The spine journal : official journal of the North American Spine Society
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Lumbar epidural steroid injection (LESI) is a valuable therapeutic option when administered to the appropriate patient, for the appropriate disease process, at the appropriate time. There is considerable variability in patient-reported outcomes (PROs) after LESI, creating uncertainty as to who will benefit from the therapy and who will not. ⋯ We have identified patient attributes that are important predictors for the achievement of MCID in ODI 3 months after LESI. The use of these attributes, in the form of a predictive model for LESI efficacy, has the potential to improve decision making around LESI. Spine care providers can use the information to gain insight into the likelihood that a particular patient will experience a meaningful benefit from LESI.
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The extraforaminal ligaments between the L5 and S1 lumbar spinal nerves and the tissues surrounding the intervertebral foramina have been well studied. However, little research has been undertaken to describe the local anatomy of the intraforaminal portion of the L5-S1 spine and detailed anatomical studies of the intraforaminal ligaments (IFLs) of the L5-S1 have not been performed. ⋯ The results demonstrate that IFLs are common structures in the IVF and that there are two types of IFLs: the transforaminal ligaments and the radiating ligaments. Transforaminal ligaments may be the potential cause of back pain. The radiating ligaments may contribute to dura laceration and epidural hemorrhage during endoscopic spinal adhesiolysis through the sacral hiatus, and an appreciation of this relationship might help reduce the risk of such complications.
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Degenerative lumbar stenosis (DLS) patients have been reported to lean forward in an attempt to provide neural decompression. Spinal alignment in patients with DLS may resemble that of adult spinal deformity (ASD). No previous studies have compared and contrasted the compensatory mechanisms of DLS and ASD patients. ⋯ Patients with DLS permit mild to moderate deformity without recruiting compensatory mechanisms of PT, reducing truncal inclination and thoracic hypokyphosis to achieve neural decompression. However, with moderate to severe deformity, their desire for upright posture overrides the desire for neural decompression, evident by the adaptation of compensatory mechanisms similar to that of ASD patients.
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Minimally invasive spine surgery (MIS) procedures carry an inherently difficult learning curve based upon anecdotal evidence. Few studies have investigated the surgeon's learning curve for MIS lumbar laminectomy or laminotomy with or without discectomy. ⋯ Continued surgical experience was associated with a reduced operative time, shorter length of hospitalization, and similar blood loss following an MIS LD. Independent of surgical experience, all patients demonstrated similar improvements in clinical outcomes. These findings appear to suggest that although surgical experience may improve perioperative parameters (operative time, length of hospitalization), an MIS LD may initially be performed safely without prior experience.
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In cervical spondylotic myelopathy (CSM), cervical sagittal alignment (CSA) is associated with disease severity. Increased kyphosis and C2-C7 sagittal vertical axis (SVA) correlate with worse myelopathy and poor outcomes. However, when alignment is lordotic, it is unknown whether these associations persist. ⋯ Although creating more lordosis and decreasing SVA are associated with improved myelopathy and outcomes in patients with kyphosis, our study did not find such associationsin patients with lordosis undergoing posterior laminectomy and fusion for CSM. This suggests that any amount of lordosis may be sufficient.