Search Results (144)

Study Design: Prospective observational study. Background: Lumbar spinal stenosis (LSS) impairs balance and gait function, increasing fall risk and limiting quality of life. Although postoperative recovery of balance is clinically important, longitudinal data using multidimensional balance assessments are limited. Methods: A prospective cohort study was conducted in 101 patients (mean age 74.9 ± 6.9 years) undergoing surgery for LSS. The Brief Balance Evaluation Systems Test (Brief BESTest), Oswestry Disability Index (ODI), Modified Falls Efficacy Scale (MFES), Zurich Claudication Questionnaire (ZCQ), and Visual Analog Scales (VAS) for pain/numbness were evaluated preoperatively and at 6 and 12 months postoperatively. Changes over time and correlations between Brief BESTest and PROMs were analyzed. Results: The total Brief BESTest score significantly improved from 13.3 ± 5.3 preoperatively to 16.1 ± 5.1 at 6 months and 16.0 ± 5.1 at 12 months (p < 0.01). Subdomains including Anticipatory Adjustments, Postural Responses, Sensory Orientation, and Stability in Gait improved significantly, while Stability Limits did not. At 12 months postoperatively, ODI decreased by 19.1%, ZCQ symptom and function scores improved by 0.8 and 0.9 points, respectively, and VAS scores improved by 17.1 mm for low back pain, 26.5 mm for lower limb pain, and 19.5 mm for numbness, all showing marked improvements from baseline. MFES also increased significantly postoperatively. The Brief BESTest score correlated significantly with MFES and ZCQ-PFS at baseline, and with ODI, ZCQ, and VAS scores at 12 months. Conclusions: Balance ability in LSS patients improved after surgery, as measured by the Brief BESTest, with clinically meaningful changes maintained for 12 months. Improvements in balance were significantly associated with reductions in pain, disability, and fear of falling, suggesting the Brief BESTest is a comprehensive indicator of postoperative recovery. Full article

In this narrative review, we explore the role of artificial intelligence (AI) in managing lumbar degenerative conditions, a topic that has recently garnered significant interest. The use of AI-based solutions in spine surgery is particularly appealing due to its potential applications in preoperative planning and outcome prediction. This study aims to clarify the impact of artificial intelligence models on the diagnosis and prognosis of common types of degenerative conditions: lumbar disc herniation, spinal stenosis, and eventually spinal fusion. Additionally, the study seeks to identify predictive factors for lumbar fusion surgery based on a review of the literature from the past 10 years. From the literature search, 96 articles were examined. The literature on this topic appears to be consistent, describing various models that show promising results, particularly in predicting outcomes. However, most studies adopt a retrospective approach and often lack detailed information about imaging features, intraoperative findings, and postoperative functional metrics. Additionally, the predictive performance of these models varies significantly, and few studies include external validation. The application of artificial intelligence in treating degenerative spine conditions, while valid and promising, is still in a developmental phase. However, over the last decade, there has been an exponential growth in studies related to this subject, which is beginning to pave the way for its systematic use in clinical practice. Full article

