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Mitsuru Yagi, Eijiro Okada, Ken Ninomiya and Michiya Kihara

Object

The object of this study was to assess the feasibility and efficacy of a novel, minimally invasive spinal surgery technique to correct degenerative lumbar spinal stenosis involving a modified unilateral-approach microendoscopic midline decompression.

Methods

In this prospective study, 41 patients with lumbar stenosis were randomly assigned to undergo either a novel, median-approach microendoscopic laminectomy (20 patients) or a conventional laminectomy (21 patients). Spinal anteroposterior diameter, cross-sectional area, lateral recess distance, spinal stability, postoperative back pain, functional outcomes, and muscle trauma were evaluated. Follow-up ranged from 16 to 24 months, with a mean of 17.8 months for the novel procedure group and 18.6 months for the conventional laminectomy group.

Results

Compared with patients in the conventional laminectomy group, patients who received the novel procedure had a reduced mean duration of hospital stay, a lower mean creatine phosphokinase muscular-type isoenzyme level, a lower visual analog scale score for back pain at 1-year follow-up, and a faster recovery rate. These patients also had less mean blood loss compared with the conventionally treated group. Satisfactory neurological decompression and symptom relief were achieved in 90% of these patients. There was no significant clinical difference compared with the conventional laminectomy group's results. There was no evidence of spinal instability in any patient, and no patient required a follow-up conventional laminectomy.

Conclusions

This novel procedure provides effective spinal decompression. Although this method requires more operating time than a conventional method, it requires only minimal muscle trauma and spinal stability maintenance, and allows for early mobilization. This shortens the hospital stay, reduces postoperative back pain, and leads to satisfactory neurological and functional outcomes. Moreover, with the midline approach, decompression was accomplished without compromising the facet joints, even with a narrow width of lamina.

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Narihito Nagoshi, Osahiko Tsuji, Daisuke Nakashima, Ayano Takeuchi, Kaori Kameyama, Eijiro Okada, Nobuyuki Fujita, Mitsuru Yagi, Morio Matsumoto, Masaya Nakamura and Kota Watanabe

OBJECTIVE

Intramedullary cavernous hemangioma (CH) is a rare vascular lesion that is mainly characterized by the sudden onset of hemorrhage in young, asymptomatic patients, who then experience serious neurological deterioration. Despite the severity of this condition, the therapeutic approach and timing of intervention for CH remain matters of debate. The aim of this study was to evaluate the clinical characteristics of CH patients before and after surgery and to identify prognostic indicators that affect neurological function in these patients.

METHODS

This single-center retrospective study included 66 patients who were treated for intramedullary CH. Among them, 57 underwent surgery and 9 patients received conservative treatment. The authors collected demographic, symptomology, imaging, neurological, and surgical data. Univariate and multivariate logistic regression analyses were performed to identify the prognostic indicators for neurological function.

RESULTS

When comparing patients with stable and unstable gait prior to surgery, patients with unstable gait had a higher frequency of hemorrhagic episodes (52.4% vs 19.4%, p = 0.010), as assessed by the modified McCormick Scale. The lesion was significantly smaller in patients who underwent conservative treatment compared with surgery (2.5 ± 1.5 mm vs 5.9 ± 4.1 mm, respectively; p = 0.024). Overall, the patients experienced significant neurological recovery after surgery, but a worse preoperative neurological status was identified as an indicator affecting surgical outcomes by multivariate analysis (OR 10.77, 95% CI 2.88–40.36, p < 0.001). In addition, a larger lesion size was significantly associated with poor functional recovery in patients who had an unstable gait prior to surgery (8.6 ± 4.5 mm vs 3.5 ± 1.6 mm, p = 0.011).

CONCLUSIONS

Once a hemorrhage occurs, surgical intervention should be considered to avoid recurrence of the bleeding and further neurological injury. In contrast, if the patients with larger lesion presented with worse preoperative functional status, surgical intervention could have a risk for aggravating the functional deficiencies by damaging the thinning cord parenchyma. Conservative treatment may be selected if the lesion is small, but regular neurological examination by MRI is needed for assessment of a change in lesion size and for detection of functional deterioration.

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Masahiro Ozaki, Nobuyuki Fujita, Azusa Miyamoto, Satoshi Suzuki, Osahiko Tsuji, Narihito Nagoshi, Eijiro Okada, Mitsuru Yagi, Takashi Tsuji, Masaya Nakamura, Morio Matsumoto, Hitoshi Kono and Kota Watanabe

OBJECTIVE

Lumbar spinal canal stenosis (LSS) and knee osteoarthritis (KOA), both of which are age-related degenerative diseases, are independently correlated with increased pain and dysfunction of the lower extremities. However, there have been few studies that investigated whether LSS patients with KOA exhibit poor clinical recovery following lumbar spinal surgery. The aim of this study was to elucidate the surgical outcomes of lumbar spinal surgery for LSS patients with KOA using multiple health-related quality of life (HRQOL) parameters.

METHODS

A total of 865 consecutive patients who underwent posterior lumbar spinal surgery for LSS were retrospectively reviewed. Baseline characteristics, radiographic parameters, perioperative factors, and multiple HRQOL parameters were analyzed preoperatively and at 1-year follow-up. HRQOL items included the Zurich Claudication Questionnaire, Oswestry Disability Index, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The effectiveness of surgical treatment was assessed using the JOABPEQ. The treatment was regarded as effective when it resulted in an increase in postoperative JOABPEQ score by ≥ 20 points compared with preoperative score or achievement of a postoperative score of ≥ 90 points in those with a preoperative score of < 90 points.

RESULTS

A total of 32 LSS patients with KOA were identified, and 128 age- and sex-matched LSS patients without KOA were selected as controls. In both groups, all HRQOL parameters markedly improved at the 1-year follow-up. On the SF-36, the postoperative mean score for the role physical domain was significantly lower in the KOA group than in the control group (p = 0.034). The treatment was significantly less “effective” in the social life domain of JOABPEQ in the KOA group than in the control group (p < 0.001).

CONCLUSIONS

The surgical outcomes of LSS patients with KOA are favorable, although poorer than those of LSS patients without KOA, particularly in terms of social life and activities. These results indicate that LSS patients with KOA experience difficulty in routine work or ordinary activities due to knee pain or restricted knee ROM even after lumbar spinal surgery. Hence, preoperative KOA status warrants consideration when planning lumbar spinal surgery and estimating surgical outcomes of LSS.