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Search Results for : Lumbar Stenosis
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
[Clinical study of iliopsoas abscess in 11 cases from 2005 to 2008]
Author(s): Tate, H
Journal: Kansenshogaku Zasshi 2010 Feb 26; Vol. 83, Issue 6; Page(s) 652-7
[Medline ID - 20034319]

Iliopsoas abscess, a rare disease, has shown a recent alarming increase in the number of patients, especially among older people. This clinical study of iliopsoas abscess in 11 cases seen from 2005 to 2008, showed the average age of patients to be 76 years-higher than the average. Causes were often orthopedic diseases such as pyogenic spondylitis. The four most commonly recognized underlying diseases were spinal, including lumbar spinal canal stenosis and lumbar disc herniation. Antibiotic induced a cure in only 6 of 11 cases. In this conservatively treated group, average abscess diameter was significantly smaller than in the non conservatively treated group. Conservative treatment thus requires that such abscess be detected as early as possible.

Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study.
Author(s): Kalichman, L; Hodges, P; Li, L; Guermazi, A; Hunter, DJ
Journal: Eur Spine J 2009 Dec 25; Vol. 19, Issue 7; Page(s) 1136-44
[Medline ID - 20033739]

The objectives of the study were to evaluate the association between lumbar paraspinal muscle density, evaluated on computed tomography (CT) and age, sex and BMI; and to evaluate the association of those changes with low back pain (LBP) and spinal degeneration features in a community-based sample. This study was an ancillary project to the Framingham Study. A sample of 3,529 participants aged 40-80 years had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this study. LBP in the last 12 months was evaluated using self-report questionnaire. Density (in Hounsfield units) of multifidus and erector spinae was evaluated on CT. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA), spondylolysis, spondylolisthesis and spinal stenosis were also evaluated. We used linear regression models to examine the association of paraspinal muscles density with age, sex, BMI, LBP, and spinal degeneration features. The results show that in our study, men have higher density of paraspinal muscles than women, younger individuals have higher density than older ones and individuals with lower weight have higher muscle density than overweight. No differences between individuals with and without LBP were found. Significant association was found between L4 multifidus/erector spinae density and FJOA at L4-L5; between multifidus at L4 and spondylolisthesis at L4-5; and between erector spinae at L4 and L5 with disc narrowing at L4-5 and L5-S1, respectively. We conclude that the paraspinal muscle density decreases with age, and increases BMI. It is associated with at some levels FJOA, spondylolisthesis and disc narrowing at the same level, but not associated with occurrence of LBP.

Fluoroscopically guided caudal epidural steroid injection for management of degenerative lumbar spinal stenosis: short-term and long-term results.
Author(s): Lee, JW; Myung, JS; Park, KW; Yeom, JS; Kim, KJ; Kim, HJ; Kang, HS
Journal: Skeletal Radiol 2009 Dec 25; Vol. 39, Issue 7; Page(s) 691-9
[Medline ID - 20033148]

OBJECTIVE: To evaluate the short-term and long-term effects of fluoroscopically guided caudal epidural steroid injection (ESI) for the management of degenerative lumbar spinal stenosis (DLSS) and to analyze outcome predictors. MATERIALS AND METHODS: All patients who underwent caudal ESI in 2006 for DLSS were included in the study. Response was based on chart documentation (aggravated, no change, slightly improved, much improved, no pain). In June 2009 telephone interviews were conducted, using formatted questions including the North American Spine Society (NASS) patient satisfaction scale. For short-term and long-term effects, age difference was evaluated by the Mann-Whitney U test, and gender, duration of symptoms, level of DLSS, spondylolisthesis, and previous operations were evaluated by Fisher's exact test. RESULTS: Two hundred and sixteen patients (male:female = 75:141; mean age 69.2 years; range 48 approximately 91 years) were included in the study. Improvements (slightly improved, much improved, no pain) were seen in 185 patients (85.6%) after an initial caudal ESI and in 189 patients (87.5%) after a series of caudal ESIs. Half of the patients (89/179, 49.8%) replied positively to the NASS patient satisfaction scale (1 or 2). There were no significant outcome predictors for either the short-term or the long-term responses. CONCLUSION: Fluoroscopically guided caudal ESI was effective for the management of DLSS (especially central canal stenosis) with excellent short-term and good long-term results, without significant outcome predictors.

