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At least 199 records · Page 11Linked to original sources
PubMed2001

Roentgenographic evaluation of ossification and calcification of the lumbar spinal canal after intradiscal betamethasone injection.

There have been reports of lumbar spinal canal ossification and calcification after triamcinolone intradiscal injection therapy. Our objective was to observe the roentgenographic changes after betamethasone intradiscal injection therapy for lumbar disc diseases. The subjects were 183 patients (498 discs; 130 men and 53 women) who underwent discography and betamethasone intradiscal injection therapy and were followed for a mean of 5 years and 7 months. Ossification and calcification appeared de novo (three patients, three discs) or enlarged (four patients, five discs) in the outer layer of the posterior annulus fibrosus or posterior longitudinal ligament in eight discs among seven patients (3.8%). The incidence and degree of ossification and calcification in our patients were significantly lower than those reported in previous studies, and a long time elapsed before ossification and calcification appeared or enlarged. Intradiscal injection of betamethasone did not appear to confer any incremental relative risk for lumbar spinal canal ossification and calcification based on review of follow-up roentgenographs.

Adolescent↗
PubMed2000

Dialysis-related spinal canal stenosis: a clinicopathological study on amyloid deposition and its AGE modification.

Three cases operated for spinal canal stenosis induced by dialysis-related amyloidosis (DRA) were investigated clinicopathologically. Cases were all-male, and had undergone hemodialysis around 20 years. In two cases, cervical plain X-rays showed only minor spondylotic changes. However, magnetic resonance imaging (MRI), myelography, and computed tomography (CT) showed extradural thickness with compression on the cervical spinal cord and cauda equina. In one case cervical X-rays showed typical destructive spondyloarthropathy (DSA), and MRI showed compression myelopathy. Surgical treatment on both cervical and lumbar spine in two cases and on cervical spine only in one case successfully reduced the symptoms. Extradural thickened tissue and ligament flavum obtained during surgery were studied histopathologically and immunostained by using anti-CD68, anti-beta2-microglobulin (beta2m), and anti-advanced glycation end product (AGE) antibody. Congo red stain showed diffuse or nodular amyloid deposition, and immunostaining with anti-beta2m and anti-AGE antibodies also demonstrated the same distribution pattern. Thus, beta2m-positive amyloid tissue in the extradural thickness (extradural amyloid deposition) was immunohistochemically demonstrated to be modified with AGE. Inflammatory reaction with histiocytic and giant cell infiltration was also shown around the amyloid tissues. There were CD68-positive cells, and some cells were positive for AGE and beta2m. These findings suggest that beta2m accumulation and inflammatory reaction finally promote destruction of connective tissues. MRI, CT and/or myelography are necessary for diagnosing spinal canal stenosis accompanied by DRA. In conclusion, we propose a more comprehensive concept of dialysis-related spinal canal stenosis, which includes both DSA and myeloradiculopathy induced by extradural thickness.

Amyloid↗
PubMedDate not supplied

Diseases of the spinal canal in children: diagnosis with noncontrast CT scans.

The spinal cord and its coverings were assessed in 131 CT studies performed without intrathecal contrast material in 108 patients ages newborn to 20 years old. The spinal cord, including the conus medullaris, and the theca can be readily identified in most patients, except in the upper thoracic region. Correlation with other radiologic studies and surgery showed few false-positive and false-negative results. Of particular importance, in no patient was unnecessary surgery performed nor was necessary surgery not performed as a result of the method. The technique was a useful screening test, often sufficient alone, for the assessment of congenital disease (proved lesions included 20 tethered spinal cords, 11 congenital mass lesions, five split cords, and 11 hydromyelic cysts or syrinxes). There were nine confirmed intraspinal neoplasms. The technique was good for identifying epidural lesions; however, we recommend myelography and/or CT myelography for suspected intradural tumors because of the greater anatomic definition required. Noncontrast CT requires careful attention to technique, and may be successful only with the use of late-model, high-resolution CT units. Noncontrast CT is a rapid, cost-effective method of assessing suspected disease in the pediatric spinal canal, at least while access to MR is still limited.

Adolescent↗
PubMed1994

Vertebral hemangioma. Spontaneous spinal canal remodeling after fracture.

STUDY DESIGN: The patient in this report had a fracture of a hemangiomatous vertebra with a fragment protruded into the canal and without neurological signs. There was a 12 month follow-up. RESULTS: After conservative treatment, there were no neurologic signs, a good fusion, and natural remodeling of the spinal canal. CONCLUSIONS: The risk of a hemangiomatous vertebra fracture with a fragment retropulsed into the spinal canal and without neurologic signs is low. Also, a remodeling of the spinal canal can occur, as after a burst fracture.

