Comparison of clinical effect and muscle injury imaging between oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of single-segment degenerative lumbar spinal stenosis / 中国骨伤

OBJECTIVE@#To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.@*RESULTS@#There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up.@*CONCLUSION@#Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.

Research progress of different minimally invasive spinal decompression in lumbar spinal stenosis / 中国修复重建外科杂志

OBJECTIVE@#To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS).@*METHODS@#The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized.@*RESULTS@#At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs.@*CONCLUSION@#The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.

Early-effectiveness of unilateral biportal endoscopic laminectomy in treatment of two-level lumbar spinal stenosis / 中国修复重建外科杂志

OBJECTIVE@#To analyze the early effectiveness of unilateral biportal endoscopy (UBE) laminectomy in the treatment of two-level lumbar spinal stenosis (LSS).@*METHODS@#The clinical data of 98 patients with two-level LSS treated with UBE between September 2020 and December 2021 were retrospectively analyzed. There were 53 males and 45 females with an average age of 59.9 years (range, 32-79 years). Among them, there were 56 cases of mixed spinal stenosis, 23 cases of central spinal canal stenosis, and 19 cases of nerve root canal stenosis. The duration of symptoms was 1.5- 10 years, with an average of 5.4 years. The operative segments were L 2, 3 and L 3, 4 in 2 cases, L 3, 4 and L 4, 5 in 29 cases, L 4, 5 and L 5, S 1 in 67 cases. All patients had different degrees of low back pain, among of which 76 cases were with unilateral lower extremity symptoms and 22 cases were with bilateral lower extremity symptoms. There were 29 cases of bilateral decompression in both segments, 63 cases of unilateral decompression in both segments, and 6 cases of unilateral decompression and bilateral decompression of each segment. The operation time, intraoperative blood loss, total incision length, hospitalization stay, ambulation time, and related complications were recorded. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months after operation, and at last follow-up. The Oswestry disability index (ODI) was used to evaluate the functional recovery of lumbar spine before operation and at 3 months and last follow-up after operation. Modified MacNab criteria was used to evaluate clinical outcomes at last follow-up. Imaging examinations were performed before and after operation to measure the preservation rate of articular process, modified Pfirrmann scale, disc height (DH), lumbar lordosis angle (LLA), and cross-sectional area of the canal (CAC), and the CAC improvement rate was calculated.@*RESULTS@#All patients underwent surgery successfully. The operation time was (106.7±25.1) minutes, the intraoperative blood loss was (67.7±14.2) mL, and the total incision length was (3.2±0.4) cm. The hospitalization stay was 8 (7, 9) days, and the ambulation time was 3 (3, 4) days. All the wounds healed by first intention. Dural tear occurred in 1 case during operation, and mild headache occurred in 1 case after operation. All patients were followed up 13-28 months with an average of 19.3 months, and there was no recurrence or reoperation during the follow-up. At last follow-up, the preservation rate of articular process was 84.7%±7.3%. The modified Pfirrmann scale and DH were significantly different from those before operation ( P<0.05), while the LLA was not significantly different from that before operation ( P=0.050). The CAC significantly improved ( P<0.05), and the CAC improvement rate was 108.1%±17.8%. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and the differences between each time points were significant ( P<0.05). According to the modified MacNab criteria, 63 cases were excellent, 25 cases were good, and 10 cases were fair, with an excellent and good rate of 89.8%.@*CONCLUSION@#UBE laminectomy is a safe and effective technique with little trauma and fast recovery for two-level LSS and the early effectiveness is satisfactory.

Short-term clinical observation on the treatment of single-segment lumbar disc herniation and lumbar spinal stenosis by improved transforaminal endoscopic spine system technique with full visual endoscopic foraminoplasty / 中国综合临床

Objective:To investigate the safety and efficacy of the modified transcutaneous endoscopic spine system (TESSYS) with full visual foramen plasty and percutaneous endoscopic discectomy (PTED) in the treatment of lumbar disc herniation and lumbar spinal stenosis.Methods:A case-control study was conducted to analyze the clinical data of 68 patients with single segment lumbar disc herniation and lumbar spinal stenosis treated with visual endoscopic foraminal plasty and modified TESSYS technique and intervertebral foraminal fusion from April 2020 to March 2021. According to the operation method, 38 cases were divided into two groups: pted group (38 cases) and TLIF group (30 cases). Independent sample t-test was used to compare the incision length, bleeding volume, operation time, time to go down and hospital stay between the two groups. Visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were measured repeatedly. The differences between preoperative and postoperative 7 days and 1, 3, 6 months were analyzed and compared by generalized estimation equation. Rank sum test was performed in combination with the modified MacNab standard in the last follow-up. The excellent and good rate was compared between groups χ 2. Test and evaluate the curative effect. Results:The postoperative follow-up was 8.5-14.0 months. The incision length (1.25±0.33) cm, operation time (119.45±14.95), blood loss (24.03±8.62) mL, downtime time (1.42±0.50) d, and hospital stay (3.39±0.55) d in the PTED group were all higher than those in the TLIF group ((14.37±2.91) cm, (140.53±16.16) min, (158.00±51.35) mL, (3.20±0.96) d, (7.33±0.55) d) had obvious advantages ( t values were 24.56, 5.57, 14.13, 9.20, and 29.48, respectively; all P<0.001). The VAS scores and ODI scores of the two groups after operation were significantly improved compared with those before operation (all P<0.001), and with the passage of time, the VAS scores and ODI scores of the two groups of patients from 7 days to 6 months after operation by month were significantly decreased ( P<0.001). However, there was no significant difference between the two groups in VAS score from 1 week to 6 months after operation: P7d=0.997, P1 month=0.139, P3 month=0.057, P6 month=0.539, all P>0.05. There was no significant difference in ODI scores between time points (ODI: P7d=0.278, P1 month=0.442, P3 month=0.963, P6 month=0.278, all P>0.05). There was no significant difference between the two groups in terms of clinical efficacy and excellent and good rate evaluated by modified MacNab criteria at the last follow-up ( Z=0.09, P=0.927; χ 2=0.92, P=0.761). Conclusion:The short-term curative effect of full visual endoscopic foraminal plasty and modified TESSYS technique in the treatment of single level lumbar disc herniation and lumbar spinal stenosis is close to that of classical foraminal interbody fusion, and has certain advantages.

