UNASSIGNED: Synovial cysts occur more frequently in the lumbar spine, especially at L4-5 level. Traditional open surgical management with posterolateral arthrodesis is the currently recommended treatment.
METHODS: This is a 64-year-old woman with no prior pathological history. Initial clinical and radiological assessment concluded that there was advanced right coxarthrosis with a degenerative lumbar spine. The patient therefore had a total hip arthroplasty secondarily presented an intermittent neurogenic claudication without sphincter disorders. The MRI concluded at a compressive synovial facet cyst at the L4-L5 level. The patient underwent surgical treatment. At two years postoperatively, the walking distance was significantly improved while maintaining moderate lower back pain.
UNASSIGNED: The diagnosis of synovial facet cysts of spine is a challenge that depends heavily on history, physical examination, and MRI. MRI will demonstrate not only the nature of the cystic lesion, but also its relationship to the root, the cord or the thecal sac. The L4-L5 level of the lumbar spine is the most common location of the synovial cyst of the facet joints. As in our case, surgical treatment combining posterolateral arthrodesis is currently recommended for these types of lesions. Surgical treatment, as in our case, is sometimes delayed when this pathology is associated with advanced osteoarthritis of the hips.
CONCLUSIONS: Improved imaging capabilities such as magnetic resonance imaging (MRI) have resulted in increased reporting, diagnostic yield and treatment of spinal synovial cysts. Surgical treatment combining posterolateral arthrodesis is the treatment for this lesion.

BACKGROUND: Researchers have recently linked hysterectomy, which alters sex hormone levels, to diseases like osteoporosis, lumbar spondylolisthesis, hypertension and diabetes etc. However, the association between hysterectomy and lumbar disc herniation (LDH)/lumbar spinal stenosis (LSS) remains unclarified.
OBJECTIVE: To determine whether there is a correlation between hysterectomy and surgical intervention for LDH/LSS in women, further substantiated through imaging and clinical research.
METHODS: A case control and cohort study.
METHODS: The study group comprised 1202 female patients aged 45 and older who had undergone operative treatment due to LDH/LSS (825 for LDH and 377 for LSS), and the comparison group comprised 1168 females without lumbar diseases who visited health examination clinic during the same period. One hundred and 2 hysterectomized patients were further selected (Hysterectomy cohort) and matched approximately with the control cohort at a 1:2 ratio from the study group with a minimum follow-up of 2 years.
METHODS: Odds Ratios (ORs) and 95% Confidence Intervals (CIs) were calculated to assess the association between hysterectomy and surgical intervention for LDH/LSS in women after adjusted by confounding factors. Patients from both the hysterectomy and control cohorts underwent a comprehensive assessment. This assessment included the evaluation of several parameters: the functional cross-sectional area, fat infiltration rate, relative functional cross-sectional area of the lumbar paravertebral muscles, facet joint degeneration grade, cartilage endplate damage, Modic changes for the L3/4-L5/S1 segments, Pfirrmann grade of lumbar disc degeneration, and disc height index for the L1/2-L5/S1 segments. Additionally, the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) scores were recorded preoperatively and at the last follow-up.
METHODS: Associations between hysterectomy and patients treated surgically for LDH or LSS were analyzed using multivariate binomial logistic regression analysis. Lumbar X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) were used to evaluate the imaging variables. Imaging and clinical variables were compared.
RESULTS: Hysterectomized women were associated with requiring surgery due to LDH/LSS, with ORs of 2.613 (p<.001) and 2.084 (p=.006), respectively. The imaging evaluation further revealed that the hysterectomy cohort had more severe degeneration of the paraspinal muscles, facet joints, endplates, and intervertebral discs, Modic changes at L3/4-L5/S1 segments, and intervertebral height reduction at L1/2-L5/S1 segments when compared to the control cohort (p<.01). Compared to the control cohort, the hysterectomy cohort exhibited higher preoperative and last follow-up VAS scores for low back pain, and last follow-up JOA scores (p<.01).
CONCLUSIONS: Based on the findings of this study, it seems that women who have had a hysterectomy are correlated with requiring surgical intervention due to LDH/LSS. Imaging and clinical studies also indicate that hysterectomized patients exhibited more severe lumbar degeneration and back pain.

BACKGROUND: Transforaminal full-endoscopic spine surgery (FESS) is the least invasive spinal surgery and can be performed under local anesthesia. In Japan, the population is rapidly aging and the number of spinal surgeries performed in the elderly is also increasing.
OBJECTIVE: In this report, we describe 3 patients aged 90 years or older in whom we performed FESS under local anesthesia.
METHODS: The first case was a 90-year-old man who presented with severe leg pain. He had multiple medical comorbidities and was unsuitable for general anesthesia. We performed FESS. After surgery, the leg pain resolved with full recovery of muscle strength. He was discharged with no perioperative complications. The second case was a 90-year-old man who presented with severe leg pain. MRI showed a herniated nucleus pulposus and foraminal stenosis at L4/5. We performed FESS. The leg pain improved immediately after surgery. The third case was a 91-year-old woman in whom we diagnosed left L5 radiculopathy due to foraminal stenosis at L5/S1. After surgery, her leg pain was relieved.
CONCLUSIONS: FESS is a good surgical procedure for elderly patients who are in a poor general condition because it is minimally invasive and can be performed under local anesthesia with early mobilization. J. Med. Invest. 71 : 169-173, February, 2024.

