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Articles 1 - 25 of 25
Full-Text Articles in Medicine and Health Sciences
Percutaneous Vertebroplasty For Osteolytic Spinal Lesion. A Pilot Study, Mohamed Amer
Percutaneous Vertebroplasty For Osteolytic Spinal Lesion. A Pilot Study, Mohamed Amer
Advanced Spine Journal
Background Data: The clinical management of osteolytic spinal lesion is unique, because it is challenging to approach these lesions. Surgery and/or radiotherapy has been the treatments of choice for many years; but, surgery may not be an option for patients with multiple spinal lesion and poor general medical status, and radiotherapy carries the risk of vertebral collapse and consequent neural compression. Through different approaches, vertebroplasty has been introduced into clinical practice as an alternative to traditional surgery and radiotherapy of osteolytic spinal lesion.Purpose: To evaluate the safety and efficacy of percutaneous vertebroplasty for selected patients with osteolytic vertebral compression fractures …
Current Trends In The Management Of The Brachial Plexus Injuries, Mohamed Elsabaie, Nader Elsayed, Ali Abou-Madawi, Galhom E.
Current Trends In The Management Of The Brachial Plexus Injuries, Mohamed Elsabaie, Nader Elsayed, Ali Abou-Madawi, Galhom E.
Advanced Spine Journal
Background Data: BPIcomprise about one third of all peripheral nerve injuries and seen in just more than 1% of patients presenting to a trauma facility. They may range from weakness or paralysis of the shoulder and/or elbow to complete paralysis and loss of feeling in the entire upper limb. Over the last two decades, refinements in microsurgical techniques, and significant advances in the concepts of peripheral nerve repair and reconstruction have greatly expanded treatment options for these otherwise devastating injuries. Traction of the shoulder or arm, often with lateral flexion of theneck in the opposite direction, Penetrating trauma to the …
Anterior Cervical Corpectomy With Cage And Plating In Subaxial Fractures: A Review Of 20 Cases., Mohamed Amer
Anterior Cervical Corpectomy With Cage And Plating In Subaxial Fractures: A Review Of 20 Cases., Mohamed Amer
Advanced Spine Journal
Background Data: Anterior cervical corpectomy was the best solution insome cases of subaxial fracture but this defect was a problem to fill aftercorpectomy, so this study was to show the efficacy and safety of carbon cageand plating in the treatment of this problem.Study Design: A clinical case series reviewPurpose: To review the safety, efficacy and outcome of anterior cervicalcorpectomy with cage and plating in the management of subaxial cervicalfractures.Patients and Methods: From January 2009 to January 2014, twenty patientsunderwent anterior cervical corpectomy with cage and plating for thetreatment of subaxial spinal injuries. The functional status was assessedusing the modified Japanese …
Cervical Spine Nerve Sheath Tumor: Surgical Experience Of A Clinical Case Series, Ehab Eissa, Hossam El-Fol
Cervical Spine Nerve Sheath Tumor: Surgical Experience Of A Clinical Case Series, Ehab Eissa, Hossam El-Fol
Advanced Spine Journal
Background Data: Cervical spine nerve sheath tumors (SNTSs) represent a special location of interest and challenge for neurosurgeons because the lesion in this region tend more to have extradural and extraspinal component (dumb-bell tumors) than dorsal or lumbar region. These tumors extension is most likely because of short intraduradural root in thecervical region. Dumb-bell tumors require special surgical strategy and approaches to allow complete removal of these tumors from both intraspinal and extraspinal components without traction on the spinal cord. Purpose: to evaluate our experience in management of cervical spinal nerve sheath tumors with special consideration for dumb-bell tumors that …
The Role Of Long Segment Posterior Fixation And Transpedicular Decompression In The Management Of Thoracolumbar Fractures, Mohamed Elgohary, Saudi Zamzam, Mohamed Okasha
The Role Of Long Segment Posterior Fixation And Transpedicular Decompression In The Management Of Thoracolumbar Fractures, Mohamed Elgohary, Saudi Zamzam, Mohamed Okasha
Advanced Spine Journal
