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European Spine Journal : Official... Sep 2020To systematically evaluate any consensus for the etiology, definition, presentation and outcomes of developmental lumbar spinal stenosis (DLSS). (Review)
Review
PURPOSE
To systematically evaluate any consensus for the etiology, definition, presentation and outcomes of developmental lumbar spinal stenosis (DLSS).
METHODS
A comprehensive literature search was undertaken by 2 independent reviewers with PubMed, Ovid, and Web of Science to identify all published knowledge on DLSS. Search terms included "developmental spinal stenosis" or "congenital spinal stenosis" and "lumbar". The inclusion criteria were English clinical studies with sample size larger than 8, articles examining the etiology, diagnostic criteria, surgical outcomes of DLSS, and its association with other spinal pathologies. Articles that did not specify a developmental component were excluded. The GRADE approach was used to assess their quality of evidence.
RESULTS
The initial database review found 404 articles. Twenty articles with moderate to very low quality met the inclusion criteria for analysis. The bony canal diameter was significantly shorter in patients with DLSS than normal subjects. In addition, the risk of re-operation on adjacent levels (21.7%) was high which could be explained by multi-level stenosis. However, there was a lack of consensus on the methodology of diagnosing DLSS and on its specific surgical techniques.
CONCLUSION
Multi-level stenosis and re-operation at adjacent levels are especially common with DLSS. Identification of these individuals provides better prognostication after surgery. However, current literature provides few consensus on its definition and the required surgical approach. Besides, there are limited reports of its etiology and association with other spinal pathologies. Due to these limitations, standardizing the definition of DLSS and investigating its etiology and expected clinical course are necessary.
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Reoperation; Spinal Stenosis
PubMed: 32623513
DOI: 10.1007/s00586-020-06524-2 -
BMC Musculoskeletal Disorders Nov 2023Unilateral laminotomy with bilateral spinal canal decompression has gained popularity recently.
BACKGROUND
Unilateral laminotomy with bilateral spinal canal decompression has gained popularity recently.
AIM
To systematically review the literature of unilateral laminotomy with bilateral spinal canal decompression for lumbar spinal stenosis (LSS) aiming to assess outcomes and complications of the different techniques described in literature.
METHODS
On August 7, 2022, Pubmed and EMBASE were searched by 2 reviewers independently, and all the relevant studies published up to date were considered based on predetermined inclusion and exclusion criteria. The subject headings "unilateral laminotomy", "bilateral decompression" and their related key terms were used. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.
RESULTS
A total of seven studies including 371 patients were included. The mean age of the patients was 69.0 years (range: 55-83 years). The follow up duration ranged from 1 to 3 years. Rate of postoperative pain and functional improvement was favorable based on VAS, JOA, JOABPEQ, RMDW, ODI and SF-36, for example improved from a range of 4.2-7.5 preoperatively on the VAS score to a range of 1.4-3.0 postoperatively at the final follow up. Insufficient decompression was noted in 3% of the reported cases. The overall complication rate was reported at 18-20%, with dural tear at 3.6-9% and hematoma at 0-4%.
CONCLUSION
Unilateral laminotomy with bilateral decompression has favorable short- and mid-term pain and functional outcomes with low recurrence and complication rates. This, however, needs to be further confirmed in larger, long-term follow-up, prospective, comparative studies between open, and minimally invasive techniques.
Topics: Aged; Aged, 80 and over; Humans; Middle Aged; Decompression, Surgical; Laminectomy; Lumbar Vertebrae; Prospective Studies; Retrospective Studies; Spinal Canal; Spinal Stenosis; Treatment Outcome
PubMed: 37990183
DOI: 10.1186/s12891-023-07033-1 -
International Journal of Molecular... Nov 2022Spinal stenosis (SS) is a multifactorial polyetiological condition characterized by the narrowing of the spinal canal. This condition is a common source of pain among... (Review)
Review
Spinal stenosis (SS) is a multifactorial polyetiological condition characterized by the narrowing of the spinal canal. This condition is a common source of pain among people over 50 years old. We perform a systematic review of molecular and genetic mechanisms that cause SS. The five main mechanisms of SS were found to be ossification of the posterior longitudinal ligament (OPLL), hypertrophy and ossification of the ligamentum flavum (HLF/OLF), facet joint (FJ) osteoarthritis, herniation of the intervertebral disc (IVD), and achondroplasia. FJ osteoarthritis, OPLL, and HLF/OLFLF/OLF have all been associated with an over-abundance of transforming growth factor beta and genes related to this phenomenon. OPLL has also been associated with increased bone morphogenetic protein 2. FJ osteoarthritis is additionally associated with Wnt/β-catenin signaling and genes. IVD herniation is associated with collagen type I alpha 1 and 2 gene mutations and subsequent protein dysregulation. Finally, achondroplasia is associated with fibroblast growth factor receptor 3 gene mutations and fibroblast growth factor signaling. Although most publications lack data on a direct relationship between the mutation and SS formation, it is clear that genetics has a direct impact on the formation of any pathology, including SS. Further studies are necessary to understand the genetic and molecular changes associated with SS.