Aged↗
PubMed1990

[A case of achondroplasia showing diffuse spinal canal stenosis].

A rare case of achondroplasia showing diffuse spinal canal stenosis is presented. A 39-year-old woman was admitted to our hospital because of numbness of lower extremities and intermittent claudication. The patient's height was 121cm and she had the typical clinical features of an achondroplastic dwarf. Neurological examination revealed spastic paraparesis, and sensory impairment below the level of T11 in the left side and L1 in the right. A plain X-ray feature of the spine showed spinal canal stenosis. The interpedicular distances were short in all vertebrae, and especially more prominent in the caudal lumbar region. The sacrum laid horizontally and the sacral angle was narrower than normal case. Myelography and computed tomographic myelography demonstrated severe stenosis of the subarachnoid space at the level of T9-11. Laminectomy was performed from the inferior half of T9 to T11. The yellow ligaments were prominently hypertrophic and these were removed as far as possible. Postoperatively, the weakness of the lower extremities was improved immediately, but numbness remained. Five months after the operation, she suffered from urinary dysfunction, so further laminectomy from T12 to L5 was performed. Also in this operation, hypertrophic yellow ligament was pathognomonic. Following this operation the patient had a good recovery course and returned to work.

Achondroplasia↗
PubMed1990

[CT analysis of developmental spinal canal stenosis].

The cervical and the lumbar vertebrae were analyzed by computed tomography in two groups. One group consisted of the patients with developmental stenosis of the cervical spine (the smallest AP diameter of the cervical spinal canal in the lateral view of X-ray was less than 12 mm) and the other was the control group (the smallest diameter was more than 14 mm). The canal to body ratio of the cross-sectional area (CBR), the modified Jones' "canal to body ratio" (JNS) and the flat index of the vertebral canal (FI) were measured at C4,C5, C6, L4 and L5. The shape of the vertebral canal of L4 and L5 was classified according to Baddeley. In the stenosis group, CBR and JNS were smaller at every measured level and FI was smaller at C4, C5 and C6 compared with the control group, Trefoil canals were found more frequently in the stenosis group. There was a clear relationship between the developmental stenosis of the cervical and the lumbar spinal canal. On treating patients with cervical spondylotic myelopathy, one should consider the possibility of pan-spinal canal stenosis.

Adult↗
PubMed2001

String test measurement to assess the effect of spinal deformity correction on spinal canal length.

STUDY DESIGN: Long cassette coronal and lateral radiographs before and after surgical correction were analyzed and string test measurements made by three observers in 55 surgical cases (13 surgical types). OBJECTIVES: The purpose of the study was to assess the effect of various corrective maneuvers for spinal deformity on the spinal canal length. SUMMARY OF BACKGROUND DATA: When perioperative neurologic deficit occurs, the surgeon removes implants because they are displaced into the spinal canal or the canal has been lengthened. It is important to know the effect certain constructs have on canal length because the ability of the spinal cord to adapt to canal lengthening is variable. METHODS: On the coronal radiographs the concave, convex, midvertebral, and adjusted midvertebral line, and on the sagittal radiographs, the anterior and posterior vertebral body lines were measured. The adjusted coronal line was the assumed path of the spinal cord starting at the midportion of the vertebral body at the top and the bottom of the deformity and then in between, hugging the pedicles as closely as possible while staying inside the pedicles. Adjustments for magnification were made. RESULTS: Anterior compression instrumentation without cages (n = 5) consistently shortened the spinal canal (mean delta -6.67 +/- 2.30 mm, P = 0.003), whereas instrumentation with cages (n = 13) lengthened the canal (mean delta 10.54 +/- 7.58 mm, P = 0.0003). Thoracic curves treated by posterior corrective forces (n = 14) demonstrated lengthening of the canal (mean delta 10.14 +/- 5.23 mm, P = 0.0001), large (n = 5) curves (81-140 degrees, mean delta 13.47 +/- 7.05 mm), and medium (n = 7) curves (50-80 degrees, mean delta 8.43 +/- 3.24 mm). CONCLUSIONS: Many deformity correction maneuvers, although they do not directly include application of posterior or anterior distraction forces, do indirectly lengthen the spinal canal.

Decompression, Surgical↗
PubMed1994

Preoperative spinal canal investigation in adolescent idiopathic scoliosis curves > or = 70 degrees.

