MRI is the modality of choice for evaluation of spinal lesions

Introduction: Spine is a longitudinal structure, and precise location of the level of a lesion from clinical examination can be difficult. MRI of spine shows the anatomy of the vertebrae that makes up the spine, as well as the discs, spinal cord and the intervertebral foramina through which the nerves pass. It also allows us to differentiate between healthy tissue and diseased tissue. Materials and methods: This study aimed at diagnosing and following up cases of spinal lesions in the department of Radio diagnosis of SBKS Medical Institute and Research Centre and Dhiraj General Hospital. The study is performed using conventional X-rays and MRI. Results: Maximum numbers of patients were between 41–50 years age group followed by 21-30 and 31-40 years of age group, whereas patients of paediatric (00-10 years) and geriatric (>70 years) age group constituted only 8% patients. Average age of patients was 42.5 years. Lumbar spine was the most commonly affected spine region. Maximum numbers of patients were of degenerative and disc lesions (49%). Conclusion: MRI by virtue of non-invasiveness, lack of radiation hazard and by ability to demonstrate structural changes is investigation of choice for spine and spinal cord pathologies. The ability to image the cord directly rather than indirectly as in myelography, the absence of bone artifact as in computed tomography, and the multiplanar capabilities indicate that MRI is the procedure of choice in the examination of the spinal cord.

Expression of inflammatory factors are increased by sorbitol in lumbar spinal stenosis of diabetic patients / 基础医学与临床

Objective To investigate the related mechanism of ligamentum flavum (LF) hypertrophy in diabetic pa-tients with lumbar spinal canal stenosis ( LSCS ) .Methods Twenty-four diabetes mellitus patients [ DM (+) ] and twenty normoglycemic patients [ DM (-) ] with LSCS were enrolled in this study .Sorbitol in LF was analyzed using D-Sorbitol/Xylitol test kit .The thickness of LF was measured by CT .The structure of LF was observed after HE and Masson's trichrome staining .The cell cycle and proliferation of fibroblastic cell NIH 3T3 line cultured in high glucose were analyzed .Sorbitol of NIH3T3 was detected under different backgrounds in vitro, normal glucose , high glucose and high glucose burdened with aldose reductase inhibitor ( ARI) , Epalrestat .The expression of inflammatory factors was detected by qPCR and Western blot under above different backgrounds .Results LF of diabetic patients exhibi-ted significantly higher level of sorbitol and pro-inflammatory cytokines , TGF-βand of CD68-positive staining than that of the normoglycemic subjects ( P<0.01 ) .The diabetic LF was significantly thicker than that of the controls , and showed evidence of degeneration .The high glucose-cultured fibroblasts exhibited significantly higher levels of sorbitol , pro-inflammatory factors , and TGF-βcompared to the low glucose-cultured cells , and these levels were dose-dependently reduced by treatment with the aldose reductase inhibitor (P<0.05).Conclusions Sorbitol level of the LF is significantly increased in the DM patients with LSCS .Increased sorbitol recruites inflammatory factors and fibrogenic-related factor TGF-βin LF of DM patients with LSCS which may contributes to the LF hypertrophy .

Prophylactic surgery is invalid intreatment of spinal injury without fracture and dislocationcomplicated by cervical spinal canal stenosis / 实用医学杂志

Objective In this study,we aim to evaluate the risk and incidence of traumatic cervical spinal cord injury (CSCI) in patients with traumatic cervical spinal canal stenosis (CSCS) without major fracture or dislocation,and evaluate the feasibility of preventive decompression surgery. Methods This study included eighty?seven patients with traumatic CSCI without major fracture or dislocation treated in our department between 2005 and 2012. Mann?Whitney U test was used for statistical analyses. Analysis of variance (ANOVA) was used to calculate the relative and absolute risks for the incidence of traumatic CSCI without major fracture or dislocation related with CSCS. Results The relative risk for the incidence of traumatic CSCI with CSCS was 145.7 times higher than that for the incidence without CSCS. However ,only 0.000026% of patients with CSCS may be able to avoid developing traumatic CSCI if they underwent decompression surgery before trauma. Conclusions Prophylactic surgical management for CSCS might not significantly affect the incidence of traumatic CSCI.

