/legs, numbness in the buttocks/legs, and low back pain; the Oswestry Disability Index (ODI); and the SF-36v2, were collected before surgery and again 3 months after surgery (the post-surgery ZCQ was administered twice for test-retest reliability). For reliability, test-retest reliability was evaluated using the intra-class coefficient (ICC) and internal consistency was evaluated using Cronbach’s alpha coefficient. Concurrent validity was assessed using Spearman’s correlation coefficients between the Japanese ZCQ and other questionnaires. Effect size (ES) and standard response mean were calculated for responsiveness. All analyses were performed individually for the Japanese ZCQ symptom, function, and satisfaction domains. Results Data from 180 LSS patients were used in this analysis. The ICCs were 0.81, 0.89, and 0.88 and Cronbach’s alpha coefficients were 0.78, 0.84, and 0.92 for the Japanese ZCQ symptom, function, and satisfaction domains, respectively. Regarding the concurrent validity, strong correlations (±0.5) were demonstrated between the Japanese ZCQ domains and the VAS leg pain, ODI, and SF-36v2 physical functioning or bodily pain, whereas correlations were approximately 0.3 in scales measuring other symptoms that are less related to symptom, function, or satisfaction domains. ESs showed high values for the ZCQ symptom and function domains (-1.73 for both). Conclusions These psychometric assessments demonstrate that the Japanese ZCQ is a psychometrically reliable and valid measure in LSS. The Japanese ZCQ can evaluate both multi-dimensional aspects and the level of surgery satisfaction.
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Affiliation(s)
- Nobuhiro Hara
- Department of Orthopaedic Surgery, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- * E-mail:
| | - Kazuhiro Masuda
- Department of Orthopaedic Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Juichi Tohnosu
- Department of Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Atsuki Kobayashi
- Department of Orthopaedic Surgery, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Motoaki Murakami
- Department of Orthopaedic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Kiyohumi Yamakawa
- Department of Orthopaedic Surgery, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Sei Terayama
- Department of Orthopaedic Surgery, Sangubashi Spine Surgery Hospital, Shibuya-ku, Tokyo, Japan
| | - Satoshi Ogihara
- Department of Orthopaedic Surgery, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Hiroo Shiono
- Department of Orthopaedic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Jiro Morii
- Department of Orthopaedic Surgery, Sanraku Hospital, Chiyoda-ku, Tokyo, Japan
| | - Keiji Hayakawa
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kozo Nakamura
- National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Chiba D, Tsuda E, Wada K, Kumagai G, Sasaki E, Nawata A, Nakagomi S, Takahashi I, Nakaji S, Ishibashi Y. Lumbar spondylosis, lumbar spinal stenosis, knee pain, back muscle strength are associated with the locomotive syndrome: Rural population study in Japan. J Orthop Sci 2016; 21:366-72. [PMID: 27021251 DOI: 10.1016/j.jos.2016.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/27/2015] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To comprehensively investigate the clinical and physical factors associating with locomotive syndrome (Loc-S); the locomotorium-disability for daily life. METHODS 647 volunteers participated (247 males, 400 females, Age: 58.4 ± 11.0, BMI: 22.5 ± 3.3). Three self-assessment questionnaires were administered: 1) "25-question Geriatric Locomotive Function Scale" (GFLS-25) for evaluating Loc-S (GLFS-25 ≥ 16 defined as Loc-S); 2) "diagnostic support tool for LSS" (LSS-DST) for evaluating the prevalence of lumbar spinal stenosis (LSS); 3) Knee injury and Osteoarthritis Outcome Score (KOOS). Plain radiographs of the bilateral knees and lumbar spine were evaluated, and the severity of lumbar spondylosis (LS) and knee osteoarthritis (KOA) defined by Kellgren-Lawrence grade. Bone status was evaluated by using the osteo-sono assessment index (OSI) at the calcaneus. Isometric muscle strength of trunk and leg (Nm/kg, both extension and flexion) were evaluated. Linear regression analysis was performed to elucidate the factors concerned with GFLS-25 including age, sex, and BMI. RESULTS Thirty-nine subjects (6.0%, 13 males, 26 females) were defined as having Loc-S. Single regression model showed that age, height, BMI, skeletal muscle mass, OSI, LSS, KOOS, the severity of LS and KOA, and trunk- and leg-muscle strength were correlated with the degree of GLFS-25. Stepwise multiple regression model showed that sex, height, LSS, KOOS, the severity of LS, and back muscle strength were significantly correlated with that of GLFS-25. CONCLUSION In this cross-sectional study, pain status associated with LSS and knee joint, structural severity for LS, and back muscle strength primarily affected the degree of GFLS-25. For managing Loc-S, we must pay more intensive attention to these factors.
