Influencia de la obesidad en los resultados del tratamiento quirúrgico de la estenosis lumbar degenerativa / Obesity Influence on the Surgical Treatment Results of Degenerative Lumbar Stenosis

Introducción: La estenosis lumbar degenerativa altera la calidad de vida y disminuye la capacidad funcional en adultos mayores. La obesidad representa un problema de la salud mundial actual. Objetivo: Detallar los efectos de la obesidad sobre el riesgo quirúrgico, los índices de complicaciones posoperatorias y los resultados funcionales en pacientes adultos mayores sometidos a cirugía electiva por estenosis lumbar degenerativa. Métodos: Estudio prospectivo-descriptivo, con pacientes adultos mayores intervenidos quirúrgicamente por diagnóstico de estenosis lumbar degenerativa y valorados un año después. Resultados: 55 pacientes, 23 obesos, 32 no obesos; relación de sexos 1,5:1 masculino-femenino, mayor cantidad de espacios intervenidos, tiempo quirúrgico y pérdida de sangre en obesos. Los obesos presentaron un mayor número de complicaciones postquirúrgicas y resultados funcionales menos buenos. Conclusiones: La obesidad constituye un mayor riesgo quirúrgico, que, aunque la diferencia en los resultados clínicos no sea muy importante, provoca intervenciones más prolongadas y mayor incidencia de complicaciones quirúrgicas(AU)

Introduction: Degenerative lumbar stenosis alters quality of life and decreases functional capacity in older adults. Obesity represents a current global health problem. Objective: To detail the effects of obesity on surgical risk, postoperative complication rates, and functional outcomes in older patients undergoing elective surgery for degenerative lumbar stenosis. Methods: Prospective-descriptive study with elderly patients who underwent surgery for a diagnosis of degenerative lumbar stenosis, who were evaluated one year later. Results: Fifty-five patients, 23 obese, 32 non-obese; sex ratio 1.5:1 male-female, higher number of intervened spaces, surgical time and blood loss in obese subjects. The obese patients showed higher number of post-surgical complications and less good functional results. Conclusions: Obesity constitutes a higher surgical risk, even when the difference in clinical results is not very important, it causes longer interventions and higher incidence of surgical complications(AU)

Surgical treatment for lumbar spinal stenosis: a single-blinded randomized controlled trial

Abstract Objective: To evaluate the effectiveness of surgery for the management of patients with symptomatic lumbar spinal stenosis. Methods: Sixty-three patients with lumbar canal stenosis were randomized into two groups: the intervention group (IG) and control group (CG). IG patients underwent surgery and both groups participated in the same physical therapy program twice a week for a period of 12 weeks and were followed up at 1 year. The primary endpoint was visual analogue scale for pain, and the secondary endpoints were function (6-min walk test, Roland Morris and Oswestry questionnaires), quality of life (SF-36 questionnaire) and satisfaction with treatment (Likert scale). Results: No significant difference between groups was observed for pain over time (p = 0.145). Significant differences between groups, in favor of the IG, were observed for the Oswestry score (p = 0.006) and vitality domain score of the SF-36 (p = 0.047). Function in the Roland Morris and 6-min walk test and the role of the physical domain of SF-36 also showed significant differences between the groups; however, these differences occurred due to a worsening of the IG in the short term, and the medium-term. The Likert scale demonstrated greater satisfaction with the IG treatment compared to control group. Conclusions: Lumbar stenosis surgery did not improve pain in short and medium terms. Function and vitality were better in the group that underwent surgery in the medium term, and patients were more satisfied with the surgical treatment. Trial registration: Clinicaltrials.gov (NCT02879461).

Robot-assisted unilateral-decompression minimally invasive transforaminal lumbar interbody fusion for radiographic bilateral lumbar stenosis / 中国组织工程研究

BACKGROUND: In the elderly patients with degenerative lumbar spinal stenosis, bilateral nerve root canal stenosis commonly shows only one side of symptoms. There is still controversy about whether or not decompression is needed on the side without symptoms or with less symptoms and how to operate. OBJECTIVE: To explore the safety and efficacy of robot-assisted unilateral-decompression using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique by investigating a series of cases with the radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms and by comparing clinical decompression effect and imaging changes before and after operation. METHODS: Cases with radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms subjected to unilateral decompression on the affected side, interbody fusion and bilateral fixation after robot-assisted MIS-TLIF in the same treatment group were retrospectively analyzed. Operation time, intraoperative blood loss and complications were recorded. The vertebral canal cross-sectional area, intervertebral foramen height, intervertebral space height, and lumbar lordosis angle were examined before and after surgery. Visual analogue scale scores for low back pain and leg pain were assessed before and after surgery. Oswestry disability index was used to assess lumbar function before and after surgery. Macnab criteria were used to evaluate the efficacy at the final follow-up after surgery. RESULTS AND CONCLUSION: (1) Operation time was 110-235 minutes, averagely 169.4 minutes. Intraoperative blood loss was 70-180 mL, averagely 112.4 mL. (2) After 3-8 months of follow-up, the visual analogue scale scores of low back pain and lower extremity pain 1 month after surgery and in final follow-up were significantly lower than those before operation (both P 0.05). (6) It is concluded that robot-assisted unilateral-decompression MIS-TLIF obtained satisfactory effect in bilateral lumbar canal stenosis patients presenting with unilateral symptoms.