Effect of unilateral biportal endoscopy for central lumbar spinal stenosis / 国际外科学杂志

Objective:To evaluate the efficacy of unilateral biportal endoscopy (UBE) in the treatment of central lumbar spinal stenosis.Methods:The retrospective case-control study was conducted. 36 patients with central lumbar spinal stenosis were treated by unilateral dual channel spinal endoscopy who underwent Beijing Mentougou District Hospital from November 2019 to September 2021 were collected. There were 19 males and 17 females, including 11 cases of L 5-S 1, 19 cases of L 4-L 5 and 6 cases of L 3-L 4; The age was (70.0±3.9) years old, and ranged from 55 to 82 years old. The observation indicators: the changes of dural sac area in lumbar magnetic resonance cross-section before and after surgery, and the improvement of visual analogue of pain (VAS) score and Oswestry dysfunction index (ODI) before and after surgery in 1, 3, 6, and 12 months, as well as the occurrence of complications. Measurement data with normal distribution were represented as mean±standard deviation ( ± s), and comprison between groups was conducted using the t test; Comprison between groups of count data was conducted using the chi-square test or Fisher exact probability. Results:Postoperative MRI showed that the area of the transverse dural sac increased from (65.5±6.7) mm 2 before operation to (173.5±5.5) mm 2 after operation after the removal of the ligamentum flavum ( P<0.05). The follow-up of 36 patients for 12 months after operation showed that the VAS score decreased from (8.5±2.0) scores to (1.3±0.8) scores, and the ODI decreased from (59.3±12.3)% to (13.6±1.6)%( P<0.05). No complications such as nerve injury, cerebrospinal fluid leakage and infection related to operation occurred in 36 patients. Conclusions:Unilateral biportal endoscopy is one of the safe and effective treatment methods in the treatment of central lumbar spinal stenosis, with obvious improvement in symptoms, and the increase in the area of the spinal dural sac. It can obtain good early clinical effects.

Frequency of vitamin d deficiency in patients with lumbar spinal stenosis and its relationship with obesity, depression, and pain intensity: a cross-sectional study / Frequência da deficiência de vitamina D em pacientes com estenose espinhal lombar e sua relação com obesidade, depressão e intensidade da dor: um estudo transversal

ABSTRACT Objective This study was conducted to determine the frequency of vitamin D deficiency in patients with lumbar spinal stenosis and to define the relationship between vitamin D levels and obesity, depression, and pain intensity. Methods This study was conducted with 69 patients (Male = 32, Female = 37) diagnosed with lumbar spinal stenosis. The participants' 25(OH)D levels were measured by radioimmunoassay. In addition, bone metabolic status, including bone mineral density and bone turnover markers, was also evaluated. The Beck Depression Inventory was used to determine the depression statuses of the patients, while the McGill Melzack Pain Questionnaire was administered to measure pain intensity. The results were evaluated at a significance level of p<0.05. Results Vitamin D deficiency (<20 ng/mL) was found in 76.8% of the patients. Binary logistic regression analysis showed a significantly higher frequency of vitamin D deficiency in patients who: 1) had higher body mass indexes (OR 3.197, 95% CI 1.549-6.599); 2) fared higher in Beck's depression score (OR 1.817, 95% CI 1.027-3.217); and 3) were female rather than male (OR 1.700, 95% CI 0.931-3.224) (p<0.05). Conclusion In this study, vitamin D deficiency was prevalent in lumbar spinal stenosis patients. In addition, obese, depressed, and female individuals have higher risks of vitamin D deficiency.

RESUMO Objetivo Este estudo foi realizado para determinar a frequência de deficiência de vitamina D em pacientes com estenose espinhal lombar e para definir a relação entre os níveis de vitamina D e obesidade, depressão e intensidade da dor. Métodos Este estudo foi realizado com 69 pacientes (homens = 32, mulheres = 37) diagnosticados com estenose espinhal lombar. Os níveis de 25(OH)D dos participantes foram medidos por radioimunoensaio. Além disso, o estado metabólico ósseo, incluindo densidade mineral óssea e marcadores de remodelação óssea, também foi avaliado. O Inventário de Depressão de Beck foi usado para determinar os estados de depressão dos pacientes, enquanto o Questionário de Dor McGill Melzack foi aplicado para medir a intensidade da dor. Os resultados foram avaliados a um nível de significância de p<0,05. Resultados A deficiência de vitamina D (<20 ng/mL) foi encontrada em 76,8% dos pacientes. A análise de regressão logística binária mostrou uma frequência significativamente maior de deficiência de vitamina D nos seguintes pacientes: 1) com maior índice de massa corporal (OR 3,197, 95% IC 1,549-6,599); 2) com maior pontuação na escala de depressão de Beck (OR 1,817, 95% IC 1,027-3,217) e 3) do sexo feminino em vez de masculino (OR 1,700, 95% IC 0,931-3,224) (p<0,05). Conclusão Neste estudo, a deficiência de vitamina D foi prevalente em pacientes com estenose espinhal lombar. Além disso, pessoas obesas, deprimidas e mulheres correm maior risco de deficiência de vitamina D.

