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PubMedDate not supplied

Extensive simultaneous multisegment laminectomy for myelopathy due to the ossification of the posterior longitudinal ligament in the cervical region.

Extensive simultaneous multisegment laminectomy (ESML) for treatment of ossification of the posterior longitudinal ligament (OPLL) in the cervical region is a technique which cuts the laminae on the median line and on the pedicles with an air drill, and then, the right and left halves of laminae are lifted simultaneously. This technique provides a protection to the spinal cord that swells instantaneously after decompression. A total of 155 cases were followed up for more than 1 year. According to the Japanese Orthopedic Association's evaluation criteria, 127 cases (81.9%) showed some improvement; specifically, 57 cases (36.8%) were rated excellent; 28 (18.1%), good; 42 (27.1%), fair; 11 (7.1%), unchanged; and 17 (11.0%) had poor results.

Activities of Daily Living↗
PubMed1986

Epidural morphine for pain relief after lumbar laminectomy.

A prospective randomized trial was conducted to evaluate the effectiveness of epidural morphine for pain relief after lumbar laminectomy. Thirty-three male patients were studied in two groups. At the end of surgery, Group 1 patients (15) received 2 mg morphine in 5 ml saline through an epidural catheter. Doses were repeated on demand. Group 2 patients (18) received 10 mg morphine intramuscularly on request in the postoperative period. Pain was assessed at 2, 6, 12, and 24 hours postoperatively by the linear analog of pain scale. There was significantly greater pain relief in Group 1 than in Group 2 after 2, 6, and 12 hours, respectively. Furthermore, Group 2 received larger doses of morphine than Group 1. There was no respiratory or cardiovascular depression detected in patients in either group. Nine patients in Group 1 and five patients in Group 2 had transient postoperative urinary retention that required catheterization. Only one patient in Group 1 had mild pruritus and three patients in Group 2 had nausea.

Adult↗
PubMed1991

Lamina repair and replacement to control laminectomy membrane formation in dogs.

This study examined the efficacy of lamina repair by the use of various techniques to prevent postlaminectomy scar formation in a canine system. Five-level noncontiguous laminectomies were performed on six adult canines. The most caudal (Site 1) was left uncovered and served as the control. Exposed dura at each of the remaining four levels was covered with one of the following: Site 2, free autogenous laminar bone graft; Site 3, polymethylmethacrylate; Site 4, Teflon-Proplast composite; Site 5, collagen gel. The dogs used in the study were killed 16 weeks after surgery. Three specimens were examined by plain roentgenography and computerized tomography, two specimens were examined histologically, and the remaining four specimens were graded according to scar volume and scar adherence, as detected during gross dissection of the postlaminectomy scar. No repair technique interfered with roentgenography evaluation. The least scar and fewest adhesions were present under the free bone graft repair site. The Teflon-Proplast composite and polymethylmethacrylate both limited the amount and adherence of scar. Collagen gel and control sites were indistinguishable in this study. It is concluded that lamina repair with a solid material covering exposed dura significantly reduces the formation of postlaminectomy membrane and scar.

Aluminum Oxide↗
PubMed1994

Spinal deformity after multiple-level cervical laminectomy in children.

Considerable controversy exists in the orthopedic and neurosurgical literature over the true incidence and nature of spinal deformity after multiple-level cervical laminectomy in children. Eighty-nine patients with a mean radiographic follow up of 5.1 years (range 2-9 years) were reviewed. Mean age at surgery was 5.7 years (range 1 month-18 years). Most common diagnoses were Arnold-Chiari malformation, syringomyelia, or both (81%). Significant deformity developed in 46 patients (53%), with 33 developing a mean kyphosis of 30 degrees (range 5-105 degrees) and 13 developing a mean hyperlordosis of 62 degrees (range 40-95 degrees). Peak age at surgery of 10.5 years correlated weakly (P = 0.08) with the development of kyphosis. The development of hyperlordosis was strongly correlated (P = 0.01) with a peak age at surgery of 4.2 years. There was no correlation between diagnosis, sex, location, or number of levels decompressed and the subsequent development of deformity.

Adolescent↗
PubMed1994

Reduction in perineural scar formation after laminectomy with Polyactive membrane sheets.

