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The Bone & Joint Journal
Vol. 98-B, Issue 8 | Pages 1093 - 1098
1 Aug 2016
Park S Kim HJ Ko BG Chung JW Kim SH Park SH Lee MH Yeom JS

Aims

The purpose of this study was to investigate the prevalence of sarcopenia and to examine its impact on patients with degenerative lumbar spinal stenosis (DLSS).

Patients and Methods

This case-control study included two groups: one group consisting of patients with DLSS and a second group of control subjects without low back or neck pain and related leg pain. Five control cases were randomly selected and matched by age and gender (n = 77 cases and n = 385 controls) for each DLSS case. Appendicular muscle mass, hand-grip strength, sit-to-stand test, timed up and go (TUG) test, and clinical outcomes, including the Oswestry Disability Index (ODI) scores and the EuroQol EQ-5D were compared between the two groups.


Bone & Joint 360
Vol. 12, Issue 3 | Pages 30 - 32
1 Jun 2023

The June 2023 Spine Roundup. 360. looks at: Characteristics and comparative study of thoracolumbar spine injury and dislocation fracture due to tertiary trauma; Sublingual sufentanil for postoperative pain management after lumbar spinal fusion surgery; Minimally invasive bipolar technique for adult neuromuscular scoliosis; Predictive factors for degenerative lumbar spinal stenosis; Lumbosacral transitional vertebrae and lumbar fusion surgery at level L4/5; Does recall of preoperative scores contaminate trial outcomes? A randomized controlled trial; Vancomycin in fibrin glue for prevention of SSI; Perioperative nutritional supplementation decreases wound healing complications following elective lumbar spine surgery: a randomized controlled trial


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 149 - 149
1 Mar 2009
REPANTIS T KOROVESSIS P PAPAZISIS Z
Full Access

Background data. The clinical outcome of decompression and posterolateral spinal fusion for patients with degenerative lumbar spinal stenosis may be influenced by a variety of pathophysiologic factors. Among them, sagittal balance of the spine has gained new interest regarding its correlation with low back pain following lumbar spine surgery. Objectives. To study the effect of sagittal spinal alignment on low back pain in patients operated for degenerative lumbar spinal stenosis. Study design. Multifactorial analysis. Materials and Methods. In this prospective randomized comparative study 45 consecutive patients were included, who underwent decompression for symptomatic degenerative lumbar spinal stenosis and two-, three- or four levels posterior transpedicular fixation with three instrumentations of different stiffness (dynamic, semirigid and rigid) plus posterolateral fusion. All patients were followed up for an average period of four-year radiologically and with SF-36 (domain Bodily pain) to investigate possible correlations between anthropometric parameters, stiffness and extension of instrumentation, roentgenographic sagittal balance, motion in adjacent free level and low back pain. Results. Bodily pain scores improved with the time lapsed from index operation (P< 0.0001). As the distance of the apical lumbar vertebra from plumbline increased, bodily pain score improved significantly (P=0.0006). At the last observation following surgery patients had better Bodily pain score than that they had preoperatively (P=0.0001) and six months postoperatively (P< 0.0001) respectively. Patients, who received four levels instrumentation had higher Bodily pain score (P=0.0245) than their counterparts who received two levels instrumentation. Discussion. Maintenance or even improvement of lumbar lordosis, instrumentation of three and four vertebrae, and time lapsed from index operation was associated with improvement of back pain. On contrary, patients’ age, gender, instrumentation stiffness, vertebral inclination, thoracic kyphosis and sagittal lumbar flexibility did not affect the surgical outcome regarding back pain in adult patients who underwent decompression and stabilization 2 to 4 levels for degenerative lumbar spinal stenosis


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 9 | Pages 1292 - 1294
1 Sep 2012
Dabasia H Rahim N Marshall R

Neurogenic claudication is most frequently observed in patients with degenerative lumbar spinal stenosis. We describe a patient with lumbar epidural varices secondary to obstruction of the inferior vena cava by pathological lymph nodes presenting with this syndrome. Following a diagnosis of follicular lymphoma, successful chemotherapy led to the resolution of the varices and the symptoms of neurogenic claudication. The lumbar epidural venous plexus may have an important role in the pathogenesis of spinal stenosis. Although rare, epidural venous engorgement can induce neurogenic claudication without spinal stenosis. Further investigations should be directed at identifying an underlying cause


