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PurposeTo provide an overview of the The Norwegian Degenerative spondylolisthesis and spinal stenosis (NORDSTEN)-study and the organizational structure, and to evaluate the study population.MethodsThe NORDSTEN is a multicentre study with 10 year follow-up, conducted at 18 public hospitals. NORDSTEN includes three studies: (1) The randomized spinal stenosis trial comparing the impact of three different decompression techniques; (2) the randomized degenerative spondylolisthesis trial investigating whether decompression surgery alone is as good as decompression with instrumented fusion; (3) the observational cohort tracking the natural course of LSS in patients without planned surgical treatment. A range of clinical and radiological data are collected at defined time points. To administer, guide, monitor and assist the surgical units and the researchers involved, the NORDSTEN national project organization was established.Corresponding clinical data from the Norwegian Registry for Spine Surgery (NORspine) were used to assess if the randomized NORDSTEN-population at baseline was representative for LSS patients treated in routine surgical practice.ResultsA total of 988 LSS patients with or without spondylolistheses were included from 2014 to 2018. The clinical trials did not find any difference in the efficacy of the surgical methods evaluated. The NORDSTEN patients were similar to those being consecutively operated at the same hospitals and reported to the NORspine during the same time period.ConclusionThe NORDSTEN study provides opportunity to investigate clinical course of LSS with or without surgical interventions. The NORDSTEN-study population were similar to LSS patients treated in routine surgical practice, supporting the external validity of previously published results.Trial registrationClinicalTrials.gov; NCT02007083 10/12/2013, NCT02051374 31/01/2014 and NCT03562936 20/06/2018.

Among patients with spondylolisthesis and lumbar spinal stenosis, laminectomy with fusion was associated with modestly greater improvement in physical health–related quality of life than laminectomy alone but not with significantly greater reduction in disability related to back pain. The increased use of the lumbar spinal fusion procedure in the United States, along with the wide variation in practice, is attracting interest from multiple stakeholders, including patients, physicians, payers, and policymakers. In a report published in 2014, spinal fusion (465,000 hospital-based procedures in 2011) accounted for the highest aggregate hospital costs ($12.8 billion in 2011) of any surgical procedure performed in U.S. hospitals. 1 The randomized, controlled Spine Patient Outcomes Research Trial (SPORT) showed that surgery was superior to nonoperative care for the management of lumbar degenerative spondylolisthesis. 2 In SPORT, most patients in the surgical group were treated by means . . .

In this randomized, controlled trial comparing decompression surgery alone with decompression surgery plus fusion surgery for patients with lumbar spinal stenosis, there was no significant between-group difference in clinical outcomes at 2 and 5 years. Lumbar spinal stenosis is caused by a gradual narrowing of the spinal canal. Patients with lumbar spinal stenosis typically present with low back pain and leg pain, which occur especially when they are walking. This degenerative condition severely restricts function, walking ability, and quality of life. Lumbar spinal stenosis has become the most common indication for spinal surgery, 1 – 4 and studies have shown that surgical treatment in selected patients is more successful than conservative alternatives. 5 – 7 As the use of surgery to treat lumbar spinal stenosis has increased during the past decades, so has the complexity of the surgical procedures. . . .

PurposeTo estimate the prevalence of degenerative lumbar spinal stenosis (LSS) in adults, identified by clinical symptoms and/or radiological criteria.MethodsSystematic review of the literature. Pooled prevalence estimates by care setting and clinical or radiological diagnostic criteria were calculated and plotted [PROSPERO ID: CRD42018109640].ResultsIn total, 41 papers reporting on 55 study samples were included. The overall risk of bias was considered high in two-thirds of the papers. The mean prevalence, based on a clinical diagnosis of LSS in the general population, was 11% (95% CI 4–18%), 25% (95% CI 19–32%) in patients from primary care, 29% (95% CI 22–36%) in patients from secondary care and 39% (95% CI 39–39%) in patients from mixed primary and secondary care. Evaluating the presence of LSS based on radiological diagnosis, the pooled prevalence was 11% (95% CI 5–18%) in the asymptomatic population, 38% (95% CI − 10 to 85%) in the general population, 15% (95% CI 13–18%) in patients from primary care, 32% (95% CI 22–41%) in patients from secondary care and 21% (95% CI 16–26%) in a mixed population from primary and secondary care.ConclusionsThe mean prevalence estimates based on clinical diagnoses vary between 11 and 39%, and the estimates based on radiological diagnoses similarly vary between 11 and 38%. The results are based on studies with high risk of bias, and the pooled prevalence estimates should therefore be interpreted with caution. With an growing elderly population, there is a need for future low risk-of-bias research clarifying clinical and radiological diagnostic criteria of lumbar spinal stenosis.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.