Early-middle stage effect of percutaneous spinal endoscopic BEIS technique for lumbar spinal stenosis / 中国骨伤

OBJECTIVE@#To explore the clinical early-middle stage clinical effect of percutaneous spinal endoscopic with the technique of Broad Easy Immediate Surgery(BEIS) for lumbar spinal stenosis.@*METHODS@#The clinical data of 57 patients with lumbar spinal stenosis treated by surgery from June 2015 to June 2016 were retrospectively analyzed, including 32 cases treated by percutaneous spinal endoscopic with the technique of BEIS (minimally invasive group) and 25 cases by posterior approach of lumbar pedicle screws internal fixation and intervertebral disc excision with bone graft fusion surgery (open surgery group). The pre-operative general data such as age, Body Mass Index (BMI) and etc. were analysed and compared. The operation time, intraoperative blood loss, hospitalization time of the two groups were analyzed. Visual analogue score(VAS), Oswestry Disability Index(ODI), Japanese Orthopedic Association Score(JOA) of preoperative and at 1 week, 1 month, 3 months, 6 months after surgery were used to evaluate the clinical outcome of the two group.@*RESULTS@#All the operations were successful and all the patients recovered smoothly without severe complications, all the wounds got good healing. The pain of the lumbar and lower limb had been improved after surgery. All the patients were followed up more than 6 months with an average of(10.65±3.38) months. There was no significant difference in general data such as age, BMI, and etc. between two groups(>0.05). There were significant differences in VAS, ODI between two groups at 1 week, 1, 3, 6 months after surgery(0.05). Intraoperative blood loss and hospitalization time of minimally invasive group was less than that of open surgery group.@*CONCLUSIONS@#BEIS technique has the advantage of less trauma, less bleeding for lumbar stenosis when compared to open surgery. It can better alleviate the postoperative local lumbar pain, and early-middle clinical effect is equivalent to open surgery, so it can be used as a safe and effective surgical treatment for lumbar spinal stenosis.

Unplanned Second-Stage Decompression for Neurological Deterioration Caused by Central Canal Stenosis after Indirect Lumbar Decompression Surgery

STUDY DESIGN: Prospective cohort study. PURPOSE: This study aimed to identify risk factors for unplanned second-stage decompression for postoperative neurological deficit after indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation. OVERVIEW OF LITERATURE: Indirect lumbar decompression with LLIF has been used as a minimally invasive alternative to direct decompression to treat degenerative lumbar diseases requiring neural decompression. However, evidence on the prevalence of neurological deficits caused by spinal canal stenosis after indirect decompression is limited. METHODS: This study included 158 patients (mean age, 71.13±7.98 years; male/female ratio, 67/91) who underwent indirect decompression with LLIF and posterior fixation. Indirect decompression was performed at 271 levels (mean level, 1.71±0.97). Logistic regression analysis was used to identify the risk factors for postoperative neurological deficits. The variables included were age, sex, body mass index, presence of primary diseases, diabetes mellitus, preoperative motor deficit, levels operated on, preoperative severity of lumbar stenosis, and preoperative Japanese Orthopedic Association (JOA) score. RESULTS: Postoperative neurological deficit due to spinal canal stenosis occurred in three patients (1.9%). Spinal stenosis due to hemodialysis (p<0.001), ligament ossification (p<0.001), presence of preoperative motor paralysis (p<0.001), low JOA score (p=0.004), and severe canal stenosis (p=0.02) were significantly more frequent in the paralysis group. CONCLUSIONS: Severe preoperative canal stenosis and neurological deficit were identified as risk factors for postoperative neurological deterioration caused by spinal canal stenosis. Additionally, uncommon diseases, such as spinal stenosis due to hemodialysis and ligament ossification, increased the risk of postoperative neurological deficit; therefore, in such cases, indirect decompression is contraindicated.

Does the Surgical Timing and Decompression Alone or Fusion Surgery in Lumbar Stenosis Influence Outcome in Cauda Equina Syndrome?

