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At least 217 records · Page 12Linked to original sources
PubMed1976

[The antero-posterior diameter of the cervical spinal canal in cervical spondylosis. (Part 2) (author's transl)].

1. The antero-posterior diameter (APD) of the cervical spinal canals in 96 cases of cervical spondylosis with radiculopathy and radiculomyelopathy was measured for each vertebra by the method of Burrows, and the thecoperiosteal diameter (TPD) of the cervical spinal canals in the same cases was measured from myelograms by the method of Symon. 2. The APD in patients with myelopathy or positive Queckentedt's test was found to be significantly smaller than those of without them. The upper limit of APD at C4 to C6 vertebrae in patients with myelopathy or positive Queckenstedt's test was 15 mm, while the lower limit of APD in patients with radiculopathy or negative Queckenstedt's test was 13 mm. As based on these findings, the following conclusions were drawn: When the APD is smaller than 15 mm, there is always a chance to develop spondylotic myelopathy or spinal subarachnoid block though not absolute, but if the APD is smaller than 12 mm, the patient will have myelopathy and spinal subarachnoid block absolutely without exception. 3. The TPD in patients with myelopathy or positive Queckenstedt's test was also found to be more significantly smaller than those of without them. It could be seen that the smaller the TPD, the more chance to develop myelopathy and also spinal subarachnoid block. The upper limit of the TPD in myelopathy was 11 mm, and that in spinal arachnoid block was 10 mm. The smallest value in radiculopathy was 9 mm, so that it was suggested that a case which has the value smaller than 8 mm might develop myelopathy. 4. The hight of the inter-body spurs was measured from lateral myelograms in individual case. The value in case with myelopathy and positive Queckenstedt's test was much larger than that of radiculopathy or negative Queckenstedt's test. The lower limit of the hight of the inter-body spurs in case with myelopathy and spinal subarachnoid block was 3 mm.

Cervical Vertebrae↗
PubMed2003

Assessment of lumbar spinal canal stenosis by magnetic resonance phlebography.

There is evidence to suggest that cauda equina intermittent claudication is caused by local circulatory disturbances in the cauda equina as well as compression of the cauda equina. We evaluated the role of magnetic resonance phlebography (MRP) in identifying circulatory disturbances of the vertebral venous system in patients with lumbar spinal canal stenosis. Extensive filling defects of the anterior internal vertebral venous plexus were evident in patients with lumbar spinal canal stenosis ( n = 53), whereas only milder abnormalities were noted in patients with other lumbar diseases ( n = 16) and none in normal subjects ( n = 13). The extent of the defect on MRP correlated with the time at which intermittent claudication appeared. In patients with lumbar spinal canal stenosis, extensive defects of the internal vertebral venous plexus on MRP were noted in the neutral spine position, but the defect diminished with anterior flexion of the spine. This phenomenon correlated closely with the time at which intermittent claudication appeared. Our results highlight the importance of MRP for assessing the underlying mechanism of cauda equina intermittent claudication in patients with lumbar spinal canal stenosis and suggest that congestive venous ischemia is involved in the development of intermittent claudication in these patients.

Adult↗
PubMed2005

Ectopic firing due to artificial venous stasis in rat lumbar spinal canal stenosis model: a possible pathogenesis of neurogenic intermittent claudication.

STUDY DESIGN: An electrophysiologic analysis was performed on a chronic lumbar spinal stenosis model of rats. The effects of venous stasis on ectopic firing originating in the nerve root were investigated. OBJECTIVES: To elucidate the mechanisms of neurogenic intermittent claudication in lumbar spinal canal stenosis. SUMMARY OF BACKGROUND DATA: Neurogenic intermittent claudication has been known as a characteristic symptom of lumbar spinal canal stenosis (LSCS), but the pathogenesis is poorly understood. Venous stasis of cauda equina has been speculated as a possible factor in the development of symptoms of the lower extremities while walking. On the other hand, ectopic firing originating in the dorsal root ganglia is thought to play an important role in the development of radicular pain or abnormal sensation. However, a direct association between venous stasis and ectopic firing has been never demonstrated. METHODS: Using 10 Wistar rats, the LSCS group was prepared by inserting two silicone strips into the L3 and L5 dorsal epidural spaces. Another 10 animals were treated without silicone insertion as a sham group. Fourteen days later, the ectopic firing originating in the L5 nerve root was antidromically recorded from the distal stump of the severed sural nerve. After recording initial spontaneous firing, the posterior vena cava was clamped for 60 seconds to simulate a transient venous stasis and the changes in firing were analyzed. RESULTS: None of the animals in the sham group showed a significant change in firing due to venous stasis. In contrast, most animals in the LSCS group showed a marked increase in firing during the venous stasis with some latency and then returned to the initial firing state after the release of the clamp. This phenomenon was repeated as long as the animals were maintained. CONCLUSIONS: We demonstrated that ectopic firing was elicited by venous stasis only in the LSCS animals. Therefore, the venous stasis may be a major factor of neurogenic intermittent claudication.