Nonoperative versus operative treatment of patients with degenerative spondylolisthesis / Tratamento conservador versus cirúrgico de pacientes com espondilolistese degenerativa / Tratamiento conservador contra quirúrgico de pacientes con espondilolistesis degenerativa

ABSTRACT Objective: To evaluate clinical and functional results of patients with lumbar degenerative spondylolisthesis treated with operatively or nonoperatively. Methods: Patients with degenerative spondylolisthesis treated either nonoperatively or operatively from 2004 to 2014 were selected from databases and a cross-sectional evaluation was performed. Outcome measures included back and leg visual analogue scales (VAS), Fischgrund criteria, Short Form-36 (SF-36) function score, and the modified Oswestry Disability Index (ODI). Results: 43 patients were evaluated: 20 with nonoperative treatment and 23 with operative treatment. Baseline characteristics were similar without significant differences between groups. Mean follow-up time was 43 months (range 10 - 72) for the nonoperative group and 36 months (range 6-80) for the operative group. Significant statistical difference in favor of operative group were found in back VAS (mean 4 versus 8, p = 0.000), leg VAS (mean 3 versus 6, p = 0.0015), SF-36 function score (mean 77 versus 35, p = 0.000), and ODI (mean 17 versus 46, p = 0.000). On the basis of the Fischgrund criteria, only 10 % of patients reported excellent or good health post nonoperative treatment versus 83% for those treated operatively (p = 0.000). Conclusion: In this cross-sectional study, we observed that symptomatic patients with degenerative spondylolisthesis who underwent operative treatment have superior clinical and functional scores compared to those that underwent nonoperative treatment.

RESUMO Objetivo: Avaliar os resultados clínicos e funcionais dos pacientes com espondilolistese degenerativa lombar tratados de maneira conservadora ou cirúrgica. Métodos: Foram selecionados pacientes com espondilolistese degenerativa tratados conservadoramente ou submetidos à cirurgia, durante 2004-2014, à partir da coleta de dados que possibilitou a realização da avaliação transversal. As medidas de avaliação da dor lombar e das pernas foram escalas analógicas visuais (VAS), critérios Fischgrund, Short Form-36 (SF-36) pontuação funcional, e o Índice de Incapacidade Oswestry modificado (ODI). Resultados: 43 pacientes foram avaliados: 20 do tratamento conservador e 23 do tratamento cirúrgico. As características de base foram similares, sem diferenças significativas entre os grupos. O tempo médio de acompanhamento foi de 43 meses (intervalo 10-72) para o grupo não-cirúrgico e 36 meses (intervalo 6-80) para o grupo cirúrgico. Diferenças estatísticas significativas em favor do grupo cirúrgico foram encontrados no VAS lombar (média de 4 versus 8, p = 0,000), VAS pernas (média 3 contra 6, p = 0,0015), SF-36 pontuação funcional (média 77 versus 35, p = 0,000), e ODI (média 17 versus 46, p = 0,000). Com base nos critérios Fischgrund, apenas 10% dos pacientes relataram excelente ou boa saúde de após o tratamento conservador contra 83% para aqueles tratados no cirúrgico (p = 0,000). Conclusão: Neste estudo transversal, observou-se que os pacientes sintomáticos com espondilolistese degenerativa que se submeteram ao tratamento cirúrgico têm escores clínicos e funcionais superiores em comparação àqueles que foram submetidos a tratamento conservador.

