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Purpose: The value of adding fusion to decompression surgery for lumbar degenerative spondylolisthesis and spinal canal stenosis remains debated. Therefore, the comparative effectiveness and selected healthcare resource utilization of patients undergoing decompression with or without fusion surgery at 3 years follow-up was assessed. Methods: Using observational data from the Lumbar Stenosis Outcome Study and a target trial emulation with index trial benchmarking approach, our study assessed the comparative effectiveness of the two main surgical interventions for lumbar degenerative spondylolisthesis—fusion and decompression alone in patients with lumbar degenerative spondylolisthesis and spinal canal stenosis. The primary outcome-measure was change in health-related quality of life (EuroQol Health Related Quality of Life 5-Dimension 3-Level questionnaire [EQ-5D-3L]); secondary outcome measures were change in back/leg pain intensity (Numeric Rating Scale), change in satisfaction (Spinal Stenosis Measure satisfaction subscale), physical therapy and oral analgesic use (healthcare utilization). Results: 153 patients underwent decompression alone and 62 had decompression plus fusion. After inverse probability weighting, 137 patients were included in the decompression alone group (mean age, 73.9 [7.5] years; 77 female [56%]) and 36 in the decompression plus fusion group (mean age, 70.1 [6.7] years; 18 female [50%]). Our findings were compatible with no standardized mean differences in EQ-5D-3L summary index change score at 3 years (EQ-5D-3L German: 0.07 [95% confidence interval (CI), − 0.25 to 0.39]; EQ-5D-3L French: 0.18 [95% CI, − 0.14 to 0.50]). No between-group differences in change in back/leg pain intensity or satisfaction were found. Decompression plus fusion was associated with greater physical therapy utilization at 3 years follow-up. Conclusion: Decompression alone should be considered the primary option for patients with lumbar degenerative spondylolisthesis and spinal stenosis. [ABSTRACT FROM AUTHOR]

Background While a laminectomy is often mandated for spinal canal stenosis, foraminal stenosis may account for pain and functional limitations instead of central canal issues. Targeted treatment directed at this specific region may enhance patient outcomes. Methods Retrospective observational study of a total of 30 patients with previous decompression laminectomies for lumbar spinal canal stenosis were operated upon for foraminotomies from November 2012 to November 2018. The surgeries were clinically done, and EMG-confirmed nerve root compressions were treated with exact decompression techniques according to the anatomy and pathology in each case. Additionally, a systematic review followed PRISMA guidelines was conducted, utilizing Scopus and PubMed databases to identify studies on reoperation rates after decompression with or without fusion in lumbar spinal stenosis. Results The results were fearsome post-operatively, trying significant improvement in pain, functional status, and walking distance. Pain reduction was achieved in 80% of patients by an increase in the Carnovsky rating scale with evidence of improved pain reduction and walking endurance; this points to minimal resulting complications of one complete case of foot drop and three infective cases managed conservatively. It was shown in the systematic review that fusion surgeries lowered the rates of reoperations at the index level but increased those for adjacent segment reoperations, while decompression alone had higher index-level reoperation rates due to recurrent stenosis. Conclusion Most of the emphasis on foraminal stenosis, rather than traditional laminectomies, significantly reduces postoperative pain and improves functional outcomes. This strategy brings a promising alternative to the management of recurrent symptoms in patients with lumbar spinal canal stenosis.

Knochen ist elastisch und verformbar. Kehrt ein Knochen nach einem Trauma, chronischem Zug, übermäßigem Druck oder einer Torsion nicht in seine alte Position zurück, verbleiben Schmerzen im Knochen und den beteiligten, nicht dehnbaren Faszien, Sehnen, Kapsel- und Bandstrukturen. Nach den theoretischen Grundlagen dieses manuellen Verfahrens zur Behandlung chronischer Schmerzen im Bewegungsapparat in Teil 1 [ 1 ] und der praktischen Anwendung dieser Technik im Teil 2 [ 2 ] an der unteren und im Teil 3 [ 3 ] an der oberen Extremität wird diesmal gezeigt, wie man mithilfe einer gezielten Behandlungskaskade pathologisch verformte Beckenknochen und den Trochanter major in ihre spannungsfreie, anatomische Ausgangsposition zurückbringen und dadurch die mit ihnen fest verankerten Bandstrukturen entlasten kann, um chronische Schmerzen zu beseitigen. Bone is elastic and deformable. However, if a bone does not return to its former position after trauma, chronic traction, excessive pressure or torsion, pain will remain in the bone and in non-stretchable fasciae, tendons, capsule and ligament structures involved. Following the introduction of the theoretical basis of a new manual method for the treatment of chronic pain in the musculosceletal system in part 1 [ 1 ] and the practical application of this technique in part 2 [ 2 ] on the lower limb and in part 3 [ 3 ] on the upper limb, this time it is demonstrated how a targeted treatment cascade can be used to return pathologically deformed pelvic bones and the greater trochanter to their tension-free, anatomical starting position and thus relieve the ligamentous structures firmly anchored to them in order to eliminate chronic pain. [ABSTRACT FROM AUTHOR]

Cervical spondylotic myelopathy (CSM) is the most serious subtype of cervical spondylosis, which is the main cause of spinal cord dysfunction in middle-aged and elderly people, and the pathogenesis of this CSM is complex, mainly including degenerative aging, dynamic instability, spinal cord ischemia, spinal cord injury, inflammation, apoptosis, and other possible mechanisms. The clinical treatment of the CSM mainly includes conservative treatment and surgical treatment, conservative treatment includes drugs, acupuncture, moxibustion, traction, physical therapy and manual treatment, surgical treatment can be divided into anterior surgery, posterior surgery, anterior and posterior combined surgery according to the surgical approach. The choice of treatment regimen should be based on the patient's symptoms, signs, and the results of auxiliary examinations, but how to choose the appropriate treatment plan is still the focus of clinicians. This article focuses on the research progress of the pathogenesis and treatment methods of this disease, in order to provide a reference for the diagnosis and treatment of cervical myelopathy.

Purpose: Neurogenic claudication presents itself as leg pain, paresthesia or cramp reproduced by walking and reduced by rest. It occurs more commonly in spinal canal Stenosis and the surgical decompression of the spine in this condition is rarely required. Nerve tissue may develop dynamic dysfunction such as adhesion and neural fibrosis can impair nerve mobility. Neurodynamic mobilization methods may enhance the neural tissue mobility and enhance physical function. The aim of this study was to explore the role of neural mobilization on the pain free walking distance (PFWD) and walking time among cases of spinal canal Stenosis presenting with neurogenic claudication. Methods: Forty eight patients diagnosed with neurogenic claudication were randomly and equally divided into any of the four groups: the "tensioner neural mobilization"; the "one ended slider neural mobilization" group; the "two ended slider neural mobilization" group; and the placebo group. The distance walked before pain onset and this pain-free walking time was recorded immediately before and after the neural mobilization intervention as per group's protocol. Result: The "two ended slider method" of neural mobilization was more superior to the "one ended slider" or the "tensioner method" for improving walking capacity. Neither "single ended" slider neural mobilization nor placebo intervention caused any statistically significant improvement in the walking capacity among patients of neurogenic claudication. Conclusion: The "double slider method" of neural mobilization is most appropriate followed by "slider method" of neural mobilization and the "single ended slider method" for enhancing the walking distance and walking time among patients suffering from neurogenic claudication. [ABSTRACT FROM AUTHOR]