Background: The objective was to evaluate and compare the efficacy of direct fragment impaction, indirect reduction through ligamentotaxis, and the combination of both techniques in burst fractures of the thoracolumbar (TL) spine. Methods: The fractures were categorized using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and assessed via standard computed tomography (CT) scans for spinal canal area (SCA) and mid-sagittal diameter (MSD). The Frankel classification was used to assess neurological deficits. Only single vertebrae AO types A3 and A4 thoracic or lumbar fractures were included. All patients received bisegmental posterior stabilization, one of the reduction techniques, and, if neurological deficits were present, a spinal decompression. Mean preoperative (µSCApre/µMSDpre), postoperative (µSCApost/µMSDpost) and difference (∆SCA/∆MSD) in radiographic values were obtained and analyzed using the Mumford formula. The significance of the reduction from preoperative stenosis was assessed using a t-test, while the effectiveness of the reduction techniques was compared using the Kruskal–Wallis test and Dunn’s post hoc test. The manuscript was focused primarily on radiographic outcomes; therefore, aside from the neurostatus, no other clinical parameters were statistically analyzed. Results: Thirteen patients (38.2%) received stand-alone indirect reduction, 13 patients (38.2%) underwent direct reduction, and a combined reduction was used in eight patients (23.6%). All methods resulted in a statistically significant reduction in spinal canal stenosis (p < 0.05), with a minimal mean ∆SCA of 19%. Patients in the direct reduction group had significantly higher µSCApre values compared to those in the indirect reduction group (p = 0.02). Conclusions: All of the tested reduction techniques provided a significant reduction in spinal canal stenosis. Patients who underwent mere direct reduction had significantly higher preoperative spinal canal stenosis compared to the indirect reduction group. Full article

Background: Transcutaneous Randomized Pulsed Radiofrequency (TCPRF-STP) is a non-invasive therapeutic approach increasingly explored for managing spine-related pain, particularly in cases involving disc herniations and degenerative spine conditions. Objectives: To evaluate the use of transcutaneous PRF-STP in the treatment of spine pathologies and its evolution in short-term follow-up. Methods: This case series examines the outcomes of three patients treated with TCPRF-STP for varying spine pathologies, including lumbar and cervical disc herniations, lumbar stenosis, and radiculopathy. All patients had previously undergone conventional conservative therapies without a satisfactory improvement and were unwilling or unable to undergo invasive procedures. The treatment involved the application of electromagnetic fields through adhesive skin patches at targeted sites. Patients underwent three sessions of TCPRF-STP, with follow-up assessments evaluating pain and MRI. Results: Transcutaneous PRF-STP showed notable reductions in pain (VAS 0 in most cases), improvements in movement, and the restoration of normal daily activities. Follow-up MRI scans demonstrated positive structural changes in the treated discs. Although long-term recurrence occurred in one case, the patient remained active without functional limitations. Conclusions: Transcutaneous PRF-STP offers a promising, minimally invasive alternative for patients seeking to avoid surgery, though further studies with larger cohorts and longer follow-up periods are necessary to establish more robust evidence of its efficacy. This technique could become an important adjunct in managing chronic spinal pain conditions, offering patients an option with minimal risk and hospital demands. Full article

Background and Aim: Neuropathic pain leads to a significant deterioration in health-related quality of life (HRQOL). Treating neuromusculoskeletal pain is especially important to prevent and improve physical frailty and the locomotive syndrome. Varied pharmacotherapies could be applicable for neuropathic pain patients, but evidence has been limited for a wide range of neuropathic pain conditions with different etiologies. The aim of this review was to highlight mirogabalin, a novel calcium channel α2δ ligand which was first approved in Japan, and which is effective for various types of neuropathic pain diseases. Methods: We conducted a narrative review of the recent evidence that mirogabalin has significant analgesic potency for varied types of neuropathic pain conditions. Futher, this review highlighted specific advantages over other calcium channel ligands. Results: Analgesic potency of mirogabalin could cover peripheral neuropathic pain conditions including post-herpetic neuralgia, diabetic peripheral neuropathy, cauda equina syndrome caused by lumbar spinal stenosis, radiculopathy caused by cervical spondylosis, and also central neuropathic pain conditions like spinal cord injury. Mirogabalin consistently demonstrated daytime sleepiness and dizziness as adverse effects, but most of these were mild. Conclusions: Mirogabalin is recommended as the first-line drug against most molecular mechanisms that cause neuropathic pain regardless of whether they have a peripheral or central origin. Mirogabalin demonstrates relatively less daytime sleepiness, making it age-friendly in the current global situation where population aging is accelerated. Considering the epidemic of ‘opiophobia’ in Japan and other countries, pharmacotherapy using mirogabalin could treat neuropathic pain associated with cancer and its treatment (e.g., chemotherapy-induced peripheral neuropathy), as well as non-cancer etiologies worldwide. Full article

