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Abstract Background Vertebral artery compression syndrome is a rare condition defined as the clinical presentation of dizziness, vertigo, ataxia, dysarthria, dysphagia, progressive or acute paralysis, hemisensory loss, and cervical myelopathy secondary to compression of the medulla and upper spinal cord by the vertebral artery. Case description Here we describe a 57-year-old Mexican–American male with bulbar symptoms, positional vertigo, and diplopia. The patient’s symptoms were managed through microsurgical decompression of the medulla utilizing a far lateral transcondylar approach. The patient reported clinical improvement on follow-up. Conclusion This case underscores the clinical complexity and heterogeneity of this rare neurovascular pathology and the importance of elucidating the pathophysiological mechanisms underlying the symptomatic presentation of vertebral artery compression syndrome.

Objective. To perform comparative analysis of the results of endoscopic and microsurgical decompression for lumbar spinal stenosis. Material and Methods. Design: Retrospective monocentric intra-cohort comparison of two groups of patients. The study included 99 patients aged 51–88 years with clinically significant lumbar spinal stenosis manifested by neurogenic intermittent claudication syndrome. Endoscopic decompression was performed in 51 patients, and microsurgical decompression – in 48 patients. To objectify and standardize clinical symptoms, walking distance in meters, pain syndrome and quality of life were assessed before and after surgery using standard scales and questionnaires (VAS, ODI). On the first day after surgery, back and lower limb pain were assessed, and during the observation period back and lower limb pain, quality of life and walking distance were assessed. Functional lumbar radiography was performed to exclude instability of the spinal motion segment. Using MRI, the cross-sectional area of the dural sac at the level of stenosis was measured before and after surgery. Clinical efficacy was assessed using the MCID (Minimal Clinical Important Difference) criterion. The results of the operation were followed-up for 12months after the operation. Results. Blood loss in the endoscopic intervention group was less than in the microsurgical group. Pain in the lumbar spine and in the lower extremities decreased, and the cross-sectional area of the dural sac increased. In the first days after surgery, patients after endoscopic decompression had less severe back and lower extremity pain than patients after microsurgical decompression due to less soft tissue trauma. Pain syndrome in back 10–12 months after surgery was without statistically significant difference between the groups. Patients after endoscopic decompression had statistically significantly better quality of life according to ODI, lesser pain in the lower extremities according to VAS and longer walking distance than those in the microsurgical decompression group. Surgical treatment in both groups turned out to be effective, which is confirmed by MCID. The time of endoscopic intervention is significantly longer than that of microsurgical intervention. The length of the incision during endoscopic decompression is shorter than that of microsurgical decompression. Conclusion. A comparative analysis of the results of endoscopic and microsurgical decompression for degenerative central lumbar stenosis showed comparable effectiveness of both methods, including an increase in the spinal canal dimension and ensuring regression of clinical symptoms. The results of the comparison do not allow making a sufficiently substantiated judgment on the advantages of one of the methods, which dictates the need for further research.

Background: Vertebral artery compression syndrome is a rare condition defined as the clinical presentation of dizziness, vertigo, ataxia, dysarthria, dysphagia, progressive or acute paralysis, hemisensory loss, and cervical myelopathy secondary to compression of the medulla and upper spinal cord by the vertebral artery. Case description: Here we describe a 57-year-old Mexican–American male with bulbar symptoms, positional vertigo, and diplopia. The patient's symptoms were managed through microsurgical decompression of the medulla utilizing a far lateral transcondylar approach. The patient reported clinical improvement on follow-up. Conclusion: This case underscores the clinical complexity and heterogeneity of this rare neurovascular pathology and the importance of elucidating the pathophysiological mechanisms underlying the symptomatic presentation of vertebral artery compression syndrome. [ABSTRACT FROM AUTHOR]

