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PubMed1992

Metastatic spinal cord compression secondary to lung cancer.

PURPOSE: Metastatic spinal cord compression (MSCC) is a disabling complication to cancer, the optimal treatment for which is not settled. An analysis was performed for all patients with MSCC secondary to lung cancer in East Denmark from 1979 to 1988. PATIENTS AND METHODS: The total series included 102 cases with small-cell carcinoma (SCLC; 40%), adenocarcinoma (ACL; 26%), squamous cell carcinoma (SQLC; 18%) and large-cell carcinoma (LCC; 9%). Symptoms, clinical presentations, and therapeutic results are described. RESULTS: The outcome of treatment depended fundamentally on the patient's neurologic condition at the time of the diagnosis. All patients with SCLC who were able to walk at the time of MSCC remained ambulatory, whereas 15% of the nonambulatory SCLC patients regained walking ability. In non-SCLC, 95% of patients continued to be able to walk, whereas 22% regained the ability to walk. No major differences in the immediate outcome of treatment between the various histologic types of lung cancer and the different treatment modalities were observed; however, 82% of the patients with non-SCLC benefited from treatment with laminectomy followed by radiotherapy (RT) compared with either laminectomy (47%) or RT (39%) alone (P = .03, chi 2 test). The group of patients who were treated with laminectomy followed by RT had a better survival (median value, 3.5; range, 0 to 132 months) than patients who were treated with either laminectomy (median value, 1.5; range, 0 to 32 months) or RT (median value, 1; range, 0 to 59 months) alone (P = .03, log-rank test). No significant difference was observed in survival between the various histologic types of lung cancer (P = .18, log-rank test). CONCLUSION: Despite a short survival, early diagnosis and immediate treatment is crucial because it may preserve the gait function in 97% of lung cancer patients who develop malignant spinal cord compression.

Adenocarcinoma↗
PubMed1985

Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study.

Of 167 episodes of spinal epidural neoplastic compression, 86 were treated by operation. The surgical approach was prospectively selected according to the location of the tumor in the spinal canal. Decompression was achieved by 61 vertebral body resections (VBRs) and by 25 laminectomies. The indications for operation were: neurological relapse after previous radiotherapy, the need to make a tissue diagnosis, a radioresistant tumor, and neurological deterioration during radiotherapy. Before VBR, 28% (17 of 61) were still able to walk, 51% (31 of 61) were parAparetic, and 21% (13 of 61) were paraplegic. Bowel and bladder dysfunction was present in 49% (30 of 61). After VBR, the outcome of only 57 procedures was available for evaluation because of the postoperative death of 4 patients. Eighty per cent (46 of 57) were able to walk, 18% (10 of 57) were paraparetic, and 2% (1 of 57) were paraplegic. Ninety-three per cent had normal sphincter control. Before laminectomy, 8% (2 of 25) were ambulatory, 84% (21 of 25) were paraparetic, and 8% (2 of 25) were paraplegic. Bowel and bladder dysfunction was present in 76% (19 of 25). After laminectomy, only 23 procedures were evaluated because of the postoperative death of 2 patients. Thirty-nine per cent (9 of 23) were ambulatory, 35% (8 of 23) were paraparetic, and 26% (6 of 23) were paraplegic. Fifty-seven per cent regained normal sphincter control. The operative mortality was 7% (4 of 61) in VBR and 8% (2 of 25) in laminectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Suspension laminotomy: a new surgical technique for compression myelopathy.

In an attempt to eliminate the many negative aspects of conventional extensive laminectomy, we originated in 1981 and have developed a new surgical technique called "suspension laminotomy." A basic principle of this operation is preservation and repair of the soft and bony tissue of the spine with osseous enlargement of the spinal canal. Eighty-one patients were treated with suspension laminotomy. This operative technique can be applied to almost all segments of the spine and can be used for all cases that would usually have been treated with conventional extensive laminectomy. We emphasize the necessity of repairing paraspinal muscles and discuss the postoperative spinal deformities and the dural constriction, which seemed to be caused by scar formation after conventional laminectomy. Suspension laminotomy should minimize the negative aspects of conventional extensive laminectomy.

Adult↗
PubMed2005

Biomechanical comparison of C1-2 posterior fixation techniques.

