Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

Leg pain/numbness and gait disturbance, two major symptoms in the lower extremities of lumbar spinal stenosis (LSS), are generally expected to be alleviated by decompression surgery. However, the paucity of information available to patients before surgery about specific predictors has resulted in some of them being dissatisfied with the surgical outcome when the major symptoms remain after the procedure. This prospective, observational study sought to identify the predictors of the outcome of a decompression surgery: modified fenestration with restorative spinoplasty. Of 109 consecutive LSS patients who underwent the decompression surgery, 89 (56 males and 33 females) completed the 2 year follow-up. Both leg pain/numbness and gait disturbance determined by the Japanese Orthopedic Association scoring system were significantly improved at 2 years after surgery compared to those preoperative, regardless of potential predictors including gender, preoperative presence of resting numbness in the leg, drop foot, cauda equina syndrome, degenerative spinal deformity or myelographic filling defect, or the number of decompressed levels. However, 27 (30.3%) and 13 (14.6%) patients showed residual leg pain/numbness and gait disturbance, respectively. Among the variables examined, the preoperative resting numbness was associated with residual leg pain/numbness and gait disturbance, and the preoperative drop foot was associated with residual gait disturbance, which was confirmed by logistic regression analysis after adjustment for age and gender. This is the first study to identify specific predictors for these two remaining major symptoms of LSS after decompression surgery, and consideration could be given to including this in the informed consent.     

步行负荷试验对腰椎管狭窄症的诊断价值

目的:研究步行负荷试验在诊断腰椎管狭窄症中与腰椎MRI检查及下肢肌电图检查的相符情况,评估其诊断价值。方法:选取2009年10月～2010年10月我院收治的腰椎管狭窄症住院患者35例,临床表现均为症状重但查体定位体征不明显。所有入选病例均对其影像学(腰椎正侧位、腰椎动力位、腰椎MRI、下肢血管多普勒)检查、下肢肌电图及步行负荷试验结果进行双盲检测及评估。观察比较步行负荷试验后出现特定阳性体征(感觉、肌力、反射等变化)所对应的神经受累节段,与腰椎MRI及肌电图检查所反应的腰椎管狭窄部位的相符情况。结果:步行负荷试验后有29例患者主诉出现下肢麻木、酸痛,其中体格检查显示L1/2、L2/3、L3/4、L4/5、L5/S1节段神经根受累节段数分别为1个、1个、12个、23个、16个,其中单节段神经根受累10例(34.5%),双节段神经根受累14例(48.3%),三节段神经根受累5例(17.2%);影像学检查显示的L1/2、L2/3、L3/4、L4/5、L5/S1节段神经受累节段数分别为2个、2个、15个、25个、18个,其中单节段神经根受累14例(40%),双节段神经根受累15例(42.9%),三节段神经根受累6例(17.1%)。31例(88.6%)患者肌电图检查有阳性发现,4例(11.4%)无异常发现,步行负荷试验阳性发现的患者肌电图均有不同程度的异常(100%)。步行负荷试验在L3/4、L4/5、L5/S1节段诊断椎管狭窄与腰椎MRI检查相比无统计学差异(P>0.05)。结论:步行负荷试验诊断低位节段(L3～S1)的腰椎管狭窄症与腰椎MRI检查及肌电图检查结果具有较好的一致性,临床上对腰椎管狭窄症有重要的诊断价值。     

单纯减压与减压融合术治疗老年退行性腰椎管狭窄症的Meta分析

目的对单纯减压术与减压融合术治疗老年退行性腰椎管狭窄症进行Meta分析。方法计算机检索Pub Med、Embase、Cochrane图书馆、万方数据库和中国期刊全文数据库中2016年2月以前的相关文献。根据纳入与排除标准,由2名研究者分别独立筛选文献,按照Cochrane偏倚风险评估工具严格进行质量评估,并利用Rev Man 5.2软件对相关结局指标(总体疗效、手术时间、术中出血量、并发症发生率、二次手术率)进行Meta分析。结果纳入9篇符合纳入标准的随机对照试验,共964例,单纯减压组580例,减压融合组384例。Meta分析结果显示,与减压融合组比较,单纯减压组手术时间和术中出血量明显更少,差异有统计学意义(P0.05);而2组在术后总体疗效、并发症发生率和二次手术率方面差异无统计学意义(P0.05)。结论单纯减压和减压融合术治疗老年退行性腰椎管狭窄症的疗效相当,但单纯减压术具有手术创伤小、出血量少、手术时间短、术后康复快的优点。     

