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Lumbar decompression

Shadi Messiah, Antony R Tharian, Kenneth D Candido, Nebojsa Nick Knezevic
PURPOSE OF REVIEW: With an aging population and increased prevalence of the disease, we set out to evaluate the validity of current diagnostic criteria for neurogenic claudication as well as the efficacy of the treatment options for the main cause, lumbar spinal stenosis (LSS). RECENT FINDINGS: Epidural steroid injections (ESI) were most efficacious when the injectate is a steroid combined with lidocaine or lidocaine only. There are promising results regarding the efficacy of the minimally invasive lumbar decompression (MILD) procedure as well as interspinous process spacers (IPS) compared to surgical alternatives...
March 19, 2019: Current Pain and Headache Reports
Osama Nezar Kashlan, Hyeun Sung Kim, Siri Sahib S Khalsa, Ravindra Singh, Zhang Yong, Sung Woon Oh, Jeong Hoon Noh, Il-Tae Jang, Seong-Hoon Oh
The conventional surgical approach to far lateral lumbar disk herniations is a paraspinal Wiltse approach. During the Wiltse approach, it is sometimes necessary to resect some of the facet or pars interarticularis to achieve an adequate exposure. The endoscopic transforaminal route can be of benefit in far lateral disk herniations due to direct access to the epidural space through Kambin's triangle, without the need for any bony removal or nerve retraction. In this video, we describe a percutaneous endoscopic transforaminal approach for far lateral discectomy in a patient presenting with a left L4 radiculopathy due to a far lateral L4-5 disk herniation...
March 19, 2019: Operative Neurosurgery (Hagerstown, Md.)
Sertac Kirnaz, Rodrigo Navarro-Ramirez, Christoph Wipplinger, Franziska Anna Schmidt, Ibrahim Hussain, Eliana Kim, Roger Härtl
This video demonstrates the workflow of a minimally invasive transforaminal interbody fusion (MIS-TLIF) using a portable intraoperative CT (iCT) scanner, (Airo®, Brainlab AG, Feldkirchen, Germany), combined with state-of-the-art total 3D computer navigation. The navigation is used not only for instrumentation but also for intraoperative planning throughout the procedure, inserting the cage, therefore, completely eliminating the need for fluoroscopy. In this video, we present a case of a 72-yr-old female patient with a history of lower back pain, right lower extremity radicular pain and weakness for 2 yr due to L4-L5 spondylolisthesis with instability and severe lumbar spinal stenosis...
March 19, 2019: Operative Neurosurgery (Hagerstown, Md.)
Jongchul Chung, Changbong Kong, Woosung Sun, Dohyung Kim, Hyungdong Kim, Heungtae Jeong
BACKGROUND AND STUDY AIMS/OBJECTIVE:  Clinical outcomes of percutaneous endoscopic lumbar foraminoplasty (PELF) performed for lumbar foraminal stenosis (LFS) have been reported in the literature. However, no study has reported the radiographic changes in magnetic resonance imaging (MRI) after surgery. This report presents the clinical outcome as well as radiographic changes in MRI after PELF for elderly patients with unilateral radiculopathy. We also describe detailed operative nuances to expand the foraminal space and mobilize the affected nerve root...
March 18, 2019: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Ju-Eun Kim, Dae-Jung Choi, Eugene J Park
BACKGROUND: Symptomatic postoperative spinal epidural hematoma is a serious complication that may occur after lumbar spine surgery. Authors analyzed epidural hematoma using postoperative MRI after biportal endoscopic spinal surgery and the impact of which to the clinical outcome. METHODS: The subject of this study were 158 patients who underwent single-level decompression using the biportal endoscopic spinal surgery technique from 2015 to 2017. MRI was performed in all patients before and after surgery, and postoperative MRI was used to identify epidural hematoma...
March 13, 2019: World Neurosurgery
H Bahadir Gokcen, Cagatay Ozturk
BACKGROUND: Achondroplasia, a genetic disorder of bone growth, produces specific clinical features of the extremities and spine. Spinal stenosis, seen in patients with achondroplasia, is a congenital disorder related to premature fusion of the pedicles to the lamina. It can be caused by ossification of the ligamentum flavum, which is rare in patients with achondroplasia. CASE PRESENTATION: We report a rare congenital spinal stenosis with ossification of the ligamentum flavum and thoracolumbar kyphosis deformity in a 24-year-old man with dwarfism and achondroplasia...
