Spondylolisthesis can be observed from plain radiographic images, but not all spondylolisthesis will lead to LSS. None of the above physical examination has higher percentage in both sensitivity and specificity. The specificity of wide-based gait, abnormal Romberg result is more than 90%, but the sensitivity is less than 50%, the sign of “No pain with flexion” has a sensitivity of 79%, only 44% for specificity ( 16). Physical examination includes the assessment of gait (normal or wide-based gait), modified Romberg maneuver (the patients’ feet are kept together and eyes closed for about 10 seconds and observed for imbalance), no pain with flexion, strength of knee flexors and extensors, ankle dorsiflexors and plantar flexors, pinprick sensation and achilles reflex. Patients with lumbar stenosis with spondylolisthesis often have low back pain ( 18, 19), and other symptoms include leg numbness, imbalance and lower extremity weakness ( 12, 20). For some dynamic components in LSS patients, the pain symptom often is relieved at the position of sitting down or lumbar flexion (using a shopping cart or bicycle), and exacerbated at the position of lumbar extension, which will reduce the area of lumbar spinal canal ( 14- 17). The patients complain of pain or discomfort that radiates to the buttock, thigh and lower leg after walking for a certain distance ( 10, 11), therefore leading to functional disability and decreased walking capacity ( 12, 13). Neurogenic claudication is the most common symptom for LSS patients. During 2002 to 2007, the rate of lumbar stenosis surgery per 100,000 Medicare beneficiaries is about 135.5–137.5 persons, the mean hospital charges for decompression alone is about $23,724 and combined with fusion is $80,888, and in 2009, the hospital bill for LSS for Medicare beneficiaries was $1.65 billion ( 9), which is a significant socioeconomic burden. The LSS is the most common reason for >65 years old patients to undergo the spinal surgery ( 8). Another study reported the incidence of symptomatic LSS is about 10% ( 7). A population-based study in Japan ( 6) found that the LSS incidence was increased by age, about 1.7–2.2% in 40–49 years old population, and 10.3%–11.2% in 70–79 years old population. The Framingham Study ( 5) found that congenital relative LSS was 4.7% and absolute LSS was 2.6%, acquired relative and absolute LSS was 22.5% and 7.3%, respectively, for 60–69 years old population, the relative and absolute LSS was 47.2% and 19.4%, respectively. It is estimated that more than 200,000 adults are affected by LSS in the United States ( 2), and will rise to 64 million elderly adults by the year 2025 ( 4). The exact prevalence of LSS is still unknown. Policy of Dealing with Allegations of Research MisconductĪi-Min Wu 1, Fei Zou 2, Yong Cao 3, Dong-Dong Xia 4, Wei He 5, Bin Zhu 6, Dong Chen 1, Wen-Fei Ni 1, Xiang-Yang Wang 1, Kenny Kwan 7ġ Department of Spine Surgery, Orthopedic Hospital, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou 325027, China Ģ Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China ģ Department of Spine Surgery, Xiangya Hospital Central South University, Changsha 410008, China Ĥ Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China ĥ Department of Orthopaedics, People’s Hospital of Shaoxing, Zhejiang University Shaoxing Hospital, Shaoxing 312000, China Ħ Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China ħ Department of Orthopaedics and Traumatology, the University of Hong Kong, Hong Kong, ChinaĬontributions: (I) Conception and design: AM Wu, XY Wang, K Kwan (II) Administrative support: WF Ni, XY Wang, K Kwan (III) Provision of study materials or patients: AM Wu, F Zou, Y Cao, DD Xia, W He, B Zhu, D Chen (IV) Collection and assembly of data: AM Wu, F Zou (V) Data analysis and interpretation: AM Wu, F Zou, D Chen (VI) Manuscript writing: All authors (VII) Final approval of manuscript: All authors.įigure 2 The spondylolisthesis patient with upper vertebra slip forward over the lower one may cause narrowing of the lumbar spinal canal. ![]() ![]() Policy of Screening for Plagiarism Process.
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