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.

The effect of non-surgical spinal decompression on the paraspinal muscles of persons with lumbar disc herniation / 中华物理医学与康复杂志

Objective To explore the effect of non-surgical spinal decompression (SDS) on the surface electromyogram signals from the paraspinal muscles of patients with lumbar disc herniation (LDH).Methods Twelve patients diagnosed with L4.5 LDH were recruited and randomly dividcd into an SDS group and a control group,each of 6 according to their order of admission.The SDS group received spinal decompression,while the control group was given lumbar traction.The average surface electromyogram signals (AEMGs) were recorded before,during and after the treatment.Results Before the treatment,the AEMG values collected from the left and right erector spinae and multifidus of the SDS group were already significantly different from those of the control group.During the treatment,the AEMG values collected from the right erector spinae and multifidus of the SDS group remained significantly different from those of the control group.After the treatment,the AEMG values were still significantly different.Conclusions SDS relieves tension and fatigue of the paraspinal muscles better than lumbar traction.

A nonoperative spinal decompression system combined with foramen injections to treat lumbar intervertebral disc herniation / 中华物理医学与康复杂志

Objective To observe the clinical efficacy and safety of non-surgical spinal decompression com-bined with intervertebral foramen injection in the treatment of lumbar intervertebral disc herniation. Methods Nine-ty-six patients were randomly divided into a control group, a decompression group, an injection group and a combined group. All of the subjects were given loxoprofen sodium and chestnut seed extract. The decompression group was trea-ted with non-operative spinal decompression. The injection group received intervertebral foramen injections. The com-bined group received both treatments. Pain perceptions, quality of life perceptions and lumbar dysfunction were ob-served before the treatment, and 2 days, 1 month, 6 months and 12 months afterward. Results There were no sig-nificant differences among the groups in average pain perceptions quantified using a visual analogue scale ( VAS) be-fore the treatment. The average scores on a 36-item short-form health survey, the Oswestry disability index and a Jap-anese Orthopedic Association instrument also were not significantly different. All of those indicators had improved sig-nificantly in the decompression, injection and combined groups at 1, 6 and 12 months after the treatment, but the combined group′s average indicators were all significantly better than the other groups′ averages at the same time points. All of the significant improvements in the combined group′s averages occurred in the first month after the com-bined treatment. Conclusion Non-operative spinal decompression has a synergistic effect with intervertebral fora-men injection in treating patients with lumbar disc herniation. Their combined effect is better than either treatment a-lone. Their combined effect is lasting, safe and has few complication risks. It is worthy of clinical application.

The Effects of Spinal Decompression Therapy on Pain and Disability in Patients with Chronic Low Back Pain

PURPOSE: The purpose of this study was to examine the effects of spinal decompression therapy on pain and disability in patients with chronic low back pain. METHODS: Twenty patients with chronic low back pain were divided into an experimental group (spinal decompression therapy, n=10) and a control group (conservative physical therapy, n=10). Both groups were treated three times a week over a four-week period. RESULTS: The comparison of between-group changes post-treatment revealed statistically significant lower levels of pain and disability in the experimental group than the control group. The comparison of within each group changes before and after the treatment showed statistically significant declines in pain and disability indexes of both groups. CONCLUSION: Spinal decompression therapy may be an effective intervention for improving pain and disability in patients with chronic low back pain.

Efficacy of transforaminal endoscopic nerve root decompression in the treatment of degenerative lumbar spinal stenosis / 北京大学学报(医学版)

Objective:To evaluate the feasibility of transforaminal endoscopic nerve root decompression for degenerative lumbar spinal stenosis (DLSS).Methods: From July 2011 to April 2016,96 cases of single segment DLSS were involved.All the patients had unilateral lower extremity neurological symptoms,signs,neurogenic intermittent claudication of less than 500 m.Imaging examinations (CT or MRI) or diagnostic nerve root block confirmed single segment degeneration.The mean age was (71.6±5.4) years,male: 55 cases,female: 41 cases.Their intraoperative blood loss,operation time,complications,ambulation time and discharge time were recorded.Leg pain VAS,ODI were used to evaluate the pain and lumbar function of the patients.The clinical efficacy was evaluated by Nakai evaluation.Results: All the patients were performed endoscopic decompression of the lateral recess and nerve root by removing the ventral part of the superior facet joint,the ligamentum flavum and the intervertebral disc.The decompression range was from the inferior edge of the upper pedicle to the superior edge of the lower pedicle.The nerve root was detected to have no compression and the pulse of nerve root returned to normal.The patient got ambulant on the operation day and discharged if he had no discomfort symptom.In the study,68 cases got follow up.The mean follow-up time was 12.1 months (6-63 months).The VAS at dif-ferent follow-up time points was improved relative to the baseline,and the difference was statistically significant (F=491.60,P<0.001).The ODI at different follow-up time points was improved relative to the baseline,and the difference was statistically significant (F=189.91,P<0.001).The excellent and good rates of Nakai evaluation were 79.4％ (excellent in 42 cases,good in 12 cases,fair in 10 cases and poor in 4 cases).The mean intraoperative blood loss was (49.29±11.86) mL.The mean operation time was (92.46±21.34) min.The mean ambulation time was 1.8 h.The mean discharge time was 2.3 days.Postoperative epidural hematoma was found in 1 case.Foot drop was found in 1 case.Second stage open surgery was performed in 6 cases.Conclusion: We can apply transforaminal endoscopic decompression for the patients of lumbar spinal stenosis who have unilateral nerve root irritation.Patients with transforaminal endoscopic decompression can get less surgical trauma,quick recovery and obtain good short-term outcome.