OBJECT: In a nondestructive, repeated-measures in vitro flexibility experiment, the authors compared the acute stability of C1-2 after placement of C-1 lateral mass and C-2 pars interarticularis (LC1-PC2) instrumentation with that of C1-2 transarticular screw fixation. METHODS: The effect of C-1 laminectomy and C1-2 interspinous cable/graft fixation on LC1-PC2 stability was studied. Screw pullout strengths were also compared. Seven human cadaveric occiput-C3 specimens were loaded nondestructively with pure moments while measuring nonconstrained atlantoaxial motion. Specimens were tested with graft alone, LC1-PC2 alone, LC1-PC2 combined with C-1 laminectomy, and graft-augmented LC1-PC2. Interspinous cable/graft fixation significantly enhanced LC1-PC2 stability during extension. After C-1 laminectomy, the LC1-PC2 construct allowed increased motion during flexion and extension. There was no significant difference in lax zone or range of motion between LC1-PC2 fixation and transarticular screw fixation, but graft-assisted transarticular screws yielded a significantly smaller stiff zone during extension. The difference in pullout resistance between C-1 lateral mass screws and C-2 pars interarticularis screws was insignificant. The LC1-PC2 region restricted motion to within the normal range during all loading modes. Atlantal laminectomy reduced LC1-PC2 stability during flexion and extension. CONCLUSIONS: The instrumentation-augmented LC1-PC2 construct performed biomechanically similarly to the C1-2 transarticular screw fixation. The LC1-PC2 construct resisted flexion, lateral bending, and axial rotation well. The weakness of the LC1-PC2 fixation in resisting extension can be overcome by adding an interspinous graft to the construct.

Adult↗
PubMed2006

Evaluation of DuraGen in preventing peridural fibrosis in rabbits. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2005.

OBJECT: Peridural fibrosis is the scar tissue formed over the dura mater after a laminectomy. It has been implicated as a cause of persistence of pain after spinal surgery and associated with increased risk of complications during revision surgery. The application of a mechanical barrier to cover the peridural space to block the migration of inflammatory cells from superficial layers to the epidural space can potentially prevent or decrease scar formation. The authors evaluated the use of DuraGen for this purpose. METHODS: Seventeen New Zealand White rabbits underwent bilateral L-4 and L-7 laminectomies. Each space was randomly assigned to either receive DuraGen, fat graft, or no (sham) treatment. At a mean 18 +/- 4 weeks after surgery, the animals underwent magnetic resonance (MR) imaging with and without Gd enhancement, and the area of the scar tissue overlying the middle of the laminectomy was measured. The rabbits were killed and the spinal cords with an intact dural covering were harvested. The midsection of each treated level was evaluated histologically and the scar area was measured. In rabbits in which a fat graft was placed, MR imaging of the epidural space demonstrated a significant (p < 0.05) increase in the mean area (0.9713 mm2) of scar tissue compared with those in which DuraGen was used (0.687 mm2) or those receiving sham treatment (0.6661 mm2). The same correlation was observed when the histological sections were measured at the middle of the laminectomy site where the mean areas of both DuraGen (1008 mm2) and control (2249 mm2) groups were significantly lower than that in the fat graft group (6007 mm2) (p < 0.01 and 0.05, respectively). No significant differences between the DuraGen and control groups were observed. CONCLUSIONS: The authors demonstrated that peridural scarring formed in all groups. The mean area of scar deposition was significantly higher in the fat graft group than in the DuraGen or control group both on MR imaging and histological analysis. DuraGen was more effective than a fat graft in preventing epidural fibrosis but not significantly different from that occurring in control animals.

Adipose Tissue↗
PubMed2003

Cervical stability with lateral mass plating: unicortical versus bicortical screw purchase.

