Thursday, March 30, 2017

Motivation: Life is Beautiful: Bichah Session

Motivational speech:

Live is so much beautiful, embrace it, you are the champion, you are the master of your life, you are the one to create the difference, you have so much precious and valuable, know yourself inside of you first and then others will know you. Today is a great day, live today, don’t worry about future, it is not in your hands, live for good, no evil will cross your mind, surround yourself with people who gives good energy vibes to you and give your best shot, imagine, dream beyond your capabilities always, walk away from comfort zone and try in panic zone in search of success, you are the winner, don’t lose hope, every time you have to get up and discover new vibes of your life. Every time do something productive that creates significance of you.

There are three spectrum in the life, live in the upper most, lower is the depression spectrum, middle is the fear zone, and upper one conquer your fear. There human life is very precious one, unchain the boundary of the society and try challenging and surprise the world around you and you will be noticed. Try to be noticed for good reason not for bad ones like terrorist. Know your identity and program your mind not according to what others think about you but according to your desire. Persuasion, happiness, desires are so much tangible things. Try to make people understand you. Fake yourself that you are the right person until you make it, until others believe in you that you are the right one.

See the donkey, it teaches us that we should be laborious and hard-working. See the lion, it teaches us that we can be king even with no hardworking. See the eagle; it can fly so high in the sky. See the astronauts, they have no limit of sky, they have gone beyond the sky and have reached the moon.

Never fall in the well of comfort. It will someday create obsession and you may never come out from that well. See opportunities and grab them when you are on land not in well. Every time you need to do what you want to do. Don’t think what others think because you are not governed by the rules of those people. You are the master of your own.

Everyone has some innate qualities. Know those qualities, which will better recognize them than you do. You are the gift of god with those qualities. Use them for the mankind.

Show others what you have. Then others will know your value. Learn to create your value among people. Then whatever the situation, the value remains, you will be remembered for your work. Do that type of work.
Life is an art. Draw the best one who you want to be. Repetition of good works is very essential. That is another word for iteration of your modeling of your frame. There is nothing important than yourself in your life. Utilize the time period, don’t think about age, health and if’s and but’s. just do it, “DIY”-“Do It Yourself”.
We need more and more focus and focus group discussion so that we see our goal clear.

Chimney baata kohi pani setai niskadaina, kasaile vanyo, ekjana seto ekjana kaalo kasari niskyo….vanda seto man6e le mukh dhoyera navannu…..so much hilarious………….

Lion every condition maa lion nai huncha, sheep sheep nai hunu parcha
Mice lai starvation maa rakhera, mice nai khayo vane tesle pachi pani mice nai khancha, brain changes according to condition.

Rabbit lai khana hare le nasake pachi, mata timi vanda chito daudina sakchu, tara pani matimlai samauna sakina kina, hare sir, hajur malai khana lai daudinu vayo, ma mero jian ko laagi daudi rahechu tesaile, purpose yesto hosh, aim yesto hosh life maa, jun kura ali authentic hosh.

Nobel prize winners kunai 5 jana ko name thaha6? Billionaires 5 jana ko name thaha6? Thaha6aina, tara aphno life maa effect parne kunai 5 jana man6e thaha6, so know these people, don’t lose them. You will need them.

Aaja padhnu hun6 voli birsin6, tara nursery maa padheko a, b, c, d………..birsinna, kina? So tyo subconscious mind lai thaha vaisakyo that tyo padhnu pardaina, so tesari nai, subconscious mind lai aaja padheko kura a, b, c, d…………jasto banaunus, tesko laagi passion, creativity, knowledge lai aphno talent sanga mix up garnus, ani success au6, chahinna vanda pani mukhai maa au6. Don’t fear and avoid reality. You are living in present for real. Don’t hide things, hidden things bring fear. Fear is the greatest weakness that pulls you backward everytime you want to step forward, you lose your mind control and creativity when your mind is not calm and nothing glooms in your mind except the black hole of fear and slowly that fear changes into anger and rage at no time. That anger kills you inside and outside and brings your demise.
So be real, don’t afraid to work in your passion.

Knowledge is Power. This proverb came from thousands of experiments. So, you don’t have to experiment it again. Your knowledge is your power to your peaceful life.
Keep Smiling!!!!

Cheers!!!!!

There are so many sessions and discussions in Bichah Meeting that are equally or much more powerful that this one. Interact with Bichah!!! Please comment to interact with us.

