Causes of asymptomatic side limb pain after minimally invasive transforaminal lumbar interbody fusion / 中国骨伤

OBJECTIVE@#To investigate possible causes and preventive measures for asymptomatic pain in the limbs after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF).@*METHODS@#Clinical data from 50 patients with lumbar degenerative disease who underwent MIS-TLIF between January 2019 and September 2020 were retrospectively analyzed. The group included 29 males and 21 females aged from 33 to 72 years old, with an average age of (65.3±7.13) years. Twenty-two patients underwent unilateral decompression, and 28 underwent bilateral decompression. The side(ipsilateral or contralateral) and site(low back, hip, or leg) of the pain were recorded before surgery, 3 days after surgery, and 3 months after surgery. The pain degree was evaluated using the visual analogue scale(VAS) at each time point. The patients were further grouped based on whether contralateral pain occurred postoperatively (8 cases in the contralateral pain group and 42 in the no contralateral pain group), and the causes and preventive measures of pain were analyzed.@*RESULTS@#All surgeries were successful, and the patients were followed up for at least 3 months. Preoperative pain on the symptomatic side improved significantly, with the VAS score decreasing from (7.00±1.79) points preoperatively to (3.38±1.32) points at 3 days postoperatively and (3.98±1.17) points at 3 months postoperatively. Postoperative asymptomatic side pain (contralateral pain) occurred in 8 patients within 3 days after surgery, accounting for 16% (8/50) of the group. The sites of contralateral pain included the lumbar area (1 case), hip(6 cases), and leg (1 case). The contralateral pain was significantly relieved 3 months after surgery.@*CONCLUSION@#More cases of contralateral limb pain occur after unilateral decompression MIS-TLIF, and the reason may include contralateral foramen stenosis, compression of medial branches, and other factors. To reduce this complication, the following procedures are recommended: restoring intervertebral height, inserting a transverse cage, and withdrawing screws minimally.

Research progress in minimally invasive treatment of cervical nerve root canal stenosis under total endoscope / 中国修复重建外科杂志

Objective: To review the research progress of total endoscopic minimally invasive technique in treating cervical nerve root canal stenosis (CNRCS). Methods: The related literature at home and abroad was extensively reviewed. The research history, current situation, research progress, advantages and disadvantages of minimally invasive treatment of CNRCS under total endoscope were summarized. Results: In recent years, with the continuous development of minimally invasive technique of total endoscope in spine surgery, the surgical treatment methods are also constantly innovated. Compared with the traditional open surgery, minimally invasive treatment of CNRCS under total endoscope can obtain better effectiveness, keep the stability of the cervical segment to the maximum extent, reduce the impact on the activity of the cervical spine and the occurrence of related surgical complications, which is an effective minimally invasive technology. Conclusion: The minimally invasive treatment of CNRCS under total endoscope has achieved some results, which is expected to be one of the indispensable means to treat CNRCS, but it still needs to be improved.

Percutaneous Stenoscopic Lumbar Decompression with Paramedian Approach for Foraminal/Extraforaminal Lesions

The lumbar foramen is affected by different degenerative diseases, including extraforaminal disc herniation, foraminal stenosis (FS), and degenerative or spondylolytic spondylolisthesis. The purpose of this study was to describe percutaneous stenoscopic lumbar decompression with a paramedian approach (para-PSLD) for foraminal/extraforaminal lesions. All operative procedures were performed using a complete uniportal endoscopic instrument system. The para-PSLD can be easily applied to patients with FS and narrow disc space or facet joint hypertrophy. The anatomical view of a para-PSLD is similar to that of a conventional open surgery and allows for good visualization of the foraminal/extraforaminal areas. We suggest that para-PSLD is an alternative and minimally invasive procedure to treat degenerative lumbar foraminal/extraforaminal stenoses.