Background: Numerous investigations have suggested links between circulating inflammatory proteins (CIPs) and spinal degenerative diseases (SDDs), but causality has not been proven. This study used Mendelian randomization (MR) to investigate the causal associations between 91 CIPs and cervical spondylosis (CS), prolapsed disc/slipped disc (PD/SD), spinal canal stenosis (SCS), and spondylolisthesis/spondylolysis. Methods: Genetic variants data for CIPs and SDDs were obtained from the genome‐wide association studies (GWAS) database. We used inverse variance weighted (IVW) as the primary method, analyzing the validity and robustness of the results through pleiotropy and heterogeneity tests and performing reverse MR analysis to test for reverse causality. Results: The IVW results with Bonferroni correction indicated that beta‐nerve growth factor (β‐NGF), C‐X‐C motif chemokine 6 (CXCL6), and interleukin‐6 (IL‐6) can increase the risk of CS. Fibroblast growth factor 19 (FGF19), sulfotransferase 1A1 (SULT1A1), and tumor necrosis factor‐beta (TNF‐β) can increase PD/SD risk, whereas urokinase‐type plasminogen activator (u‐PA) can decrease the risk of PD/SD. FGF19 and TNF can increase SCS risk. STAM binding protein (STAMBP) and T‐cell surface glycoprotein CD6 isoform (CD6 isoform) can increase the risk of spondylolisthesis/spondylolysis, whereas monocyte chemoattractant protein 2 (MCP2) and latency‐associated peptide transforming growth factor beta 1 (LAP‐TGF‐β1) can decrease spondylolisthesis/spondylolysis risk. Conclusions: MR analysis indicated the causal associations between multiple genetically predicted CIPs and the risk of four SDDs (CS, PD/SD, SCS, and spondylolisthesis/spondylolysis). This study provides reliable genetic evidence for in‐depth exploration of the involvement of CIPs in the pathogenic mechanism of SDDs and provides novel potential targets for SDDs. [ABSTRACT FROM AUTHOR]

Background and Purpose: Cervical spinal canal stenosis (cSCS) is a common cause of spinal impairment in the elderly. With conventional magnetic resonance imaging (MRI) suffering from various limitations, high‐resolution single‐shot T1 mapping has been proposed as a novel MRI technique in cSCS diagnosis. In this study, we investigated the effect of conservative and surgical treatment on spinal cord T1 relaxation times in cSCS. Methods: T1‐mapping was performed in 54 patients with cSCS at 3 Tesla MRI at the maximum‐, above and below the stenosis. Subsequently, intraindividual T1‐differences (ΔT1) intrastenosis were calculated. Twenty‐four patients received follow‐up scans after 6 months. Results: Surgically treated patients showed higher ΔT1 at baseline (154.9 ± 81.6 vs. 95.3 ± 60.7), while absolute T1‐values within the stenosis were comparable between groups (863.7 ± 89.3 milliseconds vs. 855.1 ± 62.2 milliseconds). In surgically treated patients, ΔT1 decreased inverse to stenosis severity. After 6 months, ΔT1 significantly decreased in the surgical group (154.9 ± 81.6 milliseconds to 85.7 ± 108.9 milliseconds, p =.021) and remained unchanged in conservatively treated patients. Both groups showed clinical improvement at the 6‐month follow‐up. Conclusions: Baseline difference of T1 relaxation time (ΔT1) might serve as a supporting marker for treatment decision and change of T1 relaxation time might reflect relief of spinal cord narrowing indicating regenerative processes. Quantitative T1‐mapping represents a promising additional imaging method to indicate a surgical treatment plan and to validate treatment success. [ABSTRACT FROM AUTHOR]

Spondylotic changes in the cervical spine cause degeneration, leading to cervical spinal canal stenosis. This stenotic change can affect cerebrospinal fluid (CSF) dynamics by compressing the dural sac and reducing space in the subarachnoid space. We examined CSF dynamics at the craniovertebral junction (CVJ) using time-spatial labeling inversion pulse magnetic resonance imaging (Time-SLIP MRI) in patients with cervical spinal canal stenosis. The maximum longitudinal movement of the CSF at the CVJ was measured as length of motion (LOM) in the Time-SLIP MRI of 56 patients. The sum of ventral and dorsal LOM was defined as the total LOM. Patients were classified into 3 groups depending on their spinal sagittal magnetic resonance imaging findings: control (n = 27, Kang classification grades 0 and 1), stenosis (n = 14, Kang classification grade 2), and severe stenosis (n = 15, Kang classification grade 3). Time-SLIP MRI revealed pulsatile movement of the CSF at the CVJ. The mean total, ventral, and dorsal LOM was 14.2 ± 9, 8.1 ± 5.7, and 3.8 ± 2.9 mm, respectively. The ventral LOM was significantly larger than the dorsal LOM. The total LOM was significantly smaller in the severe stenosis group (6.1 ± 3.4 mm) than in the control (16.0 ± 8.4 mm) or stenosis (11 ± 5.4 mm) groups (P < 0.001, Kruskal-Wallis H -test). In 5 patients, postoperative total LOM was improved after adequate decompression surgery. This study demonstrates that CSF dynamics at the CVJ are influenced by cervical spinal canal stenosis. Time-SLIP MRI is useful for evaluating CSF dynamics at the CVJ in patients with spinal canal stenosis. [ABSTRACT FROM AUTHOR]

Achondroplasia (ACH) is a skeletal dysplasia characterized by short-limbed short stature caused by the gain-of-function mutations in the fibroblast growth factor receptor 3 (FGFR3) gene. Activated FGFR3, which is a negative regulator of bone elongation, impairs the growth of long bones and the spinal arch by inhibiting chondrocyte proliferation and differentiation. Most patients with ACH have spinal canal stenosis in addition to short stature. Meclozine has been found to inhibit FGFR3 via drug repurposing. A 10-d treatment with meclozine promoted long-bone growth in a mouse model of ACH (Fgfr3 ach mice). This study aimed to evaluate the effects of long-term meclozine administration on promoting bone growth and the spinal canal in Fgfr3 ach mice. Meclozine (2 mg/kg/d) was orally administered to Fgfr3 ach mice for 5 d per wk from the age of 7 d to 56 d. Meclozine (2 mg/kg/d) significantly reduced the rate of death or paralysis and improved the length of the body, cranium, and long bones in male and female Fgfr3 ach mice. Micro-computed tomography analysis revealed that meclozine ameliorated kyphotic deformities and trabecular parameters, including BMD, bone volume/tissue volume, trabecular thickness, and trabecular number at distal femur of Fgfr3 ach mice in both sexes. Histological analyses revealed that the hypertrophic zone in the growth plate was restored in Fgfr3 ach mice following meclozine treatment, suggesting upregulation of endochondral ossification. Skeletal preparations demonstrated that meclozine restored the spinal canal diameter in Fgfr3 ach mice in addition to improving the length of each bone. The 2 mg/kg/d dose of meclozine reduced the rate of spinal paralysis caused by spinal canal stenosis, maintained the growth plate structure, and recovered the bone quality and growth of axial and appendicular skeletons of Fgfr3 ach mice in both sexes. Long-term meclozine administration has the potential to ameliorate spinal paralysis and bone growth in patients with ACH. [ABSTRACT FROM AUTHOR]