Analysis of the effect of inter-spinal distraction fusion and fixation combined with limited decompression on the treatment of lumbar spinal stenosis in elderly patients / 国际外科学杂志

Objective:To analyze the effect of inter-spinal distraction fusion and fixation (ISDFF) combined with limited decompression on the treatment of lumbar spinal stenosis in elderly patients.Methods:A total of 32 elderly patients with lumbar spinal stenosis, aged from 80 to 87 years old (mean age: 82.0±2.0 years) including 10 males and 22 females, in the Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University from January 2016 to January 2020 were enrolled in this retrospective study. Clinical evaluation and imaging measurement were performed before operation, after operation, 6 months and 24 months after operation. SPSS software was used for statistical analysis. Measured data of normal distribution were expressed as means±standard deviation. One way analysis of variance was used for comparison between groups. Paired t-test was used to compare between preoperative and postoperative as well as between preoperative and 24 months′ follow-up. Results:All of the 32 patients had one or more common accompanying diseases, such as hypertension, diabetes, coronary heart disease, and so on. All patients were successfully completed the operation with a total of 32 segments. VAS score was decreased from (6.22±0.91) before operation to (1.94±0.76) at 24 months( t=16.52, P<0.001). ODI score was also demonstrated the similar trend, from (54.17±10.65) preoperatively to (19.91±4.20) at 24 months follow-up( t=15.89, P<0.001). JOA score was significantly increased from (11.69±3.36) before surgery to (23.44±1.66) at the last follow-up ( t=-19.90, P<0.001). In the change of imaging, the intervertebral angle was decreased from preoperation (9.12±4.65) to (6.77±2.70) at 24 months( t=3.53, P=0.001). The posterior disk height was increased from (0.68±0.19) cm to (0.76±0.19) cm at the last follow-up( t=-2.45, P=0.020). Conclusions:As a new type of minimally invasive internal fixator, the ISDFF combined with limited decompression can relieve the pain of elderly patients with lumbar spinal stenosis and improve the quality of life. It is suitable for the treatment of elderly patients with lumbar spinal stenosis.

Examination of a Regression Model to Quantify the Severities of Low Back Pain and Lower Limb Symptoms in Patients with Lumbar Spinal Stenosis / The Japanese Journal of Rehabilitation Medicine

Objective：The Japanese Orthopaedic Association Low Back Pain Evaluation Questionnaire (JOABPEQ) consists of 25 questions, which allows for the multifaceted evaluation of patients with low back pain. In this study, we aimed to investigate whether the JOABPEQ could be used to construct a regression model to quantify low back pain, lower limb symptoms, and hip range of motion (ROM) in patients with lumbar spinal stenosis.Methods：We evaluated 115 patients with lumbar spinal stenosis scheduled to undergo surgery at our hospital. We measured the degrees of low back pain, lower leg pain, and lower leg numbness using the visual analog scale before the surgery. In addition, we measured the ROM of the hip joint during flexion, external rotation, and internal rotation. All responses of the JOABPEQ and physical function data were subjected to a partial least-squares (PLS) regression analysis.Results：Low back pain, lower limb pain, lower limb numbness, and hip ROM during flexion could each be used for significant regression models with JOABPEQ items. However, the hip ROMs during external and internal rotation could not be used for regression models with the JOABPEQ.Conclusion：On the basis of the results of the PLS regression analysis in this study, the degree of pain symptoms in patients with lumbar spinal stenosis may be quantified with the JOABPEQ items. Furthermore, the flexion angle of the hip ROM was quantified using the JOABPEQ items. The results of this study may indicate an effective means for establishing treatment plans for physical therapy.

Examination of a Regression Model to Quantify the Severities of Low Back Pain and Lower Limb Symptoms in Patients with Lumbar Spinal Stenosis / The Japanese Journal of Rehabilitation Medicine

Objective：The Japanese Orthopaedic Association Low Back Pain Evaluation Questionnaire (JOABPEQ) consists of 25 questions, which allows for the multifaceted evaluation of patients with low back pain. In this study, we aimed to investigate whether the JOABPEQ could be used to construct a regression model to quantify low back pain, lower limb symptoms, and hip range of motion (ROM) in patients with lumbar spinal stenosis.Methods：We evaluated 115 patients with lumbar spinal stenosis scheduled to undergo surgery at our hospital. We measured the degrees of low back pain, lower leg pain, and lower leg numbness using the visual analog scale before the surgery. In addition, we measured the ROM of the hip joint during flexion, external rotation, and internal rotation. All responses of the JOABPEQ and physical function data were subjected to a partial least-squares (PLS) regression analysis.Results：Low back pain, lower limb pain, lower limb numbness, and hip ROM during flexion could each be used for significant regression models with JOABPEQ items. However, the hip ROMs during external and internal rotation could not be used for regression models with the JOABPEQ.Conclusion：On the basis of the results of the PLS regression analysis in this study, the degree of pain symptoms in patients with lumbar spinal stenosis may be quantified with the JOABPEQ items. Furthermore, the flexion angle of the hip ROM was quantified using the JOABPEQ items. The results of this study may indicate an effective means for establishing treatment plans for physical therapy.

