AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Norbery Jorge Rodríguez De La Paz, Institute of Neurology and Neurosurgery of Cuba, Department of Neurosurgery
Citation: Norbery Jorge Rodríguez De La Paz, Duniel A. Casas., Conceição Sallé MD, Orestes L. Piloto., Calixto Machado, Brandon Brock. (2021) Surgical Results of Lumbar Canal Recalibration by Modified Senegas Technique. J. Neuroscience and Neurological Surgery. 9(4); DOI:10.31579/2578-8868/204
Copyright: © 2021 Norbery Jorge Rodríguez De La Paz. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 23 August 2021 | Accepted: 09 September 2021 | Published: 14 September 2021
Keywords: lumbar canal stenosis; lumbar canal recalibration; modified senegas technique
The aim of recalibration of the lumbar canal using the Senegas technique guarantees stability and preserves movement, with a considerable reduction in surgical risk and faster incorporation into daily life. Objective: To evaluate the surgical results of recalibration of the lumbar canal using the modified Senegas technique.
Materials and Methods: An ambispective and cross-sectional descriptive observational study was carried out at the Institute of Neurology and Neurosurgery between January 2011 and December 2019 that were evaluated 6 and 12 months after having been operated.
Results: 70.7% of the patients manifested chronic low back pain, and dysesthesia was found in 39.8%. There were 15.8% complications. The clinical evolution according to the Lumbar and Lower Limb Verbal Numerical Scale and the functional one according to the Oswestry Disability Index was better at 6 and 12 months after the intervention compared to the preoperative period. The result was considered good at 82.7% and 89.4%, respectively, at 6 and 12 months.
Conclusions: The clinical and functional evolution of the operated patients is significantly better at 6 and 12 months concerning the preoperative one. At both 6 and 12 months, surgical results are good in the vast majority of patients.
Currently, lumbar canal stenosis is a common cause of low back pain and lower extremity pain in older adults, with an incidence of 5/100000 and a prevalence of approximately 400,000 adults in the United States 23, it is the most frequent cause of spinal surgery in patients older than 65 years, with the improvement in life expectancy and the increase in the proportion of people over 65 years of age, the incidence of will increase even more proportionally, expecting 20% by 2026. [1] In Cuba, the prevalence of lumbar spinal canal stenosis is around 6% of the population. [2]
Since the spinal canals are the roots of the nerves and the spinal cord, when a narrowing of this canal occurs, the nerve roots can be compromised, originating characteristic symptomatology consisting of pain and sensory alterations radiating to the lower limbs.
Conservative treatment is based on the use of non-steroidal anti-inflammatory drugs, physical therapy, which requires constancy and at least three months of continuity, and lifestyle changes, not always accepted by patients, and approximately 60% of cases do not resolve with that treatment. [3]
The most practiced surgical treatment until 5 or 6 years ago was decompression and posterior arthrodesis of the lumbar segment with or without instrumentation. Still, as it is not performed, immobilization in a cast brace is necessary for six months. A great limit that exists between conservative treatment and surgical, high risk. Hence, in 1988 Professor Jacques Senegas,in France, exposed his technique of systematic recalibration of the lumbar canal, by means of which the posterior arch, the articular facets, the disc, and the holes which are progressively dilated as necessary, causing minimal damage to the integrity mechanics and stability of the spine. Shortly after, he enunciated interspinous distraction as one more element of this recalibration. At the same time, he discussed a dynamic neutralization device (conservation of movement) that guarantees stability and preserves movement, significantly reducing surgical risk and faster incorporation into daily life. For this reason, the objective of the research is to evaluate the surgical results of recalibration of the lumbar canal using the modified Senegas technique. This modification proposed by us includes the endoscopic support approach as an essential tool to avoid damage to the neurovascular structures, improving the surgical field's vision. In this case, the ligamentoplasty is optional. [4]
An descriptive observational study was carried out in patients who underwent recalibration of the lumbar canal by the Senegas technique modified in the INN between January 2011 and December 2019.
The universe consisted of all the patients operated on for lumbar canal stenosis. The sample was non-probabilistic and consisted of 133 patients operated on for lumbar canal stenosis using the modified Senegas technique with the information source the clinical histories of the patients treated in the INN.
The inclusion criteria were: patients over 19 years of age, of either sex, with lumbar canal stenosis demonstrated by imaging tests (CT and/or MRI), the condition between L1-S1, the persistence of symptoms after conservative treatment for a minimum of six months, or in the presence of progressive neurological deficit.
The exclusion criteria were: patients with tumor or pseudotumoral pathology associated with the affected level, patients who underwent surgery at the level of the lumbar spine, spondylolisthesis greater than 25% slip, lateral listhesis greater than 4 mm, non-degenerative causes of stenosis, lateral curves greater than 20º associated with a degenerative process (associated scoliosis> 20º), psychiatric diseases that do not allow the functional evaluation to be carried out.