STUDY DESIGN: A retrospective comparative analysis of 64 patients with cauda equina syndrome (CES), who underwent either decompression alone (NF) or fusion (F) surgery. PURPOSE: We compared the outcomes and timing effects. OVERVIEW OF LITERATURE: CES can cause loss of autonomic control of vesicular function and lower limb neurological deficits. Prompt diagnosis and emergency surgery markedly improve outcome. Although decompression only is a mainstream technique, there is guarded recovery of vesicular dysfunction. Decompression ventrally in a narrow window requires manipulation of neural tissue in an already jeopardised critical canal and may accentuate irreversible damages. In F surgery, the adequate exposure leads to a lower neural manipulation. METHODS: Until January 2008, we treated CES with decompression (laminectomy and/or discectomy). However, from that month forward, all our single-level CES patients have received a fusion operation. In this study, characteristic categorical variables and outcomes were analysed. RESULTS: In a retrospective analysis of 64 patients, NF (n=37) and F (n=27) who received treatment, we found that both groups improved significantly on follow-up in all objective parameters. Although, the comparison of clinical and functional outcome data between the two groups was statistically insignificant, the average value of objective outcome such as vesicular function, low back pain (LBP), and complications was better for patients in F group compared with NF group. However, the patient satisfaction for the F group was also lower, in view of their residual symptoms and disabilities. Contrary to common perceptions, we found that the timing of surgery does not influence the recovery rate for either approach. CONCLUSIONS: Although both the techniques appear to be equally effective, the fusion approach overall showed a definite edge over non-fusion, with respect to reduced incidence of iatrogenic dural tears, LBP, and overall outcome, even despite the lower patient satisfaction.

Lumbar Spinal Stenosis: The Reliability, Sensitivity and Specificity of the Nerve Root Sedimentation Sign

@#sensitivity and specificity of nerve root sedimentation sign(NRS) in our populations. The NRS is a radiological sign todiagnose lumbar spinal stenosis (LSS). It is claimed to bereliable with high sensitivity and specificity. MaterialsandMethods:A total of 82 MRI images from 43patients in Group A (LSS) and 39 patients in Group B (nonLSS) were analysed and compared for the presence of theNRS sign. Two assessors were used to evaluate intra andinter-assessor reliability of this sign based on 56 (33 patients,Group A and 23 patients, Group B). The findings werestatistically analysed using SPSS software. Results:There was a significant association between spinalclaudication and leg numbness with LSS (p<0.001 andKappa=0.857, p<0.001). The inter-assessor reliability wasalso good (Kappa of 0.786, p<0.001).Conclusion:The NRS sign has high sensitivity andspecificity for diagnosing LSS. The sign also has good intraand inter-assessor reliability.

Evaluación funcional mediante la escala de oswestry en pacientescon artrodesis postero-lateral por canal lumbar estrecho / Functional evaluation by oswestry disability index in patients with postero-lateral arthrodesis for lumbar spinal stenosis

OBJETIVOS: Establecer la evolución funcional y condición neurológica con la escala de Oswestry en la biomecánica de la columna lumbar en pacientes que fueron intervenidos mediante descompresión neurológica y artrodesis posterolateral más estabilización con tornillos transpediculares por presentar diagnóstico de canal lumbar estrecho (CLE) en el Hospital Obrero N°1 de la ciudad de La Paz, Bolivia, durante las gestiones 2012 a 2014. Identificar los factores clínicos, socio-demográficos de pacientes en los cuales se realizó artrodesis en columna vertebral por canal lumbar estrechó. MÉTODOS: Se realizó un estudio retrospectivo, descriptivo, de corte transversal de pacientes en los cuales se realizó artrodesis postero-lateral por CLE en el servicio de ortopedia traumatología entre las gestiones 2012-2014, en el Hospital Obrero Nro1. Se evaluó 16 pacientes que cumplieron los criterios de inclusión. RESULTADOS: Según valoración de la escala de Oswestry: un 56% de pacientes tienen limitación funcional mínima y un 6% discapacidad a los 6 meses post operatorio. El género más afectado fue el femenino con un 57%, la edad promedio fue de 64 años, el tiempo previo al tratamiento quirúrgico fue mayor a 12 meses en el 63%, los niveles instrumentados más frecuentes fueron de L3-L5 y L5-S1 con un 25%. CONCLUSIONES: Se realizaron técnicas quirúrgicas descompresivas: laminectomia, foraminectomia con instrumentación. El índice de discapacidad de Oswestry permite valorar que la técnica fue efectiva debido a que los pacientes presentan una evolución funcional sin limitaciones en su vida cotidiana en la mayoría de los casos.