Effect of adequate amount of tranexamic acid before operation on blood loss and safety in posterior lumbar fusion with multiple segments / 中国输血杂志

【Objective】 To investigate the effect of adequate amount of tranexamic acid(TXA)before operation on blood loss and safety in posterior lumbar fusion with multiple segments. 【Methods】 A retrospective analysis was conducted on 105 patients with lumbar spinal stenosis, submitted to our hospital for multilevel PLIF, from March 2017 to December 2019. According to the intervention method, they were divided into control group, group A and group B (n =30, 39 and 36, respectively). TXA was not used in the control group. Dripping of saline solution(100 mL) containing TXA 2g and 1g was given in Group A and Group B, and extra intravenous pumping of TXA [10 mg/(kg·h)] during surgery was conducted in Group B besides the pre-operation dripping of TXA. Total blood loss, dominant blood loss, recessive blood loss, intraoperative blood loss, postoperative drainage volume, transfusion rate and hemoglobin (Hb), hematocrit (Hct), prothrombin time international standardized ratio (PT - INR), platelet count (Plt), D - dimer (D - D), C-reactive protein (CRP), neutrophil percentage (NP), alanine aminotransferase (ALT), and blood urea nitrogen (BUN) before and after operation were compared in the three groups. Postoperative drug-related adverse events were traced. 【Results】 1)The total blood loss, dominant blood loss(mL), intraoperative blood loss(mL), drainage volume(mL) within and after 24h after surgery, and the transfusion rate(%) in group A and B were 892.6±193.5 vs 887.7±320.8, 409.1±109.2 vs, 408.6±98.3, 193.7±69.3 vs 189.6±65.6, 130.5±53.4 vs 128.3±53.5, 63.1±17.6 vs 60.9±13.5 and 7.7 (3/39) vs 8.3 (3/36), respectively, which were significantly lower than that in group C as 1 296.8±329.2, 807.6±231.5, 270.9±65.5, 365.4±127.8, 172.3±66.4 and 36.7(11/30), respectively (P< 0.05). There were no significant differences in the above indexes between group A and group B (P < 0.05). The differences in recessive blood loss was not significant by groups(P<0.05). 2) Compared with pre-operation, the levels of Hb, Hct and Plt in the three groups at 3d after operation decreased: Hb(g/L) 91.5±14.0, 107.6±16.4 and 105.9±17.1; Hct(%) 25.6±3.1, 31.2±3.9 and 30.5±4.4; Plt(×109/L)146.6±31.8, 172.8 ±40.1 and 169.7±39.5(P < 0.05); while D-D, CRP and NP increased: D-D(mmol/L)365.6±67.1, 280.9±50.5 and 286.1±53.1; CRP(mg/L): 65.4±22.0, 53.4±19.6 and 56.8±17.7; NP(%): 87.3±15.6, 73.1±13.7, and 71.9±11.8(P < 0.05), and Pt-INR, ALT and BUN showed no significant changes (P > 0.05). The changes of Hb, Hct, Plt, D-D, CRP and NP in group A and B were significantly lower than those in group C at 3 days after operation [Hb (g/L) : 107.6±16.4, 105.9±17.1, 91.5±14.0; Hct (%) : 31.2±3.9, 30.5±4.4, 25.6±3.1; Plt (×109/L) : 172.8 ±40.1, 169.7±39.5, 146.6±31.8; D-D (mmol/L) : 280.9±50.5, 286.1±53.1, 365.6±67.1; CRP (mg/L) : 53.4±19.6, 56.8±17.7, 65.4±22.0; NP (%) : 73.1±13.7, 71.9±11.8, 87.3±15.6] (P < 0.05), and no significant differences in the above index were noticed between group A and B(P> 0.05).3)No lower limb deep vein thrombosis nor pulmonary embolism were found in group A and group B after operation, and all the incisions were healed in the first stage, and no serious complications such as drug allergy, cardiovascular and cerebrovascular accident, epidural hematoma, epilepsy occurred. 【Conclusion】 The preoperative TXA administration with sufficient single dose showed equivalent hemostatic effect in comparison with intraoperative continuous administration additional to preoperative dripping, which is simple and convenient and does not increase the risk of thrombosis.

