Clinical Study of Applying Enhanced Recovery after Surgery Concept in Single-Segment Lumbar Spinal Stenosis Surgery

Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surgery (ERAS) principles provides a new approach to postoperative recovery in patients. This study aims to investigate the clinical application effects of ERAS principles in single-level lumbar spinal stenosis surgery. Methods: This study included 64 patients who underwent lumbar fusion surgery in the Spinal Surgery Department of Baise People’s Hospital from July 2022 to July 2024. These patients were divided into an experimental group (ERAS group, 33 cases) and a control group (conventional group, 31 cases) based on perioperative care, receiving ERAS principles and traditional treatment, respectively. A comparison was made between the two groups in terms of gender, age, BMI, intraoperative blood loss, postoperative length of hospital stay, postoperative complications, hospital costs, VAS scores (preoperative/postoperative day 3), and ODI scores (preoperative/postoperative day 3). Results: There were no significant differences in gender, age, and BMI between the ERAS group and the conventional group (gender: χ2 = 0.5008, P = 0.4792;age: 54.55 ± 8.51 years vs. 57.39 ± 8.16 years, P = 0.0892;BMI: 25.11 ± 2.70 vs. 24.77 ± 2.75, P = 0.3098). However, during surgery, patients in the ERAS group had significantly less blood loss than those in the conventional group (197.58 ± 195.51ml vs. 438.71 ± 349.22 ml, P = 0.0006), and the postoperative length of hospital stay was significantly shorter (7.00 ± 2.24 days vs. 11.55 ± 5.23 days, P = 0.0000). On postoperative day 3, VAS scores were significantly better in the ERAS group compared to the conventional group (3.70 ± 0.88 vs. 4.32 ± 0.87, P = 0.0031), and the ODI scores showed significant improvement as well (46.00 ± 3.04 vs. 48.00 ± 3.39, P = 0.0078). Although there were no significant differences in postoperative complications and hospital costs (complications: 3 cases vs. 0 cases, P = 0.2154;hospital costs: 63524.29 ± 17891.80 RMB vs. 58733.84 ± 13280.82 RMB, P = 0.1154), ERAS demonstrated better postoperative recovery outcomes in single-level lumbar spinal stenosis surgery. Conclusion: The study results support the implementation of ERAS principles in single-level lumbar spinal stenosis surgery to promote rapid recovery, reduce healthcare resource consumption, and improve overall patient satisfaction.

Danlu Tongdu tablets treat lumbar spinal stenosis through reducing reactive oxygen species and apoptosis by regulating CDK2/CDK4/CDKN1A expression

Lumbar spinal stenosis is caused by the compression of the nerve root or cauda equina nerve by stenosis of the lumbar spinal canal or intervertebral foramen,and is manifested as chronic low back and leg pain.Danlu Tongdu(DLTD)tablets can relieve chronic pain caused by lumbar spinal stenosis,but the molecular mechanism remains largely unknown.In this study,the potential molecular mechanism of DLTD tablets in the treatment of lumbar spinal stenosis was first predicted by the network pharmacology method.Results showed that DLTD functions in regulating anti-oxidative,apoptosis,and inflammation signaling pathways.Furthermore,the flow cytometry results showed that DLTD tablets efficiently reduced reactive oxygen species content and inhibited rat neural stem cell apoptosis induced by hydrogen peroxide.DLTD also inhibited the mitochondrial membrane potential damage induced by hydrogen peroxide.Elisa analysis showed that DLTD induced cell cycle-related protein,CDK2 and CDK4,and reduced CDKN1A protein expression level.Taken together,our study provided new insights of DLTD in treating lumbar spinal stenosis through reducing reactive oxygen species content,decreasing apoptosis by inhibiting CDKN1A and promoting CDK2 and CDK4 expression levels.

