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.

Prophylactic Decompression for Cervical Stenosis in Jeune Syndrome: Report From a Single Institution.

STUDY DESIGN: This is a level IV retrospective descriptive study at a single institution. OBJECTIVE: The objective of the study was to determine the preoperative signs or symptoms prompting cervicomedullary imaging in Jeune syndrome. SUMMARY OF BACKGROUND DATA: Jeune syndrome is a rare autosomal recessive disorder that results in pulmonary compromise from abnormal development of the thorax. Multiple medical comorbidities complicate timely diagnosis of cervicomedullary stenosis, which neurologically jeopardizes this patient population with regards to improper cervical manipulation. Currently, explicit screening of the cervicomedullary junction is not advocated in national guidelines. METHODS: The User Reporting Workbench and Center for Thoracic Insufficiency Syndrome (CTIS) Safety Registry was queried for patients with Jeune syndrome under the age of 18 with cervicomedullary stenosis with or without suboccipital craniectomy/craniotomy evaluated at the authors' institution from January 1, 2007 to August 21, 2018. The primary outcome was the clinical reason for cervicomedullary screening. Secondary outcomes were: age at time of surgery, preoperative myelopathy (spasticity, urinary retention), hydrocephalus, postoperative deficits (respiratory, motor, swallowing difficulty), and need for cervical fusion. RESULTS: Of 32 patients with Jeune syndrome, four (12.5%) had cervicomedullary stenosis requiring decompression. The average age at surgery was 5.25 months (2-9 mo). Two patients underwent imaging due to desaturation events while the other two patients were diagnosed with cervical stenosis as an incidental finding. No patients exhibited clinical myelopathy. Two patients had baseline preoperative swallowing difficulties. None of the patients postoperatively required cervical fusions, nor did they exhibit respiratory deficits, motor deficits, or worsening swallowing difficulties. CONCLUSION: Jeune patients should be routinely screened for cervicomedullary stenosis and undergo subsequent prophylactic decompression to minimize or eliminate the development of irreversible neurologic compromise. LEVEL OF EVIDENCE: 4.

Interspinous process devices for treatment of degenerative lumbar spine stenosis: A systematic review and meta-analysis.

BACKGROUND: Degenerative lumbar spinal stenosis is a condition related to aging in which structural changes cause narrowing of the central canal and intervertebral foramen. It is currently the leading cause for spinal surgery in patients over 65 years. Interspinous process devices (IPDs) were introduced as a less invasive surgical alternative, but questions regarding safety, efficacy, and cost-effectiveness are still unanswered. OBJECTIVES: The aim of this study was to provide complete and reliable information regarding benefits and harms of IPDs when compared to conservative treatment or decompression surgery and suggest directions for forthcoming RCTs. METHODS: We searched MEDLINE, EMBASE, Cochrane Library, Scopus, and LILACS for randomized and quasi-randomized trials, without language or period restrictions, comparing IPDs to conservative treatment or decompressive surgery in adults with symptomatic degenerative lumbar spine stenosis. Data extraction and analysis were conducted following the Cochrane Handbook. Primary outcomes were pain assessment, functional impairment, Zurich Claudication Questionnaire, and reoperation rates. Secondary outcomes were quality of life, complications, and cost-effectiveness. This systematic review was registered at Prospero (International prospective register of systematic reviews) under number 42015023604. RESULTS: The search strategy resulted in 17 potentially eligible reports. At the end, nine reports were included and eight were excluded. Overall quality of evidence was low. One trial compared IPDs to conservative treatment: IPDs presented better pain, functional status, quality of life outcomes, and higher complication risk. Five trials compared IPDs to decompressive surgery: pain, functional status, and quality of life had similar outcomes. IPD implant presented a significantly higher risk of reoperation. We found low-quality evidence that IPDs resulted in similar outcomes when compared to standard decompression surgery. Primary and secondary outcomes were not measured in all studies and were often published in incomplete form. Subgroup analysis was not feasible. Difficulty in contacting authors may have prevented us of including data in quantitative analysis. CONCLUSIONS: Patients submitted to IPD implants had significantly higher rates of reoperation, with lower cost-effectiveness. Future trials should improve in design quality and data reporting, with longer follow-up periods.

[Spinal extradural arachnoid cyst: A case report and review of literature]. / Quiste aracnoideo extradural espinal: reporte de un caso y revisión de la literatura.

