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Medicina
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Lumbar Spinal Stenosis: Diagnosis and Treatment Options
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Lumbar Spinal Stenosis: Diagnosis and Treatment Options

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 8494

Special Issue Editors

Prof. Dr. Koji Otani

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Guest Editor
Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
Interests: epidemiology of musculoskeletal disorders; pathomechanism of spinal pain; nerve root; cauda equina; spinal stenosis; degenerative cervical myelopathy; chronic pain syndrome
Special Issues, Collections and Topics in MDPI journals
Dr. Kazuyuki Watanabe

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Guest Editor
Department of Orthopedic Surgery, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
Interests: spine; spinal cord; low back pain
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Lumbar spinal stenosis refers to a condition in which the spinal canal is congenitally or developmentally narrowed or acquired in the lumbar region, causing compression of the cauda equina and nerve roots, resulting in lower extremity symptoms, such as pain and numbness, and perineal symptoms. The condition of lumbar spinal stenosis includes a variety of diseases inducing a narrowing of the spinal canal. In the majority of cases of lumbar spinal canal stenosis, the nerve roots and cauda equina are subjected to chronic mechanical compression due to degeneration and thickening of the perineural tissues, such as the intervertebral discs, yellow ligaments, and intervertebral joints that make up the spinal canal, mainly due to age-related degenerative changes. Therefore, lumbar spinal stenosis is a disease more commonly seen in the elderly and is one factor that reduces the quality of life in this demographic. Its diagnosis and treatment are expected to become increasingly important in the future, especially in the aging community. Although orthopedic surgery, spine surgery, and neurosurgery are the mainstays of operative treatment for lumbar spinal stenosis, diagnosis and initial treatment are mainly the responsibility of primary care. For this Special Issue, we seek a wide range of papers on the diagnosis and treatment of lumbar spinal stenosis to share the latest findings that have been obtained to date. This Special Issue will be useful in clinical practice for both specialists and primary care physicians.

Dr. Koji Otani
Dr. Kazuyuki Watanabe
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Lumbar spinal stenosis
  • Neurogenic intermittent claudication
  • Diagnosis
  • Conservative treatment
  • Surgery

Published Papers (5 papers)