Background/Objectives: There exists a need to capture the current landscape of the literature for lumbar decompression on muscle strength, as measured by manual muscle testing (MMT), in cohorts with foot drop secondary to lumbar degenerative disease (LDD). Methods: A literature search of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from each database’s inception to 21 March 2025. Eligible studies reported patients with LDD-related foot drop treated surgically. This review was registered in PROSPERO (ID: CRD42024550980). Results: A total of 20 studies comprising 918 patients met the eligibility criteria, with most cases attributable to lumbar disc herniation (79% of patients, 95% CI: 0.72–0.85, I² = 96%) or spinal stenosis (22% of patients, 95% CI: 0.15–0.30, I² = 96%). Following surgery, 60% of patients (95% CI: 0.44–0.75, I² = 97%) achieved an MMT score of 4–5, indicating recovery, while 82% (95% CI: 0.76–0.88, I² = 89%) demonstrated an improvement of at least one MMT grade. No improvement was seen in 18% of patients (95% CI: 0.12–0.24, I² = 89%). For pain, the preoperative VAS mean was 5.91 (95% CI: 4.21–7.60, I² = 99%), while the postoperative mean was 1.00 (95% CI: −0.05–2.06, I² = 99%). Overall complications were reported at 1% (95% CI: −0.00–0.02, I² = 0%). Conclusions: Lumbar decompression achieves clinically meaningful recovery of LDD-induced foot drop. However, this meta-analysis highlights the overlooked portion of patients who will not respond, providing a sequential approach for future investigation of these cohorts through foundational evidence of the present literature base. Full article

Background/Objectives: Degenerative lumbar spinal stenosis (LSS) is a prevalent cause of disability in elderly populations, often treated with decompressive surgery. However, postoperative functional outcomes are variable and influenced by factors beyond neural compression alone. This study aimed to investigate the prognostic significance of the Goutallier Classification System (GS), a radiological index of paravertebral muscle fatty degeneration, in predicting long-term postoperative disability and pain in elderly patients undergoing decompression for LSS. Methods: A retrospective cohort study was conducted on 100 elderly patients who underwent primary lumbar decompression surgery for LSS between January 2020 and July 2022, with a minimum two-year follow-up. Patients were stratified according to their preoperative GS grades assessed via MRI. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain were collected preoperatively and at follow-up. Changes in the ODI and VAS (ΔODI and ΔVAS) were analyzed to evaluate associations between GS grades and functional outcomes. Results: Significant improvements in the ODI (from 41.0 ± 17.5 to 16.9 ± 8.2) and VAS (from 6.23 ± 2.52 to 3.75 ± 2.38) were observed postoperatively (p < 0.01). However, higher GS grades were associated with greater residual disability and pain at follow-up, as well as with smaller postoperative improvements in these scores (p < 0.01 for ODI; p = 0.01 for VAS). Gender differences were noted, with females predominating in higher GS grades. No significant differences in comorbidities or complication rates were identified across GS subgroups. Conclusions: Preoperative paravertebral muscle degeneration, as measured by the GS, emerged as a significant predictor of postoperative disability and pain in elderly LSS patients. Incorporating GS assessment into preoperative planning may refine surgical risk stratification and inform shared decision-making to optimize long-term functional recovery. Full article