OBJECTIVE: Given the distinct physiological and societal traits between women and men, we propose that there are distinct risk factors for lumbar degenerative disc disease surgeries, including lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS), in middle-aged and older populations. However, few studies have focused on middle-aged and older women. This study aims to identify these risk factors specifically in this population.
METHODS: In this case-control study, the study group comprised 1202 women aged ≥ 45 years who underwent operative treatment of lumbar degenerative disc disease (LDH, n = 825; LSS, n = 377), and the control group comprised 1168 women without lumbar disease who visited a health examination clinic during the same period. The study factors included demographics (age, body mass index [BMI], smoking, labor intensity, and genetic history), female-specific factors (menopausal status, number of deliveries, cesarean section, and simple hysterectomy), surgical history (number of abdominal surgeries, hip joint surgery, knee joint surgery, and thyroidectomy), and systemic diseases (hypercholesterolemia, hypertriglyceridemia, hyper-low-density lipoprotein cholesterolemia, hypertension, diabetes, cardiovascular disease, and cerebrovascular disease). Multivariate binary logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) of associated factors.
RESULTS: The risk factors for surgical treatment of LDH in middle-aged and older women included BMI (OR = 1.603), labor intensity (OR = 1.189), genetic history (OR = 2.212), number of deliveries (OR = 1.736), simple hysterectomy (OR = 2.511), hypertriglyceridemia (OR = 1.932), and hyper-low-density lipoprotein cholesterolemia (OR = 2.662). For surgical treatment of LSS, the risk factors were age (OR = 1.889), BMI (OR = 1.671), genetic history (OR = 2.134), number of deliveries (OR = 2.962), simple hysterectomy (OR = 1.968), knee joint surgery (OR = 2.527), hypertriglyceridemia (OR = 1.476), hyper-low-density lipoprotein cholesterolemia (OR = 2.413), and diabetes (OR = 1.643). Cerebrovascular disease was a protective factor against surgery for LDH (OR = 0.267).
CONCLUSIONS: BMI, genetic history, number of deliveries, simple hysterectomy, hypertriglyceridemia, and hyper-low-density lipoprotein cholesterolemia were independent risk factors for surgical treatment of both LDH and LSS in middle-aged and older women. Two disparities were found: labor intensity was a risk factor for LDH patients, and knee joint surgery and diabetes were risk factors for LSS patients.

Oblique lateral interbody fusion (OLIF) is a powerful method to treat various spinal conditions and is frequently combined with posterior instrumentation. This is traditionally performed in dual positions, with the patient first in lateral then turned prone. Single position lateral surgery (SPS-L) has been studied in a bid to improve surgical efficiency and reduce operative costs, but various limitations have been identified. More recently, the single position prone surgery (SPS-P) has been described as an alternative to address some of these limitations. This case illustrates a patient who underwent SPS-P using an OLIF corridor with subsequent posterior decompression and instrumentation. The benefits and limitations of this procedure compared to the conventional techniques are highlighted in this case. We present the case of a 75-year-old female presenting with thoracic myelopathy over T11/12 and concurrent L2-4 spinal stenosis. She underwent OLIF of L2/3 and L3/4, posterior decompression of T11/12 and L2/3, and posterior instrumented fusion from T10-L4 via a single prone position. We aim to describe the advantages of this approach and the challenges encountered through our experience. SPS-P offers numerous benefits compared to the already powerful SPS-L. In the upper levels of the lumbar spine, a pre-psoas approach may also be feasible. However, the prone lateral technique does not replace all patients suited for a lateral interbody fusion but should be seen as a viable option for selected cases such as those with previous fusion at the L5/S1 with adjacent degeneration requiring extension and posterior fixation.