BACKGROUND: Arachnoid cysts of spine are a very rare occurrence. The aetiology still remains unclear, but the most accepted explanation is the existence of areas of weakness in the spinal dura. Symptoms depend on the location in the spine. Magnetic resonance imaging is used for its diagnosis. Management depends of clinical presentation, and the surgery is reserved for patients with neurological impairment. CLINICAL CASE: A case is described of 67 year-old male with myelopathy and radiculopathy symptoms, both diagnosed simultaneously. The magnetic resonance imaging was used to diagnose a thoracolumbar extradural arachnoid cyst from T12-L2 and lumbar spinal canal stenosis. The patient was treated with a puncture procedure to empty the cyst and decompress the neural elements. There was a clinical improvement of myelopathy syndrome after puncture procedure. One month later, the patient underwent a minimally invasive surgical approach to decompress the neural elements in lumbar spine, achieving improvement of the radiculopathy syndrome and neurogenic claudication in both legs. CONCLUSION: There is currently no standard minimally invasive approach to surgically treat these cysts, but if the patient has mild symptoms, clinical observation is recommended.

Lumbar Spinal Stenosis: How Is It Classified?

The prevalence of lumbar spinal stenosis is approximately 9.3%, with people most commonly affected in the sixth or seventh decade of life. Patients often have pain, cramping, and weakness in their legs that is worsened with standing and walking. Although the Spine Patient Outcomes Research Trial clearly demonstrated that surgery improves health-related quality of life, treatment for lumbar spinal stenosis varies widely from the type of decompression performed to the need for fusion. This variability can be attributed largely to the lack of an accepted classification system. A good classification system serves as a common language to define the severity of a condition, guide treatment, and facilitate clinical research.

Laminar fractures as a severity marker in burst fractures of the thoracolumbar spine.

PURPOSE: To assess the correlation between the presence of lamina fractures, narrowing of the spinal canal, and the severity of injury. METHODS: Records of 146 men and 44 women aged 13 to 84 (mean, 39) years diagnosed with burst fractures of the thoracolumbar spine were retrospectively reviewed. The laminar fractures and narrowing of the spinal canal were measured using computed tomography. The severity of injury was determined using the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). The ISS and NISS of patients with and without laminar fractures were compared. The sensitivity and specificity of ISS, NISS, and narrowing of the spinal canal in association with laminar fractures were also compared. RESULTS: 92 (48%) of the patients had laminar fractures. The mean narrowing of the spinal canal was more severe in patients with laminar fractures than those without (47% vs 28%, p<0.001). Patients with laminar fractures had a significantly higher mean ISS (17 vs 12, p<0.001) and NISS (19 vs 13, p<0.001). Narrowing of the spinal canal is more sensitive and specific than the ISS and NISS when correlating laminar fractures. CONCLUSION: In patients with burst fractures of the thoracolumbar spine, the presence of laminar fractures indicates a more severe injury.

Correlation among canal compromise, neurologic deficit, and injury severity in thoracolumbar burst fractures.

STUDY DESIGN: Review the association between injury severity, narrowing of the spinal canal, and neurologic deficit in thoracolumbar burst fractures. OBJECTIVE: To determine which variable has a stronger association with neurologic deficit: spinal canal compromise or injury severity. SUMMARY OF BACKGROUND DATA: Literature has not reached a consensus regarding the cause of neurologic deficits in these fractures. Some believe it to be the spinal canal compromise and others the energy of trauma. METHODS: A review of the clinical data and axial computerized tomography of 184 patients was performed. The injury severity was determined by subtracting neurologic data from the Injury Severity Score and New Injury Severity Score (ISSM and NISSM) to avoid the bias of overestimating neurologic lesions. RESULTS: Patients with neurologic deficit presented higher canal compromise (52% vs. 34%), higher Injury Severity Score (24 vs. 11), New Injury Severity Score (26 vs. 13), ISSM (10 vs. 7), and NISSM (11 vs. 8, respectively). A positive correlation was found among these scores and the spinal canal compromise (P < 0.005; r < 0.35). In the current methodology, logistic regression proved narrowing of the spinal canal to be the only independent variable associated with neurologic deficit. CONCLUSIONS: Narrowing of the spinal canal has a stronger association with neurologic deficit than injury severity in thoracolumbar burst fractures.

[Developmental lumbar stenosis in eleven French Antilles patients]. / Canal lombaire étroit constitutionnel chez des patients antillais.

