Characteristics of lumbar canal stenosis patient at Koja district hospital year 2011-2021

Background:Since there are too many cases of lumbar canal stenosis in Indonesia. The aim of the study was to discover all the factors that influence the incidence of lumbar canal stenosis.Methods:This study used all cases of lumbar canal stenosis in Koja District Hospital in Jakarta from 2011 to 2021. This was a medical record-based retrospective study in which files of patients with the diagnosis of lumbar canal stenosis were reviewed. A descriptive analytic test was used to analyze results was presented in the form of a table.Results:There were 48 lumbar canal stenosis cases in male patients out of 66 total patients. Incidents of lumbar canal stenosis occurred more frequently in anatomical locations L4-5 than in other locations. There were 48 lumbar canal stenosis cases with anatomical locations L4-5 in 50 patients from 66 patients. Incidents of lumbar canal stenosis occur in people with obesity more frequently than in people without obesity. There were 48 lumbar canal stenosis cases in people with obesity patients out of 66 total patients. The incidence of lumbar canal stenosis with a moderate VAS score was greater than that with a mild or severe VAS score. There were 48 lumbar canal stenosis patients with a moderate vas score out of 66 patients. There were 59 lumbar canal stenosis patients who got surgery out of 66 patients, and 7 of them had no surgery. Lumbar canal stenosis more frequently occurred in men than women, with more frequent anatomical lesions in L4-L5, and more frequently in people with obesity than in people without obesity. Most of them had a moderate VAS score and got surgery.Conclusions:According to this study, males had more lumbar canal stenosis incidents than females.

Anatomical Evaluation Of Lumbar Vertebral Canal In Indian Population

Introduction: Low backache is one of the most common symptoms of lumbar canal stenosis and it developed aninterest among anatomists to do osteological analysis of lumbar canal. The aim of the current study was tocreate the morphometric database of lumbar canal dimensions in context of its applied clinical implications.Materials and Methods: A dry bone study was carried out on 47 adult human lumbar vertebral sets obtained fromvarious medical colleges in Pune District of Maharashtra. Anteroposterior (LCAP) and transverse (LCT) diametersof lumbar canal were measured by ‘Digital Vernier Caliper with 0.01 mm precision’. The data analysis was donein SPSS Version 20 and ‘ANOVA’ test was applied to evaluate statistical differences.Results: Lumbar canal antero-posterior (LCAP) diameters decreased from L1 to L5 vertebrae whereas there wasgradual increase in Lumbar canal transverse (LCT) diameter from first to fifth lumbar vertebra.Conclusion: The present study reported statistically significant differences in the dimensions of lumbar canal ofL1 to L5 in Indian population. This morphometric baseline data can be utilized in surgical management of lowback pain as a result of lumbar canal stenosis.

Study of inter pedicular distance of lumbar spinal canal in perspective of lumbar canal stenosis using plain antero-posterior radiographs in western population of Rajasthan, India

Background: Various causes have been attributed to low backache, but lumbar canal stenosis is turned out to be a major causative factor. It has been suggested that reduced IPD is one among the major cause of narrowing of the spinal canal. The objective of this study was to evaluate the inter pedicular distances in lumbar vertebral column in both sexes of western Rajasthan, India.Methods: The present descriptive type study was conducted in Department of Anatomy and Neurosurgery Sawai Man Singh Medical College, Jaipur, Rajasthan, India. Antero-posterior plain radiographs of lumbar spine in 1000 subjects aged between 20 to 60 years and those who were born and brought up in Rajasthan state were used for the study. All measurements were made by using electronic digital Vernier caliper. Student t-test was used for analysis.                           Results: Mean transverse diameter of lumbar vertebral canal (I.P.D) is minimum at L1 vertebra in both sexes. The maximum values of I.P.D were recorded for vertebra L5 for both sexes.Conclusions: The values of IPD are higher in male population in comparison to female counterparts.