RESUMEN Objetivo: Evaluar los resultados clínicos y funcionales de los pacientes con espondilolistesis degenerativa lumbar tratados quirúrgicamente o sin cirugía. Métodos: Se realizó una evaluación transversal de los pacientes con espondilolistesis degenerativa, registrados en la base de datos, tratados conservador o quirúrgicamente desde 2004 hasta 2014. Las medidas de desenlace incluyeron: Escala Visual Análoga (EVA) de dolor lumbar y las piernas, criterios de Fischgrund, Short Form-36 (SF-36) e Índice de Discapacidad Oswestry modificado (IDO). Resultados: Se evaluaron 43 pacientes: 20 con tratamiento no quirúrgico y 23 con tratamiento quirúrgico. Las características de base fueron similares, sin diferencias significativas entre los grupos. El tiempo medio de seguimiento fue de 43 meses (rango 10-72) para el grupo no quirúrgico y 36 meses (rango 6-80) para el grupo quirúrgico. Diferencias estadísticamente significativas a favor del grupo quirúrgico fueron encontrados en EVA lumbar (media 4 contra 8, p=0,000), EVA pierna (media 3 contra 6, p=0,0015), SF-36 función (media 77 contra 35, p=0,000), e IDO (media 17 contra 46, p=0,000). Con respecto a los criterios de Fischgrund, sólo el 10% de los pacientes del grupo que recibió tratamiento no quirúrgico informo excelente o buen estado de salud en comparación con 83% de los que recibieron manejo quirúrgico (p = 0,000) Conclusión: En este estudio de corte transversal, se observó que los pacientes sintomáticos con espondilolistesis degenerativa que se sometieron a tratamiento quirúrgico tienen puntuaciones clínicas y funcionales superiores en comparación con los que se sometieron a tratamiento no quirúrgico.

Analysis of the Relationship between Hypertrophy of the Ligamentum Flavum and Lumbar Segmental Motion with Aging Process

STUDY DESIGN: Retrospective cross-sectional study. PURPOSE: To investigate the relationship between ligamentum flavum (LF) hypertrophy and lumbar segmental motion. OVERVIEW OF LITERATURE: The pathogenesis of LF thickening is unclear and whether the thickening results from tissue hypertrophy or buckling remains controversial. METHODS: 296 consecutive patients underwent assessment of the lumbar spine by radiographic and magnetic resonance imaging (MRI). Of these patients, 39 with normal L4-L5 disc height were selected to exclude LF buckling as one component of LF hypertrophy. The study group included 27 men and 12 women, with an average age of 61.2 years (range, 23-81 years). Disc degeneration and LF thickness were quantified on MRI. Lumbar segmental spine instability and presence of a vacuum phenomenon were identified on radiographic images. RESULTS: The distribution of disc degeneration and LF thickness included grade II degeneration in 4 patients, with a mean LF thickness of 2.43±0.20 mm; grade III in 10 patients, 3.01±0.41 mm; and grade IV in 25 patients, 4.16±1.12 mm. LF thickness significantly increased with grade of disc degeneration and was significantly correlated with age (r=0.55, p<0.01). Logistic regression analysis identified predictive effects of segmental angulation (odds ratio [OR]=1.55, p=0.014) and age (OR=1.16, p=0.008). CONCLUSIONS: Age-related increases in disc degeneration, combined with continuous lumbar segmental flexion-extension motion, leads to the development of LF hypertrophy.

Clinical Influence of Cervical Spinal Canal Stenosis on Neurological Outcome after Traumatic Cervical Spinal Cord Injury without Major Fracture or Dislocation

STUDY DESIGN: Retrospective case series. PURPOSE: To clarify the influence of cervical spinal canal stenosis (CSCS) on neurological functional recovery after traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation. OVERVIEW OF LITERATURE: The biomechanical etiology of traumatic CSCI remains under discussion and its relationship with CSCS is one of the most controversial issues in the clinical management of traumatic CSCI. METHODS: To obtain a relatively uniform background, patients non-surgically treated for an acute C3-4 level CSCI without major fracture or dislocation were selected. We analyzed 58 subjects with traumatic CSCI using T2-weighted mid-sagittal magnetic resonance imaging. The sagittal diameter of the cerebrospinal fluid (CSF) column, degree of canal stenosis, and neurologic outcomes in motor function, including improvement rate, were assessed. RESULTS: There were no significant relationships between sagittal diameter of the CSF column at the C3-4 segment and their American Spinal Injury Association motor scores at both admission and discharge. Moreover, no significant relationships were observed between the sagittal diameter of the CSF column at the C3-4 segment and their neurological recovery during the following period. CONCLUSIONS: No relationships between pre-existing CSCS and neurological outcomes were evident after traumatic CSCI. These results suggest that decompression surgery might not be recommended for traumatic CSCI without major fracture or dislocation despite pre-existing CSCS.