STUDY DESIGN: This is a prospective evaluation of a consecutive series of patients with adolescent idiopathic scoliosis (AIS) with curves > or = 70 degrees. OBJECTIVE: The authors investigated the possibility that large curve size may constitute an atypical presentation of idiopathic scoliosis suggestive of underlying neurologic pathology, which would warrant preoperative investigation. SUMMARY OF BACKGROUND DATA: The potential for intraspinal pathology to cause scoliosis is well accepted. The incidence of spinal canal abnormalities in congenital or atypical scoliosis may be as high as 30-60%. Identification of clinical neurologic deficits, congenital abnormalities, or atypical features of scoliosis are often helpful in identifying the subpopulation of scoliosis patients at risk for spinal canal pathology. METHODS: Thirty-three consecutive patients with large (> or = 70 degrees) adolescent idiopathic scoliosis (AIS) and without evidence of neurologic or congenital abnormalities, were evaluated with either computed tomography/myelogram (n = 3) or magnetic resonance imaging (n = 30) to assess the entire spinal canal. RESULTS: None of the studies revealed any pathology of the neuraxis, and all 33 patients were treated with surgery without any neurologic sequelae. CONCLUSIONS: Preoperative investigation of the central neuraxis is not mandatory in large (> or = 70 degrees) but otherwise typical AIS curves. These large curves do not appear to suggest associated spinal canal anomalies.

Adolescent↗
PubMed1996

The path of a wounding missile along the spinal canal: a case report.

STUDY DESIGN: The authors report a penetrating gunshot injury to the cervical spine at the C6 level, with retention of the missile within the spinal canal at the T10 level. OBJECTIVES: The treatment of this patient involved debridement of entrance wound on the day of admission and laminectomies in the cervical and thoracic levels 3 days after the incident. SUMMARY OF BACKGROUND DATA: The migration of a foreign body along the intracranial part of the central nervous system has been reported in the literature, but we have found no report of an intercanal gunshot wound measuring 30 cm with complete liquefaction of the cord. METHODS: On admission, a 21-year-old man had an entrance wound on the right side of neck. He had complete paraplegia and could not flex the wrist. The cervical spine radiograph revealed a fracture of the C5 arch and metallic fragments in the spinal canal. A radiograph of the thoracic and lumbar spine disclosed a bullet trapped at the T10 level. Laminectomies at C6-C7 and T9-T10 were performed and the bullet and its fragments were removed. The ruptured dura was replaced by lyophilized dura. RESULTS: The wounds healed without infection. On discharges the patient's neurologic status was unchanged. CONCLUSIONS: Laminectomies and removal of metallic foreign bodies were performed to reduce the risk of infection in the spinal canal and to prevent toxic effects of dissolved metals on uninjured parts of the central nervous system.

Adult↗
PubMed1996

A novel technique for laminoplasty augmentation of spinal canal area using titanium miniplate stabilization. A computerized morphometric analysis.

STUDY DESIGN: Titanium miniplates are used to secure the posterior elements in the open position after expansive open-door laminoplasty. Preoperative and postoperative spinal canal dimensions are measured to assess the effectiveness of this technique. OBJECTIVES: To develop a simple yet effective technique to stabilize the posterior elements after laminoplasty and to compare preoperative and postoperative spinal canal dimensions to accepted normal values. SUMMARY OF BACKGROUND DATA: Expansive open-door laminoplasty has been offered as a simple alternative to laminectomy, which has been associated with postoperative kyphosis. Although the technique of laminoplasty is effective, a simple and reliable method of holding the posterior elements open has not been described. METHODS: Ten myelopathic patients with multilevel cervical canal stenosis secondary to spondylosis or ossification of the posterior longitudinal ligament were treated with an expansive open-door laminoplasty. The posterior elements were stabilized in the open position with titanium miniplates. Computer-assisted morphometric analysis was performed on preoperative and postoperative computed tomography scans to obtain spinal canal dimensions. Plain radiographs were used to monitor construct integrity. RESULTS: The preoperative sagittal canal diameter was 8.2 +/- 0.96 mm, and the canal area was 180.6 +/- 33.7 mm2. These dimensions increased after surgery to 16.6 +/- 1.5 mm and 321.9 +/- 29.7 mm2, respectively. The titanium miniplate constructs did not fail during the follow-up period (mean, 26.4 months), and the decompression was maintained. The single significant complication was transient C5 radiculopathy. CONCLUSIONS: Normal canal dimensions can be reestablished with open-door laminoplasty. Achieving and maintaining an increased sagittal canal diameter is probably the most important change in anatomic parameters to facilitate neurologic recovery. The use of titanium miniplates to stabilize the posterior elements after laminoplasty is a simple, durable, and effective technique to maintain the increased sagittal diameter of the spinal canal.