Background Data: Treatment of spinal injury aims for restoration of spinal anatomy, relieving the pain and achieving stability without neurological damage. One of the recent surgical approaches to spinal cord compression is transpedicular re-impaction of retro-pulsed vertebral body fragments and/ or partial or complete corpectomy with verebroplasty and posterior fixation. Purpose: to assess the effectiveness of the transpedicular approach in spinal decompression, reconstruction, realignment and fixation. Study design: prospective clinical case study. Patient and Methods: we report on 25 patients with traumatic dorso-lumbar fracture causing anterior neural compression. Ten patients were males and 15were females. The mean age was 39.4±16.8 …
The Effect Of Phosphatidylcholine/ Deoxycholate On Nervous Tissues: A Histopathological Study, Hanan El-Gowelli, Bassma Elsabba Md, Hisham Elsaghir, Emad Yosry
The Effect Of Phosphatidylcholine/ Deoxycholate On Nervous Tissues: A Histopathological Study, Hanan El-Gowelli, Bassma Elsabba Md, Hisham Elsaghir, Emad Yosry
Advanced Spine Journal
Background Data: Phosphatidylcholine/deoxycholate is now widely used in injection lipolysis mainly for aesthetic purposes inducing lipolysis in subcutaneous fat for body contouring and also for shrinking small subcutaneous lipomas. In this work, the authors discuss the effects of phosphatidylcholine dissolved in deoxycholate on nervous tissues in rats to assess the hazards of injection lipolysis in treatment of spinal lipomas as an alternative to surgery.Purpose: to highlight the histopathological effects of phosphatidylcholine on neurological tissues of a rat model to determine whether it is safe to use it as a mesotherapeutic agent for treating spinal lipomas as an alternative for surgery.Study …
Safety And Efficacy Of Percutaneous Non-Canulated Transpedicular Screws Fixation (Tpsf) In The Management Of Thoracolumbar Fractures, Mohamed El-Meshtawy, Khaled Hassan
Safety And Efficacy Of Percutaneous Non-Canulated Transpedicular Screws Fixation (Tpsf) In The Management Of Thoracolumbar Fractures, Mohamed El-Meshtawy, Khaled Hassan
Advanced Spine Journal
Background Data: The use of pedicle screws for spinal stabilization has become increasingly popular worldwide. Standard open techniques for pedicle screw placement, however, require extensive tissue dissection to expose entry pointsand to provide lateral to medial orientation for optimal screw trajectory. Minimal invasive techniques (MIT) are widely accepted as being the less aggressive procedure in any kind of surgery. Purpose: The aim of this study was to describe and evaluate a new alternative percutaneous technique using the usual economic non-canulated screws in thoracolumbar fractures. Study Design: A prospective clinical case study. Patients and Methods: Between January 2007 and December 2012, …
Surgical Management Of Juxtafacet Cysts, Hosam Habib
Surgical Management Of Juxtafacet Cysts, Hosam Habib
Advanced Spine Journal
Background Data: Synovial cysts occur most frequently in the lumbar spine (88-99%). They are viewed as regenerative changes that are associated with hypermobility and instability of a motion segment as seen with spondylolisthesis and facet joint instability and facet degeneration. There is extensive controversy regarding the definition, prevalence, pathogenesis, risk factors, and most importantly, treatment options for synovial cysts management. Purpose: To assess the outcome of various surgical procedures done for the treatment of lumbar juxtafacet cysts.Study Design: Retrospective clinical case study. Patients and Methods: The data of 26 patients (17 males and 9 females) who underwent surgery for lumbar …
Primary Osseous Tumors Of The Subaxial Cervical Spine, Clinical Case Series, Mohamed El-Gaidi, Ehab Eissa
Primary Osseous Tumors Of The Subaxial Cervical Spine, Clinical Case Series, Mohamed El-Gaidi, Ehab Eissa
Advanced Spine Journal
Background Data: Primary osseous tumors of the subaxial cervical spine are rare and can present with different clinical presentations and pathologies. Study Design: Retrospective descriptive clinical case series.Purpose: To assess the prognosis, surgical management, outcome of primary osseous tumors of the subaxial cervical spine Patients and Methods: Eight patients underwent surgical treatment for primary cervical bony tumors at Kasr Al-Aini Medical School, Cairo University, between 2007 and 2012. Mean follow-up was 24.4±6.8 months. Clinical outcome wereevaluated neurologically using Frankel grading system, while visual analog scale (VAS) has been used to evaluate neck pain. Results: There was equal sex distribution and …