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Research

12 pages, 288 KiB  
Article
Process Evaluation of Lumbar Interbody Fusion Surgeries in Five Dutch Hospitals: A Qualitative Analysis
by Ruud Droeghaag, Inge J. M. H. Caelers, Aggie T. G. Paulus, Wouter L. W. van Hemert, Henk van Santbrink and on behalf of The LIFT-Study Group
Medicina 2022, 58(1), 99; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58010099 - 09 Jan 2022
Viewed by 1303
Abstract
Background and Objectives: Only limited qualitative research concerning instrumented spine surgeries has been published, despite the increasing number of these surgeries and the evident importance of qualitative analysis of the processes surrounding these complex interventions. Current qualitative research is mainly limited to [...] Read more.
Background and Objectives: Only limited qualitative research concerning instrumented spine surgeries has been published, despite the increasing number of these surgeries and the evident importance of qualitative analysis of the processes surrounding these complex interventions. Current qualitative research is mainly limited to the experiences, emotions and expectations of patients. Insight into the full process, including experiences from the perspective of informal caregivers and healthcare professionals, remains scarce. Materials and Methods: Data were gathered by means of semi-structured face-to-face interviews. In total, there were 27 participants, including 11 patients, 7 informal caregivers and 9 healthcare professionals. The interview process was audiotaped, and each interview was transcribed verbatim. To systematically analyse the gathered data, software for qualitative analysis (NVivo) was used. After immersion in the raw data of transcripts and field notes, a list of broad categories for organising the data into meaningful clusters for analysis was developed. All interviews were coded by the first author, and 25% was independently assessed by the second author. Results: The results of our study describe several promoting and limiting factors concerning the process of lumbar fusion surgery from the perspective of patients, informal caregivers and healthcare providers. The most frequently mentioned promoting factors were: information and opportunities to ask questions during consultations; multidisciplinary consultations; good communication and guidance during hospitalization; and follow-up appointments. The most frequently mentioned limiting factors were: lack of educational material; lack of guidance and communication prior to, during and after hospitalisation. Conclusion: Overall, participants were satisfied with the current healthcare-process in lumbar fusion surgery. However, we found that lack of educational material and guidance during the process led to insecurity about complaints, surgery and recovery. To improve the process of lumbar interbody fusion and to increase patient satisfaction, healthcare providers should focus on guiding and educating patients and informal caregivers about the pre-operative trajectory, the surgery and the recovery. From the healthcare providers’ perspective, the process could be improved by multidisciplinary consultations and a dedicated spine team in the operation room. Although this study focusses on lumbar fusion surgery, results could be translated to other fields of spine surgery and surgery in general. Full article
(This article belongs to the Special Issue Lumbar Spinal Stenosis: Diagnosis and Treatment Options)
11 pages, 1471 KiB  
Article
Stable Low-Grade Degenerative Spondylolisthesis Does Not Compromise Clinical Outcome of Minimally Invasive Tubular Decompression in Patients with Spinal Stenosis
by Morsi Khashan, Khalil Salame, Dror Ofir, Zvi Lidar and Gilad J. Regev
Medicina 2021, 57(11), 1270; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111270 - 19 Nov 2021
Cited by 1 | Viewed by 1367
Abstract
Background and Objectives: In recent literature, the routine addition of arthrodesis to decompression for lumbar spinal stenosis (LSS) with concomitant stable low-grade degenerative spondylolisthesis remains controversial. The purpose of this study is to compare the clinical outcome, complication and re-operation rates following minimally [...] Read more.
Background and Objectives: In recent literature, the routine addition of arthrodesis to decompression for lumbar spinal stenosis (LSS) with concomitant stable low-grade degenerative spondylolisthesis remains controversial. The purpose of this study is to compare the clinical outcome, complication and re-operation rates following minimally invasive (MIS) tubular decompression without arthrodesis in patients suffering from LSS with or without concomitant stable low-grade degenerative spondylolisthesis. Materials and Methods: This study is a retrospective review of prospectively collected data. Ninety-six consecutive patients who underwent elective MIS lumbar decompression with a mean follow-up of 27.5 months were included in the study. The spondylolisthesis (S) group comprised 53 patients who suffered from LSS with stable degenerative spondylolisthesis, and the control (N) group included 43 patients suffering from LSS without spondylolisthesis. Outcome measures included complications and revision surgery rates. Pre- and post-operative visual analog scale (VAS) for both back and leg pain was analyzed, and the Oswestry Disability Index (ODI) was used to evaluate functional outcome. Results: The two groups were comparable in most demographic and preoperative variables. VAS for back and leg pain improved significantly following surgery in both groups. Both groups showed significant improvement in their ODI scores, at one and two years postoperatively. The average length of hospital stay was significantly higher in patients with spondylolisthesis (p-value< 0.01). There was no significant difference between the groups in terms of post-operative complications rates or re-operation rates. Conclusions: Our results indicate that MIS tubular decompression may be an effective and safe procedure for patients suffering from LSS, with or without degenerative stable spondylolisthesis. Full article
(This article belongs to the Special Issue Lumbar Spinal Stenosis: Diagnosis and Treatment Options)
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9 pages, 973 KiB  
Article
Characteristics and Short-Term Surgical Outcomes of Patients with Recurrent Lumbar Disc Herniation after Percutaneous Laser Disc Decompression
by Hidetomi Terai, Koji Tamai, Masayoshi Iwamae, Kunikazu Kaneda, Hiroshi Katsuda, Nagakazu Shimada and Hiroaki Nakamura
Medicina 2021, 57(11), 1225; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111225 - 10 Nov 2021
Cited by 1 | Viewed by 1378
Abstract
Background and Objectives: Although percutaneous laser disc decompression (PLDD) is one of the common treatment methods for patients with lumbar disc herniation (LDH), the recurrence of LDH after PLDD is estimated at 4–5%. This study compares the preoperative clinical data and clinical [...] Read more.
