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PubMed1970

Decompressive laminectomy for low back and sciatic pain.

A proportion of patients with lumbar disc syndromes have little in the way of disc protrusion, but have spinal canals, either congenitally narrow, or else narrowed by degenerative changes. These patients require myelography for their assessment and decompression by complete laminectomy for their treatment, as opposed to the more usual practice of discectomy via partial laminectomy and/or fusion. Five such cases with myelographic findings are presented.

Adult↗
PubMed1983

Cervical myelopathy. Technique and results of spinal cord decompression by lateral laminectomy.

The Authors describe the technique of lateral laminectomy devised by Gui in 1965 for the treatment of cervical myelopathy secondary to cervical spondylosis. Spinal cord decompression is obtained by a lateral laminectomy with the maximum saving of bone, ligaments and muscles of the cervical spine. CAT scan demonstrated very well the effective decompression of the spinal cord achieved with this technique. The results of 87 cases treated in this way between 1968 and 1980 are reported. The average follow-up was 2.5 years. There was an improvement in the neurological symptoms in 82% of the cases.

Adult↗
PubMed1983

[An evaluation of decompressive laminectomy in metastatic spinal cord tumors].

The results of consecutive cases of decompressive laminectomy for spinal cord compression from spinal metastatic tumor were reviewed. In a series of 65 patients undergoing decompressive laminectomy, the postoperative survival was 8.3 months with 60 patients. Twenty-three per cent of the group was able to ambulate for at least some period postoperatively. Paralysis had developed with great rapidity in the half of the patients who were unable to walk prior to operation. For early diagnosis and effective removal of these lesions this treatment should be taken before when signs of cord compression are evident, and especially before the patient loses his ability to walk.

Adolescent↗
PubMed1994

Computed tomography after laminectomy for lumbar spinal stenosis. Patients' pain patterns, walking capacity, and subjective disability had no correlation with computed tomography findings.

OBJECTIVES: The purpose of this study was to evaluate the relationship between postoperative computed tomography findings and patients' pain patterns, walking capacity, and subjective disability after laminectomy for lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: Recent improvements in computed tomography have enabled this tool to reveal changes in a patient after an operation, but there is a paucity of comparative examinations regarding the lumbar spinal canal of asymptomatic and symptomatic patients after laminectomy for lumbar spinal stenosis. METHODS: Ninety-two patients (42 women, and 50 men) with a mean age of 55 years were operated upon. Mean follow-up time was 3.5 years. Based on computed tomography findings of the operative area, three patient groups were formed: 1) no stenosis, 2) moderate stenosis, 3) and severe stenosis. During treadmill testing, each patient's pain was evaluated by visual analogue scale. The patients were divided into four pain pattern groups: 1) pain in the back and leg, 2) pain in the back only, 3) pain in the leg only, and 4) no pain in the back and leg. Subjective disability was measured by the Oswestry disability score. RESULTS: The structural changes revealed by computed tomography, and the patients' pain patterns, walking capacity, and subjective disability did not correlate significantly with each other. CONCLUSIONS: Postoperative computed tomography has only limited value because asymptomatic and symptomatic patients yield similar findings after surgery for lumbar spinal stenosis.

Disability Evaluation↗
PubMed1977

Clinical and histologic evaluation of bilateral hemilaminectomy and deep dorsal laminectomy for extensive spinal cord decompression in the dog.

Various forms of 2 techniques for maximal decompression of the thoracolumbar spinal cord in dogs were evaluated clinically and histologically. Based on the results of this study, the veterinary surgeon could consider the following spinal decompression procedures: (1) deep dorsal laminectomy over 1 vertebra; (2) bilateral hemilaminectomy on 1 vertebra, with removal of articular processes and dorsal spinal plating; and (3) bilateral hemilaminectomy on 2 vertebrae, with the articular processes left intact. Of these 3, the 1st and 3rd techniques would probably be considered for use more often than the 2nd. Deep dorsal laminectomy over 2 vertebrae should be considered with reservation. Bilateral hemilaminectomy on 2 vertebrae, with rigid dorsal spinal plating and without articular processes at the ends of the defect, should not be used. Before using one of the techniques, the surgeon should consider the indications, advantages, and disadvantages for that technique.

Animals↗
PubMed1993

Appropriateness of antibiotic selection and use in laminectomy and microdiskectomy.

