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The factors of deterioration in long-term clinical course of lumbar spinal canal stenosis after successful conservative treatment

BACKGROUND: The treatment of lumbar spinal canal stenosis (LSS) depends on symptom severity. In the absence of severe symptoms such as severe motor disturbances or bowel and/or urinary dysfunction, conservative treatment is generally the first choice for the treatment of LSS. However, we experienced...

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Autores principales: Tsubosaka, Masanori, Kaneyama, Shuichi, Yano, Tomonori, Kasahara, Koichi, Kanemura, Aritetsu, Takabatake, Masato, Hirata, Hiroaki, Sumi, Masatoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145329/
https://www.ncbi.nlm.nih.gov/pubmed/30227869
http://dx.doi.org/10.1186/s13018-018-0947-2
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author Tsubosaka, Masanori
Kaneyama, Shuichi
Yano, Tomonori
Kasahara, Koichi
Kanemura, Aritetsu
Takabatake, Masato
Hirata, Hiroaki
Sumi, Masatoshi
author_facet Tsubosaka, Masanori
Kaneyama, Shuichi
Yano, Tomonori
Kasahara, Koichi
Kanemura, Aritetsu
Takabatake, Masato
Hirata, Hiroaki
Sumi, Masatoshi
author_sort Tsubosaka, Masanori
collection PubMed
description BACKGROUND: The treatment of lumbar spinal canal stenosis (LSS) depends on symptom severity. In the absence of severe symptoms such as severe motor disturbances or bowel and/or urinary dysfunction, conservative treatment is generally the first choice for the treatment of LSS. However, we experienced cases of worsening symptoms even after successful conservative treatment. The purpose of this study is to investigate the long-term clinical course of LSS following successful conservative treatment and analyze the prognostic factors associated with symptom deterioration. METHODS: The study included 60 LSS patients (34 females and 26 males) whose symptoms were relieved by conservative treatment between April 2007 and March 2010 and who were followed up for 5 years or longer. The mean age at admission was 64.8 ± 8.5 years (range, 40–85 years old), and the mean follow-up period was 7.3 years (range, 5.8–9.5 years). We defined “deterioration” of symptoms as the shortening of intermittent claudication more than 50 m compared with those at discharge or the occurrence or progression of lower limb paralysis, and “poor outcome” as the deterioration within 5 years after discharge. The long-term outcome of conservative treatment for LSS was analyzed by Kaplan-Meier analysis. Furthermore, logistic regression analysis was performed to reveal the risk factors of poor outcome for clinical classification, severe intermittent claudication (≤ 100 m), lower limb muscle weakness, vertebral body slip (≥ 3 mm), scoliosis (Cobb angle ≥ 10°), block on myelography, and redundant nerve roots of the cauda equina. RESULTS: Thirty-four (56.7%) patients preserved their condition at discharge during the follow-up, whereas 26 patients (43.3%) showed deterioration. Sixteen patients had a decreased intermittent claudication distance, and 10 patients had newly developed or progressive paralysis. The probability of preservation was maintained at 68.3% at 5 years after discharge. Logistic regression analysis demonstrated that only severe intermittent claudication (≤ 100 m) was a significant risk factor of a poor outcome (p = 0.005, odds ratio = 6.665). CONCLUSIONS: The patients with severe intermittent claudication should be carefully followed up because those are the significant deterioration candidates despite the success in conservative treatment.
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spelling pubmed-61453292018-09-24 The factors of deterioration in long-term clinical course of lumbar spinal canal stenosis after successful conservative treatment Tsubosaka, Masanori Kaneyama, Shuichi Yano, Tomonori Kasahara, Koichi Kanemura, Aritetsu Takabatake, Masato Hirata, Hiroaki Sumi, Masatoshi J Orthop Surg Res Research Article BACKGROUND: The treatment of lumbar spinal canal stenosis (LSS) depends on symptom severity. In the absence of severe symptoms such as severe motor disturbances or bowel and/or urinary dysfunction, conservative treatment is generally the first choice for the treatment of LSS. However, we experienced cases of worsening symptoms even after successful conservative treatment. The purpose of this study is to investigate the long-term clinical course of LSS following successful conservative treatment and analyze the prognostic factors associated with symptom deterioration. METHODS: The study included 60 LSS patients (34 females and 26 males) whose symptoms were relieved by conservative treatment between April 2007 and March 2010 and who were followed up for 5 years or longer. The mean age at admission was 64.8 ± 8.5 years (range, 40–85 years old), and the mean follow-up period was 7.3 years (range, 5.8–9.5 years). We defined “deterioration” of symptoms as the shortening of intermittent claudication more than 50 m compared with those at discharge or the occurrence or progression of lower limb paralysis, and “poor outcome” as the deterioration within 5 years after discharge. The long-term outcome of conservative treatment for LSS was analyzed by Kaplan-Meier analysis. Furthermore, logistic regression analysis was performed to reveal the risk factors of poor outcome for clinical classification, severe intermittent claudication (≤ 100 m), lower limb muscle weakness, vertebral body slip (≥ 3 mm), scoliosis (Cobb angle ≥ 10°), block on myelography, and redundant nerve roots of the cauda equina. RESULTS: Thirty-four (56.7%) patients preserved their condition at discharge during the follow-up, whereas 26 patients (43.3%) showed deterioration. Sixteen patients had a decreased intermittent claudication distance, and 10 patients had newly developed or progressive paralysis. The probability of preservation was maintained at 68.3% at 5 years after discharge. Logistic regression analysis demonstrated that only severe intermittent claudication (≤ 100 m) was a significant risk factor of a poor outcome (p = 0.005, odds ratio = 6.665). CONCLUSIONS: The patients with severe intermittent claudication should be carefully followed up because those are the significant deterioration candidates despite the success in conservative treatment. BioMed Central 2018-09-18 /pmc/articles/PMC6145329/ /pubmed/30227869 http://dx.doi.org/10.1186/s13018-018-0947-2 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Tsubosaka, Masanori
Kaneyama, Shuichi
Yano, Tomonori
Kasahara, Koichi
Kanemura, Aritetsu
Takabatake, Masato
Hirata, Hiroaki
Sumi, Masatoshi
The factors of deterioration in long-term clinical course of lumbar spinal canal stenosis after successful conservative treatment
title The factors of deterioration in long-term clinical course of lumbar spinal canal stenosis after successful conservative treatment
title_full The factors of deterioration in long-term clinical course of lumbar spinal canal stenosis after successful conservative treatment
title_fullStr The factors of deterioration in long-term clinical course of lumbar spinal canal stenosis after successful conservative treatment
title_full_unstemmed The factors of deterioration in long-term clinical course of lumbar spinal canal stenosis after successful conservative treatment
title_short The factors of deterioration in long-term clinical course of lumbar spinal canal stenosis after successful conservative treatment
title_sort factors of deterioration in long-term clinical course of lumbar spinal canal stenosis after successful conservative treatment
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145329/
https://www.ncbi.nlm.nih.gov/pubmed/30227869
http://dx.doi.org/10.1186/s13018-018-0947-2
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