Humans ; Lumbar Vertebrae ; surgery ; Spinal Stenosis ; complications ; surgery

Aged ; Humans ; Laminectomy ; adverse effects ; Male ; Spinal Stenosis ; surgery

Humans ; Internal Fixators ; Lumbar Vertebrae ; surgery ; Spinal Fusion ; instrumentation ; methods ; Spinal Stenosis ; surgery

BACKGROUND: A systematic literature review of interspinous dynamic stabilization, including DIAM, Wallis, Coflex, and X-STOP, was conducted to assess its safety and efficacy. METHODS: The search was done in Korean and English, by using eight domestic databases which included KoreaMed and international databases, such as Ovid Medline, Embase, and the Cochrane Library. A total of 306 articles were identified, but the animal studies, preclinical studies, and studies that reported the same results were excluded. As a result, a total of 286 articles were excluded and the remaining 20 were included in the final assessment. Two assessors independently extracted data from these articles using predetermined selection criteria. Qualities of the articles included were assessed using Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The complication rate of interspinous dynamic stabilization has been reported to be 0% to 32.3% in 3- to 41-month follow-up studies. The complication rate of combined interspinous dynamic stabilization and decompression treatment (32.3%) was greater than that of decompression alone (6.5%), but no complication that significantly affected treatment results was found. Interspinous dynamic stabilization produced slightly better clinical outcomes than conservative treatments for spinal stenosis. Good outcomes were also obtained in single-group studies. No significant difference in treatment outcomes was found, and the studies compared interspinous dynamic stabilization with decompression or fusion alone. CONCLUSIONS: No particular problem was found regarding the safety of the technique. Its clinical outcomes were similar to those of conventional techniques, and no additional clinical advantage could be attributed to interspinous dynamic stabilization. However, few studies have been conducted on the long-term efficacy of interspinous dynamic stabilization. Thus, the authors suggest further clinical studies be conducted to validate the theoretical advantages and clinical efficacy of this technique.
Decompression, Surgical ; Humans ; Postoperative Complications ; *Spinal Fusion/adverse effects/methods ; Spinal Stenosis/physiopathology/surgery

OBJECTIVETo report clinical application and therapeutic effect on the modified reconstruction of spinous processes for treating cervical vertebrae degenerative disease.

METHODSTwenty-nine cases with cervical vertebrae degenerative disease were treated with the modified reconstruction of spinous processes. Among them, 21 cases were male and 8 cases were female. The age was from 37 to 76 years with an average age of 55 years. Of them, 4 cases occured immediately with no factors, 15 cases occured chronically, and 10 cases occured following substantial trauma. The last-time of disease was 5 h to 25 years, with an average of 1 year and 8 months.

RESULTSAfter 3 months to 5 years and 6 months followed-up, the results were excellent in 18 cases (recovery rate >75%), good in 7 cases (recovery rate 50% to 75%), fair in 3 cases (recovery rate 25% to 49%), poor in 1 case (recovery rate < or =24%)with average recovery rate 86.6% according to JOA 17 score system.

CONCLUSIONThe reconstruction of spinous processes may be an effective measure in spinal decompression absolutely, meanwhile, it can maintain the spinal sequences stable, also can avoid or reduce the axial symptoms and the correction of cervical kyphosis.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Spinal Diseases ; surgery ; Spinal Stenosis ; surgery

Aged ; Female ; Humans ; Laminectomy ; methods ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Spinal Canal ; surgery ; Spinal Stenosis ; surgery ; Treatment Outcome

OBJECTIVETo evaluate the clinical effects of dynamic neutralization system (K-Rod) in treating multisegmental lumbar degenerative disease.

METHODSFrom October 2011 to October 2013, 20 patients with multisegmental lumbar degenerative disease were treated with dynamic neutralization system (K-Rod). There were 8 males and 12 females with an average age of 45.4 years old (ranged from 31 to 65) and an average course of 3.8 years (ranged from 9 months to 6.25 years). All patients had the history of low back and legs pain. Among them, 10 cases were far lateral lumbar disc herniation, 7 cases were lumbar spinal stenosis, 3 cases were lumbar spondylolisthesis (degree I in 2 cases and degree II in 1 case). Every patient had only one responsible segment which causing the symptom would have to be rigidly fixed during operations, and the adjacent intervertebral disc of the responsible segments at least 1 segment has already obvious degenerated. All patients underwent the operation to relieve compressed nerves and reconstruct spinal stability with K-Rod system (the responsible segments were fixed with interbody fusion, and the adjacent segments were fixed with dynamic stabilization). Visual analogue scale (VAS), Japanese Orthopaedic Association Scores (JOA) and Oswestry Disability Index (ODI) were used to evaluate the clinical effects. Imaging data were used to analyze the range of motion (ROM), intervertebral disc height and intervertebral disc signal (according to modified Pfirrmann grading system) in degenerative adjacent segment.