Effect of Limited Laminectomy Combined with Foraminal Stenosis Decompression on Preventing C5Palsy / 中国康复理论与实践

@#Objective To observe the effect of limited laminectomy combined with foraminal stenosis decompression on preventing C5nerve root palsy and improving neurological function. Methods From March,2014 to May,2016,69 patients with multi-segment cervical spondylotic myelopathy underwent surgical treatment in our hospital were included.Thirty-eight patients(group A)were treated with limited lami-nectomy combined with foraminal stenosis decompression and internal fixation,and 31 patients(group B)under-went routine laminectomy and internal fixation.The postoperative neurological recovery rate,cervical curvature index(CCI)and C5palsy rate were recorded and analyzed. Results No spinal cord and nerve injury occurred during the operation.The width of laminectomy was(16.8±2.1)mm in group A,and was significantly less than(21.7±2.5)mm in group B(t=8.849,P<0.001).There was no significant difference in operation time and intraoperative blood loss between two groups(t<0.439,P>0.05).The Japanese Orthopaedic Association (JOA) score increased continuously after surgery in both groups (F>42.996, P<0.05), and no significant difference was found between them at each time point(t<1.021,P>0.05).The cervical curva-ture index improved after surgery(F>86.379,P<0.05),and no significant difference was found between them at each time point(t<0.943,P>0.05).The spinal cord drift distance was(3.6±0.7)mm in group A,and ws signifi-cantly shorter than(2.5±0.5)mm in group B(t=7.602,P<0.001).There was no significantly difference in the neu-rological recovery rate between two groups(t=0.724,P=0.471).The C5palsy rate was lower in group A(5.2%,2/38)than in group B(22.5%,7/31)(χ2=4.514,P=0.034). Conclusion Limited laminectomy combined with foraminal stenosis decompression could relieve the spinal cord com-pression and restrict the excessive back drift, promote the neurological function recovery and reduce the inci-dence of C5palsy.

Surgical design and clinical application of posterior percutaneous full-endoscopic cervical foraminotomy for cervical osseous foraminal stenosis / 中国修复重建外科杂志

Objective: To design the method of posterior percutaneous full-endoscopic cervical foraminotomy (P-PECF) for treating cervical osseous foraminal stenosis and analyze its feasibility in clinical application. Methods: The clinical data of 12 patients with cervical osseous foraminal stenosis who met the selection criteria between October 2015 and June 2017 were retrospectively analysed. There were 7 males and 5 females with an age of 52-63 years (mean, 57.6 years). The disease duration ranged from 15 days to 6 months (mean, 3.7 months). The segments included C 4, 5 in 2 cases, C 5, 6 in 6 cases, and C 6, 7 in 4 cases; all showing root pain or numbness caused by nerve root compression. All patients were treated with the P-PECF technique. At preoperation, immediately after operation, and at last follow-up, visual analogue scale (VAS) scores and neck disability index (NDI) were respectively recorded to assess the patient's quality of life and the pain of neck and arm. The clinical outcomes were evaluated by the modified Macnab criteria. Results: All operations were successful. The operation time was 71-105 minutes (mean, 82 minutes); the intraoperative blood loss was about 5 mL. The CT of the cervical spine at 1 week postoperatively showed that the cervical root canal was enlarged and the nerve root compression was relieved. The symptoms of neck and arm pain and numbness were relieved; the hospitalization time was 2-5 days (mean, 3 days). All patients were followed up 6-18 months (mean, 12.3 months). Except for 1 patient's feeling transient hypoesthesia postoperatively, there was no complication such as hematoma, nerve root injury, or incision infection. The VAS scores and NDI at immediate postoperatively and at last follow-up were significantly improved when compared with preoperative scores ( P<0.05); and the scores also improved significantly at last follow-up when compared with the scores at immediate postoperatively ( P<0.05). According to modified Macnab criteria, the results were excellent in 9 cases, good in 2 cases, and fair in 1 case, with an excellent and good rate of 91.7%. Conclusion: The P-PECF technique can enlarge the nerve root canal and relieve nerve root compression, and obtain better effectiveness by minimally invasive methods. It is a safe and feasible procedure.

