• Title, Summary, Keyword: Spinal stenosis

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Anterior Epidural Irrigation in a Lumbar Spinal Stenosis Patient (척추관 협착증 환자에서 전 경막외강 세정요법)

  • Lee, Jun Seok;Kwon, Hong Tae;Park, Chan Hong
    • The Korean Journal of Pain
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    • v.19 no.1
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    • pp.63-67
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    • 2006
  • Background: Pain due to spinal stenosis is one of the major causes of low back pain, and it sometimes does not respond to conservative treatment. We postulated that anterior epidural irrigation could be a good choice for treating lumbar spinal stenosis patients. However, the effects and theoretical basis of anterior epidural irrigation have not been investigated for spinal stenosis. So, this study was designed to identify the clinical efficacy of anterior epidural irrigation for treating lumbar spinal stenosis. Methods: 71 patients with lumbar spinal stenosis underwent anterior epidural irrigation. Anterior epidural irrigation was performed with normal saline and a mixture of local anesthetic with steroid through a catheter under fluoroscopic guidance. The findings were evaluated with using visual analogue scales for low back pain and leg symptoms. Results: Relief from low back pain and leg pain was observed for up to 12 months after anterior epidural irrigation. None of the patients showed any deterioration of their motor or sensory deficits during follow up. Conclusions: Anterior epidural irrigation is effective for the relief of back and leg pain in spinal stenosis patients.

Atypical Guillain-Barr$\acute{e}$ Syndrome Misdiagnosed as Lumbar Spinal Stenosis

  • Jung, Dae Young;Cho, Keun-Tae;Lee, Seung Chul
    • Journal of Korean Neurosurgical Society
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    • v.53 no.4
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    • pp.245-248
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    • 2013
  • Guillain-Barr$\acute{e}$ syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy. In typical cases, the first symptoms of GBS are pain, numbness, paresthesia, weakness in the limbs. Autonomic involvement is common and causes urinary retention and ileus. Much of these symptoms overlap with those of lumbar spinal stenosis. Therefore, correct diagnosis of GBS in a patient with symptomatic lumbar spinal stenosis or in a patient with atypical manifestations of GBS can be difficult, especially early in the course of GBS. Here, we report on a case of atypical GBS in a 74-year-old previously healthy patient with lumbar spinal stenosis and discuss the differential diagnosis of the GBS and lumbar spinal stenosis.

Chuna Manual Therapy for Lumbar Spinal stenosis : A Systematic Review (요추 척추관협착증에 대한 추나요법의 효과 : 체계적 문헌 고찰)

  • Lim, Kyeong-Tae;Shin, Byung-Cheul;Heo, In;Hwang, Man-Suk
    • The Journal of Korea CHUNA Manual Medicine for Spine and Nerves
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    • v.13 no.2
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    • pp.1-10
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    • 2018
  • Objectives : To evaluate the evidence supporting the effectiveness and safety of Chuna manual therapy(CMT) for lumbar spinal stenosis Methods : We searched 10 electronic databases(Pubmed, EMBASE, Cochrane Library, CAJ, RISS, KISS, KISTI, KMBASE, DBpia, NDSL) and related 2 journals up to October 2018. We included randomized controlled trials(RCTs) of testing CMT for lumbar spinal stenosis patients. The methodological quality of RCTs related assessed by the Cochrane risk of bias tool 1.0. Results : Three RCTs were eligible in our inclusion criteria. The meta-analysis of 3 studies showed positive results for the using CMT for lumbar spinal stenosis. Conclusions : The review found favorable evidence of CMT for treating lumbar spinal stenosis with meta-analysis. However, our systematic review has limited evidence to support CMT for lumbar spinal stenosis because of low quality of original articles and further well-designed RCTs should be encouraged.