The Efficacy Of Stand-Alone Peek Cages Versus Locking Plate In Three Or More-Level Anterior Cervical Discectomy And Fusion, Khaled Hassan, Mohamed El-Meshtawy
The Efficacy Of Stand-Alone Peek Cages Versus Locking Plate In Three Or More-Level Anterior Cervical Discectomy And Fusion, Khaled Hassan, Mohamed El-Meshtawy
Advanced Spine Journal
Background Data: Anterior cervical discectomy and fusion (ACF) is currently the gold standard for surgical treatment of cervical degenerated disease (CDD). For many years, patients were treated with ACF using tricortical autogenous bone graft augmented with anterior cervical locking plate. Later, Cages packed with calcium triphosphate bonesubstitute were the treatment of choice. Study Design: A comparative clinical case study. Purpose: Compare the outcomes of ACF using stand-alone PEEK cages packed with calcium triphosphate bone substitute compared with tricortical iliac autograft augmented with anterior locking plate in treatment of three or more-level CDD in 47 patients.Patients and Methods: We evaluated 47 …
Atlas Lateral Mass Screw Fixation In Atlanto-Axial Instability, Clinical Case Series, Mohamed El-Gaidi
Atlas Lateral Mass Screw Fixation In Atlanto-Axial Instability, Clinical Case Series, Mohamed El-Gaidi
Advanced Spine Journal
Background Data: Segmental spinal screw fixation has been used effectively for subaxial spine instability for long time. However, atlantoaxial fixation is still challenging due to complex topographical anatomy. So, sublaminar wires werefrequently used despite their complications. Unlike transarticular atlantoaxial screws which necessitate perfect reduction before insertion, C1 lateral mass screws are inserted independently of C2. Purpose: The aim of this work is to assess the safety and efficiency of C1 lateral mass screw fixation in cases with atlantoaxial instability. Study Design: A prospective clinical case study. Patients and Methods: This study was conducted in Al-Manial university hospital, Kasr Al-Aini Medical …
Early Diagnosis And Management Of Combined Occipitoatlantoaxial Rotatory Fixation, Case_Report And Review Of The Literatures, Ali Abou-Madawi
Early Diagnosis And Management Of Combined Occipitoatlantoaxial Rotatory Fixation, Case_Report And Review Of The Literatures, Ali Abou-Madawi
Advanced Spine Journal
Background Data: atlantoaxial rotatory fixation (AARF) although rare, is a wellknown condition to most spinal surgeons. Occipitoatlantoaxial rotatory fixation (COAARF) is a condition that may develop as a compensatory event following AARFmaking diagnosis more difficult. Most cases of COAARF present late making their management a difficult task.Purpose: to demonstrate a neglected case of COAARF Study Design: case_report Patients and Methods: we report a 9 years old girl with neglected COAARF following minor trauma. 7 months after trauma we could not reduce its rotation operatively. Results: delayed diagnosis of COAARF precluded its reduction Conclusion: COAARF can result from relatively minor trauma …
Predictive Factors Of Efficacy Of Transforamenal Epidural Steroid Injection For Patients With Lumbar Discogenic Radiculopathy In Neurosurgery Department, Hassan Al-Shatoury, Ali Khedr, Ali Abou- Madawi,, Medhat Marzouk
Predictive Factors Of Efficacy Of Transforamenal Epidural Steroid Injection For Patients With Lumbar Discogenic Radiculopathy In Neurosurgery Department, Hassan Al-Shatoury, Ali Khedr, Ali Abou- Madawi,, Medhat Marzouk
Advanced Spine Journal
Background Data: Transforaminal Epidural Steroid Injection is one of the nonsurgical treatment methods for sciatic pain. The clinical outcome and predictive factors that affect its results are still under debate.Purpose: The purpose of this study is to evaluate the results of transforaminal epidural steroid injection and identify factors for predicting success. Study Design: A descriptive analytic cross sectional prospective study involving 45patients with lumbar radiculopathy. Patients and Methods: Forty-Five patients with lumbar radiculopathy wereprospectively followed up at 2 weeks and 6 months after Transforaminal Epidural Steroid Injection. The intensity of radicular pain was scored on the Visual Analog Scale (VAS). …
Sagittal Balance Improvement In Surgical Treatment Of Low- Grade Isthmic Lumbosacral Spondylolisthesis, Samir El-Ghandour, Mohamed Radwan, Hassan Alshatoury