Abstract Background Numerous investigations have suggested links between circulating inflammatory proteins (CIPs) and spinal degenerative diseases (SDDs), but causality has not been proven. This study used Mendelian randomization (MR) to investigate the causal associations between 91 CIPs and cervical spondylosis (CS), prolapsed disc/slipped disc (PD/SD), spinal canal stenosis (SCS), and spondylolisthesis/spondylolysis. Methods Genetic variants data for CIPs and SDDs were obtained from the genome‐wide association studies (GWAS) database. We used inverse variance weighted (IVW) as the primary method, analyzing the validity and robustness of the results through pleiotropy and heterogeneity tests and performing reverse MR analysis to test for reverse causality. Results The IVW results with Bonferroni correction indicated that beta‐nerve growth factor (β‐NGF), C‐X‐C motif chemokine 6 (CXCL6), and interleukin‐6 (IL‐6) can increase the risk of CS. Fibroblast growth factor 19 (FGF19), sulfotransferase 1A1 (SULT1A1), and tumor necrosis factor‐beta (TNF‐β) can increase PD/SD risk, whereas urokinase‐type plasminogen activator (u‐PA) can decrease the risk of PD/SD. FGF19 and TNF can increase SCS risk. STAM binding protein (STAMBP) and T‐cell surface glycoprotein CD6 isoform (CD6 isoform) can increase the risk of spondylolisthesis/spondylolysis, whereas monocyte chemoattractant protein 2 (MCP2) and latency‐associated peptide transforming growth factor beta 1 (LAP‐TGF‐β1) can decrease spondylolisthesis/spondylolysis risk. Conclusions MR analysis indicated the causal associations between multiple genetically predicted CIPs and the risk of four SDDs (CS, PD/SD, SCS, and spondylolisthesis/spondylolysis). This study provides reliable genetic evidence for in‐depth exploration of the involvement of CIPs in the pathogenic mechanism of SDDs and provides novel potential targets for SDDs.

Introduction: Transforaminal injections have been associated with rare but major complications. Despite several studies on epidural steroid injection as a minimally invasive non-surgical method to relieve the pain of spinal canal stenosis, there is no consensus about some details. Therefore, the present study aimed to determine the effect of transforaminal steroid injection on patients with grade 1 to 3 spinal canal stenosis. Method: The present randomized controlled trial study examined 110 patients with spinal canal stenosis. The case group (A) included 55 patients injected with bupivacaine solution and dexamethasone. The control group (B) consisted of 55 patients without intervention. The patients were examined before injection, two weeks, three and six months, and one year after the treatment using the disability index (ODI), functional status (FRI), Visual Analog Scale (VAS), and Numeric Rate Scale (NRS). Results: According to the results, transforaminal steroid injection for patients with grades 1 and 2 spinal canal stenosis had a suitable effect on reducing the severity of disability and improving functional status; however, the pain relief process was achieved gradually in them. In patients with grade 3 canal stenosis, pain relief was observed after 6 months of injection; however, improvement of functional status and reduction of disability did not follow proper trends. Conclusion: Transforaminal steroid injection has a better effect on improving the performance and ability of the patient, but its effect on reducing pain requires more time.

Objective To analyze the clinical efficacy of full-visualization single-channel endoscopic lumbar interbody fusion (PE-PLIF) in the treatment of lumbar degenerative diseases, and to explore the application skills and significance of endoscopic spinal canal decompression and interbody fusion. Methods From January 2021 to December 2022, 50 patients who underwent PE-PLIF in The Affiliated Huai ‘an No.1 Hospital of Nanjing Medical University were selected retrospectively. A total of 56 lower lumbar segments were treated with spinal canal decompression and interbody fusion. The expandable cage implantation technique was used for spinal canal decompression, intervertebral fusion, and percutaneous pedicle screw internal fixation. The visual analogue scale (VAS) score of low back pain and lower limb pain, Oswestry disability index (ODI), and modified MacNab scoring system were used to evaluate the clinical efficacy before and after operation. Results The VAS scores of low back pain were 5.2±1.1, 2.2±0.7, 1.5±0.6, 1.3±0.7, 1.0±0.9 before operation, 1 day, 3 months, 6 months after operation and at the last follow-up, respectively. The VAS scores of lower limb pain were 7.2±1.0, 2.0±1.0, 0.5±0.3, 0.3±0.2, 0.3±0.2, respectively. The ODI was 66.3±7.4, 16.6±5.0, 12.4±3.6 and 10.7±3.3 before operation, 3 months, 6 months after operation and at the last follow-up, respectively. The VAS score and ODI score decreased after operation, and the differences were statistically significant compared with those before operation (P

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Background and Aims: Spinal canal stenosis is one of the most common vertebral column diseases, which can lead to disability. Developing a registry system can help in research on the prevention and effective treatment of it. This study designs a minimum data set (MDS) as the first step in creating a registry system for spinal canal stenosis. Method: The present research is of applied‐descriptive type, performed in 2022. First, the applicable data elements about the disease were selected from a vast range of English and Farsi references, including peer reviewed articles, academic books, credible websites, and medical records of hospitalized patients. Through the extracted data, the primary MDS plan was designed as a questionnaire. The validity of the questionnaire was conducted via asking the opinion of experts (neurosurgeons, physiotherapists, epidemiologists, and health information management specialists). Also, its reliability was calculated via Cronbach ⍺ coefficient, which was 86%. Finally, the MDS of the spinal canal stenosis national registry system (for Iran) was confirmed through a two stage Delphi technique. Data analysis was applied through descriptive statistics via SPSS21 software. Results: The proposed MDS is offered in two general sets of data: administrative and clinical. For the administrative data set, 40 data elements had been proposed, as five classes. Twenty‐six of them were confirmed. In the clinical section, 95 data elements had been proposed in 14 classes; 94 of which were finally confirmed. Conclusion: Since there is no spinal canal stenosis MDS available, this study can be a turning point in the standardization of the data on this disease. Moreover, these precise, coherent, and standard data elements can be contributed to improving disease management and enhancing the public healthcare quality. Also, the MDS proposed in this study can help researchers and experts, design a spinal canal stenosis registry system in other countries. [ABSTRACT FROM AUTHOR]

Aims: Lumbar spinal stenosis (LSS) is a common skeletal system disease that has been partly attributed to genetic variation. However, the correlation between genetic variation and pathological changes in LSS is insufficient, and it is difficult to provide a reference for the early diagnosis and treatment of the disease. Methods: We conducted a transcriptome-wide association study (TWAS) of spinal canal stenosis by integrating genome-wide association study summary statistics (including 661 cases and 178,065 controls) derived from Biobank Japan, and pre-computed gene expression weights of skeletal muscle and whole blood implemented in FUSION software. To verify the TWAS results, the candidate genes were furthered compared with messenger RNA (mRNA) expression profiles of LSS to screen for common genes. Finally, Metascape software was used to perform enrichment analysis of the candidate genes and common genes. Results: TWAS identified 295 genes with permutation p-values < 0.05 for skeletal muscle and 79 genes associated for the whole blood, such as RCHY1 (PTWAS = 0.001). Those genes were enriched in 112 gene ontology (GO) terms and five Kyoto Encyclopedia of Genes and Genomes pathways, such as ‘chemical carcinogenesis - reactive oxygen species’ (LogP value = −2.139). Further comparing the TWAS significant genes with the differentially expressed genes identified by mRNA expression profiles of LSS found 18 overlapped genes, such as interleukin 15 receptor subunit alpha (IL15RA) (PTWAS = 0.040, PmRNA = 0.010). Moreover, 71 common GO terms were detected for the enrichment results of TWAS and mRNA expression profiles, such as negative regulation of cell differentiation (LogP value = −2.811). Conclusion: This study revealed the genetic mechanism behind the pathological changes in LSS, and may provide novel insights for the early diagnosis and intervention of LSS. Cite this article: Bone Joint Res 2023;12(6):387–396.