Adult↗
PubMed2005

Recombinant human bone morphogenic protein-2-enhanced anterior spine fusion without bone encroachment into the spinal canal: a histomorphometric study in a thoracoscopically instrumented porcine model.

STUDY DESIGN: A thoracoscopically assisted 5-level anterior spinal fusion and instrumentation model analyzing new bone formation when using recombinant human bone morphogenic protein-2 (rhBMP-2) with a collagen hydroxyapatite-tricalcium phosphate (HA/TCP) composite sponge carrier. OBJECTIVE: To determine whether new bone formation extends beyond the posterior confines of the vertebral body encroaching into the spinal canal when rhBMP-2 is used to enhance anterior fusion. SUMMARY OF BACKGROUND DATA: A possible concern regarding the use of rhBMP-2 to enhance spinal fusion is the risk of unwanted bone formation leading to inadvertent fusion of adjacent levels or compression of neural elements. The safety of rhBMP-2 in one spinal application does not ensure similar results in other applications. Therefore, the expanded use of rhBMP-2 should occur only after carefully monitored preclinical and clinical studies for each new application. METHODS: Eighteen pigs underwent thoracoscopically-assisted instrumentation and fusion of 5 contiguous levels (T5-T10) and randomly assigned to 4 treatment groups: group 1 (n = 6): rh-BMP-2 on a HA/TCP-collagen sponge (Medtronic Sofamor Danek, Memphis, TN); group 2 (n = 4): iliac crest autograft; group 3 (n = 4): empty; group 4 (n = 4): HA/TCP-collagen sponge (Medtronic Sofamor Danek) only. In groups 1 and 4, the HA/TCP collagen sponge was morselized into small granules and pushed through a bone delivery funnel for implantation into the disc. At 4 months after surgery, spines were sectioned longitudinally through the midsagittal plane and underwent undecalcified processing. Bone formation extending beyond the margins of the original discectomy and the confines of vertebral body were evaluated histomorphometrically at each operative level. RESULTS: Recombinant human bone morphogenic protein-2 on a HA/TCP-collagen sponge induced significant new bone formation extending anterior to the confines of the vertebral body compared with the other treatment groups (P < 0.05). In addition, rhBMP-2 on a HA/TCP-collagen sponge induced significant new bone formation extending posterior to the original margins of the discectomy (P < 0.05). However, there was no new bone formation beyond the confines of the posterior vertebral body. The total bone volume in the rhBMP-2-HA/TCP-collagen sponge group was significantly greater compared with all other groups in both the discectomy fusion area and beyond the discectomy area (P < 0.05). CONCLUSIONS: Recombinant human bone morphogenic protein-2 on a HA/TCP-collagen sponge enhanced anterior spinal fusion and induced significant new bone formation extending beyond the margins of the original discectomy and anterior vertebral body, most likely secondary to migration of some morselized carrier fragments from the disc space. However, the new bone formation did not extend beyond the posterior confines of the vertebral body to encroach into the spinal canal because of the intact posterior anulus and/or posterior longitudinal ligament.

Animals↗
PubMed2004

A deformable-model approach to semi-automatic segmentation of CT images demonstrated by application to the spinal canal.

Because of the importance of accurately defining the target in radiation treatment planning, we have developed a deformable-template algorithm for the semi-automatic delineation of normal tissue structures on computed tomography (CT) images. We illustrate the method by applying it to the spinal canal. Segmentation is performed in three steps: (a) partial delineation of the anatomic structure is obtained by wavelet-based edge detection; (b) a deformable-model template is fitted to the edge set by chamfer matching; and (c) the template is relaxed away from its original shape into its final position. Appropriately chosen ranges for the model parameters limit the deformations of the template, accounting for interpatient variability. Our approach differs from those used in other deformable models in that it does not inherently require the modeling of forces. Instead, the spinal canal was modeled using Fourier descriptors derived from four sets of manually drawn contours. Segmentation was carried out, without manual intervention, on five CT data sets and the algorithm's performance was judged subjectively by two radiation oncologists. Two assessments were considered: in the first, segmentation on a random selection of 100 axial CT images was compared with the corresponding contours drawn manually by one of six dosimetrists, also chosen randomly; in the second assessment, the segmentation of each image in the five evaluable CT sets (a total of 557 axial images) was rated as either successful, unsuccessful, or requiring further editing. Contours generated by the algorithm were more likely than manually drawn contours to be considered acceptable by the oncologists. The mean proportions of acceptable contours were 93% (automatic) and 69% (manual). Automatic delineation of the spinal canal was deemed to be successful on 91% of the images, unsuccessful on 2% of the images, and requiring further editing on 7% of the images. Our deformable template algorithm thus gives a robust segmentation of the spinal canal on CT images. The method can be extended to other structures, although it remains to be shown that chamfer matching is sufficiently robust for the delineation of soft-tissue structures surrounded by soft tissue.