The Journal of Bone & Joint Surgery British Volume
Vol. 75-B, Issue 3 | Pages 393 - 397
1 May 1993
Sanderson P Wood P

We have reviewed 31 consecutive patients, aged 65 years or more, after surgical decompression for degenerative lumbar spinal stenosis. The average follow-up was 42 months. Assessment included a standard questionnaire, a pain diagram which was completed by the patient, and clinical and radiological examination. Patients were considered in three groups; degenerative spondylolisthesis (19), lateral recess stenosis (5), and central-mixed stenosis (7). The indication for surgery was leg pain: no patient had an operation for back pain alone. Fusion was never performed. Overall, 64% of the patients had an excellent result, 17% a good result and 19% a poor result. We conclude that the long-term outcome of decompressive surgery in the elderly is good; it does not differ from that reported for younger patients


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 367 - 367
1 Jul 2011
Copuroglou C Ozcan M Aykac B Yilmaz B Gorgulu Y Yalniz E
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Degenerative lumbar spinal stenosis is one of the most frequent surgical indications of spinal surgery in the elderly patient group. Because of the progression of the disease and neurologic deficiencies, patients’ quality of life is affected. We aimed to evaluate the postoperative quality of life of the surgically treated spinal stenotic patients. Between 1998 and 2009, 38 patients, who were surgically decompressed and enstrumentated in our clinic were included to the study. The patients were preoperatively and postoperatively evaluated with Visual Analogue (Scale (VAS) and Japanese Orthopaedics Association (JOA) criterias. The same patient group were re-evaluated on the postoperative 6th month with Hamilton anxiety and depression scale, on the 12th month with short form-36 and Oswestry pain scoring scales to measure the quality of life. Mean age of 38 patients (31 female, 7 male) was 59.6 (range 44 to 82). Mean preoperative VAS was 7.97 and postoperative VAS was 2.28. The pain decreased 56.9%. According to JOA criterias, in 3 patients (7.89%) no recovery, in 13 patients (34.2%) less than 50% recovery and in 22 patients (57.8%) more than 50% recovery was obtained. On the 6th month, according to Hamilton anxiety and depression scale, in 12 patients anxiety and in 3 of these patients depression which needs treatment was observed. The pain of all the patients with anxiety recovered meaningfully (42.3%) but according to JOA, less than 50% recovery could be obtained. Surgically treated spinal stenosis patients improved clinically and radiologically and this affected the patients’ quality of life positively


The Bone & Joint Journal
Vol. 104-B, Issue 12 | Pages 1281 - 1283
1 Dec 2022
Azizpour K Birch NC Peul WC


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 149 - 149
1 Mar 2006
Fokter S Yerby S Brieske W Vengust V Kotnik M Sajovic M
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Surgical decompression is the recommended treatment for patients with moderate to severe degenerative lumbar spinal stenosis (DLSS). Although complication risk has been shown to be higher with concomitant fusion, the success rate is not necessarily superior. This study analyzed the success rates of 58 DLSS patients treated with decompressive surgery. Twenty patients received concomitant instrumented fusion. Outcomes were measured with the Swiss Spinal Stenosis Questionnaire (SSSQ) completed pre-operatively and at least 12 months post-operatively (range 12 to 54 months). Overall, 63.8% of the patients had significant clinical improvement in Symptom Severity, 55.2% had significant clinical improvement in Physical Function, and 58.6% of the patients were at least somewhat satisfied; 43.1% (25/58) of the patients met all three criteria and were considered to be clinically successful. There were no statistically significant differences between the clinical success rates of the non-fusion and fusion groups, but the change in mean change of the Symptom Severity score for the fusion group was significantly greater than that of the non-fusion group. Also, patients with more severe pre-operative symptoms and more physical function restrictions had better success results than those patients with more mild symptoms and less restrictive physical function. The results of this study demonstrate that decompressive surgery with concomitant fusion does not impose a greater risk than decompressive surgery alone and the clinical results of the added fusion are somewhat superior to decompressive surgery alone


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 280 - 281
1 May 2009
Slätis P Malmivaara A Heliövaara M Sainio P Seitsalo S Hurri H Tallroth K
Full Access