Animals↗
PubMedDate not supplied

Measurement of the lumbar spinal canal by echo ultrasound.

An echo ultrasound technique for the measurement of the lumbar spinal canal has been assessed. Duplicate measurements of each lumbar vertebral level were made by one experienced technician on 50 healthy young males. The mean spinal canal measurement of 1.37 cm was approximately 0.2 cm less than previously reported. Seven subjects returned for reassessment. The within and between session coefficients of variation were 3.7% and 5.8%, respectively. In contrast to previous reports of three distinctly separate echoes, the authors found that the first two echoes seldom were separated clearly and most commonly formed a complex. It is concluded that if suitable interobserver and interlaboratory comparisons are made at an early stage, the reproducibility of the method is likely to be adequate for prospective epidemiologic studies.

Adult↗
PubMed2004

Volumetric spinal canal intrusion: a comparison between thoracic pedicle screws and thoracic hooks.

STUDY DESIGN: A computer-aided design analysis. OBJECTIVES: To introduce the concept of volumetric spinal canal intrusion and report the relative intrusion volumes for thoracic pedicle screws compared to thoracic laminar and pedicle hooks. SUMMARY OF BACKGROUND DATA: Thoracic pedicle screws are being used more frequently; however, there is concern about neurologic risk from medial misplacement. The accepted alternative to screws is hooks. Laminar and pedicle hooks also have significant obligatory spinal canal intrusion. To date, there have been no comparison studies. METHODS: Volumetric analysis of canal intrusion of pedicle screws and hooks was performed by computer-aided design CAM. All implants were of a single product line by a single manufacturer (CD Horizon M8, Medtronic Sofamor Danek). Intrusion of pedicle screws with medial positioning was analyzed in 0.5-mm increments, including a calculation of the "screw shadow," representing additional space not available for the spinal cord between screw threads and lateral to a medially positioned screw with intrusion greater than the screw radius. The length of screw intrusion was determined from postoperative CT scans in patients with thoracic pedicle screw instrumentation. All hook styles were analyzed. The volume of the footplate in line with the dorsal surface of the footplate was considered the intruding volume for laminar hooks, with increasing offset in 0.25-mm increments to represent imperfect fit. Half of the volume of the footplate was considered to be the intruding volume for pedicle hooks since a properly positioned pedicle hook straddles the pedicle. RESULTS: Volumetric intrusion for a 4.5-mm screw ranged from 2.2 mm3 (0.5 mm medial perforation) to 83.4 mm3 (3.0 mm perforation). For a 5.5-mm screw, intrusion volume range was from 1.3 mm3 to 83.2 mm3. Accounting for the "screw shadow," the volumetric intrusion was 9.83 mm3 to 116.3 mm3 and 10.88 mm3 to 134.89 mm3, respectively. Hook volumetric intrusion ranged from 21.15 mm3 for a pediatric narrow-blade ramped pedicle hook to 113.9 mm3 for a wide-blade laminar hook with 1.0 mm of step-off. CONCLUSIONS: A 4.5-mm or 5.5-mm thoracic pedicle screw must have a medial perforation of >or=1.5 mm to have the same volumetric spinal canal intrusion as a pediatric narrow-blade pedicle hook, the smallest hook footplate. Further, the medial violation must be >3 mm to approach the same volumetric intrusion as the largest hook. Accounting for the "screw shadow," a thoracic pedicle screw must have a medial perforation of >2 mm to approach the same intrusion volume as a standard pedicle hook. In the absence of direct neural injury, this explains the clinical finding of medial perforation of up to 4 mm without neurologic compromise.

