ABSTRACT Background Lumbar spinal stenosis (LSS) has a substantial impact on mobility, autonomy, and quality of life. Previous reviews have demonstrated inconsistent results and/or have not delineated between specific nonsurgical interventions. Objective The purpose of this systematic review is to assess the effectiveness of interventions in the management of LSS. Methods Eligible studies were randomized controlled trials (RCTs) or prospective studies, included patients with LSS, assessed the effectiveness of any interventions (rehabilitation, surgical, injection, medication), included at least two intervention groups, and included at least one measure of pain, disability, ambulation assessment, or LSS-specific symptoms. Eighty-five articles met inclusion criteria. Meta-analyses were conducted across outcomes. Effect sizes were calculated using Hedge’s g and reported descriptively. Formal grading of evidence was conducted. Results Meta-analysis comparing rehabilitation to no treatment/placebo demonstrated significant effects on pain favoring rehabilitation (mean difference, MD −1.63; 95% CI: −2.68, −0.57; I 2 = 71%; p = .002). All other comparisons to no treatment/placebo revealed nonsignificant findings. The level of evidence ranged from very low to high for rehabilitation and medication versus no treatment/placebo for pain, disability, ambulation ability, and LSS symptoms. Conclusions Although the findings of this review are inconclusive regarding superiority of interventions, this accentuates the value of multimodal patient-centered care in the management of patients with LSS.

Management of lumbar spinal stenosis: a systematic review and meta-analysis of rehabilitation, surgical, injection, and medication interventions

Efficacy and Safety of Lumbar Dynamic Stabilization Device Coflex for Lumbar Spinal Stenosis: A Systematic Review and Meta-analysis.

Osteoporosis is a rising concern in the aging population and should be considered before performing spinal surgery for older patients. Nonfusion surgery using interlaminar or interspinous devices is gradually gaining acceptance because adjacent segment disease seldom occurs postoperatively; however, other complications may occur. This report discusses the surgical outcomes of two women with osteoporosis treated by laminectomy and interlaminar device (IntraSPINE®) placement. Both patients had experienced low back pain for several years and had developed vertebral compression fractures. Several conservative treatments, including rehabilitation and local injections, were ineffective. Their bone mineral density levels were -3.0 and -2.8, indicating severe osteoporosis according to the definition established by the World Health Organization. They chose to undergo nonfusion surgery with IntraSPINE® interlaminar device placement. Their pain significantly decreased postoperatively, and their visual analog scale scores decreased from 8 to 2 and 3. Their extremity numbness and back pain resolved within 3 months. Both patients were satisfied with the surgical outcomes. No complications had occurred by 1 year postoperatively. These cases indicate that osteoporosis may not be an absolute contraindication for nonfusion spinal surgery. This report suggests a possible alternative surgical treatment for patients with osteoporosis that is refractory to conservative treatments.

Application of the IntraSPINE® interlaminar device in patients with osteoporosis and spinal stenosis: two case reports:

[Purpose] To present the case of the amelioration of chronic pain and disability in a patient suffering from failed back surgery syndrome. [Participant and Methods] A 27-year-old male with chronic low back pain was treated with a Coflex® intra-spinous instrument, however, it was removed shortly after due to poor outcome including worsening pain and disability. Radiographic assessment revealed significant posterior translation of the thorax complicated by significant loss of the normal lumbar lordosis and a left lateral translated thoracic cage posture. Chiropractic Biophysics® technique was applied over a 5.5-month period leading to structural spine improvements as well as improved pain, Oswestry disability index (ODI) and quality of life (QOL). [Results] There was a 21 mm reduction in posterior thoracic translation, a 6.2° improvement in lumbar lordosis and a 16 mm reduction in lateral thoracic translation corresponding with improved ODI and QOL scores. A 6 year follow-up showed successful outcome despite some degenerative changes in the spine at the prior surgical level. [Conclusion] This case adds to the growing literature showing the efficacy of non-surgical spinal rehabilitative methods in improving outcomes in patients with spinal deformity and associated disabilities. This case also demonstrates necessity of the continued criterion standard of spinal radiography for biomechanical assessment.

Failed back surgery syndrome successfully ameliorated with Chiropractic Biophysics® structural rehabilitation improving pain, disability as well as sagittal and coronal balance: a Chiropractic Biophysics® case report with a 6 year follow-up

Hypertrophy of facet joints is associated with a high risk of central lumbar spinal stenosis (CLSS). However, no research has reported the effect of inferior articular process hypertrophy in CLSS. We hypothesize that the inferior articular process’s cross-sectional area (IAPCSA) is larger in patients with CLSS compared to those without CLSS. Data on IAPCSA were obtained from 116 patients with CLSS. A total of 102 control subjects underwent lumbar spine magnetic resonance imaging (LS-MRI) as part of a routine medical examination. Axial T1-weighted images were obtained from the two groups. Using an imaging analysis system, we investigated the cross-sectional area of the inferior articular process. The average IAPCSA was 70.97 ± 13.02 mm2 in control subjects and 88.77 ± 18.52 mm2 in patients with CLSS. CLSS subjects had significantly greater levels of IAPCSA (p < 0.001) than controls. A receiver operating characteristic (ROC) curve was plotted to determine the validity of IAPCSA as a predictor of CLSS. The most suitable cut-off point of IAPCSA for predicting CLSS was 75.88 mm2, with a sensitivity of 71.6%, a specificity of 68.6%, and an area under the curve (AUC) of 0.78 (95% CI: 0.72–0.84). Greater IAPCSA levels were associated with a higher incidence of CLSS. These results demonstrate that IAPCSA is a useful morphological predictor in the evaluation of CLSS.

