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PubMed1985

[Diagnosis and therapy of the narrow lumbar spinal canal].

In 30%-40% of the patients who are operated on for herniation of lumbar discs, osseous stenosis plays a certain role. However, only in one-third of them are special operative measures such as laminectomy necessary with or without additional lumbar fusion. When spondylodesis is carried out after laminectomy it is often combined with metal implant, which can drastically reduce the time a patient requires perioperative treatment. In younger patients showing typical signs of nerve root compression due to osseous stenosis of lateral recess, only segmental decompression in the form of foraminotomy is done. On the other hand, in cases of narrow spinal canal, which is found in elderly patients, neurogenic intermittent claudication is the predominant clinical picture. Kyphosis, scoliosis, and vertebral displacement can lead to local spinal stenosis. On addition, local pressure and tension on unstabile segments in combination with secondary fibrosis can lead to compression of the neural structures. The diagnosis is based on the clinical history and myelography. Computed tomography helps reveal the presence of herniation of a lumbar disc, which should be simultaneously operated upon. For the operative treatment there is no age limit. All in all, the operative results are so good that one is inclined to decide in favour of operation.

Bone Plates↗
PubMed2003

[Changes of neural electrophysiology properties of cauda equina in experimental lumbar spinal canal stenosis under dynamic burden].

OBJECTIVE: To study the changes of neural electrophysiology properties of cauda equina under double level compression and dynamic burdens, and to clarify the mechanisms of intermittent neurogenic claudication. METHODS: Thirty SD rats were divided into 5 groups (6 in each group). The laminectomy of L5 was performed in control group. In the experimental groups, the silicon sheets were inserted into the spinal canal of L4 and L6 to cause double level compression of cauda equina by 30%. Two hours after onset of compression, no dynamic burden was introduced in experimental group 1. Only high frequency stimulation(HFS) was introduced for 6 minutes in experimental group 2. Both HFS and additional increased compression were introduced for 6 minutes in experimental group 3. While only additional increased compression was introduced for 6 minutes in experimental group 4. After 6 minutes of dynamic burdens, all were returned to the status of static compression for another 30 minutes and then electrical examination was made. RESULTS: After 2 hours of compression, motor and sensory nerve conduction velocity (NCV) of all the four experimental groups decreased significantly (P < 0.05), but there was no significant difference between them. There was no significant change in the control group. There was no significant change of NCV in experimental group 1 during the last 30 minutes of experiment. NCV in the other three experimental groups decreased after introduction of dynamic burdens, especially in the experimental group 3. CONCLUSION: The above results showed that NCV of cauda equina decreased significantly under dynamic burdens during static compression. Two kinds of dynamic burdens introduced at the same time can cause more profound change than a single one.

Animals↗
PubMed1977

[Echinococci of the spinal canal].

The authors present a 51-year-old patient who was admitted to the neurosurgical department of the hospital because of paraparesis and vegetative disturbances. Myelography showed a complete lumbosacral stop. During surgery, large masses of Echinococcal cysts were removed from the extradural space. 20 months after the intervention, another operation became necessary because of a relapse. The fact is stressed that in spinal hydatidosis late relapses must be expected.

Clinical Trials as Topic↗
PubMed2004

Primary malignant fibrous histiocytoma extending into spinal canal through intervertebral foramina.

A 60-year-old man was referred to us because of gradual-onset radiculopathy in his left leg for 2 months. Magnetic Resonance Imaging (MRI) of the lumbar spine demonstrated a relatively homogeneous huge mass in the left paravertebral area from L1 to L3 (Fig. 1A, B). Axial MRI scan (Fig. 1C) confirmed the extension of the tumour into the adjacent spinal canal through the neural foramina, forming an extradural mass, which resulted in the compression of both the dural sac and the nerve roots. The patient was operated on by a staged-resection. First, a left retroperitoneal approach was performed for the paraspinal mass. The tumour appeared brown to tan in color and was moderately firm. Nine days after his first operation, the patient underwent a resection of the intraspinal/extradural tumour by a posterior approach. After the left L1-2 hemilaminectomy was performed, the extradural tumour was easily identified, dissected, and completely removed. Microscopically, it was a highly cellular tumour composed of anaplastic cells assuming a gigantic size with bizarre nuclei, which were admixed with inflammatory cells (Fig. 1D). The tumour cells were immunohistochemically characterized by positive staining for vimentin confirming its mesenchymal origin, and CD68 consistent with histiocyte-like qualities (Fig. 1E, F). A diagnosis of inflammatory malignant fibrous histiocytoma (MFH) could be made. Postoperatively, the patient made an uneventful recovery and received radiotherapy as an adjuvant therapy.

