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PubMedDate not supplied

The narrow lumbar spinal canal or lumbar spinal stenosis.

Narrow lumbar spinal canal or lumbar spinal stenosis is a not uncommon problem. Thirty-two patients with this disorder have been treated surgically at the Ochsner Medical Center between 1963 and 1973. The best method of diagnosis is a careful history and second is roentgenographic evidence, particularly the myelogram. The surgical treatment consists of total laminectomy and foraminotomy to insure complete decompression of the nerve roots. Eighteen patients have been followed from 14 to 44 months. Sixteen of the 18 considered their operations a success.

Adult↗
PubMed2006

Influence of X Stop on neural foramina and spinal canal area in spinal stenosis.

STUDY DESIGN: Measurements of cross sections of exit foramen and spinal canal were performed before and after placement of X Stop in physiologic postures using positional MR scanner at the stenosed level in patients with lumbar spinal stenosis. OBJECTIVE: To quantify the effect of the implant in vivo on the lumbar spine at the instrumented levels in various postures. SUMMARY OF BACKGROUND DATA: Dimensions of the spinal canal and neural foramen decrease from flexion to extension. Symptoms of spinal stenosis occur typically in standing or extension. The X Stop device is designed to distract the posterior elements of the stenotic segment and place it in flexion to treat neurogenic claudication. We think that the device will improve the dimension of the canal in standing and extension. METHODS: Twenty-six patients with lumbar spine stenosis underwent a one- or two-level X Stop procedure. All had preoperative and postoperative positional MRI in standing, supine, and sitting flexion and extension. Measurements were carried out on the images acquired. RESULTS: Significant increase in the dimensions of the neural foramen and canal area were demonstrated after surgery. CONCLUSIONS: The X Stop device improves the degree of central and foraminal stenosis in vivo.

Aged↗
PubMed1989

Stenosis of the foramen magnum and rostral spinal canal, with spinal cord deformity, in Jeune's asphyxiating thoracic dystrophy.

Ventilatory compromise in Jeune's asphyxiating thoracic dystrophy (JTD) generally is attributed to abnormalities in thoracic configuration that produce restrictive pulmonary disease and pulmonary hypoplasia. We present our findings following dissection and roentgenography of the base of the skull and the vertebral column in a premature infant with JTD. They suggest that malformations of the vertebral laminae in JTD may lead to compression of the distal medulla and rostral cervical spinal cord. Similar compression is known to contribute to ventilatory dysfunction in other osteochondrodysplasias. It is possible that vertebral laminar malformations may be partly responsible for ventilatory dysfunction in some patients with JTD. We recommend attention at necropsy in JTD to malformations of the neural arch and to their possible sequelae.

Abnormalities, Multiple↗
PubMed1996

Morphological analysis of the cervical spinal canal, dural tube and spinal cord in normal individuals using CT myelography.

To verify the conventional concept of "developmental stenosis of the cervical spinal canal", we performed a morphological analysis of the relations of the cervical spinal canal, dural tube and spinal cord in normal individuals. The sagittal diameter, area and circularity of the three structures, and the dispersion of each parameter, were examined on axial sections of CT myelograms of 36 normal subjects. The spinal canal was narrowest at C4, followed by C5, while the spinal cord was largest at C4/5. The area and circularity of the cervical spinal cord were not significantly correlated with any parameter of the spinal canal nor with the sagittal diameter and area of the dural tube at any level examined, and the spinal cord showed less individual variation than the bony canal. Compression of the spinal cord might be expected whenever the sagittal diameter of the spinal canal is below the lower limit of normal, that is about 12 mm on plain radiographs. Thus, we concluded that the concept of "developmental stenosis of the cervical spinal canal" was reasonable and acceptable.

Adolescent↗
PubMed2001

Pressure changes in spinal canal and evaluation of spinal cord injuries in spinal section subjected to impact.

