Establishment and Validation of Nomograms and Web Calculators for Different Cement Leakage Risk Types in Pedicle Screw Augmentation for Degenerative Lumbar Stenosis in Osteoporotic Vertebrae.

BACKGROUND: The use of cement in pedicle screw augmentation (PSA) enhances the pullout force of pedicle screws in vertebrae affected by osteoporosis. Risks involved in the use of cement for PSA include nerve injury and vascular damage caused by cement leakage. METHODS: This study included all patients who received PSA for degenerative lumbar stenosis in osteoporotic vertebrae from January 2014 to May 2022. Postoperative computed tomography was used to assess cement leakage. Correlation analysis and logistic regression analyses were used to establish the associated clinical or radiological factors, which were then used to construct nomograms and web calculators. RESULTS: The study comprised 181 patients including 886 screws inserted into 443 vertebrae. Perivertebral cement leakage was significantly associated with female sex, decreased bone mineral density, solid screws, and scattered cement distribution. Cement leakage through segmental veins (type S, 72.1%), leakage through basivertebral veins (type B, 23.9%), and instrument-related leakage (type I, 13.9%) accounted for most cement leakage. Patients with lower bone mineral density and scattered cement distribution were more likely to experience type S or type B leakage. Our analysis data showed that cement augmentation with cannulated and fenestrated screws tended toward concentrated cement distribution. Creation and verification of each nomogram additionally showcased the prognostic capability and medical significance of the corresponding model. CONCLUSIONS: Nomograms and web-based calculators can accurately forecast the probability of cement leakage. PSA should be routinely performed using cannulated and fenestrated screws, along with a moderate amount of high-viscosity cement, with continuous monitoring using fluoroscopy.

The Impact of Surgical Approach on Sagittal Plane Alignment in Patients Undergoing One- or Two- Level Fusions for Degenerative Pathology: A Multicenter Radiographic Evaluation 6 Months Following Surgery.

OBJECTIVE: Interbody fusion procedures, including transforaminal (TLIF), posterior (PLIF), anterior (ALIF), and lateral (LLIF), effectively treat lumbar degenerative pathology and provide spinopelvic balance. The objective of this study is to compare changes in spinopelvic parameters 6 months following 1-2 level TLIF, PLIF, ALIF, and LLIF. METHODS: This retrospective study included 18 centers across the United States. Patients were included in the study if they underwent a 1- or 2-level primary lumbar fusion for degenerative pathology. Preoperative and 6-month postoperative lumbar anteroposterior and lateral lumbar plain radiograph measurements included: pelvic incidence, pelvic tilt, lumbar lordosis from L1-S1, and segmental lordosis of each segment between L1 and S1. RESULTS: A total of 474 patients met inclusion criteria, with 632 levels that underwent fusion. Of these, 181 patients underwent an ALIF/LLIF on 381 levels, and 188 underwent a TLIF/PLIF on 252 levels. ALIF/LLIF procedures resulted in significantly more segmental lordosis (P < 0.001) and global lumbar lordotic alignment change (P < 0.01) compared with TLIF/PLIF procedures. Whether patients' alignment was preserved versus worsened was not significantly predicted by type of procedure. Similarly, whether patients' alignment was restored versus not corrected was not significantly predicted by procedure. CONCLUSIONS: In this large-scale multicenter study of lumbar fusion patients presenting with degenerative lumbar pathology, anteriorly placed grafts (ALIF/LLIF) led to a greater likelihood of patients being preserved rather than worsened in their spinopelvic mismatch. Posteriorly placed TLIF or PLIF grafts tended to worsen lordosis both segmentally and globally, yet even the anterior grafts only modestly improved those 2 same measurements.

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

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

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

Radiographic analysis of neuroforaminal and central canal decompression following lateral lumbar interbody fusion.