March 12, 2019: World Neurosurgery
G A Korshunova, A E Shul'ga, V V Zaretskov, A A Smol'kin
AIM: To estimate the character of neurophysiological monitoring in patients with thoracic and lumbar spine injuries at different treatment stages. MATERIAL AND METHODS: Thirty-eight patients with non-complicated (22 patients, group 1) and complicated (16 patients, group 2) thoracic and lumbar spine injuries underwent electroneuromyography (ENM) and transcranial magnetic stimulation (TMS). The examination was performed at early (up to 2 weeks) and later (more than 1 month) post-injury periods, before the operation and on the 10th day after decompressing-stabilizing interventions...
2019: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Jianyu Hu, Yunsheng Ou, Yong Zhu, Wei Luo, Zenghui Zhao, Xing Du, Jianxiao Li
Objective: To explore the effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) Cage in interbody fusion for degenerative lumbar scoliosis. Methods: A retrospective analysis was designed and conducted for 43 patients, who underwent posterior decompression and n-HA/PA66 Cage interbody fusion with correction of deformity between January 2013 and June 2016. Eighteen cases were single-level fusion (single-level group) and 25 cases were double-level fusion (double-level group)...
March 1, 2019: Chinese Journal of Reparative and Reconstructive Surgery
Yicun Yao, Dongping Ye, Weiguo Liang, Haixiong Miao, Jinfeng Wu, Ziqiang Zhou
Objective: To evaluate the effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration. Methods: The clinical data of 39 patients with two-level lumbar disc degeneration who met the selection criteria between June 2010 and December 2011 was retrospectively analyzed. They were divided into group A (20 cases, simple lumbar decompression and fusion) and group B (19 cases, Coflex interspinous dynamic internal fixation combined with spinal fusion) according to different surgical methods...
March 1, 2019: Chinese Journal of Reparative and Reconstructive Surgery
Tao Liu, Shuiqiang Qiu, Zhigang Xu, Jisheng Gu, Qiang Chen, Zhendong Luo, Desheng Wu
Objective: To explore the effect on sagittal spine-pelvis balance of different fusion segments in anterior cervical discectomy and fusion (ACDF). Methods: The clinical data of 326 patients with cervical spondylotic myelopathy, treated by ACDF between January 2010 and December 2016, was retrospectively analysed. There were 175 males and 151 females with an average age of 56 years (range, 34-81 years). Fusion segments included single segment in 69 cases, double segments in 85 cases, three segments in 90 cases, and four segments in 82 cases...
March 1, 2019: Chinese Journal of Reparative and Reconstructive Surgery
Kai-Uwe Lewandrowski
OBJECTIVES: The aim of this study was to analyze the accuracy and positive predictive value (PPV) of preoperative lumbar MRI grading for successful outcome after outpatient endoscopic decompression for lumbar foraminal and lateral recess stenosis. Lumbar MRI is commonly employed in preoperative decision making to identify symptomatic pain generators amenable to surgical decompression. However, its accuracy and positive predictive value for successful postoperative pain relief after endoscopic transforaminal decompression for sciatica-type back and leg pain has not been reported...
April 2019: Clinical Neurology and Neurosurgery
Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama
Study Design: Prospective cohort study. Purpose: This study aimed to identify risk factors for unplanned second-stage decompression for postoperative neurological deficit after indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation. Overview of Literature: Indirect lumbar decompression with LLIF has been used as a minimally invasive alternative to direct decompression to treat degenerative lumbar diseases requiring neural decompression...
March 15, 2019: Asian Spine Journal
Ajay Premkumar, Francis C Lovecchio, Jeffrey G Stepan, Cynthia A Kahlenberg, Jason L Blevins, Todd J Albert, Michael B Cross
Background: Prospective collection of patient-reported opioid consumption and pain levels post-surgically may hold value in highlighting solutions related to the opioid crisis. Traditional methods for collecting patient-reported outcomes after surgery, such as paper surveys, often have poor response rates, and electronic messaging may offer more convenience and therefore yield more robust data. Questions/Purposes: The purpose of this study was to evaluate whether a novel mobile phone short message service (SMS) platform would lead to better patient response rates to surveys on pain and opioid use than data-collection tools...
February 2019: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Ahmet Murat Yayik, Sevim Cesur, Figen Ozturk, Ali Ahiskalioglu, Ayse Nur Ay, Erkan Cem Celik, Nuh Cagrı Karaavci
BACKGROUND: Spinal surgery is a procedure that causes intense and severe pain in the postoperative period. Erector spinae plane (ESP) block can target the dorsal-ventral rami of thoracolumbar nerves but its effect on lumbar surgery is unclear. The aim of this study was to investigate the effect of the ESP block on postoperative opioid consumption and pain scores in patients undergoing spinal surgery. METHODS: Sixty patients undergoing open lumbar decompression surgery, were randomized two groups...