OBJECTIVES: To stablish the functional evolution and neurological condition through Oswestrydisability index (ODI)inthe biomechanics of the lumbar spine in patients who underwent neurological decompression and posterolateral arthrodesisand transpedicular screws stabilization by presenting lumbar spinalstenosis(LSS) in Obrero Hospital N° 1, La Paz city, Bolivia. To identify clinical, social and demographic factors of patients with degenerative lumbar spinal stenosis in which postero-lateral arthrodesis was performed. METHODS: A retrospective, descriptive and cross-sectional study between 2012 and 2014 was conducted. Patients who were treated with postero-lateral arthrodesis for lumbar spinal stenosis, in the traumatology service at Obrero Hospital in La Paz city were considered. We evaluated 16 patients who met the inclusion criteria. RESULTS: According to Oswestrydesability index, 56% of the patients have minimal functional limitation and 6% of disability at 6-month postoperative. The most affected gender were females with 57%, the average age was 64 years, prior time to surgical treatment was more than 12 months in 63%, and the most frequent instrumented levels were L3-L5 and L5-S1 with 25%. CONCLUSIONS: We performed decompressive surgical techniques: laminectomy, foraminotomy with instrumentation. Oswestry disability index helped to determine the applied techniqueswere effective. In most cases, patients displayed a functional evolution without limitations in their daily lives.

Clinical effect and nursing of small needle therapy in the treatment of retrograde lumbar spine stenosis / 现代临床护理

Objective To observe the clinical efficacy of small needle therapy in the treatment of retrograde lumbar spine stenosis. Methods About 30 patients with retrograde lumbar spinal stenosis from June 2015 to March 2016 were set as control group;30 patients with the same disease from ApriI 2016 to December 2016 were set as observation group. The control method of traction and massage therapy, the observation group on the basis of increased by small needle knife therapy. Result The effect of the observation group was better than the control group, the difference was statistically significant (P<0.01). Conclusions Treatment of retrograde lumbar spinal stenosis with small needle knife therapy is effective in treating patients' pain and improving clinical effect. Well condition observation and nursing during the treatment can ensure the smooth progress of treatment, the correct guidance and urged patients to exercise to reduce the recurrence of the disease, has the vital significance.

Perioperative nursing of middle-aged and elderly patients with lumbar spinal stenosis and degenerative lumbar scoliosis / 现代临床护理

Objective To summarize the perioperative experience of nursing the middle-aged and elderly patients of lumbar spinal stenosis and degenerative lumbar scoliosis treated with posterior or transforaminal lumbar interbody fusion. Methods Posterior or transforaminal lumbar interbody fusion was performed in 69 middle-aged and elderly patients with lumbar spinal stenosis and degenerative lumbar scoliosis. Nursing measures included evaluation and treatment of complications, preoperative guidance for surgical body position, and postoperative close monitoring, treatment of complications and functional exercises. Results The operation on all the 69 patients was smooth, with surgical time ranged from 3 to 7 hours and bleeding volume between 300~750 mL. Postoperatively, 9 patients suffered from CSF leaks, 3 ones had a screw loose by imageology, 2 did from pneumonia, 2 did from DVT, and 3 did from depression. After clinical management and nursing, all the patients were cured and discharged. Conclusions Meticulous clinical treatment and nursing of preoperative complications and instructions on body position are the foundation for successful surgeries. Postoperatively, close monitoring, management of the complications and the instruction on functional exercises are guarantees for the successful surgeries.

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures

STUDY DESIGN: Retrospective case-control study. PURPOSE: To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. OVERVIEW OF LITERATURE: Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. METHODS: The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. RESULTS: Stepwise logistic regression revealed kissing spine (p=0.024; odds ratio, 3.80) and foraminal stenosis (p<0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. CONCLUSIONS: When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.

Lumbar Interspinous Process Fixation and Fusion with Stand-Alone Interlaminar Lumbar Instrumented Fusion Implant in Patients with Degenerative Spondylolisthesis Undergoing Decompression for Spinal Stenosis