Morphometric Analysis Of Lumbar Vertebrae And Its Applied Clinical Importance

Introduction: The lumbosacral spine is the region of transition from the appendicular to the axial skeleton.Accidents, degenerative conditions, congenital defects and neoplastic metastases often affect the lumbar region.Low back pain resulting from lumbar canal stenosis is one of the major complaints in young to adult population.Apart from that lumbar vertebrae morphometry is required in many surgical as well as anaesthetic procedures.Aims and objectives: The present study was undertaken to determine the morphometry of human cadavericlumbar vertebrae and to compare findings with other authors and forming a baseline data in relation to variouslumbar canal pathologies that can be of help to the medical and surgical experts.Materials and methods: Dried lumbar vertebrae were obtained from the Department of Anatomy of RegionalInstitute of Medical Sciences, Imphal, India. Vertebrae belonging to same set and without any external deformitywere chosen and separated into typical and atypical ones. Measurement of Midsaggital diameter, Interpediculardistance, and Anteroposterior diameter of lateral recess was done using digital vernier calliper.Observations and Results: The study showed increase in all the diameters from L1 to L5 with a narrowing in allcases at L3 level. Therefore, L3 remains the transition point in all the measurements and thus one of the possiblesites for nerve root compression due to canal stenosis, which is one of the major causes of low back pain.Conclusion: The present data forms a baseline of adult lumbar vertebral morphology and is useful source ofinformation to surgeons, physicians and anatomists. It is also helpful for the screw and implant manufacturers.Further study with sex and ethnic consideration can generate forensic and anthropological data.KEY WORDS: Lumbar vertebrae, Lumbar canal stenosis, Morphometry, Midsaggital diameter, Interpediculardistance, Lateral recess diameter.

The impact of sarcopenia on the results of lumbar spinal surgery

OBJECTIVES: As the population ages, the number of lumbar spinal surgeries performed on sarcopenic patients will increase. The purpose of this study was to investigate the prevalence of sarcopenia and evaluated its impact on the results of lumbar spinal surgery. METHODS: This study included 2 groups: One group consisted of patients who underwent whole-body dual-energy X-ray absorptiometry (DXA) scanning before the option of undergoing surgery for lumbar spinal disease (LSD group) and a second group consisted of patients underwent DXA scanning for osteoporosis screening under hospital watch at the geriatric medicine department (control group). In order to evaluate the impact of sarcopenia on the clinical outcome of lumbar spinal surgery, the Japanese Orthopedic Association (JOA) score, the recovery rate based on the JOA score, and visual analogue scale (VAS) scores for lower back pain, lower extremity pain, and lower extremity numbness were compared within the LSD group. RESULTS: The prevalence of sarcopenia showed no statistical difference between groups (control group, 50.7%; LSD group, 46.5%). In the LSD group, while the changes in VAS scores showed no statistical difference between the nonsarcopenia subgroup and sarcopenia subgroup, the sarcopenia subgroup demonstrated inferior JOA scores and recovery rates at the final follow-up when compared with the nonsarcopenia subgroup (P < 0.05). CONCLUSIONS: This study demonstrated a high prevalence of sarcopenia among the elderly populations in Japan and a negative impact of sarcopenia on clinical outcomes after lumbar spinal surgery.

Unilateral pedicle screws on the side of the transarticular screw fixation combined with interbody fusion and traditional operation in the treatment of lumbar tube stenosis of the efficacy and safety of comparison / 中国综合临床

Objective To investigate the contralateral transarticular screw fixation combined with interbody fusion and traditional operation in the treatment of lumbar tube stenosis of the efficacy and safety of unilateral pedicle screw.Methods A retrospective analysis was made in General Hospital of Lanzhou Petrochemical Company from February 2012 to April 2015.Forty cases of lumbar spinal stenosis patients were analyzed respectively,using unilateral pedicle screws on the side of transarticular screw fixation(observation group,20 cases) and bilateral pedicle screw fixation (control group,20 cases) and interbody fusion for the treatment.Between the two groups in the amount of bleeding,operation time,incision length,postoperative drainage were compared.Regular follow-up after operation,the fusion effect was observed,the JOA score was used to evaluate spinal function and observe adverse reaction incidence.Results Intraoperative bleeding volume,operation time and postoperative drainage in the observation group were (321.60±12.35) ml,(101.18±4.11) min,(212.14±18.78) ml,lower than that in control group((377.24±18.11) ml,(134.49±5.25) min,(256.27±15.19) ml,t=2.80,4.11,-3.88,P0.05).The fusion rate and JOA score in the observation group after 3 months of observation group was (100±0)% and (87.5±2.4) points,there was no statistically significant difference compared with the control group((100±0)% and (86.3±2.2) points,t=0,0.20,P>0.05).The fusion rate and JOA score in the observation group after 1 year was (100±0)% and (91.9±1.7) points,there was no statistically significant difference compared with the control group((100±0)% and (92.1±1.5) points,t=0,0.35,P>0.05).The height of intervertebral space in the last follow-up group in the observation group was (8.25±0.13) mm,higher than that of the control group((6.97±0.16) mm,t=3.90,P<0.001).In adverse reactions,the observation group did not appear to be related to complications,while 2 cases in the control group dural leakage,3 cases of nerve injury,rate was 25%(P=0.03).Conclusion Unilateral pedicle screws on the side of the transarticular screw fixation combined with interbody fusion for the treatment of lumbar tube stenosis surgical trauma,postoperative recovery,spinal stability is good in the near future,it is worth clinical promotion.