后路椎间盘镜在治疗腰椎管狭窄症中的应用

目的：探讨后路椎间盘镜在治疗腰椎管狭窄症中的应用。方法：2000年2月--2001年12月退行性腰椎管狭窄症142例行后路椎间盘镜下椎管有限减压、全椎板或半椎板切除减压、开窗减压术。结果：应用后路椎间盘镜行椎管有限减压87例，减压松解充分。82例随访平均18月，优良率92．7％(优58例，良18例)。无并发症。结论：单纯腰椎间盘膨出或突出、黄韧带肥厚和小关节增生引起的退行性腰椎管狭窄症是后路椎间盘镜下椎管有限减压的适应证。满意的手术效果取决于：病人选择适当，术中操作精细，减压彻底。     

Histology of the ligamentum flavum in patients with degenerative lumbar spinal stenosis

The degree of calcification as well as the structural changes of the elastic fibres in the ligamentum flavum in patients with degenerative lumbar spinal stenosis were evaluated and the results were compared to those of patients without spinal stenosis. In 21 patients (13 male, 8 female) with lumbar spinal stenosis the ligamentum flavum was removed, histologically processed and stained. The calcification, the elastic/collagenous fibre ratio as well as the configuration of the fibres were evaluated with an image analyzing computer. As a control group, 20 ligaments of 10 human corpses were processed in the same way. The results were statistically analysed using the Mann-Whitney-Wilcoxon test (α = 0.05) and the t-test (α = 0.05). Nearly all the ligaments of patients with lumbar spinal stenosis were calcified (average 0.17%, maximum 3.8%) and showed relevant fibrosis with decreased elastic/collagenous fibre ratio. There was a significant correlation between age and histological changes (P < 0.05). In the control group we only found minimal calcification in 3 of 20 segments (average 0.015%). No relevant fibrosis was found and the configuration of elastic fibres showed no pathologic changes. The results of this study illustrate the important role of histological changes of the ligamentum flavum for the aetiology of lumbar spinal stenosis. Received: 31 July 1998 Revised: 19 March 1999 Accepted: 12 April 1999     

The role of JOA score as an indication for surgical or conservative treatment of symptomatic degenerative lumbar spinal stenosis

Abstract The aim of this study was to evaluate the short- to medium-term results (up to 2 years) of conservative and surgical treatments of patients with symptomatic lumbar stenosis. To our knowledge, no previous study has provided strict indications for conservative or surgical treatment. We retrospectively studied 184 patients, who were divided into 3 groups according to JOA (Japanese Orthopaedic Association) score. A cutoff JOA score was arbitrarily fixed at 7. Patients with a score ≤7 (n=12; group A) underwent surgery, while patients with a score >7 (n=172) were conservatively treated. Group A included patients surgically treated within two months from diagnosis. Group B consisted of 144 patients who received conservative treatment, while group C (28 patients) represented patients who underwent surgery after a period of failed conservative treatment. The outcomes of surgical and conservative treatments were evaluated after 12 and 24 months, and were rated as satisfactory, not totally satisfactory, not satisfactory or totally unsatisfactory. Conservative treatment consisted of physical, orthotic and drug therapy, whereas surgical treatment included spinal decompression and instrumentation (if indicated), either rigidly or dynamically performed. Surgery was indicated in 22% of all patients and we obtained excellent results in 85% of them. Operative treatment provides excellent results for patients with severe clinical presentation (JOA score ≤7), while individuals with mild to moderate spinal stenosis (JOA score >7) should receive conservative treatment.     