Purpose: Each institution or physician has to decide on an individual basis whether to continue or discontinue antiplatelet (AP) therapy before spinal surgery. The purpose of this study was to determine if perioperative AP continuation is safe during single-level microsurgical decompression (MSD) for treating lumbar spinal stenosis (LSS) and lumbar disc hernia (LDH) without selection bias. Methods: Patients who underwent single-level MSD for LSS and LDH between April 2018 to December 2022 at our institute were included in this retrospective study. We collected data regarding baseline characteristics, medical history/comorbidities, epidural hematoma (EDH) volume, reoperation for EDH, differences between preoperative and one-day postoperative blood cell counts (ΔRBC), hemoglobin (ΔHGB), and hematocrits (ΔHCT), and perioperative thromboembolic complications. Patients were divided into two groups: the AP continuation group received AP treatment before surgery and the control group did not receive antiplatelet medication before surgery. Propensity scores for receiving AP agents were calculated, with one-to-one matching of estimated propensity scores to adjust for patient baseline characteristics and past histories. Reoperation for EDH, EDH volume, ΔRBC, ΔHGB, ΔHCT, and perioperative thromboembolic complications were compared between the groups. Results: The 303 enrolled patients included 41 patients in the AP continuation group. After propensity score matching, the rate of reoperation for EDH, the EDH volume, ΔRBC, ΔHGB, ΔHCT, and perioperative thromboembolic complication rates were not significantly different between the groups. Conclusion: Perioperative AP continuation is safe for single-level lumbar MSD, even without biases. [ABSTRACT FROM AUTHOR]

Background: Clinical manifestations of Kimmerle’s anomaly are detected in 5.5 to 20% of patients. The main reason for the development of symptoms is prolonged compression of the V3 (atlantic) segment of the vertebral artery in the bone ring as a result of the atlantooccipital membrane’s exostosis. To date, the final tactics for treating patients with Kimmerle’s anomaly has not been determined. The effectiveness of conservative methods of therapy does not exceed 40%. The aim Of this study was to evaluate the results of a minimally invasive surgical treatment of patients with symptomatic Kimmerle’s anomaly using video endoscopic assistance. Methods: In the period from 2020 to 2022, 15 patients were operated on. The indication for the surgical treatment was the lack of the conservative therapy’s effect for 1 year from the onset of the disease, aggravation of the disease symptoms, a decrease in the blood flow through the vertebral artery at the Kimmerle’s anomaly side when turning the head. The vertebral artery decompression was performed using video endoscopy through a posterior median approach in two (13%) patients and through a paravertebral intermuscular approach (4 cm incision in the occipitocervical region in the projection of the Kimmerle’s anomaly) in thirteen (87%) patients. Results: The outcome of the disease was assessed at the time of discharge from the hospital, as well as in 6 and in 12 months after the operation. Following the surgical treatment, all the patients showed the complete regression of symptoms and restoration of the blood flow velocities in the vertebral artery. There were no complications after the operation. The use of video endoscopy made it possible to reduce the size of the surgical wound from 12 cm to 4 cm, which contributed to a decrease in the intensity of pain in the postoperative period, early activation and a decrease in the duration of the inpatient treatment. Conclusion: With the proper selection of patients with Kimmerle’s anomaly, decompression of the V3 segment of the VA using video endoscopy is a safe and effective method of treatment.

The purpose of this study is to investigate long-term changes in spinal sagittal balance after microsurgical decompression in lumbar canal stenosis (LCS). Fifty-two patients who underwent microsurgical decompression for symptomatic single level L4/5 spinal canal stenosis at our hospital were included in the study. All patients had standing full spine radiographs taken preoperatively, 1 year postoperatively, and 5 years postoperatively. Spinal parameters including sagittal balance were measured from the obtained images. First, preoperative parameters were compared with 50 age-matched asymptomatic volunteers. Next, the parameters before and after surgery were compared to examine long-term changes. Sagittal vertical axis (SVA) was significantly increased in the LCS cases compared to the volunteers (P = 0.03). Postoperative lumbar lordosis (LL) was significantly increased (P = 0.03). Postoperative mean SVA decreased but the difference was not significant (P = 0.12). Although there was no correlation between preoperative parameters and the Japanese Orthopedic Association score, postoperative pelvic incidence (PI)-LL and pelvic tilt changes correlated with changes in Japanese Orthopedic Association score (PI-LL; P = 0.0001, pelvic tilt; P = 0.04). However, after 5 years of surgery, LL decreased and PI-LL increased (LL; P = 0.08, PI-LL; P = 0.03). Sagittal balance began to deteriorate but was not significant (P = 0.31). At 5 years postoperatively, 18 of 52 patients (34.6%) were found to have L3/4 adjacent segment disease. Cases with adjacent segment disease showed significantly worse SVA and PI-LL (SVA; P = 0.01, PI-LL; P < 0.01). In LCS, lumbar kyphosis improves and sagittal balance tends to improve after microsurgical decompression. However, after 5 years, adjacent intervertebral degeneration occurs more frequently and sagittal balance begins to deteriorate in about one third of cases. [ABSTRACT FROM AUTHOR]

