The Clinical Syndrome Associated with Lumbar Spinal Stenosis

Goh, Khean Jin; Khalifa, Waël; Anslow, Philip; Cadoux-Hudson, Tom; Donaghy, Michael

doi:10.1159/000082369

Cited by 84 publications

(55 citation statements)

References 32 publications

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“…In fact, 65.0% (26 of 40 patients) of patients with preoperative resting numbness still showed residual leg pain/numbness 2 years after the operation (Table 2). Numbness caused by LSS has been reported to be more difficult to alleviate by surgery than other neurological symptoms such as muscle weakness or pain [2,6]. Also, it is not surprising that preoperative drop foot eventually leads to postoperative gait disturbance.…”

Section: Discussionmentioning

confidence: 99%

Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

et al. 2010

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Leg pain/numbness and gait disturbance, two major symptoms in the lower extremities of lumbar spinal stenosis (LSS), are generally expected to be alleviated by decompression surgery. However, the paucity of information available to patients before surgery about specific predictors has resulted in some of them being dissatisfied with the surgical outcome when the major symptoms remain after the procedure. This prospective, observational study sought to identify the predictors of the outcome of a decompression surgery: modified fenestration with restorative spinoplasty. Of 109 consecutive LSS patients who underwent the decompression surgery, 89 (56 males and 33 females) completed the 2 year follow-up. Both leg pain/numbness and gait disturbance determined by the Japanese Orthopedic Association scoring system were significantly improved at 2 years after surgery compared to those preoperative, regardless of potential predictors including gender, preoperative presence of resting numbness in the leg, drop foot, cauda equina syndrome, degenerative spinal deformity or myelographic filling defect, or the number of decompressed levels. However, 27 (30.3%) and 13 (14.6%) patients showed residual leg pain/numbness and gait disturbance, respectively. Among the variables examined, the preoperative resting numbness was associated with residual leg pain/ numbness and gait disturbance, and the preoperative drop foot was associated with residual gait disturbance, which was confirmed by logistic regression analysis after adjustment for age and gender. This is the first study to identify specific predictors for these two remaining major symptoms of LSS after decompression surgery, and consideration could be given to including this in the informed consent.

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Section: Discussionmentioning

confidence: 99%

Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

et al. 2010

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“…Typical presenting complaints include weakness, numbness/tingling, radicular pain and neurogenic claudication, sometimes accompanied by pain in the lower back or buttocks [17,55]. The consequence, in addition to much discomfort, is a restriction in mobility, and this, coupled with the natural age-associated decline in musculoskeletal function, results in a serious impediment to the performance of activities of daily living and a threat to the patient's independence.…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine

et al. 2007

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Spinal decompression is the most common type of spinal surgery carried out in the older patient, and is being performed with increasing frequency. Physiotherapy (rehabilitation) is often prescribed after surgery, although its benefits compared with no formal rehabilitation have yet to be demonstrated in randomised control trials. The aim of this randomised controlled trial was to examine the effects on outcome up to 2 years after spinal decompression surgery of two types of postoperative physiotherapy compared with no postoperative therapy (self-management). Hundred and fifty-nine patients (100 men, 59 women; 65 ± 11 years) undergoing decompression surgery for spinal stenosis/herniated disc were randomised to one of the following programmes beginning 2 months post-op: recommended to ''keep active'' (CONTROL; n = 54); physiotherapy, spine stabilisation exercises (PT-StabEx; n = 56); physiotherapy, mixed techniques (PT-Mixed; n = 49). Both PT programmes involved 2 · 30 min sessions/week for up to 12 weeks, with home exercises. Pain intensity (0-10 graphic rating scale, for back and leg pain separately) and self-rated disability (Roland Morris) were assessed before surgery, before and after the rehabilitation phase (approx. 2 and 5 months post-op), and at 12 and 24 months after the operation. 'Intention to treat' analyses were used. At 24 months, 151 patients returned questionnaires (effective return rate, excluding 4 deaths, 97%).Significant reductions in leg and back pain and self-rated disability were recorded after surgery (P < 0.05). Pain showed no further changes in any group up to 24 months later, whereas disability declined further during the ''rehabilitation'' phase (P < 0.05) then stabilised, but with no significant group differences. 12 weeks of post-operative physiotherapy did not influence the course of change in pain or disability up to 24 months after decompression surgery. Advising patients to keep active by carrying out the type of physical activities that they most enjoy appears to be just as good as administering a supervised rehabilitation program, and at no cost to the health-care provider.

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“…Actually, limb numbness is one of the main symptoms in LSS patients. Goh et al [11] investigated the clinical symptoms associated with LSS and reported that 66.6% of the patients experienced numbness or tingling of the legs. Since numbness is usually associated with a feeling of muscular weakness in most of LSS patients, the VAS for numbness may also reflect a subjective assessment of the severity of motor weakness in the lower limbs.…”

Section: Discussionmentioning

confidence: 99%

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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The Clinical Syndrome Associated with Lumbar Spinal Stenosis

Cited by 84 publications

References 32 publications

Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine

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

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