STUDY DESIGN: A biomechanical study using human cadaveric cervical spines was conducted. OBJECTIVE: To determine whether the cervical stability achieved with lateral mass fixation using unicortical screw purchase is comparable with that obtained with lateral mass fixation using bicortical screw purchase. SUMMARY OF BACKGROUND DATA: Cervical lateral mass fixation has traditionally required bicortical screw fixation, which is associated with potential injury to the vertebral vessels and cervical nerve roots. Unicortical fixation eliminates these possible complications. Limited stability studies suggest that unicortical fixation in the lateral masses provides stability comparable with that of bicortical fixation. However, no comprehensive biomechanical study has compared the cervical stability between bicortical and unicortical lateral mass fixations. METHODS: A total of 11 human cadaveric cervical spinal sections between C3 and C5 were tested in flexion-extension, torsion, and lateral bending modes, both with and without laminectomy, on an MTS machine. The lateral masses were plated and tested with bicortical screws in all 11 specimens. Long (14 mm) unicortical screws were used in 8, and short (10 mm) screws were used in 6 of the 11 specimens. Displacement then was determined in millimeters (of flexion-extension and lateral bending) and degrees (of torsion) for each value of applied torque (0.45, 0.9, 1.35, 1.8 Nm). Two-way analysis of variance using unequal data sets then was applied. RESULTS: Analysis demonstrates that bicortical constructs were, on the average, stiffer than unicortical constructs in most bending modes. No significant differences were found, however, between bicortical constructs and long unicortical constructs without laminectomy. In the presence of a destabilizing laminectomy, a difference was found in the lateral bending mode. More differences were found between bicortical and short unicortical constructs both with and without laminectomy. CONCLUSIONS: Cervical lateral mass fixation with "long" (up to but not through the anterior lateral mass cortex) unicortical Magerl screws may provide an acceptable and safe alternative to bicortical screw fixation.

Biomechanical Phenomena↗
PubMed2004

Treatment of pain after spinal surgery in the recovery room by single dose lornoxicam: a randomized, double blind, placebo-controlled trial.

BACKGROUND: Lornoxicam has been used in microsurgical lumbar discectomy. However, there is no data about controlling pain after open discectomy or laminectomy. OBJECTIVE: To compare the efficacy of a single dose of 16 mg of lornoxicam for the treatment of pain after disectomy or laminectomy with placebo in the PACU. STUDY DESIGN: Randomized, double blind, placebo-controlled trial. MATERIAL AND METHOD: Fifty-six patients who underwent discectomy or laminectomy were randomly allocated to receive 16 mg lornoxicam (Group L), or placebo (Group P) at the beginning of wound closure. Pain scores at rest (using a verbal numeric rating scale: VNRS 0-10), time to first analgesia requirement, morphine consumption during the first 2 hr after surgery and adverse effects were all recorded. The outcomes were assessed on admission to the PACU (T0), then at 1 (T1) and 2 (T2) hr after surgery. RESULTS: Baseline data were comparable between the two groups. The proportion of patients with VNRS > 5 at T0 in both groups were not significantly different (44.4% in group P vs 50.0% in group L, CI of difference: - 32.4%, 21.3%, p = 0.68). The mean VNRS scores, at T0 and T1 were > 5 and at T2 was < 5 in both groups. There was no difference between the two groups. The morphine consumption in both groups was not different (9.0 mg vs 9.3 mg) as well as the time to first analgesia requirement (35 min vs 40 min). Patients in the two groups had no significant difference in the symptoms or degree of nausea/vomiting. The number of patients with excessive sedation and the proportion of patients needing oxygen during transportation to the ward were not different. CONCLUSION: Lornoxicam 16 mg given intravenously before wound closure provides inadequate pain relief immediately after disectomy or laminectomy in the PACU. However, adequate pain relief was demonstrated at 2 hr after surgery, which was similar to the placebo.

Adolescent↗
PubMedDate not supplied

[Lumbar spinal surgery in elderly patients].

INTRODUCTION: In the geriatric population, pain with sciatic irradiation requires a differential diagnosis to enable a distinction to be made mainly between a herniated disc, lateral recess stenosis or lumbar stenosis. In addition, in many cases the degenerative problems are often associated with lumbar listhesis or instability. Furthermore, these patients present very diverse associated cardiovascular, pulmonary or metabolic pathologies which can make surgery complicated and, above all, prolong post-operative recovery, as well as increasing morbidity and mortality. PATIENTS AND METHODS: We reviewed a group of 50 patients aged between 70 and 87 who had been submitted to surgery between 1997 and 2003; 27 were females and 23 males. 76% of them presented associated systemic pathologies and 22% had a history of previous spinal surgery. In 15 cases clinical symptoms were gait disorders involving claudication, there were three cases of paraparesis with cauda equina syndrome, 19 lumbagos with bilateral sciatica and 16 cases of lumbago with unilateral sciatica. Unilateral decompression hemilaminectomy was performed in 16 patients (group I) with microdiscectomy in 13 cases, laminectomy of one or several vertebrae (group II) was carried out in 17 patients and another 17 patients were submitted to decompression laminectomy plus arthrodesis with transpedicular instrumentation (group III). RESULTS: Overall a significant improvement was observed in 86% of patients. Detected complications involved two serious deep infections (4%), one of which was secondary to cerebrospinal fluid fistula, and the other occurred in an instrumented patient. No instabilities secondary to the laminectomy were observed in non-instrumented patients. No intraoperative anaesthetic or surgical complications were produced. Patients are followed up simultaneously during the post-operative period by both Internal Medicine and Neurosurgery. CONCLUSIONS: In the geriatric population there is a high incidence of degenerative problems, not only involving canal stenosis but also herniated discs. Surgical intervention must be the least aggressive possible, bearing in mind that a laminectomy does not presuppose post-surgical stability. The associated pathologies presented by these patients make a good immediate post-operative follow-up indispensable if morbidity and mortality rates are to be reduced.