Topics: Humans; Middle Aged; Spinal Stenosis; Ossification of Posterior Longitudinal Ligament; Ligamentum Flavum; Achondroplasia; Osteoarthritis
PubMed: 36362274
DOI: 10.3390/ijms232113479 -
Frontiers in Oncology 2022Primary sporadic intradural malignant peripheral nerve sheath tumor (MPNST) in the spinal canal is a type of rare neoplasm with challenging diagnosis and therapy. The...
Epidemiology, Characteristic, and Prognostic Factors of Primary Sporadic Intradural Malignant Peripheral Nerve Sheath Tumor in the Spinal Canal: A Systematic Literature Review.
PURPOSE
Primary sporadic intradural malignant peripheral nerve sheath tumor (MPNST) in the spinal canal is a type of rare neoplasm with challenging diagnosis and therapy. The overall prognosis of this tumor is markedly different from that of the usual spinal intradural tumors. The purpose of this systematic review is to reduce the misdiagnosis and enhance the prognosis of the disease by reviewing the literature.
METHODS
PubMed, Medline, and Embase databases were searched for articles in English language published from 1980 to May 2021, yielding 500 potentially relevant articles. The keywords were as follows: "spinal", "malignant peripheral nerve sheath tumor", "neurosarcoma", "malignant schwannoma", and "malignant neurofibroma". Thirteen papers met the eligibility criteria, including 55 cases with spinal intradural primary sporadic MPNSTs, which were confirmed by post-operation pathology. We further analyzed the clinical manifestations, radiological manifestations, pathological features, comprehensive treatment strategies, and prognosis.
RESULTS
Fifty-five spinal intradural primary sporadic MPNSTs from 30 (54.5%) male and 25 (45.5%) female patients with an average age at diagnosis of 40 years (range, 3-70 years) were included in the study. The most common clinical manifestations were local or radicular pain and motor disturbance. All tumors had significant enhancement and heterogeneous enhancement was more common. Out of 18 lesions, 14 were diagnosed as high grade and the remaining 4 were diagnosed as low grade. The ki-67 labeling index ranged from 5% to 60%. The median recurrence and survival time were 36 and 72 months, respectively. The log-rank tests indicated that significant predictors of OS were patient age (≤30 vs. >30 years) at the time of diagnosis and the presence of metastatic disease, and similar analyses for RFS demonstrated that the presence of metastatic disease was the only significant predictor (60 vs. 10 months). The multivariate Cox proportional hazards regression analysis revealed that absence of metastasis was an independent factor for predicting a favorable prognosis.
CONCLUSIONS
Spinal intradural primary sporadic MPNSTs are challenging malignant tumors without a systematic treatment plan. The factors affecting its prognosis are not clear. Even after surgical treatment and adjuvant treatment, the recurrence rate and mortality rate are still high. Clinicians should be alert to the possibility of this disease and achieve early detection and treatment.
PubMed: 35898898
DOI: 10.3389/fonc.2022.911043 -
JBJS Reviews Sep 2017Tandem spinal stenosis refers to spinal canal diameter narrowing in at least 2 distinct regions of the spine, most commonly the lumbar and cervical regions. This entity... (Review)
Review
BACKGROUND
Tandem spinal stenosis refers to spinal canal diameter narrowing in at least 2 distinct regions of the spine, most commonly the lumbar and cervical regions. This entity can be an asymptomatic radiographic finding, or it can present with severe myelopathy and lower-extremity symptoms. Tandem spinal stenosis may impact surgeon decision-making when planning either cervical or lumbar spine surgery, and there is currently no consensus in the literature regarding the treatment algorithm for operative intervention.
METHODS
A MEDLINE literature search was performed using PubMed, the Cochrane Database of Systematic Reviews, and Embase from January 1980 to February 2015 using Medical Subject Heading queries for the terms "tandem spinal stenosis," "cervical stenosis AND lumbar stenosis," and "concomitant spinal stenosis." We included studies involving adult patients, tandem spinal stenosis of the cervical and lumbar regions, and a minimum of 5 patients. Articles that did not discuss spinal disorders or only explored disorders at a single spinal region were excluded.
RESULTS
The initial database review resulted in 234 articles. After abstracts were reviewed, only 17 articles that met inclusion criteria were identified: 2 cadaveric studies, 5 clinical studies of patients with radiographic tandem spinal stenosis, and 10 clinical studies of patients with symptomatic tandem spinal stenosis.
