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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526521

RESUMO

Vertebral osteomyelitis is an infection of the vertebrae that can lead to spinal degeneration, most commonly caused by Staphylococcus aureus Here, we report an unusual case of pyogenic osteomyelitis caused by Gardnerella vaginalis and Streptococcus parasanguinis in a 61-year-old postmenopausal woman. The patient presented with a 2-week history of worsening lower back pain and fever and a recent episode of cystitis following re-engagement of sexual activity. Imaging revealed a deterioration of vertebrae discs and spinal canal stenosis at the L3-L4 levels with a formation of abscess in the right psoas muscle. Needle aspiration of the abscess identified G. vaginalis and S. parasanguinis and the patient was successfully treated with a 6-week course of ceftriaxone and metronidazole. This case describes an unusual coinfection of two pathogens that normally reside in the urogenital tract and oral cavity, respectively, and highlights the risk posed when these organisms breach the body's normal barriers.


Assuntos
Discite/microbiologia , Gardnerella vaginalis/isolamento & purificação , Vértebras Lombares , Osteomielite/microbiologia , Abscesso do Psoas/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Antibacterianos/uso terapêutico , Técnicas de Cultura , Discite/diagnóstico por imagem , Discite/tratamento farmacológico , Discite/fisiopatologia , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Osteomielite/fisiopatologia , Pós-Menopausa , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/tratamento farmacológico , Estenose Espinal/fisiopatologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico
2.
PLoS One ; 15(12): e0244571, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378405

RESUMO

Recently, various designs and material manufactured interspinous process devices (IPDs) are on the market in managing symptomatic lumbar spinal stenosis (LSS). However, atraumatic fracture of the intervening spinous process has been reported in patients, particularly, double or multiple level lumbar decompression surgery with IPDs. This study aimed to biomechanically investigate the effects of few commercial IPDs, namely DIAMTM, CoflexTM, and M-PEEK, which were implanted into the L2-3, L3-4 double-level lumbar spinal processes. A validated finite element model of musculoskeletal intact lumbar spinal column was modified to accommodate the numerical analysis of different implants. The range of motion (ROM) between each vertebra, stiffness of the implanted level, intra stress on the intervertebral discs and facet joints, and the contact forces on spinous processes were compared. Among the three implants, the Coflex system showed the largest ROM restriction in extension and caused the highest stress over the disc annulus at the adjacent levels, as well as the sandwich phenomenon on the spinous process at the instrumented levels. Further, the DIAM device provided a superior loading-sharing between the two bridge supports, and the M-PEEK system offered a superior load-sharing from the superior spinous process to the lower pedicle screw. The limited motion at the instrumented segments were compensated by the upper and lower adjacent functional units, however, this increasing ROM and stress would accelerate the degeneration of un-instrumented segments.


Assuntos
Descompressão Cirúrgica/instrumentação , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Vértebras Lombares/fisiopatologia , Amplitude de Movimento Articular , Estenose Espinal/fisiopatologia
3.
Medicine (Baltimore) ; 99(30): e21466, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791763

RESUMO

To evaluate the effect of the severity of spinal stenosis on the peripheral nerves of lower extremities by nerve conduction study (NCS).One hundred fifteen patients with lumbar spinal stenosis were recruited retrospectively in this study. The grading system for lumbar stenosis was used based on the degree of separation of the cauda equina. The degree of cauda equina damage caused by lumbar central stenosis was assessed by NCS of peripheral nerves. Multiple regression analysis was used to estimate which factors affect peripheral nerve injury, according to the presence of DM, total grading of lumbar central stenosis, and age.Only age was associated with low amplitude in the tibial and peroneal motor NCS in the multiple regression analysis. The severity of the compression of the cauda equina, caused by spinal stenosis, did not statistically significantly affect the NCS values of nerves on the lower extremities.In conclusion, the cauda equina is resilient against degenerative lumbar central stenosis. Unlike changes caused by peripheral nerve entrapment, lumbar central stenosis did not affect the findings of NCS on the peripheral nerve of lower extremities.


Assuntos
Cauda Equina/fisiopatologia , Condução Nervosa , Estenose Espinal/fisiopatologia , Idoso , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
PLoS One ; 15(5): e0233633, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32459814

RESUMO

OBJECTIVE: To assess the learnability of two magnetic resonance imaging (MRI) grading systems for lumbar central canal stenosis based on inter-observer agreement and test-retest reliability of doctors with no prior knowledge of the two systems. MATERIALS AND METHODS: Two clinical fellows, one novice radiology resident, one neurosurgeon, and one orthopedic surgeon, who were unaware of the two qualitative MRI grading systems prior to this study, acquainted themselves with the teaching files. All five observers independently assessed the LCCS grade of 70 patients using T2-weighted axial magnetic resonance images at the L2-3, L3-4, L3-4, and L5-S1 disc levels. Analysis was performed twice at an interval of two months. RESULTS: The inter-observer agreement among all five readers was excellent and test-retest reliability was moderate to excellent for both the Schizas and Lee systems. Positive percentage agreements were found to be over 0.8 in almost all observers with relatively narrow 95% confidence limits. CONCLUSION: Both Schizas and Lee MRI grading systems for LCCS are reliable grading systems, and can be used as a learnable method for both clinicians and radiologists.