OBJECTIVE: To observe pressure changes in the spinal canal of the vertebrarium subjected to impact. From the point of view of impact, pressure changes and spinal cord injuries, the relationship between the type of spinal fracture and the severity of spinal cord injuries were analyzed and some experimental data were provided for early evaluation of severity of spinal cord injuries. METHODS: An experimental model of spinal burst fracture was made with Type BIM-I bio-impact machine and techniques of high velocity vertical loading in static pattern and stress shielding were adopted. Vertebral sections T10-L4 taken from fresh cadavers were impacted and pressure changes in the spinal canal were observed. The types and severity of spinal fracture were studied with gross and radiography examination. RESULTS: Great positive pressure wave (wave A) in the spinal canal of the 4 vertebral specimens with burst fracture was recorded. The peak value of pressure was correlated with the severity of posterior column injuries. Generally, the peak value of pressure was low in the samples with posterior column injuries, but high in the samples without injuries. The predominant features of fractures were burst fractures of vertebral body and severe destruction of the skeletal and fiber structure of the spinal canal. Positive and negative pressure waves (wave B) were recorded in 2 vertebral samples in which no significant abnormal changes were found by radiography examination, however, a little liquid effusion in the vertebral body was found by gross examination. CONCLUSIONS: The type of pressure wave in the spinal canal is related to the deformation or the destruction of the spinal canal structure. The peak value of the pressure is non-linearly related to the obstruction in the spinal canal, but related to posterior column injuries.

Biomechanical Phenomena↗
PubMed1991

[The spinal canal, dural sac and spinal cord on cervical myelograms. Possibilities of quantification using a computer].

The objective of the presented work was to investigate anatomical structures of the cervial spine and their interrelations on cervical myelograms in a neutral position and in retroflexion. Cervical myelograms were made in 34 patients from a lateral approach between the first and second vertebra. In a neutral position and in retroflexion the relations of the dural sac and spinal canal were investigated in 26 subjects with a normal antero-posterior diameter of the spinal canal and in eight patients with congenital stenosis of the spinal canal. Quantification by means of a computer revealed that in retroflexion the antero-posterior diameters of the dural sac diminishes significantly in subjects with a normal antero-posterior diameter of the spinal canal as well as in subjects with congenital stenosis of the spinal canal. Moreover, the authors provided evidence that the area of the dural sac diminishes significantly in retroflexion, as compared with the neutral position in subjects with a normal spinal canal as well as in subjects with congenital stenosis of the spinal canal.

Cervical Vertebrae↗
PubMed1986

Posterolateral approach and anterior spinal canal recalibration in severe spinal injury affecting T-12, L-1: a study of seven cases.

The authors present seven cases of spinal trauma at the T-12--L-1 level with severe spinal canal stenosis secondary to compressive, anterior discocorporeal lesions. Associated neurological disorders were of varying severity. Six cases were investigated by computed tomography, which enabled the degree of thoracolumbar spinal canal stenosis to be determined. In all cases, the surgical procedure involved rectification of spinal deformity, with an initial unilateral posterolateral approach permitting anterior spinal canal recalibration, either by impaction of protrusive fragments or ablation of ejected disc fragments. The stabilization was in all cases achieved by complimentary bilateral plates using Roy-Camille material, associated with posterolateral arthrodesis by grafting with reconstruction of the articulopedicular structure. The functional spinal result was excellent in all cases, and recalibration was verified by tomography. In those cases showing neurological deficiency, good and early recovery was attributable to the suppression of spinal canal stenosis. The application of this posterolateral approach for severe lesions of the thoracolumbar junction seems to represent, in all cases of recent lesions, an alternative to the anterior or combined methods, which present widely recognized difficulties at the thoracoabdominal junction.

Adult↗
PubMed1975

[Stenosis of the spinal canal after spondylodesis (iatrogenic stenosis of the spinal canal) (author's transl)].