Is It Safe to Perform an Autologous Epidural Blood Patch on Patients with Underlying Spinal Stenosis or Lumbar Disc Disease? Case Report and Literature Review

The most common spinal pathology seen in the obstetric population is lumbar disc herniation. There is currently no literature documenting the safety of performing an epidural blood patch on obstetric patients with underlying spinal pathology. We present a case of a patient with known severe lumbar spinal stenosis with compressive radiculopathy who received a successful epidural blood patch without worsening her underlying neurologic symptoms. Epidural blood patches can be safely performed in this patient population. However, the anesthesiologist should be aware of the risk of potentially worsening preexisting neurological deficits. Thus, we advise caution prior to placing an epidural blood patch on these patients. The risks and benefits of the procedure should be carefully weighed and considered. It is important to have a thorough discussion with the patient regarding the risks of an epidural blood patch prior to performing the procedure.

Evaluation of degree of nerve root injury by dermatomal somatosensory evoked potential following lumbar spinal stenosis

BACKGROUND： Computed Tomography （CT） and Magnetic Resonance Imaging （MRI） can display the site of lumbar spinal stenosis and predict nervous compression at the morphological level; however, pure morphological changes cannot reflect functional alterations in a compressed nerve root. Dermatomal somatosensory evoked potential （DSEP） provides a means to assess the functional state of a nerve root. OBJECTIVE： To evaluate the clinical significance of DSEP, assessing the degree of nerve root injury following lumbar spinal stenosis. DESIGN, TIME AND SETTING： A case-control study was performed in the Department of Orthopaedic Surgery, Hainan People＇s Hospital, China, between September 2004 and December 2007. PARTICIPANTS： Forty-seven patients diagnosed with lumbar spinal stenosis by CT or MRI were selected as the case group; fifty healthy subjects were collected as the control group. METHODS： A KEYPOINT myoelectric evoked potential apparatus （DANTEC Company, Denmark） was used to measure DSEP, and stimulative spots were determined in accordance with the skin key sensory spot standards established by The American Spinal Injury Association： L4 in the medial malleolus, L5 in the third metatarsophalangeal joint of the dorsum of foot and S1 in the lateral heel. The needle electrode used as the recording electrode was located at the Cz point of the cranium, and the reference electrode at the Fz point. MAIN OUTCOME MEASURES： Latency of the P40 peak of DSEP, P1-N1 amplitude, P40 waveform and differentiation and disappearance of various waves. RESULTS： The sensitivity and diagnostic concurrence with surgery of nerve root injury following lumbar spinal stenosis evaluated by DSEP was 95.7 %. P40 latencies at L4, L5 and S1 in the case group were significantly longer than in the control group （P 〈 0.05）, and the P1-N1 amplitude in the case group was significantly lower than the control group （P 〈 0.05-0.01）. Nerve root injury was categorized according to DSEP latency as follows： severe damage （disappearance of the P40 wave in 103 dermatomes）, moderate damage （prolongation of the P40 peak latency ≥ 3.0 times the standard deviation of the normal mean in 60 dermatomes） and mild damage （prolongation of the P40 peak latency ≥ 2.5 times the standard deviation of the normal mean in 31 dermatomes）. CONCLUSION： DSEP can be used to determine the severity of nerve root injury following lumbar spinal stenosis with high sensitivity and specificity.

Severe lumbar spinal stenosis combined with Guillain-Barrésyndrome:A case report

BACKGROUND Guillain-Barrésyndrome(GBS)is a rare disorder that typically presents with ascending weakness,pain,paraesthesias,and numbness,which mimic the findings in lumbar spinal stenosis.Here,we report a case of severe lumbar spinal stenosis combined with GBS.CASE SUMMARY A 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness.Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis.However,his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness.An electromyogram was performed.Based on his symptoms,physical examination,and electromyogram,he was diagnosed with GBS.After 5 d of intravenous immunoglobulin(0.4 g/kg/d for 5 d)therapy,he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias.He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up.CONCLUSION GBS should be considered in the differential diagnosis of spinal disorder,even though magnetic resonance imaging shows severe lumbar spinal stenosis.This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.