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Affiliation(s)
- Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Eiichi Tsuda
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Nawata
- Medical Engineering Laboratory, Alcare Co., Ltd, Kyojima, Sumida-ku, Tokyo, Japan
| | - Sho Nakagomi
- Medical Engineering Laboratory, Alcare Co., Ltd, Kyojima, Sumida-ku, Tokyo, Japan
| | - Ippei Takahashi
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Jensen RK, Kjaer P, Jensen TS, Albert H, Kent P. Degenerative Pathways of Lumbar Motion Segments--A Comparison in Two Samples of Patients with Persistent Low Back Pain. PLoS One 2016; 11:e0146998. [PMID: 26807697 PMCID: PMC4725847 DOI: 10.1371/journal.pone.0146998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/28/2015] [Indexed: 11/19/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persistent low back pain. However, the clinical relevance of spinal degenerative MRI findings remains uncertain. Although multiple MRI findings are almost always present at the same time, research into the association with clinical outcomes (such as pain) has predominantly focused on individual MRI findings. This study aimed to: (i) investigate how multiple MRI lumbar spine findings cluster together within two different samples of patients with low back pain, (ii) classify these clusters into hypothetical pathways of degeneration based on scientific knowledge of disco-vertebral degeneration, and (iii) compare these clusters and degenerative pathways between samples. Methods We performed a secondary cross-sectional analysis on two dissimilar MRI samples collected in a hospital department: (1) data from the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into hypothetical pathways of degeneration. Results Six clusters of MRI findings were identified in each of the two samples. The content of the clusters in the two samples displayed some differences but had the same overall pattern of MRI findings. Although the hypothetical degenerative pathways identified in the two samples were not identical, the overall pattern of increasing degeneration within the pathways was the same. Conclusions It was expected that different clusters could emerge from different samples, however, when organised into hypothetical pathways of degeneration, the overall pattern of increasing degeneration was similar and biologically plausible. This evidence of reproducibility suggests that Latent Class Analysis may provide a new approach to investigating the relationship between MRI findings and clinically important characteristics such as pain and activity limitation.
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Affiliation(s)
- Rikke K. Jensen
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- * E-mail:
| | - Per Kjaer
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Tue S. Jensen
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Hanne Albert
- Department of Orthopaedics, Bartholomew's Hospital, London, England
| | - Peter Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Hayashi H, Toribatake Y, Murakami H, Yoneyama T, Watanabe T, Tsuchiya H. Gait Analysis Using a Support Vector Machine for Lumbar Spinal Stenosis. Orthopedics 2015; 38:e959-64. [PMID: 26558674 DOI: 10.3928/01477447-20151020-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/23/2015] [Indexed: 02/03/2023]
Abstract
Lumbar spinal canal stenosis (LSS) is diagnosed based on physical examination and radiological documentation of lumbar spinal canal narrowing. Differential diagnosis of the level of lumbar radiculopathy is difficult in multilevel spinal stenosis. Therefore, the authors focused on gait analysis as a classification method to improve diagnostic accuracy. The goal of this study was to identify gait characteristics of L4 and L5 radiculopathy in patients with LSS and to classify L4 and L5 radiculopathy using a support vector machine (SVM). The study group comprised 13 healthy volunteers (control group), 11 patients with L4 radiculopathy (L4 group), and 22 patients with L5 radiculopathy (L5 group). Light-emitting diode markers were attached at 5 sites on the affected side, and walking motion was analyzed using video recordings and the authors' development program. Potential gait characteristics of each group were identified to use as SVM parameters. In the knee joint of the L4 group, the waveform was similar to that of normal gait, but knee extension at initial contact was slightly greater than that of the other groups. In the ankle joint of the L5 group, the one-peak waveform pattern with disappearance of the second peak was present in 10 (45.5%) of 22 cases. The total classification accuracy was 80.4% using the SVM. The highest and lowest classification accuracies were obtained in the control group (84.6%) and the L4 group (72.7%), respectively. The authors' walking motion analysis system identified several useful factors for differentiating between healthy individuals and patients with L4 and L5 radiculopathy, with a high accuracy rate.