Wednesday, March 29, 2017

Mystic Radiation "X-rays"

Mysticism of Radiation


So the radiation can be either in the form of particle or in the form of abstract massless, so k/a energy. Thus two types of radiation emerge. All these thousands of years of human civilization, we began to heat up and cook the resources of nature by radiation, even before that, we started to take up light, that is visible light photons as a major source of radiation for our daily life. Thus, this may seems weird but these eyes are also a profound miracle of nature that I can detect you sitting in front of me. So it’s all the radiation around just an enormous radiation all present around the globe and far beyond the universe. It is this energy field that my atoms of hand are at its position and these atoms of my hand do not flow to your cheeks and slap you. Because this energy field of radiation keeps my hand atoms together fixed at its own place, attracted toward my other atoms of my wrist, than being SEPARATED out in the space, merely not slapping your face, dear good people present here. It is the beauty of nature that I could never be able to explain it if I could not have been able to detect and monitor radiation. So radiation, the fundamental of vast nature can be explained by this simple term. It’s not the lengthy mathematical equations that describe this; it’s not the fancy algorithms of computer codes that could explain this. But simply monitoring the radiation, we can describe our nature in time and space simultaneously. So by probing the minute feature of radiation, we got to know that it can be of two types electromagnetic, in the form of energy, no mass at all and particulate, having mass and are particle alike, like we have mass too. Again, the most amazing virtue that I dig from the depth of radiation is how the massless radiation is able to interact with massive particles, how could it be able to do that?

Radiation cannot be detected with our innocent human senses, it involves something concrete measurement in so much precise and accurate way that these unseen and unfelt matters, present out here, not only here but also at the top of the Mt. Everest, SO MY VIEWS MAY GET ANNOYED, Because I may be pointing towards the Mt. Everest not only this time, but the several times. Radiation can also be harmful to human life, but how? So what I mean to underpin is, there is a borderline of radiation energy to be it may appear lethal to us, and it can interact with structures of human so immensely and vigorously that within seconds or minutes, it may take life of any elegant living smiling face breathing in nature.

Radiation is present everywhere; it is in every atom of nature. Air, water, light, soil, there is nowhere at which radiation isn’t present. It is omnipresent. If there were no radiation in air, it would never blow; if there were no radiation in water, it would never blow; if there were no radiation in light, the sun would never glow; if there were no radiation in soil, nothing would ever grow. Land would never have become so much fertile and inhabitable, and be a home place to so many creatures. It’s not an absurd thing to state that we are also a part of nature and the glow of energy of radiation is inside us as well. This perspective of understanding the human being is far better than the materialistic world.
We mustn’t forget the law of conservation of energy. Everything around us is created initially by radiation. This energy can neither be created nor be destroyed. But it can change its form, its way of functioning and controlling balance, we perceive from one form to another is quite surprising. Every fairytale is already told and written in golden manuscript in this nature. There is no new world to conquer and there is no vast new universe to explore. Every breath of air that can be felt, every drop of water that can be tasted, every grain of soil that can be stepped all comprises radiation; it is all present inside us and outside this cosmos as well.

Whatever human perform their work, this will show up as a direct impact in the equilibrium of irradiative nature. This is going to affect every cell of nature to shift its position from its initial state to somewhere other places. Then only, there would be balance again, equilibrium again in this ever-changing level of energy. In this world, what goes around comes around. Nobody can escape from this fact that radiation is all we breathe, it’s all we eat, it’s all we sleep, it’s all we drink, it’s all we think, and it’s all we do 24 hours 365 days a year in deed. But yet, we are unaware of it. We don’t know or we don’t bother to know that there is a glow within us, a light inside us. A candle a very beautiful one and also so much vivid and alive. It’s with this light that we are interacting with people surrounding us.

