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Fulltext The surgical outcome of degenerative lumbar spinal stenosis

Razak MA, Ong KP, Hyzan Y

Med J Malaysia, 1998 Sep;53 Suppl A:12-21.
PMID: 10968178

A retrospective study was conducted to assess the surgical outcomes of degenerative lumbar spinal stenosis. Twenty-five patients treated with decompressive surgery in Hospital Kuala Lumpur between January 1992 and August 1996 were reviewed. There were seven males and eighteen females. The average age was 51 years old (range 33 to 64 years old). The diagnosis of degenerative spinal stenosis was made based on the clinical features and was confirmed by radiographic findings. Ninety two percent of the patients had moderate to severe symptoms preoperatively. The types of surgery consisted of laminectomy (n = 15), laminotomy (n = 10), and laminoplasty (n = 1). The surgical outcomes were assessed based on patients' own assessment of symptoms relieved and functional returned to daily activities at least six months after the surgery. The average follow-up period was fifteen months (range 6 months to 42 months). Of these twenty-five patients, 4 (16%) claimed to have excellent results, 11 (44%) had good results, 8 (32%) reported fair, and 2 (8%) judged their surgical treatment as poor with little or no use. There was no anaesthetic, cardiovascular, or thromboembolic complications seen in this study. Four patients had recurrent claudication, one demonstrated localised arachnoiditis, and two had lumbar instability which were not documented preoperatively. One patient had L4 nerve root avulsion with dura torn and another patient had superficial wound infection. We concluded in this study that decompressive surgery offers satisfactory results in patients with moderate to severe degenerative spinal stenosis in short term follow-up.

Matched MeSH terms: Spinal Stenosis/complications; Spinal Stenosis/radiography; Spinal Stenosis/surgery*
The Morphometric Study of Degenerative Lateral Canal Stenosis at L4-L5 and L5-S1 Using Magnetic Resonance Imaging (MRI): Feasibility Analysis for Posterior Surgical Decompression

Yusof MI, Shif M, Abdullah MS

Malays Orthop J, 2015 Mar;9(1):4-10.
PMID: 28435587 MyJurnal DOI: 10.5704/MOJ.1503.015

This study was to evaluate the morphological features of degenerative spinal stenosis and adequacy of lateral canal stenosis decompression via unilateral and bilateral laminectomy. Measurements of facet joint angulation (FJA), mid facet point (MFP), mid facet point distance (MFPD), the narrowest point of the lateral spinal canal (NPLC) and the narrowest point of the lateral spinal canal distance (NPLCD) were performed. At L4L5 of the right and left side, the mean distance between the lateral border of the dura and MFP was 1.0 ± 0.2 cm and 1.0 ± 0.3cm respectively. The mean NPLC was seen at 0.7 ± 0.3 and 0.7 ± 0.3 cm cm from the dura. At L5S1 of the right and left side, the mean distance between the lateral border of the dura and MFP was 1.2± 0.2 and 1.3 ± 0.2 cm respectively. The mean NPLC was seen at 0.8 ± 0.4 and 0.9 ± 0.5 cm from the dura. Unilateral laminectomy may result in incomplete decompression.

Matched MeSH terms: Spinal Stenosis
Fulltext Lumbar Spinal Stenosis: The Reliability, Sensitivity and Specificity of the Nerve Root Sedimentation Sign

Yusof MI, Azizan AF, Abdullah MS

Malays Orthop J, 2018 Jul;12(2):1-6.
PMID: 30112121 MyJurnal DOI: 10.5704/MOJ.1807.001

Introduction: This study is to evaluate the reliability, sensitivity and specificity of nerve root sedimentation sign (NRS) in our populations. The NRS is a radiological sign to diagnose lumbar spinal stenosis (LSS). It is claimed to be reliable with high sensitivity and specificity. Materials and Methods: A total of 82 MRI images from 43 patients in Group A (LSS) and 39 patients in Group B (non LSS) were analysed and compared for the presence of the NRS sign. Two assessors were used to evaluate intra and inter-assessor reliability of this sign based on 56 (33 patients, Group A and 23 patients, Group B). The findings were statistically analysed using SPSS software. Results: There was a significant association between spinal claudication and leg numbness with LSS (p<0.001 and Kappa=0.857, p<0.001). The inter-assessor reliability was also good (Kappa of 0.786, p<0.001). Conclusion: The NRS sign has high sensitivity and specificity for diagnosing LSS. The sign also has good intra and inter-assessor reliability.