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Kwon SY, Shin JJ, Lee JH, Cho WH. Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL). J Orthop Surg Res 2015; 10:94. [PMID: 26065682 PMCID: PMC4465733 DOI: 10.1186/s13018-015-0235-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ossification of the posterior longitudinal ligament (OPLL) may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, few studies have investigated the influence of OPLL on neurological outcome after acute cord injury. We examined whether severe spinal canal stenosis caused by OPLL affects neurological outcome after SCI based on intramedullary signal intensity (SI) changes on magnetic resonance imaging (MRI). METHODS From June 2006 to July 2013, we treated 246 patients with cervical cord injury. Fifty-one (20.7%) patients had ventral cord compression due to OPLL without any bony fractures. Among them, 38 patients (34 men, mean age 62.7 years) underwent cervical laminoplasty (8) and cervical decompression and fixation (30). The neurologic assessments were performed in patients who had 1-year follow-up, and the mean follow-up period was 42.2 months. OPLL type, cause of injury, cervical sagittal angle, cervical spine stenosis, cord compression ratio (space available for the spinal cord (SAC)), and grade of intramedullary SI (grade 0, none; grade 1, light; grade 2, intense T2WI) were assessed. RESULTS Mean American Spinal Injury Association (ASIA) motor score at admission was 38.4 ± 21.9 (range, 2-70) and improved to 67.7 ± 19.1 (range, 8-94) at last follow-up (p < 0.05). Mean recovery rate of the motor score was 55.8 ± 19.9%. Five patients had SI grade 0, 20 patients had SI grade 1, and 13 patients had SI grade 2. Among the variables tested, age, initial ASIA motor grade, intramedullary SI grade, and SAC were significantly related to neurological outcome. However, initial cervical alignment, canal diameter, length of SI, time interval between injury and operation, and OPLL type had no significant effect on neurological outcome. CONCLUSIONS Preoperative neurological status, cord compression ratio, and SI grade are related to neurological outcome in patients with SCI associated with OPLL. The better the preoperative neurological status, the more favorable the neurological outcome after surgery. A higher SI grade on preoperative T2WI was negatively related to neurological outcome. Therefore, the severity of SI change, cord compression ratio, and preoperative neurological status can be regarded as significant prognostic factors in patients with SCI associated with OPLL.
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Affiliation(s)
- Soon Young Kwon
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye-7 dong, 761-1, Nowon-gu, Seoul, 139-707, South Korea.
| | - Jun Jae Shin
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye-7 dong, 761-1, Nowon-gu, Seoul, 139-707, South Korea.
| | - Ji Hae Lee
- Department of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye-7 dong, 761-1, Nowon-gu, Seoul, 139-707, South Korea.
| | - Woo Ho Cho
- Department of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye-7 dong, 761-1, Nowon-gu, Seoul, 139-707, South Korea.
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Yokogawa N, Toribatake Y, Murakami H, Hayashi H, Yoneyama T, Watanabe T, Tsuchiya H. Differences in Gait Characteristics of Patients with Lumbar Spinal Canal Stenosis (L4 Radiculopathy) and Those with Osteoarthritis of the Hip. PLoS One 2015; 10:e0124745. [PMID: 25893667 PMCID: PMC4404331 DOI: 10.1371/journal.pone.0124745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/03/2015] [Indexed: 02/04/2023] Open
Abstract
It is important to differentially diagnose thigh pain from lumbar spinal stenosis (particularly lumbar fourth nerve root radiculopathy) and osteoarthritis of the hip. In this study, using a treadmill and a motion analysis method, gait characteristics were compared between these conditions. Patients with lumbar fourth nerve root radiculopathy had increased physiological knee flexion immediately after foot-ground contact, possibly owing to a slight decrease in the muscle strength of the quadriceps femoris muscle. Patients with osteoarthritis of the hip had decreased range of motion of the hip joint probably due to anatomically limited mobility as well as gait strategy to avoid pain resulting from increased internal pressure on the hip joint during its extension. Our facile and noninvasive method can be useful for the differential diagnosis of lumbar spinal canal stenosis from osteoarthritis of the hip.
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Affiliation(s)
- Noriaki Yokogawa
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
- * E-mail:
| | | | - Hideki Murakami
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Hayashi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Takeshi Yoneyama
- School of Mechanical Engineering, College of Science and Engineering, Kanazawa University, Kanazawa, Japan
| | - Tetsuyou Watanabe
- School of Mechanical Engineering, College of Science and Engineering, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Takeuchi M, Wakao N, Kamiya M, Gosho M, Osuka K, Hirasawa A, Niwa A, Aoyama M, Kawaguchi R, Shima H, Takayasu M. Diagnostic accuracy of multifidus muscle spontaneous activity by needle electromyography for the detection of lumbar foraminal and lateral exit-zone stenosis. Eur Spine J 2015; 24:2281-7. [PMID: 25733203 DOI: 10.1007/s00586-015-3846-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/18/2014] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The medial branch of the posterior ramus of the lumbar spinal nerve is well known to be innervated independently and to end in the multifidus muscle without anastomosis. This prospective cohort study aimed to determine the diagnostic specificity and sensitivity of multifidus muscle denervation (MMD) by needle electromyography (N-EMG) for lumbar foraminal and lateral exit-zone stenosis (LF/LEZS). METHODS We enrolled 61 consecutive patients experiencing unilateral dysesthesia and/or leg pain in the L4 or L5 regions with suspicious LF/LEZS. The Japanese Orthopedic Association (JOA) score, Visual Analog Scale (VAS) for leg pain, and N-EMG were examined. In this study protocol, all patients received at least 3 months of conservative therapy. Surgery was performed on patients who experienced less than 50% VAS pain relief compared with their initial score after confirming the responsible level by lumbar nerve root block. The specificity of N-EMG was the proportion of patients who improved with conservative therapies (non-surgery) after 3 months. The sensitivity of N-EMG was the proportion of patients who improved with surgical therapies (surgery) after more than 12 months. RESULTS Twenty-three patients underwent surgery. The initial lower JOA, positive Kemp test and motor weakness were significantly higher in the surgery group. The MMD by N-EMG indicated that 34 of 38 patients were negative in the non-surgery group. In the surgery group, 21 of 23 patients were positive. The diagnostic sensitivity and specificity were 91.3 and 92.1%, respectively. CONCLUSIONS Needle electromyography is a simple and available additional method for the diagnosis of LF/LEZS.