Simulation of Lumbar Spinal Stenosis Using the Finite Element Method

Lumbar spine stenosis(LSS)is a narrowing of the spinal canal that results in pressure on the spinal nerves.This orthopedic disorder can cause severe pain and dysfunction.LSS is a common disabling problem amongst elderly people.In this paper,we developed a finite element model(FEM)to study the forces and the von Mises stress acting on the spine when people bend down.An artificial lumbar spine(L3)was generated from CT data by using the FEM,which is a powerful tool to study biomechanics.The proposed model is able to predict the effect of forces which apply to the lumbar spine.In addition,FEM allows us to investigate the tests into the lumbar spine instead of applying the tests to the real spine in humans.The proposed model is highly accurate and provides precise information about the lumbar spine(L3).We investigate the behavior of humans in daily life which effects to the lumbar spine in a normal person and a patient with LSS.The computational results revealed high displacement levels around the spinal canal and lower displacement levels in the spinal body when bending down.The total displacement of the axial load in a normal person was higher when compared with patients with LSS.Higher degree bends resulted in a lower total displacement when compared with lower degree bends,while the von Mises stress decreased as the bending degree increased.

A Case of Thoracic Spinal Stenosis Secondary to Paget's Disease

PAGET＇S disease, also called osteitis deformans, is a metabolic bone disorder. It is characterized by increased bone resorption and the compensatory formation of new bones. The increased bone conversion and remodeling lead to the incrustation of woven bones and lamellar bones and finally result in the expansion, loosening, and excessive vascularization of the affected bones, rendering them susceptible to deformity and fracture. Paget＇s disease occurs much more commonly in Anglo-Saxons than in Asians and Africans.

Observation on TCM syndromes effect of Shujinjianyao Pill in the Treatment of Lumbar Spinal Stenosis (Ganshenbuzu and Fengshiyuzu Syndrome)

Objective:To observe the TCM(Traditonal Chinese Medcine)syndromes effect and safety of Shujinjianyao Pill in the treatment of LSS(Lumbar Spinal Stenosis)(Ganshenbuzu and Fengshiyuzu Syndrome).Methods:120 LSS patients fit the inclusion criteria were separated into two groups,90 in the experimental group and 30 in the control group.No significant difference was existed in the basic data between the two groups.The experimental group was given Shujinjianyao Pill and Danlutongdu Tablet Simulator orally,while the control group was given Shujinjianyao Pill Simulator and Danlutongdu Tablet orally for 4 weeks.The VAS score,total TCM(Traditonal Chinese Medcine)syndrome score and single TCM symptom score on day 0,14 and 28 were observed,and adverse reactions were recorded.Result:There were significant differences in total TCM syndrome score between the two groups at baseline,14 day and 28 day(P<0.01).There was a significant difference in total TCM syndrome score between the two groups at 28 day(P<0.05).Significant differences were existed between this two groups in total effective rate of total TCM syndromes and waist-knee pain-weak in single TCM syndromes on the 28 day(P<0.05).There was no significant difference in the incidence of adverse events and serious adverse events between the two groups(P>0.05).Conclusion:Shujinjianyao Pill is effective on TCM syndromes in the treatment of Ganshenbuzu and fengshiyuzu syndrome LSS,especially in improving the score of total TCM syndromes and waist-knee pain-weak of single TCM syndrome,and has high safety.

Nonsurgical intervention for neuroclaudication due to lumbar spinal stenosis:Interpretation of the 2021 American Association for the Study of Pain Guidelines

Lumbar Spinal Stenosis(LSS)is the major cause of Neurogenic Claudication(NC).It is common in the elderly and has an increasing incidence.In 2021,the United States Association for the Study of Pain published new evidence-based clinical practice guidelines to provide more effective nonsurgical treatment of LSS-induced NC.Based on a thorough reading of the latest guidelines,combined with new clinical developments,and in collaboration with the 2011 North American Spine Society,NASS guidelines(hereinafter referred to as the 2011 Guidelines)were compared with the 2019 Danish Health Authority(DHA)Guidelines(hereinafter referred to as the 2019 Guidelines),and the clinical diagnosis and treatment of NC caused by LSS were reviewed and suggestions were put forward.

