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PubMed2004

Reduction in experimental peridural adhesion with the use of a crosslinked hyaluronate/collagen membrane.

The research goals were to fabricate a crosslinked hyaluronate (HA)/collagen membrane and study its efficacy in preventing peridural adhesion. Different weight ratios of HA/collagen membranes crosslinked with carbodiimide were tested for biocompatibility and biodegradability first. Forty-eight adult New Zealand white rabbits underwent an L6 laminectomy. Sixteen rabbits each received a weight ratio of HA/collagen = 60/40 membrane (Membrane A) or a 40/60 membrane (Membrane B) on the exposed dura. The last 16 rabbits received no treatment and served as controls. No adverse reaction of the membranes was noted. Magnetic resonance images revealed a hyposignal space between the dura and the scar tissues at Membrane B-treated laminectomy site 3 months after surgery. Histological examination showed that the amount of scarring decreased with time in all groups. Amount of scarring decreased significantly at laminectomy sites treated with either membrane. Compared with the control group, the extent of peridural adhesion decreased significantly in the Membrane B-treated group at 3 months after surgery; while it decreased substantially, but not significantly, in the Membrane A-treated group. The carbodiimide-crosslinked HA/collagen membrane is a safe and effective antiadhesive material in vivo. When placed onto the laminectomy site, the membrane with a weight ratio of HA/collagen = 40/60 appears to reduce peridural scar adhesion.

Animals↗
PubMed2005

[Thromboprophylaxis in elective spinal surgery and spinal cord injury].

The risk of deep vein thrombosis (DVT) after spinal cord injury is very high. Without prophylaxis the incidence of DVT using venography is 81% and the risk of symptomatic DVT is between 12 and 23%. The risk is much lower in elective spine surgery. After discectomy or laminectomy on less than two spine levels, the risk of DVT is less than 1%. After spinal fusion or extended laminectomy, the risk can be estimated between 0.3 and 2.2%. A prophylaxis is recommended for all patients after spinal cord injury (grade A). The association of a mechanical method and heparin is recommended (grade B). The duration of prophylaxis is 3 months in patients with a motor deficit (grade C). No prophylaxis is recommended after discectomy or limited laminectomy in patients without additional risk factors. Mechanical methods are recommended after spinal fusion or extended laminectomy. For patients with additional risk factors a low molecular weight heparin is recommended.

Ambulatory Surgical Procedures↗
PubMed1995

The use of ketorolac in lumbar spine surgery: a cost-benefit analysis.

The use of ketorolac was studied in patients undergoing lumbar laminectomy and those receiving lumbar fusion with or without instrumentation. Laminectomy patients in the ketorolac group used significantly less narcotic analgesic than did those in the narcotic treatment group. Ketorolac patients in both surgical categories experienced better pain control than narcotic group patients did. Laminectomy ketorolac patients experienced less sedation than did those in the narcotic group, and a similar trend was noted for fusion patients. A significant improvement in postoperative ambulation was demonstrated in the fusion ketorolac group. Postoperative total drug costs were significantly greater in both ketorolac treatment groups. A one-half day decrease in hospitalization was noted for laminectomy ketorolac patients. The overall annual financial impact of the use of ketorolac in lumbar spine patients is a net savings of $211,095.

Adult↗
PubMed1989

Scoliosis induced by anterior and posterior rhizotomy.

This paper presents the result and statistical analysis of an experiment in which selective anterior or posterior rhizotomy was carried out under microscopic surgery. The animals used for the experiment were 48 young rabbits, and they were divided into four groups. Group 1, which was used as control, was subjected to lower dorsal bilateral laminectomies with dural incision; Group II to laminectomies with three right posterior rhizotomies; Group III to laminectomies with three right anterior rhizotomies, and Group IV to laminectomies with three right anterior and posterior rhizotomies. Scoliosis was induced in Groups II, III, and IV. There was no significant statistical difference in the degree of curvatures among these three groups. The convexity of the curvature faced to the side of the divided roots. In Groups III and IV, scoliotic curvatures were obvious within 2 weeks, but there were no considerable changes thereafter. In Group II, the curves progressed slowly up to the 12th week. They were statistically significant at the fourth week and increased continuously thereafter. The histologic findings in Groups III and IV showed denervation atrophy of the paravertebral muscles at the apex of the curvature, but there was little or no muscle atrophy in Groups I and II. The experimental results indicate that scoliosis may be induced not only by anterior root paralysis but also by selective posterior root paralysis.