Bilateral facetectomy combined with pedicle screw fixation and interbody fusion in the treatment of bilateral lumbar foraminal stenosis in 41 cases / 重庆医学

Objective To explore the clinical efficacy in bilateral lumbar foraminal stenosis (LFS) after treatment with bilateral facetectomy combined with pedicle screw fixation and interbody fusion.Methods A total of 41 cases of patients with bilateral LFS underwent bilateral facetectomy combined with pedicle screw fixation and interbody fusion from February 2010 to August 2013 in Department of Spine Surgery,the People's Hospital of Tianjin City,were retrospectively analysed.The clinical efficacy was assessed by Oswestry disability index (ODD questionnaire and visual analogue scale (VAS) before and after operation,anterior and posterior disc height and L1-S1 angle were measured as well.Then the ODI and VAS scores,and changes in anterior and posterior disc height and L1-S1 angle were calculated at the time of the last patient follow-up visit.Results All 41 patients were followed up for 12 to 36 months,with an average of (26.2±2.4) months.Compared with preoperation,at the time of the last follow-up visit the back pain VAS score,leg pain VAS score and ODI were decreased,while the anterior and posterior disc height were increased,there were statistically significant differences (P＜0.05).No statistically significant difference was found in L1-S1 angle between preoperation and postoperation (P＞0.05).Conclusion The short-term clinical curative effect of posterior bilateral facetectomy combined with pedicle screw fixation and interbody fusion in the treatment of bilateral LFS is satisfactory.

Assessment of Clinical Symptoms in Lumbar Foraminal Stenosis Using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire

OBJECTIVE: It is important to develop an easy means of diagnosing lumbar foraminal stenosis (LFS) in a general practice setting. We investigated the use of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) to diagnose LFS in symptomatic patients. METHODS: Subjects included 13 cases (mean age, 72 years) with LFS, and 30 cases (mean age, 73 years) with lumbar spinal canal stenosis (LSCS) involving one intervertebral disc. The visual analogue scale score for low back pain and leg pain, the JOABPEQ were evaluated. RESULTS: Those with LFS had a significantly lower JOA score (p<0.001), while JOABPEQ scores (p<0.05) for lumbar dysfunction and social functioning impairment (p<0.01) were both significantly lower than the scores in LSCS. The following JOABPEQ questionnaire items (LFS vs. LSCS, p-value) for difficulties in: sleeping (53.8% vs. 16.6%, p<0.05), getting up from a chair (53.8% vs. 6.6%, p<0.001), turning over (76.9% vs. 40%, p<0.05), and putting on socks (76.9% vs. 26.6%, p<0.01) such as pain during rest, and signs of intermittent claudication more than 15 minutes (61.5% vs. 26.6%, p<0.05) were all significantly more common with LFS than LSCS. CONCLUSION: Results suggest that of the items in the JOABPEQ, if pain during rest or intermittent claudication is noted, LFS should be kept in mind as a cause during subsequent diagnosis and treatment. LFS may be easily diagnosed from LSCS using this established patient-based assessment method.

Discrimination between Lumbar Intraspinal Stenosis and Foraminal Stenosis using Diffusion Tensor Imaging Parameters: Preliminary Results

STUDY DESIGN: Retrospective observational study. PURPOSE: To examine fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values of damaged nerves to discriminate between lumbar intraspinal stenosis (IS) and foraminal stenosis (FS) using diffusion tensor imaging (DTI) OVERVIEW OF LITERATURE: It is important in the selection of surgical procedure to discriminate between lumbar IS and FS, but such discrimination is difficult. METHODS: There were 9 cases of IS, 7 cases of FS, and 5 healthy controls. The regions of interest were established in the lumbar intraspinal zone (Iz), nerve root (N), and extraforaminal zone (Ez). The FA and ADC values were measured on the affected and unaffected sides of the nerves. The FA ratio and the ADC ratio were calculated as the affected side/unaffected side ×100 (%). RESULTS: In the Ez, the FA value was significantly lower in FS than in IS (p<0.01). FA ratio was significantly lower in FS than in IS for the Ez (p<0.01). In the Iz, the ADC value was significantly higher in IS than FS (p<0.01). ADC ratio was significantly higher in FS than in IS for the N and Ez (p<0.05). For the Ez, receiver operating characteristic analysis of parameters revealed that the FA values showed a higher accuracy for the diagnosis of FS than the ADC values, and the FA value cut-off value was 0.42 (sensitivity: 85.7%, false positive: 11.1%) and the FA ratio cut-off value was 83.9% (sensitivity: 85.7%, false positive: 22.2%). CONCLUSIONS: The low FA value in the extraforaminal zone suggests the presence of foraminal stenosis. When the FA value and FA ratio cut-off value were established as 0.42 and 83.9%, respectively, the accuracy was high for the diagnosis of foraminal stenosis. It may be possible to use DTI parameters to help in the discrimination between IS and FS.