Animals↗
PubMed1982

Development of a mathematical model of the cervical spinal canal and its use in detecting early pathologic changes.

Detection of subtle osseous changes on plain film roentgenograms of the cervical spine is essential in expediting the evaluation of suspected intraspinal tumors. It is our experience that the earliest osseous changes in such cases involve thinning or erosion of the adjacent pedicles and/or lamina and a subsequent increase in the oblique diameter of the cervical spinal canal. A statistical model is established which accurately describes the normal cervical vertebral column in terms of its spinal canal size (sagittal and oblique diameters) as well as pedicle and lamina thickness. Data was obtained from a series of 86 normal exams. Six surgically proven cases of cervical intraspinal tumors were analyzed using this model. Variations from expected normal values reveal statistically significant osseous changes involving thinning of the lamina and increased oblique diameter of the spinal canal, while the sagittal diameter of the canal remains normal. Because of these findings we feel that oblique cervical spine films should be included in the initial evaluation of neural canal tumors.

Adult↗
PubMed2006

Intrapelvic lipoblastoma with massive spinal canal invasion.

OBJECTS: The lipoblastoma is a rare benign pediatric neoplasm that derives from embryonic white fat cells. However, this tumor with spinal invasion in children is extremely rare. We report a case of a 3-year-old boy who had lipoblastoma with massive invasion into the lower lumbosacral spinal canal. CASE REPORT: A 3-year-old boy had suffered from progressive urinary incontinence and uncontrolled defecation during past 3 months. Computed tomography and magnetic resonance imaging scans showed that a large lobulated pelvic cavity mass had invaded the lumbosacral spinal canal. The mass was located over the epidural space from L4 to the lower sacral spinal canal, resulting in the compression of the thecal sac. After total laminectomy from L4 to S3 with flavectomy, a subtotal mass removal for the intraspinal canal mass was done. Histopathologic diagnosis confirmed the lipoblastoma. CONCLUSION: Lipoblastoma is a rare benign neoplasm and lumbosacral invasion is unique. Complete surgical excision is the treatment of choice. If an incomplete surgical excision is performed, close observation and clinical follow-up must be done because a recurrence is possible.

Child, Preschool↗
PubMed1995

Transcranial magnetic stimulation of the motor cortex in cervical spondylosis and spinal canal stenosis.

STUDY DESIGN: This study investigated the clinical usefulness of motor evoked potentials and a silent period after motor evoked potentials produced by transcranial magnetic stimulation of the brain. OBJECTIVE: The results were correlated with the clinical state of the patients with myelopathy, whereas no abnormality of the conduction time was observed in the patients with spinal canal stenosis. SUMMARY OF BACKGROUND DATA: Magnetic stimulation has been widely used for examination of the descending excitatory motor pathways in the central nervous system, but little attention has been paid to cervical spondylosis and spinal canal stenosis. METHODS: Motor evoked potentials were examined in 35 normal subjects, 67 patients with cervical spondylotic myelopathy, and 24 patients with spinal canal stenosis. Motor evoked potentials were evoked by transcranial brain stimulation during relaxation and during maximum voluntary contraction of the target muscle. RESULTS: The central motor conduction time was found to correlate with the clinical state of the myelopathy patients, whereas no abnormality of the conduction time was observed in the patients with spinal canal stenosis. During maximum voluntary contraction of the target muscle, a silent period was always observed after the motor evoked potentials in the normal subjects, and its duration was markedly shortened in the myelopathy patients. CONCLUSIONS: In cervical myelopathy patients, the central motor conduction time was correlated with clinical evaluation and the silent period was significantly shortened. These findings about duration of the central motor conduction time and the silent period might be a useful parameter of spinal pathology.

Adult↗
PubMed2000

A retrospective analysis of spinal canal endoscopy and laminectomy outcomes data.