Background/Objectives: Limited research has examined the relationship between preoperative health status and health-related quality of life (HRQoL) in patients with lumbar spinal stenosis (LSS) undergoing surgery. This study aims to assess the role of clinical, preoperative health and demographic factors on short-term HRQoL and functional outcomes following LSS surgery. Methods: A longitudinal study was conducted on 61 LSS patients (mean age 72.2 ± 8.8 years) undergoing surgery, assessing HRQoL and clinical outcomes before and 30 days post-surgery. Demographic and preoperative health status data were collected at baseline. HRQoL was measured using the Short Form Health Survey 36 (SF-36); clinical evaluations included assessments of disability, pain, and psychological status. Changes in HRQoL and clinical scores were analyzed with repeated measures ANOVA. HRQoL improvement was correlated with demographic and clinical variables, using Pearson’s correlation. Results: Spinal surgery for LSS led to significant improvements in HRQoL, with notable gains in both physical and mental health components (both p < 0.001), and in particular, in the body pain (+34%) and physical functioning, role physical, and social functioning (+20%) subscales of SF-36. Clinical scores also showed significant post-surgery improvements, strongly correlating with HRQoL. Correlations between ΔSF-36 subscale scores and preoperative factors revealed negative associations with BMI, smoking, comorbidities, and psychological distress. Conversely, physical activity was positively correlated with HRQoL improvements, especially in items showing the greatest score increases. Conclusions: Surgical treatment for LSS determines a significant improvement in HRQoL and functional outcome, which are however influenced by preoperative factors such as psychological distress, high BMI, smoking, and comorbidities. Conversely, regular physical activity is associated with better daily functioning, work performance, and social engagement. A comprehensive preoperative assessment may be a useful and appropriate tool to identify patients who are most likely to benefit and optimize quality of life after LSS surgery. Full article

Background: This study aimed at delivering first clinical results after the use of a screw-and-PEEK rod system. Emphasis was placed on the ability of the construct to prevent adjacent segment disease at an average of 5 years follow up. Methods: The cohort was made up of 33 patients who received decompressive surgery in one segment and instrumentation with a screw-and-PEEK rod-based construct for stenosis of the lumbar spinal canal and a control group of 20 who received fusion surgery. Results: At an average of 68 months follow up there were 19 patients where the symptoms had markedly improved or completely subsided. There were also nine patients where the symptoms initially subsided only to reoccur years later and five who had a subjective non-satisfactory result. Conclusions: The system showed no major disadvantage when compared to similar non-fusion pedicle-based techniques, nor was it able to consequently prevent ASD. Under a clinical point of view, there was, in our opinion, no marked benefit when compared against decompressive surgery and fusion as the accepted standard. Full article

Endoscopic spine surgery (ESS) has traditionally been employed for lumbar disc herniation (LDH). Recent innovations in surgical methods and technologies have expanded its range to address other spinal pathologies, providing minimally invasive solutions with potential clinical benefits. Our review aims to summarize the applications, clinical outcomes, and limitations of ESS beyond LDH, focusing on its role in complex spinal conditions such as stenosis, thoracic disc herniation, spinal tumors, synovial cysts, and failed back surgery syndrome. A thorough review of the literature was conducted to assess and summarize the current evidence regarding ESS applications for spinal conditions beyond LDH surgery. Areas of focus included innovations in technology and technique, as well as comparisons with conventional open surgical methods. ESS shows notable potential across different spinal conditions by providing minimally invasive alternatives to traditional open surgery. Its use could be associated with reduced surgical morbidity, shorter recovery times, and improved patient outcomes. In particular, ESS is versatile in addressing both degenerative and neoplastic conditions of the spine. Despite this, challenges such as technical complexity, steep learning curves, and limited indications for certain pathologies remain as barriers to wider adoption. ESS is evolving in spine surgery, extending its utility beyond LDH surgery. While the current evidence largely supports its clinical efficacy, further studies are needed to address the present limitations and optimize its application. Future developments in surgical training and technology will likely enhance its adoption and broaden its clinical indications. Full article