Aged↗
PubMed2006

Cervical spine deformity associated with resection of spinal cord tumors.

Postoperative sagittal-plane cervical spine deformities are a concern when laminectomy is performed for tumor resection in the spinal cord. These deformities appear to occur more commonly after resection of intramedullary spinal cord lesions, compared with laminectomy for stenosis caused by degenerative spinal conditions. Postlaminectomy deformities are most common in pediatric patients with an immature skeletal system, but are also more common in young adults (< 25 years of age) in comparison with older adults. The extent of laminectomy and facetectomy, number of laminae removed, location of laminectomy, preoperative loss of lordosis, and postoperative radiation therapy in the spine have all been reported to influence the risk of postlaminectomy spinal deformities. When these occur, patients should be monitored closely with serial imaging studies, because a significant percentage will have progressive deformities. These can range from focal kyphosis to more complicated swan-neck deformities. General indications for surgical intervention include progressive deformity, axial pain in the area, and neurological symptoms attributable to the deformity. Surgical options include anterior, posterior, and combined anterior-posterior procedures. The authors have reviewed the literature on postlaminectomy kyphosis as it relates to resection of cervical spinal cord tumors, and they summarize some general factors to consider when treating these patients.

Cervical Vertebrae↗
PubMed2007

Vertebral plate regeneration induced by radiation-sterilized allogeneic bone sheets in sheep.

OBJECTIVE: To evaluate the effects and mechanism of radiation-sterilized allogeneic bone sheets in inducing vertebral plate regeneration after laminectomy in sheep. METHODS: Twelve adult male sheep (aged 1.5 years and weighing 27 kg on average) provided by China Institute for Radiation Protection underwent L3-4 and L4-5 laminectomy. Then they were randomly divided into two groups: Group A (n=6) and Group B (n=6). The operated sites of L4-5 in Group A and L3-4 in Group B were covered by "H-shaped" freeze-drying and radiation-sterilized allogeneic bone sheets (the experimental segments), while the operated sites of L3-4 in Group A and L4-5 in Group B were uncovered as the self controls (the control segments). The regeneration process of the vertebral plate and the adhesion degree of the dura were observed at 4, 8, 12, 16, 20 and 24 weeks after operation. X-ray and CT scan were performed in both segments of L3-4 and L4-5 at 4 and 24 weeks after operation. RESULTS: In the experimental segments, the bone sheets were located in the anatomical site of vertebral plate, and no lumbar spinal stenosis or compression of the dura was observed. The bone sheets were absorbed gradually and fused well with the regenerated vertebral plate. While in the control segments, the regeneration of vertebral plate was not completed yet, the scar was inserted into the spinal canal, compressing the dura and the spinal cord, and the epidural area almost disappeared. Compared with the control segments, the dura adhesion degree in the experimental regenerated segments was much milder (P less than 0.01), the internal volume of the vertebral canal had no obvious change and the shape of the dura sack remained well without obvious compression. CONCLUSIONS: Freeze-drying and radiation-sterilized allogeneic bone sheets are ideal materials for extradural laminoplasty due to their good biocompatibility, biomechanical characteristics and osteogenic ability. They can effectively reduce formation of post-laminectomy scars, prevent recurrence of post-laminectomy spinal stenosis, and induce regeneration of vertebral plates.

Animals↗
PubMed1989

[Vertebral hemangioma with neurologic signs. Therapeutic results. Survey of the French Society of Neurosurgery].