Assuntos
Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Índice de Gravidade de Doença , Estenose Espinal/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estenose Espinal/fisiopatologia
5.
J Clin Neurosci ; 75: 139-148, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32169364

RESUMO

The multifidus muscle morphology and its relation to the function of patients with degenerative lumbar spinal stenosis (DLSS) remains unclear. This study aimed to investigate the multifidus muscle morphology in patients with DLSS and to determine its relations to the patients function. Sixty-two patients with single-segment DLSS at L4-5 and sixty control patients with non-spinal-derived low back pain were retrospectively enrolled and further matched based on propensity scores. The Oswestry Disability Index (ODI) and bodily pain using the Short-Form Health Survey were evaluated. The cross-sectional area (CSA), CSA of fatty free (CSAF), and fatty infiltration rate [FIR; i.e., (1- CSAF/CSA) × 100%] of the multifidus muscle were measured on magnetic resonance images using ImageJ software. Adjustment for confounders was performed using generalized linear models. The FIR at L5-S1 in controls was statistically significant but slightly less than the DLSS group. The between-groups difference was 5% (p < 0.001), and 2.8% (p = 0.036) in the complete and matching cohorts, respectively, after adjustment. Statistically significant differences were not observed in other multifidus muscle parameters between the groups. FIR > 20% at L5-S1 was independently associated with ODI ≥ 41 in patients with DLSS [Retaining demography as control block or not, Odds ratio (OR) = 8.4, p = 0.023; OR = 12.3, p = 0.030]. The multifidus muscle at L5-S1 demonstrated slightly greater fatty infiltration in patients with L4-5 single-segment DLSS than controls. Significant fatty infiltration in the multifidus muscle at L5-S1 may be correlated with poor function in patients with L4-5 single-segment DLSS.


Assuntos
Músculos Paraespinais/fisiopatologia , Estenose Espinal/fisiopatologia , Adipócitos/patologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Dor Lombar/patologia , Vértebras Lombares/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Músculos Paraespinais/diagnóstico por imagem , Músculos Paraespinais/patologia , Pontuação de Propensão , Estudos Retrospectivos , Estenose Espinal/patologia
6.
Biomed Res Int ; 2020: 7125914, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32185215

RESUMO

The aim of this study was to compare pedicle dimensions in degenerative lumbar spinal stenosis (DLSS) with those in the general population. A retrospective computerized tomography (CT) study for lumbar vertebrae (L1 to L5) from two sample populations was used. The first included 165 participants with symptomatic DLSS (age range: 40-88 years, sex ratio: 80 M/85 F), and the second had 180 individuals from the general population (age range: 40-99 years, sex ratio: 90 M/90 F). Both males and females in the stenosis group manifested significantly greater pedicle width than the control group at all lumbar levels (P < 0.05). In addition, pedicle heights for stenosis females were remarkably smaller on L4 and L5 levels compared to their counterparts in the control group (P < 0.001). Males have larger pedicles than females for all lumbar levels (P < 0.001). Age and BMI did not demonstrate significant association with pedicle dimensions. Our outcomes indicate that individuals with DLSS have larger pedicle widths than the control group. More so, pedicle dimensions are gender-dependent but independent of age and BMI.


Assuntos
Vértebras Lombares/fisiopatologia , Estenose Espinal/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pesos e Medidas Corporais/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
7.
Medicine (Baltimore) ; 99(11): e19551, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176111

