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PubMedDate not supplied

Anatomy of soft tissues of the spinal canal.

BACKGROUND AND OBJECTIVES: Important issues regarding the spread of solutions in the epidural space and the anatomy of the site of action of spinal and epidural injections are unresolved. However, the detailed anatomy of the spinal canal has been incompletely determined. We therefore examined the microscopic anatomy of the spinal canal soft tissues, including relationships to the canal walls. METHODS: Whole mounts were prepared of decalcified vertebral columns with undisturbed contents from three adult humans. Similar material was prepared from a macaque and baboon immediately on death to control for artifact of tissue change after death. Other tissues examined included nerve root and proximal spinal nerve complex and dorsal epidural fat obtained during surgery. Slides were examined by light microscopy at magnifications of 10-40x. RESULTS: There is no fibrous tissue in the epidural space. The epidural fat is composed of uniform cells enclosed in a fine membrane. The dorsal fat is only attached to the canal wall in the dorsal midline and is often tenuously attached to the dura. The dura is joined to the canal wall only ventrally at the discs. Veins are evident predominantly in the ventral epidural space. Nerve roots are composed of multiple fascicles which disperse as they approach the dorsal root ganglion. An envelope of arachnoid encloses the roots near the site of exit from the dura. CONCLUSIONS: These features of the fat explain its semifluid consistency. Lack of substantial attachments to the dura facilitate movement of the dura relative to the canal wall and allow distribution of injected solution. Fibrous barriers are an unlikely explanation for asymmetric epidural anesthesia, but the midline fat could impede solution spread. Details of nerve-root structure and their envelope of pia-arachnoid membrane may be relevant to anesthetic action.

Adipose Tissue↗
PubMed1981

The lumbar spinal canal in hypophosphataemic vitamin D-resistant rickets.

Lumbar spine radiographs of 17 adult patients with hypophosphataemic vitamin D-resistant rickets have been examined and measured in their anteroposterior and transverse dimensions. Comparison of these measurements with those of a group of normal individuals showed the HPR patient group to have narrower spinal canals in both diameters. No differences were found between males and females in either group. The lumbar spinal canal stenosis in adult HPR patients may make them more susceptible to spinal cord compromise from space occupying lesions within the canal, causing back pain and lower limb weakness for which surgical intervention may be indicated.

Adult↗
PubMed1987

[The dumbbell shaped vertebral hemangioma developed in the pleural cavity and spinal canal].

A 44-year-old male patient visited our clinic complaining of back pain since January, 1984 and feeling of weakness at the lower extremities, sensory and vesicorectal disturbance since March of the same year. Hypesthesia and hypalgesia were observed at Th10 or below. The chest X-ray findings revealed an egg-sized tumor mass at the level of Th8. Metrizamide CT also demonstrated thoracic epidural mass. The characteristic findings of hemangioma showing delayed appearance of the tumor stain were also observed by angiography. The tumor was then confirmed as dumbbell-shaped hemangioma growing in the pleural cavity and the spinal canal. At the first surgical operation, total resection of the tumor in the spinal canal was performed by the postero-lateral approach. Although the second surgical intervention of total removal of the tumor in the pleural cavity had also been scheduled, the surgery was postponed because the patient had to return to work. The 2-year follow-up study revealed no recurrence of the tumor. And the tumor was found slightly diminished on chest X-ray. At present, the patient is still under observation. In this report, the authors discuss the therapeutic methods for thoracovertebral hemangioma including our case and reviewed in the literature related to this type of tumor.

Adult↗
PubMed1977

[The antero-posterior diameter of the cervical spinal canal in the ossification of the posterior longitudinal ligament (author's transl)].

1. The antero-posterior diameter (APD-Fig. 1A) of the cervical spinal canals in 38 cases of symptomatic ossification of the posterior longitudinal ligament (OPLL) and 29 cases of asymptomatic OPLL was measured for each vertebra, and the thecoperiosteal diameter (TPD-Fig. 1B) of the cervical spinal canals in the same cases was measured. 2. The APD in the cases of symptomatic OPLL was found to be significantly smaller than those of asymptomatic OPLL. 3. The TPD in symptomatic OPLL was also found to be more significantly smaller than those of asymptomatic OPLL. Measurements of 9 mm or less were considered liable to be associated with cord compression. 4. The growing rate of the ossification was calculated in 13 cases of symptomatic OPLL which we have followed up radiologically for more than 2 years. The growing rate varied considerably from case to case. The average growing rate per one year was 4.07 mm in axial length and 0.67 mm in thickness on antero- posterior direction. 5. The incidence of OPLL was examined.

Adolescent↗
PubMed1995

Primary spinal chondrosarcoma localized in the cervical spinal canal and intervertebral foramen--case report.

A 48-year-old male presented with a very rare case of spinal chondrosarcoma localized in the cervical spinal canal and intervertebral foramen, but without marked destruction of the vertebral column. Spinal chondrosarcoma is characterized by radiological evidence of destruction of the surrounding bone structure and mottled calcification. Magnetic resonance imaging was useful in the diagnosis and determination of the extent of this spinal chondrosarcoma. However, preoperative differential diagnosis of the tumor was not possible based on neuroimaging evidence.