Disability from back pain has continued to increase at a steady pace since the 1950's. While no study has associated chronic disability with physical factors, numerous studies have correlated chronic disability with psychological factors and surgical intervention. Even though most common surgical interventions for spinal pain pertain to the herniated disc, numerous studies have indicated that only 1% of severe episodes of low back pain is attributable to herniated discs. With the advent of spinal canal endoscopy, an additional option is available for medical management of disc disease, which facilitates irrigation, dilution, and removal of inflammatory mediators, thus decreasing the chance of reactivity to chemical and biological mediators, and facilitating administration of corticosteroid medication with specificity to site of action. This pilot study included two groups of patients, Group 1 with 22 patients treated via spinal endoscopy and Group 2 with 13 patients treated via laminectomy. After spinal canal endoscopy, only 31.8% of Group 1 patients were continued on opioid medication, whereas, 92.3% of Group 2 patients were continued on opioid medication after laminectomy. In addition, 72% from spinal canal endoscopy group and only 28% from laminectomy group returned to work. In conclusion, this study suggested remarkable differences in outcomes when comparing patients who underwent spinal canal endoscopy to a similar population who underwent lumbar laminectomy.

Journal Article↗
PubMed1989

Dynamic changes in the dimensions of the lumbar spinal canal: an experimental study in vitro.

The variation in the dimensions of the lumbar spinal canal under both flexion-extension and axial compression-distraction was studied using computerized tomography (CT) scans in human cadaver lumbar spine specimens. In 3-mm-thick CT slices through the disk at L3-L4, the cross-sectional area of the spinal canal was reduced by around 40 mm2, corresponding to a 16% reduction of the initial area when the lumbar spines were moved both from flexion to extension and from distraction to compression. A corresponding reduction in the midsagittal diameter of the canal of 2 mm was found. During these motions, the ligamentum flavum did not appear to be a significant factor for the dynamic changes affecting the dimensions of the canal. This held true even after the disk had been excised in order to produce a total collapse of the disk space.

Humans↗
PubMed1988

Intradural arachnoid cysts of the spinal canal associated with intramedullary cysts.

Five patients had intradural arachnoid cysts of the thoracic spinal canal associated with syringomyelia or posttraumatic intramedullary spinal cord cysts. Three cases were diagnosed 6 to 18 years after spinal surgery and two 14 to 17 years after spinal cord trauma. In each case, delayed progression of symptoms led to the identification of the lesions. The diagnosis was assisted by the use of myelography and delayed computerized tomography scanning in two cases and by magnetic resonance imaging in all five. In each case, the arachnoid cyst appeared to compress the spinal cord or nerve roots; in three cases, the syrinx cavities appeared to exert a significant mass effect. In the two trauma-related cases, the intramedullary cysts were small and may have represented areas of cystic myelomalacia. In four cases, intraoperative real-time ultrasonography helped to localize the arachnoid and intramedullary cavities. All five patients were treated by fenestration of the arachnoid cyst; additional peritoneal shunting of the cyst was performed in one case and of the intramedullary cavity in three. In one patient, the two lesions appeared to have a balancing effect; after drainage of the arachnoid cyst, the syrinx cavity expanded and had to be treated separately. The neurological deficits were reduced in four patients and stabilized in one. Intradural arachnoid cysts and intramedullary cysts may occur together as a late complication of spinal surgery or spinal cord trauma, and either or both lesions may cause delayed neurological deterioration.

Adult↗
PubMed1999

Widening of the spinal canal and dural ectasia in Marfan's syndrome: assessment by CT.

We describe a method for diagnosing dural ectasia (DE) and spinal canal widening (SCW) using CT. We examined 23 patients with Marfan's syndrome (MFS), 17 with Ehlers-Danlos syndrome (EDS) and 29 normal subjects, using six axial slices at the level of the L1-S1 pedicles. Transverse diameters of the vertebral bodies, spinal canal and dural sac were measured and indices were defined to differentiate patients with DE and SCW from normal. Statistical significance was assessed using Student's t -test, chi (2)-test and Pearson's correlation coefficient. DE and SCW occurred in 69.6 % and 60.9 % of cases of MFS and in 23.5 % and 35.3 % of EDS respectively. In MFS, prevalence was significantly higher than in the control group. DE was significantly more frequent in MFS than in EDS. A strong correlation existed between DE and SCW in MFS and the control group, but not in EDS. Our system enables quantitative assessment of SCW and DE. The latter is particularly important in subjects suspected of having MFS, in whom it is a common and characteristic sign.