MRI study of relationship between secondary spinal canal stenosis and subacute combined degeneration / 实用放射学杂志

Objective To investigate MRI characteristics of subacute combined degeneration(SCD)with secondary spinal canal stenosis.Methods The clinical and MRI imaging data of 56 patients with SCD were collected to analyze the performance characteristics between spinal cord lesions and spinal canal stenosis,which depended on the synergism of lumbar disc bluge or herniation,degenerative thickening of the ligament flavum and posterior longitudinal ligament.Results Among 56 SCD cases underwent MRI scan,45 cases were combined with spinal cord lesions which showed typical signs of SCD.37 patients were secondary spinal canal stenosis with typical signs,but 2 showed no typical signs.8 patients were no secondary spinal canal stenosis and showed typical.9 cases showed neither spinal cord lesions nor secondary spinal canal stenosis.There was significant difference (P <0.05)between relative secondary spinal canal stenosis and spinal anomaly signal.The course of 1 5 cases were shortened after treated by physical in 37 cases of SCD with secondary spinal canal. Conclusion The secondary spinal canal stenosis can cause microcirculation dysfunction of the spinal cord,which is a key factor contributing to the imaging manifestation.

Thickness of the Ligamentum Flavum: Correlation with Age and Its Asymmetry-An Magnetic Resonance Imaging Study

STUDY DESIGN: A retrospective radiological study of the ligamentum flavum (LF). PURPOSE: This study is an attempt to measure and compare the thickening of the LF on both the sides with the use of magnetic resonance imaging, to investigate if there is a predominant tendency to thicken a specific side and also to determine if a correlation between the thickening of the LF and increasing age exists. OVERVIEW OF LITERATURE: Even though many studies measured the thickness of the LF, very few have compared it on each side, or determined its correlation with age. METHODS: The thickness of LF was measured at the L3-4, L4-5, L5-S1 levels on both sides using the magnetic resonance images of 200 patients (n=1,200). The sample population was divided into three groups: 21-40 years, 41-60 years, and 61-80 years. The data was analyzed statistically, comparing the thickness of LF on both sides and in various age-groups. RESULTS: The thickness of the LF was found to increase with age; however, there were several younger instances with thicknesses >4 mm. The mean thickness of the right LF at different spinal levels was measured (L3-L4=3.38+/-0.94 mm, L4-L5=3.70+/-1.16 mm, and L5-S1=3.65+/-1.16 mm) while the mean thickness of the left LF was higher (L3-L4=3.52+/-0.99 mm, L4-L5=3.84+/-1.12 mm, and L5-S1=3.78+/-1.24 mm). CONCLUSIONS: The LF thickness does not appear to have any side dominance; however, it tends to thicken with increasing age.

