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neurogenic claudication

Waseem Mehmood Nizamani
Ligamentum flavum cyst is considered as a category of juxtafacet cyst and is recognized to be rare cause of cord compression and radiculopathy. The pathogenesis of these cysts is not yet fully understood, but it has been proposed that continuous stress to this ligament due to minor repetitive trauma, such as in spondylolisthesis and degenerative disc disease, may lead to the development of cyst. Intraspinal cyst can encroach and displace neural structures that can lead to neurologic symptoms. Although a rare entity, intraspinal cyst should be included in the causative factors of neurogenic claudication or lumbar radiculopathy based on typical magnetic resonance imaging appearance...
February 2018: Radiology Case Reports
Masakazu Minetama, Mamoru Kawakami, Masafumi Nakagawa, Yuyu Ishimoto, Keiji Nagata, Daisuke Fukui, Tadashi Sumiya, Tomoko Kitagawa, Takahiro Miyake, Yoshio Yamamoto, Nana Sakon, Toshiko Matsuoka, Yukihiro Nakagawa
BACKGROUND: The efficacy of physical therapy for patients with lumbar spinal stenosis (LSS) has been reported only for the short term, and few reports have compared outcomes of surgical treatment with nonsurgical treatment after physical therapy. The purpose of this study was to assess 2-year outcomes of LSS patients treated with surgery or under follow-up observation after physical therapy for 6 weeks. METHODS: Patients presenting with neurogenic claudication, radiologically-confirmed central LSS affecting both legs and refractory symptoms to pharmacotherapy of more than 3 months were enrolled...
January 29, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Patrick Fransen
Background: Neurogenic intermittent claudication (NIC) is the main symptom of degenerative lumbar spinal stenosis. Percutaneous interspinous process decompression devices (IPDs) have been designed as an alternative therapy to conservative treatment and to open decompressive surgery for patients suffering from NIC. Initial short-term results were encouraging. We present the long-term results of a group of patients that we followed to provide insight on long-term outcomes and effectiveness of this technique compared to other decompression methods...
December 2017: Journal of Spine Surgery (Hong Kong)
Noritsuna Nakajima, Toshikazu Tani, Katsuhito Kiyasu, Masashi Kumon, Shinichirou Taniguchi, Ryuichi Takemasa, Nobuaki Tadokoro, Kazuya Nishida, Masahiko Ikeuchi
BACKGROUND: Repetitive electrical nerve stimulation of the lower limb may improve neurogenic claudication in patients with lumbar spinal stenosis (LSS) as originally described by Tamaki et al. We tested if this neuromodulation technique affects the F-wave conduction on both sides to explore the underlying physiologic mechanisms. METHODS: We studied a total of 26 LSS patients, assigning 16 to a study group receiving repetitive tibial nerve stimulation at the ankle (RTNS) on one leg, and 10 to a group without RTNS...
January 15, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Rebecca A Sanders, Markus A Bendel, Susan M Moeschler, William D Mauck
OBJECTIVE: We present a case report of a patient who developed an epidural hematoma following an interlaminar epidural steroid injection with no risk factors aside from old age and aspirin use for secondary prevention. CASE REPORT: A 79-year-old man developed an epidural hematoma requiring surgical treatment following an uncomplicated interlaminar epidural steroid injection performed for neurogenic claudication. In the periprocedural period, he continued aspirin for secondary prophylaxis following a myocardial infarction...
January 9, 2018: Regional Anesthesia and Pain Medicine
Peter G Campbell, Pierce D Nunley, David Cavanaugh, Eubulus Kerr, Philip Andrew Utter, Kelly Frank, Marcus Stone
OBJECTIVE Recently, authors have called into question the utility and complication index of the lateral lumbar interbody fusion procedure at the L4-5 level. Furthermore, the need for direct decompression has also been debated. Here, the authors report the clinical and radiographic outcomes of transpsoas lumbar interbody fusion, relying only on indirect decompression to treat patients with neurogenic claudication secondary to Grade 1 and 2 spondylolisthesis at the L4-5 level. METHODS The authors conducted a retrospective evaluation of 18 consecutive patients with Grade 1 or 2 spondylolisthesis from a prospectively maintained database...
January 2018: Neurosurgical Focus
Daniel Lubelski, Vincent Alentado, Seth Williams, Colin O'Rourke, Nancy Obuchowski, Jeffrey C Wang, Michael Steinmetz, Alfred Melillo, Edward Benzel, Michael Modic, Robert Quencer, Thomas Mroz
BACKGROUND: There are a multitude of treatments for low grade lumbar spondylolisthesis. There are no clear guidelines for the optimal approach. OBJECTIVE: To identify the surgical treatment patterns for spondylolisthesis, among United States spine surgeons METHODS: 445 US spine surgeons completed a survey of clinical/radiographic case scenarios on patients with lumbar spondylolisthesis with neurogenic claudication with (S+BP) or without (S-BP) associated mechanical back pain...
