The purposes of this study were; 1) to analyze the motion characteristics of lumbar degenerative spondylolisthesis (LDS), and 2) to investigate the long-term clinical results of a compression-distraction rod system for LDS. The dominant motion of LDS was translation rather than rotation compared with normal lumbar spine and isthmic spondylolisthesis. Long-term clinical results of the compression-distraction system for LDS were satisfactory with regards to fusion rate, JOA scores and complication rates. Further clinical studies with a large sample size are needed to decide indications for decompression procedures, spinal fusion and selection of implants for treatment of LDS.
40 patients with L4/5 degenerative spondylolisthesis (LDS) underwent posterior lumbar interbody fusion (PLIF) of Harm's technique, based on our surgical strategy of LDS from 1995-2000. Patients in the advanced stage with / without lumbar instability or in the end stage with instability were candidates for PLIF. All patients were followed up with period of 6.8 years on average except two who are dead. The 34 patients without complication such as Parkinson's disease were evaluated. The JOA score was improved from 14.3 to 24.5 points on average. Solid bony union was observed in 32 of 34 patients. % slip decreased from 18.8 to 10.9 %. Slip angel was increade from 2.1 to 6.3 degrees. Two patients with symptom due to the adjacent disc (L3/4) degeneration required additional operation. PLIF for the patients in the advanced stage or in the end stage with instability in our surgical strategy affords acceptable results in middle term follow-up.
The purpose of this study was to clarify which type of low back pain in patients with degenerative spondylolisthesis could be improved by Graf stabilization. Subjects consisted of 46 cases of degenerative spondylolisthesis who had undergone surgery with Graf stabilization. As a control group, 42 cases of degenerative spondylolisthesis who had undergone surgery without Graf stabilization were used. The effects of Graf stabilization compared with the control group were as follows; ①a decrease in the frequency of persistent low back pain, ②prevention of progression of % slippage, ③decrease in mobility, ④the possibility of complications occurring, and ⑤no effects with regards to the degree of persistent low back pain, recurrence of leg symptoms, and JOA scores.
The surgical management of degenerative spondylolisthesis has remained controversial. Patients with L4/5 single-level spinal stenosis due to gradeⅠspondylilisthesis were treated by two methods, one was posterior decompression with bilateral posterolateral fusion using pedicle screw instrumentation from 1997 until 1999, and the other was posterior decompression alone with preserving the posterior elements like fenestration from the year 2000 onwards. We compared clinical outcomes (JOA score) and radiographic findings between the two groups (19 patients in the fusion group, 17 in the decompression group) after a two year follow-up period. Preoperative background factors were not statistically significant between the two groups. JOA scores improved in both groups but less improvement was obtained in the fusion group because of more complications. Our findings indicate that decompression while preserving the posterior elements can be useful for most of type of degenerative spondylolisthesis with symptomatic spinal stenosis. To confirm our findings, a randomized controlled trial with a larger number of subjects is needed.
The purpose of this study was to examine the clinical outcomes of microsurgical partial laminectomy without fusion for lumbar degenerative spondylolisthesis. Forty-four patients with lumbar degenerative spondylolisthesis who had undergone surgery were retrospectively examined for the study. The subject consisted of 23 men and 21 women whose mean age at surgery was 66 (range, 45 to 82). Preoperative JOA scores averaged 13.7 while postoperative JOA scores at the time of the final follow-up averaged 23.1. Postoperative progression of lumber slippages was minimal in most cases, and there was only one case where further surgery was needed 12 years after the initial surgery. A microsurgical partial laminectomy without fusion can decompress the lumbar segment while preserving posterior elements of the facet joints, and may prevent progression of low back pain. Moreover, this less invasive technique may be useful for elderly patients.
The effects of mono-segmental fusion at the spondylolisthetic lumbosacral vertebral level on patient pain elimination were studied. While reviewing the patient's unstable spondylolisthetic segment, sagittal plane translation and rotation must be carefully evaluated. In case of vertebral level only with grade Ⅰ or Ⅱ sagittal plane translation, neural decompression followed by posterolateral fusion may be effective. However, vertebral segments with gradeⅡor Ⅲ translation together with an increased rotation angle must be treated by PLIF surgery with transpedicular screw fixation. While patients must be followed up long-term, the majority of cases will present with favorable surgical outcomes short-term.