The effect of prior back surgery on surgical outcome in patients operated on for lumbar spinal stenosis a matched-pair study

Summary It has been widely observed that the outcome after repeat lumbar surgery is rarely comparable to that of primary surgery. In particular, the results of repeat surgery for lumbar spinal stenosis (LSS) have not been favourable. We used a matched-pair format in an attempt to decrease the confounding factors so as to determine as exactly as possible the effect of prior back surgery on the LSS patients surgical outcome. The matching criteria were sex, age, myelographic findings, major symptom, and duration of symptoms. From one group of 251 patients without prior back surgery (SO patients) and another of fifty-three patients with one preceding back operation (RS patients), forty-one similar matched patients pairs (one SO and one RS-patient) were formed.There were 8 female and 33 male pairs. The mean age of the SO patients was 51.6 and of the RS patient 51.4 years, and the mean follow-up time was 4.6 and 4.4 years. The assessment of outcome was based on a subjective disability questionnaire. The SO patients fared significantly better than the RS patients (32.1 versus 41.3, P = 0.026). A short time interval between operations in the RS patients had a worsening effect on outcome, but this trend was not significant.We concluded that one preceding back operation had a worsening effect on the outcome of patients operated on for LSS. As a whole, the results of RS patients were unfavourable. The proper time for achieving good surgical results in LSS patients is the initial operation.     

Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

Symptomatic degenerative central lumbar spinal stenosis (LSS) is a frequent indication for decompressive spinal surgery, to reduce spinal claudication. No data are as yet available on the effect of surgery on the level of activity measured with objective long-term monitoring. The aim of this prospective, controlled study was to objectively quantify the level of activity in central LSS patients before and after surgery, using a continuous measurement device. The objective data were correlated with subjective clinical results and the radiographic degree of stenosis. Forty-seven patients with central LSS and typical spinal claudication scheduled for surgery were included. The level of activity (number of gait cycles) was quantified for 7 consecutive days using the StepWatch Activity Monitor (SAM). Visual analogue scales (VAS) for back and leg pain, Oswestry disability index and Roland–Morris score were used to assess the patients’ clinical status. The patients were investigated before surgery and 3 and 12 months after surgery. In addition, the radiographic extent of central LSS was measured digitally on preoperative magnetic resonance imaging or computed tomography. The following results were found preoperatively: 3,578 gait cycles/day, VAS for back pain 5.7 and for leg pain 6.5. Three months after surgery, the patients showed improvement: 4,145 gait cycles/day, VAS for back pain 4.0 and for leg pain 3.0. Twelve months after surgery, the improvement continued: 4,335 gait cycles/day, VAS for back pain 4.1 and for leg pain 3.3. The clinical results and SAM results showed significant improvement when preoperative data were compared with data 3 and 12 months after surgery. The results 12 months after surgery did not differ significantly from those 3 months after surgery. The level of activity correlated significantly with the degree of leg pain. The mean cross-sectional area of the spinal canal at the central LSS was 94 mm². The radiographic results did not correlate either with objective SAM results or with clinical outcome parameters. In conclusion, this study is the first to present objective data on continuous activity monitoring/measurements in patients with central LSS. The SAM could be an adequate tool for performing these measurements in spine patients. Except for leg pain, the objective SAM results did not correlate with the clinical results or with the radiographic extent of central LSS.     

Depression is associated with poorer outcome of lumbar spinal stenosis surgery

The objective of this observational prospective study was to investigate the effect of depression on short-term outcome after lumbar spinal stenosis (LSS) surgery. Surgery was performed on 99 patients with clinically and radiologically defined LSS, representing ordinary LSS patients treated at the secondary care level. They completed questionnaires before surgery and 3 months postoperatively. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with Oswestry disability index, Stucki Questionnaire, self-reported walking ability, visual analogue scale (VAS) and pain drawing. Preoperatively, 20% of the patients had depression. In logistic regression analyses, significant associations were seen between preoperative depression and postoperative high Oswestry disability and Stucki severity scores and high intensity of pain (VAS score). In subsequent analyses, the patients with continuous depression, measured with BDI (60% of the patients who had preoperative depression), showed fewer improvements in symptom severity, disability score, pain intensity and walking capacity than the patients who did not experience depression at any phase. In those patients who recovered from depression, according to BDI-scores (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. In the surgical treatment of LSS, we recommend that the clinical practice should include an assessment of depression.     

Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis

No clinical diagnostic support tool can help identify patients with LSS. Simple diagnostic tool may improve the accuracy of the diagnosis of LSS. The aim of this study was to develop a simple clinical diagnostic tool that may help physicians to diagnose LSS in patients with lower leg symptoms. Patients with pain or numbness of the lower legs were prospectively enrolled. The diagnosis of LSS by experienced orthopedic specialists was the outcome measure. Multivariable logistic regression analysis identified factors that predicted LSS; a simple clinical prediction rule was developed by assigning a risk score to each item based on the estimated beta-coefficients. From December 2002 to December 2004, 104 orthopedic physicians from 22 clinics and 50 hospitals evaluated 468 patients. Two items of physical examination, three items of patients' symptom, and five items of physical examination were included in the final scoring system as a result of multiple logistic regression analysis. The sum of the risk scores for each patient ranged from −2 to 16. The Hosmer–Lemeshow statistic was 11.30 (P = 0.1851); the area under the ROC curve was 0.918. The clinical diagnostic support tool had a sensitivity of 92.8% and a specificity of 72.0%. The prevalence of LSS was 6.3% in the bottom quartile of the risk score (−2 to 5) and 99.0% in the top quartile (12 to 16). We developed a simple clinical diagnostic support tool to identify patients with LSS. Further studies are needed to validate this tool in primary care settings.     

精准定位经皮全内镜椎板开窗减压术治疗腰椎管狭窄症941

目的：应用精准定位全内镜下椎板开窗减压术式（full endoscopic fenestration,FE-FE）治疗腰椎管狭窄症（lumbar spinal stenosis,LSS）,并探讨其临床实用性及术后疗效。方法：参照传统开放手术中椎板开窗减压术,应用操作水介质椎板间脊柱内镜技术完成腰椎管减压。对2016年6月至2017年6月接受FE-FE手术治疗的37例LSS患者进行回顾性分析,其中男19例,女18例,年龄55～83（67.1±18.9）岁。记录手术前后视觉模拟评分（VAS）、腰椎疾患JOA评分、Oswestry功能残障量表（ODI）及SF-36生活质量量表评定分值,观察患者自觉疼痛及神经功能恢复情况,并根据JOA评分改善率对临床疗效进行评定。结果：37例患者均获得随访,时间8～24（13.7±6.1）个月。术后VAS、JOA、ODI及SF-36分值均较术前有明显改善（P<0.05）。根据JOA评分改善率进行疗效评估,术后6个月优17例,良13例,可5例,差2例;末次随访优19例,良13例,可4例,差1例。术后影像学显示椎管容积明显扩大,临床症状有满意的改善,腰腿疼痛缓解、生活质量提高、社会活动适应性增加,无严重并发症发生。结论：精准定位是全内镜下完成椎板开窗减压的关键,FE-FE治疗LSS创伤小、疗效肯定、安全可靠,具有较广阔应用前景。     

合并糖尿病的腰椎管狭窄症患者手术治疗效果分析

背景：糖尿病常因合并腰椎管狭窄症而需手术治疗,若同时合并糖尿病性周围血管或神经病变,其手术效果往往会受到很大影响。但目前很少有学者对合并糖尿病的腰椎管狭窄症患者的临床疗效进行随访研究。 目的：探讨合并糖尿病的腰椎管狭窄症患者的手术治疗效果。 方法：回顾性分析2008年3月至2012年12月手术治疗的腰椎管狭窄症患者94例,分为合并糖尿病组（A组）及单纯腰椎管狭窄症组（B组）各47例。通过比较两组患者体重指数、住院时间、融合节段、手术时间、术中出血量、术后引流量、围手术期并发症发生率、术前及术后1年随访的VAS评分及JOA评分、术后1年融合率等临床指标评价糖尿病对腰椎管狭窄症患者手术疗效的影响。 结果：两组患者的性别、年龄、手术时间、术中出血量、围手术期并发症发生率、术前及术后1年随访的VAS评分及JOA评分、术后1年融合率均无统计学差异（P＞0.05）,两组患者的体重指数、住院时间、术后引流量有统计学差异（P＜0.05）。 结论：合并糖尿病的腰椎管狭窄症患者的住院时间明显延长,术后引流量增加,但手术疗效尚可。     