RESUMO

Sagittal imbalance is a multifactorial complex deformity that can arise from a variety of causes such as spinal stenosis, sarcopenia, vertebral fracture, and neuromuscular diseases. Furthermore, there is lack of research regarding spinal and general conditions that precede the development of sagittal imbalance. Our aim was to evaluate aggravating factors, such as natural history, for sagittal imbalance in a cohort comprising elderly individuals by conducting various examinations.We recruited 96 participants who had a sagittal vertical axis (SVA) larger than 50 mm in a sagittal imbalance study. Finally, 69 participants were followed up and enrolled this study after 2 years. We evaluated full spine radiographs, magnetic resonance imaging (MRI), bone mineral density, and health-related quality of life from patients survey and analyzed factors associated with aggravation of sagittal imbalance. Aggravation was defined by an SVA > 30 mm and T1 pelvic angle (T1PA) > 3° in the third year compared to SVA and T1PA values of the first year.Eighteen participants of the follow-up group had a sagittal imbalance aggravation. According to the deformity severity in the first-year evaluations, the marked deformity group (38 participants) defined as Schwab classification had 11 (28.9%) participants presenting with sagittal imbalance aggravation. These participants had larger mean values of Schwab sagittal modifiers and T1PA compared with the nonaggravation participants. Logistic regression analysis showed a higher pelvic incidence (PI) (OR = 1.201, 95% CI = 1.015-1.422, P = .033) and a small multifidus (MF) volume (OR = 0.991, 95% CI = 0.983-1.000, P = .043) correlated with sagittal imbalance aggravation.From the follow-up group, 18 (26%) subjects of total 69 participants presented a deteriorated sagittal imbalance. A higher PI and smaller MF volume correlated with the aggravation of sagittal imbalance. We should consider that high PI and small MF volume are associated with aggravation of sagittal imbalance.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Equilíbrio Postural , Estenose Espinal/diagnóstico por imagem , Idoso , Estudos de Coortes , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Fusão Vertebral , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia
8.
World Neurosurg ; 139: 23-30, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32194277

RESUMO

Sacral-alar iliac (SAI) screws constitute a relatively new technique for pelvic fixation. Since their initial description in 2007, SAI screws have gained wide popularity among the spine surgery community. In 2013, we first described the possibility of using both S1 and S2 SAI screws for pelvic fixation in revision surgeries for adult degenerative scoliosis. Although a previous radiological study has suggested the feasibility of S3 and S4 SAI screws, to the best of our knowledge, there has been no report in the literature on the clinical use of such techniques. In this brief technical note, we present the first clinical report of the use of S3 SAI screws as a salvage method for pelvic fixation in a patient with suboptimal anatomy that prevented proper placement of S1 and S2 SAI screws. We also discuss the recommended anatomical entry points and trajectory of such screws.


Assuntos
Parafusos Ósseos , Ílio/cirurgia , Procedimentos Neurocirúrgicos/métodos , Sacro/cirurgia , Compressão da Medula Espinal/cirurgia , Curvaturas da Coluna Vertebral/cirurgia , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Feminino , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Laminectomia , Lordose/cirurgia , Osteotomia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/fisiopatologia , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/fisiopatologia , Espondilose/diagnóstico por imagem , Espondilose/cirurgia
9.
Muscle Nerve ; 61(5): 580-586, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32096875

RESUMO

BACKGROUND: Radiculopathies caused by spinal stenosis in the upper lumbar spinal canal (L1/2, L2/3, L3/4) have not been comprehensively investigated. METHODS: This retrospective study reviewed 14 patients from a tertiary hospital outpatient clinic. The inclusion criteria were upper lumbar stenosis seen on MRI and radiculopathies with active denervation confirmed on electromyography. Patients with any other conditions that could explain the clinical or electrophysiological manifestations were excluded. RESULTS: Neurogenic findings were predominantly observed in L5 or S1 myotomes on electromyography. Abnormal spontaneous activity was observed in distal muscles in all patients and in proximal muscles in eight patients. Axonal involvement was bilateral in 10 patients and unilaterally in 4 patients. MRI showed redundant nerve roots in 13 patients with chronic reinnervation on electromyography. CONCLUSIONS: Upper lumbar spinal stenosis usually causes L5 or S1 radiculopathies with diverse patterns. This discrepancy may cause diagnostic confusion.


Assuntos
Eletromiografia , Vértebras Lombares , Radiculopatia/fisiopatologia , Sacro , Estenose Espinal/fisiopatologia , Idoso , Eletrodiagnóstico , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiculopatia/diagnóstico , Radiculopatia/etiologia , Estudos Retrospectivos , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/fisiopatologia , Estenose Espinal/complicações , Estenose Espinal/diagnóstico
10.
Arch Osteoporos ; 15(1): 9, 2020 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-31897621

