• Asian Spine Journal
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• v.12 no.6
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• pp.1085-1091
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• 2018

Study Design: Case-control. Purpose: To determine optimal cut-off value for body mass index (BMI) in predicting surgical success in patients with lumbar spinal canal stenosis (LSCS). Overview of Literature: BMI is an essential variable in the assessment of patients with LSCS. Methods: We conducted a prospective study with obese and non-obese LSCS surgical patients and analyzed data on age, sex, duration of symptoms, walking distance, morphologic grade of stenosis, BMI, postoperative complications, and functional disability. Obesity was defined as BMI of ${\geq}30kg/m^2$. Patients completed the Oswestry Disability Index (ODI) questionnaire before surgery and 2 years after surgery. Surgical success was defined as ${\geq}30%$ improvement from the baseline ODI score. Receiver operating characteristic (ROC) analysis was used to estimate the optimal cut-off values of BMI to predict surgical success. In addition, correlation was assessed between BMI and stenosis grade based on morphology as defined by Schizas and colleague in total, 189 patients were eligible to enter the study. Results: Mean age of patients was $61.5{\pm}9.6years$. Mean follow-up was $36{\pm}12months$. Most patients (88.4%) were classified with grades C (severe stenosis) and D (extreme stenosis). Post-surgical success was 85.7% at the 2-year follow-up. A weak correlation was observed between morphologic grade of stenosis and BMI. Rates of postoperative complications were similar between patients who were obese and those who were non-obese. Both cohorts had similar degree of improvement in the ODI at the 2-year followup. However, patients who were non-obese presented significantly higher surgical success than those who were obese. In ROC curve analysis, a cut-off value of ${\leq}29.1kg/m^2$ for BMI in patients with LSCS was suggestive of surgical success, with 81.1% sensitivity and 82.2% specificity (area under the curve, 0.857; 95% confidence interval, 0.788-0.927). Conclusion: This study showed that the BMI can be considered a parameter for predicting surgical success in patients with LSCS and can be useful in clinical practice.

• Physical Therapy Korea
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• v.25 no.1
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• pp.1-11
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• 2018

Background: The continuous co-contraction of the trunk muscles through trunk stabilization exercises is important to patients with lumbar spinal stenosis (LSS). However, intentional abdominal muscle contraction (IAMC) for trunk stabilization has been used only for specific training in the treatment room. Objects: The purpose of this study was to provide feedback to adults with LSS to enable IAMC during activities of daily living (ADLs). Methods: The participants with spinal stenosis were divided into an experimental group of 15 adults and a control group of 16 adults. Electromyographic signals were measured while the subjects kept their both hands held up at $90^{\circ}$. The measured muscles were the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES). Pelvic tilt was measured using a digital pelvic inclinometer. The degree of pain was measured using the visual analogue scale (VAS) and functional capacity was measured using the Korean version of the Oswestry disability index (KODI). Results: While the experimental group showed statistically significantly higher activities in the RA, EO, and IO after the intervention compared with the control group. Pelvic tilt was significantly decreased only in the experimental group. Both the experimental and control groups exhibited statistically significant declines in the VAS and KODI (p<.01). In terms of the levels of changes, the experimental group exhibited a statistically significant larger decline only in the VAS and the pelvic tilt when compared with the control group (p<.05). Conclusions: The subjects could stabilize their trunks, and relieve their pain and dysfunctions and reduce pelvic tilt by learning abdominal muscle contraction during ADLs. The combination of therapeutic exercises and IAMC may have greater effects on patients with LSS.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.305-311
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• 2009

Objective : The purpose of this study was to determine the efficacy, radiological findings, clinical outcomes and complications in patients with lumbar stenosis and osteoporosis after the use of polymethylmethacrylate (PMMA) augmentation of a cannulated pedicle screw. Methods : Thirty-seven patients with degenerative spinal stenosis and osteoporosis (T-score < -2.5) underwent lumbar fusion using the Dream Technology Pedicle Screw ($DTPS^{TM}$, Dream Spine Total Solutions, Dream STS, Seoul. Korea) between 2005 and 2007. The clinical outcomes were evaluated by using the visual analog scale (VAS) and the Prolo scale. Radiologic findings were documented through computed tomography (CT) and plain films. Results : Thirty-seven patients were evaluated and included, 2 males and 35 females with an average bone mineral density (BMD) of $0.47g/cm^2$. The average age of the patients was 68.7 (range, 57-88). The preoperative VAS for low back and leg pain ($7.87{\pm}0.95$ and $8.82{\pm}0.83$) were higher as compared with postoperative VAS ($2.30{\pm}1.61$ and $1.42{\pm}0.73$) with statistical significance (p = 0.006, p = 0.003). According to the Prolo scale, 11, 22, one and three patients were in excellent, good, fair and poor conditions, respectively. The average amount of the injected cement per one cannulated screw was $1.83{\pm}0.11\;mL$. Conclusion : The results show favorable outcome both clinically and radiographically for 37 patients who underwent lumbar fusion using $DTPS^{TM}$ and PMMA. Based on the results, the use of this surgical method can be a safe and effective option for the operation on the osteoporotic spine.

