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PURPOSE OF THE STUDY This article presents the evidence and the rationale for the recommendations for surgical treatment of degenerative lumbar stenosis (DLS) and spondylolisthesis that were recently developed as a part of the Czech Clinical Practice Guideline (CPG) “The Surgical Treatment of the Degenerative Diseases of the Spine”. MATERIAL AND METHODS The Guideline was drawn up in line with the Czech National Methodology of the CPG Development, which is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We used an innovative GRADE-adolopment method that combines adoption and adaptation of the existing guidelines with de novo development of recommendations. In this paper, we present three adapted recommendations on DLS and a recommendation on spondy-lolisthesis developed de novo by the Czech team. RESULTS Open surgical decompression in DLS patients has been evaluated in three randomized controlled trials (RCTs). A recommendation in favour of decompression was made based on a statistically significant and clinically evident improvement in the Oswestry Disability Index (ODI) and leg pain. Decompression may be recommended for patients with symptoms of DLS in the event of correlation of significant physical limitation and the finding obtained via imaging. The authors of a systematic review of observational studies and one RCT conclude that fusion has a negligible role in the case of a simple DLS. Thus, spondylodesis should only be chosen as an adjunct to decompression in selected DLS patients. Two RCTs compared supervised rehabilitation with home or no exercise, showing no statistically significant difference between the procedures. The guideline group considers the post-surgery physical activity beneficial and suggests supervised rehabilitation in patients who have undergone surgery for DLS for the beneficial effects of exercise in the absence of known adverse effects. Four RCTs were found comparing simple decompression and decompression with fusion in patients with degenerative lumbar spondylolisthesis. None of the outcomes showed clinically significant improvement or deterioration in favour of either intervention. The guideline group concluded that for stable spondylolisthesis the results of both methods are comparable and, when other parameters are considered (balance of benefits and risks, or costs), point in favour of simple decompression. Due to the lack of scientific evidence, no recommendation has been formulated regarding unstable spondylolisthesis. The certainty of the evidence was rated as low for all recommendations. DISCUSSION Despite the unclear definition of stable/unstable slip, the inclusion of apparently unstable cases of DS in stable studies limits the conclusions of the studies. Based on the available literature, however, it can be summarized that in simple degenerative lumbar stenosis and static spondylolisthesis, fusion of the given segment is not justified. However, its use in the case of unstable (dynamic) vertebral slip is undisputable for the time being. CONCLUSIONS The guideline development group suggests decompression in patients with DLS in whom previous conservative treatment did not lead to improvement, spondylodesis only in selected patients, and post-surgical supervised rehabilitation. In patients with degenerative lumbar stenosis and spondylolisthesis with no signs of instability, the guideline development group suggests simple decompression (without fusion). [ABSTRACT FROM AUTHOR]

It is possible to recognize some cases of lumbar spine disease as an occupational disease in the Czech Republic starting from January 1, 2023. MRI examination (CT in case of contraindications) of the lumbar spine is an important part in the process of its recognition. The purpose of these examinations is to confirm the presence of skeletal and disc changes at the L3-S1 levels and to determine the severity of these changes. In addition to the usual report, the radiologist also fills out a form that will be delivered to him from the occupational medicine department. If the patient has already had an MRI (or CT) examination, the radiologist will only be asked to fill out the form. The article briefly describes the entire process of acknowledgement a new occupational disease, which includes the fulfillment of preliminary conditions, assessment of the clinical severity of the disease, and hygienic (exposure) criteria. [ABSTRACT FROM AUTHOR]

The main aim of this research is examining the needs of patients after the stabilization of their spines. The purpose is to point out the diseases that are less serious, however, still very limiting. We want to arouse interest among doctors, psychologists and relatives of patients and show them how to work with such patients. For this research we chose spondylolisthesis, which affects mainly lumbar and sacrum part of the spine. The problem is caused by the slide of one vertebra over the other. We used a qualitative method, the Interpretative phenomenological analysis. The data were gained by semi-structured interviews where patients responded retrospectively. Respon-dents describe their experience in four periods - finding out the diagnosis, finding out the necessity of the operation, the last week before the surgery, and returning to their normal life after the surgery. The research sample consists of four respondents, two women and two men who were operated in their adolescence or young adulthood. In the time of these interviews, they were not older than thirty five because we wanted them to have the exact memories from the time of the surgery. We focused on young people because vertebra diseases are more common in older age and that is why we think it is harder for young people to reconcile to it. Although we wanted to ensure homogeneity of our sample, there are big differences, concerning the time of the surgery of our respondents - one of them was just two months after the surgery but the other seventeen years. This fact could affect the whole experience. Unfortunately, this is the forfeit for our strict criteria. We found four basic needs, which were the same in all periods. It was the need to have the necessary information, appropriate behaviour, attention and the doctor care, social support and security, and the need to cope with the situation and focus on oneself. In each period there were more needs emerging than just these four. In the first period it was the need to be perceived and accepted by other people. In the second period the need of a miracle, belief in good end, the need of help from other people, the need to go back to normal life and the need to show emotions without shame. In the third period there were the need to show real emotions again and the need of having the surgery done. They wanted to do other things - to make waiting bearable and to solve practical questions of disease in this period. In the fourth period it was very important to see some progress, to learn how to move, to be careful and to let others help with casual daily activities. The results were quite often the same as the findings in some foreign articles. For example Snelgrove & Liossi (2009), Osborn & Smithe (1998), Middleton (2014) and Alqahtani (2015). We can see people with spine diseases feel the same in different parts of the Earth. We recommend focusing on this kind of a less serious disease and work with patients not just through their body but psychologically as well. For this case we create lists for doctors, psychologists and relatives which suggest how to communicate with patients. [ABSTRACT FROM AUTHOR]

Spondylodiscitis is a term used to indicate infection of the intervertebral disc and osteomyelitis of the adjacent vertebrae. It is a relatively rare dis ease in developed countries, represent ing 3- 5% of all skeletal infections. The infl am mation is localized most often in the lumbar spine. Neurological defi cits are present in 30- 50% of patients with spondylodiscitis. Frequent occurrence of chronic back pain in the general population as well as negative fi ndings on plain radiography in the earlier stages of the dis ease oftentimes make the dia gnosis diffi cult and delayed. A conservative therapeutic approach consists of antibio tic ther apy which may be reduced to six weeks in uncomplicated cases accord ing to new data. Compres sion of neural structures with neurological defi cits, spinal instability, and failure of conservative treatment are all indications for surgical intervention. We are present ing a set of 11 patients with spondylodiscitis from which we selected 3 interest ing case reports in order to demonstrate the various courses of the dis ease. [ABSTRACT FROM AUTHOR]