Microsurgical Foraminotomy via Wiltse Paraspinal Approach for Foraminal or Extraforaminal Stenosis at L5-S1 Level : Risk Factor Analysis for Poor Outcome

OBJECTIVE: The purpose of this study was to present the outcome of the microsurgical foraminotomy via Wiltse paraspinal approach for foraminal or extraforaminal (FEF) stenosis at L5–S1 level. We investigated risk factors associated with poor outcome of microsurgical foraminotomy at L5–S1 level. METHODS: We analyzed 21 patients who underwent the microsurgical foraminotomy for FEF stenosis at L5–S1 level. To investigate risk factors associated with poor outcome, patients were classified into two groups (success and failure in foraminotomy). Clinical outcomes were assessed by the visual analogue scale (VAS) scores of back and leg pain and Oswestry disability index (ODI). Radiographic parameters including existence of spondylolisthesis, existence and degree of coronal wedging, disc height, foramen height, segmental lordotic angle (SLA) on neutral and dynamic view, segmental range of motion, and global lumbar lordotic angle were investigated. RESULTS: Postoperative VAS score and ODI improved after foraminotomy. However, there were 7 patients (33%) who had persistent or recurrent leg pain. SLA on neutral and extension radiographic films were significantly associated with the failure in foraminotomy (p17.3°) and extension radiographic films (>24°).

Enlargement of Neural Foramina and Dynamic Stabilization in Spondylolisthesis without Restoring the Alignment: Technical Note

It is well known that the cause of radiculopathy is the compression of the nerve root within the foramina which is narrowed secondary to sliding of the corpus and reduced disc height. In some patients, unroofing the foramen does not resolve this problem. We described a new decompression technique using pedicle removal and transpedicular dynamic instrumentation to stabilization the spine. We performed this operation in 2 patients and achieved very good results.

Radiofrecuencia pulsada del ganglio de la raiz dorsal cervical: presentacion de un caso clinico

El tratamiento estándar del dolor radicular cervical, que acompaña a la patología discal o la estenosis neuroforaminal, se realiza con un enfoque multidisciplinario, que incluye medicación efectiva para el dolor neuropático, fisioterapia y la inyección epidural de esteroides. Cuando el dolor es refractario a este tipo de abordaje, la cirugía se propone como opción terapéutica. La radiofrecuencia pulsada del ganglio de la raíz dorsal de las raíces afectadas es una alternativa válida para tratar el dolor radicular cervical refractario. Se presenta un caso clínico de dolor radicular cervical por estenosis neuroforaminal, donde se utilizó la radiofrecuencia pulsada del ganglio de la raíz dorsal con buenos resultados, evaluados mediante la versión en español del Brief Pain Inventory

Standard treatment of cervical radicular pain due to cervical disc disease or neuroforaminal stenosis is performed utilizing a multidisciplinary approach, including neurophatic pain killers, physical therapy and epidural steroid injections. When cervical radicular pain is refractory to this treatment approach, spine surgery is often proposed. Pulsed radiofrequency of the cervical dorsal root ganglion is a valid alternative treatment to refractory cervical radicular pain. A clinical case is reported, where pulsed radiofrequency of the dorsal root ganglion was used with good results, utilizing the spanish version of the Brief Pain Inventory as an outcome evaluation tool