STUDY DESIGN: Prospective cohort study. PURPOSE: To assess the ability of a stand-alone lumbar interspinous implant (interspinous/interlaminar lumbar instrumented fusion, ILIF) associated with bone grafting to promote posterior spine fusion in degenerative spondylolisthesis (DS) with vertebral instability. OVERVIEW OF LITERATURE: A few studies, using bilateral laminotomy (BL) or bilateral decompression by unilateral laminotomy (BDUL), found satisfactory results in stenotic patients with decompression alone, but others reported increased olisthesis, or subsequent need for fusion in DS with or without dynamic instability. METHODS: Twenty-five patients with Grade I DS, leg pain and chronic low back pain underwent BL or BDUL and ILIF implant. Olisthesis was 13% to 21%. Follow-up evaluations were performed at 4 to 12 months up to 25 to 44 months (mean, 34.4). Outcome measures were numerical rating scale (NRS) for back and leg pain, Oswestry disability index (ODI) and short-form 36 health survey (SF-36) of body pain and function. RESULTS: Fusion occurred in 21 patients (84%). None had increased olisthesis or instability postoperatively. Four types of fusion were identified. In Type I, the posterior part of the spinous processes were fused. In Type II, fusion extended to the base of the processes. In Type III, bone was present also around the polyetheretherketone plate of ILIF. In Type IV, even the facet joints were fused. The mean NRS score for back and leg pain decreased by 64% and 80%, respectively. The mean ODI score was decreased by 52%. SF-36 bodily pain and physical function mean scores increased by 53% and 58%, respectively. Computed tomography revealed failed fusion in four patients, all of whom still had vertebral instability postoperatively. CONCLUSIONS: Stand-alone ILIF with interspinous bone grafting promotes vertebral fusion in most patients with lumbar stenosis and unstable Grade I DS undergoing BL or BDUL.

Diagnosis of Lumbar Foraminal Stenosis using Diffusion Tensor Imaging

Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed during nerve conduction studies. Computed tomography and magnetic resonance imaging indicated bilateral L5 lumbar foraminal stenosis. DTI imaging was done. The extraforaminal values were decreased and tractography was interrupted in the foraminal region. Bilateral L5 vertebral foraminal stenosis was treated by transforaminal lumbar interbody fusion and the pain in both legs disappeared. The case indicates the value of DTI for diagnosing vertebral foraminal stenosis.

Surgical treatment of the osteoporotic spine with bone cement-injectable cannulated pedicle screw fixation: technical description and preliminary application in 43 patients

OBJECTIVES: To describe a new approach for the application of polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws. METHODS: Between June 2010 and February 2013, 43 patients with degenerative spinal disease and osteoporosis (T-score <-2.5) underwent lumbar fusion using cement-injectable cannulated pedicle screws. Clinical outcomes were evaluated using a Visual Analog Scale and the Oswestry Disability Index. Patients were given radiographic follow-up examinations after 3, 6, and 12 months and once per year thereafter. RESULTS: All patients were followed for a mean of 15.7±5.6 months (range, 6 to 35 months). The Visual Analog Scale and Oswestry Disability Index scores showed a significant reduction in back pain (p = 0.018) and an improvement in lower extremity function (p = 0.025) in patients who underwent lumbar fusion using the novel screw. Intraoperative cement leakage occurred in four patients, but no neurological complications were observed. Radiological observation indicated no loosening or pulling out of the novel screw, and bone fusion was excellent. CONCLUSIONS: The described polymethylmethacrylate augmentation technique using bone cement-injectable cannulated pedicle screws can reduce pain and improve spinal dysfunction in osteoporotic patients undergoing osteoporotic spine surgery. .

Resultado del tratamiento quirúrgico de la estenosis lumbar degenerativa en el adulto mayor / Résultats du traitement chirurgical de la sténose lombaire dégénérative chez les personnes âgées / Results of surgical treatment of degenerative lumbar stenosis in the older adult

Introducción: la estenosis lumbar degenerativa en pacientes adultos mayores constituye un grave problema de salud actual. El tratamiento quirúrgico parece ser el de mejor resultado, pero presenta la disyuntiva de si a todos los pacientes que padezcan esta enfermedad se les debe tratar con igual técnica. Objetivos: mostrar los resultados obtenidos en el tratamiento quirúrgico de la estenosis lumbar degenerativa en pacientes mayores de 65 años. Métodos: se realizó un estudio descriptivo prospectivo en pacientes mayores de 65 años con diagnóstico de estenosis lumbar degenerativa, en el Centro de investigaciones en Longevidad, Envejecimiento y Salud, entre el 1 de enero de 2009 y el 1 de enero de 2011 (ambos incluidos). La serie quedó constituida por 28 pacientes. Las variables estudiadas fueron: edad, sexo, sintomatología, localización, principales condiciones comorbidas, clasificación radiográfica y por resonancia magnética. Se seleccionó la técnica quirúrgica empleada atendiendo al área anatómica estenosada. Se empleó el índice de Oswestry y la escala Visual Analógica de dolor como instrumentos evaluadores. Resultados: predominó el sexo masculino (67,6 por ciento), la localización en dos niveles vertebrales, y las condiciones comorbidas cardiovasculares. El síntoma predominante mostró valores semejantes entre el dolor lumbar, el irradiado y la claudicación. El índice de Oswestry y la Escala Visual Analógica del dolor mostraron significativa mejoría en el posquirúrgico. Se obtuvo un 89,2 porciento de buenos resultados. Conclusiones: el empleo de laminectomía para las estenosis centrales y recalibraje para las de receso lateral parece ser adecuada(AU)