RESUMO

Lumbar BMD and functional recovery in the acute period were independently strongly associated with subsequent new VCF after hospital conservative therapy for patients with new fragility VCFs. Functional recovery was related with age, pain intensity during first month after hospitalization, VCF past history and multiple new VCFs. PURPOSE: This study aimed to determine the factors independently associated with the subsequent vertebral compression fracture (VCF) after hospital conservative therapy in patients with new fragility VCFs and parameters related with functional recovery in the acute period. METHODS: Subsequent VCF (n = 37) was defined as patients who sustained a new VCF within 9 months after new VCF, whereas patients without a new VCF were classified as non-subsequent VCF (n = 179). Logistic regression analysis was performed to determine independent factors associated with the subsequent VCF, including patients' characteristics, past histories, number of new VCFs, bone mineral density (BMD), lumbar sagittal alignment, fractured vertebral body height, spine muscle mass, pain intensity, corset types, medications for osteoporosis and pain relief, recovery ratio of functional independence measure (FIM) and bone union. Correlation coefficients were accessed between the FIM recovery ratio and continuous variable parameters, while intergroup comparisons or analysis of variance was conducted to examine significant differences in the FIM recovery ratio for categorical variable parameters. RESULTS: Lumbar BMD, FIM recovery ratio at the first month after hospitalization and segmental Cobb angle were significantly independently associated with subsequent VCF (odds ratio: 27.8, 9.6 and 1.1, respectively). The FIM recovery ratio was moderately negatively correlated with age and pain intensity and was significantly worse in patients with multiple new VCFs or past history of VCF. CONCLUSIONS: Conservative therapies focused on lumbar BMD, functional recovery and pain relief in the acute period may be useful in preventing subsequent VCF.


Assuntos
Tratamento Conservador/métodos , Fraturas por Compressão/etiologia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea/fisiologia , Feminino , Fêmur/fisiologia , Fraturas por Compressão/fisiopatologia , Fraturas por Compressão/terapia , Hospitalização , Humanos , Vértebras Lombares/fisiologia , Masculino , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/fisiopatologia , Fraturas por Osteoporose/etiologia , Modalidades de Fisioterapia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia , Estenose Espinal/etiologia , Estenose Espinal/fisiopatologia
11.
Int J Rehabil Res ; 43(2): 116-122, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31842023

RESUMO

This study investigated whether adaptive and maladaptive coping strategies mediate the association between chronic pain and health-related quality of life among older adults experiencing chronic pain after lumbar surgery. Participants were 103 older adults with either or both of chronic lower back pain and leg pain after lumbar surgery (median age = 75 years, men = 44, women = 59). Intensity of chronic lower back and leg pain (11-point numerical rating scale), physical activities (Physical Activity Scale for the Elderly) as an adaptive coping strategy, maladaptive coping strategies (e.g. guarding, resting; Chronic Pain Coping Inventory), and health-related quality of life (12-item Short-Form Health Survey) were measured. Hypothetical models with adaptive and maladaptive coping strategies as mediators of pain intensity and health-related quality of life were tested using structural equation modeling. Model fitness was acceptable (adjusted goodness of fit index: 0.94-0.98, comparative fit index: 1.00, root mean square error of approximation: 0.00). The results showed that (1) the adaptive coping strategy of physical activity positively mediated the association between lower back and leg pain, and physical health but not mental and social health; (2) maladaptive coping strategies negatively mediated the association between pain and physical, mental, and social health; (3) physical activities were negatively associated with maladaptive coping strategies. This study demonstrated that adaptive and maladaptive coping strategies serve as mediators of the relationship between chronic pain and health-related quality of life in older adults after lumbar surgery.


Assuntos
Adaptação Fisiológica , Adaptação Psicológica , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Dor Lombar/fisiopatologia , Dor Lombar/psicologia , Idoso , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Humanos , Análise de Classes Latentes , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Qualidade de Vida , Estenose Espinal/fisiopatologia , Estenose Espinal/psicologia , Estenose Espinal/cirurgia
12.
Spine (Phila Pa 1976) ; 45(11): E639-E646, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31842106

RESUMO

STUDY DESIGN: A retrospective study of a randomized clinical trial and a prospective study of patients with lumbar spinal stenosis (LSS). OBJECTIVE: The aim of this study was to identify the effects of the number of physical therapy (PT) sessions on clinical outcomes of patients with LSS. SUMMARY OF BACKGROUND DATA: Supervised PT for patients with LSS has been reported to lead to better short-term outcomes in terms of disability and leg pain than unsupervised exercise. However, no studies have investigated the relationship between the number of PT sessions and the therapeutic effects in patients with LSS. METHODS: All patients received exercise therapy for 6 weeks. Included were 43 patients receiving supervised PT twice a week (P2 group), 38 patients receiving supervised PT once a week (P1 group), and 43 patients receiving a home exercise program alone (HE group). Clinical outcomes were measured using the Zurich Claudication Questionnaire (ZCQ), a numerical rating scale (NRS) of back pain and leg pain, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) at baseline and at 6 weeks. RESULTS: At 6 weeks, the P2 group showed significant improvements in ZCQ physical function, back and leg pain on the NRS compared with the P1 group (P < 0.05). Compared with the HE group, the P2 group showed significant improvements in ZCQ symptom severity and physical function, back and leg pain on the NRS, and JOABPEQ gait disturbance (P < 0.05). There were no significant differences in mean changes after 6 weeks between the P1 and HE groups. CONCLUSION: Six weeks of supervised PT twice a week resulted in significant short-term improvements in symptom severity, physical function, back and leg pain, and gait disturbance compared with once a week and/or home exercise alone. Patients with LSS should be treated with intensive and supervised exercise programs to obtain maximum benefit of exercise therapy. LEVEL OF EVIDENCE: 3.