• Journal of Biomedical Engineering Research
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• v.26 no.3
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• pp.151-155
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• 2005

Interspinous spacers have been developed as an alternative surgical treatment for laminectomy or fusion with pedicle screws and rods for the treatment of lumbar spinal stenosis. However, its biomedical efficacies are well not known. In this study, we evaluated kinematic behaviors of the surgical and the adjacent levels before and after inserting interspinous spacers. Three porcine lumbar spines were prepared. On each specimen, an interspinous spacer was inserted at the L4-L5. Flexion-extension moments (0, 2.5, 5.0, 7.5, 10Nm) were applied. A stereophotogrammetric set-up with DLT algorithm was used to assess the three-dimensional motions of the specimen where three markers $({\square}0.8mm)$ were attached to each vertebra. Results showed that extension motion decreased by $15-24\%$ at the surgical level (L4-L5) after insertion of interspinous spacer. At the adjacent levels, the range of motion remained unchanged. In flexion, no significant changes in motion were observed regardless of levels. Therefore, our experimental results demonstrated the interspinous spacer is very effective in limiting the extension motion that may cause narrowing of the spinal canal and vertebral foramen while maintaining kinematic behaviors at the adjacent levels. Further, these results suggested that the use of interspinous spacer may be able to prevent lower back pain at the surgical level and to lower the incidence of degenerative changes at the adjacent levels.

• The Journal of the Korean bone and joint tumor society
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• v.17 no.2
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• pp.106-110
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• 2011

In the patient who has intradural mass associated with spinal stenosis, if the operation for spinal stenosis is performed alone, the symptom may remain. We report with literature review that we achieved the successful outcome after simultaneous decompression of spinal stenosis and space occupying mass removal in the case of intradural and extradural compression. A 71-year-old female patient suffering from low back pain and radiating pain of both lower extremities admitted. In magnetic resonance imaging, spinal stenosis on L4-5 and spondylolisthesis on L5-S1 compressed dural sac and intradural space occupying mass on L4 level compressed. By posterior approach, decompression and interbody fusion were carried out. Then mass was removed with median durotomy. Pathologic diagnosis was schwannoma and the symptom was improved remarkably.

• Journal of Korean Neurosurgical Society
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• v.41 no.3
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• pp.207-209
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• 2007

We present an elderly patient with unilateral foraminal stenosis treated by isthmus resection. An 83-year-old female could not walk due to severe leg pain along right L5 sensory dermatome. Despite the laminotomy for spinal stenosis on the right side at the L4-5 level, her leg pain did not improve. Careful review of computed tomography scans and coronal source images of magnetic resonance myelography revealed foraminal stenosis on the right side at the L5 vertebra. Because of medical problem, she underwent isthmus resection on the right side at the L5 level instead of total facetectomy and fusion. After surgery, her leg pain was markedly improved. Isthmus resection showed successful result for this medically compromised elderly patient with unilateral foraminal stenosis.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2004.10a
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• pp.1207-1210
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• 2004

As many humans age, degenerative lumbar spinal stenosis (DLSS) becomes a major cause of lower limb discomfort and disability. By surgical treatment method of DLSS, the existing surgical treatment methods using internal fixation have showed degeneration changes of an adjacent vertebrae and loss of lumbar spine lordosis-kyphosis due to eliminating a motion. For solving the problems of internal fixation, a novel interspinous spacer has been developed to treat DLSS by surgical treatment method. In this study, we evaluated the biomechanical effects of the interspinous spacer on the kinematics of the porcine lumbar spine before and after insertion of the implant. For this purpose, a device that is capable of measuring 3-D motions were built based on direct linear transformation (DLT) algorithm written with MATLAB program. Results showed that in extension, a change of the mean angle between the intact and the implanted specimens at L4-L5 was 1.87 degree difference and the implant reduced the extension range of motion of the L4-L5 (p＆lt;0.05). But the range of motion in flexion, axial rotation and lateral bending at the adjacent segments was not statistically affected by the implant. In conclusion, we thought that interspinous spacer may have remedical value for DLSS by flexing human lumbar spine.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.315-322
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• 2014

Objective : Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods : A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results : A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance ($R^2=0.286$, p=0.0005). Conclusion : Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.