Finite element simulation and biomechanical analysis of fully endoscopic precisely laminectomy decompression / 中国组织工程研究

BACKGROUND:Minimally invasive endoscopic decompression is currently used in the treatment of lumbar spinal stenosis, but there are few studies on the scope of precise laminectomy under the microscope. OBJECTIVE: To explore the influence of precise decompression with different laminectomy zones on lumbar range of motion and stress distribution using the entire degenerative lumbar finite element model. METHODS: A patient with lumbar spinal stenosis was randomly selected. Based on CT data, the lumbar L4-5 segment finite element model (M1) was established using relevant biomechanical software, and the validity was verified. After that, the finite element simulation of fully endoscopic precisely laminectomy decompression operation was performed. Combined with pathological classification of lumbar spinal stenosis, personalized laminectomy decompression aiming at different L4-5 segment stenosis was established, specifically including L4 lamina margin and partial facet joint resection model (M2), L5 lamina margin and partial facet joint resection model (M3), L4/5 lamina margin and partial facet joint resection model (M4), M4+"Over-the-Top" contralateral partial facet joint resection model (M5), and L4/5 lamina margin and over 50% facet jointresection model (M6). The same boundary loading was applied to the various finite element models. The lumbar range of motion and equivalent stress of intervertebral discs were compared under six conditions including flexion, extension, left and right flexion, left and right rotation. RESULTS AND CONCLUSION: (1) Compared with the entire M1 model, ranges of motion of M2, M3, M4 and M5 models were similar under various conditions, but range of motion of M6 model was significantly increased to 151 %-264% scope, especially in the extension and rotational conditions. (2) In terms of the equivalent stress of disc, the M2, M3, M4 and M5 models showed no obvious increasing trend at the anterior, left and right regions under various working conditions. The largest increase of the equivalent stress at posterior and middle disc regions was 53% maximally, but with no significant stress concentration. However, the equivalent stress in total disc regions showed a significant increasing trend in M6 model, especially in flexion condition with the maximum three times of M1 model. (3) Results suggest that extensive laminectomy can significantly affect the stability of the lumbar spine, with the intervertebral disc stress increase at the corresponding segment which is more likely to accelerate segmental degeneration. Minimally invasive endoscopic decompression is precise and controllable. The personalized decompression schemes can be adopted for different types of lumbar spinal stenosis to ensure the surgery effect and effectively maintain the biomechanical characteristics of the segments.

Analysis of Plantar Pressure before and after Occurrence of Neurogenic Intermittent Claudication in Patients with Central Lumbar Spinal Stenosis / 医用生物力学

Objective To investigate the changes of plantar pressure distributions and risk of falling before and after the occurrence of neurogenic intermittent claudication (NIC) in patients with central lumbar spinal stenosis (LSS), so as to provide theoretical and data references for the application of plantar pressure analysis in judgment of walking abilities for LSS patients. Methods Twelve patients with LSS at the L4-5 segment were selected as the LSS group, while twelve healthy adults at the same age were selected as the control group. Footscansystem was used to measure plantar pressure of these subjects during walking. Contact area percentage of the total foot contact area (CA%), pressure-time integral (PTI), foot progression angle (FPA), contact time percentage of the stance time (CT%) and total stance time (CT) in both LSS group and control group were compared to evaluate changes of plantar pressures during walking．Results Before the occurrence of NIC, compared with the control group, the LSS group had lower CT% during the forefoot push-off phase (FFPOP) and higher CT% during the initial contact phase (ICP), the total CT and FPA also increased, and the PTI of the 1st-3rd metatarsals and the CA% of the 2nd and 3rd metatarsals were higher. After the NIC occurred, for LSS group, CT% during ICP and forefoot contact phase (FFCP) decreased, CT% during the foot flat phase (FFP) and FFPOP as well as total CT and FPA increased, the PTI and CA% increased in 1st-4th metatarsals. Moreover, the CA% also increased in toe zone, both the PTI and CA% decreased in heel zone. Conclusions In patients with central LSS during walking, the distribution of plantar pressure shifts forward, with abnormal phase of the stance time occurring. Such abnormality will be further aggravated by NIC, indicating a higher risk of falling.

Mid-long-term effect of only placed expandable Interbody fusion cage in the treatment of lumbar spinal Stenosis with vertebral instability using micro-endoscopic Discectomy system / 中国组织工程研究

BACKGROUND: The incidence of lumbar spinal stenosis with vertebral instability is increasing year by year, which can cause symptoms such as waist and leg pain, lower limbs feeling numbness and intermittent claudication. In recent years, scholars have tried various minimally invasive treatment methods to further reduce the trauma and complications of surgery. The improvement of the clinical effect of minimally invasive surgery for lumbar spinal stenosis with vertebral instability is an important issue to be solved. OBJECTIVE: To evaluate the mid-long-term effect of only placed expandable interbody fusion cage in the treatment of lumbar spinal stenosis with vertebral instability using micro-endoscopic discectomy system. METHODS: A retrospective, self-control clinical trial was conducted in the First Affiliated Hospital of Zhengzhou University from 2012 to 2014. Totally 35 patients with lumbar spinal stenosis combined with vertebral instability were treated by only placed expandable interbody fusion cage using micro-endoscopic discectomy system. This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University. RESULTS AND CONCLUSION: (1) All 35 patients were followed-up for 60-85 months, mean (70.17±5.40) months. Among these patients, lumbar interbody fusion in 1 segment, 2 segments and 3 segments was performed in 6, 20 and 9 cases, respectively. A total of 73 intervertebral spaces were fused. (2) The mean operation time was 53.49±9.13 minutes (range, 35-75 minutes). The mean blood loss was 114.86±54.23 mL (range, 50-250 mL). (3) Dural rupture occurred in one case during operation and then hypotensive cranial pressure headache occurred after operation. Headache gradually eased after the patient received rehydration and analgesic treatment for 3 days. Poor incision healing occurred in one case after operation and then healed well after one-week vacuum sealing drainage technique. (4) The Visual Analogue Scale scores, Oswestry Disability Index, and height of intervertebral space were significantly decreased at 1 week, 6 months, 1 year, 2 years after surgery and the final follow-up compared to the preoperative ones. At 6 months after the operation, 31(42.5%) intervertebral spaces reached a strong fusion, 25(34.2%) possible fusion, and 17(23.3%) did not reach fusion. At 1 year after surgery, 51(69.9%) intervertebral spaces achieved a strong fusion and 22(30.1%) achieved possible fusion. At 2 years after surgery, 57(78.1%) intervertebral spaces achieved a strong fusion and 16(21.9%) achieved possible fusion. During final follow-up, 62(84.9%) intervertebral spaces achieved a strong fusion and 11(15.1%) achieved possible fusion. (5) At the last follow-up, cage migration was found in one case. The patient was not treated because of symptomless. (6) Unilateral approach only placed expandable interbody fusion cage by using micro-endoscopic discectomy system is a safe and reliable minimally surgical method, which has a good mid-long-term effect on lumbar spinal stenosis with vertebral instability.