The variables studied were: age, sex, time of evolution, affected level, symptoms, signs, intraoperative complications, postoperative complications, Lumbar Verbal Numerical Scale (VNS), VNS lower limbs, Index of Oswestry Disability (ODI) and Surgical Outcomes.
The source of information was the patient's medical history. The clinical information was collected in collection charts and were included in a data collection worksheet.
The variables under study were expressed according to their respective summary measures as the arithmetic mean, standard deviation, median, interquartile range, minimum and maximum for the quantitative ones, and numbers and percentage for the qualitative ones.
To identify the association of the quantitative variables, the JI test of independence and the correlation coefficients (Pearson, Spearman), were used. For qualitative variables, t-test test was used to compare means and medians.
Final evaluation
The patients were evaluated 6 and 12 months after being operated on. The measurement of both lumbar and lower limb pain was performed using the Verbal Numerical Scale (VNS) and functional assessment using the Oswestry Disability Index (ODI).
To estimate the results of surgery at 6 and 12 months, the Macnab classification was used, which considered the result as:
Ethical considerations
The study was carried out according to the Declaration of Helsinki, modification of Fortaleza, Brazil, on research on human beings. For this, authorization was requested from the Neurosurgery service to access the clinical records, and the database of the patients included in the study, with the responsibility and obligation not to disclose the information collected, keeping it strictly confidential
The age of the patients ranged between 35 and 78 years, with a mean of 66.32 ± 8.98 years and a predominance of cases between 60 and 69 years with 52 (39.1%). A total of 84 (63.1%) patients were male. 67.7% (n = 90) of the cases had more than 12 months of disease evolution, with a median of 21.80 ± 6.11 months, minimum of 5 and 43 months maximum. The most affected levels were L4-L5 in 47.4% (n = 63), L5-S1 in 30.1% (n = 40) and L3-L4 in 15.8% (n = 21).
The symptoms referred by the patients were chronic low back, radicular pain continuous or intermittent and neurogenic claudication, dysesthesia, hypoesthesia, hyporeflexia and motor deficit. (Table 1).
There were a total of 21 complications (Table 2), that was presented intraoperatively and consisted of injury to the dura mater, the remaining ones occurred postoperatively and surgical wound infections, chronic pain, and epidural fibrosis and reoperation, respectively.
Regarding the clinical and functional evolution of the patients studied (Table 3);
Surgical results, at six months postoperatively, were good in 110 (82.7%), fair in 19 (14.3%) and poor in 4 (3.0%), and at 12 months, they were good in 119 (89.4%), fair in 14 (10.6%) and foul in none, significant results have been statistically analyzed (Table 4).
There is a worldwide consensus that spinal canal stenosis occurs mainly between the fifth and sixth decades of life, [5] these results are consistent with those of this and other investigations [6,7] and they are explained because as people age the ligaments of the spine thicken and harden (a process called calcification), bones and joints are deformed forming osteophytes and hernias or disc protrusions commonly appear, in addition to spondylolisthesis, all factors that lead to lumbar canal stenosis. [8]
As observed in this and other studies, most lumbar canal stenoses begin with a segment, with L4-L5, followed by L5-S1, being the most affected because they are the ones that receive the most significant load and due to the accumulation of microtraumas, which favors the development of degenerative processes. As the disease becomes progressive, it secondarily affects other, generally higher segments, becoming multisegmental, and although some patients present the method in several segments from the onset of the disease, this is not the rule. [9]
The clinical presentation of lumbar canal stenosis is generally given by chronic low back pain, radiculopathy, and intermittent non-vascular claudication. The clinical symptoms in the patients included in this series are similar to those published in the literature. Lower limb pain is present in approximately 70 to 80% of patients, while low back pain is present in 60% to 65%. [10] This also has mechanical characteristics, long evolution and is accompanied by poorly defined and sometimes changing neurological symptoms in the lower extremities. Although the clinical examination of the lumbar spine usually provides little data, motor deficits that are not observed with the patient at rest can be found frequently, as well as symmetrical reduction of reflexes and some loss of sensation. Complications derived from decompression surgery for lumbar canal stenosis range between 15-30
The main limitation of the present study is its ambispective design, which means that when data are collected from medical records, there may be errors in their interpretation.
Our study shows that the complications derived from this technique are within the range described in the literature for patients who receive decompression of the lumbar canal, with a significantly better clinical and functional evolution of the operated patients at 6 and 12 months concerning the preoperative. Both at 6 and 12 months, the surgical results were rated as good in most patients.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
