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Acta Orthopaedica May 2022Over the last decades, many countries have shown increased surgery rates for lumbar spinal stenosis (LSS), but little information is available from Denmark. We describe...
BACKGROUND AND PURPOSE
Over the last decades, many countries have shown increased surgery rates for lumbar spinal stenosis (LSS), but little information is available from Denmark. We describe the development in diagnosis and surgery of LSS in Denmark between 2002 and 2018.
PATIENTS AND METHODS
We collected diagnostic ICD10-codes and surgical procedure codes from private and public hospitals in Denmark from the Danish National Patient Register. Patients diagnosed with LSS and those with surgical procedure codes for decompression surgery with or without fusion were identified. Annual surgery rates were stratified by age, sex, and type of surgery.
RESULTS
During these 17 years, 132,138 patients diagnosed with LSS and 43,454 surgical procedures for LSS were identified. The number of surgical procedures increased by 144%, from 23 to 56 per 100,000 inhabitants. The proportion of patients diagnosed with LSS who received surgery was about 33%, which was almost stable over time. Decompression without fusion increased by 128% from 18 to 40 per 100,000 inhabitants and decompression with fusion increased by 199%, from 5 to 15 per 100,000.
INTERPRETATION
Both the prevalence of LSS diagnoses and LSS surgery rates more than doubled in Denmark between 2002 and 2018. However, the proportion of patients diagnosed with LSS who received surgery remained stable. Decompression surgery with fusion increased at a higher rate than decompression without fusion, although recent evidence suggests no advantage of decompression plus fusion over decompression alone.
Topics: Decompression, Surgical; Denmark; Humans; Lumbar Vertebrae; Registries; Retrospective Studies; Spinal Fusion; Spinal Stenosis; Treatment Outcome
PubMed: 35611476
DOI: 10.2340/17453674.2022.2744 -
Agri : Agri (Algoloji) Dernegi'nin... Jan 2023The authors aim to present when to do physical therapy or surgery in geriatric patients with degenerative lumbar stenosis.
OBJECTIVES
The authors aim to present when to do physical therapy or surgery in geriatric patients with degenerative lumbar stenosis.
METHODS
The authors retrospectively analyzed 250 patients who underwent physical therapy due to lumbar degenerative stenosis between December 2014 and April 2017. The patients were divided into two groups: Central canal stenosis and lateral recess/foraminal stenosis groups. Visual analogue scale and neurological claudication values of both patient groups were evaluated before and after physical therapy. The association between comorbid diseases and the frequency of surgery was also evaluated.
RESULTS
142 of the patients were female and 108 were male, and the mean age of these patients was 69 years. The mean onset of symptoms was 55 months. In the visual analog scale value of patients after physical therapy, the authors observed decreases of 4-6° in patients with central canal stenosis and 2-3° in patients with lateral recess/foraminal stenosis. In addition, the authors observed that patients with lateral recess/foraminal stenosis together with diabetes mellitus benefit less from physical therapy.
CONCLUSION
Physical therapy and rehabilitation play an important role in the treatment of lumbar stenosis. Physical therapy is the primary treatment option for patients who do not have motor muscle strength losses and incontinence and who have pain control through medications. The authors can consider surgical interventions in patients with lateral recess/foraminal stenosis who do not benefit from physical therapy at a satisfactory level.
Topics: Humans; Male; Female; Aged; Constriction, Pathologic; Spinal Stenosis; Retrospective Studies; Decompression, Surgical; Treatment Outcome; Lumbar Vertebrae; Pain
PubMed: 36625188
DOI: 10.14744/agri.2022.37605 -
Journal of Orthopaedic Surgery and... Nov 2022To identify age-related radiographic risk factors for degenerative lumbar spinal stenosis (DLSS) and analyze correlations among them.
OBJECTIVES
To identify age-related radiographic risk factors for degenerative lumbar spinal stenosis (DLSS) and analyze correlations among them.