Lumbar Spinal Canal Stenosis Classification Criteria: A New Tool

STUDY DESIGN: Case-control study. PURPOSE: To design a new tool for classifying lumbar spinal canal stenosis (CLSCS). OVERVIEW OF LITERATURE: Grading of patients with lumbar spinal canal stenosis (LSCS) is controversial. METHODS: The Oswestry disability index (ODI) and the neurogenic claudication outcome score (NCOS) were recorded. Four parameters, which indicate the severity of LSCS disease, including Hufschmidt-grade, grading of magnetic resonance imaging, self-paced walking test, and stenosis ratio (SR) were employed. For the SR, quartile analysis was applied for classifying LSCS and the Hufschmidt-grade was modified into a 4-grade score. An initial score was assigned to each metric based on the severity of LSCS. Using the inverse-variance weighting method, the relative weights of these domains and their categories were determined. The score for all of the cases was obtained based on their weight by summing up the points of the four variables. Quartile analysis was used and a CLSCS score was proposed. Finally, intra- and interobserver reliability, and validity were assessed. RESULTS: A total of 357 patients were studied. The final CLSCS score for each case ranged from 4 to 16.5. Based on the quartile analysis, using the new criteria set, the CLSCS score was divided into four categories: CLSCS<7 (grade 0); 7< or =CLSCS<10 (grade 1); 10< or =CLSCS<13 (grade 2); and 13< or =CLSCS< or =16.5 (grade 3). The kappa values of for the CLSCS score indicated a perfect agreement. The CLSCS was correlated with the ODI and NCOS. All patients with grade 3 CLSCS were observed in the surgical group. CONCLUSIONS: The CLSCS score can be helpful for classifying LSCS patients and in the decision-making process.

Correlation between Expression of Inducible Nitric Oxide Synthase and Neural Cell Apoptosis after Chronic Compression of Cauda Equina Nerve in Rats / 中国医科大学学报

Objective To study the relationship between the expression of inducible nitric oxide synthase(iNOS)and neural cell apoptosis after chronic cauda equina compression. Methods Totally 30 male adult SD rats were randomly divided into 2 groups as the control group and the experi?mental group. The control group received sham operation with single laminectomy of L5 lumina. In the experimental group,the silicon sheet was in?serted into the spinal canal of L4 to cause single level compression of cauda equina. The L4 level of spinal cords were harvested at 2 weeks,4 weeks,8 weeks,and 12 weeks after operation in the experimental group,and at 4 weeks in the control group respectively,and then immunohistochemistry and image analysis were performed to observe the expression of iNOS in spinal cord and the TUNEL method was applied to observe cell apoptosis. The morphology of cells was observed by transmission electron microscope. Results There was few amount of iNOS expressed in the control group. The expression of iNOS was slight at 4 weeks in the experimental group and was higher at 8 weeks and 12 weeks compared with the control group. Small amount of neural cell apoptosis was evidenced in the control group,while neuron apoptosis appeared remarkably in the experimental group since 4 weeks and increased with the extension of time. Transmission electron microscopy found apoptosis changes in neurons in the experimental group. Conclusion The expression of iNOS increases in corresponding spinal cords after chronic compression of cuada equine and neural cell apoptosis oc?curs,indicating that iNOS is positively correlated with neural cell apoptosis.

Nocturnal Cramps in Patients with Lumbar Spinal Canal Stenosis Treated Conservatively: A Prospective Study

STUDY DESIGN: Prospective cohort study with questionnaire. PURPOSE: To compare the treatment outcome of nocturnal leg cramps in lumbar spinal canal stenosis (LSCS) patients on conservative treatment with historical surgical cohorts and to determine the sensitivity and specificity as well as positive predictive value and negative predictive value of knee flexion test suggested for LSCS patient. OVERVIEW OF LITERATURE: True prevalence of nocturnal leg cramps in LSCS patients as well as the clinical outcome of its surgical treatment have been reported. METHODS: A questionnaire suggested from previous study with minor modifications was used in this study. Clinical data was collected. Knee flexion test was performed in two groups. RESULTS: The prevalence of nocturnal leg cramp was higher in the LSCS group compared to the control group (second group). In LSCS patients, 38 (88%) had improved leg cramps after the conservative treatment, 3 (6.97%) remained unchanged, and 2 (4.6%) had worsened leg cramps. Of the 43 patients, 21 (48.8%) had no disturbance to their activities of daily living. In the LSCS group, the sensitivity and specificity of the knee flexion test was 53.5% and 33.3%, respectively. The knee flexion test in the LSCS group had a positive predictive value and a negative predictive value of 65.71% and 23.1%, respectively. CONCLUSIONS: Our study demonstrated that nocturnal leg cramps were significantly more frequent in LSCS patients than in the control group.