Abstract Background Standard procedure in patients with lumbar spinal canal stenosis is decompression to relieve the neural structures. Clinical results generally show superiority compared to nonoperative therapy after an observation period of several years. However, there is still a question of postsurgical segmental stability and correlation to clinical findings. Therefore, the aim of this prospective study was to evaluate the clinical outcome in patients who underwent microsurgical decompression in lumbar spine and particularly to analyze intervertebral movement by use of upright, kinetic-positional magnetic resonance imaging (MRI) over a period of 12 months and then to correlate the clinical and imaging data with each other. Methods Complete clinical data of 24 consecutive participants with microsurgical decompression of the lumbar spine were obtained by questionnaires including visual analogue scale (VAS) for back and leg, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), Short-Form-36 (SF-36), walking distance and use of analgesics with assessment preoperatively and after 6 weeks and 12 months. At the same points of time all patients underwent upright, kinetic-positional MRI to measure intersegmental motion of the operated levels with determination of intervertebral angles and translation and to correlate the clinical and imaging data with each other. Results VAS for leg, ODI, RMDQ and physical component scale of SF-36 improved statistically significantly without statistically significant differences regarding intersegmental motion and horizontal displacement 6 weeks and 12 months after operation. Regression analysis did not find any linear dependencies between the clinical scores and imaging parameters. Conclusions In awareness of some limitations of the study, our results demonstrate no increase of intersegmental movement or even instability after microsurgical decompression of the lumbar spine over a follow-up period of 12 months, which is equivalent to preservation of intervertebral stability. Furthermore, the magnitude of intervertebral range of motion showed no correlation to the clinical score parameters at all three examination points of time.

Background: Standard procedure in patients with lumbar spinal canal stenosis is decompression to relieve the neural structures. Clinical results generally show superiority compared to nonoperative therapy after an observation period of several years. However, there is still a question of postsurgical segmental stability and correlation to clinical findings. Therefore, the aim of this prospective study was to evaluate the clinical outcome in patients who underwent microsurgical decompression in lumbar spine and particularly to analyze intervertebral movement by use of upright, kinetic-positional magnetic resonance imaging (MRI) over a period of 12 months and then to correlate the clinical and imaging data with each other.Methods: Complete clinical data of 24 consecutive participants with microsurgical decompression of the lumbar spine were obtained by questionnaires including visual analogue scale (VAS) for back and leg, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), Short-Form-36 (SF-36), walking distance and use of analgesics with assessment preoperatively and after 6 weeks and 12 months. At the same points of time all patients underwent upright, kinetic-positional MRI to measure intersegmental motion of the operated levels with determination of intervertebral angles and translation and to correlate the clinical and imaging data with each other.Results: VAS for leg, ODI, RMDQ and physical component scale of SF-36 improved statistically significantly without statistically significant differences regarding intersegmental motion and horizontal displacement 6 weeks and 12 months after operation. Regression analysis did not find any linear dependencies between the clinical scores and imaging parameters.Conclusions: In awareness of some limitations of the study, our results demonstrate no increase of intersegmental movement or even instability after microsurgical decompression of the lumbar spine over a follow-up period of 12 months, which is equivalent to preservation of intervertebral stability. Furthermore, the magnitude of intervertebral range of motion showed no correlation to the clinical score parameters at all three examination points of time. [ABSTRACT FROM AUTHOR]

Purpose: Spinal abnormalities frequently occur in patients with mucopolysaccharidosis (MPS) types I, II, IV, and VI. The symptoms are manifold, which sometimes prolongs the diagnostic process and delays therapy. Spinal stenosis (SS) with spinal cord compression due to bone malformations and an accumulation of storage material in soft tissue are serious complications of MPS disease. Data on optimal perioperative therapeutic care of SS is limited. Methods: A retrospective chart analysis of patients with MPS and SS for the time period 01/1998 to 03/2021 was performed. Demographics, clinical data, neurological status, diagnostic evaluations (radiography, MRI, electrophysiology), and treatment modalities were documented. The extent of the SS and spinal canal diameter were analyzed. A Cox regression analysis was performed to identify prognostic factors for neurological outcomes. Results: Out of 209 MPS patients, 15 were included in this study. The most dominant type of MPS was I (–H) (n = 7; 46.7%). Preoperative neurological deterioration was the most frequent indication for further diagnostics (n = 12; 80%). The surgical procedure of choice was dorsal instrumentation with microsurgical decompression (n = 14; 93.3%). A univariate Cox regression analysis showed MPS type I (–H) to be associated with favorable neurological outcomes. Conclusion: Early detection of spinal stenosis is highly relevant in patients with MPS. Detailed neurological assessment during follow-up is crucial for timeous detection of patients at risk. The surgical intervention of choice is dorsal instrumentation with microsurgical decompression and resection of thickened intraspinal tissue. Patients with MPS type I (–H) demonstrated the best neurological course. [ABSTRACT FROM AUTHOR]