Authors experience based on 15 cases of iatrogenic stenosis of spinal canal in thoracic and lumbar region. The stenosis was the sequelae of spondylodesis made for spinal tuberculosis, spondylolisthesis traumatic and idiopathic, spinal fractures and assimilation faults. The onset of signs of stenosis appeared from 1 to 7 years after the first operation. The treatment was operative in 8 cases, conservative in 7. The first gave the best results. Observation time was up to 14 years after the second operation.

Adolescent↗
PubMedDate not supplied

Repeat lumbar surgery. A review of patients with failure from previous lumbar surgery treated by spinal canal exploration and lumbar spinal fusion.

Thirty-six patients with chronic back and/or leg pain following previous lumbar surgery who underwent both spinal canal exploration and spinal fusion were subjected to retrospective review. The purpose was to determine the probability of success for this surgical approach. Twenty (56%) of the 36 patients had a satisfactory result. In 15 patients with multiple objective findings of an ongoing radiculopathy, 11 (73%) improved. Only nine (43%) of 21 patients improved if these preoperative criteria were absent. Analysis according to the type of surgery performed in the spinal canal demonstrated improvement in (a) 17 (74%) of 23 patients who had wide bony decompression, (b) eight (61%) of 12 patients who had discectomy, and (c) seven (47%) of 15 patients who had an extensive neurolysis. In 17 patients whose time interval between the previous operation and present reconstruction was greater than 18 months, 13 (76%) improved. Only seven (36%) of 19 patients with a shorter time interval improved. The presence of pseudarthrosis was a poor indication for repeat lumbar surgery. The number of previous lumbar surgeries may not necessarily preclude a satisfactory outcome. Solid fusion correlated highly with a satisfactory outcome. Best results are obtained when objective preoperative findings indicate the presence of a surgically correctable abnormality.

Back Pain↗
PubMed1983

Spinal canal stenosis. Concept of spinal reserve capacity: radiologic measurements and clinical applications.

Radiologic measurement of central spinal canal diameters is considered a static measurement and does not necessarily indicate active stenosis. A free intracanal space is detectable with CT scanning, i.e., a container/content difference expressing reserve capacity and implying a functional identity. The obliteration of this space may induce clinical symptomatology in the elderly and in persons with developmental or acquired lumbar spinal conditions. Normal and pathologic measurements are presented.

Adult↗
PubMed2003

Management of degenerative changes and stenosis of the lumbar spinal canal secondary to cervical spinal cord injury.

We describe the case of a 47-year-old female who sustained a C5/6 fracture with C6 complete spinal cord injury 26 years ago. She presented with increased spasticity of the lower extremities, the abdominal wall and episodes of autonomic dysreflexia. Imaging of the spine revealed post-traumatic kyphosis at the level of the injury and degenerative changes of the lumbar spine with marked facet joint hypertrophy at the level of L4/5 causing severe spinal canal stenosis. Discussants of this case comment on the possible pathophysiological mechanisms causing autonomic dysreflexia, especially the development of degenerative changes, Charcot arthropathy and the role of tethering mechanisms. The diagnostic options and management approaches are also discussed.

Diagnosis, Differential↗
PubMed1982

Lumbar spinal canal stenosis in osteopoikilosis.

Spinal canal stenosis is diagnosed in a 45-year-old man who has osteopoikilosis and anomalies of the hip. Clinical investigations demonstrated a lumbar syndrome, previously described as an early phase of a neuropathic condition, namely, the premyelopathic syndrome. Roentgenographic calculations of canal diameters and computerized tomography proved helpful in the diagnosis of narrowed spinal canal. This case, presenting with unusual aspects of osteopoikilosis, emphasizes the importance of early diagnosis and surgical decompression of the stenosed spinal canal.

Humans↗
PubMed1999

The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part I: An evidence-based analysis of the published literature.