STUDY DESIGN: The effectiveness of Polyactive (Osteotech, Inc., Shrewsbury, NJ), an elastomeric segmental copolymer, as a barrier material for the prevention of perineural scar formation was evaluated in eight adult mongrel dogs. Two animals each were killed at 2, 4, 8, and 12 weeks postoperation. OBJECTIVE: This study determined the ability of a Polyactive membrane to prevent perineural scar and compared the results to those obtained using free fat graft and nonimplanted control subjects. SUMMARY OF BACKGROUND DATA: Perineural scar formation after laminectomy presents considerable morbidity in lumbar surgery. To date, a wide variety of materials has been evaluated to prevent scar formation including free fat grafts, mechanical barrier devices, hemostatic agents, and anti-inflammatory drugs. However, all studies indicate scar formation is present, and the search for an effective barrier continues. METHODS: Gross dissection, radiographic studies, including computed tomography and magnetic resonance imaging, and histologic sections were used to evaluate the presence and degree of perineural scarring. If scarring was evident in each of the evaluations, the degree was graded on a 0-3 scale where: 0 = no scarring; 1 = mild scarring; 2 = moderate scarring; and 3 = extensive scar formation. RESULTS: Polyactive membranes were an effective barrier with only minimal scar formation to the dura observed at any time period. Free fat graft was an effective barrier to scar formation at early time periods; however, progressive fat graft degradation with some increased scarring was observed at latter time periods. Nonimplanted control defect sites resulted in moderate to severe scar formation to the dura as early as 2 weeks postimplantation. CONCLUSIONS: The results indicate Polyactive is a reliable and effective means of reducing perineural scar formation. The effectiveness of the Polyactive membrane could be improved markedly if techniques or methods to ensure retention of the membrane in the proper position were developed.

Adipose Tissue↗
PubMed1997

Biomechanical evaluation of posterior cervical stabilization after a wide laminectomy.

STUDY DESIGN: In vitro biomechanical investigation with nondestructive and destructive testing in a human cadaveric model simulating a wide postlaminectomy condition. OBJECTIVES: To determine the relative stability conferred by a posterior cervical spinal rod system and posterior cervical plating. SUMMARY OF BACKGROUND DATA: Posterior cervical plate fixation has been shown to be biomechanically superior to wiring techniques, but lateral mass screws may injure neurovascular structures or facet joints if they are inserted improperly. A cervical rod system has been developed to enhance the safety of lateral mass instrumentation. METHODS: The cervical spines of 12 cadavers underwent biomechanical testing. After completion of the nondestructive intact testing, a wide laminectomy with subtotal facetectomies from C4 to C6 was performed. The specimens in two subgroups (group A, cervical spine rods with unicortical fixation, and group B, reconstruction plates with bicortical fixation) were tested in flexion, lateral bending, and torsion. Finally, destructive testing in flexion was performed. Stiffness, neutral zone, failure moment, energy to failure, and mechanism of failure were determined for each specimen. The data were analyzed using paired t tests and ANOVA. RESULTS: Group B had a greater mean screw torque value. The instrumented constructs had a greater stiffness ratio (instrumented/intact) than the intact specimens in flexion, lateral bending, and torsional testing. Group A had a significantly greater flexural stiffness than Group B. Neutral zone ratio values were significantly lower during flexural testing for the cervical rod construct. Destructive testing resulted in significantly greater failure moment and energy-to-failure values for group A. In the cervical rod construct, failure occurred primarily by superior screw loosening with pull-out from the lateral mass. Reconstruction plates consistently failed with fracture of the lateral mass and superior screw loosening. CONCLUSION: Significantly greater stability was noted in the cervical rod construct during nondestructive and destructive flexural testing.

Adult↗
PubMed1999

Long-term clinical and magnetic resonance imaging follow-up assessment of patients with lumbar spinal stenosis after laminectomy.

STUDY DESIGN: A cross-sectional retrospective study to observe the correlation between postoperation findings shown on magnetic resonance imaging and clinical observations of 56 patients 10 years after laminectomy for lumbar spinal stenosis. OBJECTIVE: To evaluate the relation between postoperation findings on magnetic resonance imaging and surgical outcome in patients surgically treated for lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: Surgical management of lumbar spinal stenosis is based on the compression seen in radiologic imaging of neurovascular structures in the vertebral canal, but the success of surgical decompression and its correlation with clinical observations very seldom have been monitored by postoperation radiologic imaging. METHODS: In this study, 56 patients surgically treated for lumbar spinal stenosis were re-examined clinically by use of the Oswestry disability questionnaire. Their walking capacity was evaluated by the treadmill test. Severity of pain before and after the treadmill test was investigated using a visual analog scale. Patients' perception of improvement measured as the change in their condition during the preceding 5 years was elicited by a questionnaire. On the basis of the stenotic findings on magnetic resonance imaging, the patients were classified into no stenosis (NoSten, n = 15) and stenosis (Sten, n = 41) groups, and a summative degenerative scale also was constructed with the findings categorized as follows: disc degeneration, disc herniation, facet joint arthrosis, and degenerative spondylolisthesis. RESULTS: Whereas the patients' perception of improvement correlated very strongly with the Oswestry score and walking capacity, there was no statistical difference between the NoSten and Sten groups in the Oswestry score, walking capacity, perception of improvement, or severity of pain. The effect of the summative degenerative scale on the patients' walking capacity was 13 times greater than the effect of the minimum area of the dural sac. CONCLUSIONS: Patients' perception of improvement had a much stronger correlation with long-term surgical outcome than structural findings seen on postoperation magnetic resonance imaging. Moreover, degenerative findings had a greater effect on patients' walking capacity than stenotic findings.