Remarkable effects within 2 weeks of combined Ryokyo-jutsukan-to and Keishi-buku-ryo-gan administration were reported in 3 subjects (1 male, 2 females; average age 78 years) with low back pain. Visual Analog Scale (VAS) was used when evaluating outcomes of low back pain and limb pain, and numbness in the lower limbs several weeks after combined administration of these drugs. A chill sensation in the lumbar region and polyuria were particular features involved in the prescription of the herbal medicine Ryokyo-jutukan-to. However, it was noteworthy that such symptoms were not necessary for the medication to be effect. In this study Ryokyo-jutsukan-to was effective in clinical symptoms similar to those caused by disc injury as described by McKenzie. Chronic low back pain is associated with blood stasis and stasis of bodily fluid. Consequently it may be assumed that Ryokyo-jyutukan-to is the best medication for some but not all patients with chronic low back pain.
Mexiletene hydrochloride (MexitilTM, hereinafter MX) is widely used in clinics as an anti-arrhythmic agent having a lidocaine-like structure. Here, we report on its use and effect for radicular pain (sciatica), with reference to the literature. The anti-arrhythmic agent mexiletene hydroghloride was administered to 22 neuralgia patients. Excluding the 3 cases with side-effects, satisfactory results were seen in 19 of 22 cases (86.4%). We concluded that this drug may exhibit an effect as a treatment agent for neuralgia patients.
Since the report by Nachemson (1976) concerning pressure on L3 from various positions, it is believed that sitting in a semi-upright position is contraindicatory after lumbar spine surgery. Nachemson's report indicated that there was twice the amount of pressure or more sitting in a semi-upright position than in an upright one. In this paper, a logical investigation on disc load with regards to action and reaction was performed. When W means body weight and α inclination of the body axis, disc pressure is equal to W (sinα+√3 cosα) in a semi-upright position without back rest. This trigonometric function draws a curve whose peak is 2W at 30 degree and W at 90 degree. These results support the report by Nachemson. On the other hand, disc pressure is equal to W sinα in a semi-upright position with back rest, because reaction is caused by the back rest. As a result, sitting in a semi-upright position with back rest after lumbar spine surgery is a reasonable posture to adopt.
This study aimed to clarify and prevent the present state of low back pain among care-givers. A survey was conducted on 40 care-givers (14 men and 26 women; age 22 to 54 years; average age, 43 years) at three care facilities to identify care-givers with low back pain. After a physical examination, both a lumbar X-ray in the standing position and MRI were done. Since the results of the survey showed poor posture was related to low back pain, Lumbar flexion angles were continuously measured using an electrogoniometer. Spondylolysis was seen in 3 patients, while apophyseal separation was confirmed in another two. MRIs Showed that changes in intervertebral disc luminance varied from mild to severe among subjects. In addition, MRIs revealed posterior protrusion of the intervertebral disc in six patients. Results clarified that while none of the subjects had organic diseases to cause impairment of ADL, individual differences in pain tolerance existed. Thirty minute electrogoniometry suggested that certain work-related postures put stress on the lumbar spine. In order to prevent low back pain in care-givers, it is necessary to improve working conditions.
A questionnaire concerning symptoms of low back pain was completed by 163 professional classical ballet dancers (female: 123, male: 40). While the average number of stage performances was greater in male dancers (34 times) than in female dancers (12 times), the incidence of low back pain was approximately 90% in both sexes. Fifty-five percent of males and 38% of females reported experiencing pain that impaired their training exercises or stage performances. Among them 24% of males and 12% of females were unable to dance on occasions, but only 10% of the dancers sought medical care for their low back pain. Thirty percent of males reported lifting their female partner induced low back pain, while 30% of females attributed it to lumber extension. These results demonstrate that male dancers suffer from more serious low back pain, whose causes may be related to the quantity or severity of exercise.