Systemic amyloidosis is an incurable multisystem disease, caused by fibrillar protein deposits with resulting dysfunction of affected organ systems. It mostly affects patients > 60 years. Diagnosis is often delayed because the symptoms are nonspecific and highly variable. We report on an elderly patient with multi-organ involvement with proven wild-type transthyretin amyloidosis. The initial manifestation involved bilateral carpal tunnel syndrome and lumbar spinal canal stenosis. The occurrence of ligament and tendon disorders, unexplained muscle pain and polyneuropathy in elderly patients should be considered as a possible first manifestation of systemic amyloidosis. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims Spinal canal stenosis is one of the most common vertebral column diseases, which can lead to disability. Developing a registry system can help in research on the prevention and effective treatment of it. This study designs a minimum data set (MDS) as the first step in creating a registry system for spinal canal stenosis. Method The present research is of applied‐descriptive type, performed in 2022. First, the applicable data elements about the disease were selected from a vast range of English and Farsi references, including peer reviewed articles, academic books, credible websites, and medical records of hospitalized patients. Through the extracted data, the primary MDS plan was designed as a questionnaire. The validity of the questionnaire was conducted via asking the opinion of experts (neurosurgeons, physiotherapists, epidemiologists, and health information management specialists). Also, its reliability was calculated via Cronbach ⍺ coefficient, which was 86%. Finally, the MDS of the spinal canal stenosis national registry system (for Iran) was confirmed through a two stage Delphi technique. Data analysis was applied through descriptive statistics via SPSS21 software. Results The proposed MDS is offered in two general sets of data: administrative and clinical. For the administrative data set, 40 data elements had been proposed, as five classes. Twenty‐six of them were confirmed. In the clinical section, 95 data elements had been proposed in 14 classes; 94 of which were finally confirmed. Conclusion Since there is no spinal canal stenosis MDS available, this study can be a turning point in the standardization of the data on this disease. Moreover, these precise, coherent, and standard data elements can be contributed to improving disease management and enhancing the public healthcare quality. Also, the MDS proposed in this study can help researchers and experts, design a spinal canal stenosis registry system in other countries.

Lumbar canal stenosis (LCS) is characterized by narrowing of the central spinal canal or lateral recesses and foramina, leading to compression of nerve tissues. It causes neurogenic claudication, which manifests as back pain and variety of lower limb symptoms such as pain, tingling/numbness, or paresthesia on ambulation. A rare symptom of LCS is priapism, which is thought to occur due to parasympathetic dysfunction. We describe a case of a 45-year-old man, who presented with neurogenic claudication and intermittent priapism due to lumbar intervertebral disc prolapse, which resolved completely after surgical decompression, and literature review for the same.

In order to find out the mechanisms of pathogenesis of degenerative-dystrophic diseases of the spine, it is of particular interest to search for body parameters which are directly or indirectly interrelated with the key factors of peripheral conversion of nidus iodothyronines and constitute a system of network interactions, affecting metabolic indicators at the local and systemic level.The aim. To search for correlations of local key factors of peripheral conversion of Ligamentum flavum iodothyronines with indicators of biochemical, hematological and hormonal blood profiles of patients with stenosing processes of the spinal canal and dural sac in the lumbar spine.Materials and methods. 33 patients (15 males, 18 females) with stenosing processes of the spinal canal and dural sac in the lumbar spine were examined (mean age – 45.73 ± 1.95 years). The expression of deiodinase genes and other candidate genes was determined in Ligamentum flavum biopsies collected during surgical treatment. Biochemical, hematological and hormonal parameters were determined in peripheral blood. The resulting data array was processed in order to find correlations between the parameters of systemic and local metabolism.Results. The relationships of deiodinases with the expression of GDF5, MMP1, MMP3 and TIMP1 in Ligamentum flavum (p < 0.05) were found. Of the hormonal profile of the blood serum, the most significant indicators were thyreotropin, free triiodothyronine and thyroperoxidase antibodies. In the biochemical profile, levels of direct bilirubin, total cholesterol, HDL and LDL cholesterol and triglycerides changed along with the expression of deiodinases. Correlative relationships with the expression of deiodinases were found for the following hematological analytes of whole peripheral blood: hemoglobin, mean corpuscular hemoglobin concentration, numbers of granulocytes, lymphocytes, eosinophils, monocytes, band neutrophils, red cell distribution width and platelet crit. The data obtained indicate the involvement of peripheral conversion factors in the pathogenetic process and provide information to form a new view on the pathogenesis of degenerative-dystrophic processes in the Ligamentum flavum of patients with stenosing processes of the spinal canal and the dural sac in the lumbar spine.

Examination of the spine using radiological methods remains the most frequently conducted study in the outpatient practice of almost any radiologist. In most cases, changes in the spine are degenerative and dystrophic in nature. These changes in the spine are the leading cause of loss of activity among adults and the elderly, and cover a wide range of age-related structural changes. It is of great importance to understand the possibilities and limitations of radiological methods of diagnostics. The description of morphological changes observed in degenerative and dystrophic changes requires the use of unified terminology and classifications among clinicians and radiologists.The aim. To present modern concepts in the assessment of degenerative changes of the spine using radiological methods. A description of the standardized international nomenclature of intervertebral disc pathology and current classifications of spinal canal stenosis are presented.Material and methods. For literature search, we used electronic databases MEDLINE (PubMed), eLibrary, EMBASE and Cochrane Library with a selection of sources published from 2000 to 2021. We analyzed the works devoted to the diagnosis of degenerative changes in lumbar spine and to degenerative stenosis.Conclusion. The key to productive communication between physicians is the uniformity or standardization of terminology and definitions used. It is important that the protocol of description, its terms, semantic expressions be uniform and understandable to specialists who are involved in the diagnosis and treatment of the spine. Magnetic resonance imaging is a valuable method in the diagnosis of degenerative changes of the spinal column, but it has its limitations.

Background Context.: Proper patient selection is crucial for the outcome of surgically treated degenerative lumbar spinal stenosis (DLSS). Nevertheless, there is still not a clear consensus regarding the optimal treatment option for patients with DLSS. Purpose.: To investigate the treatment failure rate and introduce a simple, preoperative score to aid surgical decision-making. Study Design/Setting.: Retrospective observational study Patient Sample.: Four hundred forty-five patients who underwent surgical decompression for DLSS. Outcome Measures.: Treatment failure (defined as conversion to a fusion of a previously decompressed level) of lumbar decompression Materials and Methods.: Several risk factors associated with worse outcomes and treatment failures, such as age, body mass index, smoking status, previous surgery, low back pain (LBP), facet joint effusion, disk degeneration, fatty infiltration of the paraspinal muscles, the presence of degenerative spondylolisthesis and the facet angulation, were investigated. Results.: At a mean follow-up of 44±31 months, 6.5% (29/445) of the patients underwent revision surgery with spinal fusion at an average of 3±9 months following the lumbar decompression due to low back or leg pain. The baseline LBP (≥7) [odds ratio (OR)=5.4, P <0.001], the presence of facet joint effusion (>2 mm) in magnetic resonance imaging (OR=4.2, P <0.001), and disk degeneration (Pfirrmann >4) (OR=3.2, P =0.03) were associated with an increased risk for treatment failure following decompression for DLSS. The receiver operating characteristic curve analysis demonstrated that a score≥6 points yielded a sensitivity of 90% and specificity of 64% for predicting a treatment failure following lumbar decompression for DLSS in the present cohort. Conclusions.: The newly introduced score quantifying amounts of LBP, facet effusions, and disk degeneration, could predict treatment failure and the need for revision surgery for DLSS patients undergoing lumbar decompression without fusion. Patients with scores >6 have a high chance of needing fusion following decompression surgery. Level of Evidence.: Retrospective observational study, Level III [ABSTRACT FROM AUTHOR]