METHODS
A total of 180 cases were enrolled in this study, and lumbar magnetic resonance was performed. Among them, 93 cases suffered DLSS and lumbar dynamic X-ray was examined. And following parameters were measured and evaluated: intervertebral disk height (IDH), the ratio of IDH(IDH), initial IDH of L4-5(iIDH) in the DLSS group, disk degeneration (DD), cartilaginous endplate failure (CEF), Modic changes, the thickness of ligamentum flavum (LF), range of intervertebral motion (ROM), facet joint opening (FJO), facet joint angle (FJA), the standard cross-sectional area (SCSA) of the multifidus, erector spinae, and psoas major muscles. The data of two groups were compared, and the possible risk factors of DLSS were analyzed.
RESULTS
Compared with the control group, the DLSS group had higher IDH except for L4-5 and larger iIDH (P < 0.05). Significant differences were shown in CEF and the thickness of LF at L1-S1 and DD at L4-5 (P < 0.05). The DLSS group had smaller SCSA of multifidus, erector spinae, and psoas major muscles but greater FJA, FJO (P < 0.05). And the risk of DLSS increased when iIDH ≥ 10.73 mm, FJA ≥ 52.03° , or FJO ≥ 3.75 mm. IDH positively correlated with SCSA of multifidus and psoas major muscles and ROM at L1-S1 (P < 0.05). DD showed negative linear relations with SCSA of multifidus and psoas muscle and positive linear relation with CEF at L1-2, L2-3, and L5-S1 (P < 0.05).
CONCLUSION
Larger initial disk height and excessive CEF may induce DLSS by increasing intervertebral mobility to promote DD, and atrophied paravertebral muscles by weakening the stability of lumbar spine.
Topics: Humans; Spinal Stenosis; Intervertebral Disc Degeneration; Lumbosacral Region; Paraspinal Muscles; Lumbar Vertebrae; Magnetic Resonance Imaging
PubMed: 36329488
DOI: 10.1186/s13018-022-03374-0 -
BMC Musculoskeletal Disorders Sep 2019Lumbar spinal stenosis (LSS) is a common spinal condition and the most frequent indication for spinal surgery in elderly people. General practitioners (GPs) are on the 1...
BACKGROUND
Lumbar spinal stenosis (LSS) is a common spinal condition and the most frequent indication for spinal surgery in elderly people. General practitioners (GPs) are on the 1 line for its diagnosis and treatment. We aimed to assess how GPs diagnose and treat people with LSS in France.
METHODS
We conducted a cross-sectional survey in a primary care setting. French GPs were selected by a random draw from the French Medical Board. The questionnaire was designed by 3 physicians specialized in physical and rehabilitation medicine and a resident in general practice. A provisional questionnaire was tested in a pilot survey of 11 French GPs. Participants' feedbacks served to build the final questionnaire. This latter was submitted by e-mail or mail to 330 GPs. GPs were surveyed about the 3 main domains relevant to the management of people with LSS in primary care: 1/ diagnosis, 2/ pharmacological treatments and 3/ non-pharmacological treatments, using self-administered open- and closed-ended questions and visual analog scales.
RESULTS
Overall, 90/330 (27.3%) GPs completed the survey. 51/89 (57.3%) GPs were confident with managing people with LSS. Low back pain 51/87 (58.6%), neurogenic claudication 38/87 (43.7%) and paresthesia in the lower limbs 31/87 (35.6%) were the 3 most frequently cited clinical signs leading to the diagnosis of LSS. Improvement with lumbar flexion was mentioned by 9/87 (10.3%) GPs. 85/86 (98.8%) would consider prescribing lumbar imaging, 60/84 (71.4%) corticoid spinal injections and 42/79 (53.2%) would never prescribe lumbar flexion-based endurance training. All GPs would refer people with LSS to another specialist.
CONCLUSIONS
French GPs lack confidence with diagnosing LSS and prescribing pharmacological and non-pharmacological treatments for people with LSS.