Our rock star in childhood science book, Newton also stated that in every action, there is some kind of equal and opposite reaction. If we push something so hard, then it will also try to restore its shape and size. Same thing happen to our body if we push our body into some physical work beyond our limitations, it becomes so weak within no time because we can’t endure so much pain, and those pain manifest in the form of illness. It’s so much unclear and bewildering that when we get mental stress, our whole body aches, our digestive system, muscular, circulatory, hormones, every system begins to behave weird, every tissue, each of cell in our body tries to compensate the strain and stress. But the truth is we misbehaved ourselves, we misbehaved our true nature of radiation, as we try to extinguish our inner glow ourselves. At that meantime, we feel so helpless, the whole world feels like as smashed onto our chest, and yet we could do nothing for our sake. But once you try to switch off our light ourselves in such lower feeling state, the radiation surrounding us try to provide us light. They try to make us glow again. Then, our near and dear ones begin to convince us as far as they could do it possibly. But the frustration of lack of radiation within us become so much self-concerned, so much self-absorbed and detrimental to ourselves, that we put our every effort to resist the change imposed by others, we block the source of radiation. Meanwhile, we should measure our true sense of radiation, like as who is this wonderful, ethereal radiation inside me, then we begin to recognize what we are seeking till now is inside us, whom we want to build us into is inside us, just we are wasting more than 95% of our light in something what we aren’t.

See the world is full of energy, why am I begin separated? The world is full of water bodies, oceans and seas, why a droplet like me is so much thirsty? The globe is full of energy, why not I could also be connected to them and glows like an eternal being. After all this is the totality of life, this is the completeness of living; this is the heaven on earth then.

Now let’s bring some science inside this. We all know the graph of simple harmonic motion, the upper half circle and lower half circle, the sine graph. Even the words I speak also travel in similar fashion with compression and rarefaction. Compression represents the upper half circle and the rarefaction represents the lower half circle. Well, taking into consideration, from a simple pendulum to latest technology using x-rays, gamma rays, everything can be expressed in this simple incredible graph.

Our emotions what is it actually, it’s the ‘e’ for ‘energy’, it’s the flow of energy through different connections, relations which we get entangled in day-to-day life. This emotion gives rise to infinite human desires and thus we begin to face countless numerous obstacles. Sometimes we feel enormous joy which can be shown by upper half circle whereas sometimes we feel the deepest sorrow, grief, pain which can be depicted by lower half circle. In short, that is our loss of energy. Now the most remarkable question to arise is how to gain it back again? At the meantime, by releasing our flow of energy, we can get it back. The flow of energy must be continuous and consistent. But human nature is sometimes equipped with greed and they tend to keep good things with themselves. So humans become selfish and try to make all the radiation of upper half circle permanent. By doing so, we try to obstruct its immense flow, which for sure create a greatest havoc in our life. So nothing is permanent and nothing is good in static condition. Everything must be dynamic in its true form, and nature is the best example of it. Then, when we let it flow, we again begin to get immense energy which are previously blocked by ourselves and this serve as a force, a buoyant force, pulling force and we again float again at the baseline, which is our normal condition where we cherish the most.

Whatever you may notice or not, it is high time being a graduate of medical imaging, we should be able to detect and monitor radiation, whether inside of us or the electromagnetic rays or other rays present out there far beyond the Andromeda Galaxy. If that radiation travels hundreds of light years and strikes our sensor, our detecting device must be efficient and effective to measure it. Just take for now, I have two numbers of photons in my pocket. One lazy but clever sees the detector nearby the table and so it is detected shortly. However, another stupid but energetic jumps out of my pocket before I could lift it onto the table, runs away through my window, meanwhile it strikes antenna of my home, hits the highest tower of Nepal, "Thapa" Tower, Dharahara, explores the world’s highest peak Mt Everest and penetrates the atmosphere of the earth to travel around the solar system. However, if it manages to return back from the cutting edge of the universe in search of his little, tiny friend. At that time, the detector on my table should be sensitive enough to monitor and measure that photon as well to help them get together again, for the sake of their love and to live happily forever. Well, this is the actual place I am showing you the path of the photon from that window, and I if trace it, I may see Mt Everest, ayah……there I see. So, my wonderful people, you may get annoyed, I may be pointing not just one time, but numerous times towards the sky to introduce you all to my dear immovable friend, Mt. Everest. Actually, the photons I am talking right now may be souls in the spiritual science. It’s the miracle of science that by assuming such simple idea initially, can give us the most profound and astonishing discovery the world have never noticed.

