Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome

Myositis Ossificans Progressiva in the Whole Spine: A Case Report

Myositis ossificans progressiva is a rare inherited disease characterized by progressive ectopic ossifications associated with thumb and big toe anomalies. Ossification usually progresses from central to the peripheral, proximal to distal, cranial to caudal, and from dorsal to ventral directions and leading to activity limitation, significant eating disability, recurrent pulmonary infection, and atelectasis. In this report, we present a 7-year-old boy with a total spine stiffness (wooden spine) seriously limited his activity of daily living

Postoperative Cauda Equina Syndrome in Trivial Lumbar Congenital Kyphosis: A Case Report

A 25-year old man presented with chronic low back pain for about 5 years due to mild congenital lumbar kyphosis (L1-L3 25° with congenital posterior wedge vertebra L2). Preoperative neurologic examination was normal. After posterior spinal fusion and instrumentation with moderate curve correction, the patient gradually developed the symptoms and signs of cauda equina syndrome due to intraoperative L2-3 disc herniation. After 5 days the patient underwent posterior decompression surgery and on the latest follow up visit at 2 years later, nearly all the motor power was recovered but the patient complained of occasional urinary incontinence and residual right leg paresthesia. In surgical treatment of congenital kyphosis, much attention should be paid to the presence of contemporaneous asymptomatic disc herniation

Primary Epidural Varicosis as a Rare Cause of Sciatica: A Case Report

Non-discogenic sciatica can be caused by any lesion along the course of the lumbosacral nerve roots and sciatic nerve. We aim to present a rare case of refractory sciatica in an otherwise healthy 25-year-old man. He complained of left leg pain without significant back pain. Extensor hallucis longus muscle was weak on the left side with limited straight leg rising. On magnetic resonance imaging, a space-occupying lesion resembling a sequestrated disc was noted that after surgical decompression, epidural varicosis was demonstrated

Identifying predisposing factors for recurrence after successful surgical treatment of lumbar disc herniation

Background: Recurrent lumbar disc herniation (rLDH) comprises one of the most common complications of lumbar discectomy occurring in about 1-21% of the operated patients. Aim: This study aims to elucidate the role of predisposing factors in producing rLDH in the patients with previous successful lumbar discectomy. Materials and Methods: In this retrospective study, we reviewed 213 patients (133 male; 62%) who underwent simple primary lumbar discectomy in our Orthopedic Department from August 2009 to January 2014. Mean age and follow-up period were 38.1 ± 9.8 years and 48.2 ± 7.3 months, respectively. The term of rLDH referred to those cases who have suffered a relapsed sciatalgia after a primary pain improvement period. We repeated magnetic resonance imaging (MRI) scanning only in those cases with recurrent complaints. Chi-square, Fisher, and Student's t-tests were used for statistics. Results: Recurrent sciatalgia occurred in 39 patients (18.3%), while true rLDH on MRI scanning was detected in 32 patients (15%). Younger age, heavier smoking, and less severity of herniation on primary MRI scanning (protrusion vs. sequestration) play as predisposing roles in creating rLDH, while gender, level or side of LDH, the presence of Modic changes, or body mass index (BMI) have no significant effect. The most common sites of rLDH were same level same side, different level, and same level contra-lateral side, respectively. Conclusion: In the patients who had been successfully treated by simple primary lumbar discectomy, younger age, heavier smoking state, and less protrusion of the herniated disc at the time of the index surgery, were all correlated with more probability of the future rLDH, while BMI, Modic change, sex, level, and side of LDH had no significant role