Improved bone knife spinous lamina osteotomy replantation complex treatment of lumbar spinal stenosis / 临床外科杂志

Objective To improve bone knife spinous lamina osteotomy replantation complex treatment of lumbar spinal stenosis patients.Methods Retrospective analysis from January 2014 to January 2015,the clinical data of 56 patients with lumbar spinal stenosis disease,all patients were taken modified osteotome bone cutting composite lamina spinous process and implant treatment,through follow-up,the CT,preoperatie and follow-up sessions at the end of the measurement of vertebral canal sagittal diameter,spinal canal diameter,to observe the prognosis and complications,and according to the Japanese orthopaedic society of low back pain score standard(Japanese orthopaedics asso ciation,JOA),the rate of good evaluation of clinical curative effect.Results This group of 56 patients with lumbar spinal stenosis disease,the last follow-up,vertebral canal sagittal diameter,spinal canal diameter,than preoperative significantly increased;JOA score was obviously improve the preoperative;The t test,statistically significant difference(P<0.05);The rate of good clinical curative effect was 96.43%;Follow-up period,all patients by CT review that lamina in situ fusion rate was 100%,no lumbar spinal instability,secondary lumbar spinal stenosis,composite lamina spinous complications such as shift,subsidence,fall off;6 months basic achieve bony healing.Conclusion The modified bone knife spinous lamina osteotomy replantation complex therapeutic effect of lumbar spinal stenosis precise,effective reconstruction of posterior structure stability,integrity,reduce complications,the prognosis is good,worthy of clinical use.

Preliminary Results of Relationship between Preoperative Walking Ability and Magnetic Resonance Imaging Morphology in Patients with Lumbar Canal Stenosis: Comparison between Trefoil and Triangle Types of Spinal Stenosis

STUDY DESIGN: Cross-sectional. PURPOSE: To examine the relationship between magnetic resonance imaging (MRI) morphology stenosis grades and preoperative walking ability in patients with lumbar canal stenosis (LCS). OVERVIEW OF LITERATURE: No previous study has analyzed the correlation between MRI morphology stenosis grades and walking ability in patients with LCS. METHODS: This prospective study included 98 consecutive patients with LCS who were candidates for surgery. Using features identified in T2-weighted axial magnetic, stenosis type was determined at the maximal stenosis level, and only trefoil and triangle stenosis grade types were considered because of sufficient sample size. Intraobserver and interobserver reliability were assessed by calculating weighted kappa coefficients. Symptom severity was evaluated via the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Walking ability was assessed using the Self-Paced Walking Test (SPWT) and JOABPEQ subscales. Demographic characteristics, SPWT scores, and JOABPEQ scores were compared between patients with trefoil and triangle stenosis types. RESULTS: The mean patient age was 58.1 (standard deviation, 8.4) years. The kappa values of the MRI morphology stenosis grade types showed a perfect agreement between the stenosis grade types. The trefoil group (n=53) and triangle group (n=45) showed similar preoperative JOABPEQ subscale scores (e.g., low back pain, lumbar function, and mental health) and were not significantly different in age, BMI, duration of symptoms, or lumbar stenosis levels (all p>0.05); however, trefoil stenosis grade type was associated with a decreased walking ability according to the SPWT and JOABPEQ subscale scores. CONCLUSIONS: These findings suggest preoperative walking ability is more profoundly affected in patients with trefoil type stenosis than in those with triangle type stenosis.