Animals↗
PubMed1997

Destructive spondyloarthropathy of the cervical spine in patients with chronic renal failure.

STUDY DESIGN: Eleven patients with chronic renal failure and destructive spondyloarthropathy of the cervical spine were evaluated with plain radiographs, flexion-extension views, computed tomography myelogram, or magnetic resonance imaging to determine the results of surgical and nonsurgical treatment. OBJECTIVES: To determine if cervical spine fusion is an effective method of treatment for patients with chronic renal failure and destructive spondyloarthropathy. SUMMARY OF BACKGROUND DATA: Several reports have described the pathogenesis and appearance of this condition, but little has been reported about the orthopedic management of destructive spondyloarthropathy of the cervical spine. METHODS: Three patients had no spinal surgery, three patients had laminectomies alone, three patients had laminectomies with anterior fusions, and two patients had laminectomies with posterior fusions. Radiographs, computed tomography myelograms, and magnetic resonance images were evaluated to determine the results of treatment. Histologic examinations were performed in two patients. RESULTS: Patients with laminectomy alone had no improvement in pain or neurologic function (one died in the immediate postoperative period), one of three patients with anterior fusions had some improvement (one died in the immediate postoperative period), and both of those patients with posterior fusions improved, although both died within a year of surgery from unrelated causes. CONCLUSIONS: Even though the osteopenia present in patients with chronic renal failure tends to allow wire pull-out and makes internal fixation of the spine difficult, successful cervical spinal fusion can relieve pain and improve neurologic deficits in selected patients with chronic renal failure and destructive spondyloarthropathy, allowing them to remain more active for longer periods of time.

Aged↗
PubMed2003

Quadriplegia in a 10 year-old boy due to multiple cervical neurofibromas.

STUDY DESIGN: A case report of a child with quadriplegia as a result of neurofibromatosis type I who had cervical laminectomy for spinal cord decompression followed by occipitocervical instrumentation is described. OBJECTIVES: To describe the consequences of severe neurofibromatosis type I and an effective surgical technique of occipitocervical instrumentation. SUMMARY OF BACKGROUND DATA: Neurofibromatosis type I is one of the most commonly inherited genetic disorders in the human population. Extensive intraspinal involvement by neurofibromas can cause significant distortion of normal spinal structure as well spinal cord compression. Extensive laminectomy (with subsequent risk of postsurgical kyphosis) is often required for adequate decompression of the spinal cord. METHODS: The clinical and radiographic presentation of a child with severe neurofibromatosis type I resulting in quadriplegia is described. The severe neurologic deficit was caused by compression of the spinal cord by intraspinal neurofibromas. Extensive laminectomy was required to adequately decompress the spinal cord. Occipitocervical fusion from the occiput to C6 was done to stabilize the spine and prevent future kyphosis. RESULTS: Decompression of the spinal cord led to complete neurologic recovery, and instrumentation of the cervical spine was successful in preventing the development of postlaminectomy kyphosis in this pediatric patient. CONCLUSIONS: The reported case emphasizes the need for treating acute neurologic symptoms caused by spinal cord compression in neurofibromatosis type I as well as addressing the future risk of spinal deformity following laminectomy.

Cervical Vertebrae↗
PubMed2003

Spinal cord compression: a review of 70 pediatric patients.

