Prospective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis

Haro, Hirotaka; Maekawa, Shingo; Hamada, Y.

doi:10.1016/j.spinee.2007.01.010

Cited by 54 publications

(26 citation statements)

References 6 publications

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“…The primary methods used to assess walking can be grouped into three major categories: 1) questionnaires to assess patients’ perceived level of walking related disability,13–18 2) laboratory walking tests to determine ambulation capacity,19–23 and 3) community ambulation measured using activity monitors to assess walking performance in daily life 24–26. Traditionally, walking has been assessed in LSS populations using self report methods or objective tests of walking capacity in the laboratory setting.…”

Section: Introductionmentioning

confidence: 99%

Walking assessment in people with lumbar spinal stenosis: capacity, performance, and self-report measures

2011

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Section: Introductionmentioning

confidence: 99%

Walking assessment in people with lumbar spinal stenosis: capacity, performance, and self-report measures

2011

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“…MEPLT was only relatively delayed in patients showing motor deficit (MMT< 2) on physical examinations, but there was no significant difference shown in Table 2. Thus, subjective assessment might be a more reliable reflection of the real severity of neurological conditions than findings on physical examinations [13]. In our research, MEPLT showed some significant relationships with subjective assessment data, including walking distance of NIC, limb symptoms (bilateral or unilateral) and the VAS for numbness.…”

Section: Discussionmentioning

confidence: 54%

Clinical value of motor evoked potentials with transcranial magnetic stimulation in the assessment of lumbar spinal stenosis

Liu

Konno

Miyamoto

et al. 2008

International Orthopaedics (SICOT)

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The objective of this study was to evaluate the clinical usefulness of assessing motor evoked potentials (MEP) in lumbar spinal stenosis (LSS). Twenty-three LSS patients were enrolled. The preoperative data of MEP latency (MEPLT), clinical symptoms, Japanese Orthopaedic Association (JOA) scores for low back pain, visual analogue scale (VAS) for back pain, leg pain and numbness, walking distance and the minimal cross-sectional area (mCSA) of the dural sac were evaluated. The mean MEPLT was 42.1±2.8 ms. Fourteen patients had bilateral leg symptoms. The mean walking distance and mCSA were 302.1±302.8 m and 0.4±0.2 cm 2 , respectively. The mean JOA score and VAS scores for back pain, leg pain and numbness were 15.9±4.8, 6.0±2.9, 7.7±1.9 and 7.3±3.0, respectively. MEPLT was related to the walking distance, limb symptoms and the VAS for numbness. MEPLT was significantly delayed in patients who showed a walking distance less than 500 m. MEP is useful in LSS assessment. It can reflect the subjective severity of motor disturbance and predict the neurological deficit prior to appearance.Résumé L'objectif de cette étude est d'évaluer l'utilité des potentiels évoqués majeurs dans les canaux lombaires étroits. Méthode: 23 patients présentant un canal lombaire étroit (12 hommes et 11 femmes) ont été évalués. L'âge moyen était de 67,9±8,5 années. L'évaluation des potentiels évoqués moteurs pré-op ainsi que la symptomatologie, le score JOA, le score douleur ainsi que la douleur des deux membres inférieurs, la distance de marche avec claudication intermittente NIC et la surface de la section du sac dural ont été évalués, la largeur du sac dural MCSA étant évalué par IRM. Résultats: le temps de latence des potentiels évoqués moteurs était de 42,1±2,8 ms avec une symptomatologie moyenne ayant évolué pendant 31,5±31,8 mois. 12 patients présentaient un spondylolisthésis dégénératif associé. 14 patients avaient des signes bilatéraux et 9 unilatéraux. La claudication intermittente moyenne était de 302,1±302,8 mètres et la surface de section moyenne du cul-de-sac de 0,4±0,2 cm 2 . Le score moyen JOA, le score douleur VAS, les douleurs des membres inférieurs étaient respectivement de 15,9±4,8, 6±2,9, 7,7±1,9 et 7,3±3,0, avec un seul disque lésé dans 15 cas, deux dans 7 cas et trois dans un cas. Le temps moyen d'intermittence des potentiels évoqués rapporté au périmètre de marche à la symptomatologie douloureuse des membres inférieurs, au score JOA au nombre de disques, à la durée moyenne de la symptomatologie, au score douleur et au temps de latence des potentiels évoqués était significativement plus important chez les patients qui avaient un périmètre de marche inférieur à 500 mètres. En conclusion, les potentiels évoqués moteur sont utiles pour l'évaluation des canaux lombaires étroits et sont le reflet exact de la sévérité des lésions motrices. Ils permettent de prédire le déficit neurologique avant que celui-ci n'apparaisse.

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“…Decompression surgery is a treatment of choice for degenerative stenosis, but patients can still have symptoms even after a course of medication and rehabilitation [7,8]. Although current reports suggest that up to 80% of patients are satisfied with the results of surgical decompression [6,9,10], it is controversial, and further investigation is required to determine which surgical technique is most suitable [1,11]. In conventional lumbar decompression surgery, it is necessary to expose the paravertebral muscles, which can cause further significant muscle denervation [12e15].…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes of a modified Marmot operation with transverse cutting of the spinal process in patients with degenerative lumbar spinal stenosis

Hsu

et al. 2015

Tzu Chi Medical Journal

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a b s t r a c tObjective: The authors developed a minimally invasive spinal surgery techniqueda microscope-assisted modified Marmot operation combined with transverse cutting of the spinal processdto increase surgical field exposure and improve surgical outcomes in patients with degenerative lumbar spinal stenosis. Materials and methods: We retrospectively analyzed 45 patients with degenerative lumbar spinal stenosis who underwent a microscope-assisted modified Marmot operation combined with spinal process transverse cutting laminectomy from February 2009 to June 2011. Pre-and postoperative evaluations of the patients were conducted using the Oswestry Disability Index (ODI) questionnaire and visual analog scale (VAS) scores for back pain. Operation time, blood loss, and postoperative time until ambulation were also measured. Results: The age of the patients was 68.2 ± 7.2 years. The follow-up period was 15.3 ± 4.5 months. The postoperative hospital stay was 3.5 ± 2.2 days. The VAS scores of low back pain and leg pain were 72.1 ± 18.3 mm and 75.6 ± 20.1 mm preoperative, and 18.6 ± 17.3 and 23.8 ± 14.6 postoperative, respectively. The ODI questionnaire scores before and after the operation were 63.1 ± 6.8 and 26.5 ± 5.0, respectively. Patients had significant improvement in both VAS and ODI questionnaire scores after surgical decompression (p < 0.05). Operation time was 134.2 ± 19.6 minutes. Intraoperative blood loss was 66.5 ± 35.3 mL. No perioperative complication such as dural tear, hematoma, surgical site infection, or neurological deterioration was noted. All patients were able to walk within 2.4 ± 1.5 days. Conclusions: A microscope-assisted modified Marmot operation combined with spinal process transverse cutting laminectomy was an effective procedure for spinal decompression. As the procedure produces only unilateral muscular trauma, patients can ambulate early. Overall, the procedure is safe and effective. It provides good surgical field exposure and satisfactory neurological and functional outcomes.

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Prospective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis

Cited by 54 publications

References 6 publications

Walking assessment in people with lumbar spinal stenosis: capacity, performance, and self-report measures

Walking assessment in people with lumbar spinal stenosis: capacity, performance, and self-report measures

Clinical value of motor evoked potentials with transcranial magnetic stimulation in the assessment of lumbar spinal stenosis

Surgical outcomes of a modified Marmot operation with transverse cutting of the spinal process in patients with degenerative lumbar spinal stenosis

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