The Impact of Joint Mobilization and Transcutaneous Electrical Nerve Stimulation on Pain in Patients With Lumbar Spinal Stenosis

  • Go, Jun Hyeok;An, Ho Jung
    • Journal of International Academy of Physical Therapy Research
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    • v.10 no.1
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    • pp.1746-1749
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    • 2019
  • Background: Surgery has been known as an inefficient approach to reduce back pain in patients with lumbar spinal stenosis; therefore, non-surgical treatments are necessary. However, there has been little research to analyze the effect of non-surgical treatments on lumbar spinal stenosis pain. Objective: To identify the effectiveness of 2 physiotherapeutic treatment approaches to relieve pain due to lumbar spinal stenosis. Design: Randomized controlled trial Methods: The participants were 36 lumbar spinal stenosis patients who were randomized in the joint mobilization group (JMG) and transcutaneous electrical nerve stimulation group (TENSG). Joint mobilization (JM) was conducted at the posteroanterior joint in the spinous process of the lumbar spine with stenosis. Transcutaneous electrical nerve stimulation (TENS) was applied on the lumbar spine with stenosis at a high frequency and intensity. Results: Visual analog scale (VAS) pain score significantly decreased in both groups, and the VAS value decreased more after JMG than that after TENSG. The pain thresholds of both groups also significantly increased, and that of JMG increased more compared to TENSG. In both the groups, significant improvements in VAS and pain thresholds were found, and JMG showed better results than TENSG. Conclusions: JM and TENS showed significant relief in both pain threshold and painpain, and JM showed more advanced relief compared to TENS.

The Clinical Study on Effects of Bee Venom Pharmacupuncture Therapy in Patients with Lumbar Spinal Stenosis (요추관 협착증에 대한 봉약침 병행 치료 효과의 임상적 연구)

  • Jeong, Seon-Mee;Park, Chan-Kyu;Kim, Kwang-Ho;Kim, Ja-Young;Sohn, Sung-Chul
    • Journal of Acupuncture Research
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    • v.25 no.1
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    • pp.97-106
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    • 2008
  • Objectives : This study was designed to evaluate the effects of Bee Venom Pharmacopuncture therapy in patients with lumbar spinal stenosis. Methods : We investigated 16 patients with lumbar spinal stenosis. We divided patients into two groups : Bee Venom Pharmacopuncture was performed with acupuncture therapy for one group, and the other group received acupuncture therapy only. To evaluate the effectiveness of the treatment applied to the two groups, we used the Visual Analog Scale(VAS) and the Oswestry Low-back Pain Disability Index(ODI). We compared the VAS and ODI scores of the two groups statistically. Results : The Bee Venom Pharmacopuncture group received more effective relief than the acupunctureonly group as measured by decreasedpain and disability reported on the VAS and ODI by patients with lumbar spinal stenosis. Conclusions: Bee Venom Pharmacopuncture therapy can be used in addition to acupuncture therapy for highly effective treatment of patients with lumbar spinal stenosis. Further clinical studies are needed to verify these findings.

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Correlation between lumbar spinal stenosis and bone mineral density : a clinical survey of 9 cases (요추관 협착증과 골밀도와의 상관성에 관한 임상례 보고)

  • Song, Joo-Hyun;Kang, In;Im, Myung-Jang;Kim, Ha-Neul;Lee, Je-Kyun;Jang, Hyoung-Seok
    • The Journal of Korea CHUNA Manual Medicine for Spine and Nerves
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    • v.1 no.1
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    • pp.105-111
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    • 2006
  • Objective : The aim of this study was to evaluate association between lumbar spinal stenosis, one of degenerative diseases, and bone mineral density. Methods : We monitored 9 lumbar spinal stenosis patients in women above 50 years, visiting outpatient clinic of the Jaseng Oriental Medicine Hospital between January 5 2006 and March 31, 2006. They were diagnosed by radiologist ist after taking Magnetic Resonance Imaging(MRI). The cases were Investigated the bone mineral density using Dual Energy X-ray Absorptiomerty(DEXA). and then Picture Archiving Communication System(PACS) were used to assess correlation between lumbar spinal stenosis and bone mineral density. Results : 1. In comparison of the spinal canal area and lumbar spine 2 level bone mineral density, the data showed a significant result 2. The data, between spinal canal area and lumbar spine 1-2 level bone mineral density, indicated a significant result. 3. Also, the result of comparison between spinal canal area and the lowest value of bone mineral density showed significance. Conclusions : It showed that there is a statistically significant correlation between lumbar spinal stenosis and bone mineral density.