A New MRI Grading System for Cervical Foraminal Stenosis Based on Axial T2-Weighted Images

OBJECTIVE: The purpose of this study was to evaluate the reliability of a new magnetic resonance imaging (MRI) grading system for cervical neural foraminal stenosis (NFS). MATERIALS AND METHODS: Cervical NFS at bilateral C4/5, C5/6, and C6/7 was classified into the following three grades based on the T2-weighted axial images: Grade 0 = absence of NFS, with the narrowest width of the neural foramen greater than the width of the extraforaminal nerve root (EFNR); Grade 1 = the narrowest width of the neural foramen the same or less than (but more than 50% of) the width of the EFNR; Grade 2 = the width of the neural foramen the same or less than 50% of the width of the EFNR. The MRIs of 96 patients who were over 60 years old (M:F = 50:46; mean age 68.4 years; range 61-86 years) were independently analyzed by seven radiologists. Interobserver and intraobserver agreements were analyzed using the percentage agreement, kappa statistics, and intraclass correlation coefficient (ICC). RESULTS: For the distinction among the three individual grades at all six neural foramina, the ICC ranged from 0.68 to 0.73, indicating fair to good reproducibility. The percentage agreement ranged from 60.2% to 70.6%, and the kappa values (κ = 0.50-0.58) indicated fair to moderate agreement. The percentages of intraobserver agreement ranged from 85.4% to 93.8% (κ = 0.80-0.92), indicating near perfect agreement. CONCLUSION: The new MRI grading system shows sufficient interobserver and intraobserver agreement to reliably assess cervical NFS.

Effectiveness of Selective Nerve Root Block for the Patient with a Single Level Lumbar Spinal Stenosis who is on the Operation Schedule

STUDY DESIGN: Retrospective study. OBJECTIVES: We reported the therapeutic usefulness of a selective nerve root block (SNRB) for patients with a single level spinal stenosis. SUMMARY OF LITERATURE REVIEW: Selective nerve root block for the radiculopathy due to lumbar disc herniation, spinal stenosis, and spondylolisthesis have been reported frequently. MATERIALS AND METHODS: We retrospectively examined 44 patients with single-level spinal stenosis, for whom surgical treatment was considered due to the failure of other conservative treatments from January 2005 to January 2010. All 44 patients were admitted for surgical decompression. Selective nerve root block was done just before a final decision of surgical procedure; patients with his or her 50% or more pain reduction could avoid surgery. RESULTS: In fourty-four cases, twenty-seven pateints underwent a surgical operation. Seventeen patients avoided surgical procedures by successful SNRB. As a result of a 3 year follow-up, the VAS score was significantly and continuously low on the operation group (p=0.02~0.03). K-ODI and Roland-Morris Disability scores were low in both groups until 1 year after the operation and SNRB procedure (p=0.026~0.042, p=0.03), but there was no statistically significant difference beteween the two groups after 2 years upon follow-up (p=0.072~0.14, p=0.06). Generally, the operation group had good results until 1 year after operation and had better tendency for improvement. The data displayed a high probability of surgical treatment among the patients with foraminal stenosis (p=0.039) highlight - this sentence says there is no difference after 1 year and there is still no difference after 2 years. If this is true, the sentence needs to be rewritten so that it says both times show no difference. If there is a difference between 1 year and 2 year then the sentence needs to be rewritten to make this more clear. The next sentence seems to say they are different. CONCLUSIONS: Selective nerve root block avoided the surgical intervention in 39% of the patients with the spinal stenosis refractory to the conservative treatment. Thus it is one of options for the refractory spinal stenosis.