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Affiliation(s)
- Mikinobu Takeuchi
- Department of Spine Center, Aichi Medical University, Karimata Yazako, Nagakute, Aichi, 480-1195, Japan.
- Neurological Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
| | - Norimitsu Wakao
- Department of Spine Center, Aichi Medical University, Karimata Yazako, Nagakute, Aichi, 480-1195, Japan
- Orthopedics Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Mitsuhiro Kamiya
- Department of Spine Center, Aichi Medical University, Karimata Yazako, Nagakute, Aichi, 480-1195, Japan
- Orthopedics Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Masahiko Gosho
- Advanced Medical Research Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Koji Osuka
- Neurological Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Atsuhiko Hirasawa
- Orthopedics Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Aichi Niwa
- Neurological Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Masahiro Aoyama
- Neurological Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Reo Kawaguchi
- Neurological Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Hiroshi Shima
- Neurological Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Masakazu Takayasu
- Department of Spine Center, Aichi Medical University, Karimata Yazako, Nagakute, Aichi, 480-1195, Japan
- Neurological Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
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Vasilenko II, Klimov VS, Evsyukov AV, Loparev EA, Khalepa RV, Moysak GI, Rzaev DA. A change in the sagittal balance in elderly and senile patients with degenerative stenosis of the lumbar spine. Zh Vopr Neirokhir Im N N Burdenko 2015; 79:102-107. [PMID: 26665268 DOI: 10.17116/neiro2015795102-107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Degenerative-dystrophic changes in the spine have general nature, which leads to changes in the balance parameters and consequently, other elements of the musculoskeletal systems. This article is devoted to analysis of the literature data, based on which we conclude that changes in the sagittal balance in elderly and senile patients as the restabilization stage still remain unexpected.
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Affiliation(s)
| | - V S Klimov
- Federal Neurosurgical Center, Novosibirsk, Russia
| | - A V Evsyukov
- Federal Neurosurgical Center, Novosibirsk, Russia
| | - E A Loparev
- Federal Neurosurgical Center, Novosibirsk, Russia
| | - R V Khalepa
- Federal Neurosurgical Center, Novosibirsk, Russia
| | - G I Moysak
- Federal Neurosurgical Center, Novosibirsk, Russia; Novosibirsk State University, Novosibirsk, Russia
| | - D A Rzaev
- Federal Neurosurgical Center, Novosibirsk, Russia
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Deng XC, Yang AF, He CJ. [Panlongqi tablet (Chinese characters) combined with lumbar facet joint release for the treatment of lumbar spinal stenosis of Fengshi Bizu (Chinese characters)]. Zhongguo Gu Shang 2014; 27:833-837. [PMID: 25739250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy of Panlongqi tablet (Chinese characters) combined with lumbar facet joint release for lumbar spinal stenosis of type Fengshi Bizu (Chinese characters). METHODS Since February 2012 to February 2013, 120 patients with lumbar spinal stenosis of Fengshi Bizu (Chinese characters) syndrome were retrospectively studied. According to different treatment methods, 120 patients with lumbar spinal stenosis were divided into Panlongqi tablet (Chinese characters)group and control groups, respectively. In Panlongqi tablet (Chinese characters)group, 60 patients were treated by Panlongqi tablet (Chinese characters) combined with lumbar facet joints release solution including 26 males and 34 females with an average age of (60.40±3.36) years old ranging from 46 to 65 ; the course of the disease was 2 to 15 years (averaged 7.6 years). In control group the other 60 patients were treated with lumbar facet joint release including 24 males and 36 females with an average age of (61.20±2.47) years old ranging from 48 to 63; the course was 3 to 14 years (averaged 6.9 years). The clinical effect of patients were evaluated by JOA and ODI score before treatment, at 4 weeks and 3 months after treatment. RESULTS All patients were followed up for 4 to 7 months (means 5.6 months). After 3 months,7 cases in control group recurrenced symptoms,only 1 case in Panlongqi tablet (Chinese characters) group recurrenced. At 4 weeks and 3 months of follow-up, ODI score and JOA score of Panlongqi tablet group were much better than those of the control group. CONCLUSION For lumbar spinal stenosis of type Fengshi Bizu (Chinese characters),which were treated with lumbar facet joint release with Panlongqi tablet(Chinese characters), supplemented by back muscle exercise, in relieving waist and low back pain symptoms and improving functional status of lower lumbar spine, can obtain satisfactory clinical outcome, is a good method of conservative treatment for such diseases.
