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Parisa Azimi, Edward C. Benzel, Sohrab Shahzadi, Shirzad Azhari, and Hasan Reza Mohammadi

N early everyone experiences low-back pain (LBP) at some point in his or her life. A common cause of LBP is lumbar spinal canal stenosis (LSCS). 4 The term LSCS implies that a portion of the spinal canal has narrowed. 8 The symptoms of LSCS include pain, numbness, or weakness in the legs, groin, hips, buttocks, and lower back. Symptoms usually worsen when walking or standing (claudication). 8 The ability to predict the surgical success rate is important in choosing the appropriate management of LSCS in these patients. Medical informatics has been

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Kunihiko Sasai, Masayuki Umeda, Tohkun Maruyama, Ei Wakabayashi, and Hirokazu Iida

: Microdecompression for lumbar spinal canal stenosis . Spine 24 : 2268 – 2272 , 1999 11 Young S , Veerapen R , O'Laoire SA : Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report . Neurosurgery 23 : 628 – 633 , 1988

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Tomohiro Hikata, Kota Watanabe, Nobuyuki Fujita, Akio Iwanami, Naobumi Hosogane, Ken Ishii, Masaya Nakamura, Yoshiaki Toyama, and Morio Matsumoto

A s the aging population has grown in recent years, the prevalence of lumbar spinal canal stenosis (LCS) and other degenerative spinal diseases has also increased. Lumbar canal stenosis causes low-back pain (LBP), leg pain, neurogenic intermittent claudication, and bladder and rectal disorders, all of which affect health-related quality of life (HRQOL). Lumbar decompression surgery, one of the most common surgical treatments for LCS, usually improves neurogenic claudication, leg pain, and, eventually, HRQOL. Sagittal spinal alignment is an important

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Sho Dohzono, Hiromitsu Toyoda, Shinji Takahashi, Tomiya Matsumoto, Akinobu Suzuki, Hidetomi Terai, and Hiroaki Nakamura

S agittal balance of the spine is important in the management of lumbar diseases and low-back pain (LBP). 1 , 9 , 10 The sagittal vertical axis (SVA) ( Fig. 1 )—defined as the deviation of the C-7 plumb line from the posterior corner of the sacrum—has been associated with health-related quality of life (QOL). 7 , 16 In patients with lumbar spinal canal stenosis (LSS), symptomatic relief is obtained by standing or walking with lumbar flexion. 20 A correlation has been reported between sagittal spinal alignment and clinical outcome in patients with lumbar

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Sho Dohzono, Hiromitsu Toyoda, Tomiya Matsumoto, Akinobu Suzuki, Hidetomi Terai, and Hiroaki Nakamura

alignment in patients with lumbar disc herniation . Eur Spine J 19 : 435 – 438 , 2010 3 Enomoto M , Ukegawa D , Sakaki K , Tomizawa S , Arai Y , Kawabata S , : Increase in paravertebral muscle activity in lumbar kyphosis patients by surface electromyography compared with lumbar spinal canal stenosis patients and healthy volunteers . J Spinal Disord Tech 25 : E167 – E173 , 2012 4 Gelb DE , Lenke LG , Bridwell KH , Blanke K , McEnery KW : An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged

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Kentaro Fukuda, Hiroyuki Katoh, Yuichiro Takahashi, Kazuya Kitamura, and Daiki Ikeda

T he incidence of osteoporotic vertebral collapse (OVC) has been increasing with the aging population, with an estimated 1.4 million new OVC cases in the year 2000. 1 Most patients with OVC can be treated conservatively, and clinical outcome has improved with the introduction of effective osteoanabolic agents such as teriparatide. 2 , 3 In some cases, however, the posteriorly displaced fractured vertebra can encroach upon the lumbar canal and compress neural elements. When lumbar spinal canal stenosis (LSCS) associated with OVC leads to severe low

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Kentaro Fukuda, Hiroyuki Katoh, Yuichiro Takahashi, Kazuya Kitamura, and Daiki Ikeda

T he incidence of osteoporotic vertebral collapse (OVC) has been increasing with the aging population, with an estimated 1.4 million new OVC cases in the year 2000. 1 Most patients with OVC can be treated conservatively, and clinical outcome has improved with the introduction of effective osteoanabolic agents such as teriparatide. 2 , 3 In some cases, however, the posteriorly displaced fractured vertebra can encroach upon the lumbar canal and compress neural elements. When lumbar spinal canal stenosis (LSCS) associated with OVC leads to severe low

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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.

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Kazuhiro Hasegawa, Ko Kitahara, Haruka Shimoda, and Toshiaki Hara

T he number of patients with lumbar spinal canal stenosis is increasing as the percentage of the elderly population increases worldwide. Posterior decompression surgery is the first choice of treatment if conservative treatment fails. Because of the possible increase in segmental instability following a wide laminectomy, 2 , 3 , 12 , 14 , 16 traditional decompression procedures for lumbar spinal canal stenosis have been improved and are still performed with limited resection of the facet joints. 20 Decompression for lumbar spinal canal stenosis is aimed

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Junya Miyahara, Yuichi Yoshida, Mitsuhiro Nishizawa, Hiroyuki Nakarai, Yudai Kumanomido, Keiichiro Tozawa, Yukimasa Yamato, Masaaki Iizuka, Jim Yu, Katsuyuki Sasaki, Masahito Oshina, So Kato, Toru Doi, Yuki Taniguchi, Yoshitaka Matsubayashi, Akiro Higashikawa, Yujiro Takeshita, Takashi Ono, Nobuhiro Hara, Seiichi Azuma, Naohiro Kawamura, Sakae Tanaka, and Yasushi Oshima

osteophytes due to the motion of the spinal segments, residual ligamentum flavum, and epidural scars in areas that have been previously decompressed. There are two main types of primary surgery for lumbar spinal canal stenosis: decompression alone and decompression with fusion. Fusion surgery is preferred for cases of lumbar instability, radiculopathy due to foraminal stenosis, or severe low-back pain. 7–9 On the other hand, no standardized protocol has been advocated regarding the indications for fusion surgery for patients with central canal restenosis after lumbar