Most often radiation is called as basic unit of life, but why? The most important phenomenon that we will be astonished to know that radiation is also the fundamental unit to understand nature. As we all know life is also a part of nature. But what is radiation then? a little weird of some packet of energy which is literally misnomer as radiation, which travels all the way far beyond the sky to reach the surface of our planet or to feel the life of this nature, what is it? The most profound beauty of our nature is all the resources present out here in our earth and far beyond the earth all exhibit the properties of radiation, that they can be excited or de-excited by any form of radiation in the form of heat, light, sound, or just a simple touch or even just a glance of smile. That’s radiation. Everything is radiation. If we know radiation, the most bizarre questions of science like how was life created, how universe was formed could be answered.

It is the glory of science that it is able to use so much complex mathematical equations in so much simpler and amazing ways, that we are able to understand the most hidden peculiar characteristics of human nature as well. Imaging Science is one of the biggest achievements made recently. I hope one day everything can be mapped and imaged even the unimaginable thoughts that may be imaged, perhaps what you are thinking right this time as well. I hope someday spiritual science, laws of attraction, course of miracle, telekinesis, hypnotism everything could be mapped by imaging science. It is the last resort to understand the most fundamental principle of nature, how radiation was created, how life was created, how everything works on the basis of energy flow. It is the only subject by which science may provide evidences of spirituality and many hidden laws of nature, just like it has unfolded the magic of x-rays some 120 years ago.

Well guys, I know everyone have their own life. We all have right to live our life according to our will. But for a second, let’s think why we are sitting here, why we are gathered here, why we are so much curious about this single entity. Isn’t it, we are here to glow our inner light together and connect ourselves with each other. We are so much similar being and our light is so much of same kind that we perform something great and it’s the time to take a leap in imaging technology.


Tribhute to Prof Brian Cox.
Inspired from him.

Saturday, March 25, 2017

Lumbar Spinal Stenosis: A Review

Review Article

Lumbar Spinal Stenosis: A Review

Abstract

Lumbar Spinal Stenosis (LSS) is one of the most common radiologic-anatomical syndromes in all population. Magnetic Resonance Imaging (MRI) of lumbar spine is the standard test to identify the narrowing of the spinal canal and adjacent vascular structures. Population of least developed countries those work for bread and butter are at highest risk of this disorder. This review attempts to describe the types, patho-anatomy, patho-physiology, clinical presentation, diagnosis, treatment and complication of lumbar stenosis. The effectiveness of conversative treatment and the need for surgery according to the severity of the stenosis play a crucial role for patient management. Spinal stenosis is categorized as primary and secondary. MRI provides detail anatomic structures which is adequate for surgical planning.

Introduction

Lumbar spinal stenosis (LSS)) is a one of the commonest disorder in aging as well as adolescent population.[1] It is characterized by the narrowing of the spinal canal and the nerve root canals.[2] Aching, cramping, or heaviness in the buttocks, hips, thighs, knees or lower legs with standing or walking, is the classic clinical symptom of neurogenic claudication. LSS thus have become most common cause for spinal surgery in patients over age 65 years.1 LSS is not life threatening, but it negatively impacts the quality of life (QOL) due to substantial disability, with limitations in performing routine daily life activities.[3]

MRI is suggested as the standard non-invasive test to confirm the presence of anatomic narrowing of the spinal canal or the presence of nerve root impingement. It seems to be useful to consider the dynamic aspect of LSS and assess neural and vascular tissue impingement based on morphology of the dural sac and its content.[4] Machado et al, (2015) investigated the effectiveness of spinal surgery. They concluded that the relative efficacy of various surgical options remained uncertain.4

Supe et al. (2015) stated the spinal synovial cyst are associated with pain in back with radicular pain and are most common at L4-L5 as this region is the most mobile. They recommended MRI scan of the spine is best diagnostic modality for these cysts.[5] In appropriately selected patients, surgical intervention has been demonstrated to provide for improvement in pain, disability and quality of life. Outcomes seemed less favorable with greater complication rates among patients with diabetes or obesity. Elderly patients are recommended to be excluded from surgical intervention for symptomatic LSS.[6]
Pathoanatomy
Ligamentum flavum, the facet joints and the disk space are the three primary structures that contribute to spinal stenosis. With degenerative changes, the ligamentum flavum and facet joints may hypertrophy, secondary to mechanical stresses. The aging process results in diminished disk height, which if pronounced can allow buckling of the ligamentum flavum into the spinal canal. Ligament hypertrophy, osteophytes or disk bulging can all encroach on the spinal canal.[7]