The selection and timing of antibiotic prophylaxis in spinal surgery patients were studied. All laminectomy and microdiskectomy cases in which surgical-wound infection had developed within 60 days of surgery during 1990 at a medical center were retrospectively reviewed because of the high rate of postoperative wound infection for these procedures at the institution. The evaluation covered drug selection, the timing of antibiotic administration relative to the surgical incision, culture and susceptibility test results, and the length of the surgical procedure. Surgical-wound infection was found to have developed in 22 (7%) of the 315 patients who underwent laminectomy or microdiskectomy. There was no apparent difference between the infected group and a matched, uninfected control group in either the antibiotic selected or the number of doses given. On the basis of the organisms isolated from the wounds and susceptibility test results, the selection of cefazolin as the antibiotic was appropriate in 17 of the 22 infected patients. However, compared with the control group, the infected group had a significantly higher percentage of patients in whom antibiotics had been given more than two hours before the time of the surgical incision. The policy on administering prophylactic antibiotics was modified; current guidelines include giving the first dose of cefazolin upon the induction of anesthesia and follow-up administration in three hours if the incision has not been closed by then. The selection of a prophylactic antibiotic for spinal surgery patients was appropriate, but the timing of drug administration was usually not optimal.

Adult↗
PubMed1997

Finite element modeling of cervical laminectomy with graded facetectomy.

In this study, an anatomically accurate three-dimensional finite element model of the human lower cervical spine (C4-C6) was used to study the biomechanical effects of cervical laminectomy with and without graded facetectomy. The intact finite element model was validated under flexion, extension, lateral bending, and axial torsion load vectors of 1.8 Nm magnitude. The moment rotation response of the finite element model matched well with experimental data. The gross external (angular motion) and the internal (superior and inferior intervertebral disc stress) responses were delineated under the four physiological loading modes for these iatrogenic changes. Results indicated that laminectomy markedly altered the cervical angular motion and the disc stress under flexion compared with all other loading modes. Facetectomy increased the angular motion and the inferior disc stress notably under flexion but did not affect the adjacent superior disc stress. Facet resection of > 50% caused pronounced increases in angular rotation and intervertebral disc stresses. These findings suggest that the resection of more than one-half of this structure may require additional procedures to restore the strength of the cervical column. Although gross external motion response can be obtained by experimental studies, the internal stress response can only be determined using mathematical models such as the finite element model used in the present study. The accentuated changes in the disc stress compared with the changes in the external rotation may be clinically relevant because increased internal load/stress can result in disc degeneration. The present three-dimensional finite element model offers additional information to better understand the extrinsic and intrinsic responses of the iatrogenically altered cervical spine.

Biomechanical Phenomena↗
PubMedDate not supplied

[Clinical and radiological analysis of lumbar spine stability after hemilaminectomy and laminectomy in cases of lumbar disk excision with simultaneous interbody fusion].

108 patient were operated on the Neurosurgical Department of the Military Clinical Hospital in Wrocław since 1989 till 1991. The stability of the lumbar spine after hemilaminectomy and laminectomy with disc excision and interbody fusion was analysed. The period after operation ranged from 6 months to 2 years. Signs of clinical and radiological instability were the base of the study. Respective segmental motions in maximal ante- and retroflexion were calculated. Horizontal intercorporal dislocation was assessed. No signs of instability where found in the analysed material. The results after laminectomy and hemilaminectomy were similar. The failures were not caused by instability.

Adult↗
PubMed1996

[Prevention of peridural fibrosis and adhesion after laminectomy: an experimental study in rats].

An experimental study on the effectiveness of various materials including poly carboxymethylcellulose (PCMC), gelatin foam (GF), ligment (L), free fat (FF) in prevention of peridural fibrosis and adhension (PDA) was done in 144 SD rats using a total laminectomy model (L1-2). PDA was measured with a double-blind protocol at 2, 4, 8, 12 weeks postoperatively by gross anatomical appearance (blunt-dissection), microscopical evaluation, computed imaging analysis and MRI enhanced with gadolinium. The results demonstrated that the peak of PDA is within 8 weeks after operation. PCMC, as a three dimensional protective material, could effectively inhibit PDFA after laminectomy, but GF and L could not. SHA had some effect in the early stage, but not in the late period. For FF though it could effectively prevent PDA, the incision infection rate was higher, the atrophy and necrosis of FF were serious. What is more, almost all transplanted fat remained in situ extended into the spinal cord in some measure after 8 weeks postoperatively.

Animals↗
PubMed1988

Use of the MMPI and MCMI in predicting outcome of lumbar laminectomy.

This study compared the abilities of the MMPI and Millon Clinical Multiaxial Inventory (MCMI), using discriminant analyses, to predict outcome after lumbar laminectomy for chronic back pain. Sixty-nine males and 60 females with lumbar discogenic disease completed MMPIs and MCMIs before surgery and were classified as either having good or fair/poor surgical outcomes based on self-reported pain relief, return to work, restriction of activities, and medication use. Results showed both the MMPI and MCMI to have moderate ability to predict surgery outcome. A slightly higher classification hit rate was obtained with both instruments when age, sex, employment status, and presence of compensation/litigation issues also were entered into the prediction equation. Results indicate the need for caution in using either instrument to make predictions of surgery outcome in individual cases.

Adolescent↗
PubMed1991

Risk and severity of non-back occupational injuries after lumbar laminectomy for degenerative disc disease.