Background and Objectives: Although percutaneous laser disc decompression (PLDD) is one of the common treatment methods for patients with lumbar disc herniation (LDH), the recurrence of LDH after PLDD is estimated at 4–5%. This study compares the preoperative clinical data and clinical outcomes of patients who underwent primary microendoscopic discectomy (MED) or MED following PLDD. Materials and Methods: We retrospectively analyzed 2678 patients who underwent MED for LDH. The PLDD group included patients with previous PLDD history at the same level of LDH, and a matched control group was created using propensity score matching for age, sex, and body mass index. Preoperative data, preoperative radiographic findings, and surgical data of the groups were compared. To compare postoperative changes in clinical scores between the groups, a mixed-effect model was used. Results: As a result, 42 patients (1.6%) had previously undergone PLDD, and a control group with 42 patients were created. The disc degeneration severity was not significantly different between the groups. However, Modic changes were more frequent in the PLDD group than in the matched control group (p = 0.028). There were no significant differences in dural adhesion rate or surgery-related complications including dural injury, length of stay, and recurrence rate of LDH after surgery. In addition, the improvement of clinical scores did not significantly differ between the two groups (p = 0.112, 0.913, respectively). Conclusions: We concluded that patients with recurrent LDH after PLDD have advanced endplate degeneration, which may reflect endplate injury from a previous PLDD. However, a previous history of PLDD does not have a negative impact on the clinical result of MED. Full article
(This article belongs to the Special Issue Lumbar Spinal Stenosis: Diagnosis and Treatment Options)
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10 pages, 5745 KiB  
Article
Long-Term Pain Characteristics and Management Following Minimally Invasive Spinal Decompression and Open Laminectomy and Fusion for Spinal Stenosis
by Gilad J. Regev, Gil Leor, Ran Ankori, Uri Hochberg, Dror Ofir, Morsi Khashan, Ron Kedem, Zvi Lidar and Khalil Salame
Medicina 2021, 57(10), 1125; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57101125 - 18 Oct 2021
Cited by 5 | Viewed by 1652
Abstract
Background and Objectives: To compare the long-term pain characteristics and its chronic management following minimally invasive spinal (MIS) decompression and open laminectomy with fusion for lumbar stenosis. Materials and Methods: The study cohort included patients with a minimum 5-year postoperative follow-up [...] Read more.
Background and Objectives: To compare the long-term pain characteristics and its chronic management following minimally invasive spinal (MIS) decompression and open laminectomy with fusion for lumbar stenosis. Materials and Methods: The study cohort included patients with a minimum 5-year postoperative follow-up after undergoing either MIS decompression or laminectomy with fusion for spinal claudication. The primary outcome of interest was chronic back and leg pain intensity. Secondary outcome measures included pain frequency during the day, chronic use of non-opioid analgesics, narcotic medications, medical cannabinoids, and continuous interventional pain treatments. Results: A total of 95 patients with lumbar spinal stenosis underwent one- or two-level surgery for lumbar spinal stenosis between April 2009 and July 2013. Of these, 50 patients underwent MIS decompression and 45 patients underwent open laminectomy with instrumented fusion. In the fusion group, a higher percentage of patients experienced moderate-to-severe back pain with 48% compared to 21.8% of patients in the MIS decompression group (p < 0.01). In contrast, we found no significant difference in the reported leg pain in both groups. In the fusion group, 20% of the patients described their back and leg pain as persistent throughout the day compared to only 2.2% in the MIS decompression group (p < 0.05). A trend toward higher chronic dependence on analgesic medication and repetitive pain clinic treatments was found in the fusion group. Conclusions: MIS decompression for the treatment of degenerative spinal stenosis resulted in decreased long-term back pain and similar leg pain outcomes compared to open laminectomy and instrumented fusion surgery. Full article
(This article belongs to the Special Issue Lumbar Spinal Stenosis: Diagnosis and Treatment Options)
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14 pages, 1295 KiB  
Article
The Change of Lumbar Spinal Stenosis Symptoms over a Six-Year Period in Community-Dwelling People
by Koji Otani, Shin-ichi Kikuchi, Shoji Yabuki, Takuya Nikaido, Kazuyuki Watanabe, Kinshi Kato, Hiroshi Kobayashi and Shin-ichi Konno
Medicina 2021, 57(10), 1116; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57101116 - 16 Oct 2021
Cited by 4 | Viewed by 1974
Abstract
Background and Objectives: The high prevalence of lumbar spinal stenosis (LSS) and its negative impact on quality of life in the elderly is well known. However, the longitudinal time course of LSS symptoms remains unclear. The purpose of this study was to [...] Read more.
Background and Objectives: The high prevalence of lumbar spinal stenosis (LSS) and its negative impact on quality of life in the elderly is well known. However, the longitudinal time course of LSS symptoms remains unclear. The purpose of this study was to clarify the longitudinal time course and associated factors of LSS symptoms over a period of six years in a community. Materials and Methods: This study was conducted with data prospectively collected in 2004 and 2010 under a retrospective design. In 2004, 1578 subjects (age range: 40 to 79 years) were interviewed on LSS symptoms using a specially designed and validated questionnaire. In 2010, a follow-up study was performed by mail, to which 789 subjects of the 2004 study population responded. Considering that the presence of osteoarthritis (OA) of the knee or hip may influence the participants’ answers in the questionnaire, analysis was performed in all 789 subjects with and 513 subjects without either knee or hip OA. Changes in LSS symptoms between the initial and the 6-year survey were investigated. Multiple logistic regression analysis was used for detecting the risk factors for LSS symptom presence at the six-year follow-up. Results: 1. At the six-year follow-up, more than half of the subjects who showed LSS symptoms at the initial analysis became LSS-negative, and 12–15% of those who were LSS-negative became LSS-positive. 2. From the multiple logistic regression analysis, a lower Roland-Morris Disability Questionnaire (RDQ) score and a positive LSS symptom at the initial analysis were detected as predictive factors of the presence of LSS symptoms at the six-year follow-up in the total number of subjects, as well as just in those who did not have either knee or hip OA. Conclusions: More than half of the subjects who were LSS-positive at their initial assessment still experienced improvement in their symptoms even after 6 years. This means that both LSS symptoms and their time course vary from person to person. Predictive factors for the presence of LSS symptoms during the six-year follow-up period were RDQ score and positive LSS symptoms. Full article
(This article belongs to the Special Issue Lumbar Spinal Stenosis: Diagnosis and Treatment Options)
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