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Background: In the diagnosis of lumbar spinal stenosis (LSS), finding stenosis with magnetic resonance imaging (MRI) does not always correlate with symptoms such as sciatica or intermittent claudication. We perform decompression surgery only for cases where the levels diagnosed from neurological findings are symptomatic, even if multiple stenoses are observed on MRI. The objective of this study was to examine the time course of asymptomatic stenosis in patients with LSS after they underwent decompression surgery for symptomatic stenosis. Materials and Methods: The participants in this study comprised 137 LSS patients who underwent single-level L4–5 decompression surgery from 2003 to 2013. The dural sac cross-sectional area at the L3–4 disc level was calculated based on preoperative MRI. A cross-sectional area less than 50 mm2 was defined as stenosis. The patients were grouped, according to additional spinal stenosis at the L3–4 level, into a double group (16 cases) with L3–4 stenosis, and a single group (121 cases) without L3–4 stenosis. Incidences of new-onset symptoms originating from L3–4 and additional L3–4-level surgery were examined. Results: Five years after surgery, 98 cases (72%) completed follow-up. During follow-up, 2 of 12 patients in the double group (16.7%) and 9 of 86 patients in the single group (10.5%) presented with new-onset symptoms originating from L3–4, showing no significant difference between groups. Additional L3–4 surgery was performed for one patient (8.3%) in the double group and three patients (3.5%) in the single group; again, no significant difference was shown. Conclusion: Patients with asymptomatic L3–4 stenosis on preoperative MRI were not prone to develop new symptoms or need additional L3–4-level surgery within 5 years after surgery when compared to patients without preoperative L3–4 stenosis. These results indicate that prophylactic decompression for asymptomatic levels is unnecessary. [ABSTRACT FROM AUTHOR]

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare type of premenopausal osteoporosis that occurs mainly in the third trimester or immediately after delivery; one of its most common symptoms is back pain caused by a vertebral fracture. The pathogenesis of PLO is unclear, and there is no accepted consensus regarding the treatment of PLO. Although treatments with drugs such as bisphosphonate, strontium ranelate, denosumab, and teriparatide were reported, there is no report of a patient with PLO treated with romosozumab. We present the first case of a patient with PLO treated with romosozumab following 4-month teriparatide treatment. A 34-year-old primiparous and breastfeeding Japanese woman experienced severe low back pain 1 month postdelivery. She was diagnosed with PLO on the basis of low bone marrow density (BMD) and multiple vertebral fractures with no identified cause of secondary osteoporosis. She was treated with teriparatide injection for 4 months, but the treatment was discontinued because of the patient feeling severe nausea after every teriparatide injection and the appearance of new vertebral fractures. Thereafter, we used romosozumab for 12 months. After the romosozumab treatment, her BMD was increased from the baseline by 23.6% at L1–L4, 6.2% at the femoral neck, and 11.2% at the total hip. Treating PLO with 12-month romosozumab after 4 months of teriparatide injection remarkably increased the BMD of the lumbar spine, femoral neck, and total hip without subsequent fracture. Romosozumab has potential as a therapeutic option to improve the BMD and reduce the subsequent fracture risk of patients with PLO. [ABSTRACT FROM AUTHOR]

Background: Lumbar spinal stenosis (LSS) is one of the important health problems in an aging society because it can significantly impair quality of life (QOL) and active daily living (ADL). However, the natural history or long-term change of LSS symptoms is still unclear. The purpose of this study was to clarify the 10-year course of lumbar spinal stenosis (LSS) symptoms in community-dwelling residents of more than 1000 people with prospective data collection. Methods: A total of 1149 subjects were analyzed for the time course of LSS symptoms for ten years. LSS symptoms were assessed using a questionnaire specially designed and validated to detect LSS symptoms without image information such as magnetic resonance imaging. Results: The prevalence of positive LSS symptoms was about 16% in the initial survey and 10-year follow-up. Of the subjects who were LSS positive at the initial survey, 40% showed positive LSS symptoms at follow-up and 60% switched to negative LSS symptoms. According to the multivariable logistic regression analysis, severe depression and positive LSS symptoms were extracted as predictors of the presence of LSS symptoms after a 10-year follow-up. Conclusion: The statistical predictor of the presence of LSS symptoms at 10 years was the presence of LSS symptoms at the initial survey; however, 60% of those who were positive for LSS symptoms at the initial survey were not determined to have LSS symptoms at the 10-year follow-up. This was the same result as at the 1-year and 6-year follow-up. [ABSTRACT FROM AUTHOR]

Early diagnosis of degenerative cervical myelopathy (DCM) is desirable, as delayed treatment can cause irreversible spinal cord injury and subsequent activity of daily living (ADL) impairment. We attempted to develop a straightforward and accurate diagnostic tool for DCM by combining the grip and release test (GRT) and grip strength. As a pilot study, we measured the GRT and grip strength of patients with DCM (n = 247) and a control group (n = 721). Receiver operating characteristic analysis was performed using the lower left and right. The Youden index was used to set cutoff values by sex and age group. The diagnostic performance of each test varied by sex and age, and a diagnostic support tool was created to determine any abnormal results in a test. The calculated M/F cutoff values for GRT were as follows: 40–59 years, 21/18; 60–69 years, 17/17; 70–79 years, 15/15; and 80–89 years, 11/12. The calculated M/F cutoff values for grip strength 32/20, 29/13, 21/15, and 19/10. When either GRT or grip strength was judged as positive, the overall sensitivity was 88.2%, specificity was 78.1%, positive likelihood ratio was 4.03, and the negative likelihood ratio was 0.15. This novel diagnostic support tool was superior to using GRT and grip strength alone in the early DCM diagnosis. Future research to obtain age- and sex-specific data is necessary to validate and further improve the tool. [ABSTRACT FROM AUTHOR]