CONCLUSIONS
Tandem spinal stenosis is a common condition present in up to 60% of patients with spinal stenosis. This disorder, however, is often overlooked, which can lead to serious complications. Identification of tandem spinal stenosis is paramount as a first step in management and, although there is still no preferred intervention, both staged and simultaneous procedures have been shown to be effective. Surgeons may utilize a single, staged, or combined approach to decompression, always addressing cervical myelopathy as a priority.
Topics: Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Clinical Decision-Making; Decompression, Surgical; Diagnosis, Differential; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Neurosurgical Procedures; Spinal Cord Diseases; Spinal Stenosis; Treatment Outcome
PubMed: 28872572
DOI: 10.2106/JBJS.RVW.17.00007 -
Clinical Spine Surgery Nov 2022This was a systematic review of the literature. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
This was a systematic review of the literature.
OBJECTIVE
The aim was to examine the contemporary demographics, etiological factors, treatment options and outcomes of spinal epidural lipomatosis (SEL) in adults.
SUMMARY OF BACKGROUND DATA
SEL is primarily seen in obese patients as well as those on steroid therapy. Much regarding the etiology and treatment outcomes of SEL is unknown.
METHODS
We reviewed Ovid MEDLINE, PubMed, SCOPUS, and Google Scholars databases from 1990 through August 2020 to identify cases of SEL. Data collected included patient characteristics, disease associations, level of pathology, treatment, and clinical outcomes.
RESULTS
Ninety articles (145 individual cases) were included in the analysis. The median age was 54 years and 79% were males. Obesity-associated SEL constituted the largest proportion (52%) of our cohort. 22% of SEL cases were related to steroid use, while 26% cases were considered to be idiopathic. Lumbosacral SEL was the most frequently reported level of disease (68.9%), followed by the thoracic level (26.2%). The mean age of cases who underwent surgical intervention was 55 years, as compared with 48 years in those who received conservative management ( P =0.03). 95% of patients reported some degree of symptomatic improvement regardless of the treatment modality. Logistic regression suggested a possible superior outcome associated with those undergoing surgical treatment.
CONCLUSION
In contrast to historical comparisons, contemporary articles support that obesity has become the major contributing factor for SEL. Logistic regression of the existing cases suggests that there may be a role for surgical intervention in select patients.
Topics: Adult; Female; Humans; Male; Middle Aged; Epidural Space; Lipomatosis; Magnetic Resonance Imaging; Obesity; Steroids; Treatment Outcome
PubMed: 35552292
DOI: 10.1097/BSD.0000000000001344 -
Neurospine Mar 2024Primary atypical teratoid/rhabdoid tumors (AT/RTs) in the spinal canal are rare central nervous system (CNS) neoplasms that are challenging to diagnose and treat. To...
Primary atypical teratoid/rhabdoid tumors (AT/RTs) in the spinal canal are rare central nervous system (CNS) neoplasms that are challenging to diagnose and treat. To date, there has been no standard treatment regimen for these challenging malignant tumors. Thus, we conducted this research to explore potential prognostic factors and feasible treatment modalities for improving the prognosis of these tumors. Articles were retrieved from the PubMed, MEDLINE, and Embase databases, using the keywords "atypical teratoid/rhabdoid tumor," "rhabdoid tumor," "spine," "spinal," "spinal neoplasm", and "spinal cord neoplasm." All eligible cases demonstrated SMARCB1-deficient expression validated by pathological examination. We collected and analyzed data related to clinical presentation, radiological features, pathological characteristics, treatment modalities and prognosis via Kaplan-Meier and Cox regression analyses. Thirty-six articles comprising 58 spinal AT/RT patients were included in the study. The median progression-free survival (PFS) and overall survival (OS) were 18 and 22 months, respectively. Kaplan-Meier analysis demonstrated significant survival improvements for OS in the nonmetastasis, male, radiotherapy and intrathecal chemotherapy groups as well as for PFS in the chemotherapy and radiotherapy groups. Multivariate analysis revealed that chemotherapy and radiotherapy were prognostic factors for improved PFS, and that intrathecal chemotherapy reduced the risk of mortality. Spinal AT/RTs are uncommon malignant entities with a dismal survival rate. Although our review is limited by variability between cases, there is some evidence revealing potential risk factors and the importance of systematic chemotherapy, intrathecal chemotherapy and radiotherapy in spinal AT/RT treatment modalities.
PubMed: 38317556
DOI: 10.14245/ns.2347096.548 -
European Archives of... Sep 2022BPPV (benign paroxysmal positional vertigo) is a syndrome marked by brief bouts of vertigo accompanied by rapid changes in head position. Recent ongoing therapeutic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVES
BPPV (benign paroxysmal positional vertigo) is a syndrome marked by brief bouts of vertigo accompanied by rapid changes in head position. Recent ongoing therapeutic approaches used are vestibular rehabilitation exercises and physical maneuvers like the Epley maneuver, Semont maneuver. Gans repositioning maneuver (GRM) is a new hybrid maneuver, consisting of safe and comfortable series of postures that can be conveniently applied on patients with any spinal pathology or even in elderly.
