Suchergebnisse

Background and Objective Lumbar spinal stenosis (LSS) is a common degenerative condition that occurs in the spine with increasing age. Clinically, LSS causes a progressive reduction in walking autonomy, resulting in a poor quality of life and impaired functional capacity. The aim of this study was to evaluate the clinical outcome and quality of life of elderly patients presenting with LSS and associated comorbidities after a 5-year follow-up who were treated with an interspinous process device (IPD).
Material and Methods Sixty patients > 75 years of age presenting with symptomatic degenerative LSS were included. All were treated with an IPD under local anesthesia. American Society of Anesthesiology score, Zurich Claudication Questionnaire, and Short Form 36 were evaluated pre- and postoperatively and at the follow-up visit each year for 5 years.
Results The mean surgery time while under local anesthesia was 20 minutes. Forty-eight patients were followed for 5 years. Significant clinical improvements in all outcome scores (p < 0.05) both postoperatively or at follow-up were found.
Conclusions IPD seems to be an effective and safe treatment for LSS in elderly patients with general comorbidities. In our study, all followed up patients had a meaningful improvement of their quality of life even at 5 years after surgery.

Background and Study Objective In surgery for gliomas and brain metastases, preservation of neurologic functions is essential to ensure a good quality of life and the eligibility for adjuvant therapies. This article assesses which factors could influence the functional outcome in patients with lesions located in the motor pathways.
Materials and Methods A total of 92 patients with gliomas and metastases involving the motor pathways were studied for concerns regarding quality of life (Karnofsky performance status [KPS] and modified Rankin scale [mRS]) before and after surgical treatment supported by intraoperative neuromonitoring. Patient-related, surgery-related, and lesion-related data were recorded to identify the relationships with postoperative performance status. The relationship between lesions and the corticospinal tract were investigated with preoperative magnetic resonance imaging sequences and tractographic reconstructions.
Results Means of preoperative mRS and KPS were 1.91 ± 1.34 and 80.8 ± 20, and at 30 days postoperatively they were 1.93 ± 1.63 and 79.8 ± 24.4, respectively. The better preoperative performance status was a predictor of better outcome in terms of quality of life. Gender showed a statistical association with ∆KPS (p = 0.033) and ∆mRS (p = 0.031). A recurrent lesion was a predictor of poor functional outcome (p= 0.045 for KPS at 30 days).A left-sided lesion showed a statistical association with a lesser improvement with respect to right sided. Complications were associated with a lesser functional improvement (∆mRS, ∆KPS, and clinical improvement: p = 0.001, p = 0.006, and p = 0.003, respectively). Hemorrhagic complications were associated with the worst functional prognosis.
Conclusions In our experience, factors associated with worse functional prognosis and quality of life were a poor preoperative performance status, female gender, operating on a recurrent lesion, involvement of the left corticospinal tract, and surgical or medical postoperative complications.

Abstract
Background The impact of minimally invasive decompression (MID) techniques on spinopelvic parameters and on the sagittal alignment remains a controversial topic. Here we studied the changes in clinical and radiologic parameters and their relationships in a series of lumbar spinal stenosis (LSS) submitted to MID with a minimum follow-up (FU) of 24 months.
Methods We prospectively collected clinical and radiologic data of 20 consecutive patients who were evaluated preoperatively, at the 6-month FU, and at the 24-month FU. Visual analog scale (VAS) for back and leg pain, Oswestry disability index (ODI), neck disability index (NDI), sagittal vertical axis (SVA), C7 slope (C7S), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were assessed for each patient. Moreover, the percentage variation of clinical and radiologic factors at the 24-month FU compared with the preoperative factors was calculated to perform correlation studies among these variables.
Results We reported a significant improvement of all clinical parameters. A significant increase of LL and SS and a significant decrease of PT and SVA were observed. The preoperative values of ODI, LL, SS, PT, and SVA significantly affect the 24-month FU values, and the percentage improvement of SVA at the 24-month FU compared with the preoperative values was significantly related to the percentage improvement of LL.
Conclusions MID is clinically effective in patients with LSS and improves the spinopelvic parameters and the global sagittal balance of the spine. The preoperative spinal alignment affects the spinal alignment at FU. The improvement of SVA was strictly related to the improvement of LL.