Study Design: Prospective cohort study. Objective: To evaluate whether pre-existing adjacent spinal canal stenosis (SCS) is associated with short-term outcomes after lumbar fusion surgery. Methods: We included patients with lumbar spinal stenosis treated surgically between July 2015 and December 2017 at 4 centers. All patients had the same pathology, with L4-S1 as the culprit sections. Patients were divided into 2 groups based on the cerebrospinal fluid occlusion sign on MRI at the adjacent L3/4 level. Patients without SCS (grade 0) and with mild SCS (grade 1) were classified into the non-stenosis (NS) and mild stenosis (MS) groups, respectively. All patients underwent PLIF and completed at least 1-year follow-up. The incidence of adjacent segment degeneration (ASDeg) and clinical outcomes were compared between the 2 groups. Results: A total of 308 patients (NS, 156; MS, 152) met the inclusion criteria. The incidence of ASDeg in the NS group (n = 40, 25.6%) was significantly lower than that in the MS group (n = 74, 48.7%; P <.001). The most frequent type of ASDeg in the 2 groups was the SCS-aggravated type. No significant difference was observed in adjacent segment disease incidence between the 2 groups (P =.243). The NS group had better outcomes according to the clinical function scores (P <.05). Conclusions: The cerebrospinal fluid occlusion sign on MRI is valuable for evaluating the adjacent segment with pre-existing degeneration. Patients with mild SCS in adjacent segments were more likely to have ASDeg, and the most frequent type of ASDeg was the SCS-aggravated type at early follow-up. [ABSTRACT FROM AUTHOR]

Mateusz Krakowiak,1 Natalia Rulewska,2 Marcin Ruda&sacute;,1 Maciej Broda,1 Micha&lstrok; Sabramowicz,1 Andrzej Jaremko,1 Krzysztof Leki,3 Pawe&lstrok; Sokal1 1Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; 2Students’ Scientific Circle at the Department of Neurosurgery, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; 3Centre for Statistical Analysis, Nicolaus Copernicus University, Toru&nacute;, PolandCorrespondence: Pawe&lstrok; Sokal, Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland, Tel/Fax +48 523655505, Email pawel.sokal@cm.umk.plAim: Interspinous process device (IPD) placement is an attractive treatment option for lumbar spinal and foraminal stenosis. The goal of the treatment is to release the stress on facets joints as well as decompress the nerve roots by enlarging the intervertebral foramina and narrowed canal recesses.Purpose: To evaluate possible structural changes in the lumbar spine after implantation of an IPD on operated and adjacent segments.Patients and Methods: Twenty-two patients were enrolled in the study. Preoperative MRI scans of the lumbar spine evaluated recess and foraminal stenosis prior to the application of an IPD. CT exams were performed and morphometric measurements were made to assess the size of intervertebral foramina after implantation on the operated and adjacent segments.Results: Statistically significant enlargements in diameter and surface area of the intervertebral foramen were seen at the operating level. On the right and left sides, foraminal enlargement after the procedure was 1 mm in diameter. The average enlargement of the foramina surface area at the level of implantation was 10 mm2. The median interspinous distance was significantly enlarged by 3.5 mm. No significant changes in adjacent segments were observed. Clinical improvement was confirmed by the Oswestry Disability Index (ODI) and visual analog scale (VAS). Preoperative disability was reduced (mean ODI from 70.5 (12.25) to 49.5 (23.75)), as well as back pain (mean VAS from 8.0 (1.7) to 4.4 (2.6)) and pain in lower limbs (mean VAS from 7.4 (1.9) to 3.8 (2.9)).Conclusion: Decompression surgery using an IPD is effective in the treatment of lumbar foraminal and canal stenosis. It provides relief of symptoms in short-term observation through enlargement of intervertebral foramina and decompression of neural roots. It reduces overload of facet joints of the operated segment and does not decrease the size of the intervertebral foramina and disc heights of adjacent segments.Keywords: interspinous device, low lumbar back pain, lumbar decompression, spinal canal stenosis, foraminal stenosis

Objective: To correspond clinical findings of patients with lower backache to those demonstrated at Magnetic Resonance Imaging of the Lumbosacral spine. Study Design: Cross-sectional study. Place and Duration of Study: Department of Diagnostic Radiology, Pakistan Institute of Medical Sciences Hospital, Islamabad Pakistan, from Oct 2019 to Jan 2020. Methodology: All consecutive adult patients with lower backaches of more than one month duration were enrolled in the study. Detailed clinical history and examination were obtained. Pain scoring was done by visual analogue score, and a straight leg raise test was performed. Patients then underwent magnetic resonance imaging in the hospital, and findings were reported. Results: Mean age of the patients was 30.2±13.53 with male preponderance. The mean duration of symptoms was 2.3±2.34 years. According to the visual analogue score, most patients had a moderate pain scale. Seventy-six percent of patients had no sensory deficit; upon clinical examination, twenty-one had a loss of power. Upon Lasegue Test, the majority (43,48.9%), had pain between 30-70 of hip flexion. Conclusion: History and detailed clinical examination play an emphasising role in the treatment regimen of patients with lower backache, with special concern on the correlation of findings with Magnetic Resonance Imaging of the lumbosacral spine, thus alleviating morbidity of patients.

Objective. To analyze clinical outcomes and complication rates of transforaminal and interlaminar endoscopic decompression and open microsurgical operations performed for lumbosacral spinal canal stenosis. Material and Methods. The data of 60 literature sources selected in accordance with the inclusion and exclusion criteria in the PubMed, Science Direct, Google Scholar and Cochrane Library databases were systematized by evaluating diagnostic methods, clinical pictures and surgical treatment of the lumbar spinal canal stenosis. Original studies, case series and reviews containing information on surgical methods for the treatment of spinal stenosis at the lumbar level were analyzed. Results. The complication rate after transforaminal endoscopic decompression (relapses, infectious complications, damage to the dural membrane and spinal roots) does not exceed 2.7 %, which is significantly lower than that in open microsurgical operation (4.8–8.8 %). Endoscopic decompression and reconstruction of the spinal canal demonstrate good clinical outcomes, lower number of bed-days, readmissions, and good economic benefits. When stenosis is combined with instability of the spinal motion segment, performing only a decompressive operation in any volume does not give a significant clinical result, and stabilization surgery is required. Conclusion. The introduction of endoscopic reconstructive surgery for spinal canal stenosis in the lumbosacral spine is associated not only with technical progress and improvement of endoscopic optics, but also with the search for the causes of unsatisfactory results of open operations. Endoscopic interventions showed good clinical outcomes and a decrease in the complication rate. However, the evidence base needs to be expanded due to the lack of randomized trials to compare open decompression and stabilization, and endoscopic reconstructive surgeries in patients with various manifestations of spinal stenosis.