Assuntos
Terapia por Exercício/métodos , Vértebras Lombares , Medição da Dor/métodos , Estenose Espinal/diagnóstico , Estenose Espinal/terapia , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/diagnóstico , Dor nas Costas/fisiopatologia , Dor nas Costas/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Estudos Prospectivos , Estudos Retrospectivos , Estenose Espinal/fisiopatologia , Inquéritos e Questionários
13.
World Neurosurg ; 134: e866-e873, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31715409

RESUMO

OBJECTIVE: To assess the dynamic change of the dural sac size in patients with lumbar spinal stenosis (LSS) from supine to standing position and their correlation with clinical symptoms. METHODS: A total of 110 patients with LSS were prospectively enrolled to undergo both supine (0°) and standing (78°) magnetic resonance imaging (MRI). Dural sac cross-sectional area (DCSA) and dural sac anteroposterior diameter (DAPD) at the most constricted spinal level in supine and standing MRI were measured and compared. Clinical symptoms were assessed by duration of disease, claudication distance, visual analog scale (VAS) score of leg pain, and Chinese Oswestry Disability Index score of low back pain. The correlation between the parameters and clinical symptoms was analyzed by Pearson correlation coefficient (r). RESULTS: Mean minimum DCSA and DAPD in the standing position were significantly smaller (both P < 0.01) than in the supine position. DCSA and DAPD in standing MRI and their changes had better correlation with the intermittent claudication distance and VAS score of leg pain than in the supine position. A more than 15 mm2 reduction of DSCA was observed in patients with shorter claudication distance and more severe VAS score of leg pain (both P < 0.01). CONCLUSIONS: Dural sac size on MRI was reduced significantly from supine to standing position. Standing MRI and the changes of DCSA significantly correlated with claudication distance and VAS score of leg pain in patients with LSS. Therefore, standing MRI provides more radiologic information correlating with clinical symptoms in patients with LSS than supine MRI.


Assuntos
Dura-Máter/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Posição Ortostática , Decúbito Dorsal , Adulto , Idoso , Dura-Máter/patologia , Feminino , Humanos , Perna (Membro) , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Dor/etiologia , Dor/fisiopatologia , Medição da Dor , Estenose Espinal/complicações , Estenose Espinal/fisiopatologia
14.
Clin Orthop Relat Res ; 478(2): 348-356, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31633587

RESUMO

BACKGROUND: Micro-tubular decompression in extreme lumbar spinal stenosis is challenging because it is technically difficult to achieve adequate decompression. Whether the results of micro-tubular decompression related to pain, function, and complications in lumbar spinal stenosis of the extreme and non-extreme varieties are different has not yet been conclusively established. QUESTIONS/PURPOSES: Are there differences between patients with extreme stenosis and non-extreme stenosis in terms of (1) VAS back or leg pain, (2) Oswestry Disability Index (ODI), or (3) complications when they were treated with spinal decompression using a tubular retractor system? METHODS: Between January 2007 and January 2017, one surgeon performed 325 single-level lumbar micro-tubular decompressions without fusion. Of those, 43% (140 of 325) had extreme stenosis (defined as the absence of cerebrospinal fluid signal and a grey homogeneous dural sac with unrecognizable rootlets and posterior epidural fat in T2 weighted axial MRI image) and the rest had non-extreme stenosis. During this time, we used tubular retractors for these procedures in patients with simple lumbar spinal stenosis who had persistent symptoms despite conservative treatment for neurogenic claudication. No alternate form of decompression was performed in the study period. Patients with complex lumbar spinal stenosis associated with a deformity or instability who were treated with instrumented fusion were excluded. A total of 14% (20 of 140) patients in the extreme stenosis group and 15% (28 of 185) patients in the non-extreme stenosis group were lost to follow-up before 2 years; the remaining 120 patients with extreme stenosis and 157 patients with non-extreme stenosis were analyzed at a mean follow-up of 33 ± 5 months in this retrospective, comparative study. The groups were not different at baseline in terms of preoperative VAS score for back pain, age, gender, BMI or the percentage who had diabetes or who smoked. However, patients with extreme stenosis had higher preoperative ODI scores and higher preoperative VAS score for leg pain compared with the non-extreme group. There was a higher proportion of men in the non-extreme stenosis group (56% [104 of 185] versus 50% [71 of 140]; p = 0.324). Study endpoints were VAS score for leg and back pain, ODI, and complications, all of which were ascertained by chart review. With the numbers available, we could detect with 80% power at p < 0.05 a difference of 0.93 cm of 10 cm on a 10-cm VAS scale for VAS leg pain; a difference of 1.00 cm of 10 cm on a 10-cm VAS scale for VAS back pain and a difference of 2.12 cm of 100 cm on a 100-cm ODI scale. RESULTS: In terms of pain, both groups improved after surgery, but there was no between-group difference in terms of the VAS scores at the most recent follow-up. VAS back pain improved from a mean of 3 ± 1 to 2 ± 1 in the extreme stenosis group and from 3 ± 1 to 1 ± 1 in the non-extreme stenosis group (p = 0.904); VAS leg pain improved from 7 ± 1 to 1 ± 1 versus 6 ± 1 to 1 ± 1, respectively (p = 0.537). ODI scores likewise improved in both groups, with no between-group difference in the ODI scores at latest follow-up (66 ± 7 to 19 ± 2 in the extreme stenosis group versus 59 ± 5 to 19 ± 2 in the non-extreme stenosis group (p = 0.237). Complications in the group with extreme stenosis occurred in six patients (incidental dural tears in two patients, urinary retention in three patients, and Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH) in one patient); complications in the non-extreme stenosis occurred in two patients (incidental dural tears in two patients). CONCLUSIONS: The results in terms of improvement in VAS for leg and back pain and ODI scores were not different between patients with extreme and non-extreme stenosis. Micro-tubular decompression can be thus considered an alternative for patients with extreme stenosis. Future studies, ideally multicentre, comparative trials, are needed to confirm our preliminary results. LEVEL OF EVIDENCE LEVEL: III, therapeutic study.


