Correlations between sedimentation sign, dural sac cross-sectional area, and clinical symptoms of degenerative lumbar spinal stenosis

Ko, Sangbong

doi:10.1007/s00586-017-5374-2

Cited by 20 publications

(18 citation statements)

References 29 publications

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“…There are numerous causes of LBP, so it is di cult to clearly identify the exact cause [23]. Ko et al [3] reported that they are related to the cross sectional area (CSA) and the sedimentation sign (SedSign) but have little to do with SedSign and LLRP, LBP, and NIC, and they insisted that the spinal area has nothing to do with lower leg pain and LBP except for severe spinal stenosis. However, according to many authors, the narrower CSA is in CLSS, the more pressure is applied to the nerve root in the cauda equina [24].…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, because sudden and severe neurological abnormality in patients with LSS is very rare and functional loss develops gradually, conservative treatment is primarily applied as a general rule [1], but in case of failure of that conservative treatment, decompression surgery is the standard surgical method [2]. When the chief complaints of patients are LLRP or NIC before surgery, they can be the best indication for surgery [3], and various authors have reported good results in improvements of LLRP or NIC [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…However, as LBP can be affected by various other factors, there is a great deal of disagreement on improvement of LBP after surgery. Many authors reported that, with more correct diagnosis and surgical indications applied, a single procedure of decompression surgery for CLSS can improve LBP up to approximately 60% as well as lower leg pain in the rst year after surgery [3,[9][10][11]. But some authors insist that serious LBP is a contraindication for surgery because it can cause poor surgical results [12][13][14], and Spetzger et al [15] claimed that during the procedure of decompression surgery, persistent retraction of the multi dus muscles can cause muscle damage, as a result of which muscle atrophy occurs and LBP deteriorates accordingly [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Decompression Surgery on Low Back Pain in Patients with Central Lumbar Spinal Stenosis

Jae-Jun

Nam

2020

Preprint

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Background: Patients with central lumbar spinal stenosis (CLSS) complain of not only the lower leg symptoms but also low back pain (LBP) simultaneously in many cases. Therefore, patients who undergo decompressive surgery expect recovery from LBP as well as lower leg symptoms, and surgeons who perform decompression surgery are making efforts to improve both symptoms. The objective of this study is to investigate whether decompression surgery can improve low back pain and symptoms of lower limb pain in patients with one level central lumbar spinal stenosis.Methods: The present study included 39 patients who had findings of central lumbar spinal stenosis and underwent decompression surgery due to its corresponding claudication and lower leg radiating pain complaints from 2013 to 2018. Their pain (lower leg radiating pain and low back pain) and functional outcomes (Oswestry Disability Index (ODI), Roland–Morris Disability Questionnaire (RMDQ), and Short Form-36 (SF-36)) were evaluated before surgery and 6 and 12 months after surgery.Results: Mean lower leg radiating pain continuously showed statistically significant improvement (p < 0.05, p = 0.003); however, the clinical significance of differences above minimum clinically important difference (MCID) was up to 6 months. Mean low back pain was 4.72 ± 3.40 before surgery, 2.33 ± 2.27 at 6 months after surgery, and 2.21 ± 2.02 at 12 months after surgery, showing statistically and clinically significant improvement (p < 0.05) up to 6 months after surgery, after which there were no findings of improvement. Conclusion: Decompression surgery for patients with central lumbar spinal stenosis showed clinically significant improvements in lower leg radiating pain and low back pain up to 6 months after surgery and continuous improvements in lower leg radiating pain up to 12 months, but there was no continuous improvement in LBP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Decompression Surgery on Low Back Pain in Patients with Central Lumbar Spinal Stenosis

Jae-Jun

Nam

2020

Preprint

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“…PSLD could lead to enlargement of the lumbar spinal stenosis postoperatively to a maximum of 71.1% in the middle segment of the treated canal at the index level and to 39.7% in the lower segment, but with minimal bone work. However, a high degree of canal enlargement is not considered better improvement of surgical outcome compared with a low degree of enlargement [27].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Feasibility of Full Endoscopic Decompression in One- to Three-Level Lumbar Canal Stenosis via a Single Skin Port Using a New Endoscopic System, Percutaneous Stenoscopic Lumbar Decompression