Background/Objectives: One of the surgical treatments for lumbar foraminal stenosis, full endoscopic foraminotomy, is known for its numerous advantages and favourable clinical outcomes. While previous studies have analyzed preoperative radiological risk factors associated with recurrence within one year after endoscopic foraminal decompression, no research has investigated postoperative radiological changes. The aim of this study is to analyze the radiological changes occurring in cases of early recurrence within six months after endoscopic foraminal decompression. Methods: A retrospective review was conducted on patients with unilateral lumbar foraminal stenosis who underwent full endoscopic foraminotomy at a single institution. The study included 11 recurrent patients who initially experienced symptomatic improvement and sufficient neural decompression on radiological evaluation, but exhibited recurrent radicular pain and radiological restenosis within six months postoperatively. Additionally, 33 control patients with favourable clinical outcomes and no evidence of restenosis were analyzed. Preoperative and postoperative plain X-ray imaging was used to evaluate sagittal and coronal parameters reflecting spinal anatomical characteristics, including disc height, foraminal height, disc wedging, coronal Cobb’s angle, total lumbar lordosis angle, segmental lumbar lordosis angle, and dynamic segmental lumbar lordosis angle. The study aimed to analyze postoperative changes in these parameters between the recurrent and control groups. Clinical outcomes were assessed using the Visual Analog Scale (VAS). Results: There were no significant differences between the groups in terms of age, sex distribution, presence of adjacent segment disease, or existence of Grade 1 spondylolisthesis. Analysis of preoperative and postoperative radiological changes revealed that, in the recurrent group, disc height and foraminal height showed a significant decrease postoperatively, while disc wedging and the coronal Cobb’s angle demonstrated a significant increase. In contrast, the control group exhibited a significant postoperative increase in the total lumbar lordosis angle and segmental lumbar lordosis angle. Conclusions: Progressive worsening of disc wedging and the coronal Cobb’s angle, and reductions in disc and foraminal height, along with minimal improvement in lumbar lordosis following TELF, suggest the presence of irreversible preoperative degenerative changes. Careful radiologic assessment and close postoperative monitoring are essential to identify patients at risk of early recurrence. Full article

Background: Acupotomy is a modern acupuncture technique using a knife-shaped needle for pain treatment, combining traditional and anatomical knowledge. This study evaluates the diversity and safety of acupotomy procedures for lumbar spine disorders to aid in developing safety and reporting guidelines for clinical studies. Methods: A literature search was conducted on 30 October 2023 in PubMed, five Korean databases, and relevant journals with keywords like ‘low back pain’ and ‘acupotomy’. The search included clinical trial articles in English or Korean on lumbar spinal disorders treated by acupotomy. We reviewed 22 clinical studies involving 731 Korean patients published from 2008 to 2023. Data extracted included disease types, diagnosis methods, treatment specifics, needling factors, anesthesia, clinical outcomes, and safety reports. Results: Most studies focused on lumbar herniated discs and stenosis, with acupotomy performed on damaged tissue sites. Treatment frequency varied, and outcomes included pain scales and imaging assessments. Reporting gaps were found in needle size, insertion depth, and anesthesia status. Safety measures were poorly documented, with only six studies addressing safety and two reporting adverse events. Conclusions: There is a critical need for standardized clinical and reporting guidelines for acupotomy, akin to acupuncture’s existing guidelines, to enhance research consistency and quality. Future studies should develop guidelines covering target tissues, needle details, techniques, anesthesia, and adverse effects to improve acupotomy safety and effectiveness. Full article

