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- Hermansen, Erland, et al.
(author)
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Dural Sac Cross-sectional area change from preoperatively and up to 2 years after decompressive surgery for central lumbar spinal stenosis: investigation of operated levels, data from the NORDSTEN study
- 2024
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In: EUROPEAN SPINE JOURNAL. - 0940-6719 .- 1432-0932.
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Journal article (peer-reviewed)abstract
- PurposeThe aim of the present study was to investigate how canal area size changed from before surgery and up to 2 years after decompressive lumbar surgery lumbar spinal stenosis. Further, to investigate if an area change postoperatively (between 3 months to 2 years) was associated with any preoperative demographic, clinical or MRI variables or surgical method used.MethodsThe present study is analysis of data from the NORDSTEN- SST trial where 437 patients were randomized to one of three mini-invasive surgical methods for lumbar spinal stenosis. The patients underwent MRI examination of the lumbar spine before surgery, and 3 and 24 months after surgery. For all operated segments the dural sac cross-sectional area (DSCA) was measured in mm2. Baseline factors collected included age, gender, BMI and smoking habits. Furthermore, surgical method, index level, number of levels operated, all levels operated on and baseline Schizas grade were also included in the analysis.Results437 patients were enrolled in the NORDSTEN-SST trial, whereof 310 (71%) had MRI at 3 months and 2 years. Mean DSCA at index level was 52.0 mm2 (SD 21.2) at baseline, at 3 months it increased to 117.2 mm2 (SD 43.0) and after 2 years the area was 127.7 mm2 (SD 52.5). Surgical method, level operated on or Schizas did not influence change in DSCA from 3 to 24 months follow-up.ConclusionThe spinal canal area after lumbar decompressive surgery for lumbar spinal stenosis increased from baseline to 3 months after surgery and remained thereafter unchanged 2 years postoperatively.
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- Pazarlis, Konstantinos, MD, 1983-
(author)
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On the Diagnosis and Treatment of Lumbar Spinal Stenosis
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Lumbar spinal stenosis (LSS) is the most common indication for spinal surgery. The aging global population is increasing the demand for strategies that promote physical activity among the elderly. As the prevalence of LSS rises, the condition gains constantly demographic and socioeconomic attention. Until recently, there has been no clear consensus regarding LSS treatment. Further, using electrodiagnostic examinations (EDX) as predictive tools to identify surgical candidates, could lead to a more tailored medical approach. Methodological issues in previous studies have left some questions unanswered. The necessity of extensive surgery for LSS remains a topic of debate among spinal surgeons, which this work addressed by analyzing data from 723 patients. Parts of the work aimed to compare surgery and structured non-surgical treatment for LSS (Paper I, II, III). Furthermore, it aimed to investigate, by means of EDX, whether the degree of neurological affection correlates to the surgical outcome of LSS (Paper I, II). Additionally, this work evaluated the radiological outcome for surgical vs non-surgical treatment for LSS in terms of sagittal balance parameters (Paper III, V). Finally, parts of this thesis aimed to confirm findings from previous studies regarding DA and DF for LSS with DS (Paper IV, V). The current thesis is based on two randomized controlled trials and a cohort study: the Uppsala Spinal Stenosis Trial, the Swedish Spinal Stenosis Study, and the Cohort Study on LSS with DS. Patient reported outcome measures from the Swedish National Quality Registry for Spine Surgery (Swespine) were used to collect follow-up data. We concluded that at six months, surgery with decompression leads to superior clinical outcome, compared to structured physical therapy. The improvement is not affected by delay of surgery (Paper II). EDX does not add predictive value when assessing the patients for eligibility before surgery (Paper II). DA improves the spinal sagittal balance, regardless of preoperative DS (Paper III) and provides good two-year clinical outcome in LSS with DS with low rate of complications, and low need for subsequent surgery (Paper IV). New radiological stenosis was less common two years after DA than after DF, in LSS with or without preoperative DS (Paper V).