Report of a Rare Case: Ligamentum Flavum Cyst.

A rare case of ligamentum flavum cyst of the lumbar spine in an elderly male is reported. The patient presented with low backache and features of bilateral radiculopathy of a sudden onset. The cyst was lying in the extradural space. After surgery, the patient reported complete relief of symptoms.

Evaluation of Lumber Vertebral Canal at Disc Level in Symptomatic and Asymptomatic subjects: A Radiological Evaluation.

Background: Spinal stenosis is defined as the narrowing of central spinal canal or its lateral recesses. Stenosis of spinal canal becomes important only when it results in interference with the normal functions of the contents of the canal. Narrowing of spinal canal seems to be a normal part of advancing age but certain uncertainties persist as regards to radiological definition of lumbar spinal canal stenosis. Material & Method: The present study was aimed to evaluate the clinical relevance of stenosis of spinal canal through the most recent technique, MRI. Fifty symptomatic and 18 asymptomatic subjects were included. Antero-posterior and transverse diameters of vertebral canal were compared between symptomatic and asymptomatic subjects and statistically analyzed. Results & Discussion: The present study clearly shows that in both symptomatic and asymptomatic subjects there is a gradual decrease in the antero-posterior diameter from above downwards . The minimum anteroposterior and maximum transverse diameter was seen at L4L5 level making this level susceptible to compressive symptomatology. Apparent stenosis was observed in some asymptomatic subjects.

Anatomical Study of Lumbar Spinal Canal Diameter on MRI to Assess Spinal Canal Stenosis.

Introduction: Lumbar canal stenosis occurs due to narrowing of spinal canal diameter and is usually diagnosed by MRI. Aims and Objectives of the study: To study and compare the lumbar canal diameters (Antero Posterior) and Cross sectional areas in symptomatic and asymptomatic patients with Lumbar canal stenosis diagnosed using MRI. Materials and Methods: It is a prospective observational study. A total of 100 patients were subjected to MRI and canal diameters were measured. Among them 60 patients were symptomatic with low back pain and 40 patients were asymptomatic without any back pain. Fifty five patients were males and 45 were females. Majority (31%) were in the age group of 20-30 years. Results: In symptomatic cases, 41 (68%) cases were stenosed. Stenosis at all the three levels was seen in 5 (12%) cases. At L3-L4, L4- L5 stenosis was seen in 6 (14%) cases, L4-L5, L5-S1 stenosis was seen in 22(53%) cases, L3- L4, L5-S1 stenosis was seen in 8(19%) cases. In asymptomatic cases, stenosis at all the three levels was seen in 5 (13%) cases and at L4-L5; L5-S1 stenosis was seen in 5(12.5%) cases, L3-L4, L5-S1stenosis was seen in 2(5%) cases. Conclusion: Even in symptomatic Patients, normal diameter of the spinal canal was noticed in 19 (32%) cases. Even in asymptomatic cases canal narrowing was noticed. Most of the symptomatic cases had normal Cross sectional area. Detailed history and clinical examination of the patient along with the radiological investigation of stenosis with MRI scan, will establish the diagnosis.

A Study of Transverse Diameter of Lumbar Vertebral Canal in North Indian Population.

Lumbar spinal stenosis is a medical condition occurring due to reduction in the diameter of bony vertebral canal. The transverse diameter of the canal plays a significant role in determining diagnostic criteria for defining stenosis. The present study aims at defining baseline values of transverse diameter of lumbar vertebral canal in healthy north Indian population by radio-diagnosis. Fifty healthy subjects, within age range of 20-70 years were radio-imaged and transverse diameter of vertebral body and canal were assessed. There was a gradual increase in diameter from L1 to L5 vertebral levels. The means of transverse diameter of vertebral body and vertebral canal show no significant differences between genders and the results were compared with earlier published research work. There are subtle differences in morphometry of lumbar canal in different population group suggesting regional and ethnic differences.