The aim of the study was to assess the effectiveness of surgical treatment for degenerative lumbar spinal stenosis (LSS) as compared with non-operative measures. Four university hospitals contributed, after agreement on study protocol, surgical rationale and non-operative procedures (For details, see . Spine. 2007. ;. 32. :. 1. –8. ). Ninety-four patients were randomized into a surgical or nonoperative treatment group, 50 and 44 patients, respectively. Surgery comprised undercutting laminectomy of the stenotic segments, in 10 patients augmented with transpedicular instrumented fusion. The primary outcome was based on assessment of functional disability using the Oswestry Disability Index (ODI, scale 0–100). Intensity of leg and back pain (scales 0–10), as well as self-reported walking ability, were recorded at randomization and at follow-ups at 6, 12, 24 months and on average 6 years after the randomization. At the 2-year follow-up, back and leg pain scales and ODI had improved more in the surgical than the nonoperative group (p-values for global difference < 0,01). At the 6-year follow-up the mean difference in ODI in favor of surgery was 9.5 (95% confidence interval 0.9–18.1). However, the intensity of pains did not any-more differ between the two treatment groups at the 6-year follow-up. Walking ability did not differ between the treatment groups at any time point. Of the 44 patients in the nonoperative group, 4 had been subjected to surgery within two years after randomization because of persistent symptoms. We conclude that surgical treatment improves functional ability in lumbar spinal stenosis. We emphasize that improvement also occurs after nonoperative measures. We recommend starting treatment with non-operative measures during a 2-year surveillance period, as during this period only 10 per cent of the patients will need surgical intervention


The Bone & Joint Journal
Vol. 106-B, Issue 7 | Pages 705 - 712
1 Jul 2024
Karlsson T Försth P Öhagen P Michaëlsson K Sandén B

Aims

We compared decompression alone to decompression with fusion surgery for lumbar spinal stenosis, with or without degenerative spondylolisthesis (DS). The aim was to evaluate if five-year outcomes differed between the groups. The two-year results from the same trial revealed no differences.

Methods

The Swedish Spinal Stenosis Study was a multicentre randomized controlled trial with recruitment from September 2006 to February 2012. A total of 247 patients with one- or two-level central lumbar spinal stenosis, stratified by the presence of DS, were randomized to decompression alone or decompression with fusion. The five-year Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were the EuroQol five-dimension questionnaire (EQ-5D), visual analogue scales for back and leg pain, and patient-reported satisfaction, decreased pain, and increased walking distance. The reoperation rate was recorded.


The Bone & Joint Journal
Vol. 104-B, Issue 12 | Pages 1343 - 1351
1 Dec 2022
Karlsson T Försth P Skorpil M Pazarlis K Öhagen P Michaëlsson K Sandén B

Aims

The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion.

Methods

The Swedish Spinal Stenosis Study (SSSS) was conducted between 2006 and 2012 at five public and two private hospitals. Six centres participated in this two-year MRI follow-up. We randomized 222 patients with central lumbar spinal stenosis at one or two adjacent levels into two groups, decompression alone and decompression with fusion. The presence or absence of a preoperative spondylolisthesis was noted. A new stenosis on two-year MRI was used as the primary outcome, defined as a dural sac cross-sectional area ≤ 75 mm2 at the operated level (restenosis) and/or at the level above (proximal adjacent level stenosis).


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 294 - 294
1 Sep 2005
El Masry M Farrington W l.-Shawi A Weatherley C
Full Access

Introduction and Aims: To evaluate the long-term results of an operation which does not involve instrumentation or fusion and which leaves the midline structures intact. Method: A retrospective clinical and radiological review of consecutive patients. Results: One hundred and sixty patients (87 females and 73 males) with a mean age at operation of 68 (range 40–90); the majority of patients (79%) had either a one or two level bilateral decompression. The most common level decompressed was the L4/5 level (91%). The mean post-operative follow-up was 22 months. Summary of background data: spondylosis, commonly involving a degenerative listhesis, is the most common cause of stenosis in the lumbar spine. The symptoms arise from root compromise of the stenotic level and surgery offers the only permanent cure. To date, the standard procedure remains a laminectomy with fixation and fusion in the presence of possible instability. A laminectomy, however, destabilises the spine and the instrumented fusion makes it a much bigger operation in patients often not best placed to cope with it. There has been, therefore, a need for an effective operation that does not compromise spinal stability. Conclusion: At six weeks post-operation, 141 patients (85%) reported relief of leg pain and this rose to 90% at six months. One hundred and fifty-three patients (96%) reported an increase in their walking distance. Of those patients who also presented with back pain pre-operatively, 79% reported an improvement. There were no significant post-operative complications. The results were sustained at follow-up. The operation of limited segmental decompression for degenerative lumbar spinal stenosis has been found to be effective, safe, and providing good long-term results, without compromising the existing spinal stability. Appropriate patient selection and attention to operative technique are of paramount importance