• Journal of Korean Neurosurgical Society
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• v.47 no.5
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• pp.352-357
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• 2010

Objective : This retrospective study was performed to evaluate the clinical and radiological results of anterior lumbar interbody fusion (ALIF) using two different stand-alone cages in the treatment of lumbar intervertebral foraminal stenosis (IFS). Methods : A total of 28 patients who underwent ALIF at L5-S1 using stand-alone cage were studied [Stabilis$^{(R)}$ (Stryker, Kalamazoo, MI, USA); 13, SynFix-LR$^{(R)}$ (Synthes Bettlach, Switzerland); 15]. Mean follow-up period was 27.3 ${\pm}$ 4.9 months. Visual analogue pain scale (VAS) and Oswestry disability index (ODI) were assessed. Radiologically, the change of disc height, intervertebral foraminal (IVF) height and width at the operated segment were measured, and fusion status was defined. Results : Final mean VAS (back and leg) and ODI scores were significantly decreased from preoperative values (5.6 ${\pm}$ 2.3 ${\rightarrow}$ 2.3 ${\pm}$ 2.2, 6.3 ${\pm}$ 3.2 ${\rightarrow}$1.6 ${\pm}$ 1.6, and 53.7 ${\pm}$ 18.6 ${\rightarrow}$ 28.3 ${\pm}$ 13.1, respectively), which were not different between the two devices groups. In Stabilis$^{(R)}$ group, postoperative immediately increased disc and IVF heights (10.09 ${\pm}$ 4.15 mm ${\rightarrow}$ 14.99 ${\pm}$ 1.73 mm, 13.00 ${\pm}$ 2.44 mm ${\rightarrow}$ 16.28 ${\pm}$ 2.23 mm, respectively) were gradually decreased, and finally returned to preoperative value (11.29 ${\pm}$ 1.67 mm, 13.59 ${\pm}$ 2.01 mm, respectively). In SynFix-LR$^{(R)}$ group, immediately increased disc and IVF heights (9.60 ${\pm}$ 2.82 mm ${\rightarrow}$ 15.61 ${\pm}$ 0.62 mm, 14.01 ${\pm}$ 2.53 mm ${\rightarrow}$ 21.27 ${\pm}$ 1.93 mm, respectively) were maintained until the last follow up (13.72 ${\pm}$ 1.21 mm, 17.87 ${\pm}$ 2.02 mm, respectively). The changes of IVF width of each group was minimal pre- and postoperatively. Solid arthrodesis was observed in 11 patients in Stabilis group (11/13, 84.6%) and 13 in SynFix-LR$^{(R)}$ group (13/15, 86.7%). Conclusion : ALIF using stand-alone cage could assure good clinical results in the treatment of symptomatic lumbar IFS in the mid-term follow up. A degree of subsidence at the operated segment was different depending on the device type, which was higher in Stabilis$^{(R)}$ group.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.610-614
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• 2016

Objective : The purpose of this study was to present the outcome of the microsurgical foraminotomy via Wiltse paraspinal approach for foraminal or extraforaminal (FEF) stenosis at L5-S1 level. We investigated risk factors associated with poor outcome of microsurgical foraminotomy at L5-S1 level. Methods : We analyzed 21 patients who underwent the microsurgical foraminotomy for FEF stenosis at L5-S1 level. To investigate risk factors associated with poor outcome, patients were classified into two groups (success and failure in foraminotomy). Clinical outcomes were assessed by the visual analogue scale (VAS) scores of back and leg pain and Oswestry disability index (ODI). Radiographic parameters including existence of spondylolisthesis, existence and degree of coronal wedging, disc height, foramen height, segmental lordotic angle (SLA) on neutral and dynamic view, segmental range of motion, and global lumbar lordotic angle were investigated. Results : Postoperative VAS score and ODI improved after foraminotomy. However, there were 7 patients (33%) who had persistent or recurrent leg pain. SLA on neutral and extension radiographic films were significantly associated with the failure in foraminotomy (p<0.05). Receiver-operating characteristics curve analysis revealed the optimal cut-off values of SLA on neutral and extension radiographic films for predicting failure in foraminotomy were $17.3^{\circ}$ and $24^{\circ}s$, respectively. Conclusion : Microsurgical foraminotomy for FEF stenosis at L5-S1 level can provide good clinical outcomes in selected patients. Poor outcomes were associated with large SLA on preoperative neutral (>$17.3^{\circ}$) and extension radiographic films (>$24^{\circ}$).