高龄腰椎管狭窄症患者手术治疗的安全性及有效性

目的:分析高龄腰椎管狭窄症患者接受手术治疗的临床疗效及并发症,评价其安全性和有效性。方法:自2015年12月~2017年6月,共有49例75岁以上的腰椎管狭窄症患者在我院接受腰椎后路减压融合内固定术,其中获得半年以上随访且资料完整的患者44例,单节段融合11例,双节段融合21例,3节段融合7例,3节段以上融合5例。34例(77.3%)患者合并高血压,13例(29.5%)合并糖尿病,9例(20.5%)合并冠心病(3例曾行心脏支架植入术,1例曾行心脏搭桥术),6例(13.6%)有脑梗死病史但无明显后遗症,2例(4.5%)合并慢性阻塞性肺疾病,2例(4.5%)慢性肾功能不全。将患者分为短节段融合组(3节段,n=32)和长节段融合组(≥3节段,n=12)。统计两组患者的一般资料、术中出血量、手术时间、疼痛视觉模拟量表(visual analoge score,VAS)评分、Oswestry功能障碍指数(ODI)以及手术并发症。将患者对手术疗效的主观满意度分为满意、基本满意、不满意、非常不满意。结果:44例患者均顺利完成手术,手术时间为234.2±74.56min(100~411min),术中出血量为475.5±343.4ml(100~1400ml)。术后发生脑脊液漏2例,切口愈合不良5例。随访13.8±2.1个月(6~25个月),末次随访时,VAS评分由术前的7.53±1.19分改善至2.38±1.58分(P0.001),ODI由术前的(70.32±6.90)%改善至(46.38±9.89)%(P0.001);8例出现螺钉松动,2例cage后移,2例cage下沉,再手术2例。30例对疗效满意,6例基本满意,5例不满意,3例非常不满意,满意率为81.8%。两组患者年龄和BMI无显著性差异,长节段融合组女性患者占比较高,手术时间较长,出血量较多;两组患者的VAS评分改善率和ODI改善率无显著性差异;与长节段融合组相比,短节段融合组再手术比例、螺钉松动比例以及cage后移比例较低。结论:高龄腰椎管狭窄症患者并存病较多,围手术期内固定相关并发症较多,且与融合节段有关。围手术期积极控制内科疾病,术中仔细操作,手术的安全性可以得到保障,术后临床症状和功能评分均可以获得显著性改善。     

Prediction of long-term clinical outcome in patients with lumbar spinal stenosis

Purpose

The natural course of lumbar spinal stenosis (LSS) fluctuates and is not necessarily progressive. The aim of this study was to explore the predictors of clinical outcome in patients with LSS that might eventually help to optimise the therapeutic choices.

Methods

A group of 56 patients (27 men, 29 women, median age 55; range 31–72 years) with clinically symptomatic mild-to-moderate LSS were re-examined after a median period of 88 months and their clinical outcomes classified as satisfactory (34 patients, 60.7 % with stable or improved clinical status) or unsatisfactory (22 patients, 39.3 % for whom clinical status deteriorated). A wide range of demographical, clinical, imaging and electrophysiological entry parameters were evaluated as possible predictors of clinical outcome.

Results

Unlike the demographical, clinical and imaging variables, certain electrophysiological parameters were significantly associated with unsatisfactory outcomes. There was a significantly higher prevalence of pluriradicular involvement detected by EMG in patients with unsatisfactory outcome than those with satisfactory outcome (68.2 vs. 32.3 %; p = 0.035). Patients with unsatisfactory outcome had more frequent bilateral abnormalities of the soleus H-reflex (50.0 vs. 14.7 %; p = 0.015) and lower mean H-reflex amplitude. Multivariate logistic regression proposed two variables as mutually independent predictors of unsatisfactory outcome: EMG signs of pluriradicular involvement (OR = 3.72) and averaged soleus H-reflex amplitude ≤2.8 mV (OR = 2.87).

Conclusions

Satisfactory outcomes were disclosed in about 61 % of the patients with mild-to-moderate LSS in a 7-year follow-up. Electrophysiological abnormalities, namely the presence of pluriradicular involvement and abnormalities of the soleus H-reflex, were predictive of deterioration of clinical status in these patients.     