Association between age, sex, BMI and CT-evaluated spinal degeneration features.
Author(s): Kalichman, L; Guermazi, A; Li, L; Hunter, DJ
Journal: J Back Musculoskelet Rehabil 2010 Mar 24; Vol. 22, Issue 4; Page(s) 189-95
[Medline ID - 20023349]

OBJECTIVE: The aim of our study was to evaluate the association between age, sex and body mass index (BMI) and lumbar spine degeneration features evaluated on computed tomography (CT) in a community-based sample. METHODS: This cross-sectional study was an ancillary project to the Framingham Study. A sample of 3529 participants of the Framingham study aged 40-80 had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this ancillary study. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (OA), spondylolysis, spondylolisthesis and spinal stenosis were evaluated. To evaluate the association between spinal degeneration features and age, sex and BMI we used chi2 test and logistic regression analyses. RESULTS: 104 men and 83 women, mean age 52.6 +/- 10.8 participated in the study. Statistically significant sexual dimorphism was found in prevalence of spondylolysis (p = 0.015) the male-to-female ratio was 3.3:1; and degenerative spondylolisthesis (p=0.008), the male-to-female ratio was 1:2.8. Prevalence of disc narrowing, facet joint OA, and degenerative spondylolisthesis showed a significant linear trend (p < 0.0001) of association with increasing age. Significantly higher prevalence of facet joint OA was found in the obese group OR (95%CI): 2.8 (1.1-7.2). CONCLUSIONS: Marked differences in the prevalence of spinal degeneration features occur in association with age, sex and obesity. Given the high prevalence of many of these degeneration features these simple demographic factors should be considered when interpreting imaging results reporting these features.

Magnetic resonance imaging for low back pain: indications and limitations.
Author(s): Sheehan, NJ
Journal: Ann Rheum Dis 2010 Feb 2; Vol. 69, Issue 1; Page(s) 7-11
[Medline ID - 20007621]

Magnetic resonance imaging (MRI) is the preferred investigation for most spinal diseases and is increasingly requested for people with low back pain (LBP). However, determining the cause of back pain is complicated as it is often multifactorial and anatomical abnormalities are common in the spine and may not necessarily translate into clinical symptoms. Thus, national guidelines discourage the use of MRI in non-specific LBP and recommend reserving it for the investigation of severe or progressive neurological deficits or for those cases in which serious underlying pathology is suspected. It also has an acknowledged role in planning surgical management in cases of radiculopathy and spinal stenosis. This review summarises the indications for MRI in LBP and calls for improved education of patients and health professionals in the limitations of this investigation.

Computed tomography-evaluated features of spinal degeneration: prevalence, intercorrelation, and association with self-reported low back pain.
Author(s): Kalichman, L; Kim, DH; Li, L; Guermazi, A; Hunter, DJ
Journal: Spine J 2010 Jun 4; Vol. 10, Issue 3; Page(s) 200-8
[Medline ID - 20006557]