UNASSIGNED: Lumbar spinal stenosis is a frequent and disabling disease of the elderly. However, the impact of its surgery on the long term (≥5 years) postoperative results and quality of life has not yet been evaluated in our setting.
UNASSIGNED: The study population consisted of 224 patients operated between 2010 and 2017 at the Yaounde Central Hospital and the Yaounde General Hospital, of whom 33 were evaluated. Long term postoperative results were defined as reoperations, indication for reoperation, time elapsed to reoperation and control-X ray findings. Quality of life (QOL) was evaluated using the Oswestry Disability Index (ODI) and Numerical Pain Rating Scale (NRS), and compared to reported preoperative values. The one-way analysis of variance and Kruskal-Wallis tests were used for associations between patient characteristics and quality of life outcomes.
UNASSIGNED: Participants had a mean age of 57.3 years. 21% of participants were reoperated at least once, two years later on average due to reappearance of their clinical pictures. QOL significantly improved from being crippled (mean ODI 67.5%) and having severe pain (mean NRS 8) before surgery, to moderate disability (mean ODI 34.4%, p < 0.01) and moderate pain (means NRS 4, p < 0.01) five years later. Having large family support was the only factor independently associated with improved ODI and NRS (p = 0.01).
UNASSIGNED: Lumbar spinal stenosis surgery is still beneficial five years later. Large cohort studies need to be conducted in our setting.

暂无摘要。

Lumbar spinal stenosis (LSS) is a prevalent cause of leg and back pain. In the youth, LSS is not common and mainly results from hereditary musculoskeletal disorders. Moreover, spinal fusion is a surgical approach to the treatment of LSS. Entrapment of surgical tools due to breakage is a rare yet important phenomenon in such operations. Therefore, neurological sequelae of these events need to be explored. The case was a 24-year-old male complaining of local back pain. Initially, he was diagnosed with LSS at L4 and L5. After the fusion of the vertebrae by the posterior spinal fusion (PSF) method, the patient\'s pain was resolved. However, the subject complained of worsening local back pain limiting his ability to do routine tasks. A few years later, radiographical evaluations indicated the possible presence of a surgical tool that could not be removed via surgery. During a third operation, the object was removed, and the patient\'s symptoms recovered. Immediate removal of entrapped surgical objects is necessary due to risks associated with migration and central nervous system damage. Comparing our results to other similar reports, we conclude that in cases of foreign object entrapment, neurological sequelae may be nonexistent or progressively worsen. Also, sequelae emerge either soon after the operation or emerge later. This complicates the diagnosis of such events and the decision of whether to subject the patient to additional neurosurgical operations to remove the tool. These variations may be observed due to the moving of the entrapped tool. Follow-up of neurological sequelae in spinal surgery patients is recommended.

OBJECTIVE: Uniportal full-endoscopic unilateral laminotomy for bilateral decompression (UFE-ULBD) has been used to treat lumbar spinal stenosis (LSS) with satisfactory outcomes. However, a limited number of studies have investigated the relationship between decompression range and clinical outcomes. This study aimed to investigate the efficacy of UFE-ULBD for single-segment LSS and to explore the relationship between the decompression range and functional outcomes.
METHODS: Single-segment LSS patients who had undergone UFE-ULBD using an interlaminar approach between November 2021 and February 2023 were retrospectively analyzed. Patient demographics, visual analogue scale (VAS) scores for leg and back pain, Oswestry disability index (ODI) scores, modified MacNab grades, and radiological outcomes, including the decompression ratio of the disc-flava ligament space and osseous lateral recess, the enlargement ratio of superior articular process interval, lamina interval dural sac cross-sectional area (DSCA), were collected. The independent sample t-tests, paired sample t-tests, chi-square tests, Fisher\'s exact tests, and Pearson\'s and Spearman\'s correlation analyses were used.
RESULTS: Forty patients (23 males, and 17 females) were retrospectively enrolled in this study. The mean follow-up period was 12 months. At the last follow-up, VAS scores for leg pain and back pain decreased from 6.0 ± 0.8 to 1.0 ± 1.9 (p < 0.001), and from 6.0 ± 0.8 to 1.2 ± 1.8 (p < 0.001) respectively; ODI score decreased from 71.7 ± 6.2 to 24.3 ± 21.3 (p < 0.001). According to the modified MacNab criteria, the results were excellent in 28 (70%), good in 5 (12.5%), fair in 6 (15%), and poor in 1 (2.5%), with an excellent-good rate of 82.5%. The postoperative DSCA enlarged from 57.69 ± 21.86 to 150.75 ± 39.33 mm2 (p < 0.001), with an enlargement ratio of 189.43 ± 107.83%. No difference in clinical or radiological parameters was detected between patients with excellent, good, fair, or poor outcomes based on the modified MacNab criteria.
CONCLUSIONS: UFE-ULBD can provide satisfactory clinical and radiological outcomes in single-segment LSS patients. With sufficient exposure to the dural sac boundary, the functional outcome was not related to the radiological decompression range in LSS patients who had undergone UFE-ULBD.

UNASSIGNED: Rarely, chronic tophaceous gout can result in lumbar spinal stenosis and neural compression.
UNASSIGNED: A 67-year-old male presented with the radiographic and magnetic resonance findings of gout involving and causing compression of the lumbar spine that responded to surgical decompression.
UNASSIGNED: It is difficult to diagnose lumbar spinal stenosis secondary to tophaceous gout. Notably, the treatment, based on the clinical presentation, may include both medication and surgical decompression.