Sagittal Balance Improvement In Surgical Treatment Of Low- Grade Isthmic Lumbosacral Spondylolisthesis, Samir El-Ghandour, Mohamed Radwan, Hassan Alshatoury
Advanced Spine Journal
Background Data: The role of surgical correction of sagittal plane deformity in cases of lytic spondylolisthesis is essential. While evidence is emerging of the possible short- and long-term benefits of restoring spinal balance, some surgeonshave been concerned about the associated risks especially if instrumentation has to be used for reduction of the slipping.Purpose: To evaluate the Sagittal Balance improvement in surgical Treated Lowgrade Isthmic Lumbosacral Spondylolisthesis Study Design: Prospective clinical case study Patients and Methods: Twenty two patients with low-grades (<50%) of isthmic spondylolisthesis of lumbosacral junction (L5-S1) were managed by a surgical intervention aiming for correction of the deformity even with partial reduction of the slipping. Sagittal alignment at the lumbosacral junction was tried to be achieved by appropriate positioning of the patient during the surgery and by rod contouring. Posterior decompression of nerve structures by laminectomy in conjunction with posterior instrumented fusion from L5 to sacrum were also done. They were fourteen females and eight males with a mean age of 40.45 years. The mean follow up period was 20 months. Results: All patients achieved satisfactory results as regards the back pain, radicular pain and neurologic deficits. The mean preoperative estimated values of slip percentage, L1-S1 lordosis, sacral inclination angle and lumbosacral kyphosis were 30.2%, 48.8°, 46.04°, and 35°. The mean reconstructed values were 25%, 34.9°, 36.86°, and 28° postoperative. Pelvic version improved in patients with unbalanced spondylolisthesis as evidenced by decreased sacral slope [from 46.04 degrees to 36.86 degrees] (P<0.5). All patients could return to their normal activities of daily living.Conclusion: This study suggests that, the described technique can yield satisfactory clinical outcomes and substantial deformity correction using single posterior approach with proper patient position before surgery. (2013ESJ040)
Posterior Surgical Decompression And Fusion Augmented With Internal Fixation In Thoracic And Lumbar Spondylodiscitis; Is It Possible?, Ehab El Gamal, Ashraf Farid
Posterior Surgical Decompression And Fusion Augmented With Internal Fixation In Thoracic And Lumbar Spondylodiscitis; Is It Possible?, Ehab El Gamal, Ashraf Farid
Advanced Spine Journal
Background Data: Posterior surgical treatment of spinal infections was adopted since 1912. However, most authors strictly advocated anterior or anterolateral debridement and subsequent bone grafting and fixation. These procedures oftenbear a high risk for elderly and debilitated patients. Purpose: To assess the efficacy of posterior surgical decompression, fusion and fixation in thoracic and lumbar spine spondylodiscitis. Study Design: A retrospective clinical case study.Patients and Methods: Fifteen patients suffering from thoracic and lumbar spondylodiscitis, both tuberculous and non-tuberculous, underwent posterior surgical decompression with posterolateral and interbody fusion augmentedwith posterior fixation, according to the degree of vertebral wedging, the kyphotic angle and …
Two Or More Levels Anterior Cervical Discectomy And Fusion (Acdf) Using Stand-Alone Peek Cages Filled With Bone Graft Substitute, Mohamad El-Meshtawy, Belal Elnady, Khaled Hassan, Hamdan Ahmad, Mohamad Hassan, Mahmoud Fouad, Amr Abo El-Fadl
Two Or More Levels Anterior Cervical Discectomy And Fusion (Acdf) Using Stand-Alone Peek Cages Filled With Bone Graft Substitute, Mohamad El-Meshtawy, Belal Elnady, Khaled Hassan, Hamdan Ahmad, Mohamad Hassan, Mahmoud Fouad, Amr Abo El-Fadl
Advanced Spine Journal
Background Data: Anterior cervical discectomy and fusion (ACDF) has become a standard and a highly successful procedure for degenerative cervical disc disease associated with radiculopathy or myelopathy. In addition to graft complication, multilevel cervical discectomy is often combined with plate fixation to maintain the spinal curvature, and increasing the graft fusion rate but this also may carry risk of complications. Study Design: Prospective descriptive clinical case study Purpose: To evaluate the safety and efficacy of standalone PEEK cages filled with bone graft substitute in treatment of multi-level cervical disc disease. Patients and Methods: Ninety one patients underwent multiple levels ACDFfor …