Female↗
PubMed2001

Neurologic deficits after cervical laminectomy in the prone position.

New neurologic deficits are known to occur after spine surgery. We present four patients with cervical myeloradiculopathy who underwent cervical laminectomy, fusion, or both in the prone position, supported by chest rolls. Three patients were intubated and positioned while awake, whereas the fourth patient was positioned after induction. Surgeries were successfully carried out, except for transient episodes of relative hypotension intraoperatively. On recovery from anesthesia, all patients were noted to have new neurologic deficits. Immediate CT myelography or surgical reexploration was unremarkable. All patients improved gradually with administration of high-dose steroids and induction of hypertension. Use of the prone position with abdominal compression may compromise spinal cord perfusion and lead to spinal cord ischemia. The use of frames that prevent abdominal compression, as well as avoidance of perioperative arterial hypotension, is important in maintaining adequate spinal cord perfusion during and after decompressive spinal cord surgery.

Adult↗
PubMed2002

Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients.

The authors performed single- or multiple-level unilateral laminectomy to treat lumbar spinal stenosis in patients with mild to moderate leg pain and compared the results with those from patients treated with conservative therapy in a prospective study. This decompression technique produced a 68% rate of improvement compared with a 33% rate for conservatively treated patients. The surgical group exhibited significant and sustained improvement, whereas the functional and clinical status of the conservatively managed group had returned to baseline during the same period. The preoperative dural sac cross-sectional area at the level of the most stenosis was 70.76 +/- 28.2 mm(2) for the surgical group, whereas on postoperative scans it was 108.12 +/- 31.5 mm(2), with an average correction rate of 65%. Neither new degenerative spondylolisthesis nor any evidence of instability was detected in any patient during the study.

Adult↗
PubMed2003

Laminectomy contributes to cervical spine deformity demonstrated by holographic interferometry.

Multiple factors contribute to the pathogenesis of postlaminectomy deformity and instability of the cervical spine. The complex alterations in both static and dynamic biomechanics after laminectomy are incompletely defined. We sought to examine the role of the lamina in compressive load bearing across the vertebral body. Holographic interferometry was used to study the surface deformation of single axially loaded cervical vertebral bodies before and after hemilaminotomy, hemilaminectomy, and experimental acrylic laminar reconstruction. Our results showed that hemilaminotomy did not alter the surface deformation because of axial loading across the cervical vertebral body. However, gross alterations in surface deformation across the cervical vertebral body were consistently observed after hemilaminectomy. Experimental reconstruction of the laminar arch using acrylic restored the deformation pattern to the prelaminectomized baseline. Our results support a role for the lamina and the integrity of the laminar arch in axial load bearing across the cervical vertebral body. The altered axial load bearing may be a significant contributor to postlaminectomy deformity and instability. These findings offer an additional biomechanical advantage to minimal bony intervention for cervical spine pathology.

Acrylic Resins↗
PubMed1990

Severity of disability due to occupational low back injury after lumbar laminectomy for degenerative disc disease.

Thirty-two postal workers were rated low risk in preplacement examinations after lumbar laminectomies for degenerative disc disease. They demonstrated an odds ratio for occupational back injury of 5.9 when compared with 192 control subjects matched by age, gender, employment date, and job classification. Each injured employee was subsequently observed for 2 years after injury. Data were collected on time lost from work due to the injury and incidence of surgical treatment. Injured subjects lost a median of 66 and a mean of 292.8 days from work, whereas injured control subjects lost a median of 8.5 and a mean of 24.8 days. Mean time lost per person hired was 73.2 days for subjects compared with 1.6 days for control subjects. Three of eight injured subjects required repeat surgery and three remain totally disabled. No injured control subjects required surgery and all resumed work.

Adult↗
PubMed2006

Osteomyelitis secondary to sacral colpopexy mesh erosion requiring laminectomy.