Limited Laminectomy and Restorative Spinoplasty in Spinal Canal Stenosis

STUDY DESIGN: Prospective cohort study. PURPOSE: Evaluation of the clinico-radiological outcome and complications of limited laminectomy and restorative spinoplasty in spinal canal stenosis. OVERVIEW OF LITERATURE: It is critical to achieve adequate spinal decompression, while maintaining spinal stability. METHODS: Forty-four patients with degenerative lumbar canal stenosis underwent limited laminectomy and restorative spinoplasty at our centre from July 2008 to December 2010. Four patients were lost to follow-up leaving a total of 40 patients at an average final follow-up of 32 months (range, 24-41 months). There were 26 females and 14 males. The mean+/-standard deviation (SD) of the age was 64.7+/-7.6 years (range, 55-88 years). The final outcome was assessed using the Japanese Orthopaedic Association (JOA) score. RESULTS: At the time of the final follow-up, all patients recorded marked improvement in their symptoms, with only 2 patients complaining of occasional mild back pain and 1 patient complaining of occasional mild leg pain. The mean+/-SD for the preoperative claudication distance was 95.2+/-62.5 m, which improved to 582+/-147.7 m after the operation, and the preoperative anterio-posterior canal diameter as measured on the computed tomography scan was 8.3+/-2.1 mm, which improved to 13.2+/-1.8 mm postoperatively. The JOA score improved from a mean+/-SD of 13.3+/-4.1 to 22.9+/-4.1 at the time of the final follow-up. As for complications, dural tears occurred in 2 patients, for which repair was performed with no additional treatment needed. CONCLUSIONS: Limited laminectomy and restorative spinoplasty is an efficient surgical procedure which relieves neurogenic claudication by achieving sufficient decompression of the cord with maintenance of spinal stability.

Morphometric analysis of lumbosacral canal in human foetuses / Análisis morfométrico del canal lumbosacro en fetos humanos

Lumbosacral part of the spinal canal requires special attention because this is the site commonly involved in spina bifida, tethered cord syndrome and some other pathologies like fatty tumours in the spine, cysts and syrinxes. The diagnosis as well as the treatment of neural tube defects mandates an accurate knowledge of morphometry of lumbosacral vertebral canal. There are various reports on radiological morphometric measurements in human foetuses by various authors but these possess inherent variability due to imaging techniques, patient positioning, observer's measuring techniques and normal and pathological variations. To overcome all these limitations, direct measurements by vernier calliper were preferred. 30 Formalin preserved human foetuses, of all age groups and both sexes, free of congenital craniovertebral anomalies, were obtained from the museum of Dept. of Anatomy, J. N. Medical College AMU Aligarh for the present study. Foetuses were divided into five groups (I-V) based on their gestational ages. Group I foetuses were of less than 17 weeks, II of 17-20 weeks, III of 21-25 weeks, IV of 26-30 weeks and V of more than 30 weeks. Each group contained 6 foetuses having both male and female, 3 each. Morphometric parameters taken into account were length of lumbar canal, maximum transverse diameters of lumbar vertebral canal at different vertebral levels, heights of the posterior surfaces of bodies of all lumbar vertebrae and length of sacral canal. Readings of adjacent groups were compared and results were analyzed by using Student's 't' test. Lumbar canal starts growing in length significantly in group III foetuses onward. There was consistency in the growth of lumbar canal diameters with gestational age at all levels. Heights of vertebral bodies of Ist two lumbar vertebrae showed variability in some adjacent groups. The same in the next three grew constantly with the growth of foetuses. Sacral canal showed variable growth in lengths in different grou...