Topics: Adult; Cross-Sectional Studies; Female; France; General Practitioners; Humans; Intermittent Claudication; Low Back Pain; Lumbar Vertebrae; Male; Middle Aged; Paresthesia; Pilot Projects; Practice Patterns, Physicians'; Primary Health Care; Spinal Stenosis; Surveys and Questionnaires
PubMed: 31521138
DOI: 10.1186/s12891-019-2782-y -
European Spine Journal : Official... Oct 2003Lumbar spinal stenosis is a common condition in elderly patients and also one of the most common reasons to perform spinal surgery at an advanced age. Disc degeneration,... (Review)
Review
Lumbar spinal stenosis is a common condition in elderly patients and also one of the most common reasons to perform spinal surgery at an advanced age. Disc degeneration, facet degeneration and hypertrophy, and ligamentum flavum hypertrophy and calcification usually participate in the genesis of a stenotic condition in the elderly. These changes can lead to symptoms by themselves or decompensate a preexisting narrow canal. Although some lesions are more central or more lateral, this classic dichotomy is less present in the elderly patient, in whom the degenerative process usually encroaches both central and lateral pathways. Some less common causes of lumbar spinal stenosis are found in the aging subject, such as Paget's disease. However, it must be stressed that so-called stenotic images (sometimes severe) are present on imaging studies in a great number of symptom-free individuals, and that the relationship between degenerative lesions, importance of abnormal images, and complaints is still unclear. Lumbar stenosis is a very common reason for decompressive surgery and/or fusion. Various conditions can lead to a narrowing of the neural pathways and differential diagnosis with vascular troubles, also common in the elderly, can be challenging. The investigation of stenotic symptoms should be extremely careful and thorough and include a choice of technical examinations including vascular investigations. This is of utmost importance, especially if a surgical sanction is considered to avoid disappointing results.
Topics: Aged; Aging; Diagnosis, Differential; Humans; Lumbar Vertebrae; Occupational Diseases; Osteitis Deformans; Radiography; Spinal Stenosis; Spondylolisthesis
PubMed: 13680315
DOI: 10.1007/s00586-003-0612-1 -
Frontiers in Endocrinology 2022The purpose of this study was to elaborate the characteristics of paraspinal muscles in lower lumbar, to compare the differences of paraspinal muscle between patients...
OBJECTIVE
The purpose of this study was to elaborate the characteristics of paraspinal muscles in lower lumbar, to compare the differences of paraspinal muscle between patients with lumbar spinal stenosis and normal people and to explore the influencing factors of paraspinal muscle degeneration in patients with lumbar spinal stenosis.
METHOD
The 39 pairs of patients and normal people were selected by propensity score matching. The differences of multifidus muscle and erection spine muscle parameters between the two groups were compared by independent-samples t-test and the relationship between age, paraspinal muscle degeneration and other factors in patients with lumbar spinal stenosis was analyzed by Pearson or Spearman correlation analysis.
RESULT
The general conditions of the two groups (patients with lumbar spinal stenosis and normal people) were well matched. There were significant differences in the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle at L3 level. The fatty infiltration and relative signal intensity of multifidus muscle at L4 level and the relative signal intensity of multifidus muscle at L5 level were also significantly different. For male, the relative fatty cross sectional area, the fatty infiltration and relative signal intensity of multifidus muscle in patients were higher than those in healthy peers. For female, the relative signal intensity of multifidus muscle in patients was higher, too. In patients group, age was significantly correlated with the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle and erector spinae muscle. Weight and BMI were significantly correlated with the relative total cross-sectional area of erector spinae muscle. The fatty infiltration increased more significantly with age in patients than that in normal people.
CONCLUSION
The change rules of paraspinal muscles in patients with lumbar spinal stenosis are similar to those in normal people. The degeneration of paraspinal muscle in patients with lumbar spinal stenosis was more severe than that in normal people, mostly in multifidus muscle. The paraspinal muscle degeneration was related to age in patients, and the effect of age on atrophy of paraspinal muscle was greater than that of normal people.