Abstract BACKGROUND: Degenerative cervical myelopathy encompasses a group of conditions resulting in progressive spinal cord injury through static and dynamic compression. Although a constellation of changes can present on magnetic resonance imaging (MRI), the clinical significance of these findings remains a subject of controversy and discussion. OBJECTIVE: To investigate the relationship between clinical presentation and quantitative MRI features in patients with degenerative cervical myelopathy. METHODS: A secondary analysis of MRI and clinical data from 114 patients enrolled in a prospective, multicenter study was conducted. MRIs were assessed for maximum spinal cord compression (MSCC), maximum canal compromise (MCC), signal changes, and a signal change ratio (SCR). MRI features were compared between patients with and those without myelopathy symptoms with the use of t tests. Correlations between MRI features and duration of symptoms were assessed with the Spearman ρ. RESULTS: Numb hands and Hoffmann sign were associated with greater MSCC (P < .05); broad-based, unstable gait, impairment of gait, and Hoffmann sign were associated with greater MCC (P < .05); and numb hands, Hoffmann sign, Babinski sign, lower limb spasticity, hyperreflexia, and T1 hypointensity were associated with greater SCR (P < .05). Patients with a T2 signal hyperintensity had greater MSCC and MCC (P < .001). CONCLUSION: MSCC was associated with upper limb manifestations, and SCR was associated with upper limb, lower limb, and general neurological deficits. Hoffmann sign occurred more commonly in patients with a greater MSCC, MCC and SCR. The Lhermitte phenomenon presented more commonly in patients with a lower SCR and may be an early indicator of mild spinal cord involvement. Research to validate these findings is required.

This clinical trial compared surgical treatment with nonsurgical treatment of spondylolisthesis. Because of extensive patient crossover, the data were essentially nonrandomized, and as-treated analyses were performed. During 2 years of follow-up, patients treated surgically had greater improvement in pain and function than those treated nonsurgically. Patients treated nonsurgically showed moderate improvement over time. This clinical trial compared surgical treatment with nonsurgical treatment of spondylolisthesis. During 2 years of follow-up, patients treated surgically had greater improvement in pain and function than those treated nonsurgically. Degenerative spondylolisthesis is the slipping forward of one lumbar vertebra on another with an intact neural arch. It rarely occurs before the age of 50 years, and it disproportionately affects women, particularly black women, with a male:female ratio of approximately 1:6. 1 Slippage most commonly occurs at the L4–L5 level and rarely exceeds 30% of vertebral width. 1 Degenerative spondylolisthesis is generally asymptomatic, but it can be associated with symptomatic spinal stenosis. 1 Spinal stenosis, the most common reason for lumbar surgery in adults over the age of 65, is a narrowing of the spinal canal with encroachment on the neural structures by . . .

IntroductionSurgical decompression is standard care in the treatment of degenerative spondylolisthesis in patients with symptomatic lumbar spinal stenosis, but there remains controversy over the benefits of adding fusion. The persistent lack of consensus on this matter and the availability of new data warrants a contemporary systematic review and meta-analysis of the literature. MethodsMultiple online databases were systematically searched up to October 2022 for randomized controlled trials (RCTs) and prospective studies comparing outcomes of decompression alone versus decompression with fusion for lumbar spinal stenosis in patients with degenerative spondylolisthesis. Primary outcome was the Oswestry Disability Index. Secondary outcomes included leg and back pain, surgical outcomes, and radiological outcomes. Pooled effect estimates were calculated and presented as mean differences (MD) with their 95% confidence intervals (CI) at two-year follow-up. ResultsOf the identified 2403 studies, eventually five RCTs and two prospective studies were included. Overall, most studies had a low or unclear risk of selection bias and most studies were focused on low grade degenerative spondylolisthesis. All patient-reported outcomes showed low statistical heterogeneity. Overall, there was high-quality evidence suggesting no difference in functionality at two years of follow-up (MD − 0.31, 95% CI − 3.81 to 3.19). Furthermore, there was high-quality evidence of no difference in leg pain (MD − 1.79, 95% CI − 5.08 to 1.50) or back pain (MD − 2.54, 95% CI − 6.76 to 1.67) between patients undergoing decompression vs. decompression with fusion. Pooled surgical outcomes showed less blood loss after decompression only, shorter length of hospital stay, and a similar reoperation rate compared to decompression with fusion.ConclusionBased on the current literature, there is high-quality evidence of no difference in functionality after decompression alone compared to decompression with fusion in patients with degenerative lumbar spondylolisthesis at 2 years of follow-up. Further studies should focus on long-term comparative outcomes, health economic evaluations, and identifying those patients that may benefit more from decompression with fusion instead of decompression alone. This review was registered at Prospero (CRD42021291603).