Background: Nervus intermedius neuralgia (NIN), known as geniculate neuralgia (GN), is an uncommon cranial nerve disease caused by an offending vessel compressing the nervus intermedius (NI). Microvascular decompression (MVD) has now become a valued treatment approach for NIN because it can resolve neurovascular conflict (NVC) at the root entry zone of the NI. In the era of continuously optimizing and improving the surgical technique of MVD, further minimization of all possible postoperative complications is not only welcome but also necessary.Objective: The aim of this work is to assess the postoperative outcome of direct visualization of the NI during the MVD procedure.Methods: This study retrospectively reviewed the clinical records of a group of seven consecutive patients with NIN who underwent MVD in the period of 2013–2020 in our clinic and 16 studies reported NIN patients who underwent MVD in the period of 2007–2020.Results: In total, 91.3% of all patients experienced immediate and complete relief of cranial neuralgia after MVD. Six of 23 patients have experienced direct visualization of the NI intraoperatively, and 66.7% of those patients had complications such as facial paralysis, dysacousia, or a combination of these conditions postoperatively. Slight surgical approach-related complications such as complaints associated with excessive drainage of cerebrospinal fluid (CSF), nausea and vertigo, and delayed wound union were observed in 80% of the remaining 15 patients, and these symptoms are totally relieved in the telephone and outpatient follow-up after 6 months.Conclusion: Our case series shows that MVD produced immediate pain relief in the majority of NIN patients. MVD carries surgical risk, especially in patients who experience direct visualization of the NI after mechanical stretch and blunt dissection in surgical procedures. Attempts to avoid mechanical stretch and blunt dissection of the compressed nerve were important for intraoperative neuroprotection, especially facial nerve protection

Background: Nervus intermedius neuralgia (NIN), known as geniculate neuralgia (GN), is an uncommon cranial nerve disease caused by an offending vessel compressing the nervus intermedius (NI). Microvascular decompression (MVD) has now become a valued treatment approach for NIN because it can resolve neurovascular conflict (NVC) at the root entry zone of the NI. In the era of continuously optimizing and improving the surgical technique of MVD, further minimization of all possible postoperative complications is not only welcome but also necessary. Objective: The aim of this work is to assess the postoperative outcome of direct visualization of the NI during the MVD procedure. Methods: This study retrospectively reviewed the clinical records of a group of seven consecutive patients with NIN who underwent MVD in the period of 2013–2020 in our clinic and 16 studies reported NIN patients who underwent MVD in the period of 2007–2020. Results: In total, 91.3% of all patients experienced immediate and complete relief of cranial neuralgia after MVD. Six of 23 patients have experienced direct visualization of the NI intraoperatively, and 66.7% of those patients had complications such as facial paralysis, dysacousia, or a combination of these conditions postoperatively. Slight surgical approach-related complications such as complaints associated with excessive drainage of cerebrospinal fluid (CSF), nausea and vertigo, and delayed wound union were observed in 80% of the remaining 15 patients, and these symptoms are totally relieved in the telephone and outpatient follow-up after 6 months. Conclusion: Our case series shows that MVD produced immediate pain relief in the majority of NIN patients. MVD carries surgical risk, especially in patients who experience direct visualization of the NI after mechanical stretch and blunt dissection in surgical procedures. Attempts to avoid mechanical stretch and blunt dissection of the compressed nerve were important for intraoperative neuroprotection, especially facial nerve protection [ABSTRACT FROM AUTHOR]