Matched MeSH terms: Spinal Stenosis
Fulltext Acute cauda equina syndrome secondary to free fat graft following spinal decompression

Imran Y, Halim Y

Singapore Med J, 2005 Jan;46(1):25-7.
PMID: 15633005

A 63-year-old man developed acute cauda equina syndrome due to fat graft compression. Following decompressive laminectomy and posterior instrumented fusion with pedicle screw fixation for spinal stenosis of L5 and S1 vertebral levels, free fat grafting was performed to cover the exposed dura. The patient developed gradual neurological deficit three days postoperatively. This started with sensory loss and weakness of the affected dermatomes and myotomes, followed by bowel incontinence on the 12th postoperative day. Intraoperatively, significant dural compression by the fat graft was confirmed. Immediate removal of the fat graft resulted in recovery from cauda equina syndrome.

Matched MeSH terms: Spinal Stenosis/surgery*
Endoscopic, endonasal decompression of spinal stenosis with myelopathy secondary to cranio-vertebral tuberculosis: two cases

Puraviappan P, Tang IP, Yong DJ, Prepageran N, Carrau RL, Kassam AB

J Laryngol Otol, 2010 Jul;124(7):816-9.
PMID: 20003599 DOI: 10.1017/S0022215109992271

Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency.

Matched MeSH terms: Spinal Stenosis/etiology; Spinal Stenosis/surgery*
Erosive inflammatory pseudotumor of the odontoid process in association with Forestier's disease (diffuse idiopathic skeletal hyperostosis)

Mirzasadeghi A, Mokhtar SA, Azmi B, Haflah NM, Razak MA

Am J. Orthop., 2009 Feb;38(2):E41-4.
PMID: 19340387
Matched MeSH terms: Spinal Stenosis/etiology; Spinal Stenosis/pathology; Spinal Stenosis/surgery
Fulltext Tandem Spinal Stenosis

Zulkefli, A., Ramanathan, R.

Malays Orthop J, 2010;4(1):46-49.
MyJurnal

A 42 years old gentleman presented with predominant low back pain associated with bilateral lower limb neurological deficit leading to an initial diagnosis of lumbar stenosis. Further history taking and examination revealed upper limb neurological deficit, and the lower limbs actually presented with upper motor neuron instead of lower motor neuron signs. Imaging studies confirmed the clinical findings with presence of both cervical and lumbar spinal stenosis. Twostage decompression procedures were performed at 6 monthintervals starting with cervical decompression. Postoperative improvement was noted on follow-up. This case highlights the importance of accurate diagnosis of cervical pathology for patients presenting with or referred for predominantly lumbar symptomology

Matched MeSH terms: Spinal Stenosis
Fulltext An elderly woman with intermittent claudication

Wazir NN

Malays Fam Physician, 2006;1(1):23-24.
PMID: 26998205 MyJurnal

This case report illustrates the misdiagnosis of intermittent claudication in an elderly with multiple cardiac risk factors. Careful clinical evaluation and imaging shifts the diagnosis from peripheral vascular disease to spinal stenosis. The decision whether to offer conservative therapy or proceed to spinal surgery requires an accurate assessment of the severity of the symptoms without ignoring the important role of patient preferences.

Matched MeSH terms: Spinal Stenosis
Fulltext Scalene myofascial pain syndrome mimicking cervical disc prolapse: a report of two cases

Abd Jalil N, Awang MS, Omar M

Malays J Med Sci, 2010 Jan;17(1):60-6.
PMID: 22135529 MyJurnal

Scalene myofascial pain syndrome is a regional pain syndrome wherein pain originates over the neck area and radiates down to the arm. This condition may present as primary or secondary to underlying cervical pathology. Although scalene myofascial pain syndrome is a well known medical entity, it is often misdiagnosed as being some other neck pain associated with radiculopathy, such as cervical disc prolapse, cervical spinal stenosis and thoracic outlet syndrome. Because scalene myofascial pain syndrome mimics cervical radiculopathy, this condition often leads to mismanagement, which can, in turn, result in persistent pain and suffering. In the worst-case scenarios, patients may be subjected to unjustifiable surgical intervention. Because the clinical findings in scalene myofascial pain syndrome are "pathognomonic", clinicians should be aware of ways to recognize this disorder and be able to differentiate it from other conditions that present with neck pain and rediculopathy. We present two cases of unilateral scalene myofascial pain syndrome that significantly impaired the patients' functioning and quality of life. This case report serves to create awareness about the existence of the syndrome and to highlight the potential morbidity due to clinical misdiagnosis.

Matched MeSH terms: Spinal Stenosis
Monitoring the quality of robot-assisted pedicle screw fixation in the lumbar spine by using a cumulative summation test

Kim HJ, Lee SH, Chang BS, Lee CK, Lim TO, Hoo LP, et al.

Spine (Phila Pa 1976), 2015 Jan 15;40(2):87-94.
PMID: 25575085 DOI: 10.1097/BRS.0000000000000680

Prospective randomized controlled trial.