Finite element simulation and biomechanical analysis of fully endoscopic precisely laminectomy decompression / 中国组织工程研究

BACKGROUND: Minimally invasive endoscopic decompression is currently used in the treatment of lumbar spinal stenosis, but there are few studies on the scope of precise laminectomy under the microscope. OBJECTIVE: To explore the influence of precise decompression with different laminectomy zones on lumbar range of motion and stress distribution using the entire degenerative lumbar finite element model. METHODS: A patient with lumbar spinal stenosis was randomly selected. Based on CT data, the lumbar L4-5 segment finite element model (M1) was established using relevant biomechanical software, and the validity was verified. After that, the finite element simulation of fully endoscopic precisely laminectomy decompression operation was performed. Combined with pathological classification of lumbar spinal stenosis, personalized laminectomy decompression aiming at different L4-5 segment stenosis was established, specifically including L4 lamina margin and partial facet joint resection model (M2), L5 lamina margin and partial facet joint resection model (M3), L4/5 lamina margin and partial facet joint resection model (M4), M4 + "Over-the-Top" contralateral partial facet joint resection model (M5), and L4/5 lamina margin and over 50% facet jointresection model (M6). The same boundary loading was applied to the various finite element models. The lumbar range of motion and equivalent stress of intervertebral discs were compared under six conditions including flexion, extension, left and right flexion, left and right rotation. RESULTS AND CONCLUSION: (1) Compared with the entire M1 model, ranges of motion of M2, M3, M4 and M5 models were similar under various conditions, but range of motion of M6 model was significantly increased to 151%-264% scope, especially in the extension and rotational conditions. (2) In terms of the equivalent stress of disc, the M2, M3, M4 and M5 models showed no obvious increasing trend at the anterior, left and right regions under various working conditions. The largest increase of the equivalent stress at posterior and middle disc regions was 53% maximally, but with no significant stress concentration. However, the equivalent stress in total disc regions showed a significant increasing trend in M6 model, especially in flexion condition with the maximum three times of M1 model. (3) Results suggest that extensive laminectomy can significantly affect the stability of the lumbar spine, with the intervertebral disc stress increase at the corresponding segment which is more likely to accelerate segmental degeneration. Minimally invasive endoscopic decompression is precise and controllable. The personalized decompression schemes can be adopted for different types of lumbar spinal stenosis to ensure the surgery effect and effectively maintain the biomechanical characteristics of the segments.

Minimally invasive transforaminal lumbar interbody fusion for treatment of single-segment lumbar spinal stenosis improves lumbar-pelvic balance / 中国组织工程研究

BACKGROUND: More and more studies have shown that lumbar-pelvic parameters are closely related to the clinical effect and adjacent segment degeneration after lumbar fusion, but the effect of minimally invasive transforaminal interbody fusion on lumbar-pelvic parameters is not clear. OBJECTIVE: To evaluate the effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on the lumbar-pelvic imaging parameters in patients with single-segment lumbar spinal stenosis. METHODS: The clinical data of 85 patients with single-segment lumbar spinal stenosis treated by MIS-TLIF and open-TLIF in the First Affiliated Hospital of Dali University from January 2015 to January 2017 were retrospectively analyzed, including 39 cases of MIS-TLIF operation (MIS-TLIF group) and 46 cases of open-TLIF operation (open-TLIF group). On the standing lateral lumbar X-ray containing bilateral femoral heads: lumbar lordosis, segmental lordosis, height of the intervertebral disc, the L1 axis and S1 distance, pelvic incidence, pelvic tilt, and sacral slope were measured, and the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were calculated. RESULTS AND CONCLUSION: (1) During the last follow-up, lumbar lordosis, height of the intervertebral disc, and sacral slope were increased in both groups compared with preoperative parameters, but pelvic tilt was decreased compared with preoperatively, and the difference was significant (P 0.05). (2) During the last follow-up, lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope, and the L1 axis and S1 distance were not significantly different compared with preoperative parameters (P > 0.05). (3) The difference between pelvic incidence−lumbar lordosis was significantly decreased at the last follow-up compared with preoperative parameters in the two groups (P 0.05). (4) Above results indicated that for single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open-TLIF in recovery of lumbar lordosis, intervertebral height, and improving lumbar-pelvic balance.