Introduction: degenerative lumbar spinal stenosis is a serious health problem in the older adults at present. The surgical treatment seems to attain better results, but the controversy is whether all the patients suffering the disease can be treated with this procedure or not. Objectives: to show the results of the surgical treatment of degenerative lumbar spinal stenosis in over 65 years-old patients. Methods: a prospective and descriptive study was carried out in patients aged over 65 years and diagnosed with degenerative lumbar spinal stenosis in the Center of Research on Old Age, Aging and Health from January 1st 2009 to January 1st, 2011. The series was finally made up of 28 patients. The study variables were age, sex, symptoms, location, main comorbid conditions, and classification according to radiographies and to magnetic resonance. The choice of the surgical technique depended on the stenosed anatomical area. The Oswestry Disability Index and the Analogue Visual Scale of pain were the evaluation instruments. Results: males (67.6 percent), the location of disease at two vertebral levels and comorbid cardiovascular conditions prevailed. The predominant symptom showed similar values among lumbar pain, the irradiated pain and claudication. Oswestry Disability Index and the Analog Visual Scale of pain showed the significant improvement of patient in the postsurgical period. Good results reached 89.2 perent. Conclusions: laminectomy for central stenosis and regaging for the lateral recess seem to be adequate(AU)

Introduction: des nos jours, la sténose lombaire dégénérative constitue un sérieux problème de santé chez les personnes âgées. La chirurgie paraît être le traitement le plus prometteur, mais une question se pose, est-ce que tous les patients atteints de cette maladie doivent être traités par la même technique? Objectif: le but de cette étude est de montrer les résultats obtenus avec le traitement chirurgical de la sténose lombaire dégénérative chez les personnes âgées de plus de 65 ans. Méthode: une étude descriptive prospective de patients âgés de plus de 65 ans, diagnostiqués de sténose lombaire dégénérative, a été réalisée au Centre de recherches sur la longévité, le vieillissement et la santé entre le 1e janvier 2009 et le 1e janvier 2011. La série a été conformée de 28 patients. Les variables en étude comprennent âge, sexe, symptomatologie, localisation, comorbidité, classification radiographique et RM. La technique chirurgicale a été déterminée en accord avec la localisation de la sténose; l'index d'Oswestry et l'Échelle visuelle analogique (EVA) de la douleur ont été utilisés comme instruments d'évaluation. Résultats: dans l'étude, quelques variables ont prédominé (67.6 pourcent du sexe masculin, localisation à deux niveaux vertébraux, comorbidité cardiovasculaire, irradiation de la douleur lombaire, et claudication). L'index d'Oswestry et l'Échelle visuelle analogique de la douleur ont montré une amélioration significative dans le post-chirurgical. En général, on a obtenu de très bons résultats (89.2 pourcent). Conclusions: Dans le cas de la sténose centrale et de la sténose latérale, la laminectomie et le récalibrage respectivement semblent être appropriées(AU)

Tratamiento quirúrgico de la estenosis lumbar degenerativa del adulto mayor según la imagenología / Traitement chirurgical de la sténose lombaire dégénérative chez les personnes âgées, d'après les résultats d'imagerie / Surgical treatment of degenerative lumbar stenosis in elderly patients based on imaging findings

Introducción: la estenosis lumbar degenerativa en pacientes adultos mayores constituye un grave problema de salud actual. Objetivo: demostrar la validez del tratamiento quirúrgico de la estenosis lumbar degenerativa del adulto mayor cuando la decisión del tipo de técnica a realizar se determina por los hallazgos imagenológicos por rayos X y resonancia magnética. Métodos: se estudiaron 102 pacientes mayores de 65 años, atendidos en el Centro de investigaciones en Longevidad, Envejecimiento y Salud, entre el 1 de enero de 2002 y el 31 de diciembre de 2008, ambos incluidos. Las variables estudiadas fueron: edad, sexo, localización, principales condiciones comorbidas, clasificación por rayos X y por resonancia magnética. La decisión de la técnica quirúrgica empleada estuvo en relación con los hallazgos imagenológicos, se empleó el índice de Oswestry y la escala visual analógica de dolor como instrumentos evaluadores. Las técnicas quirúrgicas fueron: liberación simple, recalibraje y laminectomía, instrumentación y fusión. Resultados: hubo predominio del sexo masculino, entre 65 y 70 años de edad con localización en dos niveles vertebrales y condiciones comorbidas cardiovasculares, el mayor número de casos se encontró en los grados 3 y 4 de Kellgren y IV y V de Pfirrmann. El índice de Oswestry y la escala visual analógica del dolor mostraron significativa mejoría a los dos años y se obtuvo el 88 por ciento de buenos resultados. Conclusiones: determinar la técnica quirúrgica a emplear según los hallazgos imagenológicos, permite obtener buenos resultados en altos porcentajes de pacientes intervenidos. La relación imagenología/técnica quirúrgica, es adecuada(AU)