Seven patients with thoracolumbar compression fracture were treated using with the newly produced Damen-Jewett type elasticity corset. In clinical evaluation, JOA-scores for low back pain were measured. In roentgenographical evaluation, the wedge condition ratio of the damaged vertebral body was measured. All patients' lumbagos were decreased, and returned to original walking state. JOA-score returned an average of 22.1 points from an average of 10.4 points. The wedge condition ratio of vertebral body returned an average of 69.2% from an average of 72.8%. The Damen type elasticity corset has the abdominal pressure rise effect. And the Jewett type elasticity corset supports the body in the waist back section and the sternum and the pelvis. The newly produced Damen-Jewett type elasticity corset has both excellent characteristics of Damen type and Jewett type elasticity corset. It is easy to wear and prevents abdominal compression by the removal of the abdominal band.
Osteoporosis patients were divided into two groups based on the presence or absence of a vertebral compression fracture for eight months from December, 2002. In both groups, a comparison was carried out regarding the grade of osteoporosis, the character and grade of the pain, and the pain field of the body. The compression fracture group (F group) consisted of 27 patients (average age: 70.8 years, average age at menopause: 48.3 years), while the non-compression fracture group (P group) had 25 patients (average age: 67.3 years, average age at menopause: 50.3 years). Vertebral fractures averaged 2.3 vertebrae per person and the affected level of the spine was from T6 to L5. Both groups had mainly low back motion pain. A significant difference was seen in age, height diminishment, BMD, and VAS values between the fracture group and non-fracture group.
Sixty-eight cases of degenerative spondylolisthesis were subjected to micro bone saw laminectomy, complete nerve decompression and laminoplasty with PLLA pins. Twenty-two cases were male, and 46 female. Pre and post operative JOA score was 18.1±4.4, 27.9±1.9. This improvement ratio was 90.7% and very satisfactory. Pre and post operative slip ratio was 20.1±6.7%, 22.3±7.3%. The slip ratio was slightly progressive. The next another two groups were comprared. One group of 10 cases were operated on with PLIF. The other 10 cases were operated on with laminoplasty using PLLA pins. The slip angle of these 20 cases was more than 23%. Pre and post operative slip ratio and the spinal stability at the operative slip level of these two groups did not differ significantly. 75.8% of the facet joints fixed with PLLA pins obtained stability and immobility in 62 cases. Spinal stability was achieved with this new operation method.
Surgical results over 3 years of two groups treated by one surgeon decompression only or decompression with spinal fusion for lumbar degenerative spondylolisthesis were investigated.The decompression group consisted of 53 patients with an average age of 69.4 years and a follow-up period of 56 months, while the fusion group were 11 patients with an average age of 64.9 years and a follow-up period were 55 months. In the former JOA scores improved from 6.5 to 13.1 and in the later the improvement from 6.1 to 14.4 was observed. The low back pain scores improved from 1.6 to 2.7 in the decompression group and from 1.1 to 2.7 in the fusion group. These results suggest that the necessity of spinal fusion for degenerative spondylolisthesis is quite limited. In the decompression group , 5 cases who affected by compression fractures in the follow-up period or presented degenerative kyphosis or severe degenerative scoliosis showed poor result at final study.
The clinical outcome of lumbar disc herniation surgery (postoperative duration; 10-23 years, average 14 years) with or without posterolateral fusion (PLF) was evaluated using the Japanese version of the Roland-Morris Disability Questionnaire (RDQ). The results were also compared with average RDQ scores of the general public suffering from low back pain in Japan. No difference was found in RDQ scores between the post-operative patients and the general public with low back pain. Eighty-six percent of patients showed similar or better RDQ scores compared to the general public. There was no difference in RDQ scores of post-herniotomy patients with or without PLF. In conclusion, from the point of measuring low back pain disability such as utilizing the RDQ, the clinical outcome of surgery for lumbar disc herniation seemed good compared with general public and in this study, at least, fusion surgery was not shown as being superior to simple herniotomy.
