Clinical implications of lumbar developmental spinal stenosis on back pain, radicular leg pain, and disability

Lai, Manhong; Cheung, Pty; Samartzis, Dino; Karppinen, Jaro

doi:10.1302/0301-620x.103b1.bjj-2020-1186.r2

Cited by 18 publications

(15 citation statements)

References 74 publications

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“…Developmental lumbar spinal stenosis, for example, a condition with pre-existing short pedicles and a narrow bony spinal canal at many levels, was not assessed on MRI. 39 , 40 This study presents only radiological outcomes from the SSSS, as a complement to clinical results that are presented elsewhere. 8 The correlation between baseline parameters, two-year MRI findings, and two-year clinical outcomes will be evaluated in separate reports.…”

Section: Discussionmentioning

confidence: 99%

Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up

Karlsson

Försth

Skorpil

et al. 2022

The Bone & Joint Journal

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Aims The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion. Methods The Swedish Spinal Stenosis Study (SSSS) was conducted between 2006 and 2012 at five public and two private hospitals. Six centres participated in this two-year MRI follow-up. We randomized 222 patients with central lumbar spinal stenosis at one or two adjacent levels into two groups, decompression alone and decompression with fusion. The presence or absence of a preoperative spondylolisthesis was noted. A new stenosis on two-year MRI was used as the primary outcome, defined as a dural sac cross-sectional area ≤ 75 mm2 at the operated level (restenosis) and/or at the level above (proximal adjacent level stenosis). Results A total of 211 patients underwent surgery at a mean age of 66 years (69% female): 103 were treated by decompression with fusion and 108 by decompression alone. A two-year MRI was available for 176 (90%) of the eligible patients. A new stenosis at the operated and/or adjacent level occurred more frequently after decompression and fusion than after decompression alone (47% vs 29%; p = 0.020). The difference remained in the subgroup with a preoperative spondylolisthesis, (48% vs 24%; p = 0.020), but did not reach significance for those without (45% vs 35%; p = 0.488). Proximal adjacent level stenosis was more common after fusion than after decompression alone (44% vs 17%; p < 0.001). Restenosis at the operated level was less frequent after fusion than decompression alone (4% vs 14%; p = 0.036). Vertebral slip increased by 1.1 mm after decompression alone, regardless of whether a preoperative spondylolisthesis was present or not. Conclusion Adding fusion to a decompression increased the rate of new stenosis on two-year MRI, even when a spondylolisthesis was present preoperatively. This supports decompression alone as the preferred method of surgery for spinal stenosis, whether or not a degenerative spondylolisthesis is present preoperatively. Cite this article: Bone Joint J 2022;104-B(12):1343–1351.

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Section: Discussionmentioning

confidence: 99%

Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up

Karlsson

Försth

Skorpil

et al. 2022

The Bone & Joint Journal

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“…All families showed involvement of multilevel DSS in first‐degree relatives and in at least two generations, which suggests the entity as highly integrated between close relatives. Due to its relatively high prevalence of 7.3% in the population, 12 it is possible and reasonable that both parents being cases of multilevel DSS could marry each other as shown in Families 1–4. It is also important to note that the unaffected mother (2‐2) in Family 2 gave birth to at least 3 cases (50%) and 2 controls (33%), which may imply the father (2‐1) passing the disease gene to his offspring.…”

Section: Discussionmentioning

confidence: 99%

“…It is also important to note that the spinal canal should be studied in a three‐dimensional manner. The clinical implications of DSS should be addressed in future study 32,12 …”

Section: Discussionmentioning

confidence: 99%

“…Due to its developmental nature, 9,10 multilevel stenosis is expected and justified by multiple authors 6,7,11 . According to a large‐scale multilevel DSS study, 12 its prevalence is reported to be 7.3% in the southern Chinese. Clinically, Cheung et al 13 reported a 22% reoperation rate for patients who did not receive prophylactic decompression for levels of DSS during the index operation.…”

Section: Introductionmentioning

confidence: 99%

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Pedigree analysis of lumbar developmental spinal stenosis: Determination of potential inheritance patterns

Lai

Cheung

Song

et al. 2020

Journal Orthopaedic Research

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Lumbar developmental spinal stenosis (DSS) refers to multilevel pre‐existing narrowed spinal canals, which predispose to neural compromise. The objective of this study is to identify any inheritance pattern of DSS by utilizing pedigree charts. This was a case series of 13 families with a total of 80 subjects having magnetic resonance imaging (MRI) from L1 to S1. Cases (subjects with DSS) or controls (subjects without DSS) were identified by measuring their anteroposterior (AP) vertebral canal diameters. Multilevel model analyses were also performed to evaluate whether there is substantial clustering of observations within the families, and the effect of multilevel DSS. The intraclass correlation coefficient (ICC) and Akaike information criteria (AIC) were compared between models. Correlations between subject demographics and AP vertebral canal diameter were statistically insignificant at all levels. Only vertebral canal cross‐sectional area, and axial and sagittal vertebral canal diameter were found to be statistically different between cases and controls at all levels (all p < .05). Both males and females were affected by DSS and there was no skipping of generation, which highly suggested DSS followed an autosomal dominant inheritance pattern. After accounting for multilevel DSS, there was a drop of more than 10 in AIC and some variances were also explained within families. This is the first study that suggests multilevel lumbar DSS to have an autosomal dominant inheritance pattern. Within families with a background of DSS, subjects had a smaller canal size, contributed by shortened axial and sagittal AP vertebral canal diameter, and smaller canal cross‐sectional area.

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“…A further limitation is the lack of detail about the presence of developmental stenosis that could be implicated in symptomatic adjacent level deterioration, which has been shown to be a risk factor for worse disability and poorer quality of life in a previous report. 19 Finally, the authors showed some fine examples of images, but does this represent usual care?…”

mentioning

confidence: 99%

No need to add fusion to lumbar decompression for stenosis

Azizpour

Birch²,

Peul³

2022

The Bone & Joint Journal

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Clinical implications of lumbar developmental spinal stenosis on back pain, radicular leg pain, and disability

Cited by 18 publications

References 74 publications

Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up

Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up

Pedigree analysis of lumbar developmental spinal stenosis: Determination of potential inheritance patterns

No need to add fusion to lumbar decompression for stenosis

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