Pathophysiology
The pathophysiological changes of Lumbar spinal stenosis (LSS) are caused by degenerative changes of the lumbar spine which include thickening and buckling of ligamentum flavum (LF), osteophyte formation, facet hypertrophy, and bulging of the intervertebral disk. Consequently, the central spinal canal is narrowed resulting in compression-induced ischemia of the cauda equine. Venous congestion is another proposed mechanism of intermittent postural radiculopathy in lumbar stenosis.6, [8]

Clinical Presentation
Patients classically present with Low Back Pain (LBP) that may be associated with neurogenic claudication, described as radiating pain along the lower extremities usually down to the knees or even to the calf muscle level. The pain is triggered and is worsened as the patient ambulates or stands and is relieved with flexion of the spine or sitting down. Neurogenic claudication is believed to be a result of structural narrowing of the spinal central canal, which impedes venous return thus causing venous hypertension, resulting in arterial ischemia of the cauda equine.2

Diagnosis
Definitive diagnostic information is most readily obtained from lumbar spinal MR images and/or CT scans with sagittal reconstructions. These studies clearly show the size, shape and anatomic relationships of spinal and neural elements and can demonstrate the relative contribution of developmental stenosis as well as disk, facet and ligamentous elements of nerve root compression.6
In addition, MRI usually provides anatomic information sufficient for surgical planning. Axial MRI scan of central stenosis typically demonstrates a circumferentially narrowed canal. Hypertrophic bone appears as a dark region of low signal of T1-weighted and T2-weighted images, hypertrophic ligamentum flavum as an intermediate signal on T1-weighted and T2=weighted images, and loss of fat in the epidural space due to prolonged compression as a loss of high T1 signal. T2 weighted sagittal images are useful for their myelogram like representation of the thecal sac. Lateral stenosis appears on axial and sagittal views as bone encroachment and loss of fat signal (best appreciated on T1-weighted images) surrounding the exiting nerve root.6

Classification
Spinal stenosis is classified as either primary or secondary. In primary stenosis, the spinal canal is constricted due to a congenital abnormality or a disorder in postnatal development. Primary stenosis is extremely rare. However, secondary stenosis is due to degenerative changes of the vertebral bodies, facet joints and disks.[9]

Treatment
Current treatment options range from conservative management to invasive spinal surgical decompression and lumbar fusion, with or without instrumentation.

Conservative Therapy VS Surgery
Conservative methods of therapy may be of use in early and moderately severe cases; it is certainly useful and appropriate to initially pursue nonsurgical measures. Conservative measures usually include bed rest, non-steroidal anti-inflammatory drug, acetaminophen, exercise program, aerobic fitness and epidural steroid injections. Once patients progress past the point of moderate symptom severity, conservative methods may become ineffective or unrealistic. Surgical decompression has been helpful in about two-thirds of patients, but is associated with considerable morbidities. Patients who delay surgery have similar outcomes to patients who proceed immediately with surgery. Thus, the consideration of proceeding with surgery should await evaluation of comorbidities as well as assessing the patient’s response to conservative therapy.2

Weight loss is recommended for obese patients. to reduce symptoms, including pain, patients are generally advised to avoid activities that place mechanical stress on the lower back, particularly those that place the spine in extension. When oral drugs and physical therapy fail to provide relief of symptoms, epidural steroid injections may be used on the assumption that symptoms result from inflammation at the interface between the nerve root and compressing tissues. The goal of surgery is to decompress the central spinal canal and neural foramina to eliminate pressure on nerve roots. Alternatively, a minimally invasive laminectomy can be done using several smaller incisions.

Complications
Although lumbar spinal stenosis is not life-threatening, it can cause chronic and substantial pain and can severely limit patient activity.

Discussion

Lumbar spinal stenosis has a high prevalence in older adults and a strong negative influence on quality of life, preventing many older adults from maintaining an active independent life.1 Surgery is superior to nonsurgical treatment for improving pain and function. Symptoms may recur with either approach.1 The chief complaint of patients with symptomatic spinal stenosis is claudication, an intense pain brought on by walking and usually felt in one or both lower extremities.9
Knutsson et al in 2015 described the experience of being a person with LSS and how life and suffering were managed under the influence of their disease. Being a patient with LSS included suffering. Both physicians and patients needed to work towards salutogenic perspective, focusing on resources to improve care, making it more comprehensible, manageable and meaningful.[10]
K. Kato et al, 2014 conducted LSS support tool project in 1657 hospitals and evaluated the diagnostic accuracy of the Self-administered, Self-reported History Questionnaire in Japan. They concluded the improved version can be used for LSS screening and its use may improve the quality of LSS diagnostic practice in Japanese primary care settings.[11]