An increased risk, after lumbar laminectomy, for lost work time occupational back injury (odds ratio, 5.9; 95% confidence interval, 1.9-18.8) and disability (mean 292.8 days vs. 24.8 for controls) was previously demonstrated. Such differences could be due to physical sequelae of back surgery or to psychosocial factors. Extensive literature addresses the impact of psychosocial factors on the incidence of occupational injury and severity of disability. This study assumes that psychosocial factors would affect both back and non-back injuries, while surgery-related physical factors would not. The odds ratio for non-back lost work time injury for subjects in the same cohort studied previously was 1.5 (0.5-4.5), with no significant increase in duration of disability (mean 27.0 days vs. 24.8 for controls). The increased risk for back injury in the absence of an increased risk for other injuries suggests that physiologic rather than psychosocial factors provide the more likely explanation for the differences in back injuries.

Adult↗
PubMed1985

Lancinating pain in post-laminectomy chronic sciatica.

Lancinating pain, as described in tabes dorsalis, was noted in four patients with chronic sciatica after several months of laminectomy. The pain responded well to carbamezapine therapy. Abnormal or ephaptic neural transmission of impulses in the roots was considered to be the cause of such pain.

Carbamazepine↗
PubMed1996

Injury of a medial sacral vessel during lumbar laminectomy.

Vascular injury sustained during neurosurgical procedures is surprisingly rare, especially considering the anatomic proximity of major blood vessels to the vertebral column. Mortality rates are high if the injury is not recognized and definitive management is delayed. Case reports include massive hemorrhage, arteriovenous fistulas, and development of false aneurysms. Diagnostic CT scan and arteriography are useful if the patient's condition permits; however, rapid intervention is crucial to the patient's survival. After reviewing the current surgical literature, we present a case of medial sacral artery injury occurring during laminectomy.

Adult↗
PubMed2002

[Comparison of different vertebral body prosthesis with reference to migration and primary stability in dorsoventral spondylodesis after corporectomy with and without laminectomy].

In order to allow speedy mobilization after vertebral body replacement, high primary stability as well as prevention of implant dislocation are required. It is unclear whether differences between common vertebral body replacement systems exist and whether spreadable implants improve primary stability. Migration characteristics of 3 different vertebral body replacement systems were determined using human lumbar spine specimens. Primary stability was assessed by loading specimens successively in 5 conditions: native, after dorsal spondylodesis, after laminectomy and after vertebral body replacement. Migration was shown to depend on cage design and spike shape. Dorsal spondylodesis in combination with vertebral body replacement reduced flexion/extension movement effectively independent of cage design. Stabilization potential in lateral bending was limited. None of the cages limited movement under torsional loading effectively. The possibility to spread the cage had a positive effect on stabilization.

Biomechanical Phenomena↗
PubMed2005

Spinal stenosis in grade I degenerative lumbar spondylolisthesis: a comparative study of outcomes following laminoplasty and laminectomy with instrumented spinal fusion.

The management of grade I lumbar degenerative spondylolisthesis remains controversial. There have been few reports comparing any form of surgery with conservative treatment. As for surgical management, the need for arthrodesis with instrumentation has not been established. A series of 53 patients with single-level spinal stenosis at L4/5 due to grade I degenerative spondylolisthesis entered into a study to compare outcomes of two surgical methods of treatment with those of a control group treated conservatively: group 1, 19 patients treated by decompression laminectomy combined with posterolateral fusion and pedicle screw instrumentation; group 2, 18 patients treated by decompression of the spinal canal using a laminoplasty technique to preserve the integrity of the midline structure; group 3, 16 patients treated conservatively after being recommended that they have surgery. We compared the 2-year results among the three groups. Alleviation of symptoms was noted in groups 1 and 2, whereas the controls (group 3) showed no improvement. There was no significant difference in the degree of clinical improvement between groups 1 and 2. Spondylolisthesis was controlled in group 1, but it did not lead to better clinical results than those achieved in group 2. Our findings indicate that the technique for decompressing the spinal canal with preservation of the posterior elements of its roof can be useful for treating patients with grade I degenerative spondylolisthesis with symptoms of spinal stenosis.

Aged↗
PubMed1987

Syringomyelia after decompressive laminectomy for cervical spondylosis.

We describe a case of cervical spondylotic myelopathy in which deterioration occurred a month after decompressive laminectomy. Syringomyelia was then in evidence as seen by myelography and delayed metrizamide computed tomography scanning. The etiology of this finding and its possible relation to the course and treatment of cervical spondylotic myelopathy are discussed.

Adult↗
PubMed1994

Hyaluronidase in the management of pain due to post-laminectomy scar tissue.

We describe a 31-year-old male with a rebound radicular syndrome due to post-laminectomy scarring in the intervertebral foramen and epidural space. Repeated injection of hyaluronidase through the intervertebral foramen into the scar tissue resulted in periods of appreciably reduced pain and increasing duration. No untoward effects were seen.

Adult↗