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Lumbar spinal stenosis treatment

Andreas Kiilerich Andresen, Carsten Ernst, Mikkel Ø Andersen
Lumbar spinal stenosis is the most common reason for spinal surgery in Denmark. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking or lumbar extension and relieved by forward flexion. The options for non-surgical management include drugs and physiotherapy. Treatment outcomes seem to be better for surgical neural decompression than for non-operative treatment...
October 10, 2016: Ugeskrift for Laeger
Tae Hyun Kim, Jun Jae Shin, Woo Yong Lee
BACKGROUND: Percutaneous epidural neuroplasty with a Racz catheter is widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. The breakage or shearing of an epidural catheter, particularly a percutaneous epidural neuroplasty catheter, is reported as a rare complication. There has been a controversy over whether surgical removal of a shorn epidural catheter is needed. Until now, only three cases related to sheared Racz neuroplasty catheters have been reported...
October 6, 2016: Journal of Medical Case Reports
Kevin Phan, Prashanth J Rao, Jonathon R Ball, Ralph J Mobbs
BACKGROUND: Interspinous spacers are used in selected patients for the treatment of lumbar spinal stenosis. The uses of interspinous devices are still debated, with reports of significantly higher reoperation rates and unfavourable cost-effectiveness compared to traditional decompression techniques. METHODS: Six electronic databases were searched from their date of inception to December 2015. Relevant studies were identified using specific eligibility criteria and data was extracted and analyzed based on predefined primary and secondary endpoints...
March 2016: J Spine Surg
Ralph J Mobbs, Kevin Phan, Greg Malham, Kevin Seex, Prashanth J Rao
Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life. Surgical interbody fusion of degenerative levels is an effective treatment option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity. The surgical options for interbody fusion of the lumbar spine include: posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF)...
December 2015: J Spine Surg
Christopher S Graffeo, Avital Perry, Eelco F M Wijdicks
BACKGROUND: Intracranial subarachnoid hemorrhage (SAH) and spinal subdural hematoma (SDH) are rare complications of spine surgery, thought to be precipitated by cerebrospinal fluid (CSF) hypotension in the setting of an intraoperative durotomy or postoperative CSF leak. Considerable clinical variability has been reported, requiring a high level of clinical suspicion in patients with a new, unexplained neurologic deficit after spine surgery. METHODS: Case report...
September 22, 2016: Neurocritical Care
Chan Hong Park, Sang Ho Lee
BACKGROUND : Spinal stenosis is characterized by narrowing of the spinal canal, with mechanical compression of spinal nerve roots. The latter may cause low back pain and/or leg pain, as well as neurogenic claudication. Epidural steroid injection is commonly used to treat patients with lumbar spinal stenosis (LSS), but percutaneous epidural adhesiolysis has been utilized when symptoms prove refractory. Our goal was to assess the relationship between improvement shown on epidurogram and subjective patient response to adhesiolysis...
September 20, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Alexander Antoniadis, Nils H Ulrich, Samuel Schmid, Mazda Farshad, Kan Min
INTRODUCTION: With increasing age, ubiquitous degeneration processes lead to a narrowing of the spinal canal. Degenerative lumbar spinal stenosis (DLSS) causes functional disability and is associated with back and lower extremity pain in older individuals. The goal of this study was to determine if decompression surgery can be performed safely and provide a stable benefit in our octogenarian patient population. METHODS: In this retrospective study, 121 patients over the age of 80 (mean age: 82...
September 20, 2016: British Journal of Neurosurgery
Dong Hwa Heo, Won Suh Choi, Choon-Keun Park, Jin-Sung Kim
OBJECTIVE: The purpose of this report is to describe the surgical methodology and effectiveness of minimally invasive oblique lumbar interbody fusion (OLIF) assisted by spinal endoscopy, which can treat disc herniation from the central to contralateral foramen. OLIF showed indirect decompression effects on reduction of spondylolisthesis and a foraminal widening effect on disc height restoration. METHODS: In this study, the indirect decompression effect of OLIF was augmented by direct endoscopic decompression and spinal endoscopy for removal of herniated disc materials...