Matched MeSH terms: Spinal Stenosis/surgery*
Fulltext Feasibility of Unilateral Approach for Bilateral Decompressive Endoscopic Spinal Surgery for Lumbar Stenosis to Improve Back and Leg Pain: A Consecutive Single-Center Series of 60 Patients

Salim AA, Yusof AH, Johari J, Yusof MI

Front Surg, 2020;7:507954.
PMID: 33364252 DOI: 10.3389/fsurg.2020.507954

Introduction: Endoscopic surgery is one of the methods that achieve the goal of decompression while minimizing collateral tissue damage. Its efficacy and safety have been supported by numerous studies. There is a plethora of studies on lumbar stenosis regarding the outcomes and related issues in endoscopic spine surgery. However, few studies evaluated the outcome of the decompressive lumbar spine surgery. The present study aims to analyze the outcome of a unilateral approach to endoscopic surgery for lumbar stenosis using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and MacNab's criteria. Methods: This is a retrospective study (level IV) conducted between January 2009 and December 2013 on 60 patients who underwent endoscopic interlaminar decompressive spine surgery (Destandau method) for lumbar degenerative spinal stenosis in the Hospital Universiti Sains Malaysia. The clinical outcome was measured pre-operatively and post-operatively for VAS: for back and leg pain, motor and sensory grading, the ODI, and MacNab's criteria. A paired t-test was used for statistical analysis. Results: The mean age of patients was 60.82 years comprising 23 males (38.3%) and 37 females (61.7%). The mean follow-up period was 30.1 months (range = 17.2-43 months). The mean operation time was 183.6 min (ranging from 124.8 to 242.4 min), and the mean blood loss was 150.18 mL (ranging from 30.82 to 269.54 mL). Post-operatively, mean hospital stay was 2.45 days (ranging from 1.34 to 3.56 days). The most frequently involved level was L4/L5 in 51 patients (52.6%), followed by L3/L4 in 19 patients (19.6%), L5/S1 in 24 patients (24.7%), and L2/L3 in three patients (3.1%). Improvement in the post-operative VAS for back and leg pain and the ODI for pre-operation and post-operation was statistically significant (p < 0.001). Conversely, the reduction in neurological status was statistically insignificant. Based on MacNab's criteria, 88.4% showed excellent to good outcomes. Conclusion: To summarize, unilateral percutaneous endoscopic spine surgery to achieve the bilateral decompression in lumbar stenosis provides excellent yet safe and effective outcomes. It improves back and leg pain and patients' function significantly.

Matched MeSH terms: Spinal Stenosis
Fulltext Variations in Practice among Asia-Pacific Surgeons and Recommendations for Managing Cervical Myelopathy: The First Asia-Pacific Spine Society Collaborative Study

Cheung JPY, Cheung PWH, Chiu CK, Chan CYW, Kwan MK

Asian Spine J, 2019 Feb;13(1):45-55.
PMID: 30326696 DOI: 10.31616/asj.2018.0135

STUDY DESIGN: Surgeon survey.
PURPOSE: To study the various surgical practices of different surgeons in the Asia-Pacific region.
OVERVIEW OF LITERATURE: Given the diversity among Asia-Pacific surgeons, there is no clear consensus on the preferred management strategies for cervical myelopathy. In particular, the role of prophylactic decompression for silent cervical spinal stenosis is under constant debate and should be addressed.
METHODS: Surgeons from the Asia-Pacific Spine Society participated in an online questionnaire comprising 50 questions. Data on clinical diagnosis, investigations and outcome measures, approach to asymptomatic and silent cervical spinal stenosis, guidelines for surgical approach, and postoperative immobilization were recorded. All parameters were analyzed by the Mantel-Haenszel test.
RESULTS: A total of 79 surgeons from 16 countries participated. Most surgeons used gait disturbance (60.5%) and dyskinetic hand movement (46.1%) for diagnosis. Up to 5.2% of surgeons would operate on asymptomatic spinal stenosis, and 18.2% would operate on silent spinal stenosis. Among those who would not operate, most (57.1%) advised patients on avoidance behavior and up to 9.5% prescribed neck collars. For ossification of the posterior longitudinal ligament (OPLL), anterior removal was most commonly performed for one-level disease (p<0.001), whereas laminoplasty was most commonly performed for two- to four-level disease (p=0.036). More surgeons considered laminectomy and fusion for multilevel OPLL. Most surgeons generally preferred to use a rigid neck collar for 6 weeks postoperatively (p<0.001).
CONCLUSIONS: The pooled recommendations include prophylactic or early decompression surgery for patients with silent cervical spinal stenosis, particularly OPLL. Anterior decompression is primarily suggested for one- or two-level disease, whereas laminoplasty is preferred for multilevel disease.

Matched MeSH terms: Spinal Stenosis