Changes in Paraspinal Muscles and Facet Joints after Minimally Invasive Posterior Lumbar Interbody Fusion Using the Cortical Bone Trajectory Technique: A Prospective Study

In this prospective cohort study, we aimed to determine the surgical and adjacent segment changes in paraspinal muscles and facet joints in patients with lumbar spinal stenosis after minimally invasive posterior lumbar interbody fusion (PLIF) using the cortical bone trajectory (CBT) technique. We enrolled 30 consecutive patients who underwent the single-level CBT technique between October 2017 and October 2018. We evaluated preoperative and 1-month, 3-month, 6-month, and 1-year postoperative clinical data including Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI). Magnetic resonance imaging (MRI) was performed a year after surgery. The erector spinae (ES) muscle area, volume, and fat infiltration (FI) on the surgical and adjacent segments were evaluated using the thresholding method, and the degree of adjacent facet joint degeneration was calculated using the Weishaupt scale. FI rate was graded using the Kjaer method. All patients underwent a 12-month follow-up. The VAS and ODI scores significantly improved after surgery in all patients. No patient showed degeneration of the adjacent facet joints ( P > 0.05 ) during the 1-year follow-up postoperation. There was no significant difference in ES muscle volume, area, and FI on the surgical and adjacent segments ( P > 0.05 ). The FI rate of the upper ES muscles increased postoperatively ( P < 0.05 ); however, there were no significant changes in FI rate of the lower ES muscles. Patients with lumbar spinal stenosis could obtain satisfactory short-term clinical outcomes via minimally invasive PLIF using the CBT technique. Moreover, this technique may reduce the impact on the paravertebral muscles, especially the ES muscle, and the adjacent facet joints.

Degrees of Canal Stenosis, Levels of Interleukin-6 (IL-6) And C-Reactive Protein (CRP) Preoperative as Predictors of the Output of Neurogenic Claudication Outcome Score (NCOS) 8 Weeks Post-Decompression-Stabilization-Fusion in Degenerative Lumbar Spinal Stenosis Patients

Introduction: Lumbar Spinal Stenosis (LSS) or spinal stenosis is the most common spinal disease in elderly patients. LSS is also one of the leading causes of spinal surgery in the world. The problem that is often encountered is the limited predictor of outcomes that are considered affordable and accurate, so as to provide education to patients about possible output after the surgery process is carried out. Therefore, a predictor is needed that is considered accurate and affordable such as the degree of measurable canal stenosis of Magnetic resonance imaging (MRI), serum levels of C-Reactive Protein (CRP) and Interleukin-6 (IL-6) Method: This study used a prospective cohort design conducted to compare Neurogenic Claudication Outcome Score scores among people with degenerative lumbar canal stenosis whose post-decompression-stabilization-fusion had higher degrees of canal stenosis (measured through Schizas grading of Magnetic resonance Imaging/MRI) examinations), as well as high pre-operative CRP and IL-6 levels with those with normal CRP and IL-6 levels. From the population of lumbar spinal stenosis, the selection of samples was conducted consecutively sampling. After that, statistical tests in the form of descriptor tests, normality tests, risk factor assessments with 2x2 cross tabulation, and proportion comparison analysis using the Fisher Exact test. Result: Severe lumbar canal stenosis degrees resulted in worse NCOS 8 weeks postoperative than mild degrees of lumbar canal stenosis, with statistically significant differences (p=0.008; p < 0.05) and RR 6.4 (0.99-41.08). High CRP levels resulted in worse NCOS 8 weeks postoperative than mild lumbar degrees of canal stenosis, with statistically significantly differences (p=0.008; p < 0.05) and RR 6.4 (0.99-41.08). High pre-operative IL-6 levels resulted in worse NCOS 8 weeks postoperative than normal pre-operative IL-6 levels with statistically significantly differences (p=0.002; p < 0.05) and RR 8 (1.24-51.50). Conclusion: Degrees of preoperative (mild) canal stenosis, high pre-operative CRP levels, and high levels of pre-operative IL-6 were predictors for better 8-week NCOS scores in patients with post-decompression-stabilizing-fusion degenerative LSS disease. Key words: Degenerative lumbar spinal stenosis, IL-6, CRP, canal degree stenosis, NCOS.

Uniportal Full-Endoscopic versus Minimally Invasive Decompression for Lumbar Spinal Stenosis: A Meta-analysis

Background In this study, we systematically analyze the effectiveness of the uniportal full-endoscopic (UPFE) and minimally invasive (MIS) decompression for treatment of lumbar spinal stenosis patients. Methods We performed a systematic search in Medline, Embase, Europe PMC, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, China national knowledge infrastructure, and Wanfang Data databases for all relevant studies. All statistical analyses were performed using Review Manager version 5.3. Results A total of 9 articles with 522 patients in the UPFE group and 367 patients in the MIS group were included. The results of the meta-analysis showed that the UPFE group had significantly better results in hospital stay time (mean difference [MD]: –2.05; 95% confidence interval [CI]: –2.87 to –1.23), intraoperative blood loss (MD: –36.56; 95% CI: –54.57 to –18.56), and wound-related complications (MD: –36.56; 95%CI: –54.57 to –18.56) compared with the MIS group, whereas the postoperative clinical scores (MD: –0.66; 95%CI: –1.79 to 0.47; MD: –0.75; 95%CI: –1.86 to 0.36; and MD: –4.58; 95%CI: –16.80 to 7.63), satisfaction rate (odds ratio [OR] = 1.24; 95%CI: 0.70–2.20), operation time (MD: 30.31; 95%CI: –12.55 to 73.18), complication rates for dural injury (OR = 0.60; 95%CI: 0.29–1.26), epidural hematoma (OR = 0.60; 95%CI: 0.29–1.26), and postoperative transient dysesthesia and weakness (OR = 0.73; 95%CI: 0.36–1.51) showed no significant differences between the two groups. Conclusions The UPFE decompression is associated with shorter hospital stay time and lower intraoperative blood loss and wound-related complications compared with MIS decompression for treatment of lumbar spinal stenosis patients. The postoperative clinical scores, satisfaction rate, operation time, complication rates for dural injury, epidural hematoma, and postoperative transient dysesthesia and weakness did not differ significantly between two groups.

Bilateral leg pain and unilateral calf atrophy caused by polymyositis accompanying lumbar spinal stenosis and disc herniation: a case report

Polymyositis is a subgroup of idiopathic inflammatory myopathies characterized by symmetric proximal limb weakness and chronic skeletal muscle inflammation. We herein report the first case of bilateral leg pain and unilateral calf atrophy caused by polymyositis accompanying lumbar spinal stenosis and disc herniation. A 52-year-old man presented with intermittent claudication and calf pain that had become gradually aggravated during the last 3 months. Magnetic resonance imaging showed spinal stenosis at the L3/4 and L4/5 levels and lumbar disc herniation at the L4/5 level. Preoperative laboratory investigations revealed elevated muscle enzyme concentrations. Magnetic resonance imaging also showed atrophy, fatty degeneration, and edema in both calf muscles. Histological examination showed inflammatory myositis and fibrosis in the perifascicular connective tissues. The patient was diagnosed with polymyositis. We performed decompressive laminectomy at the L3/4 and L4/5 levels and discectomy at the L4/5 level. After administration of prednisolone for 6 months and methotrexate for 3 months, the patient’s bilateral calf pain and abnormal laboratory findings improved. The combination of surgical decompression and adequate medical treatment resulted in a successful recovery. Polymyositis should be suspected in patients with lumbar spinal stenosis or lumbar disc herniation who exhibit increased muscle enzyme concentrations or lower extremity muscle atrophy.