Study Design: Retrospective case series and systemic literature meta-analysis.

Background: Thoracolumbar junction region stenosis produces spinal cord compression just above the conus and may manifest with symptoms that are not typical of either thoracic myelopathy or neurogenic claudication from lumbar stenosis.

Objective: As few studies describe its specific pattern of presenting symptoms and neurological deficits, this investigation was designed to improve understanding of this pathology.

Methods: A retrospective review assessed surgically treated cases of T10-L1 degenerative stenosis. Clinical outcomes were evaluated with the thoracic Japanese Orthopedic Association score. In addition, a systematic review and meta-analysis was performed in accordance with guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results: Of 1069 patients undergoing laminectomy at 1477 levels, 31 patients (16M/15F) were treated at T10-L1 a mean age 64.4 (SD=11.8). Patients complained of lower extremity numbness in 29/31 (94%), urinary dysfunction 11/31 (35%), and back pain 11/31 (35%). All complained about gait difficulty and objective motor deficits were detected in 24 of 31 (77%). Weakness was most often seen in foot dorsiflexion 22/31 (71%). Deep tendon reflexes were increased in 10 (32%), decreased in 11 (35%), and normal 10 (32%); the Babinski sign was present 8/31 (26%). Mean thoracic Japanese Orthopedic Association scores improved from 6.4 (SD=1.8) to 8.4 (SD=1.8) ( P <0.00001). Gait subjectively improved in 27/31 (87%) numbness improved in 26/30 (87%); but urinary function improved in only 4/11 (45%).

Conclusions: Thoracolumbar junction stenosis produces distinctive neurological findings characterized by lower extremity numbness, weakness particularly in foot dorsiflexion, urinary dysfunction, and inconsistent reflex changes, a neurological pattern stemming from epiconus level compression and the myelomeres for the L5 roots. Surgery results in significant clinical improvement, with numbness and gait improving more than urinary dysfunction. Many patients with thoracolumbar junction stenosis are initially misdiagnosed as being symptomatic from lumbar stenosis, thus delaying definitive surgery.

Download full-text PDF

Source
http://dx.doi.org/10.1097/BSD.0000000000001539DOI Listing

Publication Analysis

Top Keywords

thoracolumbar junction
8
junction region
8
region stenosis
8
thoracic japanese
8
japanese orthopedic
8
orthopedic association
8
11/31 35%
8
distinctive characteristics
4
characteristics thoracolumbar
4
stenosis study
4

Similar Publications

Objective: To compare correction of kyphotic deformity (KD) and implant failure (IF) in percutaneous short-segment pedicle screws fixation (SSPF) with index level versus long-segment pedicle screws fixation (LSPF) without index level for traumatic thoracolumbar (TL) fractures.

Methods: This prospective study comprised 56 patients who met the study's inclusion criteria from the Department of Neurosurgery at the Punjab Institute of Neurosciences in Lahore, Pakistan presented between June 2022 and May 2023. We separated them into two groups: Group-A and Group-B, each with 28 patients.

View Article and Find Full Text PDF

Background: Effects of rigid posterior instrumentation on the three-dimensional post-operative spinal flexibility are widely unknown. Purpose of this in vitro study was to quantify these effects for characteristic adolescent idiopathic scoliosis instrumentations.

Methods: Six fresh frozen human thoracic and lumbar spine specimens (C7-S) with entire rib cage from young adult donors (26-45 years) without clinically relevant deformity were loaded quasi-statically with pure moments of 5 Nm in flexion/extension, lateral bending, and axial rotation.

View Article and Find Full Text PDF

The characteristic of thoracolumbar junction syndrome (TLJS( described by Maigne are pain in the iliac crest and tenderness on palpation at the level of the junction between the lower dorsal and the upper lumbar vertebra. It is an often unrecognized and treatable cause of low back pain. TLJS is commonly associated with those who have low back pain, although it does not always present pain in this region.

View Article and Find Full Text PDF

Meralgia paresthetica (MP), a common entrapment syndrome, presents with paresthesias in the anterolateral aspect of the thigh. Clinical tests used to diagnose MP are the pelvic compression test, neurodynamic testing, and Tinel's sign. The diagnostic accuracy of these three tests has not been analyzed to date.

View Article and Find Full Text PDF

: Thoracolumbar and lumbar spine injuries account for 30-60% of spinal fractures, especially at the thoracolumbar junction. Conservative treatment is recommended for stable fractures without neurological symptoms, but studies suggest surgical intervention may offer better outcomes. However, there is no consensus on the best stabilization method.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!