The spine journal : official journal of the North American Spine Society
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Study of dural sac cross-sectional area in early and late phases after lumbar decompression surgery.
Lumbar magnetic resonance imaging (MRI) in the early phase after lumbar decompression surgery sometimes reveals an absence in the expansion of the dural sac, regardless of the presence or absence of clinical symptoms; the reason for such a condition is often difficult to explain. There are some reports that compared the dural sac area between the preoperative and early postoperative phases; however, no report exists that compares the early and late phases after lumbar decompression surgery. ⋯ The dural sac area increased significantly between the early and late postoperative phases. No significant difference in the dural sac CSA between the early and late postoperative phases was observed with regard to age or the presence/absence of dural sac injury. A smaller preoperative dural sac CSA resulted in a smaller dural sac CSA in the early and late postoperative phases.
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In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. ⋯ We found poor agreement on the morphologic injury characteristics of the SLIC system, and its treatment algorithm showed no improved agreement on treatment decisions among surgeons. The authors discuss that the reproducibility of the SLIC system is likely to improve when unambiguous true morphologic injury characteristics are being implemented.
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It has been controversially stated that pain-related fear is a more important determining factor for disability in chronic low back pain (CLBP) than pain or physical impairment in itself. So far, the relationship between psychological and physiological determinants of chronic pain, that is, pain-related fear and physiological abilities, remains unclear. ⋯ The present study shows that neither the task-specific tool (FVAS) nor the non task-specific questionnaires (TSK and PHODA) were significantly correlated to the spine tests in patients with CLBP. This is contrary to earlier evidence according to which physical capacity is inversely related to the level of pain-related fear, and it suggests that one should not draw conclusions about physical capacity based on pain-related fear scores. Furthermore, the different assessment tools for pain-related fear were surprisingly not correlated with each other.
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Ossification of the ligamentum flavum (OLF) may result in thoracic myelopathy (TM) because of narrowing of the spinal canal. Because symptoms vary and are subjective, diagnosis of TM caused by OLF is sometimes difficult when based on symptoms and physical examination. Posterior decompression is indicated in patients with TM caused by OLF because it is believed that surgery is the most effective treatment. However, surgical outcomes vary. We are unaware of reports of objective presurgical diagnostic parameters, such as neurologic and radiologic findings, relating to the postsurgical prognosis in patients with TM caused by OLF. ⋯ An excellent postoperative prognosis is not always possible in patients with TM caused by OLF. It may be important to check for impairment of joint position sense in the big toe, the number of levels affected by OLF, and presurgical intramedullary signal change on MRI before continuing to surgery.