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 114 - 114
1 Feb 2004
Weatherley CR Farrington WJ Chow GLS Masry ME Emran IM
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Objective: To evaluate the long term results of an operation developed to decompress the roots at the stenotic level, preserve the midline structures, and not use instrumentation or fusion. Design: A retrospective clinical and radiological review of consecutive patients operated on for spinal stenosis secondary to lumbar spondylosis. Subjects: One hundred and sixty patients (eighty seven female and seventy three male) with a mean age at operation of sixty eight (range 40–90). Sixty one patients (38%) had a degenerative listhesis causing stenosis. The mean post operative follow-up was twenty two months (range two months to fourteen years). Summary of background data: Lumbar spondylosis, commonly involving degenerative listhesis, is the commonest cause for spinal stenosis in the lumbar spine. Surgery offers the only permanent cure. The standard procedure remains a laminectomy with fixation and fusion in the presence of possible instability. The laminectomy destabilises the spine and the instrumented fusion makes it a much bigger operation in patients often not best placed to cope with it. There is a need, therefore, for an effective operation that does not compromise spinal stability. Results: At six weeks one hundred and forty one patient (85%) reported relief of leg pain and a further nine patients were improved at three to six months. 52% of the patients reported a concomitant improvement in back pain. The results were sustained at follow-up. The operation was not responsible for the development of a new spondylolisthesis. A minimal increase in an existing degenerative listhesis was seen in two patients only without compromise of their good results. There was no revision surgery at any of the operated levels. Conclusions: The operation of segmental spinal decompression for degenerative lumbar spinal stenosis has been found to be effective, safe, and give good long term results, without compromising the existing spinal stability. Patient selection and attention to operative technique are essential


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 438 - 438
1 Sep 2009
Wilby M Vernon-Roberts B Fraser R Moore R
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Introduction: Thickened ligamentum flavum (LF) is a major contributor to the clinical syndrome of lumbar canal stenosis (LCS). The patho-mechanisms responsible for this phenomenon remain unclear. Cysts adjacent to facet joints (FJ) in the spine are regarded as rare entities that may uncommonly contribute to LCS. Inaccurate pathological interpretation and unawareness of a key anatomical feature has generated erratic terminology and confusion about their origin. Methods: Twenty-seven consecutive patients with radiologically confirmed central canal or lateral recess stenosis underwent lumbar laminectomy for neurogenic symptoms. Surgical specimens comprising en bloc excision of LF and medial inferior facet (to retain LF and FJ relationships) were examined microscopically following staining with haematoxylin-eosin and Miller’s elastic stain. Controls were facet/LF specimens from 89 cadaver lumbar spines. Results: Mean LF thickness was 8.9 mm (+/− 0.3 mm SEM) at the operated levels and 2.9 mm (+/− 0.3 mm) at the non-operated, adjacent levels (p < 0.01). Twenty-eight synovial cysts (8 bilateral, 12 unilateral) were present at a single level in 20 (74%) patients. Synovial cysts per spine level were: L1/2 = 0; L2/3 = 3; L3/4 = 7; L4/5 = 16; L5/S1 = 2. The cyst levels all showed advanced osteoarthritis and LF degeneration. Ten patients (50 %) with cysts had pre-existing degenerative spondylolisthesis (DS). Only 5 patients had pre-operative radiological apperances of unilateral facet cysts. Therefore 82 % of our observed synovial cysts were microscopic or occult. The synovial cysts communicated with the FJ via a bursa-like cleft within the LF, and their linings of synoviocytes and other cells contained fragments shed from the articular surface. The control cadaver specimens revealed that a synovial bursa or intra-ligamentous out-pouching from the synovial cavity was present in 90% of normal LF at L4/5 and was up to 12 mm in length. This intra-ligamentous synovial recess, either wholly or partially lined by synoviocytes, was only present in 55% of specimens at L1/2 with a maximum length of 5 mm. Several other juxtafacet cyst types were observed in the experimental group and a novel classification based upon pathological findings is presented. Discussion: Para-facetal intraspinal cysts are common in degenerative lumbar spinal stenosis. DS is also a frequent finding but is statistically unrelated to cyst formation (Chi-square: p=0.187). We have found that debris from osteoarthritic facet joints enters a bursa-like cleft within the LF where it becomes incorporated into the wall where it excites a granulomatous reaction leading to blockage and synovial cyst formation. The existence of this channel has not been reported previously. We suggest that microscopic synovial cysts contribute significantly to the ligamentous thickening seen in LCS. We also present a novel classification of juxtafacet cysts based on our pathological findings