A finite element model of full endoscope lumbar fenestration and biomechanical characteristics / 中国组织工程研究

BACKGROUND: The effective treatment of lumbar spinal stenosis with total endoscopic decompression is a breakthrough frontier technology. Compared with open surgery, it has the characteristics of fewer traumas, controllable operation, and fewer complications, but it reported less in finite element biomechanics. OBJECTIVE: To establish a finite element model of full endoscope lumbar fenestration and to investigate the effects of decompression range and nucleus pulposus removal on lumbar range of motion and stress distribution of disc. METHODS: CT scan data of a case of L4-5 segmental lumbar spinal stenosis were collected and imported in Mimics 20.0 software. A finite element model M of L4-5 lumbar spinal stenosis in degenerative lumbar spine was established. The model M was imported into 3-matic for surgical simulation, i.e., unilateral disc resection of the small joints 1/2 and 1/4 model M1, bilateral joints 1/2 and 1/2 resection of intervertebral disc model M2, and unilateral disc and articular process of 1/4 model M3. In the ANSYS software, the mechanical comparative analysis was conducted in four kinds of models under six working conditions of the same pure couple moment, including forward bending, backward extension, left bending, right bending, left rotation and right rotation, and the same load of the intervertebral disc. RESULTS AND CONCLUSION: (1) Compared with the spinal M model, the range of motion of M1 model was similar under six working conditions, but the range of motion of M2 and M3 was significantly increased than that of M, especially under the left/right flexion and forward/backward flexion working conditions, which was 130%-200% of the overall activity of M model. (2) In terms of the stress of intervertebral disc, M1 model showed no obvious upward trend of the effect force in the posterior region, central region and right region of intervertebral disc under various working conditions. The equivalent stress in the left region and front region of intervertebral disc increased to a maximum of 63%, but there was no significant stress concentration. In the M2 and M3 models, the equivalent stress of intervertebral discs in all regions showed a significant increased trend. (3) Endoscopic minimally invasive surgery is accurate and controllable for different types of lumbar spinal stenosis decompression surgery. The resection of facet joints and the removal of nucleus pulposus by less than 1/2 have little influence on the biomechanical stability of the corresponding segments. The successful and reliable finite element modeling of lumbar lamina fenestration can provide an important method and basis for the follow-up biomechanical study of lumbar surgery.

Full endoscopic I See technique for the treatment of single-segment degenerative lumbar spinal stenosis / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy and advantages of the full endoscopic I See technique for the single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 38 patients with the single-segment degenerative lumbar spinal stenosis treated by full endoscopic I See technique from January 2017 to March 2018 were analyzed retrospectively. There were 16 males and 22 females, aged from 35 to 79 years with an average of(53.45±12.56) years. Five cases were L, 23 cases were L, 10 cases were LS. The clinical efficacy was evaluated by VAS, ODI and Macnab scores.@*RESULTS@#All the patients were followed up for more than 12 months after operation. The length of operation was from 55 to130 (86.0± 17.5) min. Intraoperative blood loss was ranging from 10 to 50 (17±6) ml, and the hospitalization length was from 3 to 7 days with an average of 4.6 days. The VAS scores of low back pain assessed before operation, and 3 d, 3 months, 12 months post operation were 6.67 ±1.25, 3.87 ±1.35, 2.55 ±1.21, 2.05 ±0.97, respectively, and the differences were statistically significant (P < 0.05);VAS scores of leg pain at these time points were 7.85±2.62, 3.31±1.42, 2.02±1.13, 1.85±0.86, respectively, and the differences were statistically significant (<0.05);ODI scores were 40.32±5.38, 25.76±4.81, 12.66±4.64, 9.32±2.91, respectively, and the differences were statistically significant (<0.05). Tevaluate the lumbar vertebrae function according to the Macnab criteria, 15 cases obtained excellent results, 19 cases were good, and 4 cases were fair.@*CONCLUSION@#Full endoscopic I See technique is effective in the treatment of single-segment degenerative lumbar spinal stenosis, with the advantages of less trauma, shorter hospital stay, and faster recovery.

Middle and Long-term Clinical Effiacacy of Duhuo Jishengtang Combined with Minimally Invasive Decompression of Lumber Spine in Treatment of Degenerative Lumbar Spinal Stenosis with Kidney Deficiency Syndrome / 中国实验方剂学杂志

Objective:To observe the clinical efficacy of Duhuo Jishengtang combined with minimally invasive decompression of lumber spine in the treatment of degenerative lumbar spinal stenosis with kidney deficiency syndrome for more than 3 years. Method:Through a single-center parallel randomized controlled clinical trial， 63 patients with degenerative lumbar spinal stenosis who were hospitalized in Jiangsu Hospital of Traditional Chinese Medicine from October 2015 to April 2017 were observed for more than three years. Among them， there were 31 cases in the operation combined with traditional Chinese medicine group （observation group） and 32 cases in the operation combined with Celebrex and Mecobalamin group （control group）. Both groups were given routine treatment. The observation group was treated with Duhuo Jishengtang for 3 weeks， while the control group was treated with Celebrex and Mecobalamin for 3 weeks. Result:In the aspect of pain improvement， only 3 months after operation， the observation group was superior to the control group （P<0.05）， with no significant advantage at other time nodes during follow-up. During the 3-month follow-up and a longer period， it was confirmed that observation group had a significant advantage in improving lumbar function （P<0.01）. At the last follow-up， the good efficacy rate of observation group was 83.87% （26/31）， while the good efficacy rate of the control group was 62.5% （20/32）. There was no unstable performance in the last follow-up of the two groups. There was no statistically significant difference between two groups. Conclusion:The middle and long-term follow-up for minimally invasive decompression of lumber spine showed a satisfactory efficacy in the treatment of degenerative lumbar spinal stenosis， with no impact on the stability of the operative segments. For patients of lumbar spinal stenosis with kidney deficiency syndrome， Duhuo Jishengtang can promote the recovery of postoperative neurological function， and improve the good efficacy rate of clinical treatment， but with no obvious advantage in pain relieve after operation.