BACKGROUND CONTEXT: Although the role of radiographic abnormalities in the etiology of nonspecific low back pain (LBP) is unclear, the frequent identification of these features on radiologic studies continues to influence medical decision making. PURPOSE: The primary purposes of the study were to evaluate the prevalence of lumbar spine degeneration features, evaluated on computed tomography (CT), in a community-based sample and to evaluate the association between lumbar spine degeneration features. The secondary purpose was to evaluate the association between spinal degeneration features and LBP. STUDY DESIGN: This is a cross-sectional community-based study that was an ancillary project to the Framingham Heart Study. SAMPLE: A subset of 187 participants were chosen from the 3,529 participants enrolled in the Framingham Heart Study who underwent multidetector CT scan to assess aortic calcification. OUTCOME MEASURES: Self-report measures: LBP in the preceding 12 months was evaluated using a Nordic self-report questionnaire. Physiologic measures: Dichotomous variables indicating the presence of intervertebral disc narrowing, facet joint osteoarthritis (OA), spondylolysis, spondylolisthesis, and spinal stenosis and the density (in Hounsfield units) of multifidus and erector spinae muscles were evaluated on CT. METHODS: We calculated the prevalence of spinal degeneration features and mean density of multifidus and erector spinae muscles in groups of individuals with and without LBP. Using the chi(2) test for dichotomous and t test for continuous variables, we estimated the differences in spinal degeneration parameters between the aforementioned groups. To evaluate the association of spinal degeneration features with age, the prevalence of degeneration features was calculated in four age groups (less than 40, 40-50, 50-60, and 60+ years). We used multiple logistic regression models to examine the association between spinal degeneration features (before and after adjustment for age, sex, and body mass index [BMI]) and LBP, and between all degeneration features and LBP. RESULTS: In total, 104 men and 83 women, with a mean age (+/-standard deviation) of 52.6+/-10.8 years, participated in the study. There was a high prevalence of intervertebral disc narrowing (63.9%), facet joint OA (64.5%), and spondylolysis (11.5%) in the studied sample. When all spinal degeneration features as well as age, sex, and BMI were factored in stepwise fashion into a multiple logistic regression model, only spinal stenosis showed statistically significant association with LBP, odds ratio (OR) (95% confidence interval [CI]): 3.45 [1.12-10.68]. Significant association was found between facet joint OA and low density of multifidus (OR [95% CI]: 3.68 [1.36-9.97]) and erector spinae (OR [95% CI]: 2.80 [1.10-7.16]) muscles. CONCLUSIONS: Degenerative features of the lumbar spine were extremely prevalent in this community-based sample. The only degenerative feature associated with self-reported LBP was spinal stenosis. Other degenerative features appear to be unassociated with LBP.

Continuous intraoperative electromyographic and transcranial motor evoked potential recordings in spinal stenosis surgery.
Author(s): Voulgaris, S; Karagiorgiadis, D; Alexiou, GA; Mihos, E; Zigouris, A; Fotakopoulos, G; Drosos, D; Pahaturidis, D
Journal: J Clin Neurosci 2010 Jun 9; Vol. 17, Issue 2; Page(s) 274-6
[Medline ID - 20006509]

Spinal stenosis refers to narrowing of the spinal canal with encroachment of the neural structures by adjacent bone and soft tissue. Surgical treatment usually offers greater pain relief and functional recovery than non-surgical treatment. Nevertheless, neurological complications from decompressive laminectomy have been reported to range between 1% and 33%. Therefore, the purpose of this prospective study was to evaluate the efficacy of transcranial motor evoked potentials (TcMEP) and continuous electromyography (EMG) to prevent irreversible pyramidal tract damage during decompressive laminectomy. We prospectively evaluated 25 patients (11 males and 14 females) who underwent decompressive laminectomy for lumbar spinal stenosis. TcMEP and EMG were monitored intraoperatively. Postoperatively all patients had regular follow-up examinations. Electrophysiological monitoring was not performed in two patients because of the use of incompatible anaesthetic regimens. In 17/25 patients there was an increase in TcMEP amplitudes of more than 50%, whereas in six patients the amplitudes only slightly increased or remained unchanged. The 17 patients with the increased TcMEP amplitudes had the greatest improvement 3 and 12 months postoperatively, based on neurological examination and the visual analog scale pain ratings (p < 0.001). Intraoperative monitoring may allow rapid identification of potential damage of the neural structures and avoidance through corrective action. TcMEP and continuous EMG monitoring is an effective method for monitoring neural function cord during surgical decompression of the lumbar spine and may additionally give prognostic information for the assessment of patient outcome.