Cervical Vertebrae↗
PubMed1991

Spinal canal remodeling after thoracolumbar fractures with intraspinal bone fragments. 17 cases followed 1-4 years.

The long-term fate of nonreduced intraspinal bone fragments in 17 thoracolumbar fractures--three not operated on and 14 stabilized with Harrington's rods or a Hartshill rectangle--was studied with CT. The reduction of the spinal canal area was measured in conjunction with the trauma in the nonoperated on cases and immediately after surgery in the other cases. The mean reduction was 29 (10-70) percent. The reduction had decreased to 14 (0-30) percent at the follow-up examination 31 (12-44) months later. The restitution of the spinal canal did not differ in the nonoperated and operated on patients. Our findings indicate that stable thoracolumbar fractures with intraspinal bone fragments, but without neurologic symptoms, can be treated nonoperatively, irrespective of the size of the fragment, without risk of subsequent symptomatic neural compression.

Adult↗
PubMed1995

Correlation of spinal canal post-traumatic encroachment and neurological deficit in burst fractures of the lower cervical spine (C3-7).

Burst fractures of the lower cervical spine (C3-7) are often associated with severe neurological injury. During the last 5 years (1987-1992) we operated on 11 patients who had sustained burst fractures together with neurological deficit. The operations were performed through an anterior approach. The burst vertebra was excised, and the defect was filled with bone graft. Implants (plates and screws) were used in 10 cases. The preoperative examination was conducted by computed tomography and revealed that in 4 patients with complete tetraplegia (Frankel grade A) there was more than 50% spinal canal narrowing, whilst in the remaining 7 patients, with various levels of incomplete tetraplegia, there was less than 50% spinal canal narrowing, resulting in considerable improvement. The above results support the hypothesis that a correlation exists between the magnitude of the spinal canal encroachment, the initial neurological deficit and the final outcome.

Adolescent↗
PubMed1992

Intradural extramedullary cysts of the spinal canal: clinical presentation, radiographic diagnosis, and surgical management.

Fourteen patients with intradural extramedullary cysts of the spinal canal are described. Histological classification included 11 arachnoid, 2 epithelial, and 1 ependymal cyst. There were 9 thoracic, 3 cervical, and 2 lumbar cysts. The most common clinical presentation was a slowly progressive myelopathy. Twelve patients (85%) had objective neurological findings at the time of diagnosis. Radiographic diagnosis was made by a combination of myelography, computed tomographic scan with myelography, and magnetic resonance imaging. Complete surgical resection was accomplished for 8 dorsal cysts, and 6 ventral cysts were widely fenestrated into the subarachnoid space. Overall results were considered excellent or good in 9 patients, fair in 3, and poor in 2. There was one recurrence, which required a second operation. We conclude that the majority of intradural spinal cysts can be successfully managed surgically with a favorable clinical outcome.

Adolescent↗
PubMed1986

[Stress myelography. A new functional study technic in diseases of the lumbar spinal canal].

To optimize functional diagnostics in lumbar syndromes a new myelographic technique was developed termed "loading myelography". During the procedure the patient stands with a 10 kg. weight on his outstretched arms. Based on the law of leverage the load exercised on the vertebral column is more than two and a half times of one-half of the body weight. The author tested the efficacy of the method in 119 patients suffering from disc prolapse, spinal canal stenosis, spondylolisthesis or arachnitis. The results of the conventional myelogram compared with myelography under load conditions demonstrate the value of the method: without load the diagnosis would have remained uncertain in 25% and in 18% load myelogram revealed a pathological finding although conventional myelography was normal. We consider as indications for load myelography: Discrepancy between clinical and conventional myelographic findings; clinically expected multisegmental lesions; spinal canal stenosis; and spondylolisthesis.

Humans↗
PubMed1995

Paraparesis after rib penetration of the spinal canal in neurofibromatous scoliosis.

Paraplegia or paraparesis is uncommon in patients with neurofibromatous scoliosis. The main causes of spinal cord compression in neurofibromatosis are vertebral angulation, vertebral subluxation, and tumorous lesions around the spinal cord. We report a rare case of paraparesis due to spinal cord compression by a rib penetrating the spinal canal in a patient with neurofibromatous scoliosis. There was complete recovery after laminectomy and proximal resection of the compressing rib along with combined anterior and posterior spinal fusion.

Child↗
PubMed1980

Soft-tissue anatomy within the spinal canal as seen on computed tomography.

The CT appearance of the vascular, ligamentous, and neural tissues in the spinal canal was studied in 50 patients and 5 cadavers. In some patients, iodinated contrast medium was first injected into the ascending lumbar veins, nucleus pulposus, or theca. Positive identification of spinal soft tissues on the CT image was made by reference to cadaver dissections. The spinal cord, nerves, root sheaths, retrovertebral plexus, epidural and basivertebral veins, posterior longitudinal ligament and ligamentum flavum, intervertebral disks, and vertebral arteries can be demonstrated by CT, indicating its value in the diagnosis of disease of the cord, disk, and epidural space.