Topics: Humans; Female; Male; Aged; Middle Aged; Paraspinal Muscles; Spinal Stenosis
PubMed: 36482999
DOI: 10.3389/fendo.2022.1080033 -
International Journal of Surgery... Aug 2017Lumbar spinal stenosis (LSS) was a common degenerative disease that affected the lumbar spine function and quality of life, which can be treated both surgery and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Lumbar spinal stenosis (LSS) was a common degenerative disease that affected the lumbar spine function and quality of life, which can be treated both surgery and conservative treatment. We did this study to compare the effectiveness of surgery versus conservative treatment for LSS.
METHODS
We searched PubMed as well as other databases in September.18th.2016. Randomized controlled trials compared surgery versus conservative treatment for patients with LSS were enrolled. Outcomes and complications were collected with data selection criteria and analyzed with Review Manager Version 5.3.
RESULTS
Nine RCTs (14 articles) and 1658 patients were included, and three of them were high-quality studies. At first 6 months after treatment, there were no significant differences for ODI scores between two therapeutic groups (P > 0.05), however, surgery group showed significant higher ODI scores at one year (P < 0.05) and two years (P < 0.05). Two studies reported no significant difference between laminectomy and conservative treatment for the SF-36 physical function scores at 3 months, 6 months, 12 months and 24 months (P > 0.05) and two studies reported patients were satisfied with X-STOP implanted at six weeks, six months, and one year. No statistical differences for the adverse events intra-operation or within 72 h (P > 0.05) between surgery and non-surgery groups. Moreover, subgroup analysis showed there were no safety differences between laminectomy and conservative treatment, X-STOP and conservative treatment at early stage of duration. However, the surgical groups had higher complication rates than non-surgery groups throughout the follow-up duration.
CONCLUSION
Surgery groups showed better late clinical outcomes after one year and higher complication rate throughout the follow-up duration, although it had no significant differences compared with conservative groups in the first six months post-treatment. However, there was no evidence that a definitive method could be firmly recommended to LSS patients. Further researches were needed to achieve high quality and credible results.
Topics: Conservative Treatment; Decompression, Surgical; Humans; Lumbar Vertebrae; Quality of Life; Randomized Controlled Trials as Topic; Spinal Stenosis
PubMed: 28705591
DOI: 10.1016/j.ijsu.2017.07.032 -
Revista Medica de Chile Nov 2011Spinal lumbar stenosis is a disease that occurs mainly between the 5th and 7th decade of life and can be congenital or acquired. The latter has many etiologies, but a... (Review)
Review
Spinal lumbar stenosis is a disease that occurs mainly between the 5th and 7th decade of life and can be congenital or acquired. The latter has many etiologies, but a degenerative cause is the most common. Stenosis is a narrowing of the spinal canal diameter caused by many factors such as bulging discs, hypertrophy of flavum ligament, facet capsule thickening and osteophyte formation. The classical symptom of the disease is sciatic pain, that improves with lumbar flexion and worsens with ambulation. Neurological examination is often normal and the most useful imaging test is magnetic resonance imaging (MRI). Conservative management consists in non-steroidal anti-inflammatory drugs, muscle relaxants, physical therapy and epidural - radicular infiltrations. Spinal infiltrations have a proven efficacy for pain management. A good result of this therapy predicts a favorable outcome after surgery. Surgical treatment consists in decompression with or without lumbar fusion. The addition of an arthrodesis is recommended for degenerative spondylolisthesis, correction of deformities, recurrent spinal stenosis with instability, sagittal or coronal imbalance and adjacent segment disease.
Topics: Humans; Lumbar Vertebrae; Middle Aged; Spinal Stenosis
PubMed: 22446657
DOI: No ID Found -
European Spine Journal : Official... Nov 2010As life expectancy increases, degenerative lumbar spinal stenosis (DLSS) becomes a common health problem among the elderly. DLSS is usually caused by degenerative...