Background: Lateral lumbar interbody fusion (LLIF) is a minimally invasive surgical option for treating symptomatic degenerative lumbar spinal stenosis (DLSS) in select patients. However, the efficacy of LLIF for indirectly decompressing the lumbar spine in DLSS, as well as the best radiographic metrics for evaluating such changes, are incompletely understood. Methods: A single-institutional cohort of patients who underwent LLIF for DLSS between 5/2015 - 12/2019 was retrospectively reviewed. Diameter, area, and stenosis grades were measured for the central canal (CC) and neural foramina (NF) at each LLIF level based on preoperative and postoperative T2-weighted MRI. Baseline facet joint (FJ) space, degree of FJ osteoarthritis, presence of spondylolisthesis, interbody graft position, and posterior disc height were analyzed as potential predictors of radiographic outcomes. Changes to all metrics after LLIF were analyzed and compared across lumbar levels. Preoperative and intraoperative predictors of decompression were then assessed using multivariate linear regression. Results: A total of 102 patients comprising 153 fused levels were analyzed. Pairwise linear regression of stenosis grade to diameter and area revealed significant correlations for both the CC and NF. All metrics except CC area were significantly improved after LLIF (p < 0.05, 2-tailed t-test). Worse FJ osteoarthritis ipsilateral to the surgical approach was predictive of greater post-operative CC and NF stenosis grade (p < 0.05, univariate and multivariate ordinary least squares linear regression). Lumbar levels L3-5 had significantly higher absolute postoperative CC stenosis grades while relative change in CC stenosis at the L2-3 was significantly greater than other lumbar levels (p < 0.05, one-way ANOVA). There were no baseline or postoperative differences in NF stenosis grade across lumbar levels. Conclusions: Radiographically, LLIF is effective at indirect compression of the CC and NF at all lumbar levels, though worse FJ osteoarthritis predicted higher degrees of post-operative stenosis.

[Neurogenic intermittent claudication in patients with degenerative lumbar stenosis]. / Neirogennaya peremezhayushchayasya khromota u bol'nykh s poyasnichnym degenerativnym stenozom.

OBJECTIVE: To study the clinical manifestations of neurogenic intermittent claudication (NIC) in patients with degenerative lumbar stenosis (DLS). MATERIAL AND METHODS: The neurological status, intensity and nature of pain syndrome, and pain-free walking distance were evaluated in 83 NIC patients with DPS, who underwent surgical treatment. RESULTS: The predominance of the clinical picture of sensorimotor pain (n=30; 36.1%) and isolated pain (n=31; 37.3%) forms of NIC was established. Isolated sensory (n=1; 1.2%), sensorimotor (n=3; 3.6%), and motor-pain (n=4; 4.8%) forms were significantly less common. In 6 (7.2%) patients, there was a pain-free form of NIC. In most patients, surgical treatment led to regression of neurological symptoms and an increase in the distance of pain-free walking. No relationship was found between the demographic and clinical characteristics of patients (gender, age, pain severity, pain-free walking distance), MRI results and the features of NIC clinical picture. In 4 patients, the phenomenon of pacing was revealed in the form of an increase in pain at the beginning of walking and a significant decrease or complete regression as walking continues. CONCLUSION: The clinical picture of NIC is polymorphic, its pain-free course is possible. The decision on the feasibility of surgical treatment of patients with PLS is possible taking into account the clinical picture of NIC and MRI results.

Redefining lumbar spinal stenosis as a developmental syndrome: does age matter?

OBJECTIVE: Age is commonly thought to be a risk factor in defining lumbar spinal stenosis (LSS) degenerative or developmental subtypes. This article is a follow-up to a previous article ("Redefining Lumbar Spinal Stenosis as a Developmental Syndrome: An MRI-Based Multivariate Analysis of Findings in 709 Patients Throughout the 16- to 82-Year Age Spectrum") that describes the radiological differences between developmental and degenerative types of LSS. MRI-based analysis of "degeneration" variables and spinal canal morphometric characteristics of LSS segments have been thought to correlate with age at presentation. METHODS: The authors performed a re-analysis of data from their previously reported prospective MRI-based study, stratifying data from the 709 cases into 3 age categories of equal size (instead of the original < 60 vs ≥ 60 years). Relative spinal canal dimensions, as well as radiological degenerative variables from L1 to S1, were analyzed across age groups in a multivariate mode. The total degenerative scale score (TDSS) for each lumbar segment from L1 to S1 was calculated for each patient. The relationships between age and qualitative stenosis grades, TDSS, disc degeneration, and facet degeneration were analyzed using Pearson's product-moment correlation and multiple regression. RESULTS: Multivariate analysis of TDSS and spinal canal dimensions revealed highly significant differences across the 3 age groups at L2-3 and L3-4 and a weaker, but still significant, association with changes at L5-S1. Age helped to explain only 9.6% and 12.2% of the variance in TDSS at L1-2 and L2-3, respectively, with a moderate positive correlation, and 7.8%, 1.2%, and 1.9% of the variance in TDSS at L3-4, L4-5, and L5-S1, respectively, with weak positive correlation. Age explained 24%, 26%, and 18.4% of the variance in lumbar intervertebral disc (LID) degeneration at L1-2, L2-3, and L3-4, respectively, while it explained only 6.2% and 7.2% of the variance of LID degeneration at L4-5 and L5-S1, respectively. Age explained only 2.5%, 4.0%, 1.2%, 0.8%, and 0.8% of the variance in facet degeneration at L1-2, L2-3, L3-4, L4-5, and L5-S1, respectively. CONCLUSIONS: Age at presentation correlated weakly with degeneration variables and spinal canal morphometries in LSS segments. Age correlated with upper lumbar segment (L1-4) degeneration more than with lower segment (L4-S1) degeneration. The actual chronological age of the patients did not significantly correlate with the extent of degenerative pathology of the lumbar stenosis segments. These study results lend support for a developmental contribution to LSS.