Technical Nuances of Minimal Invasive Interlaminar Decompression in Lumbar Spinal Stenosis: The Role of Minimal Invasive Bilateral Approach

We report a series of patients operated for one or multilevel lumbar spinal stenosis (with and without spondylolisthesis) using the minimal invasive bilateral interlaminar decompression. We discuss our results, comparing this procedure (from a technical point of view) with the muscle-preserving interlaminar decompression (MILD) and the unilateral approach for bilateral decompression (ULBD). Clinical and outcome data of 62 consecutive patients were reviewed, using the Visual Analogue Scale for both low back pain (LBP) and legs pain and the Oswestry Disability Index (ODI) for the degree of disability. Mean age was 68.88 ± 9.54 years and mean follow-up (FU) was 16.38 ± 11.12 months. A statistically significant improvement of LBP, legs pain and ODI was globally observed. At latest FU, patients with multilevel lumbar spinal stenosis significantly improved all scores and patients with spondylolisthesis significantly decreased their disability. No major complications occurred. Two cerebrospinal fluid (CSF) collections were treated conservatively. No wound infection occurred. No progression of spondylolisthesis was observed. No reoperation was needed. Although efficacious in patients with lumbar spinal stenosis, MILD and ULBD can have both some limitations. MILD has been found to decrease lumbar function in multilevel decompression (increasing sagittal translation and lumbar lordosis probably due to the removal of half of the spinous processes) and ULBD shows some disadvantages due to the difficulty of manipulating instruments through a small portal and the inadequate decompression due to a minimal exposure. The minimal invasive bilateral interlaminar decompression (in this technique, the access is bilateral but the supraspinous and interspinous ligaments and the spinous processes are preserved) allows wide access (bilateral exposure) with minimal invasiveness and very low morbidity in patients with lumbar spinal stenosis at one or more levels.

Comparison of Physical Therapy Follow-Up of Patients with Operated and Non-Operated Lumbar Spinal Stenosis According to the Nottingham Health Profile-Pain Scale

Background: Lumbar spinal stenosis (LSS) continues to be a major problem in societies, causing job loss and lowering quality of life. There are two types of treatment methods, physical therapy and surgery. If patients with LSS avoid treatment, they are likely to experience neurological deterioration in later years. Objective: The study aimed to evaluate the effect of physical therapy applied after decompression surgery or the effect of only applied physical therapy in patients with lumbar spinal stenosis. Materials and Methods: The results of the physical therapy follow-up of patients who had surgery and did not have surgery due to lumbar spinal stenosis between July 2014 and December 2019 were compared with each other. All patients received physical therapy for 6 months. Included were 42 patients who underwent decompression surgery due to LSS; 56 patients were not operated. Clinical outcomes were measured using the Nottingham Health Profile-Pain (NHP-Pain) scale at the initial, first, third and sixth months. The results were compared statistically. Results: The age of the operated patients was 54.69 ± 8.42 (39 - 71), while the non-operated patients were 59.16 ± 14.04 (34 - 83). There was no significant difference in the statistical comparison (p = 0.053). While the body mass index (BMI) of the operated patients was 29.43 ± 4.99 (21 - 40), the BMI of the non-operated patients was 28.84 ± 4.62 (22 - 42). There was no significant difference in the statistical comparison (p = 0.552). The scores of a 6-month physical therapy follow-up of patients were evaluated according to the NHP-pain scale. The values of patients who underwent surgery, initial - 1st month (p < 0.001), 1st month - 3rd month (p = 0.028), 3rd month - 6th month (p = 0.389) follow-up of the intervals were compared statistically. The values of non-operated patients, initial - 1st month (p = 0.008), 1st month -3rd month (p = 0.013), 3rd month - 6th month (p = 0.025) were compared statistically. Patients with and without surgery had significantly different initial pain scores (p < 0.001). Conclusions: The NHP-Pain scores of the patients undergoing physical therapy with the operation were shown to provide more significant improvement than the group receiving only the physical therapy. Patients with LSS should be treated with an operation to obtain the maximum benefit of physical therapy.