Introduction: degenerative lumbar stenosis in elderly patients is a serious health problem. Objective: demonstrate the validity of the surgical treatment of degenerative lumbar stenosis in elderly patients when decision on what technique to apply is based on X-ray and magnetic resonance imaging findings. Methods: a study was conducted of 102 patients aged over 65 cared for at the Center for Research on Longevity, Aging and Health from 1 January 2002 to 31 December 2008. The variables considered were age, sex, location, main comorbid conditions, and classification based on X-ray and magnetic resonance imaging. Decision on the surgical technique to apply was based on imaging findings. The Oswestry index and the Pain Visual Analog Scale were used as evaluation instruments. The surgical techniques applied were simple release, recalibration and laminectomy, instrumentation and fusion. Results: there was a predominance of male patients in the 65-70 age group with location at two vertebral levels and cardiovascular comorbid conditions. The largest number of cases were classed as degrees 3 and 4 on Kellgren's scale, and IV and V on Pfirrmann's. The Oswestry index and the Pain Visual Analog Scale showed significant improvement at two years, and 88 percent of the results obtained were good. Conclusions: determination of the surgical technique to apply based on imaging findings makes it possible to obtain good results in a high percentage of the patients undergoing surgery. There is an appropriate relationship between imaging findings and surgical technique(AU)

Introduction: de nos jours, la sténose lombaire dégénérative chez des patients âgés constitue un problème grave de santé. Objectif: le but de cette étude es de démontrer la validité du traitement chirurgical de la sténose lombaire dégénérative chez les personnes âgées lorsque la technique à utiliser est décidée par imagerie (rayons-X et résonance magnétique). Méthodes: cent-deux patients âgés de 65 ans ont été étudiés et traités au Centre de recherches de la longévité, le vieillissement et la santé entre le 1e janvier 2002 et le 31 décembre 2008. Les variables étudiées ont compris l'âge, le sexe, la localisation, les principales conditions de comorbidité, et la classification par rayons-X et résonance magnétique. Le choix de la technique chirurgicale à utiliser a été en rapport avec les résultats d'imagerie, et les instruments d'évaluation ont compris l'indice d'Oswestry et l'échelle visuelle analogique de la douleur. Les techniques chirurgicales ont compris la libération simple, le recalibrage et la laminectomie, l'instrumentation et la fusion. Résultats: les patients du sexe masculin, âgés de 65 - 70 ans, avec une sténose localisée à deux niveaux vertébraux, une comorbidité cardiovasculaire, en grades 3 et 4 de Kellgren, et IV et V de Pfirmann en majorité, ont été les plus souvent touchés. L'indice d'Oswestry et l'échelle visuelle analogique de la douleur ont montré une amélioration significative en deux ans, et la plupart de cas a eu de bons résultats (88 pourcent). Conclusions: le choix de la technique chirurgicale selon les résultats d'imagerie permet d'atteindre de bons résultats dans un grand nombre de patients opérés. Le rapport entre l'imagerie et la technique chirurgicale est effectivement approprié(AU)

Extensive decompression through transforaminal lumbar interbody fusion pathway combined with pedicle screw fixation for the treatment of lumbar stenosis in elderly patients / 中国综合临床

Objective To observe the efficacy of extensive decompression through transforaminal lumbar interbody fusion (TLIF) pathway combined with pedicle screw fixation on treating degenerative lumbar stenosis in the dderly.Methods Seventy-five elderly patients (28 males and 47 females) with degenerative lumbar stenosis were treated with extensive decompression through transforaminal pathway at our hospital from Jan.2007 to Aug.2010.The operation is through the TLIF pathway to resect part of the articular facet,and expose unilaterally the intervertebral vertebral foramen.Decompression of the vertebral canal was conducted by removing the disc.In the end,we performed posterolateral fixation with pedicle screw and placement of bone graft in posterolateral part of the lumbar or did the interbody fusion.JOA scores were obtained before and 1 day after operation and in 3 month follow-up consultation.The intervertebral height and bone fusion were observed by X ray.Results The follow-up period of the 75 patients was 6-36 months with an average of 12 months.There was significant difference (t =20.79,P ＜ 0.05 ;t =25.89,P ＜ 20.05) in JOA score between 3 month follow-up (21.08 ± 3.60) and preoperation (10.91 ± 2.23),between 1 d follow-up (22.72 ± 3.26) and preoperation (10.91 ±2.23),respectively.The rate of improvement was (88.6 ± 10.8)％,with 98％ of excellent or good in 3-month follow-up.Lumbar plane films showed neither instability or internal fixation loosening,breakage or distortion in follow-up consultation.There were 2 cases in whom Cage dislocation occurred without any neurological symptoms.Conclusion Extensive decompression through TLIF pathway combined with pedicle screw fixation is an efficacious method of treating degenerative lumbar stenosis in elderly patients.This method can retain the structure of lumbar posterior complex,reduce the risk of low back pain.It is a safe choice for treatment of degenerative lumbar stenosis in the elderly.