METHODS
Randomized controlled/clinical trials of the Gans maneuver were identified. The proportion of patients who improved as a result of each intervention was assessed, as well as the conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test.
RESULTS
Improvement was seen in almost all patients with the Gans maneuver and the Epley Maneuver in three trials with the pooled estimate for random effect model is 1.12 [0.87; 1.43: 100%]. There were no significant side effects from the treatment.
DISCUSSION
This study shows that the Gans maneuver is a safe and effective treatment for patients suffering from posterior canal BPPV.
TRIAL REGISTRATION
The review is registered in Prospero with no. CRD42021234100.
Topics: Aged; Benign Paroxysmal Positional Vertigo; Humans; Patient Positioning; Physical Examination; Posture; Treatment Outcome
PubMed: 35460377
DOI: 10.1007/s00405-022-07396-6 -
AJR. American Journal of Roentgenology Nov 2013The objective of our study was to perform a systematic review of the semiquantitative and qualitative radiologic criteria that are used for the diagnosis of lumbar... (Review)
Review
OBJECTIVE
The objective of our study was to perform a systematic review of the semiquantitative and qualitative radiologic criteria that are used for the diagnosis of lumbar spinal stenosis (LSS).
MATERIALS AND METHODS
A four-step systematic literature search including the MEDLINE database was performed by an experienced librarian to reveal all semiquantitative or qualitative radiologic criteria used for the diagnosis of LSS. The precise definitions of all criteria, normal or abnormal values (if applicable), and intra- and interrater reliability were noted by two independent readers. Descriptive statistics were used.
RESULTS
A total of 14 semiquantitative or qualitative radiologic parameters were identified and distinguished according to relevant anatomic spaces into criteria for central canal stenosis, lateral (recess) stenosis, and foraminal stenosis. Great variability in terms of the exact definitions of the criteria was found. For 10 of the 14 criteria, the intra- and interrater reliability data were found with kappa values ranging from 0.01 to 1.0.
CONCLUSION
Our systematic literature review identified 14 different semiquantitative or qualitative radiologic criteria that are used for the diagnosis of LSS; however, these criteria show remarkable variability in terms of their exact individual definitions and intra- and interrater reliability.
Topics: Diagnostic Imaging; Humans; Lumbar Vertebrae; Spinal Stenosis
PubMed: 24147503
DOI: 10.2214/AJR.12.10163 -
The Spine Journal : Official Journal of... Jan 2022Lumbar spinal stenosis (LSS) is one of the most common orthopaedic conditions and affects more than half a million people over the age of 65 in the US. Patients with LSS... (Review)
Review
BACKGROUND CONTEXT
Lumbar spinal stenosis (LSS) is one of the most common orthopaedic conditions and affects more than half a million people over the age of 65 in the US. Patients with LSS have gait dysfunction and movement deficits due to pain and symptoms caused by compression of the nerve roots within a narrowed spinal canal.
PURPOSE
The purpose of the current systematic review was to summarize existing literature reporting biomechanical changes in gait function that occur with LSS, and identify knowledge gaps that merit future investigation in this important patient population.
STUDY DESIGN/SETTING
This study is a systematic literature review.
OUTCOME MEASURES
The current study included biomechanical variables (e.g., kinematic, kinetic, and muscle activity parameters).
METHODS
Relevant articles were selected through MEDLINE, Scopus, Embase, and Web of Science. Articles were included if they: 1) included participants with LSS or LSS surgery, 2) utilized kinematic, kinetic, or muscle activity variables as the primary outcome measure, 3) evaluated walking or gait tasks, and 4) were written in English.
RESULTS
A total of 11 articles were included in the current systematic review. The patients with LSS exhibited altered gait function as compared to healthy controls. Improvements in some biomechanical variables were found up to one year after surgery, but most gait changes were found within one month after surgery.
CONCLUSIONS
Although numerous studies have investigated gait function in patients with LSS, gait alterations in joint kinetics and muscle activity over time remain largely unknown. In addition, there are limited findings of spinal kinematics in patients with LSS during gait. Thus, future investigations are needed to investigate longer-term gait changes with regard to spinal kinematics, joint kinetics, and muscle activity beyond one month after LSS surgery.
Topics: Biomechanical Phenomena; Gait; Humans; Kinetics; Lumbar Vertebrae; Muscles; Spinal Stenosis
PubMed: 34116219
DOI: 10.1016/j.spinee.2021.06.003