Posterior Decompression and Fusion in Patients with Multilevel Lumbar Foraminal Stenosis: A Comparison of Segmental Decompression and Wide Decompression

STUDY DESIGN: This is a prospective study. PURPOSE: We compared the outcomes of segmental decompression and wide decompression in patients who had multilevel lumbar foraminal stenosis with back pain. OVERVIEW OF LITERATURE: Wide decompression and fusion in patients with multilevel lumbar foraminal stenosis may increase the risk of perioperative complications. METHODS: From March 2005 to December 2007, this study prospectively examined 87 patients with multilevel lumbar foraminal stenosis and who were treated by segmental or wide decompression along with posterior fusion using pedicle screw fixation, and these patients could be followed-up for a minimum of 2 years. Of the 87 patients, 45 and 42 patients were assigned to the segmental decompression group (group 1) and the wide decompression group (group 2), respectively. We compared the clinical and radiological outcomes of the patients in these two groups. RESULTS: There were no significant differences between groups 1 and 2 in terms of the levels of postoperative pain based on the visual analogue scale, the Oswestry Disability Score, the clinical results based on the Kirkaldy-Willis Criteria, the complication rate or the posterior fusion rate. On the other hand, the mean operating times in groups 1 and 2 were 153 +/- 32 minutes and 187 +/- 36 minutes, respectively (p < 0.05). The amount of blood loss during surgery and on the first postoperative day was 840 +/- 236 ml and 1,040 +/- 301 ml in groups 1 and 2, respectively (p < 0.05). CONCLUSIONS: These results suggest that segmental decompression offers promising and reproducible clinical and radiological results for patients suffering from multilevel lumbar foraminal stenosis.

Clinical and Radiological Outcomes of Unilateral Facetectomy and Interbody Fusion Using Expandable Cages for Lumbosacral Foraminal Stenosis

OBJECTIVE: Surgical treatment of lumbosacral foraminal stenosis requires an understanding of the anatomy of the lumbosacral area in individual patients. Unilateral facetectomy has been used to completely decompress entrapment of the L5 nerve root, followed in some patients by posterior lumbar interbody fusion (PLIF) with stand-alone cages. METHODS: We assessed 34 patients with lumbosacral foraminal stenosis who were treated with unilateral facetectomy and PLIF using stand-alone cages in our center from January 2004 to September 2007. All the patients underwent follow-up X-rays, including a dynamic view, at 3, 6, 12, 24 months, and computed tomography (CT) at 24 months postoperatively. Clinical outcomes were analyzed with the mean numeric rating scale (NRS), Oswestry Disability Index (ODI) and Odom's criteria. Radiological outcomes were assessed with change of disc height, defined as the average of anterior, middle, and posterior height in plain X-rays. In addition, lumbosacral fusion was also assessed with dynamic X-ray and CT. RESULTS: Mean NRS score, which was 9.29 prior to surgery, was 1.5 at 18 months after surgery. The decrease in NRS was statistically significant. Excellent and good groups with regard to Odom's criteria were 31 cases (91%) and three cases (9%) were fair. Pre-operative mean ODI of 28.4 decreased to 14.2 at post-operative 24 months. In 30 patients, a bone bridge on CT scan was identified. The change in disc height was 8.11 mm, 10.02 mm and 9.63 mm preoperatively, immediate postoperatively and at 24 months after surgery, respectively. CONCLUSION: In the treatment of lumbosacral foraminal stenosis, unilateral facetectomy and interbody fusion using expandable stand-alone cages may be considered as one treatment option to maintain post-operative alignment and to obtain satisfactory clinical outcomes.

Anterior Lumbar Interbody Fusion with Stand-Alone Interbody Cage in Treatment of Lumbar Intervertebral Foraminal Stenosis : Comparative Study of Two Different Types of Cages