In this trial in patients with lumbar central stenosis and moderate-to-severe leg pain and disability, epidural injection of glucocorticoids plus lidocaine offered minimal or no short-term benefit over epidural injection with lidocaine alone with respect to disability and pain. Lumbar spinal stenosis, a common cause of spine-related disability, is the leading reason for spinal surgery in older adults. 1 , 2 Degenerative changes resulting in narrowing of the spinal canal and nerve-root compression can cause back and leg pain, lower-extremity paresthesias, and weakness. 3 , 4 The treatment of symptomatic lumbar stenosis remains controversial. Symptoms of lumbar stenosis are commonly treated with epidural glucocorticoid injections. These injections typically contain a glucocorticoid and an anesthetic, which are thought to relieve pain by reducing nerve-root inflammation and ischemia. 1 An estimated 25% of all epidural glucocorticoid injections administered in the Medicare population and 74% of those . . .

The case of Lumbar spinal stenosis (LSS) combined with tophi due to gout is rarely reported. In the course of our clinic work, we encountered a young male patient who was diagnosed with a history of gout for 5 years and was targeted as LSS combined with gouty tophi, and we would like to share this case. In addition, in order to further investigate the deep mechanism of LSS associated with gout, we obtained the intersecting genes of the two diseases based on a machine learning approach by obtaining the dataset GSE113212 related to LSS from the Gene Expression Omnibus (GEO) database, and the genes related to gout from the human gene database. We found that TGFB1, PPARG, and SAMRCC1 may be important biomarkers for treating of both diseases. From a clinical perspective, clinicians should be vigilant about the possibility of gouty lumbar spinal stenosis with tophi in young patients presenting with back pain, hyperuricemia, and elevated inflammatory markers. A combined surgical and pharmacological treatment plan has a favorable prognosis. Investigating the mechanisms of action of core genes may provide new insights for treatment, ultimately leading to the development of comprehensive and personalized diagnostic and therapeutic strategies.

Background: Extensive decompression with laminectomy, where appropriate, is often still described as the method of choice when operating on degenerative lumbar spinal stenosis. Nonetheless, tissue-sparing procedures are becoming more common. Endoscopic techniques have become the standard in many areas because of the surgical advantages they offer and the benefits for rehabilitation. One key issue when operating on the spine was the development of instruments to provide sufficient bone resection under continuous visual control. This was achieved by using endoscopes for operations carried out in cases of spinal canal stenosis. Objective: This study of patients with degenerative lumbar central spinal stenosis compares the results of spinal decompression using the full-endoscopic interlaminar technique (FI) with a conventional microsurgical laminotomy technique (MI). Study Design: Prospective, randomized, controlled study. Settings: 135 patients with microsurgical or full-endoscopic decompression were followed up for 2 years. Alongside general and specific parameters, the following measuring instruments were also used for the investigation: Visual Analog Scale (VAS), German version of the North American Spine Society Instrument (NASS), Oswestry Low-Back-Pain-Disability Questionnaire (ODI). Results: Postoperatively 72 % of the patients no longer had leg pain or the pain was almost completely reduced and 21.2 % experienced occasional pain. The clinical results were the same in both groups. The rate of complications and revisions was significantly reduced in the FI Group. The full-endoscopic techniques brought advantages in the following areas: operation, complications, traumatization, rehabilitation. Limitations: Lack of placebo control group. Conclusions: The recorded results demonstrate that the full-endoscopic interlaminar bilateral decompression adopting a unilateral approach provides an adequate and safe supplement and alternative to the conventional microsurgical bilateral laminotomy technique when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention. Key words: Spinal stenosis, central stenosis, spinal decompression, endoscopic spinal decompression, minimally invasive spine surgery