Analysis on risk factor for lumbar disc herniation after decompression / 局解手术学杂志

Objective The study aimed to identify risk factors of lumbar disc herniation in patients after decompression,and provide theoretical basis for postoperaive rehabilitation.Methods A told of 169 patients with lumbar spinal stenosis underwent bilateral partial laminectomy were included in the study,24 patients in herniation group,and 145 patients without develop postoperative acute sciatica as a control group.The radiographic variables were measured.The threshold of risk factors was evaluated by multiple logistics analysis and receiver operating characteristic curve(ROC) analysis.Results The results revealed that preoperative retrolisthesis during extension was the independent risk factor for lumbar disc herniation(1.24,95％CI[1.07～1.43];P<0.01).The area under the curve(AUC) was 0.801,and the cutoff value was 6.89％.Conclusion The preoperative retrolisthesis was the risk factor of lumbar disc herniation.

06-3Rehabilitation to residual functional disorders in spinal decompression sickness resulting from recreational scuba diving / 日本温泉気候物理医学会雑誌

  Spinal decompression sickness including spinal cord damage is indeed a rare sickness, and in particular, there have been few reports on residual functional disorder. This case was a 39-year-old male who had been a recreational scuba diver for 13 years. While scuba diving overseas, he had suffered from decompression sickness with spinal cord involvement. As a result, imcomplete paraplegia with spasticity, sensory disturbance, neurogenic bladder and bowel disturbance occurred. Inclusive rehabilitation containing physical therapy, was provided to control the spasticity, the pain, and the improvement of the activities of daily living was thereby achieved. However, the changes of the muscle hardness, paresthesia, and hyperalgesia, and the disturbance of position and vibration sense remained. The cause of spinal decompression sickness is not clear, but a venous embolism in the spinal veins has been reported. Further observation is considered necessary.

Nonsurgical spinal decompression and common cervical traction compared / 中华物理医学与康复杂志

Objective To compare the effects of nonsurgical spinal decompression system (SDS) cervical traction and common cervical traction using surface electromyography (sEMG).Methods Twenty-two volunteers' sEMG signals were recorded before,during and after two modes of cervical traction:the conventional traction in sitting and SDS traction in supine.The interval between the two modes of traction was no shorter than 24 hours.The mean and peak amplitudes of their sEMG signals were observed before,during and after traction.The sEMG signals of the posterior cervical muscle while sitting or lying were compared at different stages of the traction.Results There was no statistically significant difference in sEMG signals between the subjects' right and left posterior cervical muscles.The sEMG signals decreased significantly during both traction trials.With common cervical traction the mean and peak amplitudes of the left posterior cervical muscle pre-and post-traction were higher than during traction,and the same as that of the right posterior cervical muscle.In the SDS trials the sEMG signals during traction and post-traction were significantly lower than those pre-traction.After traction the sEMG signals while sitting (common cervical traction) were significantly higher than those post-traction while lying (SDS cervical traction),and the sEMG signals post-traction while either lying or sitting were stronger than during traction while lying.The post-traction signals in sitting were stronger than those in lying.Conclusions Both nonsurgical SDS and common cervical traction can relax the posterior cervical muscles.The effect of nonsurgical SDS was better than that of common cervical traction.