Assuntos
Dor nas Costas/cirurgia , Descompressão Cirúrgica/instrumentação , Procedimentos Ortopédicos/instrumentação , Estenose Espinal/cirurgia , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Avaliação da Deficiência , Desenho de Equipamento , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Medição da Dor , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Estenose Espinal/diagnóstico , Estenose Espinal/fisiopatologia , Resultado do Tratamento
15.
World Neurosurg ; 134: e672-e681, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31698129

RESUMO

OBJECTIVE: Conventional laminectomy for spine decompression involves inherent complications resulting from perioperative traumatization of posterior structures. Minimally invasive decompression was developed to address these issues. Full endoscopic spine surgery has shifted the paradigm from disc pathology to spinal stenosis by overcoming the limitation of bony procedures with evolving endoscopic instruments. However, a steep learning curve restricts the development of endoscopic decompression. The purpose of this study is to describe full endoscopic uniportal unilateral laminotomy for bilateral decompression through the interlaminar approach and to evaluate its efficacy and safety in 2 years of follow-up. METHODS: A total of 106 patients (45 men, 61 women) with degeneration lumbar stenosis involving 165 segments were enrolled from April 2015 to June 2017, and treated by full endoscopic uniportal unilateral laminotomy for bilateral decompression. We made an 8-mm incision and used a general-size endoscope (working channel 4.3 mm) to avoid neurological compromise during the demonstration. RESULTS: The visual analogue scale (VAS) results for back pain revealed a significant reduction from preoperative 6.8 ± 2.1 to 1.7 ± 1.7 after 2 years (P < 0.001). The VAS results for leg pain revealed a significant reduction from preoperative 7.6 ± 1.3 to 1.3 ± 1.6 after 2 years (P < 0.001). The Oswestry Disability Index showed significant improvement from preoperative 62.0 ± 13.9 to 14.6 ± 15.7 after 2 years (P < 0.001). The average operation time was 68.9 ± 10.0 minutes per level. One case had iatrogenic durotomy, 1 case underwent revision surgery due to incomplete decompression, and 2 cases had delayed wound healing. CONCLUSIONS: This procedure obtained successful and satisfactory outcomes for patients, and was more feasible for surgeons.


Assuntos
Laminectomia/métodos , Ligamento Amarelo/cirurgia , Vértebras Lombares/cirurgia , Neuroendoscopia/métodos , Estenose Espinal/cirurgia , Idoso , Descompressão Cirúrgica/métodos , Feminino , Humanos , Perna (Membro) , Dor Lombar/etiologia , Dor Lombar/cirurgia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/cirurgia , Radiculopatia/etiologia , Radiculopatia/cirurgia , Estenose Espinal/complicações , Estenose Espinal/fisiopatologia , Resultado do Tratamento
16.
Spine J ; 20(1): 112-120, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31479778