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Fritz JM, Lurie JD, Zhao W, Whitman JM, Delitto A, Brennan GP, Weinstein JN. Associations between physical therapy and long-term outcomes for individuals with lumbar spinal stenosis in the SPORT study. Spine J 2014; 14:1611-21. [PMID: 24373681 PMCID: PMC3997631 DOI: 10.1016/j.spinee.2013.09.044] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/26/2013] [Accepted: 09/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A period of nonsurgical management is advocated before surgical treatment for most patients with lumbar spinal stenosis. Currently, little evidence is available to define optimal nonsurgical management. Physical therapy is often used, however its use and effectiveness relative to other nonsurgical strategies has not been adequately explored. PURPOSE Describe the use of physical therapy and other nonsurgical interventions by patients with lumbar spinal stenosis and examine the relationship between physical therapy and long-term prognosis. STUDY DESIGN Secondary analysis of the Spine Patient Outcomes Research Trial (SPORT) combining data from randomized and observational studies. SETTING Thirteen spine clinics in 11 states in the United States. PATIENT SAMPLE Patients with lumbar spinal stenosis receiving nonsurgical management including those who did or did not receive physical therapy within 6 weeks of enrollment. OUTCOME MEASURES Primary outcome measures included crossover to surgery, the bodily pain and physical function scales changes from the Survey Short Form 36 (SF-36), and the modified Oswestry Disability Index. Secondary outcome measures were patient satisfaction and the Sciatica Bothersomeness Index. METHODS Baseline characteristics and rates of crossover to surgery were compared between patients who did or did not receive physical therapy. Baseline factors predictive of receiving physical therapy were examined with logistic regression. Mixed effects models were used to compare outcomes between groups at 3 and 6 months and 1 year after enrollment adjusted for baseline severity and patient characteristics. RESULTS Physical therapy was used in the first 6 weeks by 90 of 244 patients (37%) and was predicted by the absence of radiating pain and being single instead of married. Physical therapy was associated with a reduced likelihood of crossover to surgery after 1 year (21% vs. 33%, p=.045), and greater reductions on the Short Form 36 physical functioning scale after 6 months (mean difference=6.0, 95% confidence interval: 0.2-11.7) and 1 year (mean difference=6.5, 95% confidence interval: 0.6-12.4). There were no differences in bodily pain or Oswestry scores across time. CONCLUSIONS Many patients with lumbar spinal stenosis pursuing conservative management receive physical therapy. Using physical therapy was associated with reduced likelihood of patients receiving surgery within 1 year. Results for other outcomes were mixed with no differences in several measures. Further research is needed to examine the effectiveness of physical therapy relative to other nonsurgical management strategies for patients with lumbar spinal stenosis.
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Affiliation(s)
- Julie M Fritz
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA; Physical Therapy Division, Intermountain Healthcare, 5848 South 300 East Murray, Salt Lake City, UT 84107, USA.