Adolescent↗
PubMed1993

Combined form of developmental cervical-lumbar stenosis of the spinal canal in two young patients.

Symptomatic combined cervical and lumbar developmental spinal canal stenosis without spondylosis in young patients has rarely been reported. Two such cases are presented here. The symptoms appeared at 21 and 18 years of age and progressed gradually for each patient. The main clinical manifestations included lower back pain, intermittent claudication, polyradiculopathy and myelopathy. Myelogram and computed tomography scanning showed developmental spinal canal stenosis without evidence of spondylosis in either the cervical or lumbar spine. Both of the patients underwent a canal expansive laminoplasty at the cervical level and a decompressive laminectomy at the lumbar level. They both showed satisfactory improvement after surgery. The pathologic features consisted mainly of thin and flat laminae at the cervical spine, and thick, hard laminae and facet joints at the lumbar spine. The mechanism of early onset of symptoms was probably due to the additive effects of irritation of both the spinothalamic tract at the cervical level and the nerve roots at the lumbar level. A one-staged operation is considered to be the most suitable treatment for this disease entity.

Adult↗
PubMed1984

Transuncodiscal approach to dumbbell tumors of the cervical spinal canal.

A combined anterior and lateral approach to the anterior cervical spinal canal with fusion was performed on five patients with cervical dumbbell-shaped tumors. The procedure consists of anterior discectomy and ipsilateral uncectomy, and removal of the posterolateral corners and posterior transverse ridges of the upper and lower vertebral bodies at the level of the tumor. In the case of a large tumor in the spinal canal, additional removal of a limited segment from the lateral part of the vertebral body was performed. The bone defect was filled with a T-shaped iliac bone graft. Two vertebral bodies were fused in each case. The highest level of the operation was C-2 and the lowest was T-1. The authors believe that any cervical dumbbell-shaped tumor below the C-2 level can be removed via an anterolateral approach as long as no more than three levels of the spine are involved.

Adult↗
PubMed1980

Quantitative assessment of the lumbar spinal canal by computed tomography.

An experimentally validated simple standardized method for making precise measurements of the spinal canal directly from the video display of a CT scanner is described. Using this method, normal values for anteroposterior diameter, interpediculate distance, and cross-sectional area of the lumbar spinal canal have been determined in a series of 60 adults. A careful study of canal configuration combined with the prudent use of the normal values should allow the CT diagnosis of lumbar spinal stenosis to be made with a high level of confidence.

Adolescent↗
PubMed2007

Long term outcome with post-operative radiation therapy for spinal canal ependymoma.

PURPOSE: A retrospective study was performed to evaluate the long term efficacy and safety of post-operative radiation therapy in the management of spinal canal ependymoma at our institution. METHODS AND MATERIALS: Between 1954 and 1997, 22 patients with spinal canal ependymoma were treated with post-operative radiotherapy at our institution. The median age at diagnosis was 34.7 years (range 9.8-56.1 years). All patients underwent open biopsy with histologic diagnosis: 13 patients (59%) had ependymoma (WHO Grade II) and 9 patients (41%) had myxopapillary ependymoma (WHO Grade I). The median tumor size was 4.0 cm (range 1.5-15.0 cm). Twenty patients received subtotal resection and 2 patients received gross-total resection. Median radiation dose was 45.0 Gy. RESULTS: The median follow up for surviving patients was 11.4 years (range 0.6-37.0 years). An 80% progression-free-survival (PFS) was observed for all patients at 5-, 10- and 15-year endpoints. All recurrences were within 3 years of treatment. The 5-, 10- and 15-year overall-survivals (OS) for all patients were 85%, 78% and 64%, respectively. Patients with tumors larger than 6.0 cm at time of presentation demonstrated 5- and 10-year PFS of 58.3% compared to 92.3% for patients with tumors 6.0 cm or smaller (P = 0.047). There was no significant correlation between tumor size and OS. CONCLUSIONS: Post-operative radiation after subtotal resection is safe and offers durable tumor control and long term patient survival.

Adolescent↗