Transfacet approach decompression for thoracic spinal stenosis caused by anterior compression

Objective To study the efficiacy and safety of transfacet approach decompression to treat thoracic spinal stenosis caused by anterior compression. Methods Thirty-three patients with thoracic spinal stenosis caused by anterior

"Cave-in"technique: 360° circumferential decompression for thoracic spinal stenosis with ossification of posterior longitudinal ligament

Objective To investigate the surgical techniqueand efficiency of the "Cave-in" 360° circumferential decompression for thoracic spinal stenosis(TSS)with ossification of posterior longitudinal ligament(OPLL).Methods From October 2005 to

Diagnosis and one stage surgical treatment of lower thoracic ossification of ligamentum flavum combined with lumbar spinal stenosis

Objective To study the diagnosis and treatment of lower thoracic ossification of ligamentum flavum(OLF) combined with lumbar spinal stenosis.Methods Retrospective analysis was carried out on 11 cases of lower thoracic OLF combined with

Surgical strategy to dural ossification of thoracic spinal stenosis

Objective To explore the surgical strategies of thoracic spinal stenosis with dural ossification.Methods One-hundred and eight patients with thoracic spinal stenosis were treated.Dural ossification was found in 29 cases during operation

Transpedicular osteotomy en bloc lamina resection for the treatment of thoracic spinal stenosis

Objective To study the safety and efficacy of transpedicular osteotomy en bloc lamina resection to treat thoracic spinal stenosis.Methods A retrospective study of 23 consecutive patients underwent transpedicular osteotomy en bloc lamina

LUMBAR SPINAL STENOSIS: A REVIEW OF BIOMECHANICAL STUDIES

Objective. To investigate the biomechanical aspects of etiology,pathology, clinical manifestation, diagnosis and surgical treatment of the lumbar spinal stenosis. Methods’ A series of biomechanical methods, such as three-dimensional finite element models. three-dimensional kinematic measurement, cadeveric evaluation, and imaging assessment was applied to correlate lumbar biomechanics and lumbar spinal stenosis. Surgery of lumbar spinal stenosis has been improved. Results. The stresses significantly concentrate on the posterolateral part of the annulus fibrosus of disc, the posterior surface of vertebral body, the pedicle, the interarticularis and the facet joints. This trend is intensified by disc degeneration and lumbar backward extension. Posterior element resection has a definite effect upon the biomechanical behavior of lumbar vertebrae. The improved operations proved satis- factory. Conclusion. Stress concentration in the lumbar vertebrae is of importance to the etiology of degenerative lumbar spinal stenosis, and disc degeneration is the initial key of this process. Then these will be aggravated by backward extension. Functional radiography and myelography are of assistance to the diagnosis o f the lumbar spinal stenosis. For the surgical treatment of the lumbar spinal stenosis, destruction of the posterior element should be avoid as far as possible based upon the thorough decompression. Maintaining the lumbar spine in flexion by fusion after decompression has been proved a useful method. When developmental spinal stenosis is combined with disc herniation, discectomy through laminotomy is recommend for decompression.