OBJECTIVE: This retrospective study was performed to evaluate the clinical and radiological results of anterior lumbar interbody fusion (ALIF) using two different stand-alone cages in the treatment of lumbar intervertebral foraminal stenosis (IFS). METHODS: A total of 28 patients who underwent ALIF at L5-S1 using stand-alone cage were studied [Stabilis(R) (Stryker, Kalamazoo, MI, USA); 13, SynFix-LR(R) (Synthes Bettlach, Switzerland); 15]. Mean follow-up period was 27.3 +/- 4.9 months. Visual analogue pain scale (VAS) and Oswestry disability index (ODI) were assessed. Radiologically, the change of disc height, intervertebral foraminal (IVF) height and width at the operated segment were measured, and fusion status was defined. RESULTS: Final mean VAS (back and leg) and ODI scores were significantly decreased from preoperative values (5.6 +/- 2.3 --> 2.3 +/- 2.2, 6.3 +/- 3.2 --> 1.6 +/- 1.6, and 53.7 +/- 18.6 --> 28.3 +/- 13.1, respectively), which were not different between the two devices groups. In Stabilis(R) group, postoperative immediately increased disc and IVF heights (10.09 +/- 4.15 mm --> 14.99 +/- 1.73 mm, 13.00 +/- 2.44 mm --> 16.28 +/- 2.23 mm, respectively) were gradually decreased, and finally returned to preoperative value (11.29 +/- 1.67 mm, 13.59 +/- 2.01 mm, respectively). In SynFix-LR(R) group, immediately increased disc and IVF heights (9.60 +/- 2.82 mm --> 15.61 +/- 0.62 mm, 14.01 +/- 2.53 mm --> 21.27 +/- 1.93 mm, respectively) were maintained until the last follow up (13.72 +/- 1.21 mm, 17.87 +/- 2.02 mm, respectively). The changes of IVF width of each group was minimal pre- and postoperatively. Solid arthrodesis was observed in 11 patients in Stabilis group (11/13, 84.6%) and 13 in SynFix-LR(R) group (13/15, 86.7%). CONCLUSION: ALIF using stand-alone cage could assure good clinical results in the treatment of symptomatic lumbar IFS in the mid-term follow up. A degree of subsidence at the operated segment was different depending on the device type, which was higher in Stabilis(R) group.

Efficacy of Microdecompression with Microscope and Tubular Retractor in Lumbar Foraminal Stenosis: Surgical Technique and Clinical Outcomes

OBJECTIVE: The objective of this study is to evaluate the efficacy of microdecompression (MD) with microscope and tubular retractor in lumbar foraminal stenosis (FS) and to analyze the clinical outcomes. METHODS: From January 2006 to December 2007, 22 patients with symptomatic lumbar FS underwent conventional decompressive surgery (CDS) and MD was performed in other 20 patients. Clinical outcome was measured using a Visual Analogue Scale (VAS) and Macnab?fs criteria. Spinal instability was determined by radiologic assessment of flexion-extension radiographs. RESULTS: The CDS group included 14 men and 8 women. The MD group included 14 men and 6 women. The mean age was 66.2 years (range, 46-80 yrs) in the CDS group and 65.4 years (range, 59-74 yrs) in the MD group. Average follow-up periods were 18.6 months in the CDS group and 16.5 months in the MD group. Mean operating time was 126 minutes in the CDS group and 168 minutes in the MD group. The mean VAS of back pain decreased from 2.68 to 1.36 in the CDS group and from 2.85 to 1.25 in the MD group. The mean VAS score of leg pain decrea- sed from 6.68 to 1.48 in the CDS group and from 6.65 to 1.40 in the MD group. The success rate of CDS group was 86.3 % (19/22), compared with 85.0% (17/20) for MD group. Radiologically, there was no spinal instability. CONCLUSION:MD could achieve neural decompression and offer an effective treatment of lumbar FS. However it was a technically demanding procedure and effective in limited operative indications. We need to consider long-term follow-up.

Transforaminal Selective Nerve Root Blocks for Treating Single Lumbosacral Radiculopathy: The Short-term Outcome and Efficiency / 대한정형외과학회잡지