RESULTSAll patients were followed up for more than 1 year, and preoperative symptoms obviously relieved. There were significant differences in VAS, JOA, ODI between preoperative and postoperative (postoperative at 1 week and 1 year) (P<0.05). Radiological examination showed that all responsible segments had already fused, and no looseness, displacement and breakage of internal fixations were found. Postoperative at 1 year, the ROM of adjacent segments were decreased (P<0.05). There was no significant difference in intervertebral disc height between preoperative and postoperative at 1 year (P>0.05). According to modified Pfirrmann grading system to classification for the 25 disks of adjacent segment, 8 disks (32%) got improvement, 15 disks (60%) got no change and 2 disks (8%) got aggravation at 1 year after operation.

CONCLUSIONDynamic neutralization system (K-Rod) combined with interbody fusion could obtain short-term clinical effects in the treatment of multisegmental lumbar degenerative disease.

Adult ; Aged ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Range of Motion, Articular ; Spinal Diseases ; surgery ; Spinal Fusion ; methods ; Spinal Stenosis ; surgery ; Spondylolisthesis ; surgery

This paper aims to establish an accurate finite element model of complete lumbar spine with complex lumbar spinal stenosis (LSS), and then to do comparison and analysis of normal model and decompression surgery model. Firstly, we chose some patients with complex LSS and then collected the CT scanned data. Then we generated a complete FE model of Lumbar with complex LSS using a specially designed modeling system, and we also created a normal lumbar model and a decompression treated model. We applied same boundary conditions in all the three models. The results showed that the active movement range of complex LSS was smaller than that of the normal model, but the movement range of the decompression model was larger than that of the normal. There are stress concentration around the endplate and disk at the degenerative intervertebral? disk L4-L5 and adjacent disk L3-L4 for LSS model, and the stress of the decompression model increased more significantly. This simulation demonstrated that the treatment of simple decompression for lumbar spine with complex LSS can release the pain, but may result in unstability and accelerate the degeneration.
Decompression, Surgical ; methods ; Finite Element Analysis ; Humans ; Lumbar Vertebrae ; surgery ; Models, Biological ; Spinal Stenosis ; surgery

OBJECTIVETo evaluate the effect of the treatments of lumbar spinal stenosis by selective decompression of lumbar root canal and laminectomy.

METHODSFrom March 2007 to March 2011, 144 lumbar spinal stenosis patients were treated by selective decompression of lumbosacral root canal and laminectomy. All of these patients included 64 male and 80 female patients, age range 60-87 years, average (66 ± 5) years. Duration 6-72 months, average (12 ± 16) months. The patients were divided into 2 groups according to surgical procedure underwent: group A including 70 patients who were treated with selective decompression of lumbar root canal, group B including 74 patients who were treated with traditional laminectomy. Five time points were selected to assess clinical effect using Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA), which were pre-operation and 1 month, 6 months, 12 months and last follow-up. The data were analyzed through Wilcoxon matched-pairs signed-ranks test.

RESULTSAll operations were completed well without severe complications. The duration of follow-up was 12-55 months, average (31 ± 6) months. All patients' symptoms got improved or partial remission. The average pre- and post-operative scores of JOA in group A and B were from 14.0 ± 1.6 to 20.3 ± 1.7, from 13.6 ± 1.7 to 20.2 ± 2.0, respectively, there were significant statistical differences (Z = 2.41 and 2.23, P < 0.05). The average pre- and post-operative scores of ODI in group A and B were from 62% ± 4% to 28% ± 4%, from 63% ± 4% to 27% ± 3%, respectively, there were significant statistical differences (Z = 2.93 and 2.64, P < 0.05).

CONCLUSIONSPersonalized treatment programs should be established for elderly lumbar spinal stenosis according to stenosis location. Laminectomy is carried out with the stenosis in the central spinal canal; selective decompression of lumbosacral root canal is accepted with the stenosis in the nerve root canal without central stenosis.

Aged ; Decompression, Surgical ; Dental Pulp Cavity ; Humans ; Lumbar Vertebrae ; surgery ; Spinal Stenosis ; surgery ; Treatment Outcome

Percutaneous endoscopic spine decompression(PSED) in recent years in the treatment of degenerative lumbar spinal stenosis(DLSS) achieved excellent results.Compared with traditional open surgery, which is characterized by large trauma, much bleeding, longer bed stay and slow recovery, the rapid development of PSED technology has greatly reduced the surgical trauma, postoperative recovery time and complications of DLSS patients. PSED core as the target therapy, with minimal trauma at the same time to achieve satisfactory decompression effect for lumbar spinal stenosis. Depending on the level, location, and degree of lumbar spinal stenosis, it is important to determine the ideal treatment. However, in practice, PSED has insufficient understanding of the treatment of different pathological types of lumbar spinal stenosis, such as indication selection, surgical approach selection, advantages and limitations of various approaches, and endoscopic vertebral fusion.At present, with the deepening of PSED research and the improvement of endoscopic instruments, great progress has been made in the treatment of DLSS.In this paper, the research progress in the treatment of DLSS by PSED in recent years will be described from four aspects, namely, the grasp of indications, the selection of approaches, the advantages and disadvantages of endoscopic approaches, and endoscope-assisted vertebral fusion, in order to provide certain guidance for the clinical treatment of DLSS by PSED.
Decompression, Surgical/methods* ; Endoscopy/methods* ; Humans ; Lumbar Vertebrae/surgery* ; Spinal Stenosis/surgery* ; Treatment Outcome