September 15, 2016: World Neurosurgery
Yong-Jun Ahn, Joon-Shik Shin, Jinho Lee, Yoon Jae Lee, Me-Riong Kim, Ki Byung Park, Jun-Hwan Lee, Kyung-Min Shin, In-Hyuk Ha
OBJECTIVES: To assess medical care and costs of the 3 highest prevalence lumbar disorders-non-specific low back pain (nLBP), intervertebral disc disorder (IDD) and spinal stenosis (SS)-from national billing data to provide basic information for standards of appropriate management. DESIGN: Retrospective analysis of National Health Insurance National Patient Sample data provided by the Korean Health Insurance Review and Assessment Service (HIRA). SETTING: 2011 claims data from all medical institutions which filed billing statements to HIRA...
September 12, 2016: BMJ Open
Yoshihito Sakai, Sadayuki Ito, Tetsuro Hida, Kenyu Ito, Atsushi Harada, Ken Watanabe
BACKGROUND: The ligamentum flavum hypertrophy is considered to be one of the important causes of development of lumbar spinal stenosis (LSS). Several histologic and biologic mechanisms in hypertrophied flavum have proposed. However, no study that investigated the relationship between clinical outcome and ligamentum flavum hypertrophy has been published. The purpose of this study was to identify a new classification of LSS, in ligamentous and nonligamentous stenosis, according to the cutoff value of the area proportion of the ligamentum flavum in the spinal canal, and to assess the value of surgical and conservative treatments for LSS based on the classification of the ligamentous stenosis...
August 28, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
C Fleege, M Rickert, I Werner, M Rauschmann, M Arabmotlagh
INTRODUCTION: Determination of the extent of spinal fusion for lumbar degenerative diseases is often difficult due to minor pathologies in the adjacent segment. Although surgical intervention is required, fusion seems to be an overtreatment. Decompression alone may be not enough as this segment is affected by multiple factors such as destabilization, low grade degeneration and an unfavorable biomechanical transition next to a rigid construct. An alternative surgical treatment is a hybrid construct, consisting of fusion and implantation of an interlaminar stabilization device at the adjacent level...
September 2016: Der Orthopäde
Mohammad J Hadianfard, Ali Aminlari, Arghavan Daneshian, Ali R Safarpour
Lumbar spinal stenosis (LSS) is a major cause of debilitation in adults, and acupuncture is a recommended treatment. We assessed the effect of acupuncture on pain and quality of life in patients with LSS. Twenty-four patients with LSS who had symptoms of neurogenic claudication were randomly selected and underwent 10 sessions of acupuncture. Pain and quality of life were evaluated before and immediately after the intervention and 6 weeks later using a visual analogue scale and Short Form-36 Health Survey. Paired t tests and repeated measure tests were used to analyze the data...
August 2016: Journal of Acupuncture and Meridian Studies
Kosei Nagata, Shinichi Yamamoto, Kota Miyoshi, Masaki Sato, Yusuke Arino, Yoji Mikami
Eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) is a rare systemic vasculitis and is difficult to diagnose. EGPA has a number of symptoms including peripheral dysesthesia caused by mononeuropathy multiplex, which is similar to radiculopathy due to lumbar disc hernia or lumbar spinal stenosis. Therefore, EGPA patients with mononeuropathy multiplex often visit orthopedic clinics, but orthopedic doctors and spine neurosurgeons have limited experience in diagnosing EGPA because of its rarity...
August 2016: Acta Medica Okayama
Niel Davis, Patrick Hourigan, Andrew Clarke
BACKGROUND CONTEXT: Transforaminal epidural steroid injection (TFESI) is recognised as a treatment for symptomatic lumbar disc herniation, whilst surgical decompression is generally thought to be the most effective treatment option for lumbar spinal stenosis. There is little available literature examining the effect of TFESI on symptomatic lumbar spinal stenosis. PURPOSE: To evaluate the use of TFESI as an alternative to surgery in patients with symptomatic stenosis...