Objective: Microsurgical decompression for patients with symptomatic lumbar spinal stenosis (LSS) has demonstrated long-term improvement concerning pain and function. Nonetheless, a considerable proportion of these patients do not experience satisfactory alleviation of symptoms. Previous studies have not found a direct influence of single sagittal parameters on patient outcomes. However, recent research indicates that a composite of parameters, presented in specific sagittal profile types (SPTs) that were defined by Roussouly and colleagues, may affect these outcomes. This study aims to investigate the impact of SPT on long-term outcomes of patients with LSS following microsurgical decompression., Methods: This study is a prospective clinical observation. Patients with symptomatic LSS, who underwent microsurgical treatment and had long-term follow-up data for at least 36 months, were included. Patients with spinal deformity, fractures, or significant instability were excluded. Outcomes were measured using the numeric rating scale for pain, 36-Item Short Form Health Survey for quality of life, walking distance, Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Odom's criteria. SPT was determined in blinded fashion by using preoperative long standing radiographs., Results: The initial population of this observational study consisted of 128 patients, with long-term results available for 87 individuals, including 24 patients with SPT1, 20 with SPT2, 27 with SPT3, and 16 with SPT4. The average age was 70 years, with a slight male majority (56.3%) and a mean BMI of 27.9 kg/m2. After a median follow-up of 48 months, all groups showed significant improvement in walking distance, leg pain, and disability. Overall, 75% reported satisfaction with the surgery. However, patients with SPT1, which is characterized by low sacral slope and specific spinal curvatures, experienced significantly less improvement in back pain (p = 0.018) and related disability (p = 0.030), and lower satisfaction compared to other SPT groups (p = 0.008)., Conclusions: The sagittal spinal type is influencing the long-term outcome of patients suffering from symptomatic LSS. Patients with a combination of a flat sacral slope and a low overall lumbar lordosis with a high lordosis in the lower lumbar spine (i.e., spinal SPT1) showed worse outcome concerning back pain and had decreased satisfaction with surgery than comparable subjects from other SPT groups. Consequently, the authors recommend the assessment of sagittal spinal types in patients diagnosed with symptomatic spinal stenosis prior to decompression surgery. Inclusion of SPT in the preoperative consultation process can provide valuable insights, potentially guiding practitioners to more tailored patient counseling.

Few studies have examined the underlying cause of adjacent segment disease (ASD) after decompression surgery for lumbar spinal stenosis. The goal of this study is to investigate factors related to the onset of ASD after decompression surgery based on the imaging results. We examined 95 patients who underwent single-level decompression for lumbar spinal stenosis (L3/4, L4/5) and follow-up for 5 or more years. Radiographic images were performed preoperatively and at each year of follow-up. We then examined image parameters by focusing on the level operated on and adjacent segments in relation to the postoperative onset of symptomatic ASD. During the mean observation period of 7.5 years, 39 of 95 patients developed symptomatic ASD. Patients with a high preoperative sagittal rotation angle in adjacent segments possibly developed postoperative ASD (P = 0.0006). Furthermore, postoperative ASD tended to be unlikely in patients who exhibited postoperative slip progression at the operated level (P = 0.025). Based on receiver operating characteristic analysis, ASD developed with a probability of 91.3% in patients with a preoperative sagittal rotation angle of ≥7.5° in adjacent segments when there was no postoperative slip progression at the operated level. However, ASD developed in only 16.7% of patients with a preoperative adjacent segment sagittal rotation angle of 7.5° or less when there was postoperative slip progression at the operated level. Biomechanical changes at the operated level and adjacent segments contribute to the onset of ASD after lumbar decompression. Preoperative high sagittal rotation angle of adjacent segments and negative postoperative slip progression at the operated level are risk factors of ASD. [ABSTRACT FROM AUTHOR]