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Using Magnetic Resonance Myelography to Improve Interobserver Agreement in the Evaluation of Lumbar Spinal Canal Stenosis and Root Compression

  • Al-Tameemi, Haider Najim;Al-Essawi, Sattar;Shukri, Mahmud;Naji, Farah Kasim
    • Asian Spine Journal
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    • v.11 no.2
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    • pp.198-203
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    • 2017
  • Study Design: Cross-sectional retrospective study designed to assess interobserver agreement. Purpose: To investigate if interobserver agreement using magnetic resonance imaging (MRI) in the evaluation of lumbar spinal canal stenosis and root compression can be improved upon combination with magnetic resonance myelography (MRM). Overview of Literature: The interpretation of lumbar spinal MRI, which is the imaging modality of choice, often has a significant influence on the diagnosis and treatment of low back pain. However, using MRI alone, substantial interobserver variability has been reported in the evaluation of lumbar spinal canal stenosis and nerve root compression. Methods: Hardcopies of 30 lumbar spinal MRI (containing a total of 150 disk levels) as well as MRM films were separately reviewed by two radiologists and a neurosurgeon. At each intervertebral disk, the observers were asked to evaluate the thecal sac for the presence and degree of spinal stenoses (mild, moderate, or severe) and presence of root canal compression. Interobserver agreement was measured using weighted kappa statistics. Results: Regarding lumbar spinal canal stenosis, interobserver agreement between the two radiologists was moderate (kappa, 0.4) for MRI and good (kappa, 0.6) for combination with MRM. However, the agreement between the radiologist and neurosurgeon remained fair for MRI alone or in combination with MRM (kappa, 0.38 and 033, respectively). In the evaluation of nerve root compression, interobserver agreement between the radiologists improved from moderate (kappa, 0.57) for MRI to good (kappa, 0.73) after combination with MRM; moderate agreement between the radiologist and neurosurgeon was noted for both MRI alone and after combination with MRM (kappa, 0.58 and 0.56, respectively). Conclusions: Interobserver agreement in the evaluation of lumbar spinal canal stenosis and root compression between the radiologists improved when MRM was combined with MRI, relative to MRI alone.

Limited Unilateral Decompression and Pedicle Screw Fixation with Fusion for Lumbar Spinal Stenosis with Unilateral Radiculopathy : A Retrospective Analysis of 25 Cases