Abstract Background In case of spinal cord compression behind the vertebral body, anterior cervical corpectomy and fusion (ACCF) proves to be a more feasible approach than cervical discectomy. The next step was the placement of an expandable titanium interbody in order to restore the vertebral height. The need for additional anterior plating with ACCF has been debatable and such technique has been evaluated by very few studies. The objective of the study is to evaluate radiographic and clinical outcomes in patients with multilevel degenerative cervical spine disease treated by stand-alone cages for anterior cervical corpectomy and fusion (ACCF). Methods Thirty-one patients (66.5 ± 9.75 years, range 53–85 years) were analyzed. Visual Analog Scale (VAS) and the 10-item Neck Disability Index (NDI) were assessed preoperatively and during follow-up on a regular basis after surgery and after one year at least. Assessment of radiographic fusion, subsidence, and lordosis measurement of Global cervical lordosis (GCL); fusion site lordosis (FSL); the anterior interbody space height (ant. DSH); the posterior interbody space height (post. DSH); the distance of the cage to the posterior wall of the vertebral body (CD) were done retrospectively. Mean clinical and radiographic follow-up was 20.0 ± 4.39 months. Results VAS-neck (p = 0.001) and VAS-arm (p

Objective To investigate the influence of bone cement dispersion on vertebral reconstruction after unilateral percutaneous kyphoplasty (PKP) for single level osteoporotic vertebral compression fracture (OVCF) .Methods From July 2015 to June 2019,70 patients with single segmental OVCF who were treated with unilateral PKP in the hospital were selected and divided into group A (39 cases) and group B (31 cases) according to the degree of bone cement dispersion.The pain visual analogue scale (VAS),Oswestry dysfunction index (ODI) scores, the amount of bone cement injected, the degree of kyphosis correction, the correction rate of vertebral anterior column height, and the leakage of bone cement were compared between the two groups.At the same time, the linear correlation between the correction rate of vertebral anterior column height and relevant parameters was analyzed.Results The VAS and ODI scores of the two groups after operation were lower than those before operation, and the differences were statistically significant (P<0.05) .There were no significant differences in the VAS and ODI scores between the two groups (P>0.05) .The preoperative vertebral anterior column height ratio in the group A was higher than that in the group B,with a statistically significant difference (P=0.030),but there was no statistically significant difference between the two groups in the postoperative vertebral anterior column height ratio (P>0.05) .There was no significant difference between the two groups (P>0.05) .There were no statistically significant differences in kyphosis angle before and after operation between the two groups (P>0.05) .The correction rate of vertebral anterior column height and kyphosis in the group B were higher than those in the group A,and the differences were statistically significant (P<0.05) .The amount of bone cement injected and the incidence of bone cement leakage in the group B were higher than those in the group A,with statistical significance differences (P<0.01) .There was no significant correlation between the correction rate of vertebral anterior column height, kyphosis correction and the incidence of bone cement leakage, but there was a negative correlation between the correction rate of vertebral anterior column height and the ratio of vertebral anterior column height (r=-14.901,P<0.001),and a positive correlation between the correction rate of vertebral anterior column height and the amount of bone cement injected (r=3.681,P<0.001) .Conclusion When unilateral PKP is used to treat patients with single level OVCF,the degree of bone cement dispersion during operation can well predict the effect of postoperative vertebral reconstruction. [ABSTRACT FROM AUTHOR]

Hemophilia B is a quantitative or qualitative factor IX anomaly that manifests as an X-linked recessive inheritance pattern in which females are carriers. Postoperative epidural hematoma emerges as a typical complication in spinal surgery, although its incidence is infrequent. No documentation of postoperative epidural hematoma in carriers of hemophilia B exists. A 64-year-old female patient presented with progressive pain and muscle weakness in both lower limbs. Despite a history of childbirth and prior colorectal cancer surgery, the patient displayed no abnormal bleeding tendencies. Subsequently undergoing decompression surgery for lumbar spinal canal stenosis, the patient experienced paralysis and pain in both legs within 5 hours postoperatively. A magnetic resonance imaging scan revealed severe spinal canal compression attributed to a postoperative epidural hematoma, prompting emergency decompression surgery that ameliorated symptoms. The application of gelatin-thrombin matrix sealants (GTMS) facilitated hematoma removal, resulting in an uneventful recovery. In a postoperative interview, it was revealed that her grandson was undergoing treatment for hemophilia B. Additionally, she exhibited diminished factor IX levels and was diagnosed as a hemophilia B carrier. A definitive preoperative diagnosis of the carrier status is imperative. In instances where surgical intervention is warranted, the implementation of factor IX replacement and intraoperative hemostasis with GTMS is promising for potentially averting the onset of postoperative epidural hematoma., Competing Interests: None, (Copyright © Japan Medical Association.)

New data have been obtained for assessing the expression of genes of metalloproteinases and their tissue inhibitors (MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, TIMP-1 and TIMP-2) in the Ligamentum flavum in patients with lumbar stenosis of spinal canal and dural sac. The features of the metabolism of the extracellular matrix (ECM) were revealed, the data obtained were compared with those for previously studied candidate genes. The search for relationships with the features of the ECM metabolic characteristics was carried out.The aim. To study the expression of genes of metalloproteinases and their tissue inhibitors in intraoperative biopsies of the Ligamentum flavum of patients with lumbar stenosis of the spinal canal and dural sac.Materials and methods. A group of 33 people (17 women, 16 men) with lumbar stenosis of the spinal canal and dural sac was studied; the average age is 45.73 ± 1.95 years. RNA was isolated from intraoperative biopsies of the Ligamentum flavum, reverse transcription was performed, and PCR using specific primers was performed.Results. In Ligamentum flavum of patients with stenosing processes of the spinal canal and dural sac, an increased activity of MMP-1 and insufficient response of TIMP-1 and TIMP-2 were found; the expression of MMP-1 increased synchronously with Dio2, and both genes decreased their activity with increasing age of the patient. In patients with Ligamentum flavum ossification, the MMR-8 gene was more actively expressed, and the synthesis of the mRNA of the MMR-9 gene decreased compared to the subgroup without ossification.

Aim of the study. The aim of this study was to assess the diagnostic value of diffusion tensor imaging (DTI) in patients with symptoms of cervical myelopathy. Detailed goals included determining the diagnostic effectiveness of quantitative parameters, i.e. fractional anisotropy (FA) and apparent diffusion coefficient (ADC), in the diagnosis of cervical myelopathy, and the correlation between these parameters and clinical symptoms. Clinical rationale for the study. The demonstration of an ischaemic focus in the spinal cord by standard magnetic resonance imaging (MRI) methods is associated with already accomplished spinal cord damage, and of course limited treatment options. Therefore, finding a new examination protocol that allows early diagnosis of myelopathic focus, before the onset of full neurological symptoms, has become a priority in the diagnosis and treatment of spine diseases. Such an examination increases the chances of correctly qualifying the patient for conservative vs. surgical treatment. Material and methods. Between 2013 and 2017, 128 adults with clinical signs of cervical myelopathy were examined, and were divided into four symptomatic subgroups. A control group consisted of 37 healthy volunteers. DTI values were measured at the level of C2/C3, and at the most severe stenosis of the spine. Results. In patients with cervical spondylotic myelopathy (CSM), the ADC values were significantly higher (p < 0.001), and FA values were significantly lower (p < 0.001), than in healthy volunteers at the stenotic level. There were significant differences in DTI parameters between the clinical subgroups (p < 0.001). Conclusions and clinical implications. Changes in DTI parameters indicate a microstructural disorder of the core which is not visible in a structural MRI. FA and ADC values measured at the level of the most severe stenosis of the spinal canal allow the differentiation of patients with myelopathy of varying degrees of clinical severity. Extending standard MRI to include assessment of FA and ADC may be helpful in deciding treatment modalities (conservative vs. surgical) for patients with visible canal stenosis without full neurological symptoms. This may be useful in selecting patients for urgent rehabilitative treatment. This study is a starting point for further research, i.e. an evaluation of the extent of FA and ADC lesion withdrawal after surgical treatment. [ABSTRACT FROM AUTHOR]