This study reports the outcome of the patient's questionnaire (based on JOA score except the item of SLR test: total 27 points) for the surgical results of anterior lumbar interbody fusion (ALIF). Of 243 patients, 156 patients who replied to the questionnaire (returned rate, 64.2%) were investigated as the subjects of this study. The postoperative questionnaire score for the patients with degenerative spondylolisthesis was significantly low compared with the patients with disc herniation (p<0.005), especially in the evaluation items of the leg symptom and walking (p<0.01). The author discussed the possibility that ALIF did not solve the segmental spinal stenosis associated with the posterior compression factor.
Although most women with parturient low back pain recover within a few months, it takes years for some patients. We have investigated about women with parturient low back pain complaining for more than 1 year. Medical histories, physical examinations and lumber and pelvic x-rays of 23 women with parturient low back pain were examined. Pain persisted from the back to buttocks for an average of 6.9 years and 22 subjects presented with pressure tenderness of the sacro-iliac joint. Standing, walking, assuming a spinal or lateral position, and taking long strides made the pain more severe. A pubic bone displacement of more than 2 mm was seen on X-ray examination of 11 women. Thirteen women used a soft pelvic band as an effective treatment. Our previous study showed that 12.2% of 990 women had parturient pelvic pain for more than 6 months and consequently parturition may be a risk factor for prolonged low back pain in women.
During pregnancy, some women suffer from low back pain due to pelvic ring instability. While pelvic ring instability is generally investigated by using x-ray image, this is not a suitable examination for pregnant women due to the risk of irradiation. Consequently, a study investigating the effectiveness of ultrasound in the diagnosis of pelvic ring instability was performed. Using ultrasound, the difference in front and back displacement of the pubic tubercle can be seen by having pregnant women lie on their back or changing position of their legs by flexing their hip joint. Furthermore, symphyseolysis can be seen as an area of high density. These findings show that the ultrasound examination is suitable for the diagnosis of pelvic ring instability. Since it is, however, not yet an established method, further study is necessary for selecting the best method to diagnose these pathologic findings.
A questionnaire survey was conducted to evaluate rehabilitation after lumbar spine surgery in Eniwa Hospital. One hundred patients who underwent rehabilitation after lumbar spine surgery participated in the current study. Almost all patients (94%) were satisfied with rehabilitation during hospitalization. However, some responders (36%) complained of the shortness of the rehabilitation period. There were many cases (31%) who returned to their original occupation very early. Therefore, occupational rehabilitation both before and after discharge was suggested to be very important. Accelerated rehabilitation not only during hospitalization but also after discharge is likely to be established and implemented under the consistent follow-up system.
The efficacy of the tricyclic antidepressant, amoxapine, was investigated in 20 subjects suffering from somatoform pain disorder, consisting of chronic lower back and leg pain with no identifiable organic cause and resistant to treatment. Evaluation of efficacy was made both prior to and 6 months after administration using the visual analogue scale (VAS) and self-rating depression scale (SDS). VAS and SDS improved significantly after amoxapine administration. If a VAS improvement rate ≥50% is defined as effective and < 50% as ineffective, then there were 10 subjects where the treatment could be rated as effective and 10 as ineffective. Correlations between pain response to amoxapine and subject background factors were consequently examined, but no predictive factors could be identified. The onset of the effect was 1 week in 7 subjects, and after 2, 3 and 4 weeks in 1 subject, respectively. The strongest effect tended to be shown in those subjects where the onset was earliest. These results indicate amoxapine administration may be an intervention worthy of consideration in cases of lower back and leg pain with no identifiable organic cause and resistant to other forms of treatment and that the efficacy can be evaluated in relatively short period of time.
A review of 50 patients suffering from aortic dissection or a ruptured aortic aneurysm was carried out to find the frequency of back pain and paraplegia among initial complaints, and the key points that differentiated these conditions from spinal disease. Of these patients, 32 patients (64%) had acute and severe back pain, while one patient (2%) had sudden paraplegia. A past history of hypertension and abnormal blood pressure on admission were important predisposing factors for suspecting aortic diseases, while the most reliable tool for imaging diagnosis was a CT scan. In a patient with a severe back pain or paraplegia, acute aortic dissection and a ruptured aortic aneurysm should always be included in the differential diagnosis.