06-3 Rehabilitation to residual functional disorders in spinal decompression sickness resulting from recreational scuba diving / 日本温泉気候物理医学会雑誌

  Spinal decompression sickness including spinal cord damage is indeed a rare sickness, and in particular, there have been few reports on residual functional disorder. This case was a 39-year-old male who had been a recreational scuba diver for 13 years. While scuba diving overseas, he had suffered from decompression sickness with spinal cord involvement. As a result, imcomplete paraplegia with spasticity, sensory disturbance, neurogenic bladder and bowel disturbance occurred. Inclusive rehabilitation containing physical therapy, was provided to control the spasticity, the pain, and the improvement of the activities of daily living was thereby achieved. However, the changes of the muscle hardness, paresthesia, and hyperalgesia, and the disturbance of position and vibration sense remained. The cause of spinal decompression sickness is not clear, but a venous embolism in the spinal veins has been reported. Further observation is considered necessary.

Effect of Spinal Decompression Therapy Compared with Intermittent Mechanical Traction in Lumbosacral Disc Herniation

OBJECTIVE: To compare the effects of intermittent mechanical traction with spinal decompression therapy (SDT), using the newly introduced device DRX 3000(R), in patients suffering from low back pain associated with lumbosacral disc herniation documented on MRI. METHOD: Thirty-five patients with low back pain with or without lower extremity radiating pain were prospectively enrolled in this study. They were all diagnosed with lumbosacral disc herniation according to physical examinations and MRI. Patients over age 60 years or those with previous spinal surgery, spondylolisthesis, severe osteoporosis, rheumatic diseases, hypertension, and other serious medical problems were excluded. Patients were randomly assigned to intermittent mechanical traction group (15 patients) or SDT group (20 patients) and compared visual analog pain scale (VAS) pre- and post-treatment. RESULTS: There was a significant improvement in VAS in SDT group compared to intermittent mechanical traction group. The mean reduction in VAS for intermittent mechanical traction group equaled 1.93+/-0.83 (from 6.4+/-1.28 to 4.5+/-1.22) while the mean reduction in VAS in SDT group equaled 4.35+/-2.21 (from 6.9+/-1.86 to 2.6+/-1.43) (p=0.0006). CONCLUSION: Spinal decompression therapy can be used as an effective treatment for discogenic low back pain without serious complications.

Application of posterior circumferential fusion in the surgery of lumbar spondylolisthesis / 中国矫形外科杂志

[Objective] To evaluate the feasibilitiy,methods and therapeautical effects of the posterior circumferential fusion (PCF) combined with short -segmental pedicle screw system fixation for the treatment of lumbar spondylolisthesis(LSL). [Method] From October 2002 to March 2006, 44 cases of LSL were treated with decompression for spine canal stenosis, circumferential fusion and short-segmental pedicle screw system fixation. There were 15 male and 29 female, average age was 48. 6 (ranged, 31~68) years. The diagnoses of LSL and stenosis were confirmed by X-ray and CT. According to Newman classification, 15 of them were the degenerative type and 29 were isthmic type. According to Meryerding classification of LSL, 17 patients had degree I, 24 patients had degree Ⅱ and 3 patients had degree Ⅲ spondylolisthesis. The levels of LSL was between L4 and L5,in 18 patients and between L5 and S1 in 26 cases.[Result]The follow-up period was 18~36 months , averaged 26 months.Seventeen patients with degree Ⅰ spondylolisthesis were all reduced anatomically after surgery. Twenty-four patients with degree Ⅱ spondylolisthesis were reduced anatomically except for 6 patients with Ⅰ degree residual spondylolisthesis. 3 patients with degree Ⅲ spoadylolisthesis were reduced anatomically except for 2 spatients with Ⅰ degree residual spondylolishesis. The effect was evaluated according to Hou Shuxun's evaluation standard, the results were excellent in 28 cases, good in 13 cases, and fair in 3 cases. The excellent and good rate was 93.2%. No complication such as interfixation failure and nerve pedicle injury or cauda equine injury were found. All cases got bony union in 3 to 10 months (mean 4.2 months) postoperatively. All patients had normal disc height and no loss of spondylolisthesis reduction. [Conclusion] The PCF combined with short-segmental pedicle screw system fixation is reasonable options in treating the LSL. It can improve the fusion rate of the spine and maintain good intervertebral space and good lordosis of the lumbar spine. The satisfactory clinical result is relied on the completely understanding of the characteristics of PCF and short-segmental pedicle screw fixation.

Evaluation and comparison in the results of surgical treatment of lumbar spondylolisthesis with reduction or non-reduction of spinal sliding / 中国矫形外科杂志

0.05).[Conclusion]It is suggested that reduction of spinal sliding in lower grade LS is not needed after surgical decompression of spinal cord,releasing of nerve root,internal fixation and bone fusion.