March 7, 2019: World Neurosurgery
Masaaki Machino, Kei Ando, Kazuyoshi Kobayashi, Kyotaro Ota, Masayoshi Morozumi, Satoshi Tanaka, Keigo Ito, Fumihiko Kato, Naoki Ishiguro, Shiro Imagama
BACKGROUND: Optimal treatment of lumbar spinal stenosis (LSS) with neurological deficit due to osteoporotic vertebral fractures (OVFs) has been controversial. We assessed the usefulness, safety, and efficacy of posterior lumbar interbody fusion (PLIF) for LSS with neurological deficit due to OVFs and compared this procedure to posterior/anterior combined surgery (PACS). METHODS: Of 36 consecutive patients with LSS with neurological deficit due to OVFs, 15 underwent PLIF (6 males, 9 females; mean age, 74 years), and 21 underwent PACS (4 males, 17 females; mean age, 70 years)...
March 7, 2019: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Meng Qi, Tao Huang, Lei Xu, Ning Wang, Peipei Zhang, Xi Hu
We present a rare case of spinal subdural hematoma induced by guidewire-based lumbar drainage in a subarachnoid hemorrhage patient with a ruptured intracranial aneurysm. Decreased muscle strength and muscle tension of bilateral lower limbs were noted, and an MRI confirmed the spinal subdural hematoma from the sacral to the thoracic segments. The spinal subdural hematoma evacuation and spinal canal decompression were performed by laminectomy. However, the patient did not benefit from the surgery and developed lower limb muscle atrophy...
2019: Open Medicine (Warsaw, Poland)
Yusuf Sukru Caglar, Onur Ozgural, Murat Zaimoglu, Cemil Kilinc, Umit Eroglu, Ihsan Dogan, Gokmen Kahilogullari
OBJECTIVE: Hydatid cyst disease is caused by the parasite Echinococcus granulosus. It is rarely seen in the vertebral system, occurring at a rate of 0.2-1%. The aim of this study is to present 12 spinal hydatid cyst cases, and propose a new type of drainage of the cyst. METHODS: Twelve cases of spinal hydatid cysts, surgical operations, multiple operations, chronic recurrences, and spinal hydatic cyst excision methods are discussed in the context of the literature...
March 2019: Journal of Korean Neurosurgical Society
Zachary B Adkins, Azeem T Malik, Nikhil Jain, Elizabeth Yu, Jeffery Kim, Safdar N Khan
STUDY DESIGN: Systematic review. OBJECTIVE: To assess the impact of hospital volume on postoperative outcomes in spine surgery. SUMMARY OF BACKGROUND DATA: Several strategies have recently been proposed to optimize provider outcomes, such as regionalization to higher volume centers and setting volume benchmarks. MATERIALS AND METHODS: We performed a systematic review examining the association between hospital volume and spine surgery outcomes...
February 11, 2019: Clinical Spine Surgery
Hyung-Youl Park, Young-Hoon Kim, Kee-Yong Ha, Sang-Il Kim, Hyung-Ki Min, In-Soo Oh, Jun-Yeong Seo, Dong-Gune Chang, Jong-Tae Park
STUDY DESIGN: This was a retrospective comparative study. OBJECTIVE: The main objective of this article was to evaluate the clinical and radiologic efficacies of minimally invasive lateral lumbar interbody fusion (LLIF) for clinical adjacent segment pathology (ASP). SUMMARY OF BACKGROUND DATA: Minimally invasive techniques have been increasingly applied for spinal surgery. No report has compared LLIF with conventional posterior lumbar interbody fusion for clinical ASP...
February 11, 2019: Clinical Spine Surgery
Seung Myung Wi, Hui Jong Lee, Sam Yeol Chang, Oh Hyo Kwon, Choon-Ki Lee, Bong-Soon Chang, Hyoungmin Kim
Background: In lumbar spinal stenosis, spinous process-splitting decompression has demonstrated good clinical outcomes with preservation of the posterior ligamentous complex and paraspinal muscles in comparison to conventional laminectomy, but the radiological consequence and clinical impact of the split spinous processes have not been fully understood. Methods: Seventy-three patients who underwent spinous process-splitting decompression were included. The bone union rate and pattern were evaluated by computed tomography performed 6-18 months after surgery and compared among subgroups divided according to the number of levels decompressed and the extent of spinous process splitting...
March 2019: Clinics in Orthopedic Surgery
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