Redefining lumbar spinal stenosis as a developmental syndrome: an MRI-based multivariate analysis of findings in 709 patients throughout the 16- to 82-year age spectrum.

OBJECTIVEUsing an imaging-based prospective comparative study of 709 eligible patients that was designed to assess lumbar spinal stenosis (LSS) in the ages between 16 and 82 years, the authors aimed to determine whether they could formulate radiological structural differences between the developmental and degenerative types of LSS.METHODSMRI structural changes were prospectively reviewed from 2 age cohorts of patients: those who presented clinically before the age of 60 years and those who presented at 60 years or older. Categorical degeneration variables at L1-S1 segments were compared. A multivariate comparative analysis of global radiographic degenerative variables and spinal dimensions was conducted in both cohorts. The age at presentation was correlated as a covariable.RESULTSA multivariate analysis demonstrated no significant between-groups differences in spinal canal dimensions and stenosis grades in any segments after age was adjusted for. There were no significant variances between the 2 cohorts in global degenerative variables, except at the L4-5 and L5-S1 segments, but with only small effect sizes. Age-related degeneration was found in the upper lumbar segments (L1-4) more than the lower lumbar segments (L4-S1). These findings challenge the notion that stenosis at L4-5 and L5-S1 is mainly associated with degenerative LSS.CONCLUSIONSIntegration of all the morphometric and qualitative characteristics of the 2 LSS cohorts provides evidence for a developmental background for LSS. Based on these findings the authors propose the concept of LSS as a developmental syndrome with superimposed degenerative changes. Further studies can be conducted to clarify the clinical definition of LSS and appropriate management approaches.

Radiological and Clinical Comparison of Posterolateral Fusion and Transforaminal Interbody Fusion Techniques in Degenerative Lumbar Stenosis.

OBJECTIVE: Fusion surgery for lumbar degenerative stenosis is an established treatment mode. Despite comparable patient-related outcomes and radiologic results, the necessity of adding interbody fusion to posterolateral fusion remains controversial. We aimed to compare the clinical and radiologic outcomes of posterolateral fusion and transforaminal interbody fusion techniques in degenerative lumbar stenosis with or without spondylolisthesis. METHODS: We retrospectively evaluated the clinical and radiologic outcomes of 48 patients who underwent decompression plus either posterolateral fusion (PLF; n = 23) or transforaminal interbody fusion (TLIF) plus PLF (TLIF+PLF; n = 25) procedures, which incorporated 71 segments for degenerative lumbar stenosis with or without spondylolisthesis. RESULTS: The median follow-up duration for the PLF and TLIF groups were 26 and 31 months, respectively. Both procedures significantly improved the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores; however, the postoperative ODI and VAS scores were unaffected by the procedure type. Postoperative disc heights and percent changes in disc heights did not change by operation type; however, the percent change in the foramen areas was significantly greater in the TLIF group. The addition of TLIF to the PLF procedure resulted in significantly longer operating time and more intraoperative blood loss. Cerebrospinal fluid fistula was the only major complication noted. The radiologic fusion rates were similar between both study groups. CONCLUSIONS: Both PLF and TLIF+PLF procedures were effective in ameliorating the symptoms of degenerative lumbar stenosis and spondylolisthesis. Although some radiologic parameters favor TLIF, this was not reflected in the clinical outcomes.

Improvement in Sagittal Balance After Decompression Surgery without Fusion in Patients with Degenerative Lumbar Stenosis: Clinical and Radiographic Results at 1 Year.