Background: Lumbar spinal stenosis (LSS) is a clinical syndrome based on anatomic narrowing of the spinal canal. It is well known that anatomic narrowing of the spinal canal is essential for manifestation, but not all of them cause symptoms. There are many studies assessing the relationship between dural tube compression on MRI and clinical symptoms; however, most of them are cross-sectional. The purpose of this study was to reveal the magnitude of dural tube compression's influence on the presence or development of LSS symptoms at the six-year follow-up and the occurrence of surgery during the follow-up period or not in the community setting. Methods: This was a longitudinal observational study of 459 participants who were assessed for typical LSS symptoms, and whose Roland–Morris Disability Questionnaire and numerical rating scale of leg pain and numbness was recorded using a questionnaire and conventional MRI of the lumbar spine. Typical LSS symptoms were judged using an LSS diagnostic support tool, which was a self-administered, self-reported history questionnaire (LSS-SSHQ). After six years, 232 subjects (follow-up rate 50.5%) were followed-up with typical LSS symptoms using LSS-SSHQ by mail. The relationship between the magnitude of dural tube compression evaluated by dural tube cross-sectional area (DCSA) in the initial assessment and the time course of typical LSS symptoms for the six-year duration were analyzed. In addition, predictors of the presence of typical LSS symptoms at the six-year follow-up were assessed. Furthermore, we investigated the relationship between typical LSS symptoms and DCSA during the initial assessment of patients who underwent surgery during the follow-up period. A multivariate logistic regression analysis was performed for statistical analysis. Results: (1) Severe dural tube compression did not show that LSS symptoms continued after six years. (2) Severe dural tube compression could not detect development of LSS-symptoms and surgery during the six-year period. Conclusion: Severe dural tube compression could not detect typical LSS symptom development and occurrence of surgery during the six-year period. [ABSTRACT FROM AUTHOR]

Background and Objective: The aim of this review was to analyze the existing literature and investigate the outcomes or complications of lateral lumbar interbody fusion (LLIF) combined with indirect decompression for degenerative lumbar spondylolisthesis (DS). Materials and Methods: A database search algorithm was used to query MEDLINE, COCHRANE, and EMBASE to identify the literature reporting LLIF with indirect decompression for DS between January 2010 and December 2021. Improvements in outcome measures and complication rates were pooled and tested for significance. Results: A total of 412 publications were assessed, and 12 studies satisfied the inclusion criteria after full review. The pooled data available in the included studies showed that 438 patients with lumbar spondylolisthesis (mean age 65.2 years; mean body mass index (BMI) 38.1 kg/m2) underwent LLIF. A total of 546 disc spaces were operated on. The most frequently treated levels were L4–L5 and L3–L4. Clinically, the average improvement was 32.5% in ODI, 46.3 mm in low back pain, and 48.3 mm in leg pain estimated from the studies included. SF-36 PCS improved by 51.5% and MCS improved by 19.5%. For radiological outcomes, a reduction in slippage was seen in 6.3%. Disc height increased by 55%, foraminal height increased by 21.1%, the foraminal area on the approach side increased by 21.9%, and on the opposite side it increased by 26.1%. The cross-sectional spinal canal area increased by 20.6% after surgery. Post-operative complications occurred in 5–40% of patients with thigh symptoms, such as anterior thigh numbness, dysesthesia, discomfort, pain, and sensory deficits. Conclusions: Indirect decompression by LLIF for DS is an effective method for improving pain and dysfunction with less surgical invasion. In addition, it has the effect of significantly improving disc height, foraminal height and area, and segmental lordosis on radiological outcomes compared to the posterior approach. [ABSTRACT FROM AUTHOR]

Background and Objectives : The high prevalence of lumbar spinal stenosis (LSS) and its negative impact on quality of life in the elderly is well known. However, the longitudinal time course of LSS symptoms remains unclear. The purpose of this study was to clarify the longitudinal time course and associated factors of LSS symptoms over a period of six years in a community. Materials and Methods : This study was conducted with data prospectively collected in 2004 and 2010 under a retrospective design. In 2004, 1578 subjects (age range: 40 to 79 years) were interviewed on LSS symptoms using a specially designed and validated questionnaire. In 2010, a follow-up study was performed by mail, to which 789 subjects of the 2004 study population responded. Considering that the presence of osteoarthritis (OA) of the knee or hip may influence the participants' answers in the questionnaire, analysis was performed in all 789 subjects with and 513 subjects without either knee or hip OA. Changes in LSS symptoms between the initial and the 6-year survey were investigated. Multiple logistic regression analysis was used for detecting the risk factors for LSS symptom presence at the six-year follow-up. Results : 1. At the six-year follow-up, more than half of the subjects who showed LSS symptoms at the initial analysis became LSS-negative, and 12-15% of those who were LSS-negative became LSS-positive. 2. From the multiple logistic regression analysis, a lower Roland-Morris Disability Questionnaire (RDQ) score and a positive LSS symptom at the initial analysis were detected as predictive factors of the presence of LSS symptoms at the six-year follow-up in the total number of subjects, as well as just in those who did not have either knee or hip OA. Conclusions : More than half of the subjects who were LSS-positive at their initial assessment still experienced improvement in their symptoms even after 6 years. This means that both LSS symptoms and their time course vary from person to person. Predictive factors for the presence of LSS symptoms during the six-year follow-up period were RDQ score and positive LSS symptoms.