Therapy effect of transforaminal lumbar interbody fusion technical on complex lumbar spinal stenosis / 中国综合临床

Objective To investigate the surgical effect on complex spinal canal stenosis of lumbar spine through the technical of transforaminal lumbar interbody fusion (TLIF).Methods The retrospective analysis was performed on 46 patients admitted from December 2008 to March 2012.Of all patients,spinal canal stenosis of lumbar spine associated with lumbar scoliosis were 13 cases,lumbar sondylolisthesis for 17 cases,lumbar discogenic pain for 11 cases,lumbar revision surgery for 5 cases.All were underwent the surgical procedures including correction,internal fixation with pedicle screw,then use TLIF technology to compression and fusion.JOA,VAS,Nahal evaluating standards were applied to evaluate the therapeutic effect.The intervertebral height and bone fusion were observed by X ray.Results Forty-six patients were get follow-up for 6-36 months with an average of 12 months.There was significant difference (P ＜0.05) in JOA score between preparation (11.5 ± 2.2) and postoperation (22.5 ± 3.5).VAS score was (2.68 ± 2.08) at pre-operation,lower than that in postoperation (7.25 ± 1.85).There showed the excellent bone fusion,non loss of correction angle and the height of intervertebral disc space.Conclusion The complex of lumbar stenosis is difficult to operate and with high risk.Application of the TLIF procedure combined with clinical symptom,imaging of the spinal cord to decompression,fusion and fixation can restore the spine physical curve and improve patient's symptom.

Comparison of Magnetic Resonance Imaging and Computed Tomography-Myelography for Quantitative Evaluation of Lumbar Intracanalar Cross-Section

PURPOSE: A comparison of MRI and computed tomography-myelography (CTM) for lumbar intracanalar dimensions. To compare the capability and reproducibility of MRI and CTM in measuring the cross-sectional morphology of intracanalar lesions of the lumbar spine. MATERIALS AND METHODS: MRI and CTM of lumbar disc levels from 61 subjects with various lumbar spinal diseases were studied. Dural area, dural anteroposterior (AP) diameter, dural right-left diameter, and thickness of the ligamentum flavum were measured by two orthopedic surgeons. Each section was graded by degree of stenosis. Absolute value and intra- and inter-observer correlation coefficients (ICC) of these measurements and the associations between MRI and CTM values were determined. RESULTS: Except for MRI determination of ligament flavum thickness, CTM and MRI and intra- and ICC suggested sufficient reproducibility. When measurements of dural area, dural AP diameter, and RL diameter were compared, values in CTM were significantly (p = 0.01-0.004) larger than those in MRI (CTM/MRI ratios, 119%, 111%, and 105%, respectively). As spinal stenosis became more severe, discrepancies between CTM and MRI in measurements of the dural sac became larger. CONCLUSION: Both CTM and MRI provided reproducible measurements of lumbar intracanalar dimensions. However, flavum thickness may be more accurately measured by CTM. Because the differences in the measurements between CTM and MRI are very slight and there is very little data to suggest that the precise degree of stenosis is related to symptoms or treatment outcome, the usefulness of the CTM over MRI needs to be confirmed in future studies.

Acrodysostosis Associated with Symptomatic Cervical Spine Stenosis

Acrodysostosis is an extremely rare disorder characterized by short fingers and toes with peripheral dysostosis, nasal hypoplasia, and mental retardation. We report a 16-year-old Korean boy with acrodysostosis who had characteristic clinical features and cervical spine stenosis manifested by neurologic symptoms. On presentation, he complained of difficulty in raising his arms, and suffered from intermittent pain and weakness in both upper extremities. He had short stature and dysmorphic facial features, including a broad, depressed nasal bridge, small, upturned nose, bilateral epicanthal folds, and mild hypertelorism. Moderate mental retardation and sensorineural hearing loss in both ears were also present. Radiological findings included broad, short metacarpals and phalanges with cone-shaped epiphyses, bilateral Madelung deformities, hypertrophied first metatarsals, and thickening of the calvarium. Magnetic resonance imaging findings included stenosis of the cervical spine, platybasia with compression into the cervicomedullary junction, and downward displacement of the cerebellar tonsils. Here, we report a case of acrodysostosis with symptoms and signs of cervical spinal stenosis first in Korea. If it is diagnosed in the early stages, possible life-threatening complications, including spinal canal stenosis, can be managed properly and permanent neurologic sequelae might be avoided. Therefore, it is important to consider acrodysostosis in the differential diagnosis of peripheral dysostosis.