| | - Jon D Lurie
- Department of Medicine, Dartmouth Medical School, 1 Rope Ferry Rd, Hanover, NH 03755, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 35 Centerra Pkwy, Lebanon, NH 03766, USA
| | - Wenyan Zhao
- Department of Orthopaedics, Dartmouth Medical School, One Medical Center Dr, Lebanon, NH 03756, USA
| | - Julie M Whitman
- Fellowship Program, Evidence in Motion, 3000 Equity Place, Suite 105, Louisville, KY 40223, USA
| | - Anthony Delitto
- Department of Physical Therapy, University of Pittsburgh, 6036 Forbes Tower, Pittsburgh, PA 15241, USA
| | - Gerard P Brennan
- Physical Therapy Division, Intermountain Healthcare, 5848 South 300 East Murray, Salt Lake City, UT 84107, USA
| | - James N Weinstein
- Department of Medicine, Dartmouth Medical School, 1 Rope Ferry Rd, Hanover, NH 03755, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 35 Centerra Pkwy, Lebanon, NH 03766, USA; Department of Orthopaedics, Dartmouth Medical School, One Medical Center Dr, Lebanon, NH 03756, USA
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Ohtori S, Yamashita M, Murata Y, Eguchi Y, Aoki Y, Ataka H, Hirayama J, Ozawa T, Morinaga T, Arai H, Mimura M, Kamoda H, Orita S, Miyagi M, Miyashita T, Okamoto Y, Ishikawa T, Sameda H, Kinoshita T, Hanaoka E, Suzuki M, Suzuki M, Aihara T, Ito T, Inoue G, Yamagata M, Toyone T, Kubota G, Sakuma Y, Oikawa Y, Inage K, Sainoh T, Sato J, Yamauchi K, Takahashi K. Incidence of nocturnal leg cramps in patients with lumbar spinal stenosis before and after conservative and surgical treatment. Yonsei Med J 2014; 55:779-84. [PMID: 24719148 PMCID: PMC3990082 DOI: 10.3349/ymj.2014.55.3.779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/03/2013] [Accepted: 10/07/2013] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To examine the effects of conservative and surgical treatments for nocturnal leg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS. MATERIALS AND METHODS The subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatment such as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment. RESULTS The severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improved in both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122). CONCLUSION The findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgical treatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associated with spinal nerve compression by LSS.
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Affiliation(s)
- Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaomi Yamashita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuaki Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiromi Ataka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jiro Hirayama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoyuki Ozawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuo Morinaga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Arai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaya Mimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroto Kamoda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohiro Miyashita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuzuru Okamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Ishikawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroaki Sameda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoaki Kinoshita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiji Hanaoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Miyako Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Munetaka Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takato Aihara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshinori Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masatsune Yamagata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoaki Toyone
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gou Kubota
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiro Sakuma
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Oikawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Sainoh
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuyo Yamauchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Garbelotti SA, Lucareli PRG, Ramalho A, de Godoy W, Bernal M, D'Andréa Greve JM. An investigation of the value of tridimensional kinematic analysis in functional diagnosis of lumbar spinal stenosis. Gait Posture 2014; 40:150-3. [PMID: 24755459 DOI: 10.1016/j.gaitpost.2014.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 02/27/2014] [Accepted: 03/10/2014] [Indexed: 02/02/2023]
Abstract
Diagnosis of lumbar spinal stenosis (LSS) is based on clinical examination and imaging. The aim of this study was to evaluate the influence of 3D gait analysis as a tool in the differential diagnosis of LSS. Fourteen patients participated in the study that consisted of three phases: (1) capture six gait cycles after rest, (2) walk on a treadmill for a maximum of 20 min, (3) capture six gait cycles after effort. From these data, the kinematic variables were compared with the perception of pain and the cross sectional area of the spinal canal as measured by magnetic resonance. Most of correlations were weak and showed that the most significant results are reported by the Gait Deviation Index (GDI). The Gait Deviation Index demonstrated moderate negative correlation with the perception of pain after effort was made by both limbs. This means that there is a significant decrease in the overall function of the lower limbs according to the increase in pain symptoms. This situation may be reflected in decreased cadence and speed beyond the times of single support for the left limb, and the balance of the right limb, as part of a strategy to protect against pain and imbalance. We found no correlation between gait and pain in the cross-sectional area of the spinal canal. Therefore, we believe that there is no advantage for the patient to make a 3-D gait analysis because the analysis does not add relevant information to clinical diagnosis.
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Affiliation(s)
| | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Amâncio Ramalho
- Movement Analysis Laboratory, Albert Einstein Hospital, São Paulo, Brazil
| | - Wagner de Godoy
- Movement Analysis Laboratory, Albert Einstein Hospital, São Paulo, Brazil
| | - Milena Bernal
- Movement Analysis Laboratory, Albert Einstein Hospital, São Paulo, Brazil
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Truszczyńska A, Truszczyński O, Rąpała K, Gmitrzykowska E, Tranowski A. Postural stability disorders in rural patients with lumbar spinal stenosis. Ann Agric Environ Med 2014; 21:179-182. [PMID: 24738520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Hard work in farming may lead to lumbar spinal stenosis, and consequently, to pain. The pain and neurological disorders may lead to disability and postural disorders. OBJECTIVE The aim of the presented study was to analyse postural stability and its correlation with functional disability of patients with lumbar spinal stenosis living in rural areas. MATERIALS AND METHODS The study population consisted of 30 rural patients with lumbar spinal stenosis; mean age: 51.40 (±12.92); mean BMI: 28.60 (±3.77). The control group consisted of 30 rural inhabitants without spinal disorders. Postural stability was tested on the Biodex Balance System. The patients were also evaluated according to the ODI, the Rolland- Morris disability questionnaire, and VAS. RESULTS The mean results of the patients studied were as follows: 49.37 (±17.39) according to ODI, 15 (±6.19) according to the Rolland-Morris disability scale, and pain intensity of 7 (±1.93) according to the VAS. The following statistically significant differences were found: the mean balance index result was 1.8 (±1.88) and 0.64 (±0.41) in the control group. The mean centre of mass deviation in the A/P plane was 1.39 (±1.88) and 0.46 (±0.41) in the control group. The mean centre of mass deviation in the M/L plane was 0.8 (±0.51) and 0.32 (±0.22) in the control group. The balance in the studied population correlated significantly with the Rolland-Morris disability questionnaire and the VAS. CONCLUSIONS 1) Serious disability was found in rural patients with spinal stenosis. There was a statistically significant correlation between the disability and postural stability disorders. 2) Most of the patients (84%) were overweight. 3) Postural stability disorders were statistically significant for both the stability index and the A/P plane deviation.