La porción lumbosacra del canal espinal requiere una atención especial; es un sitio frecuentemente implicado en la espina bífida, el síndrome de médula anclada y algunas otras patologías como tumores de grasa en la columna vertebral, quistes y siringomelia. El diagnóstico y el tratamiento de los defectos del tubo neural requieren de un conocimiento preciso de la morfometría del canal vertebral lumbosacro. Existen diversos informes radiológicos sobre mediciones morfométricas en fetos humanos por parte de diversos investigadores, pero estos poseen una variabilidad inherente debido a las técnicas de imagen, posicionamiento del paciente, técnicas de medición del observador y, las variaciones normales y patológicas. Para superar todas estas limitaciones, para las mediciones directas se utilizó un caliper vernier. 30 fetos humanos conservados en formalina, de todas las edades y de ambos sexos, sin anomalías congénitas craneovertebrales, fueron obtenidos del museo del Departamento de Anatomía, J. N. Facultad de Medicina de la UMA, Aligarh. Los fetos fueron divididos en cinco grupos (I-V) sobre la base de su edad gestacional. El grupo I de fetos fueron los menores de 17 semanas, el II de 17-20 semanas, el III de 21-25 semanas, IV de 26 a 30 semanas, V de más de 30 semanas. Cada grupo contenía 6 fetos de ambos sexos (1:1/H:M)). Los parámetros morfométricos tomados en cuenta fueron la longitud del canal lumbar, el diámetro transversal máximo del canal vertebral lumbar en diferentes niveles, la altura de las superficies posteriores de los cuerpos de todas las vértebras lumbares y la longitud del canal sacro. Las mediciones de los grupos fueron comparadas y analizadas mediante el uso de la prueba de "t". El canal lumbar comenzó a aumentar en longitud significativamente desde el grupo de fetos III en adelante. No hubo consistencia en el crecimiento de los diámetros del canal lumbar con la edad gestacional en todos los niveles. Las alturas de los primeros dos cuerpos verte...

Tratamiento quirúrgico de la estenosis del canal lumbar / Surgical treatment of lumbar canal stenosis / Traitement chirurgical de la sténose canalaire lombaire

INTRODUCCIÓN. El tratamiento de la estenosis lumbar degenerativa es un tema controversial. Ante el fracaso de los métodos incruentos y la solicitud del enfermo de obtener una mejoría, se plantea la necesidad de una descompresión quirúrgica. El objetivo de la presente investigación fue demostrar la eficacia del tratamiento quirúrgico en la estenosis de canal lumbar en pacientes operados mediante las técnicas de recalibraje, laminectomía, instrumentación y fusión, entre enero y diciembre del 2008. MÉTODOS. Se realizó un estudio descriptivo prospectivo sobre el tratamiento quirúrgico en la estenosis del canal lumbar raquídeo en pacientes operados en el Hospital Ortopédico «Fructuoso Rodríguez¼ entre enero y diciembre de 2008. La selección del tipo de cirugía estuvo determinada por el área anatómica específica estenótica del canal vertebral. Se analizaron variables importantes para definir la factibilidad de aplicación de cada procedimiento quirúrgico. RESULTADOS. La serie quedó constituida por 15 pacientes, con edad promedio de 49,6 años y predominio del sexo masculino. Se practicó laminectomía a 10 pacientes, a 5 fusión y a 10, recalibraje. Hubo una mejoría notoria de los pacientes que presentaban claudicación neurógena, con un índice de Oswestry de 62,7 que disminuyó a 22,1, En los pacientes con lumbociatalgia, el índice de Oswestry disminuyó de 77,1 a 15,7. CONCLUSIONES. Las técnicas utilizadas para las estenosis centrales fueron la laminectomía con instrumentación, y para las estenosis del receso lateral, la técnica de recalibraje descrita por Senegas. Se recomienda realizar ligamentoplastia con corion, la cual confiere estabilidad dinámica al segmento recalibrado, limita la extensión a ese nivel y disminuye la sobrecarga y subluxación de las carillas articulares, con lo cual protege el espacio adyacente.

INTRODUCTION: The treatment of degenerative lumbar stenosis is a controversial subject. Due to the failure of non-significant methods and to on request of patient to achieve a improvement, it is proposed the need of a surgical decompression. The aim of present research was to demonstrate the effectiveness of surgical treatment in cases of lumbar canal stenosis in patients operated on by recalibration techniques, laminectomy, instrumentation and fusion from January to December, 2008. METHODS: A prospective and descriptive study was conducted on surgical treatment in rachidial lumbar canal stenosis in patients operated on in “Fructuoso Rodríguez” Orthopedics Hospital from January to December, 2008. The choice of the type of surgery was determined by the stenotic specific anatomic area of vertebral canal. Significant variables were analyzed to define the feasibility to apply each surgical procedure. RESULTS: Cohort included 15 patients mean aged 49,6 and a male sex predominance. Laminectomy was carried out in 10 patients, a fusion in 5 and recalibration in 10. There was a marked improvement in patients presenting with neurogenic claudication, with a Oswestry’s rate of 62,7 decreasing to 22,1. In patients with lumbar back pain Oswestry’s rate decreased from 77,1 to 15,1. CONCLUSIONS: Techniques used for central stenosis included laminectomy with instrumentation and for lateral recess stenosis we used the recalibration technique described by Senegas. It is recommendable to perform chorion-ligamentoplasty which gives dynamic stability to recalibrated segment, limits the extension in that level, and decreases the overload and subluxation of articular superficies protecting the adjacent space.