Background: The need for systematization, generalization and analysis of structural changes in various organs and systems that occur in patients with mucopolysaccharidosis (MPS). MPS is a rare disease, therefore, there is a lack of structured information in Russian publications in the field of radiology. Aims: The purpose of the study is to summarize our own experience, identifying the incidence of changes in various organs and describing the most significant changes and their causes. Identification of more informative and safe diagnostic methods of various organs, taking into account the specificity of changes in MPS. Methods: Retrospectively, 303 children with MPS of different types were examined (the sample included 70 cases verified by the laboratory studies and molecular genetics), the revision of tomograms and radiographs was carried out for the studies from 2015 to 2021. All the patients underwent MRI of the brain and cervical spine, X-ray of the skeletal bones. Results: The analysis of the obtained images revealed the most common changes, such as dysostosis (in 100%; 70 patients), stenosis of the spinal canal at the craniovertebral level (73%; 51 patients), atrophy (47%; 33 patients) and focal lesions of the brain substance (67%; 47 patients), hydrocephalus (28%; 20 patients), expansion of the perivascular spaces (70%; 58 patients). The pathophysiological mechanisms of the occurrence of structural changes have been analyzed and described. Conclusions: The assessment and comparison of various diagnostic methods for different organs and systems has demonstrated that MRI is the most informative imaging method for the assessment of the craniovertebral junction. Given the lower radiation exposure compared to computed tomography, it is preferable to use digital radiography for examining the bones of the extremities.

Background and Objectives This study aims to assess the frequency of positive lumbosacral magnetic resonance imaging (MRI) results in patients with non-traumatic low back pain (LBP) based on the specialty of the referring physician. Subjects and Methods In this retrospective study, 335 patients with non-traumatic LBP aged >18 years participated. Their demographic information and MRI findings and the specialty of the referring physician were extracted and recorded from the imaging information system of a hospital. Frequency of positive lumbosacral MRI results based on the specialty of the referring physician were compared. To avoid bias, the MRIs with a same imaging protocol were selected, and reporting was done by a same radiologist. Results Of 335 patients, 145(43.3%) were male and 190(57.6%) were female. Among the referring physicians, 139(41.5%) were neurosurgeon, 114(34%) were orthopedists, 61(18.2%) were neurologists, and 21(6.3%) were physical medicine specialist. There was no significant difference in positive MRI results between different specialties of the referring physicians (P>0.05). Conclusion There is no difference in the frequency of positive lumbosacral MRI results in patients with non-traumatic LBP treated by orthopedics, neurologists, neurosurgeons, and physical medicine specialists. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Posterior single open-door laminoplasty (LAMP) and anterior cervical corpectomy fusion (ACCF) can effectively treat cervical spondylotic myelopathy. However, the two treatments have different effects on the postoperative cervical spine sagittal balance. OBJECTIVE: To compare the effects of LAMP and ACCF on cervical sagittal balance parameters in the treatment of multilevel cervical spondylotic myelopathy. METHODS: Seventy patients with multilevel cervical spondylotic myelopathy in First Affiliated Hospital of Bengbu Medical College from August 2017 to August 2020 were enrolled in this study. There were 40 cases in ACCF group and 30 cases in LAMP group. Lateral cervical X-ray films were taken before operation and during follow-up. C2-7 Cobb angle, C2-7 sagittal vertical axis, and T1 inclination angle were compared between the two groups. This study was approved by the Ethics Committee of First Affiliated Hospital of Bengbu Medical College. RESULTS AND CONCLUSION: (1) Compared with preoperatively, there was no significant change in the T1 inclination angle between the two groups at 10 months after surgery (P > 0.05). There was no significant difference between the two groups in the T1 inclination angle at the 10-month postoperative period (P > 0.05). (2) Compared with preoperatively, the C2-7 Cobb angle of patients in the ACCF group increased at 10 months after surgery (P < 0.05), and the C2-7 Cobb angle of patients in the LAMP group decreased at 10 months after surgery (P < 0.05). The C2-7 Cobb angle of patients in the ACCF group was greater than that of the LAMP group at 10 months after surgery (P < 0.05). (3) Compared with preoperatively, C2-7 sagittal vertical axis in the ACCF group decreased at 10 months after the operation (P < 0.05), and C2-7 sagittal vertical axis increased in the LAMP group at 10 months after the operation (P < 0.05). The C2-7 sagittal vertical axis of the ACCF group was smaller than that of the LAMP group at 10 months after surgery (P < 0.05). (4) In the ACCF group, the postoperative C2-7 Cobb angle and C2-7 sagittal vertical axis changes in patients with high T1 inclination angle were not significantly different from those in patients with low T1 inclination angle (P > 0.05). In the LAMP group, the changes of C2-7 Cobb angle and C2-7 sagittal vertical axis in patients with high T1 inclination angle were greater than those in patients with low T1 inclination angle (P < 0.05). (5) The findings showed that compared with LAMP, ACCF in the treatment of multilevel cervical spondylotic myelopathy can avoid cervical kyphosis, better maintain the physiological curvature of the cervical spine and improve the sagittal balance of the cervical spine. To avoid postoperative sagittal balance decompensation of cervical vertebra, ACCF is more suitable than LAMP for the treatment of cervical spondylotic myelopathy with high T1 inclination angle. [ABSTRACT FROM AUTHOR]

Introduction: Lumbar Spinal Stenosis (LSS) is a condition in which the spinal canal narrows to the point at which it can exert pressure on the nerves that travel through the spine. Aetiology is categorised into congenital, developmental and acquired (degenerative) causes. Magnetic Resonance Imaging (MRI) is an investigation of choice in the evaluation of patients with symptoms related to lumbar central canal stenosis. Aim: To assess the morphologically grade of thecal sac in lumbar central canal stenosis on MRI. Materials and Methods: This cross-sectional observational study was conducted from November 2017 to October 2019 at Department of Radiology of Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, Andhra Pradesh, India. Study included 100 patients who were referred with symptoms of lumbar stenosis and outcome was to determine the correlation between the morphological grade and thecal sac axial anteroposterior diameter grade. Correlation was assessed by Fisher's-exact test and Spearman's rank correlation coefficient test. A p-value <0.0001 was considered highly significant. Results: Morphological Grade II corresponded to maximum number of cases, amounting to 46% with mean anteroposterior thecal sac diameter of 6.21 mm, followed by 36% of Grade III with mean thecal sac diameter of 4.57 mm. Grade I corresponded to 14% of cases mean thecal sac diameter of 8.35 mm and Grade IV corresponded to 4% of cases with mean thecal sac diameter of 1.1 mm. A significant correlation was obtained (r=0.78) in this study between the morphological grade and thecal sac measurement. Conclusion: Morphological grade of the thecal sac has significant correlation with the canal measurements and it helps in quick assessment of the severity of the lumbar canal stenosis. [ABSTRACT FROM AUTHOR]