  • Zhang, Li;Miao, Hai-xiong;Wang, Yong;Chen, An-fu;Zhang, Tao;Liu, Xiao-guang
    • Journal of Korean Neurosurgical Society
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    • v.58 no.1
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    • pp.65-71
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    • 2015
  • Objective : Lumbar spinal stenosis is conventionally treated with surgical decompression. However, bilateral decompression and laminectomy is more invasive and may not be necessary for lumbar stenosis patients with unilateral radiculopathy. We aimed to report the outcomes of unilateral laminectomy and bilateral pedicle screw fixation with fusion for patients with lumbar spinal stenosis and unilateral radiculopathy. Methods : Patients with lumbar spinal stenosis with unilateral lower extremity radiculopathy who received limited unilateral decompression and bilateral pedicle screw fixation were included and evaluated using visual analog scale (VAS) pain and the Oswestry Disability Index (ODI) scores preoperatively and at follow-up visits. Ligamentum flavum thickness of the involved segments was measured on axial magnetic resonance images. Results : Twenty-five patients were included. The mean preoperative VAS score was $6.6{\pm}1.6$ and $4.6{\pm}3.1$ for leg and back pain, respectively. Ligamentum flavum thickness was comparable between the symptomatic and asymptomatic side (p=0.554). The mean follow-up duration was 29.2 months. The pain in the symptomatic side lower extremity (VAS score, $1.32{\pm}1.2$) and the back (VAS score, $1.75{\pm}1.73$) significantly improved (p=0.000 vs. baseline for both). The ODI improved significantly postoperatively ($6.60{\pm}6.5$; p=0.000 vs. baseline). Significant improvement in VAS pain and ODI scores were observed in patients receiving single or multi-segment decompression fusion with fixation (p<0.01). Conclusion : Limited laminectomy and unilateral spinal decompression followed by bilateral pedicle screw fixation with fusion achieves satisfactory outcomes in patients with spinal stenosis and unilateral radiculopathy. This procedure is less damaging to structures that are important for maintaining posterior stability of the spine.

Central Decompressive Laminoplasty for Treatment of Lumbar Spinal Stenosis : Technique and Early Surgical Results

  • Kwon, Young-Joon
    • Journal of Korean Neurosurgical Society
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    • v.56 no.3
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    • pp.206-210
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    • 2014
  • Objective : Lumbar spinal stenosis is a common degenerative spine disease that requires surgical intervention. Currently, there is interest in minimally invasive surgery and various technical modifications of decompressive lumbar laminectomy without fusion. The purpose of this study was to present the author's surgical technique and results for decompression of spinal stenosis. Methods : The author performed surgery in 57 patients with lumbar spinal stenosis between 2006 and 2010. Data were gathered retrospectively via outpatient interviews and telephone questionnaires. The operation used in this study was named central decompressive laminoplasty (CDL), which allows thorough decompression of the lumbar spinal canal and proximal two foraminal nerve roots by undercutting the lamina and facet joint. Kyphotic prone positioning on elevated curvature of the frame or occasional use of an interlaminar spreader enables sufficient interlaminar working space. Pain was measured with a visual analogue scale (VAS). Surgical outcome was analyzed with the Oswestry Disability Index (ODI). Data were analyzed preoperatively and six months postoperatively. Results : The interlaminar window provided by this technique allowed for unhindered access to the central canal, lateral recess, and upper/lower foraminal zone, with near-total sparing of the facet joint. The VAS scores and ODI were significantly improved at six-month follow-up compared to preoperative levels (p<0.001, respectively). Excellent pain relief (>75% of initial VAS score) of back/buttock and leg was observed in 75.0% and 76.2% of patients, respectively. Conclusion : CDL is easily applied, allows good field visualization and decompression, maintains stability by sparing ligament and bony structures, and shows excellent early surgical results.

Dynamic Lumbar Spinal Stenosis : The Usefulness of Axial Loaded MRI in Preoperative Evaluation

  • Choi, Kyung-Chul;Kim, Jin-Sung;Jung, Byung-Joo;Lee, Sang-Ho
    • Journal of Korean Neurosurgical Society
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    • v.46 no.3
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    • pp.265-268
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    • 2009
  • Two cases of dynamic lumbar spinal stenosis were identified by the authors using axial loaded magnetic resonance image (MRI). In both cases, the patients presented with neurogenic claudication but MRI in decumbency showed no definite pathologic condition associated with their symptoms. In contrast, axial loaded MRI demonstrated constrictive spinal stenosis and a significantly decreased dural sac caused by epidural fat buckling and thickening of the ligamentum flavum in both cases. In the second case, a more prominent disc protrusion was also demonstrated compared with decumbent MRI. After decompressive surgery, both patients had satisfactory outcomes. Axial loaded MRI can therefore give decisive information in dynamic spinal disorders by allowing simulation of an upright position.