Histiocytoma, Benign Fibrous↗
PubMed1992

[Extensive arterial anomaly in the spinal canal (Th5-S5) in a 3-year-old boy].

A case of an extensive arterial anomaly in the vertebral canal (Th5-S5) in a boy aged 3 years is described. Sudden onset of the disease with massive subarachnoid haemorrhage, loss of consciousness and signs of raised intracranial pressure suggested rather a lesion in the cranial cavity. The final diagnosis was made after myelography and spinal arteriography. In view of the extent of the lesion its radical removal was not possible. Embolization was done twice of the greatest vessels feeding the anomaly followed by decompression laminectomy. The patient is without neurological defects and pains. The case is reported in view of its rarity and atypical character of the lesion as well as its extent.

Angiography↗
PubMed2002

Changes in the microhemodynamics of nerve root retraction in patients with lumbar spinal canal stenosis.

STUDY DESIGN: Assessment of qualitative and quantitative changes in the microcirculation of nerve roots, such as the diameter of blood vessels and the low rate of erythrocytes, was observed during lumbar interbody fusion. OBJECTIVE: To ascertain changes in the microcirculation of nerve roots before and after retraction during lumbar interbody fusion surgery. SUMMARY OF BACKGROUND DATA: The changes in microhemodynamics caused by nerve root retraction have not yet been elucidated. METHODS: Subjects were patients with lumbar spinal canal stenosis who underwent lumbar interbody fusion. Changes in the microcirculation of nerve roots were examined in the L5 nerve root in 26 patients and the S1 nerve root in 3 patients. Through the use of video images captured by contact endoscope and stored in a computer, erythrocytes were automatically followed to measure flow rate and the diameter of blood vessels. RESULTS: Plasma skimming, where blood cells and plasma flow separately, was seen in 3 of the 29 patients (10.3%) before retraction of the nerve root and in 8 of the 29 patients (27.6%) following retraction. Intravascular erythrocyte agglutination, when erythrocytes flow in clumps due to changes in the charge state of erythrocytes, was seen in blood vessels larger than 100 microm in 3 patients (10.3%) after retraction. Following nerve root retraction, the flow rate of erythrocytes through blood vessels decreased an average of 23.9% (P< 0.005). CONCLUSIONS: A contact endoscope was used to observe the microhemodynamics of nerve roots before and after retraction of the nerve root during lumbar interbody fusion surgery, and a decrease in the flow rate of erythrocytes was observed.

Adult↗
PubMed2004

[Blood flow changes of cauda equina in experimental lumbar spinal canal stenosis under dynamic burden].

OBJECTIVE: To study the changes of blood flow of the already-compressed cauda equina under dynamic burden, high frequency stimulation (HFS) and increased additional compression, and to clarify the mechanism of neurogenic intermittent claudication. METHODS: Thirty SD rats were divided into 5 groups, 6 in each. All groups were operated with laminectomy of the fifth lumbar verfebra. One hour after the measurement of blood flow, in 4 experimental groups, the silicon sheets were inserted into the spinal canal of L4 and L6 to cause double level compression of cauda equina by 30%. Two hours after onset of compression, no dynamic burden was introduced to the subjects of the experimental group 1. Only HFS was introduced to the subjects of the experimental group 2 for 6 minutes. Both HFS and increased additional compression were introduced to the subjects of the experimental group 3 for 6 minutes. While only increased additional compression was introduced to the subjects of the experimental group 4 for 6 minutes. The subjects of control group only underwent laminectomy of the fifth lumbar vertebra and HFS 6 minutes. The blood flow of cauda equina was measured with laser Doppler flowmeter. RESULTS: In the first 2 hours, there was no significant change of cauda equina blood flow in the control group. During the time of HFS, the blood flow increased significantly to 186.4% +/- 31.5% of initial value (P < 0.05). In the experimental group 1, there was no blood flow change during the period of dynamic burden(110.4% +/- 7.5%, P > 0.05). After introduction of dynamic burden, there was no blood flow changes in the experimental group 2 (111.6% +/- 17.6%, P > 0.05). The blood flow in the experimental group 3 decreased to 65.3% +/- 10.7% of initial value (P < 0.05); and the blood flow in the experimental group 4 decreased to 60.1% +/- 9.2% of initial value (P < 0.01). There was no significant difference between the experimental groups 3 and 4 (P > 0.05). CONCLUSION: The results above show that during the period of increased impulse transmission, double level compression of cauda equina may limit the increase of blood flow, which may cause relative ischemia. If there is increased additional compression along with increased impulse transmission, the blood flow will decrease significantly, which will cause absolute ischemia.