45 cases of vertebral hemangiomas with neurologic involvement are reported. This series corresponds to the french experience between 1969 to 1988 (series of the "Société Française de Neuro-Chirurgie" (S.F.N.)). In this report, the therapeutic results are detailed. 16 patients were treated by a simple laminectomy, 6 by laminectomy associated with radiotherapy, 4 by radiotherapy alone. In 9 patients, a large removal of the hemangioma was performed by mean of a lamino-arthrectomy (7 cases) or a corporectomy (2 cases). 7 patients were treated by embolization or vertebroplasty. Both techniques were used alone or in association with surgery or radiotherapy. 3 patients had no therapy. Results of the S.F.N. series demonstrated that 75.5% of the patients had a long term favorable clinical course. 13.4% of the patients were not improved. Mortality was of 11.1%. The mean follow up time was of 51.6 months. Recurrence was encountered in 13 cases. It was mainly observed in the first two years. In cases of total involvement of the vertebrae by hemangioma, laminectomy associated with radiotherapy was the best mean of therapy: 93% of recovery without recurrence. Treatment of body localization appeared to be difficult. Corporectomy could be unefficient if a complete removal of the hemangioma could not be performed. In contrast, posterior arch localization was successfully treated by a simple laminectomy without radiotherapy, even in cases of incomplete removal of the hemangioma: all such cases (10 cases) had a complete recovery without recurrence.

Combined Modality Therapy↗
PubMed1987

[Open-door decompressive cervical laminotomy. Technic and initial experiences].

The cervical laminectomy is usually applied in the treatment of cervical myelopathy caused by cervical canal stenosis and multiple spondylosis. Nevertheless, late complications are often reported, especially scar formation, the so-called laminectomy membrane, between the dura and overlying paraspinal muscles, which, compressing the cord, reduces until to abolish the favourable effects of the previous laminectomy; moreover, malalignment of the cervical spine with secondary kyphosis may follow an expansive laminectomy. In order to avoid these complications, in 1977 Hirabayashi introduced a new surgical technique, the "expansive open-door laminoplasty", which permits the enlargement of the spinal canal over multiple segments by completely incising the laminae laterally on one side and partially on the opposite: elevation with tilting of the laminae upward in the incised side, allows enlargement of the canal. The Authors describe in detail the operative procedure and report their experience in 10 patients.

Adult↗
PubMed1985

The results of treatment of acute injuries of the upper thoracic spine with paralysis.

We studied the cases of 218 patients who had had trauma to the upper region of the thoracic spine (first to tenth thoracic vertebra) that resulted in paralysis. Of these, 184 patients had a complete and thirty-four had an incomplete lesion of the spinal cord. Of the 184 patients who had a complete lesion of the spinal cord, none of the 149 patients who were followed for two to fifteen years recovered any significant neurological function, regardless of the type of operative or non-operative treatment. Thirty of the patients with an incomplete lesion of the spinal cord were followed for two to twenty years. Three others were lost to follow-up, and one died with ascending necrosis of the spinal cord and pulmonary failure three months after the laminectomy. Of the remaining thirty patients, twenty-three had an anterior cord syndrome, four had a central cord syndrome, and three had a Brown-Séquard syndrome. Five patients with an incomplete lesion were treated without surgery. Three of these patients recovered the ability to walk while two recovered some function but were still not able to walk. Seventeen patients with an incomplete lesion of the spinal cord were treated by laminectomy. Of these patients, two also had cord-cooling, two had a posterior fusion, and one had cord-cooling, spine fusion, and posterior instrumentation with Harrington rods. Five patients recovered partial ability to walk with braces, four did not, and eight lost neurological function or became completely paraplegic after surgery and did not recover. Eight patients with an incomplete lesion of the spinal cord were treated with anterior transthoracic decompression and fusion, three of whom had had a previous laminectomy that had not improved their status. Five patients recovered the ability to walk without aids, two walked with braces, and one recovered some motor function but was not able to walk. From this study, we concluded that laminectomy is contraindicated for incomplete lesions of the upper region of the thoracic spinal cord and that anterior transthoracic decompression and fusion offers the best chance of recovery of neurological function.

Adolescent↗
PubMed1983

Paraplegia in unstable thoracolumbar injuries. A study of conservative and operative treatment regarding neurological improvement and rehabilitation.