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- Wänman, Johan, et al.
(author)
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The association between lumbar lordosis preoperatively and changes in PROMs for lumbar spinal stenosis patients 2 years after spinal surgery: radiological and clinical results from the NORDSTEN-spinal stenosis trial
- 2024
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In: EUROPEAN SPINE JOURNAL. - : Springer. - 0940-6719 .- 1432-0932.
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Journal article (peer-reviewed)abstract
- BackgroundPatients with lumbar spinal stenosis (LSS) sometimes have lower lumbar lordosis (LL), and the incidence of LSS correlates closely with the loss of LL. The few studies that have evaluated the association between LL and clinical outcomes after non-instrumented surgery for LSS show conflicting results. This study investigates the association between preoperative LL and changes in PROMs 2 years after decompressive surgery.MethodThis prospective cohort study obtained preoperative and postoperative data for 401 patients from the multicenter randomized controlled spinal stenosis trial as part of the NORwegian degenerative spondylolisthesis and spinal STENosis (NORDSTEN) study. Before surgery, the radiological sagittal alignment parameter LL was measured using standing X-rays. The association between LL and 2-year postoperative changes was analyzed using the oswestry disability index (ODI), a numeric rating scale (NRS) for low back and leg pain, the Zurich claudication questionnaire (ZCQ), and the global perceived effect (GPE) score. The changes in PROMs 2 years after surgery for quintiles of lumbar lordosis were adjusted for the respective baseline PROMs: age, sex, smoking, and BMI. The Schizas index and the Pfirrmann index were used to analyze multiple regressions for changes in PROMs.ResultsThere were no associations in the adjusted and unadjusted analyses between preoperative LL and changes in ODI, ZCQ, GPE, and NRS for back and leg pain 2 years after surgery.ConclusionLL before surgery was not associated with changes in PROMs 2 years after surgery. Lumbar lordosis should not be a factor when considering decompressive surgery for LSS.
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- Åkerstedt, Josefin, et al.
(author)
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Change in lumbar lordosis after decompressive surgery in lumbar spinal stenosis patients and associations with patient related outcomes 2 years after surgery : radiological and clinical results from the NORDSTEN spinal stenosis trial
- 2024
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In: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159.
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Journal article (peer-reviewed)abstract
- Study design: A prospective cohort study.Objective: The aim was to investigate changes in lumbar lordosis (LL) and its association to changes in patient reported outcome measures (PROMs) after decompressive surgery for lumbar spinal stenosis (LSS).Summary of background: Few studies have addressed change in LL after decompression surgery for LSS in relation to outcomes.Method: Pre- and postoperative data from 310 patients having standing x-ray both before and 2 years after surgery were included. The patients were grouped based on the change in LL preoperatively to 2 years after surgery; group 1: <5 degrees (n=196), group 2: ≥5 <10 degrees (n=55) or group 3: ≥10 degrees (n=59) of change in LL. The changes in function, disability and pain were assessed by the Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and the Zurich claudication questionnaire (ZCQ). The three groups were compared regarding baseline variables using the ANOVA test for continuous variables and the chi-square test for categorical variables. The groups were further compared with a likelihood ratio test in relation to changes in PROMs 2 year after surgery and outcomes were adjusted for respective baseline PROMs, age, sex, smoking, BMI, Schizas and Pfirrmann scores.Results: LL was significantly changed at group level 2 years after surgery with a mean difference of 2.2 (SD 9.4) degrees (P=0.001). The three LL change groups did not show any significant differences in patient characteristics, function, disability, and pain at baseline. The two groups with a change of more than 5 degrees in LL 2 year after surgery (group 2 and 3) had significantly greater improvements in ODI (P=0.022) and ZCQ function (P=0.016) in the adjusted analyses, but was not significant for back and leg painConclusion: Changed LL after decompressive surgery for LSS was associated with improved ODI and physical function.
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