Animals↗
PubMed2004

Glass foreign body in the spinal canal of a child: case report and review of the literature.

Retained foreign bodies pose a risk to the patient from the perspective of potential morbidity. We describe a previously healthy 8-year-old boy with head and back trauma from a glass picture frame that fell off the wall. He sustained a closed head injury and a back laceration several centimeters lateral to the spine. A persistent drainage from the back laceration contained glucose and protein levels consistent with cerebral spinal fluid. A foreign body was easily visible on subsequent plain radiograph. The glass foreign body was removed by neurosurgeons after computed tomography and magnetic resonance imaging clarified the exact location of the glass fragment. Physicians should have a low threshold for obtaining plain radiographs in patients with glass foreign bodies and consider that projectiles may rest some distance from the laceration site.

Accidents, Home↗
PubMedDate not supplied

[A case of malignant extrameningeal meningioma of the spinal canal with multiple metastases in a 17-year-old patient. Clinical and morphologic studies].

A clinical description and pathological findings are reported in a case of extrameningeal, angiogenic malignant meningioma of the vertebral canal (Th7-Th11) in a patient aged 17 years. Clinical picture was that of transverse myelitis at the Th9 level, with spastic paraparesis, funicular loss of all sensory functions and sphincter disturbances. The authors suppose that the used combined treatment (chemotherapy and radiotherapy, surgery) improved greatly the health state inhibiting the spread of metastases and prolonged survival to 3 years. Autopsy demonstrated recurrence of he tumour in the vertebral canal and numerous metastases to the brain, lungs, liver, bones and pancreas.

Adolescent↗
PubMed1994

Transdural approach to the anterior spinal canal in patients with cervical spondylotic myelopathy and superimposed central soft disc herniation.

We present seven patients with multilevel cervical spondylotic myelopathy and superimposed midline soft disc herniation who were treated by decompressive laminectomies of the spondylotic segments followed by transdural excision of the anteriorly located disc extrusion. There was no perioperative neurological morbidity or mortality associated with this operation, and no patients have developed postoperative kyphotic deformity with an average follow-up of 50.1 months (range, 24 to 87 mo). Two patients had full neurological recovery, whereas five patients had improvement in their preoperative neurological status. We conclude that a posterior transdural approach may offer an alternative surgical option for select patients with multilevel cervical spondylosis with superimposed midline soft disc herniation in whom multiple segment decompression plus access to the anterior spinal canal is necessary.

Adult↗
PubMed2000

[HASTE sequence and cine-MRI evaluation of the cervical spinal canal: evaluation in 11 healthy subjects].

PURPOSE: We studied 11 healthy subjects were evaluated using cine MR imaging comparing HASTE and gradient echo sequences. Materials and methods :HASTE is a high-speed turbo-spin echo T2-weighted sequence. All examinations were performed using dynamic MRI using a simple process allowing acquisition of images at different stages during flexion and extension. The cine MR evaluation was obtained by rebuilding a cine-loop sequence. RESULTS: HASTE sequence provides a myelographic effect of the cervical spine. The size, the pattern and the movements of the cervical spine, the spinal cord, as well as the functional reserve of cerebro-spinal fluid are analysable. CONCLUSION: Because of its very high speed, HASTE sequence is particularly useful for cine MR imaging.

Adult↗