Minimum 3-Year Outcomes in Patients with Lumbar Spinal Stenosis after Bilateral Microdecompression by Unilateral or Bilateral Laminotomy

OBJECTIVE: Lumbar spine stenosis (LSS) can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Minimally invasive surgery has come to be more commonly used for the treatment of LSS. The current study describes outcomes of bilateral microdecompression by unilateral or bilateral laminotomy (BML) for degenerative LSS after a minimum follow-up period of 3 years and investigates factors that result in a poor outcome. METHODS: Twenty-one patients who were followed-up for at least 3 years were included in this study. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, and disc height. RESULTS: Twenty-one patients (10 men, 11 women) aged 53-82 years (64.1+/-8.9 years) were followed-up for a minimum of 3 years (36-69 months). During follow-up, two patients underwent reoperation. Average preoperative JOA score and clinical symptoms, except persistent low back pain, improved significantly at the latest follow-up. There were no significant differences in radiological findings preoperatively and postoperatively. Thirteen patients (61.9%) had excellent to fair outcomes. CONCLUSION: BML resulted in a favorable and persistent outcome for patients with degenerative LSS without radiological instability over a mid-term follow-up period. Persistent low back pain unrelated to postoperative instability adversely affects mid-term outcomes.

Under microscope bilateral decompression via unilateral approach for the treatment of lumbar stenosis / 中华显微外科杂志

Objective To evaluate the characteristics and efficacy of microscope-assisted bilateral decompression via unilateral approach for the treatment of lumbar stenosis. Methods From June 2007 to June 2010, Sixty case lumbar stenosis with bilateral decompression were treated via unilateral approach under microscopy. Patients were followed up from 6 to 24 months, average (12 ± 4.7) months. Results The pain level of each patient was assessed both before and after the opeartion, using a visual analogue scale (VAS). Intermittent claudication was completely relieved in 57 out of 60 cases, moderately relieved in 3 cases. VAS score decreased from pre-operational 9.08 ± 0.76 to post-operational 2.33 ± 1.43, and there was significantly difference between them. There was no recurrent case during the whole follow-up. Conclusion Bilateral decompression via unilateral approach under microscope is proved to be an effective and safe procedure for the treatment of lumbar stenosis, and have the advantages of minimal invasion, less pain, quick recovery, better effect, little influence on the spinal stability.

Asymptomatic Cervical or Thoracic Lesions in Elderly Patients who Have Undergone Decompressive Lumbar Surgery for Stenosis

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the prevalence and risk factors of asymptomatic cervical or thoracic lesions in elderly patients who have undergone surgery for lumbar spinal stenosis. OVERVIEW OF LITERATURE: Concurrent multiple spinal lesions have been reported in many studies with a varied prevalence, and described the characteristics of the disease and its treatment options. However, the cervical or thoracic lesions without apparent symptoms in patients with symptomatic lumbar stenosis had not been evaluated. METHODS: A total of 101 elderly patients (aged 65 or more), who had undergone surgery for lumbar spinal stenosis from January 2005 to December 2005, were enrolled in this study. All patients underwent lumbar magnetic resonance imaging (MRI) along with T2-weighted cervical and thoracic sagittal MRI prior to surgery. The concurrent cervical or thoracic lesions were classified according to the disease entity, and the severity of the lesions was graded from grade 0 (no lesion) to grade 4 (any lesion compressing the cord with a signal change). The prevalence of concurrent cervical and thoracic lesions was then analyzed. In addition, the risk factors for the development of concurrent lesions were evaluated, and the risk factors affecting the severity of the concurrent lesion were analyzed individually. RESULTS: Seventy-seven (76.2%) and 30 (29.7%) patients had a concurrent cervical and thoracic lesion, respectively. Twenty-six patients (25.7%) had both a cervical and thoracic lesion. There was a positive correlation between the symptom duration of lumbar stenosis and the prevalence of both cervical (p = 0.044) and thoracic (p = 0.022) lesions. CONCLUSIONS: The incidence of asymptomatic cervical or thoracic lesions is apparently high in elderly patients who have undergone surgery for lumbar spinal stenosis, particularly in those with longer symptom duration. This highlights the need for a preoperative evaluation of the cervical and thoracic spine in these patients.