https://www.mdpi.com/2077-0383/9/1/214/pdf

Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

The aim of the present study was to examine the curative effect of dynamic fixation Coflex treatment for patients with degenerative lumbar spinal stenosis. In the present study, 78 patients with degenerative lumbar spinal stenosis were recruited and divided equally into the control and observation groups. The control group was treated with traditional decompression fusion and the observation group received dynamic fixation Coflex system. Surgery and hospitalization were shorter in the observation group than in the control group. Intraoperative blood loss and drainage volume after surgery were significantly lower in the observation group compared to the control group. The treatment effective rate for the observation group was significantly higher. Visual analogue scale, Oswestry disability index and Japanese Orthopaedic Association pain and functional scores as well as postoperative vertebral canal area and adjacent segment quantitative scores improved after surgery in the two groups, but the observation group showed greater improvement. The curative effect of dynamic fixation Coflex treatment for degenerative lumbar spinal stenosis demonstrates advantages over traditional surgery, including less trauma and bleeding, pain reduction, improved postoperative rehabilitation, and lower incidence of adjacent segment degeneration.

/pdf/effectiveness-of-dynamic-fixation-coflex-treatment-for-3e4bpyqyr6.pdf

Effectiveness of dynamic fixation Coflex treatment for degenerative lumbar spinal stenosis.

Limited cross-sectional or case-control studies have identified the relationship between basilar artery (BA) curvature and posterior circulation infarction (PCI). This study aimed to identify the influence of BA curvature severity on the risk of PCI occurrence in patients without vertebrobasilar stenosis through a prospective cohort study.In this study, we enrolled 171 patients with BA dolichosis but without vertebrobasilar stenosis. The BA geometric parameters were evaluated on MRA. The primary outcome was the occurrence of PCI, mainly referring to cerebellar and/or brainstem infarction. Cox proportional hazard models were used to detect possible predictors of PCI.Among them, 134 (78.4%) patients were diagnosed with BA curvature, including 124 with moderate curvature and 10 with prominent curvature. The defined PCI occurrence was observed in 32 (18.7%) patients with a median follow-up time of 45.6 months. Cox proportional hazard analysis showed that BA prominent curvature (HR = 6.09; 95% CI: 1.36-27.28; P = 0.018) significantly increased the risk of PCI occurrence, and bending length (BL) was also significantly associated with PCI occurrence, with the adjusted HR per 1-mm increase of BL of 1.09 (95% CI: 1.01-1.18; P = 0.040). In the subgroup analysis stratified by age, BA prominent curvature was highly associated with PCI occurrence in patients aged > 61 years (HR = 11.76; 95% CI: 1.21-113.90; P = 0.033). Additionally, good antiplatelet therapy adherence could significantly reduce the risk of PCI occurrence.BA curvature may increase the risk of PCI occurrence, especially in elderly patients with prominent curvature. Improving adherence to antiplatelet therapy can help reduce the risk of PCI occurrence. 

/pdf/basilar-artery-curvature-increases-the-risk-of-posterior-391tjiqd.pdf

Basilar artery curvature increases the risk of posterior circulation infarction occurrence in patients without vertebrobasilar stenosis

Introduction Little attention has been given to the factors associated with basilar artery (BA) dolichosis. This study aims to elucidate the prevalence and associated factors of BA dolichosis in patients with acute cerebral infarction (ACI). Methods We collected the clinical and laboratory data of 719 patients with ACI admitted to our department. Magnetic resonance angiography was used to evaluate the geometric parameters of the BA and intracranial vertebral arteries (VAs). A BA curve length > 29.5 mm or bending length (BL) > 10 mm was identified as BA dolichosis. Univariate and multivariate logistic regression were performed to determine the factors associated with BA dolichosis. Results Among 719 patients with ACI, 238 (33.1%) demonstrated BA dolichosis, including 226 (31.4%) with simple BA dolichosis and 12 (1.7%) with basilar artery dolichoectasia (BADE). Pearson correlation analyses showed that BA curve length was positively correlated with BL (r = 0.605). Multivariate logistic regression analysis demonstrated that current smoking (OR = 1.50, 95% CI: 1.02–2.21, p = 0.039), diabetes mellitus (OR = 1.66, 95% CI: 1.14–2.41, p = 0.008), BA diameter (OR = 3.04, 95% CI: 2.23–4.13, p < 0.001), BA bending (OR = 4.24, 95% CI: 2.91–6.17, p < 0.001) and BL (OR = 1.45, 95% CI: 1.36–1.55, p < 0.001) were significantly associated with BA dolichosis. Conclusion This study suggests that BA dolichosis was common in patients with ACI, and the morphological parameters of the vertebrobasilar artery and acquired risk factors (including smoking and diabetes) were risk factors for BA dolichosis.

/pdf/prevalence-and-associated-factors-of-basilar-artery-1ygu81cg.pdf

Prevalence and associated factors of basilar artery dolichosis in patients with acute cerebral infarction

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Papers

Effectiveness of dynamic fixation Coflex treatment for degenerative lumbar spinal stenosis.

Basilar artery curvature increases the risk of posterior circulation infarction occurrence in patients without vertebrobasilar stenosis

Prevalence and associated factors of basilar artery dolichosis in patients with acute cerebral infarction