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Affiliation(s)
- Aleksandra Truszczyńska
- 1. Prof. A. Gruca Independent Public Research Hospital, Otwock Department of Orthopaedic Surgery, Centre for Postgraduate Medical Education, Otwock, Poland 2. Department of Physical Education and Sport, Biała Podlaska, Academy of Physical Education, Warsaw, Poland 3. Jozef Pilsudski University of Physical Education, Physiotherapy Department, Warsaw, Poland
| | | | - Kazimierz Rąpała
- Department of Physical Education and Sport, Biała Podlaska, Academy of Physical Education, Warsaw, Poland; University of Social Science, Warsaw, Poland
| | - Elzbieta Gmitrzykowska
- Prof. A. Gruca Independent Public Research Hospital, Otwock Department of Orthopaedic Surgery, Centre for Postgraduate Medical Education, Otwock, Poland
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Ohtori S, Yamashita M, Murata Y, Eguchi Y, Aoki Y, Ataka H, Hirayama J, Ozawa T, Morinaga T, Arai H, Mimura M, Kamoda H, Orita S, Miyagi M, Miyashita T, Okamoto Y, Ishikawa T, Sameda H, Kinoshita T, Hanaoka E, Suzuki M, Suzuki M, Aihara T, Ito T, Inoue G, Yamagata M, Toyone T, Kubota G, Sakuma Y, Oikawa Y, Inage K, Sainoh T, Yamauchi K, Takahashi K. Conservative and surgical treatment improves pain and ankle-brachial index in patients with lumbar spinal stenosis. Yonsei Med J 2013; 54:999-1005. [PMID: 23709437 PMCID: PMC3663234 DOI: 10.3349/ymj.2013.54.4.999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI. MATERIALS AND METHODS One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment. RESULTS Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05). CONCLUSION This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.
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Affiliation(s)
- Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
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Adamova BM, Vohanka S, Hnojcikova M, Okacova I, Dusek L, Bednarik J. Neurological impairment score in lumbar spinal stenosis. Eur Spine J 2013; 22:1897-906. [PMID: 23483310 DOI: 10.1007/s00586-013-2731-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 02/20/2013] [Accepted: 02/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM The Oswestry Disability Index (ODI) is an interview-based instrument generally accepted as a measure of disability in patients with lumbar spinal stenosis (LSS). There is, however, no generally accepted measure for neurological impairment in LSS. We therefore developed a scoring system [neurological impairment score in lumbar spinal stenosis (NIS-LSS)] for the assessment of neurological impairment in the lower limbs of patients with LSS, then performed a validation study to facilitate its implementation in the routine clinical evaluation of patients with LSS. METHODS The NIS-LSS is based on the combined evaluation of tendon reflexes, tactile and vibratory sensation, pareses, and the ability to walk and run; the total score ranges from 0 (inability to walk) to 33 points (no impairment). A group of 117 patients with LSS and a control group of 63 age- and sex-matched healthy volunteers were assessed with the NIS-LSS to evaluate capacity to discriminate between LSS patients and controls. A correlation with the ODI was performed for assessment of construct validity. RESULTS The median NIS-LSS was 27 points in LSS patients compared with 33 points in controls. The NIS-LSS discriminated LSS patients from healthy controls to a high degree of significance: the optimum NIS-LSS cut-off value was 32 points with a sensitivity of 85.5% and a specificity of 81.3% (p < 0.001). Overall NIS-LSS correlated significantly with the ODI score (p < 0.001). Vibratory sensation (p = 0.04), presence of paresis (p = 0.01) and especially the ability to walk and run (p < 0.001) were the NIS-LSS elements that correlated most closely with the degree of disability assessed by the ODI. CONCLUSIONS The NIS-LSS is a simple and valid measure of neurological impairment in the lower limbs of patients with LSS (without comorbidity), discriminating them from healthy controls to a high degree of sensitivity and specificity and correlating closely with the degree of disability. It extends our ability to quantify neurological status and to follow changes arising out of the natural course of the disease or the effects of treatment.