The Bone & Joint Journal
Vol. 101-B, Issue 6_Supple_B | Pages 37 - 44
1 Jun 2019
Liu N Goodman SB Lachiewicz PF Wood KB

Aims

Patients may present with concurrent symptomatic osteoarthritis (OA) of the hip and degenerative disorders of the lumbar spine, with surgical treatment being indicated for both. Whether arthroplasty of the hip or spinal surgery should be performed first remains uncertain.

Materials and Methods

Clinical scenarios were devised for a survey asking the preferred order of surgery and the rationale for this decision for five fictional patients with both OA of the hip and degenerative lumbar disorders. These were symptomatic OA of the hip and: 1) lumbar spinal stenosis with neurological claudication; 2) lumbar degenerative spondylolisthesis with leg pain; 3) lumbar disc herniation with leg weakness; 4) lumbar scoliosis with back pain; and 5) thoracolumbar disc herniation with myelopathy. This survey was sent to 110 members of The Hip Society and 101 members of the Scoliosis Research Society. The choices of the surgeons were compared among scenarios and between surgical specialties using the chi-squared test. The free-text comments were analyzed using text-mining.


Bone & Joint 360
Vol. 5, Issue 5 | Pages 25 - 27
1 Oct 2016


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 11 | Pages 1546 - 1550
1 Nov 2012
Longo UG Loppini M Romeo G Maffulli N Denaro V

Wrong-level surgery is a unique pitfall in spinal surgery and is part of the wider field of wrong-site surgery. Wrong-site surgery affects both patients and surgeons and has received much media attention. We performed this systematic review to determine the incidence and prevalence of wrong-level procedures in spinal surgery and to identify effective prevention strategies. We retrieved 12 studies reporting the incidence or prevalence of wrong-site surgery and that provided information about prevention strategies. Of these, ten studies were performed on patients undergoing lumbar spine surgery and two on patients undergoing lumbar, thoracic or cervical spine procedures. A higher frequency of wrong-level surgery in lumbar procedures than in cervical procedures was found. Only one study assessed preventative strategies for wrong-site surgery, demonstrating that current site-verification protocols did not prevent about one-third of the cases. The current literature does not provide a definitive estimate of the occurrence of wrong-site spinal surgery, and there is no published evidence to support the effectiveness of site-verification protocols. Further prevention strategies need to be developed to reduce the risk of wrong-site surgery.


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 2 | Pages 210 - 216
1 Feb 2009
Jansson K Németh G Granath F Jönsson B Blomqvist P

We investigated the pre-operative and one-year post-operative health-related quality of life (HRQoL) outcome by using a Euroqol (EQ-5D) questionnaire in 230 patients who underwent surgery for lumbar spinal stenosis. Data were obtained from the National Swedish Registry for operations on the lumbar spine between 2001 and 2002. We analysed the pre- and postoperative quality of life data, age, gender, smoking habits, pain and walking ability. The relative differences were compared to a Swedish EQ-5D population survey.

The mean age of the patients was 66 years, and there were 123 females (53%). Before the operation 62 (27%) of the patients could walk more than 500 m. One year after the operation 150 (65%) were able to walk 500 m or more.

The mean EQ-5D score improved from 0.36 to 0.64, and the HRQoL improved in 184 (80%) of the patients. However, they did not reach the level reported by a matched population sample (mean difference 0.18). Women had lower pre- and post-operative EQ-5D scores than men. Severe low back pain was a predictor for a poor outcome.