Yaldiz et al, 2015 retrospectively, demographically and clinically investigated the causes of postoperative infection in patients with lumbar spinal stenosis who underwent posterior stabilization. Implant-related infections (IRIs) still appeared to be a major problem in spinal surgery, even though the infection rate has been reported to be around 1%. However, PSI rate increased upto 2.1% to 8% as the frequently performed spine surgeries such as laminectomies and discectomies with plantation increased. Dead space in the surgical field, foreign bodies, necrotic tissue and prolonged surgical procedures are among the factors that increase the risk of IRI. Implant use in spinal surgery increased the risk of infection about 3 fold.[12] Beyer et al in 2015 studied the influence of spinopelvic parameters on non-operative treatment of lumbar spinal stenosis.[13]

Kim et al, 2015displayed patients with high pain sensitivity may display less improvement in back pain, leg pain, and disability after surgery for LSS compared with patients with low pain sensitivity. Furthermore, the Pain Sensitivity Questionnaire (PSQ) can be used to predict surgical outcomes after spine surgery for LSS.[14]  

Shamji et al, in 2015 systematically reviewed the effectiveness of lumbar spinal surgery for symptomatic LSS in elderly patients (over age 65 years). They revealed that the majority of elderly patients exhibited significant symptomatic improvement. Outcomes seem less favorable with greater complication rates among patients with diabetes or obesity. They recommended that elderly patients should not be excluded from surgical intervention for symptomatic LSS.[15]

Ulrich in 2015 concluded the patients 80 years or older can expect a clinically meaningful improvement after lumbar decompression for symptomatic DLSS and the patients showed significant positive development in quality of life in the short and long term follow ups.[16] Ferrari et al, 2015 investigated the clinical validity of clinical tests for the diagnosis of lumbar instability. They suggested Passive Lumbar Extension (PLE) test was the most appropriate test to detect lumbar instability in specific LBP.[17]

LBP is a growing health problem in the industrialized world. Despite the high medical expenses required for its management, the prevalence of LBP is increasing. LBP is a heterogeneous condition, and the identification of different sub-groups could help the management decisions.14
Lurie et al, 2015 compared 8-year outcomes of surgery with non-operative care for symptomatic LSS. They concluded symptomatic spinal stenosed patients showed diminishing benefits of surgery in as-treated analyses of the randomized group between 4 and 8 years, whereas outcomes in the observational group remained stable.[18]

Maugeri et al (2015) also gave a new concept to treat LSS in a mini invasive way.[19]
Dahal et al (2012) noticed most common spinal pathology in patients with low back ache was degenerative changes of the spine. MRI, though expensive was beneficial in early diagnosis and management of lumbar spine abnormalities.[20] Markman and Nandigam (2015) assessed changes in spine segment biomechanics due to laminotomy and laminectomy.[21]

Segar et al (2015) also investigated that obesity might be associated with clinical diagnosis of LSS but not lumbar disc herniation or degenerative spondylolisthesis.[22] Burton et al (1981) noticed 800 Failed Back Surgery Syndrom (FBSS) and stated FBSS is actually a spectrum of organic disease processes complicated by secondary financial gain and learned chronic pain behavior. While many of the patients can be salvaged to varying degrees by comprehensive rehabilitation programs, it is uncommon to achieve complete pain relief by any combination of therapeutic measures. This is due in part to the great difficulty in quantitating pain and associated psychologic occupational, social, monetary, intellectual, motivational and education factors.[23]

Atlas et al (1996) resulted the patients with severe LSS who were treated surgically had greater improvement than patients treated non-surgically.[24]They again assessed outcomes till 4 year and concluded for severe LSS, surgical treatment was associated with greater improvement in patient-reported outcomes than non-surgical treatment. The relative benefit of surgery declined over time but remained superior to non-surgical treatment.[25] Atlas et al (2005) again completed follow-up for 8 to 10 years and concluded LBP relief, predominant symptom improvement and satisfaction with the current state were similar in patients initially treated surgically or non-surgically. These results support a shared decision-making approach among physicians and patients when considering treatment options for LSS.[26]