OBJECTIVE: To evaluate modifications in static spinal status after posterior decompression surgery without fusion in patients with symptomatic central canal stenosis. METHODS: From November 2014 to May 2016, 72 patients who underwent isolated decompression for lumbar spinal stenosis were enrolled prospectively in this single-center study. All of the patients had lateral full-body x-ray scans with the EOS system (EOS Imaging, Paris, France) before surgery and after 12 months of follow-up. Patients were classified into 3 groups according to their preoperative sagittal vertical axis (<50 mm, ≥50 mm, and <100 mm, ≥100 mm). RESULTS: SVA decreased significantly (SVA preoperative: 72.3 ± 43.1; SVA postoperative: 48.3 ± 46.8. P < 0.001). Lumbar lordosis increased significantly from 41.9 ± 13.4 in the preoperative period to 46.5 ± 14.8 at the last follow-up (P < 0.001). In the imbalance groups, the mean postoperative SVA decreased significantly compared with preoperative SVA (P = 0.004). Surgery led to a significant increase in lumbar lordosis in the 3 groups (P < 0.05). Nonetheless, a certain degree of residual imbalance persisted in the major imbalance group. In all of the groups, decompression surgery led to a significant improvement in clinical scores (P < 0.05). CONCLUSIONS: Our study showed an improvement in sagittal balance and lumbar lordosis after decompression surgery without fusion, even in patients with a preoperative SVA >100 mm. However, a certain degree of sagittal imbalance may persist after surgery in patients with major initial imbalance (SVA >100 mm). Nonetheless, after surgery, these patients experienced a clinical benefit comparable with that in the other groups.

The impact of pelvic balance, physical activity, and fear-avoidance on the outcome after decompression and instrumented fusion for degenerative lumbar stenosis.

PURPOSE: To evaluate the impact of pelvic balance, physical activity, and fear-avoidance in a cohort of patients undergoing decompression and instrumented fusion for degenerative lumbar stenosis. MATERIALS AND METHODS: This study includes consecutive patients undergoing decompression and instrumented fusion for degenerative lumbar stenosis by one main surgeon from January 2014 to January 2015. Patients were interviewed by a psychologist and underwent standing whole spine X-ray. Lumbar and pelvic parameters (PI, SS, PT, iPT, LL) were measured by an independent spinal surgeon. Physical activity was measured with the International Physical Activity Questionnaire (IPAQ). The "fear-avoidance" was measured with the Tampa Scale for Kinesiophobia (TSK). Back pain was assessed by the Graphic Rating Scale (GRS). The disability was assessed by the Roland-Morris Low Back Pain and Disability Questionnaire. Statistical interpretation of the data was performed using SPSS v19 software (SPSS Inc, Chicago, Illinois). RESULTS: The sample included 51 patients underwent standard posterior laminectomy and instrumented fusion. Surgery has a positive global impact on the perceived low back pain. No significant (Spearman) correlations emerged among pelvic parameters and the pre- and post-surgical GSR. Patients were divided into three groups according to the IPAQ scores after the operation: "inactive" (I), "minimally inactive" (m-I), and "HEPA". Significant differences emerged between IPAQ and Roland-Morris scores (F(2, 48) = 5.48, p = 0.007): the "inactive" (M(R-M) = 11.3) or "minimally active" (M(R-M) = 9.8) groups scored significantly higher than the "HEPA" group (M(R-M) = 4.7). Tampa scores correlated with gender (rho = -0.408, p = 0.003) and with BMI (rho = -0.369, p = 0.008). Females and obese patients reported higher levels of Tampa scores. Significant relationship was found between Tampa scores and pre-GSR (rho(pre) = 0.250, p = 0.08) and significant with post-surgical GSR (rho(post) = 0.275, p = 0.05) and with post-Roland-Morris score (rho(post) = 0.599, p < 0.01). CONCLUSION: The fear-avoidance and the physical inactivity are related to the highest levels of low back pain, more than pelvic imbalance. "Inactive" and "fear-avoidant" patients have also the worst outcome after surgery and the worst level of disability.

Analysis of surgeries for Degenerative lumbarstenosis in elderly patients.

OBJECTIVE: To analyze the effect of decompression alone and combined decompression, fusion and internal fixation procedure for degenerative lumbar stenosis in elderly patients. METHODS: We reviewed 168 lumbar stenosis patients treated using decompression alone or with combined procedures in the department of orthopaedics of Tianjin 4(th) Centre Hospital from October 2010 to January 2014. The clinical data including age, gender, procedure type, operation time, follow-up period, blood loss, preoperative and postoperative JOA and ODI scores were recorded. The patients were divided into decompression alone group and combined surgeries group according to the procedure type. RESULTS: The combined surgeries group presented with larger blood loss (p<0.05) and more operation time (p<0.05), compared with the group of decompression alone. The preoperative and postoperative JOA scores were significantly higher (p<0.05), and the ODI scores significantly lower in the decompression alone group (P<0.05), but at the final follow-up, there were no significant difference between the two groups (p>0.05). The complication rate was lower in the group of decompression alone, but there was no significant difference between the two groups (p>0.05). CONCLUSION: Both the decompression alone and combined surgeries can result in a satisfactory effects in elderly patients with degenerative lumbar spinal stenosis, but the combined surgeries presented with a relatively higher complication rate.