Lim¹,

Nam²,

Kim³

et al. 2019

Asian Spine J

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Study Design This retrospective study involved 450 consecutive cases of degenerative lumbar stenosis treated with percutaneous stenoscopic lumbar decompression (PSLD). Purpose We determined the feasibility of PSLD for lumbar stenosis at single and multiple levels (minimum 1-year follow-up) by image analysis to observe postoperative widening of the vertebral canal in the area. Overview of Literature The decision not to perform an endoscopic decompression might be due to the surgeon being uncomfortable with conventional microscopic decompression or unfamiliar with endoscopic techniques or the unavailability of relevant surgical tools to completely decompress the spinal stenosis. Methods The decompressed canal was compared between preoperative controls and postoperative treated cases. Data on operative results, including length of stay, operative time, and surgical complications, were analyzed. Patients were assessed clinically on the basis of the Visual Analog Scale (VAS) score for the back and legs and using the Oswestry Disability Index (ODI). Results Postoperative magnetic resonance imaging revealed that PSLD increased the canal cross-sectional area by 52.0% compared with the preoperative area at the index segment ( p <0.001) and demonstrated minimal damage to the normal soft tissues including muscles and the extent of removed normal bony tissues. Mean improvements in VAS score and ODI were 4.0 ( p <0.001) and 40% ( p <0.001), respectively. Conclusions PSLD could be an alternative to microscopic or microendoscopic decompression with various advantages in the surgical management of lumbar stenosis.

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“…Third, several methods are known to effectively discriminate LCCSS, such as analysis of cauda equina, morphological grading, and sedimentation signs. 22 – 30 However, this study only used SAPCSA measurement. Therefore, our results may be limited regarding measurement of the epidural pressure or morphologic changes.…”

Section: Discussionmentioning

confidence: 99%

Superior articular process cross-sectional area is a new sensitive parameter for the diagnosis of lumbar central canal spinal stenosis

An¹,

Mun²,

Kang³

et al. 2018

CIA

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PurposePrevious studies reported that hypertrophied superior articular process (SAP) was associated with an increased risk of lumbar foraminal stenosis. However, no study investigated the effect of SAP hypertrophy in lumbar central canal spinal stenosis (LCCSS). We hypothesized that the SAP cross-sectional area (SAPCSA) is the main morphologic feature in the diagnosis of LCCSS.Patients and methodsData regarding the SAPCSA were collected from 109 patients with LCCSS. All patients were enrolled after the LCCSS diagnosis was confirmed by an experienced, board-certified neuroradiologist. All patients had clinical manifestations compatible with LCCSS. A total of 120 subjects in the control group underwent lumbar spine MRI as part of non-symptomatic medical examination. T2-weighted axial images were obtained from the 2 groups. Using a picture archiving and communications system, we analyzed the CSA of the bone margin of SAP at the level of L4–L5 facet joint on MRI.ResultsThe average SAPCSA was 96.63±13.37 mm2 in the control group, and 123.59±14.18 mm2 in the LCCSS. The LCCSS group showed significantly higher levels of the SAPCSA (P<0.001) compared with the control one. Receiver operator characteristic (ROC) curve analysis was performed to determine the validity of the SAPCSA as a predictor of LCCSS. In the LCCSS group, the optimal cut-off-point was 110.71 mm2, with 83.5% sensitivity, 83.3% specificity, and area under the curve of 0.92 (95% CI: 0.88–0.95).ConclusionHigher SAPCSA values were associated with a higher possibility of LCCSS. These results are important in the evaluation of patients with LCCSS.

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Correlations between sedimentation sign, dural sac cross-sectional area, and clinical symptoms of degenerative lumbar spinal stenosis

Abstract: Increasing severity of SedSign indicates progressively smaller dural sac CSA, but there is an inconsistent association with clinical symptoms. Therefore, it is reasonable to suggest that spinal stenosis is severe in patients with severe symptoms.

Cited by 20 publications

References 29 publications

The Effectiveness of Decompression Surgery on Low Back Pain in Patients with Central Lumbar Spinal Stenosis

The Effectiveness of Decompression Surgery on Low Back Pain in Patients with Central Lumbar Spinal Stenosis

Therapeutic Feasibility of Full Endoscopic Decompression in One- to Three-Level Lumbar Canal Stenosis via a Single Skin Port Using a New Endoscopic System, Percutaneous Stenoscopic Lumbar Decompression

Superior articular process cross-sectional area is a new sensitive parameter for the diagnosis of lumbar central canal spinal stenosis

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