Lumbar spinal stenosis: prognostic factors for bilateral microsurgical decompression using a unilateral approach.
Author(s): Papavero, L; Thiel, M; Fritzsche, E; Kunze, C; Westphal, M; Kothe, R
Journal: Neurosurgery 2010 Mar 6; Vol. 65, Issue 6 Suppl; Page(s) 182-7; discussion187
[Medline ID - 19934993]

OBJECTIVE: We describe a prospective cohort study that investigated the effectiveness of microsurgical bilateral decompression using unilateral laminotomy for lumbar spinal stenosis and assessed the factors influencing the outcome. METHODS: A total of 165 consecutive patients underwent decompression for lumbar spinal stenosis. They were divided into 3 age groups: A ( < 65 years), B (65-75 years), and C ( > 75 years). Further classification was performed according to body mass index (BMI): BMI 1 ( < 26), BMI 2 (26-30), and BMI 3 ( > 30), anesthesiological risk factors (American Society of Anesthesiologists), and the number of levels decompressed. The outcome was monitored by an independent observer at 1 week, 3 months, and 1 year after surgery. The following parameters were evaluated: pain (visual analog scale and analgesic consumption), functional improvement (Neurogenic Claudication Outcome Score), and walking performance, defined as walking distance x speed (treadmill). RESULTS: One week after surgery, pain decreased in 85.9% of patients, and a comparison of the pre- and postoperative use of analgesics showed that 38% of nonopioid use and 74% of opioid use were discontinued, whereas nonsteroidal anti-inflammatory drug consumption increased 13%. One year after surgery, pain remained decreased in 83.9% of patients, Neurogenic Claudication Outcome Score increased in 90.3% of patients, and walking performance improved in 92.2% of patients. BMI greater than 30 was the only negative prognostic factor for pain reduction (P = 0.012) and Neurogenic Claudication Outcome Score improvement (P = 0.019). Surprisingly, patients who underwent multilevel decompression benefitted more from surgery than those who underwent single-level decompression. CONCLUSION: Microsurgical bilateral decompression using unilateral laminotomy is an effective surgical option for lumbar spinal stenosis, even in high-risk patients with multilevel stenosis.

[Cage assisted fusion operation of the spine]
Author(s): Zilkens, G; R; öllinghoff, M; Sobottke, R; Eysel, P; Delank, KS
Journal: Z Orthop Unfall 2010 May 27; Vol. 147, Issue 6; Page(s) 751-60; quiz 761-2
[Medline ID - 19998223]

ABSTRACT NOT AVAILABLE

Validation study of a clinical diagnosis support tool for lumbar spinal stenosis.
Author(s): Kato, Y; Kawakami, T; Kifune, M; Kishimoto, T; Nibu, K; Oda, H; Shirasawa, K; Tominaga, T; Toyoda, K; Tsue, K; Taguchi, T
Journal: J Orthop Sci 2010 May 25; Vol. 14, Issue 6; Page(s) 711-8
[Medline ID - 19997817]

BACKGROUND: A clinical diagnosis support tool for lumbar spinal stenosis was developed by the Japanese Society for Spine Surgery and Related Research. However, the use of this tool has not yet been validated. METHODS: Patients with symptoms in the lower extremities and who visited the Department of Orthopedics initially were recruited to the study. Orthopedic physicians who were not spine specialists completed the support tools. Spine specialists examined the patients, made a diagnosis, and completed the lumbar spine examination sheet made for the study. The support tool and lumbar spine examination sheet were sent to a central panel comprising four panelists who then decided on a final diagnosis. RESULTS: In total, 118 patients were evaluated, including 62 males and 56 females. Lumbar spinal stenosis was diagnosed in 58 and nonlumbar spinal stenosis in 60 patients. The mean score in the lumbar spinal stenosis group was 12.2 points (median 13 points). In the nonlumbar spinal stenosis group, the mean score was 7.5 points (median 7 points). Sensitivity was 0.948, and specificity was 0.40. CONCLUSIONS: Patients with lumbar spinal stenosis with a very low score were diagnosed with mild lumbar spinal stenosis, whereas nonlumbar spinal stenosis patients with a very high score were diagnosed as suffering from spine disease and needing special treatment by spine surgeons. Our results validate the use of the support tool for the diagnosis of lumbar spinal stenosis. Although the specificity observed in the present study was lower than that reported at development, we conclude that this support tool is useful for screening patients with lumbar spinal stenosis.
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