Background: In case of spinal cord compression behind the vertebral body, anterior cervical corpectomy and fusion (ACCF) proves to be a more feasible approach than cervical discectomy. The next step was the placement of an expandable titanium interbody in order to restore the vertebral height. The need for additional anterior plating with ACCF has been debatable and such technique has been evaluated by very few studies. The objective of the study is to evaluate radiographic and clinical outcomes in patients with multilevel degenerative cervical spine disease treated by stand-alone cages for anterior cervical corpectomy and fusion (ACCF).Methods: Thirty-one patients (66.5 ± 9.75 years, range 53-85 years) were analyzed. Visual Analog Scale (VAS) and the 10-item Neck Disability Index (NDI) were assessed preoperatively and during follow-up on a regular basis after surgery and after one year at least. Assessment of radiographic fusion, subsidence, and lordosis measurement of Global cervical lordosis (GCL); fusion site lordosis (FSL); the anterior interbody space height (ant. DSH); the posterior interbody space height (post. DSH); the distance of the cage to the posterior wall of the vertebral body (CD) were done retrospectively. Mean clinical and radiographic follow-up was 20.0 ± 4.39 months.Results: VAS-neck (p = 0.001) and VAS-arm (p < 0.001) improved from preoperatively to postoperatively. The NDI improved at the final follow-up (p < 0.001). Neither significant subsidence of the cages nor significant loss of lordotic correction were seen. All patients showed a radiographic union of the surgically addressed segments at the last follow up.Conclusions: Application of a stand-alone expandable cage in the cervical spine after one or two-level ACCF without additional posterior fixation or anterior plating is a safe procedure that results in fusion. Neither significant subsidence of the cages nor significant loss of lordotic correction were seen.Trial Registration: Retrospectively registered. According to the Decision of the ethics committee, Jena on 25th of July 2018, that this study doesn't need any registration.  https://www.laek-thueringen.de/aerzte/ethikkommission/registrierung/ . [ABSTRACT FROM AUTHOR]

The overall incidence of symptomatic lumbar spinal stenosis is about 1015% among persons aged 5070 years. Due to the aging of the population, the incidence of this pathology is constantly growing. The desire of older patients to preserve their quality of life and their functional abilities, along with the improvement of surgical techniques, leads to an increase in the number of surgical interventions for lumbar stenosis. This publication describes the classification of spinal canal stenosis. The clinical picture of this disease has been studied in detail. A special attention is paid to such diagnostic methods as computed tomography (CT), radiography, CT-myelography, magnetic resonance imaging (MRI). Various methods of surgical treatment decompression and decompression-stabilization are described in detail.. The efficiency of various types of decompression operations are 7280%, the results of surgery not differing statistically between the types of decompression (hemilaminectomy, interlaminectomy). Decompression-stabilization operations are used for progressive degenerative spinal deformity, destabilization after the surgical treatment, and disruption of the vertebral-pelvic relations. Currently, the following types of stabilization are used in the lumbar stenosis surgery: ALIF, PLIF, PLF, TLIF, XLIF, OLIF, and transpedicular fixation. The rate of complications in the stabilizing interventions is 27.6%; after decompression operations 9.7%. The frequency of revision operations is also higher after stabilization 10.3%, while after decompression it is 6.5%, which makes us cautious about these types of interventions. Systems of interosseous fixation are also used in the treatment of lumbar stenosis. In the 14 years of followup after interosseous fixation and decompression in 142 patients, 30 (21.1%) patients underwent revision interventions, with chronic pain (38.5%) and disc herniation (42.3%) being the main indication for repeated surgery in 26 of them.

Issues of epidemiology, classification and radiological signs of the spinal stenosis in this review are present. Modern European criteria for spinal stenosis and radicular openings can improve the diagnosis of the condition of the spinal cord and roots; clarify the criteria for indications for surgical treatment.

Abstract Background Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension. C1-C2 sign is a characteristic imaging feature, which indicates CSF collection between the spinous processes of C1 and C2, occasionally observed on magnetic resonance imaging (MRI) in patients with intracranial hypotension. Case presentation A 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3 months, along with numbness and muscle weakness of extremities. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. Despite 72 h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3–4 at the same time. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively. Conclusion The present case suggested the mechanism where the CSF leakage was revealed as fluid collection in the retrospinal region at C1-C2 level. Increased intradural pressure due to the spinal canal stenosis resulted in dural tear. CSF leaked into the epidural space and subsequently to the retrospinal region at C1-C2 level, due to the presence of spinal canal stenosis caudally as well as the vulnerability of the tissue structure in the retrospinal region at C1-C2 level. Thus, our theory supports the mechanisms of previously reported CSF dynamics associated to C1-C2 sign, and also, we suggest spinal canal stenosis as a novel etiology of intracranial hypotension.

Introduction: Lumbar Spinal Stenosis (LSS) is a condition in which the spinal canal narrows to the point at which it can exert pressure on the nerves that travel through the spine. Aetiology is categorised into congenital, developmental and acquired (degenerative) causes. Magnetic Resonance Imaging (MRI) is an investigation of choice in the evaluation of patients with symptoms related to lumbar central canal stenosis. Aim: To assess the morphologically grade of thecal sac in lumbar central canal stenosis on MRI. Materials and Methods: This cross-sectional observational study was conducted from November 2017 to October 2019 at Department of Radiology of Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, Andhra Pradesh, India. Study included 100 patients who were referred with symptoms of lumbar stenosis and outcome was to determine the correlation between the morphological grade and thecal sac axial anteroposterior diameter grade. Correlation was assessed by Fisher’s-exact test and Spearman’s rank correlation coefficient test. A p-value

Objective: Back pain is reported to be the fifth most common reason for referral a patient to a physician and the most common disability in modern society. The present study aimed to evaluate the effects of calcitonin addition on epidural injection in patients with degenerative spinal canal stenosis in comparison with epidural triamcinolone injection. Methods: This clinical trial study was performed on 40 patients with degenerative spinal stenosis, referred to pain clinic of Rasoul Akram Hospital in 2018, who were randomly divided into two groups, intervention and control groups, including 20 individuals in each group. In the intervention group, 50 units of calcitonin were injected with 8 cc of ropivacaine 0.2%, whilst 80 mg of triamcinolone with 8 cc of ropivacaine 0.2% was injected in the control group. Functional disability was evaluated based on the Oswestry Disability Index and pain ratings were assessed using the Visual Analogue Scale. Results: Pain at 4 and 8 weeks after the procedure was significantly different between the two groups. A significant difference in the patient disability index was observed between the two groups at 8 and 12 weeks after the procedure. On the other hand, the rate of analgesic consumption at 4, 8, and 12 weeks after the procedure was significantly decreased in the calcitonin group (P < .001). Conclusions: Based on our results, injection of calcitonin into the epidural space can reduce the pain of the patients and their analgesic consumption compared to the group receiving steroids through the epidural space. [ABSTRACT FROM AUTHOR]

Introduction: Axial-loaded magnetic resonance imaging (MRI), which can simulate an upright position of the patient may cause a significant reduction of the dural sac cross-sectional area (DCSA) compared with standard MRI, thus providing valuable information in the assessment of the lumbar spinal canal. The purpose of this study was to investigate excessiveness of the change in DCSA and depth of lateral recesses (DLRs) before and after axial-loaded imaging in relation to body mass index (BMI) of the subjects. Methods: Twenty patients were scanned to evaluate DCSA and DLR at three consecutive lumbar spine intervertebral disc levels (L3/4, L4/5, and L5/S1) on conventional-recumbent MRI, and after axial loading were applied. Results: Axial-loaded MRI demonstrates a significant difference of DSCA in comparison to conventional MRI. Furthermore, results show a significant correlation between the DCSA and BMI on level L3/L4, both before and after axial loading MRI. With axial loading, there is a reduction of DSCA of 12.2%, 12.1%, and 2.1% at the levels L3/L4, L4/L5, and L5/S1, respectively. After axial loading has been applied, the depth of the neural foramen has been reduced by an average of 10.1%. Conclusion: Axial-loaded MRI reduces DCSA and DLRs in comparison to standard MRI. Information obtained in this way may be useful to explain the patient’s symptomatology and may provide an additional insight that can influence the treatment decision plan accordingly.