PURPOSE: We wanted to determine the clinic usefulness of selective nerve root block for treating lumbosacral radiculopathy that's due to a herniated nucleus pulposus (HNP) or foraminal stenosis (FS) by analyzing the short-term results after the selective nerve root block (SNRB) procedure. MATERIALS AND METHODS: Sixty-five patients were investigated in our research. Sixty-five patients were divided into two groups: thirty-seven patients of group one were the HNP patients and twenty-eight patients of group two were the FS patients. The effect of SNRB treatment was assessed by the degree of radiating pain in lower legs with using the visual analogue scale (VAS) and patients' subjective satisfaction. The average overall follow-up period was eleven months: that of the first group was 13.5 months and that of the group was 7.6 months. RESULTS: For the 65 patients, the average VAS was 7.8 before a SNRB procedure and this decreased to 2.9 and 3.4 after one to three SNRB procedures, respectively. For group one, the VAS was 7.4 before the procedure and it decreased to 3.3 at one month and 3.7 at three months after the procedure. For group two, the VAS was 8.3 before the SNRB procedure and this favorably changed to 2.3 at one month and 3.0 at three months after the procedure. An operation was carried out due to no response for 8 patients (12%) and due to aggravation for 4 patients (6%) after the SNRB procedures. Three patients (8%) of group one and two patients (11%) of group two obtained pain relief at one month and aggravation at three months, respectively. On comparing the two groups, a better treatment effect was observed for the FS group after one month (p=0.002) and three months (p=0.01). Complications related to the SNRB procedure haaves not been observed in both groups. CONCLUSION: The SNRB procedure is a very effective and safe procedure, after the appearance of symptoms, as a non-operative treatment for single lumbosacral radiculopathy due to a herniated nucleus pulposus or foraminal stenosis. This treatment appears to be more effective for the FS group than for the HNP group and it should be considered before carrying out an operative treatment.

Unilateral Augmented Pedicle Screw Fixation for Foraminal Stenosis

OBJECTIVE: The purpose of this study is to evaluate the effectiveness of unilateral decompression and pedicle screw fixation for the unilateral symptomatic foraminal stenosis. METHODS: The study group comprises consecutive 16 patients who underwent unilateral decompression and bone cement augmented pedicle screw fixation from May 2003 to January 2006. The patients were evaluated by visual analog scale (VAS) for pain and the scoring system of the Japanese Orthopedic Association (JOA) for low back pain. The result of surgery was also evaluated with McNab's classification. Excellent or good outcome was considered as successful. The patients were followed at postoperative 1 month, 3 month, 6 month, and 1 year with standing AP and lateral films. RESULTS: The average VAS and JOA score of the 16 patients were 7.8 (range, 6-9) and 5.8 (range, 3 - 10) before surgery and 2.2 (range, 0 - 5) and 12.3 (range, 9 - 15) at the time of last follow up. Both VAS and JOA score improved significantly after the surgery (p < 0.05, t-test). All patients improved after the operation and no revision surgery was required. No metal failure or pseudoarthrosis was observed during the follow-up. The success rate was 87.5%. CONCLUSION: Our data suggest that unilateral decompression and pedicle screw fixation for the unilateral symptomatic foraminal stenosis is an effect method for obtaining satisfactory clinical outcome. Its possible advantage is shorter operation time and reduced surgical extent. We believe that the reduced stiffness of unilateral fixation was compensated by pedicle screw augmentation and interbody fusion.

The Diagnostic Value of Parasagittal Reconstruction CT for the Lumbar Intervertebral Foraminal Stenosis / 实用放射学杂志

Objective To discuss the diagnostic value of parasagittal reconstruction CT for the lumbar intervertebral foraminal stenosis.Methods From Jan.2003 to Apr.2004,15 suspected cases with lumbar intervertebral foraminal stenosis based on the routine clinical and radiologic examinations were diagnosed by means of the CT parasagittal reconstruction and operated on .Results All showed L_(4~5) or L_5~S_1 foraminal stenosis,2 cases far lateral disc protruded,8 cases the vertebral endplate posteriolateral spurs extruded into foramina,1 spondylolisthesis pseudoarthrosis pressed,4 cases had the narrow intervertebral space along with the flavum ligament hypertrophy and facet superioanterio subluxation. 7 cases showed horizontal stenosis and 8 cases showed vertical stenosis.6 cases wereⅡ?,9 cases were Ⅲ?. Conclusion The parasagittal reconstruction CT for the lumbar foraminal stenosis can compensate for the drawbacks of the routine axial CT, show more clearly and vividly and guide the operations more accurately.