December 27, 2017: World Neurosurgery
Masashi Miyazaki, Shozo Kanezaki, Naoki Notani, Toshinobu Ishihara, Hiroshi Tsumura
RATIONALE: Fixed thoracolumbar kyphosis with spinal stenosis in adult patients with achondroplasia presents a challenging issue. We describe the first case in which spondylectomy and minimally invasive lateral access interbody arthrodesis were used for the treatment of fixed severe thoracolumbar kyphosis and lumbar spinal canal stenosis in an adult with achondroplasia. PATIENT CONCERNS: A 61-year-old man with a history of achondroplastic dwarfism presented with low back pain and radiculopathy and neurogenic claudication...
December 2017: Medicine (Baltimore)
Daniel Diaz-Aguilar, Sergei Terterov, Rudi Scharnweber, Harsimran Brara, Alex Tucker, Catherine Merna, Stephanie Wang, Shayan Rahman
Background: Chordomas are uncommon malignant bone tumors that are often minimally symptomatic for several years. By the time they are diagnosed, these lesions are typically large, involve major neural, bony, and vascular structures, and are no longer readily resectable. This leads to a high recurrence rate. Case Description: In this case report, we present a 67-year-old male with nonmechanical axial back pain, neurogenic claudication, and a large mass centered at the L3 level on magnetic resonance imaging consistent with a locally invasive chordoma...
2017: Surgical Neurology International
Marie Doualla-Bija, Mbeng Ashu Takang, Emmanuella Mankaa, Jude Moutchia, Pierre Ongolo-Zogo, Henry Luma-Namme
BACKGROUND: Lumbar spinal stenosis (LSS) refers to narrowing of the lumbar central spinal canal, lateral recess, and/or neuro-foramina. Radiographic LSS plays an important role in clinical LSS but is not solely accountable for the presence of symptoms. We sought to characterise clinical LSS and to determine factors associated with presence of symptoms of LSS in patients with radiographic LSS in a sub Saharan Africa setting. METHODS: After prior ethical clearance, a case control study was done in a tertiary hospital in Douala-Cameroon, including 105 patients with radiographic LSS: 57 with symptoms of LSS (cases) and 58 with no symptoms (controls)...
November 28, 2017: BMC Musculoskeletal Disorders
Kevin Shah, Daniel Segui, Sergio Gonzalez-Arias
BACKGROUND: Ligamentum flavum cysts are thought to develop due to facet joint hypermobility; however, the etiology of these lesions is not completely elucidated. These cysts may lead to compressive pathologies of the spine requiring surgical intervention. CASE REPORT: We report the case of a 63-year-old male with chronic back pain and progressive neurogenic claudication for 6 months. He was found to have a ligamentum flavum cyst situated along the dorsal midline of the lumbar spinal canal contributing to spinal stenosis...
February 2018: World Neurosurgery
Mark P Arts, Jasper Fc Wolfs, Jos Ma Kuijlen, Godard Cw de Ruiter
INTRODUCTION: Patients with symptomatic spondylolisthesis are frequently treated with nerve root decompression, in addition to pedicle screw fixation and interbody fusion. Minimally invasive approaches are gaining attention in recent years, although there is no clear evidence supporting the proclamation of minimally invasive spine surgery (MISS) being better than open surgery. We present the design of the MISOS (Minimal Invasive Surgery versus Open Surgery) trial on the effectiveness of MISS versus open surgery in patients with degenerative or spondylolytic spondylolisthesis...
November 12, 2017: BMJ Open
Nancy E Epstein, Renee D Hollingsworth
Background: In the lumbar spine, degenerative spondylolisthesis or degenerative (not traumatic) slippage of one vertebral body over another is divided into 4 grades - grade I (25%), grade II (50%), grade III (75%), and grade IV (100%). Dynamic X-rays, magnetic resonance (MR), and computed tomography (CT) scans document the slip secondary to arthritic changes of the facet joint plus stenosis, ossification of the yellow ligament, disc herniations, and synovial cysts. MR best demonstrates soft tissue pathology whereas CT better delineates ossific/calcified disease...