Background and aims: Opinions diverge concerning the prognostic importance of preoperative degenerative spondylolisthesis in patients with lumbar spinal stenosis, as well as the significance of further slippage post-operatively following decompression alone. However, a slip is only one among several factors related to the topic, e.g. duration and intensity of back and leg pain, pre-operative walking ability, number of levels operated and not least the experience of the surgeon. Our aim was to take all of the above-mentioned factors into consideration when analysing the patients' clinical outcome, reported as Change in back pain, Change in leg pain, Overall satisfaction and Change in walking ability, with special emphasis on the possible importance of pre- and/or post-operative degenerative spondylolisthesis. Methods: We studied 200 consecutive patients, mean follow-up time 81 months (range 62–108). Before treatment and on the follow-up occasion all patients answered the SF-36 questionnaire and assessed their back and leg pain on a visual analogue scale (VAS). At follow-up the patients were asked about possible changes in back and leg pain (completely free, much better, somewhat better, unchanged, somewhat worse, much worse) and whether they were; satisfied with the outcome, in doubt or not satisfied. Before treatment and at follow-up the presence or not of degenerative spondylolisthesis was determined in the lateral view on a plain X-ray or MRI. By use of a microsurgical technique decompression was achieved in all patients by bilateral laminotomy not sparing the midline ligaments, irrespective of a degenerative spondylolisthesis or not. Eight surgeons with different surgical experience performed the operations. Four separate multivariate analyses were conducted, one for each clinical outcome. The Lasso method was used for variable selection and multiple imputation was applied to handle missing values. Results: At follow-up 78.5% of the patients were completely satisfied with the outcome. Minimal clinical important difference (MCID) was achieved for 69% of the patients. Before surgery 28 patients were able to walk more than 1 km compared to 111 at follow-up. The reoperation rate at 6.8 years was 12% further decompressions and 2.5% fusions at the index level. Post-operative slippage was equally common in patients with and without a preoperative slip (around 30%). There were no notable differences in outcome in patients with and without a preoperative slip and no effect of further slippage at the index or another level post-operatively. Nor could the statistical analysis show any of the other covariates (age, gender, duration and intensity of back and leg pain, pre-operative walking ability or number of levels operated) to be of statistically significant importance for predicting the outcome. In the univariate statistical analysis differences were found between the patients of individual surgeons regarding satisfaction, pain improvement, and reoperation rates in favour of surgical experience, which were, however, not statistically significant in the multivariate analysis. Conclusions: None of the covariates, including pre-operative spondylolisthesis and further slippage post-operatively, were statistically significant for predicting the clinical outcome. Implication: Our results provide no evidence for adding fusion to the decompression. [ABSTRACT FROM AUTHOR]

Purpose: The lumbar epidural lipomatosis (LEL) is a rare disease that can cause sciatic pain syndrome or neurological deficits comparable to symptoms caused by a classical spinal canal stenosis. In severe cases surgical decompression was conducted. However, the outcome after decompressive surgery has only been investigated in small case series. In this study we compared the outcome of LEL patients after microsurgery with the outcome of patients with classical spinal stenosis (CSS).Methods: Patients with LEL (n = 38) and patients with CSS (n = 51), who received microsurgical decompression, were followed in a prospective observational study for 3 years. The clinical results including the Oswestry Disability Index, Numeric Pain Rating Scale (NRS), Roland and Morris Disability Questionnaire, the Short Form-36 Score and the Walking Distance were analysed and compared between both groups.Results: Patients with LEL improved significantly after microsurgical decompression in a 3-year follow-up concerning back pain, leg pain and pain-associated disability equal to patients with CSS (NRSback_LEL_preop. = 6.4; NRSback_CSS_preop. = 6.3; NRSback_LEL_3-years = 3.2; NRSback_CSS_3-years = 3.6; NRSleg_LEL_preop. = 6.3; NRSleg_CSS_preop. = 6.5; NRSleg_LEL_3-years = 2.5; NRSleg_CSS_3-years = 2.9; ODILEL_preop. = 52.7; ODICSS_preop = 51.8; ODILEL_3-years = 32.3; ODICSS_3-years = 27.6). The microsurgical decompression had a positive effect on the health-related quality of life, and patient satisfaction was high in both groups (LEL group-71%, CSS group-69%).Conclusions: LEL can influence the quality of life dramatically and cause a high degree of disability. A surgical decompression is a safe and effective procedure with a good clinical outcome comparable to the results in patients with an osteoligamentous spinal stenosis. Therefore, microsurgical decompression can be recommended in patients with LEL if conservative treatment fails. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients), were treated minimally invasive by this method from 2010-2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks - 5 years). Fifteen of twenty procedures were successful and cyst rupture was confirmed by CTscans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints.

Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients), were treated minimally invasive by this method from 2010-2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks - 5 years). Fifteen of twenty procedures were successful and cyst rupture was confirmed by CTscans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints. [ABSTRACT FROM AUTHOR]

Study Design. A retrospective study with retrospective and prospective inclusion of 100 patients. Objective. To determine whether the sagittal balance (SB) influences the clinical outcome of patients with degenerative lumbar spinal stenosis, who underwent microsurgical decompression. Summary of Background Data. The SB has become a critical factor for clinical decision making in the surgical treatment of spinal degenerative diseases. However, a frequently recommended sagittal realignment of elderly, multimorbid patients is accompanied by a significant rate of complications. The influence of SB on the clinical outcome of patients with degenerative spinal stenosis, who undergo decompressive surgery is not well understood. The aim of this study was to explore whether the clinical outcome of these patients is related to the SB and whether patients with spinal stenosis and degenerative sagittal imbalance necessitate restoration of the SB in addition to microsurgical decompression. Methods. One hundred patients with lumbar spinal stenosis, who received microsurgical decompression, were retrospectively identified and classified according to the severity of sagittal imbalance: (1) normal balance group, (2) minor loss of balance group, and (3) major loss of balance group. Sagittal parameters were determined from preoperative lateral spinal radiographs. As outcome parameters, we analyzed pre- and postoperative visual analogue scales for leg and back pain, walking distance, Oswestry disability index, Roland and Morris disability questionnaire, Odom's criteria, and the SF-36 score. Results. All groups significantly benefited from surgery concerning leg pain, back pain, and disability in every day's life. There was no difference in patients with decompensated sagittal imbalance compared to patients with normal SB regarding life quality 6 to 24 months after microsurgical decompression. Conclusions. Patients with symptomatic degenerative spinal stenosis and excluded major instability significantly benefit from microsurgical decompression regardless of their sagittal spinal balance. Thus, restoration of the SB for patients with symptomatic degenerative spinal stenosis cannot be recommended in addition to microsurgical decompression. [ABSTRACT FROM AUTHOR]

Object: Microsurgical decompression of the lumbar spine is a beneficial approach for selected patients of lumbar spinal stenosis (LSS). The purpose of this prospective study was to describe the clinical results of surgical treatment for microsurgical bilateral decompression via unilateral approach on patients with LSS with multiple-level involvement. Materials and methods: Seventy-three consecutive patients who had microsurgical bilateral decompression via unilateral approach of more than two spinal levels were included in this study. Seventy-seven patients who had surgery at a single level over the same time periods were compared as a single-level LSS group. Results: The preoperative Japanese Orthopaedic Association scores averaged 11.7 points, and the postoperative scores averaged 21.2 points with an average recovery rate (RR) of 56 % in the multiple-level LSS group. There was no significant difference in the RR between the groups. There were no major complications related to the surgery in the both groups. Conclusion: Microsurgical bilateral decompression via unilateral approach was a useful and safe operative procedure for LSS patients. Sufficient clinical results that were comparable to single-level LSS patients were obtained even in the patients with multiple-level LSS, if the patient were correctly selected and the microsurgical decompression surgery were carefully performed. [ABSTRACT FROM AUTHOR]

Background There has been no report regarding the results of two-level keyhole foraminotomy. The purpose of this study was to detail clinical outcomes following consecutive two-level cervical foraminotomy (tandem keyhole foraminotomy (TKF)) in patients with radiculopathy. Methods The authors conducted a retrospective review of 35 cases involving patients treated by a single surgeon using TKF. Clinical symptoms, data of physical examinations, pathology and clinical outcomes were detailed and discussed about this surgical method. Results Patients consisted of cervical disc herniation (CDH) (19/35), cervical spondylotic radiculopathy (CSR) (13/35), and cervical spondylotic amyotrophy (CSA) (3/35). TKF was performed from C3 to C5 in 2 patients (6%), from C4 to C6 in 7 patients (20%), from C5 to C7 in 23 patients (66%), and from C6 to T1 in 3 patients (8%). The mean operative duration was 99.2 min (range, 72 to 168 min). The mean estimated blood loss was 55.8 g (range, 0 to 200 g). Radicular pain was relieved within 3 months in 88% (29/32) and in 97% (31/32) at final follow-up. Resolution of muscle weakness was recognized within 6 months after operation in all CSA cases. Sixty-six percent of patients showed a greater than 20% deficit in grip weakness on the affected side compared with the normal side. After pain was relieved, grip strength improved by more than 15%. Conclusions TKF is a safe and highly effective procedure for patients with cervical radiculopathy and does not require invasive preoperative examinations. Further investigation is required to determine the effects of consecutive facetectomy. [ABSTRACT FROM AUTHOR]