Reduction Of Lumbar Spondylolisthesis, Surgical Technique And Clinical Outcome., Mohamed Eshra
Reduction Of Lumbar Spondylolisthesis, Surgical Technique And Clinical Outcome., Mohamed Eshra
Advanced Spine Journal
Background Data: Reduction of the slipped vertebrae as a part of surgical approach is now attempted. In the current literature, the studies have paid attention to the surgical reduction of the slippage or in situ spinal fixationtechnique. These studies have a lack of comparison between these variable techniques. Purpose: To define the role and benefits of reduction and stabilization of lumbar spondylolisthesis. Study Design: A retrospective clinical case study.Patients and Methods: 24 patients with low grade isthmic lumbar spondylolisthesis between January 2008 and June 2010 were enrolled for this study. Patients were treated by slip reduction, interbody fusion with or …
Posterior Lumbar Interbody Fusion (Plif) Augmented With Pedicle Screw Fixation Versus Plif Augmented With Percutaneous Pedicle Screw Fixation In Low Grade Lumbar Spondylolisthesis, Esam Elkhatib,
Advanced Spine Journal
Background Data: The optimal treatment for patients with Spondylolisthesis has been the subject of many recent studies which provide some of the best evidence for lumbar spinal fusion. Purpose: Compare the clinical and radiological outcome of treating low grade lumbar spondylolisthesis patients with PLIF augmented with PSF versus those treated with PLIF augmented with Percutaneous PSF. Study Design: This is a prospective comparative clinical case study.Patients and Methods: Seventeen patients with low grade spondylolisthesis who underwent instrumented fixation were retrospectively analyzed from the period of 2011 to 2012. A PLIF and PSF (Group A) was performed in 9 patients, andPLIF …
Adjacent Segment Degeneration (Asd) Following Lumber Arthrodesis; Risk Factors And Management., Mohammed Eshra
Adjacent Segment Degeneration (Asd) Following Lumber Arthrodesis; Risk Factors And Management., Mohammed Eshra
Advanced Spine Journal
Background Data: Spinal bony fusion is considered to be a good method for treating deformity, trauma, and degenerative lesions. Fusion rates have a good outcome due to improvements in instrumented fixation and bone graft sources. In contrast, numerous complications of fusion surgery may occur and are considered as the predisposing factors for clinical failure after instrumented lumbar fusion. Adjacent segment disease after lumbar spine fusion has been found to occur nowadays with a variable incidence. The risk factors for ASD have not been precisely documented.Purpose: To identify the possible risk factors responsible for adjacent segment affection following lumbosacral fixation and …
Outcome Evaluation Of Anterior Cervical Discectomy With Fusion Versus Corpectomy In Spondylotic Myelopathic Patients, Esam Elkhatib
Outcome Evaluation Of Anterior Cervical Discectomy With Fusion Versus Corpectomy In Spondylotic Myelopathic Patients, Esam Elkhatib
Advanced Spine Journal
Background Data: Anterior cervical discectomy and fusion and anterior cervical corpectomy and fusion both are used as a surgical technique in the cervical spondylotic myelopathic cases but yet no comparison was done of which is superior,and has a better outcome even after long term follow up. Purpose: To evaluate the outcome of surgical interference for cervical myelopathy either using anterior cervical discectomy versus corpectomy. Study Design: This is a prospective comparative clinical case study Patients and Methods: Cervical spondylotic myelopathy patients who underwenttwo levels anterior cervical discectomy and fixation (ACDF) or one level Anterior cervical corpectomy and fixation (ACCF) between …
Comparison Between Computed Tomography & Fluoroscopy Guided Facet Joint Block In Lumbar Spine, Hassan Al-Shatoury, Mohammad Al-Shatouri, Samir Alghandour
Comparison Between Computed Tomography & Fluoroscopy Guided Facet Joint Block In Lumbar Spine, Hassan Al-Shatoury, Mohammad Al-Shatouri, Samir Alghandour
Advanced Spine Journal