INTRODUCTION. Le traitement de la sténose lombaire dégénérative est un sujet polémique. Étant donné l'échec des méthodes cruentées et la demande de soulagement du malade, une décompression chirurgicale est donc nécéssaire. Le but de cette étude est de demontrer l'efficacité du traitement chirurgical dans la sténose du canal lombaire chez les patients opérés par les techniques de recalibrage, laminectomie, instrumentation et fusion entre janvier et décembre 2008. MÉTHODES. Une étude descriptive et prospective sur le traitement chirurgical de la sténose du canal lombaire rachidien chez des patients opérés à l'Hôpital d'orthopédie “Fructuoso Rodríguez” est réalisée entre janvier et décembre 2008. La sélection du type de chirurgie a été déterminée par une région sténotique spécifique du canal rachidien. Différentes variables ont été analysées afin de définir la convenance de chaque acte chirurgical. RÉSULTATS. La série a été composée de 15 patients, avec un âge moyen de 49,6 ans et une prédominance du sexe masculin. Dix patients ont subi une laminectomie (5 fusions et 10 recalibrages). Il y a eu une amélioration remarquable des patients présentant une claudication neurogène, avec un taux d'Oswestry de 62,7 diminuant à 22,1. Le taux d'Oswestry a diminué de 77,1 à 15,7. CONCLUSIONS. Les techniques utilisées pour les sténoses centrales ont été la laminectomie avec instrumentation, et pour les sténoses du récessus latéral la technique de recalibrage décrite par Senegas. Il est conseillé de réaliser une ligamentoplastie à chorion, laquelle peut confèrer une stabilité dynamique au segment recalibré, limiter l'extension à ce niveau et diminuer la surcharge et la subluxation des faces articulaires, en protégeant ainsi l'espace adjacent.

The Clinical Effect of Gait Load Test in Two Level Lumbar Spinal Stenosis

STUDY DESIGN: This study is a prospective, clinical study assessing the efficacy of selective decompression of the level responsible in a two-level stenosis in accordance with the neurological findings defined by the gait load test with a treadmill. PURPOSE: To clarify the clinical features of multilevel lumbar spinal stenosis (LSS) regarding the neurological level responsible for the symptoms, neurogenic claudication, and outcomes of selective decompression. OVERVIEW OF LITERATURE: Most spine surgeons have reported that multilevel compression of the cauda equina induces a more severe impairment of the nerve function than a single-level compression. However, the clinical effects of multilevel LSS on the cauda equine and nerve roots are unknown. METHODS: A total of 21 patients with lumbar spinal canal stenosis due to spondylosis and degenerative spondylolisthesis were selected. The level responsible for the symptoms in the two-level stenosis was determined from the neurological findings on the gait load test and functional diagnosis based on a selective nerve root block. All patients underwent a prospective, selective decompression at the level neurologically responsible only. The average follow-up period was 2.6 years (range, 1 to 6 years). The postsurgical outcome was defined using the Visual Analogue Scale (VAS) at the post-gait load test, 2 weeks after surgery, 3 months after surgery and at the last follow up. RESULTS: Before surgery, the mean threshold distance and mean walking tolerance was 34.3 m and 113 m, respectively. All patients had neurogenic claudication and 19 of the patients had cauda equina syndrome, including hypesthesia in 11 cases, muscle weakness in 5 cases and radicular pain in 7 cases. Selective nerve blocks to determine the level responsible for the lumbosacral symptoms in 2 cases revealed a mean VAS score of 7.1, 2.61, 3.04, and 3.47 at the post-gait load test, 2 weeks after surgery, 3 months after surgery and at the last follow up, respectively. All subjects underwent surgery. After the operation, neurogenic claudication with or without cauda equna syndrome subsided in all patients. CONCLUSIONS: The gait load test allows an objective and quantitative evaluation of the gait characteristics of patients with lumbar canal stenosis and is useful for determining the appropriate level for surgical treatment.