Whether arterial or venous compression or arachnoid adhesions are primarily responsible for compression of the trigeminal nerve in patients with trigeminal neuralgia is unclear. The aim of this study was to determine the causes of trigeminal nerve compression in patients with trigeminal neuralgia. The surgical findings in patients with trigeminal neuralgia who were treated by micro vascular decompression were compared to those in patients with hemifacial spasm without any signs or symptoms of trigeminal neuralgia who were treated with microvascular decompression. The study included 99 patients with trigeminal neuralgia (median age, 57 years) and 101 patients with hemifacial spasm (median age, 47 years). There were significant differences between the groups in the relationship of artery to nerve ( p < 0.001) and the presence of arachnoid adhesions ( p < 0.001) but no significant difference in relationship of vein to nerve. After adjustment for age, gender, and other factors, patients with vein compression of nerve or with artery compression of nerve were more likely to have trigeminal neuralgia (OR = 5.21 and 42.54, p = 0.026 and p < 0.001, respectively). Patients with arachnoid adhesions were less likely to have trigeminal neuralgia (OR = 0.15, p = 0.038). Arterial compression of the trigeminal nerve is the primary cause of trigeminal neuralgia and therefore, decompression of veins need not be a priority when performing microvascular dissection in patients with trigeminal neuralgia. [ABSTRACT FROM AUTHOR]

Purpose: Percutaneous interspinous stand-alone spacers offer a simple and effective technique to treat lumbar spinal stenosis with neurogenic claudication. Nonetheless, open decompressive surgery remains the standard of care. This study compares the effectiveness of both techniques and the validity of percutaneous interspinous spacer use. Methods: Forty-five patients were included in this open prospective non-randomized study, and treated either with percutaneous interspinous stand-alone spacers (Aperius) or bilateral open microsurgical decompression at L3/4 or L4/5. Patient data, operative data, COMI, SF-36, PCS and MCS, ODI, and walking distance were collected 6 weeks, 3, 6, 9, 12, and 24 months post-surgery. Results: Group 1 ( n = 12) underwent spacer implantation, group 2 ( n = 33) open decompression. Five patients from group 1 required implant removal and open decompression during follow-up (FU); one patient was lost to FU. From group 2, seven patients were lost to FU. Remaining patients were assessed as above. After 2 years, back pain, leg pain, ODI, and quality of life improved significantly for group 2. Remaining group 1 patients ( n = 6) reported worse results. Walking distance improved for both groups. Conclusion: Decompression proved superior to percutaneous stand-alone spacer implantation in our two observational cohorts. Therapeutic failure was too high for interspinous spacers. [ABSTRACT FROM AUTHOR]

We performed microscopic lumbar foraminotomy in all the patients diagnosed with degenerative lumbar foraminal stenosis (DLFS) and retrospectively reviewed the clinical outcomes and the factors influencing them. The preoperative Japanese Orthopaedic Association (JOA) score of 13.8 significantly improved to 21.9 postoperatively. Although leg pain reduced in 44 patients (95.7%) immediately after surgery, it recurred in 9 patients (19.6%). The recurrence frequency was significantly higher and the JOA score improvement ratios significantly lower in patients with degenerative lumbar scoliosis (DLS) than in those without DLS. Even among patients with DLS, those with <3° Cobb angle difference between the supine and standing positions showed satisfactory results, with no recurrence. In conclusion, microscopic lumbar foraminotomy for DLFS produced satisfactory clinical outcomes even in patients with DLS. However, the outcomes were poor in patients with unstable DLS. [ABSTRACT FROM AUTHOR]

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Study design: Case report. Clinical question: To report successful surgical therapy for spinal canal stenosis in an adult patient with congenital thoraco-lumbar kyphoscoliosis with spina bifida aperta and myelomeningocele. Methods: A 65-year-old woman with a history of congenital thoraco-lumbar kyphoscoliosis with spina bifida aperta and myelomeningocele presented with severe radicular pain and weakness in her left lower limb. Results: The patient underwent microsurgical decompression at the level of L3/S1 on the left side. Postsurgery, the patient showed significant amount of pain relief and improvement in weakness in the left lower limb. Conclusion: Surgery for spinal canal stenosis in patients with severe thoraco-lumbar scoliosis can be effective in relieving radicular pain, weakness and numbness, and while not curative can greatly improve the quality of life. [ABSTRACT FROM AUTHOR]