STUDY DESIGN: An evidence-based analysis of published radiologic criteria for assessing spinal canal compromise and cord compression in patients with acute cervical spinal cord injury. OBJECTIVES: This study was conducted to determine whether literature-based guidelines could be established for accurate and objective assessment of spinal canal compromise and spinal cord compression after cervical spinal cord injury. SUMMARY OF BACKGROUND DATA: Before conducting multicenter trials to determine the efficacy of surgical decompression in cervical spinal cord injury, reliable and objective radiographic criteria to define and quantify spinal cord compression must be established. METHODS: A computer-based search of the published English, German, and French language literature from 1966 through 1997 was performed using MEDLINE (U.S. National Library of Medicine database) to identify studies in which cervical spinal canal and cord size were radiographically assessed in a quantitative manner. Thirty-seven references were included for critical analysis. RESULTS: Most studies dealt with degenerative disease, spondylosis, and stenosis; only 13 included patients with acute cervical spinal cord injury. Standard lateral radiographs were the most frequent imaging method used (23 studies). T1- and T2-weighted magnetic resonance imaging were used to assess spinal cord compression in only 7 and 4 studies, respectively. Spinal cord size or compression were not precisely measured in any of the cervical trauma studies. Interobserver or intraobserver reliability of the radiologic measurements was assessed in only 7 (19%) of the 37 studies. CONCLUSIONS: To date, there are few quantitative, reliable radiologic outcome measures for assessing spinal canal compromise or cord compression in patients with acute cervical spinal cord injury.

Cervical Vertebrae↗
PubMed2001

Sagittal splitting laminoplasty for spinal canal enlargement for ossification of the spinal ligaments (OPLL and OLF).

Patients have been followed up radiologically after sagittal splitting laminoplasty (SSL) for ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum. The enlarged spinal canal was maintained satisfactorily in all the cases, and the posterior spinal elements were also almost completely restored. In most cases, the range of the vertebral motion was good with more than 50% of the preoperative status. Postoperative instability of the vertebral column was not identified in any case. Mild cervical kyphosis was noted in 6% of cervical OPLL patients. There were no patients with neurological deterioration. Using SSL, reconstruction and restoration of the posterior spinal elements and retention of the enlarged spinal canal were accomplished safely and adequately.

Female↗
PubMed2005

Surgical technique and results of endoscopic anterior spinal canal decompression.

OBJECT: Decompression of the spinal canal in the management of thoracolumbar trauma is controversial, but many authors have advocated decompression in patients with severe canal compromise and neurological deficits. Anterior decompression, corpectomy, and fusion have been shown to be more reliable for spinal canal reconstruction than posterior procedures; however, traditional anterior-access procedures, thoracotomy, and thoracoabdominal approaches are associated with significant complications. Endoscopy-guided spinal access avoids causing these morbidities, but it has not been shown to yield equivalent results in spinal canal clearance. This study was conducted to demonstrate the effectiveness of endoscopic spinal canal decompression and reconstruction quantitatively by using pre- and postoperative computerized tomography (CT) scanning. METHODS: Thirty patients with thoracolumbar canal compromise underwent endoscopic anterior spinal canal decompression, interbody reconstruction, and stabilization for fractures (27 cases), and tumor, infection, and severe degenerative disc disease (one case each). The mean follow-up period was 42 months (range 24 months-6 years). Neurological examinations, Frankel grades, radiological studies, and intraoperative findings were prospectively collected. Spinal canal clearance quantified on pre- and postoperative CT scans improved from 55 to 110%. A total of 25% of patients with complete paraplegia and 65% of those with incomplete neurological deficit improved neurologically. The complication rate was 16.7% and included one reintubation, two pleural effusions, one intercostal neuralgia, and one persistent lesion of the sympathetic chain. CONCLUSIONS: The authors describe the endoscopic technique of anterior spinal canal decompression in the thoracolumbar spine. The morbidities associated with an open procedure were avoided, and excellent spinal canal clearance was accomplished as was associated neurological improvement.

Adult↗