Lumbar Spinal Stenosis Accompanied by Severe Osteoarthritis of Knee: Comparison between Staged Operations and Same-day Operations / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To compare the peri-operative morbidity of patients who undergo same-day operations for lumbar spinal stenosis accompanied by severe osteoarthritis of knee with those who undergo staged operations . SUMMARY AND LITERATURE REVIEW: There is no report on the peri-operative morbidity of same-day operations for patients who have a concurrent lumbar spinal stenosis and severe osteoarthritis of the knee, even though elective surgery for lumbar spinal stenosis or total knee arthroplasty are safe procedures. MATERIALS AND METHODS: From January 1996 to December 2005, 11 patients who underwent staged operations for lumbar spinal stenosis and concomitant osteoarthritis of the knee (Group I) and 14 patients who underwent total knee arthroplasty and lumbar spinal decompression and fusion on the same-day (Group II) were compared in terms of the operative time, blood loss, perioperative complications and admission days. The data was analyzed statistically using a chi-square test through SPSS v.10.0. RESULTS: The mean surgery time in groups I and II was 266+/-34.4 minutes and 258+/-54.2 minutes, respectively. The estimated blood loss during operation of groups I and II was 1055+/-229.6 and 925+/-174.0. There was no statistical differences between the two groups. There were no life-threatening complications in any group. The admission period for group I and group II were 41.0+/-6.05 days and 30.1+/-5.10 days respectively, but there was no statistical significance. CONCLUSION: There was no difference in the surgical time, estimated blood loss, and complications between the group that underwent the staged operations and the group that underwent same-day operations. A possible surgical option is to perform both procedures on the same day.

Minimally Invasive Lumbar Decompression, Interbody Fusion, and Pedicle Screw Fixation: Preliminary Report

OBJECTIVE: With improvement in endoscopic visualization and surgical tools, several minimally invasive procedures such as transpedicular fixation, interbody fusion, or decompression have advocated their respective advantages. But all these procedures are developed separately and are not related to other techniques. The authors utilize these procedures as organized procedure like comprehensive conventional procedure. This study is designed to study early results of minimally invasive decompression, interbody fusion, and endoscopic pedicle screw fixation. METHODS: We utilized minimally invasive decompression, interbody fusion, and endoscopic pedicle screw fixation on 12 consecutive patients(9 female, 3 male, mean age 54.8 years). For decompression, unilateral laminectomy and controlateral laminar undercutting was performed through tubular retractor, and interbody fusion(PLIF or TLIF) was done with one cage and bone packing. Pedicle screw fixation was done using expandable tubular retractor under endoscopic visualization and fluoroscopic guidance. Contralateral screw fixation was done with the same manner. RESULTS: There were five spinal stenosis and seven degenerative spondylolisthesis. All patients received one level (L4-5) decompression, interbody fusion, and fixation. Mean operating time was 245.8 minutes. There was dural tear in one patient. All patients were excellent or good with average follow up of 7.2 months. Bone fusion was not evident due to short-term follow-up, but there were no instability or screw loosening. CONCLUSION: Although it is small series and has short-term follow-up, this study demonstrates that minimally invasive decompression, interbody fusion, and pedicle screw fixation are feasible and effective.

Clinical Evaluation of Anterolateral Surgical Decompression and Instrumentation in Thoracolumbar Bursting Fracture

The authors report clinical results of fifty-two traumatic thoracolumbar bburstfractures treated by internal fixation with Kaneda device after anterior decompression during recent six years. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were vehicle accident and fall.In all cases, spinal decompression, internal instrumet fixation and bone fusion(rib, iliac bone) were performed. No patient showed neurological deterioration after surgery and almost all patients improved post operatively by on grade of Frankel's(classification). Thirty-three patients(85%) with Denis type I and II showed the correction of the fracture deformities with good bony fusion and 9 of 13 patients(70%) with Denis type IV showed bony fusion in serial follow-up. It if thus concluded that anterolateral internal fixation combined with bony fusion provide good mechanical stability and decompression of protruding ventral bone fragments above conus medullaris level.

Anterolaateral Surgical Decompression and Instrumentation in Thoracolumbar Bursting Fracture / 영남의대학술지

Ten patients with a thoracolumbar spine fractures were treated with Kaneda internal fixation device through anterolateral approach during last 1 year. In all cases, spinal decompression, internal instrument fixation and bone fusion with rib were performed. No patient showed neurological deterioration after surgery and 6(60%) patients improved postoperatively with entering the next Frankel subgroup. Follwo-up patient evaluation showed the correction of the fracture deformity with good bony fusion, but 3 patient are remained back pain. According to above results we concluded that anterolateral internal fixation combined.with bone fusion using rib was good mechanical stability and decompression of protruding ventral bone fragments above conus medullaris level.