RESUMO

BACKGROUND CONTEXT: To understand the role of compensation mechanisms in the development and treatment of symptomatic degenerative lumbar spinal stenosis (DLSS), pelvic stability during walking should be objectively assessed in the context of clinical parameters. PURPOSE: To determine the association among duration of symptoms, lumbar muscle atrophy, disease severity, pelvic stability during walking, and surgical outcome in patients with DLSS scheduled for decompression surgery. STUDY DESIGN/SETTING: Prospective observational study with intervention. PATIENT SAMPLE: Patients with symptomatic DLSS. OUTCOME MEASURES: Oswestry Disability Index score; duration of symptoms; lumbar muscle atrophy; severity grade; pelvis rigidity during walking. METHODS: Patients with symptomatic DLSS were analyzed on the day before surgery and 10 weeks and 12 months postoperatively. Duration of symptoms was categorized as: <2years, <5years, and >5years. Muscle atrophy at the stenosis level was categorized according to Goutallier. Bilateral cross-sectional areas of the erector spinae and psoas muscles were quantified from magnetic resonance imaging. Stenosis grade was assessed using the Schizas classification. Pelvic tilt was measured in standing radiographs. Pelvic rigidity during walking was assessed as root mean square of the pelvic acceleration in each direction (anteroposterior, mediolateral, and vertical) normalized to walking speed measured using an inertial sensor attached to the skin between the posterior superior iliac spine. RESULTS: Body mass index but not duration of symptoms, lumbar muscle atrophy, pelvic rigidity, and stenosis grade explained changes in Oswestry Disability Index from before to after surgery. Patients with greater stenosis grade had greater pelvic rigidity during walking. Lumbar muscle atrophy did not correlate with pelvic rigidity during walking. Patients with lower stenosis grade had greater muscle atrophy and patients with smaller erector spinae and psoas muscle cross-sectional areas had a greater pelvis tilt. CONCLUSIONS: Greater pelvic rigidity during walking may represent a compensatory mechanism of adopting a protective body position to keep the spinal canal more open during walking and hence reduce pain. Pelvic rigidity during walking may be a useful screening parameter for identifying early compensating mechanisms. Whether it can be used as a parameter for personalized treatment planning or outcome prognosis necessitates further evaluation.


Assuntos
Pelve/fisiopatologia , Estenose Espinal/fisiopatologia , Caminhada , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Músculos Paraespinais/diagnóstico por imagem , Músculos Paraespinais/fisiopatologia , Pelve/diagnóstico por imagem , Postura , Radiografia , Estenose Espinal/etiologia , Estenose Espinal/patologia
17.
J Orthop Sci ; 25(2): 213-218, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30982707

RESUMO

BACKGROUND: Owing to musculoskeletal dysfunction, locomotive syndrome elevates the risk of requiring nursing care. Among degenerative musculoskeletal disorders, lumbar spinal canal stenosis (LSS) associates with locomotive syndrome; however, whether lumbar spinal surgery for LSS improves locomotive syndrome remains unclear. Hence, this study aimed to identify the efficacy of lumbar spinal surgery on locomotive syndrome among elderly patients with LSS. METHODS: We prospectively collected the clinical data from multiple institutions of patients (age >65 years) who underwent lumbar spinal surgery. Patients were examined for the locomotive syndrome risk test, including the stand-up Test, the two-step Test, and the 25-question risk assessment, 1-day preoperatively and 6-month and 1-year postoperatively. Using a logistic regression model, we identified factors associated with improvement of locomotive syndrome in the total assessment. RESULTS: Overall, we examined the data of 166 patients in this study. Upon converting each score of three tests to the stage of locomotive syndrome, the two-step test and the 25-question risk assessment revealed marked improvement in the postoperative distribution of stages. However, the stand-up test revealed a comparable distribution of stages pre- and postoperatively. In the total assessment, the postoperative distribution of stages was significantly improved than that preoperatively. The multivariable analysis revealed that failed back surgery syndrome [odds ratio (OR), 0.2; 95% confidence interval (CI): 0.04-1.05; P = 0.057)] and preoperative stage of 2 in stand-up test (OR, 0.2; 95% CI: 0.05-1.02; P = 0.054) tended to have inverse association with postoperative improvement of locomotive syndrome in the total assessment. CONCLUSIONS: Lumbar spinal surgery improved the stage of locomotive syndrome among elderly patients with LSS. This study suggests that lumbar spinal surgery for LSS could be beneficial in alleviating locomotive syndrome.


Assuntos
Transtornos Neurológicos da Marcha/cirurgia , Vértebras Lombares/cirurgia , Limitação da Mobilidade , Estenose Espinal/cirurgia , Idoso , Teste de Esforço , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Vértebras Lombares/fisiopatologia , Masculino , Estudos Prospectivos , Estenose Espinal/fisiopatologia , Inquéritos e Questionários
18.
J Orthop Sci ; 25(3): 379-383, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31235197

