Comparison of spinous process-splitting laminectomy versus posterolateral fusion for lumbar degenerative spondylolisthesis.

BACKGROUND: Although several studies have recently shown that spinous process-splitting laminectomy (SPSL) maintains lumbar spinal stability by preserving posterior ligament components and paraspinal muscles as compared with conventional laminectomy, evidence is scarce on the treatment outcomes of SPSL limited to lumbar degenerative spondylolisthesis. We herein compare the surgical results and global alignment changes for SPSL versus posterolateral lumbar fusion (PLF) without instrumentation for lumbar degenerative spondylolisthesis. METHODS: A total of 110 patients with Grade 1 lumbar degenerative spondylolisthesis who had undergone SPSL (47 patients) or PLF (63 patients) with minimum 1-year follow-up were retrospectively enrolled from a single institutional database. RESULTS: Mean operating time per intervertebral level and intraoperative blood loss per intervertebral level were comparable between the SPSL group and PLF group. Japanese Orthopaedic Association scores, Oswestry disability index, and visual analog scale scores were significantly and comparably improved at 1 year postoperatively in both groups as compared with preoperative levels. The numbers of vertebrae with slip progression to Grade 2 and slip progression of 5% or more at 1 year postoperatively were similar between the groups. In the SPSL group, mean pelvic tilt (PT) was significantly decreased at 1 year postoperatively. In the PLF group, mean lumbar lordosis (LL) was significantly increased, while mean sagittal vertical axis, PT, and pelvic incidence-LL were significantly decreased at 1 year after surgery. CONCLUSIONS: Compared with PLF without instrumentation, SPSL for Grade 1 lumbar degenerative spondylolisthesis displayed comparable results for slip progression and clinical outcomes at 1 year postoperatively.

A prospective study of recovery from leg numbness following decompression surgery for lumbar spinal stenosis.

BACKGROUND: Residual leg numbness (LN) following lumbar surgery can lower patient satisfaction; however, prospective studies are sparse. The purpose of this study was to evaluate recovery from LN following decompression surgery for lumbar spinal stenosis (LSS). METHODS: A total of 145 patients with LSS were enrolled. All patients underwent decompressive surgery, with or without spinal fusion, followed by a 12 month prospective follow-up. The degree of LN and leg pain (LP) was assessed using the visual analog scale (VAS), a patient-reported outcome measure. RESULTS: Six patients dropped out, and we evaluated 139 patients (average age, 68.1 years). The average VAS-LN scores were 5.9 ± 2.6, 1.8 ± 2.3, 2.0 ± 2.5, 2.1 ± 2.6, 2.2 ± 2.5, and 2.1 ± 2.6, and the average VAS-LP scores were 5.7 ± 2.8, 1.2 ± 1.7, 0.9 ± 1.5, 1.4 ± 2.0, 1.4 ± 2.0, and 1.4 ± 1.9 preoperatively and at 2 weeks, 3, 6, 9, 12 months following the surgery, respectively. Significant improvement in VAS-LN and VAS-LP scores was observed during the first 2 weeks after the surgery. At 12 months after the surgery, the VAS-LN score was significantly greater than the VAS-LP score. The change in the VAS-LN score between the preoperative and 12 month-postoperative values was significantly smaller than that in the VAS-LP score. Multivariate logistic analyses revealed that preoperative symptom duration and preoperative dural sac cross-sectional area (DCSA) were the significant independent predictive factors for residual LN. CONCLUSIONS: Following lumbar decompression surgery, LN improved significantly during the first 2 weeks after surgery. However, the improvement in the VAS-LN score was less than in the VAS-LP score. Patients with longer preoperative symptom duration and narrow preoperative DCSA showed less LN improvement. LEVEL OF EVIDENCE: Level 3.

Predictors of improvement in low back pain after lumbar decompression surgery: Prospective study of 140 patients.