Background Data: Facet joint disorders are main source of chronic low back pain with a prevalence of 16.7%. Facet joint block is performed for diagnostic or therapeutic purposes and generally is carried out under computed tomograpy(CT) or fluoroscopy. Facet joint block is the gold standard in diagnosis of facet joint syndrome. It can also relief pain for up to 6 months. Purpose: To identify which imaging modality (CT or fluoroscopy) is more suitable to guide the procedure of lumbar facet joint block, and results in better relieve of symptoms.Study Design: Prospective analytic clinical case study.Patients and Methods: Sixty eight lumbar …
Comparison Of Long Segment Fixation Versus Short Segment Fixation With Pedicle Screws At The Level Of The Fracture In The Management Of Thoracolumbar Fractures, Amr El-Shehaby, Khaled Saoud, Ahmed Elayouty
Comparison Of Long Segment Fixation Versus Short Segment Fixation With Pedicle Screws At The Level Of The Fracture In The Management Of Thoracolumbar Fractures, Amr El-Shehaby, Khaled Saoud, Ahmed Elayouty
Advanced Spine Journal
Background Data: long segment fixation have been frequently used for management of thoracolumber burst fractures of the spine. Concerns about lost motion segment with this type of fixation made the suggestion for a shorter fixation method. Purpose: To assess ability of short segment pedicle screw fixation to correct deformity, maintain correction and prevent failure in comparison to the traditional long segment fixation. Study Design: A comparative clinical case study.Patients and Methods: A total of 46 patients presented with thoracolumbar burst fractures between 2008 and 2012. All cases were operated with posterior fixation and instrumentation. We classified patients into 2 groups, …
Lumbar Herniated Degenerated Disc: Simple Discectomy Or Fusion?, Alaa Abou-Shousha
Lumbar Herniated Degenerated Disc: Simple Discectomy Or Fusion?, Alaa Abou-Shousha
Advanced Spine Journal
Background Data: Low back pain is estimated to occur in 84% of individuals at some point of their life. Lumbar disc degeneration is one of the most common finding in the work up of low back pain. Mechanical, nutritional, and genetic factors may play a role in the pathogenesis of disc degeneration. The etiology of back pain in degenerated discis a complex process, and appears to be a combination of mechanical deformation and the release of inflammatory mediators. Being a recently highlighted illness, still there is a great controversy concerning the surgical treatment of degenerated lumbar disc hernia. Study Design: …
Functional Recovery & Neurogenesis After Transplantation Of Stem Cells From Human Umbilical Cord Blood Into Spinal Cord Injured Rats, Endegena Gemta, Amani El- Baz, Yasser El Wazir, Mohammed Abdo, Hassan Al-Shatoury, Eman Asaada
Functional Recovery & Neurogenesis After Transplantation Of Stem Cells From Human Umbilical Cord Blood Into Spinal Cord Injured Rats, Endegena Gemta, Amani El- Baz, Yasser El Wazir, Mohammed Abdo, Hassan Al-Shatoury, Eman Asaada
Advanced Spine Journal
Background Data: Transplantation of umbilical cord blood stem cells into damaged spinal cords was used experimentally for several years. Such transplants survive and integrate to some degree with the host tissue and may be associated with functional improvement. Purpose: To find out the functional improvement, and axon regeneration in spinal cord injured rats after human umbilical cord blood stem cells (HUCBs) transplantation. Study Design: Prospective analytic animal experimental study. Material and Methods: Forty rats were recruited and divided into four groups, each containing 10 rats: Group (1): Control group with no lesion and intervention. Group (2): Injured animals with no …
Post-Operative Complications In Patients Older Than 60 Years Old With Lumbar Stenosis After Spinal Decompressive Surgery, Esam Elkhatib
Post-Operative Complications In Patients Older Than 60 Years Old With Lumbar Stenosis After Spinal Decompressive Surgery, Esam Elkhatib
Advanced Spine Journal
Background Data: Morbidity and mortality tend to increase with advancing in age, surgical interference and its outcome may be influenced by age. In elderly stenotic canal decompressive surgery outcome is affected by age.Purpose: To assess complications in patients older than 60 years old with lumbar canal stenosis after spinal decompressive surgery. Study Design: This is a retrospective clinical case study. Patients and Methods: All postoperative complications of patients with spinal canal stenosis older than 60 years old who went through spinal decompressive surgery were reviewed and evaluated using the Charlson Weighted Index. Fifty-five patients treated between 2004 and 2010 were …