As life expectancy increases, degenerative lumbar spinal stenosis (DLSS) becomes a common health problem among the elderly. DLSS is usually caused by degenerative changes in bony and/or soft tissue elements. The poor correlation between radiological manifestations and the clinical picture emphasizes the fact that more studies are required to determine the natural course of this syndrome. Our aim was to reveal the association between lower lumbar spine configuration and DLSS. Two groups were studied: the first included 67 individuals with DLSS (mean age 66 ± 10) and the second 100 individuals (mean age 63.4 ± 13) without DLSS-related symptoms. Both groups underwent CT images (Philips Brilliance 64) and the following measurements were performed: a cross-section area of the dural sac, vertebral body dimensions (height, length and width), AP diameter of the bony spinal canal, lumbar lordosis and sacral slope angles. All measurements were taken at L3 to S1. Vertebral body lengths were significantly greater in the DLSS group at all levels compared to the control, whereas anterior vertebral body heights (L3, L4, L5) and middle vertebral heights (L3, L5) were significantly smaller in the LSS group. Lumbar lordosis, sacral slope and bony spinal canal were significantly smaller in the DLSS compared to the control. We conclude that the size and shape of vertebral bodies and canals significantly differed between the study groups. A tentative model is suggested to explain the association between these characteristics and the development of degenerative spinal stenosis.
Topics: Aged; Case-Control Studies; Female; Humans; Lordosis; Lumbar Vertebrae; Male; Middle Aged; Models, Biological; Muscle Strength; Muscle, Skeletal; Sacrum; Spinal Stenosis; Tomography, X-Ray Computed
PubMed: 20652366
DOI: 10.1007/s00586-010-1516-5 -
Scientific Reports Jun 2022This study aimed to explore the feasibility of Phase I percutaneous spinal endoscopy with a 270° single incision in the ventral and dorsal dura mater for decompression...
This study aimed to explore the feasibility of Phase I percutaneous spinal endoscopy with a 270° single incision in the ventral and dorsal dura mater for decompression treatment of thoracic spinal stenosis (TSS). Phase I percutaneous spinal endoscopy with a two-path (posterior and posterolateral approaches) single incision with a 270° decompression was performed in four cases of TSS with compression in the ventral and dorsal dura mater. The affected intervertebral space was located during the surgery, and the ossified ligamentum flavum in the ventral and dorsal dura mater was removed via laminectomy, which formed a decompression space in the thoracic cord. Next, posterolateral transforaminal expansion and plasty were performed to remove the ventral intervertebral disk. The visual analogue scale (VAS) score, thoracic spinal cord function score of the Japanese Orthopaedic Association (JOA) (11-point method), and Oswestry Disability Index (ODI) scores were used to evaluate the clinical efficacy. No dura mater or thoracic nerve injury occurred during the surgery. The symptoms of weakness in the lower extremities improved after the surgery. The postoperative magnetic resonance imaging and computed tomography examinations showed compression removal and dura mater bulging. The postoperative VAS, JOA, and ODI scores improved compared with the preoperative scores. Two surgical trajectories, posterior and posterolateral approaches, were established by a single incision using thoracic spinal canal decompression with Phase I 270° single-incision percutaneous spinal endoscopy. The posterior approach was performed mainly by translaminar unilateral fenestration and bilateral decompression in the ventral and dorsal dura mater, whereas the posterolateral approach was performed by decompression in the ventral dura mater to the midline of the vertebrae. This surgical method could be applied as a safe and feasible minimally invasive treatment for TSS with compression on both the ventral and dorsal dura mater.
Topics: Decompression, Surgical; Endoscopy; Endoscopy, Gastrointestinal; Feasibility Studies; Humans; Lumbar Vertebrae; Retrospective Studies; Spinal Canal; Spinal Stenosis; Thoracic Diseases; Treatment Outcome
PubMed: 35676323
DOI: 10.1038/s41598-022-13666-4