Background: This study aimed to evaluate the long-term clinical usefulness and radiologic changes around the Coflex device following decompression with Coflex insertion for degenerative lumbar spinal stenosis (DLSS), with an average follow-up of 14 years. Methods: This retrospective study included 147 patients who underwent decompression and Coflex insertion for single-level DLSS at a single institution between January 2007 and December 2010. Patients with spinal stenosis unresponsive to 3 months of conservative treatment were treated surgically. The mean follow-up duration was 173.9 ± 23.7 (range, 119–214) months. Results: The mean visual analog scale score decreased from 8.22 ± 1.06 preoperatively to 2.08 ± 1.58 postoperatively. Intervertebral disc height and foramen height at the Coflex insertion site decreased by 5.3% and 2.0%, respectively, after surgery. The reoperation rate at the operated site was 25% (n = 37). A significantly higher reoperation rate was observed in patients with translational instability (odds ratio [OR], 7.77; 95% confidence interval [CI], 2.453–24.658; p < 0.01) and angular instability (OR, 1.59; 95% CI, 0.492–5.133; p < 0.001). Eight patients underwent reoperation due to rapid progression of instability within 2 years of Coflex insertion; thereafter, a similar cumulative incidence rate was consistently observed. The adjacent-segment reoperation rate was 10.8% (n = 16). Conclusions: The Coflex interspinous device helps preserve disc and foramen height but is associated with a high reoperation rate, particularly in patients with spinal instability. Therefore, careful patient selection is crucial when considering its use. Full article

Background/Objectives: This is a retrospective study. We aimed to identify an optimal biportal endoscopic spine surgery (BESS) technique that maximizes facet joint preservation while achieving sufficient decompression for central to extraforaminal lumbar stenosis across all spinal levels. Methods: We retrospectively analyzed the data of 46 patients who underwent surgery and assessed clinical outcomes (visual analogue scale scores for pain; pregabalin usage) and radiological changes (using computed tomography/magnetic resonance imaging) in the spinal canal; intervertebral foramen area expansion; facet joint preservation; and degenerative change. Results: Using interlaminar and transforaminal approaches (two-way BESS decompression technique), the mean facet joint volume preservation ratio was 87%, and the mean facet joint length maintenance ratio was 90%, indicating a successful anatomical preservation compared with previous studies. Radiological outcomes revealed effective decompression (178% in the spinal canal; 245% in intervertebral foramen expansion). Additionally, all clinical outcome parameters significantly improved (p < 0.001). Conclusions: To the best of our knowledge, this study is the first to accurately estimate the degree of facet joint preservation using different methods after endoscopic surgery. The two-way BESS decompression technique maximized facet joint preservation with sufficient decompression and clinically improved central to extraforaminal stenosis across all lumbar levels. Therefore, this technique can sufficiently preserve facet joints to prevent rapid degenerative change after surgery. Full article

Background and Objectives: Lumbar spinal stenosis (LSS) is a leading cause of back surgery in elderly individuals. Additionally, LSS can result in buttock pain; abnormal sensations; or even loss of sensation in the thighs, feet, legs, and buttocks, as well as potential loss of bowel and bladder control. As a further consequence, sexual activity is impaired. However, there is limited information on sexual function in patients undergoing LSS surgery, in general, and among male patients, in specific. Accordingly, the aim of this study was to investigate the effect of LSS surgery on sexual function in male patients over 50 years. Materials and Methods: Participants were fifty male patients with LSS aged 50 years and older who underwent LSS surgery at the Imam Reza Hospital in Kermanshah from March 2024 to the end of 2024. To assess sexual performance over time, participants completed the International Index of Erectile Function (IIEF-15) questionnaire both before LSS surgery and six months after LSS surgery. For pre–post comparison, we used paired t-tests. Results: Compared to the pre-surgery stage, six-month post-surgery improvements were erectile function (+21%; Cohen’s d: 1.40), orgasmic function (+35.1%; Cohen’s d: 1.49), sexual desire (+27.3%; Cohen’s d: 1.48), intercourse satisfaction (+14% Cohen’s d: 0.77), overall satisfaction (+34.6% Cohen’s d: 1.74), and overall sexual function (+25.3%; Cohen’s d: 1.48). Conclusions: Among a sample of male patients aged 50 years and older, LSS surgery improved all dimensions of sexual satisfaction, including orgasmic, erectile, and sexual functions; sexual desire; intercourse satisfaction; and overall satisfaction. Medical doctors treating males with LSS might consider informing their patients about the favorable effects of LSS surgery on sexual life and sexual satisfaction. Full article