Differential diagnostics in patients with mild lumbar spinal stenosis: the contributions and limits of various tests

Lumbar spinal stenosis (LSS) and diabetic polyneuropathy are common ailments of older age. Many people suffer from both at the same time. In such patients it may sometimes be difficult to separate signs and symptoms that could be attributed to either disease. This study evaluates the contributions and limits of various tests, especially the exercise treadmill test (ETT) and electrophysiological examination, in the diagnostics of patients with mild LSS. Twenty-nine patients with mild LSS documented by computed tomography (CT) participated in this study. Sixteen of the patients had neurogenic claudication (LSS NC+), and 13 patients did not (LSS NC-). Patients with LSS were compared with a group of 24 patients with diabetic polyneuropathy and 25 healthy volunteers. The distance covered, the time spent walking and the reasons for preliminary termination of the ETT were evaluated in all groups. Initial electrophysiological examination included electromyography (EMG) from the upper and lower extremities and motor evoked potentials (MEPs) to the lower extremities. LSS NC+ patients covered a significantly shorter distance and the time spent walking was significantly shorter than in LSS NC- patients and in the two control groups. The main reason for preliminary termination of the ETT was the development of NC in 67% of the LSS NC+ patients. In contrast, no LSS NC- patient and none from the control groups revealed NC, but 31% of LSS NC- patients were not able to finish the ETT for other reasons (e.g. dyspnoea). Electrophysiological parameters evaluated from the upper extremities distinguished diabetic patients from LSS patients. The latencies of the tibial F-wave, soleus H-reflex and spinal MEP response reliably distinguished healthy volunteers from diabetic patients and LSS patients, and particularly LSS patients from diabetic patients. The chronodispersion of the tibial F-wave distinguished LSS NC+ patients from the other groups. The results of the study show that electrophysiological examination contributes to the differential diagnostics between mild lumbar spinal stenosis and diabetic polyneuropathy. The contribution of electrophysiological methods in verification of NC in LSS patients is limited (chronodispersion of the tibial F-wave only). The ETT is useful in confirmation of NC and walking capacity verification, but restriction of walking capacity should be carefully analysed.     

MED治疗老年腰椎管狭窄症44例体会

目的探讨显微内镜后路椎间盘手术系统(MED)治疗老年腰椎管狭窄症的价值. 方法根据含定位物的腰椎正、侧位 X线片定位,在局部麻醉或浅硬外麻醉下建立 MED系统,用自制微型骨刀凿去部分椎板、增生内聚的关节突,彻底解除硬脊膜及神经根周围的压迫. 结果手术时间25～180 min.术中出血量50～300 ml.1例因硬膜及神经根与周围组织广泛粘连中转开放手术.44例均获随访,时间3～ 40个月,平均15个月.按照 Nakai评价标准:优30例,良8例,差 6例,优良率 86.4%(38/44).并发症:椎间隙感染1例,出现健肢症状2例. 结论 MED创伤小、出血少、恢复快,在神经充分减压的前提下,能尽可能保持脊柱的稳定性,是治疗老年性腰椎管狭窄症有效方法之一.     

经皮内镜下腰椎减压融合术治疗腰椎管狭窄症伴不稳的疗效研究

目的 我院采用经皮内镜下腰椎减压椎间融合+经皮椎弓根螺钉固定术治疗腰椎管狭窄症伴不稳,分析其安全性、有效性。方法 回顾性分析自2019年4月～2020年11月我科30例患者的临床资料,均为单节段腰椎管狭窄症伴不稳,依次完成经皮椎弓根螺钉置入、经皮内镜下椎管神经根管减压、椎间盘切除及椎间融合器置入。随访时间为（13.6±1.3）个月。统计相关参数。结果 30例患者均顺利完成手术,手术时间为（267.8±74.3）min;术中出血量为（83.6±13.3）ml;平均切口长度为（1.7±0.3）cm;住院时间为（9.6±1.9）d。30例患者顺利随访,最终随访显示视觉模拟评分及 Oswestry功能障碍指数较术前有显著改善(P＜0.05),融合器、钉棒位置良好,融合满意。末次随访时改良MacNab疗效结果:优良率为96.67%。结论 经皮内镜下腰椎减压椎间融合+经皮椎弓根螺钉固定术治疗腰椎管狭窄症伴不稳的患者创伤小,出血少,术后恢复快,并发症少,短期内随访手术效果满意。     

Osteoporotic profiles in elderly patients with symptomatic lumbar spinal canal stenosis

Background:

The osteoporosis and lumbar canal stenosis, in elderly patients are under diagnosed and under reported. We report a cross sectional study to demonstrate the osteoporotic profile in patients with lumbar spinal stenosis (LSS) and to determine the proportion of patients with LSS who need to be treated for osteoporosis.