2017: Surgical Neurology International
Stéphane Genevay, Delphine S Courvoisier, Kika Konstantinou, Francisco M Kovacs, Marc Marty, James Rainville, Michael Norberg, Jean-François Kaux, Thomas D Cha, Jeffrey N Katz, Steven J Atlas
BACKGROUND CONTEXT: Because imaging findings of lumbar spinal stenosis (LSS) may not be associated with symptoms, clinical classification criteria based on patient symptoms and physical examination findings are needed. PURPOSE: The objective of this study was to develop clinical classification criteria that identify patients with neurogenic claudication (NC) caused by LSS. STUDY DESIGN: This study is a two-stage process that includes Phase 1, the Delphi process, and Phase 2, the cross-sectional study...
October 12, 2017: Spine Journal: Official Journal of the North American Spine Society
Steven D Trigg, Zachary Devilbiss
Lumbar spinal stenosis (LSS) is a frequent cause of chronic low back and lower extremity pain in older patients. Symptomatic LSS typically is described as neurogenic claudication consisting of pain, weakness, numbness, and/or fatigue arising in the back and radiating into the buttock, thigh, or lower leg. The diagnosis is complicated by lack of reliable clinical or x-ray criteria. North American Spine Society guidelines recommend magnetic resonance imaging study without contrast to confirm anatomic narrowing of the spinal canal or nerve root impingement...
October 2017: FP Essentials
Xiaofei Cheng, Feng Zhang, Kai Zhang, Xiaojiang Sun, Changqing Zhao, Hua Li, Yan Michael Li, Jie Zhao
OBJECTIVE: To investigate the ability of transforaminal lumbar interbody fusion (TLIF) to improve lumbar lordosis (LL). METHODS: In this retrospective study, 92 patients undergoing single-level TLIF to treat lumbar degenerative disease were divided into a low back pain, radiculopathy, and neurogenic claudication group according to their symptoms. Preoperative and postoperative measures, including segmental LL, whole LL, pelvic incidence (PI), pelvic tilt, thoracic kyphosis, sagittal vertical axis, visual analog scale for back and leg pain, and Oswestry Disability Index, were used to evaluate radiographic and clinical outcomes...
January 2018: World Neurosurgery
Bernhard Meyer, Adad Baranto, Frederic Schils, Frederic Collignon, Bjorn Zoega, Leong Tan, Jean-Charles LeHuec
BACKGROUND: Standalone interspinous process devices (IPDs) to treat degenerative lumbar spinal stenosis with neurogenic intermittent claudication (NIC) have shown ambiguous results in the literature. OBJECTIVE: To show that a minimally invasive percutaneous IPD is safe and noninferior to standalone decompressive surgery (SDS) for patients with degenerative lumbar spinal stenosis with NIC. METHODS: A multicenter, international, randomized, controlled trial (RCT) was con- ducted...
June 26, 2017: Neurosurgery
Gonçalo Novais, Bernardo Ratilal, Lia Pappamikail, Pedro Branco, Nuno Reis
BACKGROUND: Pseudomeningocele, an extradural collection of cerebrospinal fluid (CSF), has only been rarely reported to occur spontaneously in conjunction with isthmic spondylolisthesis (with lysis) in the lumbar spine. CASE DESCRIPTION: A 68-year-old male presented with low back pain and neurogenic claudication of several years duration without any history of trauma, epidural spine injections, or spine surgery. Lumbosacral magnetic resonance imaging (MRI) revealed a grade-I L4-L5 isthmic spondylolisthesis with spinal canal narrowing and a posterior paravertebral collection consistent with CSF...
2017: Surgical Neurology International
Pierluigi Vergara, Christopher Yusuf Akhunbay-Fudge, Mark Robert Kotter, Rodney John Charles Laing
OBJECTIVE: Lumbar synovial cysts are relatively infrequent. Historically, these benign lesions have been treated with open excision, sometimes associated with fusion. The aim of this study is to compare minimally invasive surgery (MIS) with open surgery (OS) for the treatment of lumbar synovial cysts. METHODS: This was a retrospective review of patients who underwent minimally invasive or open excision of lumbar synovial cysts. Clinical outcomes, recurrence rate, and surgical complications were compared in the 2 groups...
December 2017: World Neurosurgery
Pierce D Nunley, Vikas V Patel, Douglas G Orndorff, William F Lavelle, Jon E Block, Fred H Geisler
BACKGROUND: Lumbar spinal stenosis is the most common indication for spine surgery in older adults. Interspinous process decompression (IPD) using a stand-alone spacer that functions as an extension blocker offers a minimally invasive treatment option for intermittent neurogenic claudication associated with spinal stenosis. METHODS: This study evaluated the 5-year clinical outcomes for IPD (Superion(®)) from a randomized controlled US Food and Drug Administration (FDA) noninferiority trial...
2017: Clinical Interventions in Aging
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