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Affiliation(s)
- B Micankova Adamova
- Department of Neurology, University Hospital and Masaryk University Brno, Jihlavska 20, 62500 Brno, Czech Republic.
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Radcliff K, Kepler C, Hilibrand A, Rihn J, Zhao W, Lurie J, Tosteson T, Vaccaro A, Albert T, Weinstein J. Epidural steroid injections are associated with less improvement in patients with lumbar spinal stenosis: a subgroup analysis of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976) 2013; 38:279-91. [PMID: 23238485 PMCID: PMC3622047 DOI: 10.1097/brs.0b013e31827ec51f] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Subgroup analysis of prospective, randomized database from the Spine Patient Outcomes Research Trial (SPORT). OBJECTIVE The hypothesis of this study was that patients who received ESI during initial treatment as part of SPORT (The Spine Patient Outcomes Research Trial) would have improved clinical outcome and a lower rate of crossover to surgery than patients who did not receive ESI. SUMMARY OF BACKGROUND DATA The use of epidural steroid injection (ESI) in patients with lumbar spinal stenosis is common, although there is little evidence in the literature to demonstrate its long-term benefit in the treatment of lumbar stenosis. METHODS Patients with lumbar spinal stenosis who received ESI within the first 3 months of enrollment in SPORT (ESI) were compared with patients who did not receive epidural injections during the first 3 months of the study (no-ESI). RESULTS There were 69 ESI patients and 207 no-ESI patients. There were no significant differences in demographic factors, baseline clinical outcome scores, or operative details between the groups, although there was a significant increase in baseline preference for nonsurgical treatment among ESI patients (ESI 62% vs. no-ESI 33%, P < 0.001). There was an average 26-minute increase in operative time and an increased length of stay by 0.9 days among the ESI patients who ultimately underwent surgical treatment. Averaged over 4 years, there was significantly less improvement in 36-Item Short Form Health Survey (SF-36) Physical Function among surgically treated ESI patients (ESI 14.8 vs. no-ESI 22.5, P = 0.025). In addition, there was significantly less improvement among the nonsurgically treated patients in SF-36 Body Pain (ESI 7.3 vs. no-ESI 16.7, P = 0.007) and SF-36 Physical Function (ESI 5.5 vs. no-ESI 15.2, P = 0.009). Of the patients assigned to the surgical treatment group, there was a significantly increased crossover to nonsurgical treatment among patients who received an ESI (ESI 33% vs. no-ESI 11%, P = 0.012). Of the patients assigned to the nonoperative treatment group, there was a significantly increased crossover to surgical treatment in the ESI patients (ESI 58% vs. no-ESI 32%, P = 0.003). CONCLUSION Despite equivalent baseline status, ESIs were associated with significantly less improvement at 4 years among all patients with spinal stenosis in SPORT. Furthermore, ESIs were associated with longer duration of surgery and longer hospital stay. There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically.
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Affiliation(s)
- Kris Radcliff
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Watanabe T, Yoneyama T, Toribatake Y, Hayashi H. Main disease classification of intermittent claudication via L1-regularized SVM. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:6409-6412. [PMID: 24111208 DOI: 10.1109/embc.2013.6611021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There are multiple diseases that cause intermittent claudication, including lumber spinal canal stenosis (LSS) and peripheral arterial disease (PAD). LSS is categorized on the basis of the diseased part: L4 and L5. The medical treatment for these groups is totally different and the differentiation is important. With this in mind, we examined walking-motion data for patients and derived several features for the differentiation in previous studies. However, these features were not specialized for classification, and there is no guarantee that the features are effective for real differentiation. The present study investigates the possibility of differentiation by gait analysis, via use of an L1-regularized support vector machine (SVM). An L1-regularized SVM can execute both classification and feature selections simultaneously. On the basis of this method, our paper presents the methodology for classifying the underlying disease of the intermittent claudication with an accuracy of 79.7%. In addition, new effective features for the differentiation are extracted.
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Lee JYB, Whang PG, Lee JY, Phillips FM, Patel AA. Lumbar spinal stenosis. Instr Course Lect 2013; 62:383-396. [PMID: 23395043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lumbar spinal stenosis affects many patients and is one of the most common reasons for spinal surgery in the elderly population. New research and surgical innovations have resulted in a better understanding of the disease and its diagnosis and treatment. To select the optimal treatment approach for each patient, it is helpful to review patient presentations, diagnostic workups, surgical and nonsurgical treatment options, evidence-based outcomes, and the pathophysiology of lumbar spinal stenosis.
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Affiliation(s)
- Joe Y B Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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