PURPOSE OF THE STUDY: Developmental lumbar stenosis is a rare entity, exceptionally described in the literature. No study has been directly devoted to this condition. The purpose of the present study was to examine specific features, particularly clinical and anatomic expression, observed in a series of operated patients. MATERIAL AND METHODS: Eleven patients from the French Antilles were treated for developmental lumbar stenosis between 1996 and 2000. The Verbiest criteria were used to define canal narrowness. Signs of degeneration and presence of discal herniation were exclusion criteria. Epidemiological and clinical data were collected for the 11 patients. The degree of sagittal stenosis (fixed diameter at the bone level and mobile diameter at the discal level) was measured on computed tomography images. Transverse stenosis was determined by measuring the interpedicular and interapophyseal distances. Lateral stenosis was determined by measuring the depth of the recessus. RESULTS: These patients were young (mean age 42.4 years). Most of the clinical signs were monoradicular. Discal level stenosis predominated, generally at level L4-L5. It was generally central and lateral, sagittal and transverse. The interpedicular distance was the only diameter that remained within normal limits. Soft tissues (yellow ligaments and joint capsules) played an important role in the stenosis. DISCUSSION: The rare reports of developmental lumbar stenosis describe decompensated stenosis due to discal herniation in the adolescent. Developmental lumbar stenosis is considered to be a genetic disease and its particular high frequency in the French Antilles favors this hypothesis. The stenosis results from bony (short pedicles, hypertrophic lateral masses) and ligament (hypertrophy of the yellow ligament and joint capsules) structures. CONCLUSION: Developmental lumbar stenosis produces a global (sagittal, transverse, central, lateral) narrowing of the lumbar canal where soft tissue structures apparently play a greater role than usually thought. A prospective study examining the impact of ethnic origin is required to analyze the genetic hypothesis.

Limbus lumbar and sacral vertebral fractures.

We evaluated the fractures of the lumbar and sacral vertebral limbus by disc impingement at the peripheral ring apophysis in 23 adults associated with trauma in 16 of them. Lumbalgia, radicular pain and narrow canal symptoms are the presenting forms of this underdiagnosed pathology. CT is the best method of examination, while plain roentgenograms and MR are usually negative. Accurate diagnosis and surgical technique with larger exposure are needed to resect the fractured fragments and protruded disc material for decompressing the roots and the dural sac. Our results were very good on the majority of cases.

Quantificaçäo das fibras elásticas maduras e das fibras colágenas na porçäo interlaminar do ligamento amarelo na estenose degenerativa da coluna vertebral lombar / Quantification of the mature elastic fibers and collagenous fibers in the interlaminar portion of the yellow ligament in the degenerative stenosis of the lumbar spine

O autor analisou histologicamente a porçäo interlaminar do ligamento amarelo lombar, no tocante a seu conteúdo de fibras elásticas maduras e fibras colágenas, retirado de 12 pacientes operados por estenose degenerativa do canal vertebral lombar. Todos os ligamentos foram retirados do espaço entre a quarta e a quinta vértebra lombar. A idade dos pacientes operados variou de 50 a 89 anos, com a média de 71,5 anos. Oito pacientes eram do sexo masculino e quatro do feminino. Os cortes histológicos foram corados pela técnica de hematoxilina férrica de Verhoeff para evidenciar as fibras elásticas maduras e pela técnica de Picrosirius-hematoxilina que, associada à microscopia de polarizaçäo, evidencia as fibras colágenas. A estimativa da área ocupada pelas fibras elásticas, nos cortes histológicos do ligamento amarelo, foi realizada através de sistema digital de análise de imagem. A média geral (n=12) da área relativa ocupada pelas fibras elásticas maduras foi de 46,26 por cento e, de fibras colágenas, de 51,63 por cento. Näo foram observadas diferenças estatisticamente significantes entre a quantidade de fibras elásticas e colágenas nos ligamentos analisados. Os resultados sugerem ocorrer uma "substituiçäo fibrosa" (diminuiçäo na quantidade de fibras elásticas maduras e aumento de fibras colágenas) na porçäo interlaminar do ligamento amarelo na estenose degenerativa do canal vertebral lombar.

Mielopatia cervical secundária a ossificaçäo do ligamento longitudinal posterior: relato de caso / Cervical myelopathy secondary to ossification of the posterior longitudinal ligament: report of a case

Os autores relatam um caso de mielopatia cervical por calcificaçäo do ligamento longitudinal posterior, reveêm a bibliografia pertinente, tecem comentários sobre esta rara causa de mielopatia em nosso meio e defendem o acesso anterior (discectomia, corporectomía, experese do ligamento calcificado, seguido de fusäo com fíbula) como o melhor tratamento

La estenosis espinal lumbar: su diagnóstico y el tratamiento quirúrgico mediante la facetectomía parcial apofisaria en el atrapamiento de las raíces lumbares / Lumbar spinal stenosis: its diagnosis and surgical by partial apophyseal facetectomy for entrapment of the lumbar nerve roots

Se estudian 34 pacientes diagnosticados con estenosis espinal lumbar, a los cuales se les practicó facetectomía apofisaria parcial para liberar las raíces lumbares con atrapamiento óseo. Se señala la edad y los resultados obtenidos, así como el principal factor causal. Se evalúan los síntomas y signos antes y después de la operación. Se describe la técnica quirúrgica y se presentan 4 casos clínicos