Contrast Media↗
PubMed1988

Relationship between traumatic spinal canal stenosis and neurologic deficits in thoracolumbar burst fractures.

Using CT scans of 112 consecutive patients with thoracolumbar burst fractures, we investigated the relationship between traumatic spinal canal stenosis and neurologic deficits. We calculated the stenotic ratios of the area occupied by the retropulsed bony fragments to the estimated area of the original spinal canal. We also examined the shape of the narrowed canal and the disruption of spinal elements. Burst fractures having the following ratios are at significant risk of neurologic involvement: at T11 to T12 with 35% more, at L1 with 45% or more, and at L2 and below with 55% or more.

Adolescent↗
PubMed2000

Herrmann multiple synostosis syndrome with neurological complications caused by spinal canal stenosis.

A young man was found to have multiple synostosis syndrome type I after presenting with a neck injury causing a cervical spinal cord contusion. Neurological symptoms and signs suggested spinal cord compression. Magnetic resonance (MR) and computerized tomography (CT) imaging of the spine showed spinal canal stenosis with cord compression at C3-C6, a deformed spinal canal flattened in the anteroposterior dimension, vertebral fusions and deformed lateral processes of the vertebrae. He had a long broad nose with hypoplasia of the alae nasi, conductive hearing loss requiring hearing aids, muscular build, stiff spine, prominent acromia, pectus excavatum, ischial prominences, short fifth fingers, fusion at the proximal interphalangeal joints of the fifth fingers with indistinct overlying creases, and toe syndactyly. Spinal cord stenosis is a serious complication of multiple synostosis syndrome, that should be kept in mind in considering the risk of neck or back injury associated with certain sports or other activities. In both the multiple synostosis syndrome and the less severe proximal symphalangism deafness syndrome, mutations have been detected in the human homologue of the noggin gene on chromosome 17q21-q22.

Abnormalities, Multiple↗
PubMed1976

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

1. The antero-posterior diameter (APD) of the cervical spinal canals in 96 healthy adults, 108 cases of radiological cervical spondylosis (asymptomatic) and 96 cases of cervical spondylosis with radiculopathy or radiculomyelopathy was measured for each vertebra by the method of Burrows. (Filmfocus distance was 1.2m). 2. The APD in patients with symptomatic spondylosis was found to be significantly narrower than those of without. 3. Since the upper limit of APD at C4 to C6 vertebrae in symptomatic spondylosis was 16 mm, while the lower limit of APD in asymtomatic spondylosis was 14 mm, the following conclusion appears justified. 1) When the APD is narrower than 16 mm, the osteophytes along the posterior border of the spinal bodies or degenerative disc protrusions may produce cervical radiculomyelopathy, although the cord and the roots may escape from compression by the spondylotic changes even when the APD is wider than 14 mm. 2) When the APD is narrower than 13 mm, it is almost always certain that the osteophytes or herniated discs compress the cervical cord and roots.

Adult↗
PubMed1979

[Stenosis of the lumbar spinal canal and dolichophalangy in a case of dyschondrosteosis (author's transl)].

A case of dyschondrosteosis in a 13 years old boy, with multiple epiphyseal changes, atypical Madelung's deformity, stenosis of the lumbar spinal canal and dolichophalangy is described. Skeletal changes show manifold characters of resemblance with those encountered in Turner's syndrome. An osteogenetic defect affecting chiefly mesenchymal cells surrounding the epiphyseal plate is supposed. Stenosis of the lumbar spinal canal is not previously reported.

Adolescent↗
PubMed2000

Magnetic resonance imaging in the management of suspected spinal canal disease in patients with known malignancy.

AIM: The aim of this study was to examine the spectrum of spinal canal disease in patients with known malignancy using magnetic resonance imaging (MRI). MATERIALS AND METHODS: One hundred and fifty-five patients underwent a total of 159 spinal MRI examinations over a three-year period. Patients were examined using a 1.0T magnet and a phased array surface spine coil. Sagittal T1 weighted spin echo and STIR sequences were routinely employed. Axial T1 and T2 weighted spin echo images were obtained at sites of identified pathology. Contrast enhanced sagittal and axial T1 weighted spin echo images were acquired when the unenhanced appearances did not correlate with the clinical findings or when the images suggested intradural or intramedullary disease. RESULTS: Malignant disease affecting the spinal cord or cauda equina was noted in 104/159 (65%) patients (extradural n= 78, intradural n= 20, intramedullary n= 7); one patient had evidence of both intradural and intramedullary deposits. Multiple levels of extradural cord/cauda equina compression were present in 18/78 patients (23%). The thoracic spine was the most frequently affected (74%). Bone elements were the major component of extradural compression in 11/78 patients (14%). Intradural metastases were multiple in 15/20 patients (75%). Four of the six solitary intramedullary metastases were situated in the conus medullaris. CONCLUSION: Magnetic resonance imaging of the entire spine is the investigation of choice in patients with known malignancy and suspected spinal canal disease. Contrast-enhanced images should be acquired when the unenhanced appearances do not correlate with the clinical findings or when they suggest intradural or intramedullary disease.Loughrey, G. J. (2000). Clinical Radiology55, 849-855.

Adolescent↗