RESUMO

BACKGROUND: The impact of a positive sagittal vertical axis (SVA) on the surgical outcome for lumbar spinal stenosis (LSS) remains unclear, because sagittal imbalance in LSS may partly result from the tendency of patients to lean forward to reduce symptoms. Such an abnormality could be normalized by decompression surgery alone without corrective fusion. As this spontaneous correction is not well known, some surgeons perform only neural decompression in patients with positive SVA and decreased lumbar lordosis (LL), unless flatback-related symptoms are present, whereas other surgeons add corrective fusion to restore spinopelvic alignment. We systematically reviewed previous studies on this issue. METHODS: PubMed, Cochrane Library, and Embase were searched for English articles on the relationship between SVA and decompression surgery for LSS. The rates of spontaneous correction in spinopelvic parameters and the impact of SVA on clinical outcomes were analyzed. RESULTS: The rate of spontaneous SVA correction from >40-50 mm to normal values following decompression surgery alone varied from 25% to 73%. Overall, the spinopelvic parameters tended to improve postoperatively, with statistically significant changes in some series. Postoperative residual sagittal imbalance, rather than preoperative imbalance, more consistently showed a negative impact on clinical outcomes, but not on leg symptoms. For predicting postoperative sagittal imbalance, 2 studies identified the cutoff of >20° for preoperative PI-LL mismatch. Another study suggested SVA >80 mm as a useful value for this purpose. CONCLUSION: In LSS treated with decompression surgery alone, postoperative rather than preoperative sagittal imbalance more consistently affects clinical outcomes, particularly low back pain. This is probably because decompression usually partly improves preoperative spinopelvic sagittal malalignment. Thus, LSS, if associated with preoperative PI-LL mismatch <20° and SVA <80 mm, may not require additional corrective fusion procedures.


Assuntos
Mau Alinhamento Ósseo/fisiopatologia , Descompressão Cirúrgica/métodos , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia , Humanos , Remissão Espontânea
19.
J Clin Neurophysiol ; 37(1): 62-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31335564

RESUMO

INTRODUCTION: This study investigated whether the prolongation of the cauda equina conduction time (CECT) was related to the type of neurogenic intermittent claudication due to lumbar spinal stenosis. METHODS: In total, 149 patients who underwent surgery due to lumbar spinal stenosis with neurogenic intermittent claudication were classified into three groups as follows: cauda equina-type(n = 67), radicular-type(n = 29), and mixed-type(n = 53). Cauda equina conduction time was measured by placing disc electrodes on the abductor hallucis muscle, electrically stimulating the tibial nerve of the ankle and recording the compound muscle action potentials and F-waves. Motor evoked potentials from the abductor hallucis muscle were measured after magnetically stimulating the lumbosacral spine. Cauda equina conduction time was calculated from the latencies of compound muscle action potentials, F-waves, and motor evoked potentials. The measurement of the dural sac cross-sectional area were assessed using computed tomography myelography or MRI. RESULTS: The values of CECT were as follows: cauda equina-type, 5.6 ± 1.1 ms; mixed-type, 5.1 ± 0.9 ms; and radicular-type, 4.0 ± 0.9 ms. The values of dural sac cross-sectional area were as follows: cauda equina-type, 42.8 ± 18.7 mm; mixed-type, 49.6 ± 20.9 mm; and radicular-type, 75.3 ± 19.1 mm. In the cauda equina-type and mixed-type patients, CECT was significantly prolonged and there were negative correlations between CECT and dural sac cross-sectional area. CONCLUSIONS: Cauda equina conduction time differed according to the type of lumbar spinal stenosis. The prolongation of CECT may be caused by the demyelination of the CE. Cauda equina conduction time may be a useful measure for evaluating the dysfunction of the CE rather than radiculopathy for patients with lumbar spinal stenosis.


Assuntos
Cauda Equina/fisiopatologia , Claudicação Intermitente/etiologia , Claudicação Intermitente/fisiopatologia , Estenose Espinal/complicações , Adulto , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Estenose Espinal/fisiopatologia
20.
J Am Acad Orthop Surg ; 28(6): 229-239, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31663913

RESUMO

Tandem spinal stenosis (TSS) refers to simultaneous narrowing of noncontiguous regions of the spinal canal, typically the cervical and lumbar region. Symptomatic TSS may be present in more than 10% of patients presenting with spinal symptoms secondary to stenosis in any one region. Clinical presentation may present challenges because of a mixture of upper and lower motor neuron lesions that can confuse and mislead the clinician. Stenosis at another level may only be detected late, when there is failure to improve after treatment, and, if not detected, can result in either poor treatment outcomes or catastrophic complications. There is no uniform agreement in the management of TSS, and the reported surgical strategies include both simultaneous and staged approaches with each having positive and negative features. This article aims to provide the reader with details on the prevalence, evaluation, and guidance in treatment strategy for TSS.


Assuntos
Vértebras Cervicais/cirurgia , Vértebras Lombares/cirurgia , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia , Vértebras Cervicais/fisiopatologia , Humanos , Vértebras Lombares/fisiopatologia , Exame Físico
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