Evaluation of Functional Outcome of Laminectomy and Laminotomy for The Surgical Management of Lumber Spine Stenosis: An Institutional Based Study

Background: Lumbar spinal stenosis (LSS) is commonly seenin the elderly especially owing to the aging of the spine.Growing in the facet joints, ligamentum flavum hypertrophy,disc degeneration, and osteophytes cause the spinal canal toconstrict and accordingly result in spinal cord and nerve rootcompression. If conservative treatments fail, surgicalintervention will be considered as the next treatment. Surgicaldecompression for LSS is indicated in a patient with intractablepain, neurogenic claudication, and motor weakness,accompanied by compromised spinal canal. Laminectomy forLSS is considered the standard surgical option to which othertechniques are compared. Ascertaining superiority of adecompression technique necessitates establishing if anydifferences exist in the complication rates and the functionaland symptomatic outcomes.Aim of the Study: To evaluate functional outcome oflaminectomy and laminotomy for the surgical management oflumber spine stenosis.Materials and Methods: The present study was conducted inthe Department of Orthopaedics, NIIMS Medical College,Jaipur, Rajasthan, India. For the study, patients with confirmedLSS (both lateral and/or central) on MR imaging who had failedconservative management, were considered for operativemanagement. Patients with spondylolisthesis, or scoliosis andthose who had undergone fusion, discectomies or furtherrevisions were excluded from the study. Following exclusions,50 patients were enrolled; 30 underwent a laminectomy withoutfusion and 20 underwent either a bilateral or unilaterallaminotomy.Results: We observed that VAS pain score decreased 6weeks post operatively for patients who underwentlaminectomy and laminotomy, however there was slightincrease in the pain score at 1-year post operatively. Theresults on comparison were found to be statically significant.Conclusion: Within the limitations of the present study, it canbe concluded that both surgeries were equally effective inimproving pain and disability.

Influence of age, sex, height and lumber stenosis on the position of the conus medullaris in adults / Influencia de la edad, sexo, altura y estenosis lumbar en la posición del cono medular en adultos

Anatomical orientation of the termination level of Conus Medullaris (CM) has imperative role clinically for anesthetists and neurosurgeons which is considered as an objective guide to perform spinal anesthesia and spinal punctures circumspectly with less chance to have serious injuries. The current retrospective study was carried on to determine the location of the CM and how its termination level can be influenced by age, sex, height and lumber stenosis spine disease. The study included 462 participants that consisted of 199 men and 263 women range from 21 to 80 years of age and height range between 150-190 cm. Also, it included 150 lumber stenosis patients. The location of the CM was imaged using a series of magnetic resonance images (MRI) for the lumbosacral spine at different levels including, T12, T12-L1, L1, L1-L2, and L2. The measurements revealed inconsiderable differences in the CM termination level in relation to age, sex and height in a healthy study population. Moreover, the results showed insignificant differences in the CM termination level between men and women whether they are healthy or having lumbar spinal stenosis. In conclusion, the most common level of CM termination is at L1 followed by L1-L2. It is safe to perform a lumbar neuraxial procedures at the level of L3-L4.

La orientación anatómica del nivel de terminación del Conus medullaris (CM) tiene un importante papel clínico para los anestesistas y neurocirujanos, que se considera una guía objetiva para realizar la anestesia espinal y las punciones de la columna circunspectivamente con menos posibilidades de provocar lesiones graves. Se llevó a cabo un estudio retrospectivo para determinar la ubicación del CM y cómo su nivel de terminación puede verse afectado por la edad, el sexo, la altura y una patología de la columna vertebral, la estenosis lumbar. El estudio incluyó 462 participantes que consistían en 199 hombres y 263 mujeres de 21 a 80 años de edad y una altura de entre 150-190 cm. Además, se incluyeron 150 pacientes con estenosis lumbar. La ubicación del CM se determinó mediante una serie de imágenes de resonancia magnética (RM) de la columna lumbosacra a diferentes niveles, incluidos T12, T12-L1, L1, L1-L2 y L2. Las mediciones revelaron diferencias considerables en el nivel de terminación de CM en relación con la edad, el sexo o la altura en una población de estudio saludable. Además, los resultados mostraron diferencias poco significativas en el nivel de terminación de CM entre hombres y mujeres, sanos o con estenosis espinal lumbar. En conclusión, se encontró que el nivel más común de terminación del CM es L1 seguido de L1-L2, considerándose seguro realizar procedimientos neuroaxiales lumbares a nivel de L3-L4.