Kuslich (1991) defined the tissue origin of low back pain and sciatica. He took 193 patients who had surgery for herniated discs, spinal stenosis, or both.[27] Pasqualini et al. (2012) concluded there was no correlation between the degree of stenosis and  the Oswestry index and MRI in cases and controls.[28] Paine et al (1974) defined LSS as a condition in which the A-P and lateral diameters of the bony canal are narrower than normal and/or in which the shape of the canal in cross section is often abnormal.[29]

DA Chad (2007) also stated LSS may be congenital or acquired. A classic clinical presentation is described as neurogenic claudication. Physical signs of sensory loss, weakness and attenuation of reflexes often are mild and limited in distribution.[30] Bowen et al (1978) reviewed LSS as a condition not only affecting the middle-aged and elderly but young adults may produce symptoms.[31] J Englund (2007) stated LSS is a clinical syndrome first described in the 1950s. It is defined as narrowing of the spinal canal with cord or nerve root impingement resulting in symptoms of radiculopathy or pseudoclaudication.[32]
Conclusion
In summary, LBP resulting from degenerative disease of the lumbosacral spine is a major cause of morbidity, disability, and lost productivity. So, rapid diagnosis and treatment are essential if patients are to be returned to their previous levels of activity.

References



[1] Deasy J. Acquired lumbar spinal stenosis. Journal of the American Academy of Physician Assistants. 2015;28(4):19-23.

[2] Costandi S, Chopko B, Mekhail M, Dews T, Mekhail N. Lumbar Spinal Stenosis: Therapeutic Options Review. Pain Practice. 2015;15(1):68-81.

[3] Adamova B, Mechl M, Andrasinova T, Bednarik J. Radio logic Assessment of Lumbar Spinal Stenosis and its Clinical Correlation. CESKA A SLOVENSKA NEUROLOGIE A NEUROCHIRURGIE. 2015;78(2):139-47.

[4] Machado GC, Ferreira PH, Harris IA, Pinheiro MB, Koes BW, van Tulder M, et al. Effectiveness of Surgery for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. PloS one. 2015;10(3).

[5] Supe AC, Badole CM, Babhulkar S, Wandile KN. Spinal synovial cyst. Journal of Mahatma Gandhi Institute of Medical Sciences. 2015;20(1):82.

[6] Binder DK, Schmidt MH, Weinstein PR, editors. Lumbar spinal stenosis. Seminars in neurology; 2002: [New York]: Thieme-Stratton Inc.,[c1981-.

[7] Alvarez JA, Hardy Jr RH. Lumbar spine stenosis: a common cause of back and leg pain. American family physician. 1998;57(8):1825-34, 39-40.

[8] Lurie JD, Tosteson TD, Tosteson A, Abdu WA, Zhao W, Morgan TS, et al. Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine. 2015;40(2):63-76.

9 Nowakowski P, Delitto A, Erhard RE. Lumbar spinal stenosis. Physical therapy. 1996;76(2):187-90.

10 Knutsson B, Jong M, Sjödén G, Marika A. Waiting for lumbar spinal stenosis surgery: suffering, resources to cope and expectations. 2015.

11 Kato K, Sekiguchi M, Yonemoto K, Kakuma T, Nikaido T, Watanabe K, et al. Diagnostic accuracy of the Self-administered, Self-reported History Questionnaire for lumbar spinal stenosis patients in Japanese primary care settings: a multicenter cross-sectional study (DISTO-project). Journal of Orthopaedic Science. 2015;20(5):805-10.

12 Yaldiz C, Yaldiz M, Ceylan N, Kacira OK, Ceylan D, Kacira T, et al. Retrospective, demographic, and clinical investigation of the causes of postoperative infection in patients with lumbar spinal stenosis who underwent posterior stabilization. Medicine. 2015;94(29).
13 Beyer F, Geier F, Bredow J, Oppermann J, Eysel P, Sobottke R. Influence of spinopelvic parameters on non-operative treatment of lumbar spinal stenosis. Technology and Health Care. 2015;23(6):871-9.

14 Kim H-J, Lee J-I, Kang K-T, Chang B-S, Lee C-K, Ruscheweyh R, et al. Influence of Pain Sensitivity on Surgical Outcomes After Lumbar Spine Surgery in Patients With Lumbar Spinal Stenosis. Spine. 2015;40(3):193-200.

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