Incidence and the factors of postoperative residual numbness in lumbar canal stenosis / 中国矫形外科杂志

[Objective]To evaluate the incidence of postoperative residual numbness and the factors that influenced numbness in lumbar canal stenosis(LCS).[Method]Eighty patients with LCS including 24 males and 32 females,who were 27～78 years of age with an average age of 61.3,were operated by posterior decompression,and followed 10 days,1 month,3 months,1 year and 2 years after operation.All patients were examined by neurological findings and residual symptoms.[Result]In LCS,there were 82.1% of patients who complained numbness preoperativety.The incidence of residual numbness was 43.6%,39.1%,36.6%,35.3% and 35.7% after 10 days,1 month,3 months,12 months and 24 months,respectively.The factors that influenced residual numbness were related to stenosis types;JOA score before operation and the type of spinal canal stenosis were independent of age and nerve root diameter.[Conclusion]The lower limbs numbness recovered within 1 month postoperatlvely.The incidence of postoperative residual numbness was 35.3% and 35.7% in LCS after 1 year and 2 years.It is speculated that the potential of recovery of neural tissue is important for lower limbs residual numbness.

Microcirculation in lower limbs with lumbar canal stenosis:the changes and clinical significance / 中国矫形外科杂志

[Objective]To discuss the changes and clinical significance of microcirculation in lower limbs in patients with lumbar canal stenosis under different circumstances.[Method]Prospectively,randomly,the nail fold microcirculation of the big toe in 50 patients were investigated with WX-6 microcirculation instrument before and after operation at 7~10 days and 3~6 months.The averages were compared with that of 30 healthy persons with q test.Two groups were defined according to the claudication distance as 0～100 meter and 300～400 meter and tested.The averages were analyzed with t test.[Result]There were statistically significant differences between the patients group and the healthy group and before and after surgery(P0.05).The most significant change was the form of blood flow.[Conclusion]The dysfunction of sympathetic nerve resulting from lumbar canal stenosis will impair the microcirculation of lower limbs and aggravate intermittent claudication.The operation will improve the microcirculation and alleviate the symptoms significantly.The microcirculation test in lower limbs can serve as an objective method for the preoperative diagnosis and postoperative assessment for therapeutic efficacy.

Measurement of the Oblique Diameter of the Lumbar Spinal Canal in Korean Army-aged Group by Echographic Method / 대한정형외과학회잡지

The size and configuration of the lumbar spinal canal constitute one of the important factors in the production of symptoms referable to cauda equina and nerve roots of the lumbar spine and the narrowness of the spinal canal. Numerous attempts have been made to measure the size of the lumbar spinal canal, but most of those are not sufficient to measure the oblique diameter of the lumbar spinal canal. Also, echographic diagnosis is much simple, safe, less expensive and non-invasive and furthermore demonstrates much more accuracy than other alternative and radiographic procedures. The purpose of this study is to establish the range of normal values of the oblique diameter of the lumbar spinal canal in Korean Army-aged group by echographic method in the interest of facilitating clinical evaluation of the lumbar spinal canal stenosis. The author measured oblique diamenter of the lumbar spinal canal in thirty healthy persons of both sexes of ages between nineteen and twenty-five years by ultrasound using sonolayergraphy model SSL-21A. Distance from the ligamentum flavum to the posterior longitudinal ligament was measured in millimeters with dial vernier caliper. Actual distance of oblique diameter of the lumbar spinal canal is obtained by multiplication of the distance of echogram by calibration factor 2.22. The results were as follows; 1. The mean values of the oblique diameter of the lumbar spinal canal in male and female between nineteen and twenty-five years of age were 14.77±0.85mm and 14.87±0.82mm in Ll, 13.99±0.87mm and 14.13±0.96mm in L2, 13.40±0.69mm and 13.71±0.75mm in L3, 12.88±0.69mm and 12.93±0.68mm in L4, 14.58±0.79mm and 14.42±0.84mm in L5 respectively. 2. The oblique diameter of the lumbar spinal canal was the widest at the first lumbar vertebra, the next at the fifth lumbar vertebra and the narrowest at the fourth lumbar vertebra. 3. There was no difference of diameter of the lumbar spinal canal between both sexes.