Thirty-seven patients with unstable thoracolumbar fractures and paraplegia were studied: 11 patients were given exclusively conservative treatment, 14 patients were treated conservatively after laminectomy with or without fusion, and 12 patients were treated with Harrington instrumentation. None of the 12 cases with complete paraparesis at admission to the hospital improved their neurological status. In patients with moderate and severe but not complete paraparesis one month after injury, the neurological improvement continued for several years and in many the neurological restitution was complete. There was no difference between the three treatment groups regarding the neurological improvement. A new Rehabilitation Index was constructed with special reference to paraplegic patients. One month after the injury the Rehabilitation Score in the Harrington group was considerably higher than in the other groups. After three months the score was equalized in the conservatively treated group and the Harrington group whereas the score of the laminectomy-fusion group remained lower as long as two years after injury. Thirty-two patients were followed-up two years after the injury. Irrespective of the treatment, 30 of 32 patients had reached their maximal ADL scores at the follow-up. In 19 patients the bladder function was satisfactory. Eleven patients could walk independently. Twelve patients used wheel-chairs. Twenty-eight patients managed outdoor transportation without help. Twenty-four patients (75 per cent) had returned to work. Complaints about back deformity, skin problems and pain at direct pressure over the fracture site were significantly more frequent in the conservative and laminectomy-fusion groups. The treatment with open reduction, fusion and stabilization with Harrington rods considerably reduced the immobilization and hospitalization time. The complications were few. - The Harrington operation resulted in an early rehabilitation, which is of great psychological importance for the patient. - Our study confirms the disadvantages of laminectomy followed by conservative treatment reported by other authors.

Adolescent↗
PubMed1995

[An experimental study on the prevention of postlaminectomy scar formation: efficacy of interpositional collagen-sponge].

The efficacy of collagen-sponge to reduce postoperative scar formation was investigated in 65 Japanese white rabbits that received laminectomy in the 7th and 8th thoracic vertebra. The defect after laminectomy was filled by collagen-sponge in 25 rabbits, by free fat in 20 rabbits, and by nothing in 20 rabbits as controls. The animals were sacrificed 2, 4, 8 and 12 weeks and additional 5 rabbits of which defects were filled with collagen-sponge were sacrificed after 24 weeks. All the defects were examined histologically. At 4 weeks after laminectomy, the defects filled by collagen-sponge showed that fibrous tissue had invaded into the sponge, but there was no remarkable adhesion to the dura mater. At 8 weeks, the defect with collagen sponge showed foaming cells, and no thickening of the dura mater was observed. At 12 weeks, the grouping of foaming cells was partially replaced by fat cells. At 24 weeks, most of the foaming cells were replaced by fat cells, and the defect was then similar to that filled by free fat at 12 weeks. In contrast, the defect with no interposed membrane was already filled with fibrous tissue at 4 weeks, and adhesion to the dura mater was observed. Although the free-fat graft at 12 weeks postoperatively showed no remarkable adhesion around the dura mater, infiltration of fat tissue into the spinal canal was observed in 2 of 5 rabbits. These results indicated that collagen-sponge can be utilized as a new biomaterial to effectively prevent scar formation after laminectomy.

Animals↗
PubMedDate not supplied

[Vertebral hydatidosis with extra- and intra-rachidian hydatid ossifluent pseudoabscess].

A clinical case of a 35-year-old male with antecedents of frequent dog contacts suffering a progressive spastic paraparesis and pains of the low dorsal column is presented. Radiographies of the spinal column showed absence + of D6 right pedicle and a mass in the vicinities. A dorsal spinal column computed axial tomography revealed a retropleural mass close to D6-D7 invading the epidural space and compressing the spinal cord. An indirect hemagglutination test for hydatidosis resulted positive. Laminectomy of D5-D6-D7 and extraction of hydatic vesicles from the epidural space were performed. The patient had an excellent evolution, but four months later symptomatology reappeared with paraplegia. A new laminectomy of D8-D9, also with extraction of hydatic vesicles were carried out. As paraplegia persisted, another laminectomy of D3-D4 and D5 with extraction of additional hydatic elements was executed. Fifteen days later thoracotomy permitted to extirpate an osifluent hydatic abscess. Finally, 18 months after the onset of the illness, laminectomy of D1-D2 with extirpation of hydatic vesicles were performed. The patient was submitted to physiotherapy and rehabilitation. At present he needs a wheel chair. The characteristics of vertebral hydatidosis are commented and the frequent erroneous concepts on the parasitology and clinics of the disease are stressed.

Abscess↗
PubMedDate not supplied

Impact of patient-controlled analgesia on required nursing time and duration of postoperative recovery.