BACKGROUND: Severe infectious morbidity associated with the use of synthetic mesh and abdominal sacral colpopexy is rare. Pelvic abscess, sinus tract formation, enterovaginal fistula, and osteomyelitis have been reported. CASE: This case involves a patient who presented with staphylococcal bacteremia and vaginal erosion of a sacral colpopexy synthetic mesh. Despite prolonged courses of intravenous antibiotics and complete removal of the mesh material, she developed osteomyelitis. Progressive neurologic symptoms required a decompression laminectomy to facilitate a complete recovery and resolution of symptoms. CONCLUSION: In the treatment of abdominal sacral colpopexy mesh erosion, we recommend maintaining a high index of suspicion for secondary infections.

Bacteremia↗
PubMed2004

Unilateral limited laminectomy as the approach of choice for the removal of thoracolumbar neurofibromas.

STUDY DESIGN: The paper reports a minimally invasive approach to the dorsolumbar spine for the removal of neurofibromas. OBJECTIVES: Demonstrating that a limited unilateral approach is the one of choice for this kind of tumors. SUMMARY OF BACKGROUND DATA: Spinal intradural extramedullary tumors are generally removed by single-level or multilevel laminectomy with midline dural incision. Cases of delayed postoperative kyphosis and spinal instability (6%) may be reduced by unilateral microsurgery, causing minimum damage to ligaments and joints. METHODS: Ten patients with dorsolumbar neurofibroma were operated on between June 2000 and June 2002. There were 5 males (all with lumbar) and 5 females (2 with lumbar and 3 with inferior dorsal neurofibromas). One female had 3 lumbar tumors and required two operations. Surgery was performed in the prone position with a unilateral approach, sparing the joint and the ligamentum interspinosum. The dura was opened paramedially and the tumor dissected from the root and removed in one piece when possible. Water-tight dural closure was done with 5-0 or 6-0 stitches. RESULTS: All the patients were mobilized on day 2 and discharged on day 4 or day 5. No complications resulting from the technique were observed. Static and dynamic plain radiograph films showed that none of them had kyphosis and/or instability 6 months postoperatively. Neurologic results were good. CONCLUSIONS: Hospital stay may be reduced and stability may be preserved with an appropriate microsurgical technique. The technique reported in the paper should thus become the one of choice and extended to other spinal intradural extramedullary tumors.

Adult↗
PubMed1985

Factors related to length of stay of laminectomy patients.

A retrospective record audit was done to address the following research question: Are there factors associated with the length of hospital stay of laminectomy patients? According to the information on their records, patients with the following characteristics tended to have longer stays: were of the black race, had other medical diagnoses, had cervical region procedure, had "partial" procedure, had "extensive" pathology, and had greater use of pain medications. Those who were employed prior to admission, who were permitted to be more active, and who had muscle spasms had significantly shorter stays. The implications for nursing practice are discussed.

Adult↗
PubMed1986

The significance of selected variables in laminectomy length of stay.

Factors affecting hospital length of stay of patients undergoing laminectomy were examined by replicating a study by Sutcliffe and Vincent. Results were similar, indicating that hospital stays were longer for patients unemployed prior to admission and for those who lived alone, had previous medical diagnoses, and had a Jackson Pratt drain. Amount of postoperative ambulation also affected length of stay. There were several limitations to the study, including failure to differentiate regarding the extent of the surgical procedure. The results support the need for early discharge planning and underscore the importance of the nurse in identifying patients who are prone to longer lengths of stay.

Adult↗
PubMed1988

Factors determining length of hospitalization for patients having laminectomy surgery.

The purpose of this study was to determine factors associated with length of stay for patients undergoing lumbar laminectomy. Significant differences were identified related to method of payment for hospitalization, number of doses of analgesic medications, and presence of muscle spasms. Other factors studied were sex, pre- or postoperative administration of steroids, presence of complications, age, length of surgical procedure and types of antispasmodic medications administered. The study was conducted in an urban north Texas hospital, using a retrospective review of 30 charts selected randomly. Further study of factors related to length of hospitalization is necessary in this, as well as other patient populations, especially since the advent of prospective payment.

Diagnosis-Related Groups↗
PubMed1995

Body image in preoperative and postoperative lumbar laminectomy patients.

Many patients each year undergo a lumbar laminectomy for removal of a herniated disc. This study was conducted to determine if the patient had a change in body image from the preoperative to postoperative period. Body image was measured using the Body-Cathexis Scale. Twenty-four (24) patients were included in the study. Results indicated that there was a significantly higher difference in the total Body-Cathexis score postoperatively as compared to preoperatively. In addition, there was a significantly higher difference in the patients' ratings of back, knee, posture, energy level and sexual activity in the postoperative period. Further research is needed with a larger sample and over time to see whether these effects hold true.

Adult↗