August 22, 2016: British Journal of Neurosurgery
J C Le Huec, A Cogniet, S Mazas, A Faundez
UNLABELLED: Degenerative de novo scoliosis is commonly present in older adult patients. The degenerative process including disc bulging, facet arthritis, and ligamentum flavum hypertrophy contributes to the appearance of symptoms of spinal stenosis. Idiopathic scoliosis has also degenerative changes that can lead to spinal stenosis. PURPOSE: The aetiology, prevalence, biomechanics, classification, symptomatology, and treatment of idiopathic and degenerative lumbar scoliosis in association with spinal stenosis are reviewed...
October 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Anastasia Topalidou, George Tzagarakis, Konstantine Balalis, Alexandra Papaioannou
The mobility of the spine and the change in the angle of the curvatures are directly related to spinal pain and spinal stenosis. The aim of the study was the evaluation of morphology and mobility of the spine in patients who were subjected to decompression and posterior fusion with pedicle screws. The treatment group consisted of 20 patients who underwent posterior fixation of lumbar spine (one and two level fusion). The control group consisted of 39 healthy subjects. Mobility and curvatures of the spine were measured with a non-invasive device, the Spinal Mouse...
2016: PloS One
Ko Ikuta, Keigo Masuda, Fuyuki Tominaga, Takahide Sakuragi, Kazuhiro Kai, Takahiro Kitamura, Hideyuki Senba, Satoshi Shidahara
STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to identify the clinical and radiological features of low back pain (LBP) that was relieved following decompression alone of lumbar spinal stenosis (LSS) associated with Grade I lumbar degenerative spondylolisthesis (LDS). SUMMARY OF BACKGROUND DATA: Although decompression and fusion is generally the recommended surgical treatment of LDS, several authors have reported that some patients with LDS could obtain good clinical results including relief from LBP by decompression alone...
August 3, 2016: Spine
Gen Inoue, Masayuki Miyagi, Masashi Takaso
Lumbar spinal stenosis (LSS) is the most common indication for spinal surgery in older adults; however, the efficacy of surgery for LSS as compared to nonsurgical treatments remains unclear. Here, we reviewed numerous studies, including randomized control trails (RCTs), to compare nonsurgical and surgical treatments for LSS. The nonsurgical management of LSS includes medication, epidural injections, physiotherapy, lifestyle modification, and multidisciplinary rehabilitative approaches. Patients with LSS who do not improve after nonsurgical treatments are typically treated surgically using decompressive surgery, which has the strongest evidence base...
October 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Young Uk Kim, Myung Hwan Karm, Yuseon Cheong, Jonghyuk Lee, Yu Gyeong Kong, Se Hun Kim, Jeong Hun Suh
BACKGROUND: No studies to date have compared bone mineral density (BMD) changes after epidural steroid injection (ESI) between postmenopausal patients taking antiosteoporotic medication and those who are not. OBJECTIVE: The aim of the present study was to analyze the relationship between ESI and BMD changes in postmenopausal patients according to antiosteoporotic medication use. STUDY DESIGN: Retrospective analysis. SETTING: Department of Anesthesiology and Pain Medicine at Asan Medical Center, Korea...
July 2016: Pain Physician
Sumihisa Orita, Masaomi Yamashita, Yawara Eguchi, Miyako Suzuki, Gen Inoue, Masayuki Miyagi, Tomoko Watanabe, Tomoyuki Ozawa, Hiroto Kamoda, Tetsuhiro Ishikawa, Yasuchika Aoki, Toshinori Ito, Go Kubota, Munetaka Suzuki, Kazuyo Yamauchi, Eiji Hanaoka, Yoshihiro Sakuma, Jun Shimbo, Yasuhiro Oikawa, Takane Suzuki, Kazuhisa Takahashi, Seiji Ohtori
We investigated the efficacy of pregabalin (PGB) for neuropathic leg pain in lumbar spinal stenosis (LSS) patients with disturbed activities of daily living (ADL)/quality of life (QOL) in a prospective observational study. Subjects were a total of 104 LSS patients with neuropathic pain (NeP) in leg and neurological intermittent claudication (IMC) refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) for at least a month. NeP was identified using screening tool, Pain DETECT questionnaire. Visual analog scale (VAS) scores and responses to the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were assessed before and 6 weeks after PGB treatment initiation...
2016: Pain Research & Management: the Journal of the Canadian Pain Society
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