A Case with Lumber Spinal Canal Stenosis Successfully Treated with Kigikenchutokauzu / 日本東洋医学雑誌

We report on a patient with residual complaints after an operation for lumber canal stenosis, successfully treated with the Kampo medicine, kigikenchutokauzu. The patient was 69 year-old woman complaining of severe coldness, numbness, and bilateral leg pain. She was diagnosed as having spinal canal stenosis when she was 67 years of age. Posterolateral fusion with laminectomy was performed at the age of 69, although severe coldness, numbness, and pain persisted even after her surgery. Also, her sutures had not healed. She was referred to our department 26 days after her surgery in order to receive Kampo therapy. Kigikenchutokauzu was prescribed, and her condition markedly improved. Her sutures healed completely 7 days after start of administration. This suggests that kigikenchutokauzu may be effective not only for the residual spinal canal stenosis symptoms, but also for the postoperative healing of sutures.

Preliminary study on lumbar facet joint derived inflammatory factors in degenerative lumbar spinal canal stenosis / 中国矫形外科杂志

[Objective]To initially approach the role of lumbar facet joint derived inflammatory factors in degenerative lumbar spinal canal stenosis. [Methods]Totally 75 cases of degenerative lumbar spinal canal stenosis(LSCS)(n=41)and lumbar intervertebral disc herniation(LDH)(n=34) undergoing posterior lumbar spinal surgery in our department were evaluated in terms of the extent of degenerative arthrosis according to the Weishaup grading criteria.The grading of backleg pain,melosalgia and functional impairment were recorded.The excised lumbar facet joints were collected as species.The content of interleukin-1? and tumor necrosis factor-? in the species were determined by ELISA.[Results]There was no TNF-? detected in both of the two groups.More IL-1? was detected in degenerative lumbar spinal canal stenosis group than that in lumbar intervertebral disc herniation group.It was demonstrated that the content of IL-1? in the species increased as the degeneration of lumbar facet joint sharpened.IL-1?-positive cases in degenerative lumbar spinal canal stenosis group showed higher grading of backleg pain,melosalgia and functional impairment.[Conclusion]The cartilage of degenerative lumbar spinal canal produced more IL-1?.Lumbar facet joint derived inflammatory factors might be one of the reasons that cause backleg pain and melosalgia and functional impairment in degenerative lumbar spinal canal stenosis patients.

Relationship among the traumatic spinal canal stenosis,location of conus medullaris,and neurologic deficits in burst fracture of the first lumbar vertebra / 中国矫形外科杂志

[Objective]To assess whether the canal compromise and the location of conus medullaris determine neurological deficit in burst fracture of the first lumbar vertebra(L1).[Method]Twenty-seven consecutive patients with L1 burst fracture were collected in the study.The compressive ratios of anterior and posterior heights of fractured vertebral bodies,the remains to the estimated ones of the original vertebral bodies were measured on the radiogram,the extent of spinal canal compromise was assessed by computed tomography,and the location of conus medullaris was determined by the MRI examination.The neurological status was evaluated according to the standard neurological classification of spinal cord injury(ASIA).[Result]The compressive ratio of the anterior height was 0.63,the posterior height was 0.91,the stenotic ratio of the canal mid-sagital diameter was 0.69,the stenotic ratio of the distance between pedicles was 1.14,and the stenotic ratio of canal area was 0.83.The group having the stenotic ratio of canal area below 0.5 was at significant risk of neurologic involvement than the control [above(or equal to) 0.5(P=0.049)],and the group with lower conus medullaris had more serious neurological deficit than the upper ones(P=0.046).[Conclusion]There is a significant difference of neurological deficit between the groups with the spinal canal stenosis level of more than 50% and less 50%,and the group with lower conus medullaris had more serious neurological deficit than the upper one.