BACKGROUND AND OBJECTIVES: Patient-controlled analgesia (PCA) offers effective postoperative pain management. However, the evidence of economic benefits associated with its use is lacking. Although suggestive, the potential economic advantages of PCA in saving nursing time and shortening hospital stay need objective documentation. METHODS: This study compared the effects of morphine administered by PCA systems with intramuscular (i.m.) morphine injection on patient analgesic response, satisfaction, nursing time requirements, and postoperative recovery in 23 patients undergoing "open" cholecystectomy and 44 patients undergoing lumbar laminectomy and bony fusion. After the operation, patients in the PCA group received 1.5-2 mg morphine with a lockout of 5-10 minutes on demand, whereas those in the i.m. group received 0.15-0.2 mg/kg every 4 hours on demand. Visual analog scale (VAS) pain scores and satisfaction scores were evaluated at 4-hour intervals while nursing time spent on both analgesia-related and non-analgesia-related activities was recorded continuously by a team of independent observers on the ward. Recovery time profile for the return of bowel function, activities of daily living, ambulation without support, and length of hospital stay was also recorded. RESULTS: It was found that morphine consumption, VAS, and satisfaction scores were similar in both PCA and i.m. treatment groups following both types of surgery. However, the delay in nurse response to i.m. morphine request ranged from 27.2 +/- to 42.1 +/- 11.8 minutes. The demand of nursing time on analgesia administration was less with PCA. The magnitude of time saving was 10 min/patient/d in cholecystectomy patients and 13 min/patient/d in laminectomy patients. The speed of postoperative patient recovery was similar between the two analgesia groups. Length of hospital stay following cholecystectomy was shorter--92.0 +/- 5.9 hours with PCA versus 128.6 +/- 22.2 hours with i.m. (not statistically significant)--whereas that following laminectomy was not different. CONCLUSIONS: Data in this study have demonstrated some beneficial effects of PCA on nursing time requirements when it was used following cholecystectomy and lumbar laminectomy at the University of Toronto: however, the magnitude of these benefits was less than previously reported. The effects of PCA on postoperative recovery and hospital stay, however, were not significantly different from i.m. therapy.

Adult↗
PubMed1996

[Extra osseous tumors of the spine in children and adolescents. Spinal complications].

PURPOSE OF THE STUDY: The delay in diagnosis of spinal tumors is not rare. The chief complaint may include pain, walking disability, and spinal or limb deformities. The purpose of our study is to analyze the spinal deformities associated with non osseous intraspinal tumors, to assess the complications of treatment, and to set out a preventive protocol. MATERIALS: We reviewed retrospectively 40 consecutive cases of non osseous intraspinal tumors treated between 1972 and 1991. There were 32 intradural, 2 extradural, and 6 intra and extradural combined tumors. At the first consultation, the age ranged between 4 months and 15 years, and only 16 patients showed neurologic deficit. Spinal deformity existed in 9 patients, 7 of which had no neurologic deficit. All the tumors were treated surgically. Laminectomy was done in 28 cases, and osteoplastic laminotomy in 12 cases. The number of levels included in the laminectomy ranged from 3 to 18. Bilateral arthrectomy at least at one level was undertaken in 15 cases. A postoperative brace was worn in all cases for an average period of 4 months. An adjuvant radiotherapy was undertaken in 12 cases for an incomplete resection. METHODS: The incidence and pattern of spinal deformity was assessed before tumor treatment and ultimately after laminectomy or osteoplastic laminotomy (or laminoplasty). RESULTS: Among the 9 cases with preexisting spinal deformity, the curve magnitude increased after laminectomy in 4. A kyphotic, kyphosoliotic or scoliotic deformity developed in 18 cases after surgery for tumor resection. Among these 18 patients, only one had had an adequate osteoplastic laminotomy. The treatment of spinal deformities was surgical in 12 cases, and done by either posterior or anterior and posterior combined arthrodesis. DISCUSSION: Spinal deformity may be the main complaint of a patient who has intraspinal tumor. Prevention of postlaminectomy spinal deformity is mandatory, and could be done by osteoplastic laminotomy and the use of a brace during a minimum period of 4 to 6 months after surgery. CONCLUSION: Diagnosis of intraspinal tumors in children and adolescents should be done early, and laminoarthrectomy should be replaced by osteoplastic laminotomy.

Adolescent↗