Impact of computed tomography/magnetic resonance imaging registration on rehabilitation after percutaneous endoscopic decompression for lumbar stenosis: Retrospective study

BACKGROUND Percutaneous endoscopic lumbar decompression(PELD)shows promise for lumbar spinal stenosis(LSS)treatment,but its use is limited by the disease's complexity and procedural challenges.AIM In this study,the effects of preoperative planning and intraoperative guidance with computed tomography(CT)/magnetic resonance imaging(MRI)registration techniques on PELD for LSS and postoperative rehabilitation outcomes were evaluated.METHODS This retrospective study was conducted with data from patients who underwent PELD for LSS between January 2021 and December 2023.Patients were assigned to preoperative CT/MRI registration and control groups.Data collected included the operative time,length of hospital stay,visual analog scale(VAS)scores for low back and leg pain,and the Japanese Orthopaedic Association(JOA)lumbar spine score.Differences between groups were assessed using Student’s t test.RESULTS Data from 135 patients(71 in the CT/MRI registration group,64 in the control group)were analyzed.The operative time was significantly shorter in the CT/MRI registration group(P=0.007).At 2 months postoperatively,both groups showed significant reductions in VAS leg and low back pain scores(all P<0.001)and improvements in the JOA score(both P<0.001).No complication or death occurred.Preoperatively,pain and JOA scores were similar between groups(P=0.830,P=0.470,and P=0.287,respectively).At 2 months postoperatively,patients in the CT/MRI registration group reported lower leg and low back pain levels(P<0.001 and P=0.001,respectively)and had higher JOA scores(P=0.004)than did patients in the control group.CONCLUSION Preoperative CT/MRI registration for PELD for LSS reduced the operative time and VAS pain scores at 2 months and improved JOA scores,demonstrating enhanced effectiveness and safety.

Spinal stenosis treated with acupuncture on Huátuó Jiájǐ(夹脊EX-B 2) and vertebral curvature adjustment:report of therapeutic effect on 189 cases

Objective To observe the clinical effects on spinal stenosis treated with acupuncture on Huatuo Jiaji （夹脊EX-B 2） and vertebral curvature adjustment. Methods Comprehensive therapy was applied to all of 189 cases of any type of spinal stenosis, in which gukong needling technique was applied to Huatuo Jiaji （夹脊EX-B 2） at C4 - T5 and T12 - L5, associated with vertebral curvature adjustment with traction. The therapeutic effects were observed. Results Total effective rate was 96.8%, in which, clinical cured rate was 31.7% and excellent and good rate was 89.9% in average 28-month fol- low-up visit. Conclusion Spinal stenosis is segmental dynamic stenosis. It can be cured by acupuncture on Huatuo Jiaji （夹脊EX-B 2） and vertebral curvature adjustment and satisfactory result is achieved.

Intraoperative ultrasonography in ＂cave-in＂ 360° circumferential decompression for thoracic spinal stenosis

The surgical outcomes of decompression for thoracic spinal stenosis （TSS） are unfavorable. The purpose of this study was to determine the efficacy of intraoperative ultrasonography during ＂cave-in＂ 360~ circumferential decompression surgery in patients with TSS. Methods Thirteen patients with TSS underwent ＂cave-in＂ 360° circumferential decompression surgery between May 2010 and November 2010. Intraoperative ultrasonography was used after removal of the posterior wall of thoracic spinal canal to assess the morphologic restoration of the spinal cord and the anterior surface of the spinal canal. In seven patients, ultrasonography was used again after circumferential decompression to compare the cross-sectional area of the spinal cord before and after circumferential decompression. Results The average period of follow-up was （12±2） months （range 9-15 months）. The Japanese Orthopedic Association score was significantly higher at the final follow-up （8.5±2.1, range 3-10） than preoperatively （5.2±1.1, range 3-7; P 〈0.01）. The cross-sectional area of the spinal cord was （30.8±6.6） mm2 before and （53.6±19.1） mm2 after circumferential decompression （P 〈0.01）. For five patients with TSS caused by thoracic disc herniation, the levels of circumferential decompression performed corresponded to those expected preoperatively. In contrast, for eight patients with TSS caused by ossification of the posterior longitudinal ligament, on average 1.6±0.9 fewer levels of circumferential decompression were performed than expected preoperatively. Conclusions ＂Cave-in＂ 360° circumferential decompression is an effective therapeutic option for TSS. Intraoperative ultrasonographic evaluation may reduce the levels of circumferential decompression and ensure sufficient decomoression, and increase the efficacy of this surqical technique.