Clinical outcome of non-surgical treatment of senile people with degenerative lumbar spinal canal stenosis / 中国矫形外科杂志

0.05),the symptoms and activities of daily living were improved significantly in three groups after treatment(P0.05),but the clinical effect had obvious difference between traditional Chinese medicine group and traditional Chinese medicine-western medicine group or western medicine group and traditional Chinese medicine-western medicine group(P

Preliminary study on lumbar spinal canal stenosis treated by microendoscopic unilateral approach and bilateral decompression / 中国矫形外科杂志

[Objective]To evaluate the clinical outcome of lumbar spinal canal stenosis treated by microendoscopic decompressive laminotomy with facet-preserving technique.[Method]Twenty-nine consecutive patients of posterior lumbar spinal canal stenosis were treated by microendoscopic unilateral approach and bilateral decompression with facet-preserving technique using the METRxTM microendoscopic spinal system.Moreover,operation time,blood loss,use of diclofenac suppositories,intra-and postoperative complications and Imaging evaluation were investigated.Clinical outcomes were evaluated by the Japanese Orthopaedic Association scoring system for lumbar disease.[Result]Twenty-four patients were followed up for 7 to 24 months,mean 15.3 months.Mean preoperative JOA scores were(14.5?3.7),and postoperative JOA scores were(22.4?2.3).The mean recovery rate was 54.7%.Operation time was 94.2 minutes for one level decompression,and mean blood loss was 56.4 ml.The use of diclofenac suppositories was average 0.37 times.Intra and postoperative complications were due to one misjudgment of the vertebral level,one dural tears.Intraoperative endoscopic photograph showed satisfactory decompression of dural sac and contralateral nerve root from ipsilateral laminotomy could be performed completely.Postoperative CT and 3DCT showed bilateral decompression from ipisilateral laminotomy and revealed no damage of the facet joints.[Conclusion]Microendoscopic unilateral approach and bilateral decompression with facet-preserving technique using the METRxTM microendoscopic spinal system minimizes resection of the pathologic compression tissues and is a safe,effective and ideal decompressive method for lumbar spinal canal stenosis.

Two Cases of Acupuncture Treatment for Lumbar Spinal Canal Stenosis Due to Hemodialysis-related Spondyloarthropathy / 日本東洋医学雑誌

One of the complications in patients on long-term hemodialysis is spondyloarthropathy resulting from amyloidosis due to abnormal accumulation of β2-microglobulin. With deposition of β2-microglobulin in soft tissues, such as ligaments and joints, destruction of bones and cartilages begins at the site of ligament attachment and proceeds with the accompanying inflammatory reaction, fibrosis and ligament thickening. The soft tissue proliferative lesion and destruction of bones and cartilages produce spinal canal stenosis and, ultimately, compression of the spinal cord and cauda equina, to give rise to various clinical symptoms.<br>We tried acupuncture treatment on two patients with lumbar spinal canal stenosis due to hemodialysis-related spondyloarthropathy who presented with neurogenic intermittent claudication, and evaluated its effects. Acupuncture treatment involved placement of acupuncture needles chiefly in the stenotic region, once weekly, for about three months. Marked improvement was obtained regarding claudication distance and JOA score in patient number one, who had radicular type intermittent claudication. Slight improvement of claudication distance and improvement of JOA score (particularly relief of pain) were obtained in patient number two, who had mixed type intermittent claudication. These results suggest that acupuncture treatment might be effective for dialysis patients with lumbar spinal canal stenosis associated with hemodialysis-induced spondyloarthropathy.