Progression of Coronal Cobb Angle After Short-Segment Lumbar Interbody Fusion in Patients with Degenerative Lumbar Stenosis.

OBJECTIVE: The progression of scoliosis after fusion surgery is a poor prognostic factor of long-term outcomes in patients with degenerative lumbar stenosis (DLS). In this study we aimed to investigate changes in coronal alignment and identify risk factors related to progression of scoliosis after fusion. METHODS: There were 540 patients with symptomatic DLS treated by short-segment lumbar fusion surgery. Among them, 50 patients had coronal Cobb angles >10° at the final follow-up. Sixteen patients had increases >5° (progression group), and 34 patients had increases <5° (nonprogression group). Radiologic parameters that may affect the progression of scoliosis were compared. RESULTS: The mean progression of the Cobb angle was 7.92° in the progression group and 1.25° in the nonprogression group. The progression group had significantly longer follow-up periods and a lower preoperative Cobb angle. The apical vertebra (AV) of the major curve was more frequently thoracic in the progression group. Progression of the Cobb angle was correlated with the follow-up period, preoperative Cobb angle, and location of the AV. Multivariate regression analysis showed that progression of the Cobb angle was significantly associated with a lower preoperative Cobb angle, and both facet degeneration of the upper instrumented vertebra at the fusion site and vertebral spur formation on the concave side also appeared to be associated with progression of the Cobb angle. CONCLUSIONS: The global magnitude of progression of the Cobb angle after short-segment lumbar fusion surgery in patients with DLS is similar to the natural curve progression of adult degenerative scoliosis.

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

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

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

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

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

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

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

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

Comparison of short term outcome in the treatment of degenerative lumbar stenosis with Coflex implant versus laminectomy and posterior interbody fusion along with pedicle screw system / 中国矫形外科杂志

[Objective]To compare the short term outcome in treatment of degenerative lumbar stenosis with Coflex implant versus laminectomy and posterior interbody fusion along with pedicle screw system. [Methods]Thirty patients with degenerative lumbar stenosis were randomly divided into two groups.Fifteen patients in the control group were treated with laminectomy and posterior interbody fusion along with pedicle screw system. The other 15 patients in the experiment group were treated with Coflex implant. The parameters for assessment included operation time,intraoperative blood loss,hospital stay,pre- and postoperative JOA score,improvement rate and complication rate.[Results]Compared to the control,significant reduction was found in terms of operation time,intraoperative blood loss,and hospital stay in the experiment group.No significant difference was found regard to the improvement rate and postoperative JOA score. In addition ,there was no complication in the Coflex group during the follow-up.[Conclusion]Coflex implant is an effective,save and minimally invasive surgical method for the treatment of degenerative lumbar stenosis.

Result of Pedicle Screw Fixation in Lumbar Stenosis with: A Comparison of Degenerative Type Lumbar Stenosis with Spondylolisthetic type Lumbar Stenosis / 대한정형외과학회잡지

Concurrent use of instrumentation has been shown to increase fusion rates and satisfactory results for surgical treatment of the lumbar stenosis. The objectives of the present study were to evaluate clinically and radiologically two groups of lumbar stenosis who were surgically treated with pedicular screw fixation system and posterior lumbar interbody or posterolateral autogenous bone graft following complete posterior decompression. One group was degenerative type and the other group was spondylolisthetic type spinal stenosis. We analyzed the results of 39 cases of lumbar stenosis who underwent pedicular screw and rod fixation system and posterior lumbar interbody or posterolateral autogenous iliac bone fusion following complete posterior decompressive operation during the period from May 1988 to December 1992. There were 27cases of degenerative type and 12 cases of spondylolisthetic type lumbar stenosis. The were 25 women and 14 men. Their age was ranged 20 to 76 years old with an average of 51.7 years old. The follow up period was the interval from 18 months to 6 years with an average of 3.2 years. The radiologic union rate was average 94.9% and 96.3%(26cases) in degenerative spinal stenosis and 91.7%(11 cases) in spondylolisthetic spinal stenosis. The clinical success rate was average 92.3%(36 cases), 88.9%(24 cases) in degenerative spinal stenosis and 100%(12 cases) in spondylolisthetic spinal stenosis. The patients with spondylolytic spinal stenosis showed better result in their life than the patient with degenerative spinal stenosis.