Algorithms↗
PubMed1978

The spinal canal in symptomatic lumbar disc lesions.

The oblique sagittal diameter of the lumbar spinal canal was measured by diagnostic ultrasound in seventy-three patients with symptomatic disc lesions, and compared with measurements from 200 asymptomatic subjects. Results suggest that the available space in the spinal canal is highly significant in the symptomatology of disc lesions, and in the patient's response to treatment.

Adolescent↗
PubMed1984

[Clinical study of lumbar spinal canal stenosis on 70 operated cases --clinical symptoms, pathogenesis, operative method, postoperative results].

In surgical treatment of lumbar spinal canal stenosis, the stenotic area related to the clinical symptoms was determined and the stenotic form and stenotic factors in this stenotic area were estimated before operation. The most appropriate decompression of the stenotic area was performed taking the stenotic form into consideration and retaining the spinous process and interspinous ligament. In cases of stenosis of the spinal canal, posterolateral decompression of the dural sheath was performed by means of resection of the medial edge of the bilateral inferior articular processes and the yellow ligaments. In cases of stenosis of the spinal canal associated with stenosis of the lateral recess, the root was decompressed by unroofing the lateral recess in addition to posterolateral decompression of the dural sheath. And in cases with stenosis of the lateral recess, the root in an affected area was decompressed. Neither operation on the intervertebral disc nor incision of the dural sheath was performed. After operation as described above, symptoms, operative findings and postoperative results were investigated in 70 cases which could be directly examined. In this paper we discuss the relationship between the symptoms and the stenotic area, stenotic forms and stenotic factors. When our postoperative results were compared with those of cases with extensive laminectomy, it was seen that none of the patients we treated had low back pain nor recurrence of intermittent claudication and that lessening of paralysis was sufficient.

Adult↗
PubMed1991

Solitary extradural cavernous hemangiomas in the spinal canal. Report of five cases.

Five cases of solitary extrathecal cavernous hemangioma in the spinal canal are reported. In one case, two coexistent massive cerebral venous medullary malformations were found. The symptomatology and prognosis of extrathecal spinal cavernous hemangiomas are discussed, as is the significance of various diagnostic measures. The patient material further permitted a rough calculation of the incidence of symptomatic extrathecal cavernous hemangiomas in the spinal canal.

Adolescent↗
PubMed1999

The effect of Lipo prostaglandin E1 on cauda equina blood flow in patients with lumbar spinal canal stenosis: myeloscopic observation.

STUDY DESIGN: Myeloscopic examination was performed to observe the cauda equina in patients with lumbar spinal canal stenosis before and after treatment with Lipo prostaglandin E1, a strong peripheral vasodilator. OBJECTIVES: The purpose of this study was to clarify the effects of Lipo prostaglandin E1 on blood flow in the cauda equina in patients with lumbar spinal canal stenosis. SETTING: Japan, Kagoshima METHODS: We performed myeloscopic observations of morphological changes in blood vessels running along the cauda equina in 11 patients with lumbar spinal canal stenosis before and after treatment with Lipo prostaglandin E1. RESULTS: In six of these patients, dilation of the running blood vessels was observed immediately after administration. In all of the patients who exhibited a dilation of vessels on the surface of the cauda equina, intermittent claudication and lower extremity pain and/or numbness lessened immediately after examination. However, none of the patients who exhibited no morphological changes in the vessels along the cauda equina after administration of Lipo prostaglandin E1 experienced any improvement of symptoms at the time of examination. CONCLUSION: Results of this study suggest that Lipo prostaglandin E1 may enhance blood flow in the cauda equina and improve clinical symptoms in some patients with lumbar spinal stenosis.

Aged↗
PubMedDate not supplied

Spontaneous resolution of spinal canal deformity after burst-dispersion fracture.

We reviewed the records of 28 patients with 30 burst-dispersion spinal fractures treated since the introduction of CT facilities in Western Australia. Twenty-five patients showed spinal canal deformity and stenosis with bone fragments protruding into the canal on the initial scan. Of these, 22 patients were treated nonsurgically. Fifteen of the conservatively treated patients were available for follow-up, and they form the basis of this report. Thirteen of the 15 patients who had repeat CT at follow-up showed correction of the previously measured spinal canal stenosis by spontaneous resorption of intraspinal bone fragments. In view of this previously unreported finding, it is suggested that the role of surgical correction of spinal canal stenosis resulting from displaced bone fragments after trauma be more clearly defined.

Adolescent↗