BACKGROUND: Lumbar decompression surgery is often used to treat neurological symptoms of the lower extremity as a result of lumbar disease. However, this method also leads to the improvement of the accompanying low back pain (LBP). We studied the extent of LBP improvement after lumbar decompression surgery without fusion and the associated preoperative factors. METHODS: Patients (n = 140) with lumbar spinal stenosis (n = 90) or lumbar disc herniation (n = 50) were included. To evaluate the change in LBP, VAS scores and the Oswestry disability index scores were measured before surgery and 2 weeks, 3 months, and 6 months after surgery. The predictors of residual LBP were investigated using logistic regression analyses. RESULTS: In total, 140 patients were examined. The VAS scores for LBP before surgery and 2 weeks, 3 months, and 6 months after surgery were 4.4 ± 3.0 (mean ± standard deviation), 1.1 ± 1.5, 1.3 ± 1.8, and 1.9 ± 2.2, respectively. LBP significantly improved 2 weeks after surgery (P < 0.001), stabilized between 2 weeks and 3 months after surgery, but was significantly aggravated 3-6 months after surgery (P < 0.001). At 6 months after surgery, 67 (47.9%) patients had a VAS score of >1. The predictors of residual LBP included severe preoperative LBP, degenerative scoliosis and the size of the Cobb angle. The independent predictors, determined by multivariate analysis were degenerative scoliosis and the size of the Cobb angle. CONCLUSIONS: LBP was alleviated at 2 weeks after lumbar decompression surgery for lumbar disc herniation and lumbar spinal stenosis. The predictors of residual LBP after decompression included more severe LBP at baseline, degenerative scoliosis and the size of Cobb angle. LEVEL OF EVIDENCE: Level 3.

Preoperative spinal cord damage affects the characteristics and prognosis of segmental motor paralysis after cervical decompression surgery.

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To test the hypothesis that preoperative spinal cord damage affects postoperative segmental motor paralysis (SMP). SUMMARY OF BACKGROUND DATA: SMP is an enigmatic complication after cervical decompression surgery. The cause of this complication remains controversial. We particularly focused on preoperative T2-weighted high signal change (T2HSC) on magnetic resonance imaging in the spinal cord, and assessed the influence of preoperative T2HSC on SMP after cervical decompression surgery. METHODS: A retrospective review of 181 consecutive patients (130 males and 51 females) who underwent cervical decompression surgery was conducted. SMP was defined as development of postoperative motor palsy of the upper extremities by at least 1 grade in manual muscle testing without impairment of the lower extremities. The relationship between the locations of T2HSC in preoperative magnetic resonance imaging and SMP and Japanese Orthopedic Association score was investigated. RESULTS: Preoperative T2HSC was detected in 78% (142/181) of the patients. SMP occurred in 9% (17/181) of the patients. Preoperative T2HSC was not a significant risk factor for the occurrence of SMP (P = 0.682). However, T2HSC significantly influenced the severity of SMP: the number of paralyzed segments increased with an incidence rate ratio of 2.2 (P = 0.026), the manual muscle score deteriorated with an odds ratio of 8.4 (P = 0.032), and the recovery period was extended with a hazard ratio of 4.0 (P = 0.035). In patients with preoperative T2HSC, Japanese Orthopaedic Association scores remained lower than those in patients without T2HSC throughout the entire period including pre- and postoperative periods (P < 0.001). CONCLUSION: Preoperative T2HSC was associated with worse severity of SMP in patients who underwent cervical decompression surgery, suggesting that preoperative spinal cord damage is one of the pathomechanisms of SMP after cervical decompression surgery. LEVEL OF EVIDENCE: 3.

[Soft tissue sarcoma: postoperative chemotherapy].

In high-grade musculoskeletal sarcomas, adjuvant chemotherapy is often performed to prevent distant metastases. The efficacy of chemotherapy varies according to the histological type of sarcoma. Prognoses are poor in patients with osteosarcoma, Ewing's sarcoma, or rhabdomyosarcoma, when surgery alone is performed. However, because these sarcomas are chemosensitive, their prognoses are improved with adjuvant chemotherapy. On the other hand, the efficacy of chemotherapy is not statistically demonstrated in non-round cell sarcomas, e. g., malignant fibrous histiocytoma. Nowadays, several kinds of antitumor agents are usually used for adjuvant chemotherapy, and many authors have reported various kinds of regimens and their clinical results. Commonly used drugs include adriamycin, ifosfamide, cisplatin, methotrexate, cyclophosphamide, dacarbazine, vincristine, and actinomycin-D. Recently, high-dose chemotherapy combined with autologous peripheral blood or bone marrow stem cell transplantation has been begun in patients who do not respond to standard chemotherapy, and a better prognosis is expected.