Materials and Methods:

One hundred and six postmenopausal patients with symptomatic LSS were evaluated for osteoporotic profile, which included lumbar and hip bone mineral density (BMD), serum vitamin D concentration, bone resorption and formation markers. Demographic and disease related variables were analyzed to identify the association with the risk of osteoporosis or osteopenia. Statistical analysis used were multivariate logistic regression with a forward stepwise procedure.

Results:

Twenty-four patients (22.6%) had osteoporosis and 60 (56.6%) had osteopenia. Overall, 84 patients (79.2%) with symptomatic LSS had osteoporosis or osteopenia. Fifty-nine patients (55.6%) had hypovitaminosis D. All bone turnover makers [alkaline phosphatase, osteocalcin, urinary-N-terminal telopeptide (u-NTx)] were demonstrated to be within normal range. Only age was associated with the risk of osteoporosis or osteopenia in the hip region. In the lumbar spine, all variables were not associated with osteoporosis or osteopenia. 44 patients (41.5%) required treatment for osteoporosis as per risk factors for osteoporosis. According to the guidelines from the Health Insurance Review Agency, however, only 20 patients (18.8% required) qualified for reimbursement for osteoporosis medications.

Conclusions:

LSS is associated with osteopenia, osteoporosis, and hypovitaminosis D, which should prompt careful screening and treatment in cases of osteoporosis and osteoarthritis.     

伴与不伴弥漫性特发性骨质增生症的腰椎管狭窄症患者脊柱骨盆参数的比较

目的 :探讨弥漫性特发性骨质增生症(diffuse idiopathic skeletal hyperostosis,DISH)对腰椎管狭窄症(lumbar spinal stenosis,LSS)患者脊柱骨盆矢状面参数的影响。方法 :回顾性分析2014年1月~2017年6月于南京鼓楼医院行腰椎后路全椎板切除减压椎间融合手术的伴DISH的LSS患者40例,其中男23例,女17例,年龄51~75岁(65.1±7.3岁)。同时选取年龄及性别匹配且接受相同术式的不伴DISH的LSS患者40例作为对照组,其中男23例,女17例,年龄51~75岁(64.7±7.1岁)。两组患者性别、年龄、责任节段分布均无统计学差异(P0.05)。分别测量两组患者术前胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、矢状面平衡(sagittal vertical axis,SVA)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、腰骶角(lumbar-sacral angle,LSA)、腰5入射角(L5 incidence,L5I)等脊柱骨盆参数,并用术前VAS评分和ODI评分评估入选对象的生活质量。采用独立样本t检验比较两组患者脊柱骨盆参数的差异及生活质量的差异。结果:伴DISH的LSS患者的术前SVA显著低于不伴DISH的LSS患者(20.0±38.7mm vs.40.0±46.3mm,P=0.039),而TK(27.2°±10.7°vs 25.5°±16.0°)、LL(48.1°±13.7°vs 47.1°±13.5°)、PI(51.4°±14.1°vs 52.5°±13.9°)、PT(18.0°±8.0°vs 19.0°±7.6°)、SS(33.6°±9.5°vs 34.4°±7.8°)、LSA(17.0°±12.0°vs 18.4°±6.7°)及L5I(22.4°±9.8°vs 24.7°±11.9°)两组均无统计学差异(P0.05)。伴DISH患者术前腰痛和下肢痛VAS评分及ODI评分(分别为5.6±1.0,6.5±1.3,36.9±4.9)均高于不伴DISH组患者(分别为5.4±1.2,6.2±1.7,36.8±5.0),但差异均无统计学意义(P0.05)。结论:与不伴DISH的LSS患者相比,伴DISH的LSS患者SVA显著降低,TK、LL、PI、PT、SS、LSA及L5I等其他脊柱骨盆矢状面参数无显著差异。     

高龄腰椎椎管狭窄症患者的手术治疗

正高龄腰椎椎管狭窄症(LSS)指腰椎椎管、神经根管、椎间孔极度狭窄压迫神经根或马尾神经导致的临床症状。可出现严重腰腿痛和间歇性跛行,单次步行距离甚至不足100 m,常合并大小便失禁、褥疮等,病情持续时间长,合并症多。本研究对在本院接受手术治疗的48例LSS患者(≥80岁)的临床资料进行了回顾性研究,旨在探索高龄LSS患者手术治疗的并发症和安全性,现报告如下。1资料与方法