The authors report their experience with 70 pediatric patients with spinal cord compression (SCC) due to malignancies identified among 898 patients with solid tumors. An extradural tumor was the most frequent cause of SCC (71%); 54% of these were soft tissue sarcomas and neuroblastoma. Most intradural tumors (70%) were outside the spinal cord, 9/12 being metastatic medulloblastomas. The SCC localized mainly to the dorsal and lumbosacral regions (42% each). Pain was the most common symptom (94%). MRI proved diagnostic in all cases in which it was used, while myelography was diagnostic in 85% of 26 patients. CT scan demonstrated the lesion in 83% of the patients. Laminectomy was provided for patients with paraplegia of less than 96 h evolution; isolated recurrence of the main tumor; a primary spinal cord tumor; progression of neurologic symptoms after chemotherapy/radiotherapy; chemotherapy and radiotherapy-resistant tumor (when known); resection of a paraspinal tumor. Surgery was avoided when prognosis of primary disease was poor or risks exceeded possible benefits. Twelve/twenty-one (57%) patients with paraplegia were able to walk after laminectomy only, while 14% (2/14) improved after chemotherapy and radiotherapy. Survival rates were 38% for the former and 36% for the latter. Overall survival was related to the original malignancy. All patients (12) admitted without paraplegia and submitted to laminectomy were able to walk, and of these, 6 presented a primary spinal cord tumor. The remaining had paraspinal tumors that extended to the spinal canal. Almost 87% (20/23) of the patients without paraplegia who submitted to medical treatment were able to walk, while only one progressed to paraplegia. Patients with SCC may entertain radio- and chemotherapy when harboring tumors responding to such therapies and present no evidence of neurologic damage progression. The latter manifestation is a strong indication for laminectomy without delay.

Adolescent↗
PubMed2004

[Reoperation after surgical treatment of lumbar spondylolisthesis].

OBJECTIVE: To study the causes of failure following surgical treatment of lumbar spondylolisthesis, procedures for redo surgery and the final result of reoperation. METHODS: 20 patients who had a repeat operation for lumbar spondylolisthesis were studied retrospectively. On average 24.3 months following the previous surgery, all of these patients had recurrence or progression of back and leg pain. All of 20 patients were reoperated by means of three different procedures. RESULTS: The causes of failure were post-operative destabilization (6 cases); progressive spondylolithesis (3 cases) implants failure (10 cases) and mistake segment (one case). After reoperation, a mean 34.1 months' follow-up was made. The excellent or good rate was 90%. Incorporation of graft was found in 18 cases with fusion by inter-transverse process and 2 cases by intervertebral space. New bone formation was found in 6 out of 8 cases that had a simultaneous intervertebral cage implant. No implant failure was found in all patients. CONCLUSIONS: Simple laminectomy or discectomy was not indication for lumbar spondylolithesis. No bone graft or union was the main causes of implant failure. Posterior instrumented fusion with laminectomy decompression can be used in the patients who had a prior surgery of simple discectomy or anterior intervertebral bone graft. Except for posterior instrumented fusion with extensive laminectomy decompression, Intervertebral fusion should be considered in the patients who had a prior surgery of laminectomy decompression with instrument, anterior intervertebral fusion (ALIF) was recommended for these cases.

Adult↗
PubMed1991

Diagnostic and therapeutic technology assessment. Reassessment of automated percutaneous lumbar diskectomy for herniated disks.

Although the safety of the APLD procedure is clearly established both by reports in the published literature and by a consensus of the DATTA panelists, there was no consensus among the DATTA panelists on the effectiveness of the procedure. The average 75% success rate reported in the larger studies contrasts with the 95% success rate reported for laminectomy and diskectomy. For APLD, careful patient selection is essential. Candidates must have failed an adequate trial of conservative therapy (bed rest and limitation of activity) and have disk herniation documented by appropriate imaging studies. These studies are important because they can demonstrate not only the degree of herniation, but also whether it is contained within the annulus and if any free fragments are present. For herniated lumbar disks with nuclear material outside and contiguous with the annulus, a statistically significant consensus of DATTA panelists believed that APLD is an inappropriate procedure. Another study has shown that the procedure can be taught to other surgeons without compromising patient safety, and, as reported, this holds with large numbers of cases. In appropriately selected patients, the clinical trade-off of APLD appears to be between a procedure with a 75% success rate with low risk and rapid recovery vs one with a 95% success rate and a more prolonged recovery. A research question is whether APLD could be extended to patients who have undergone previous surgery whose disks reherniate after a successful laminectomy. Conversely, does an APLD procedure that fails to relieve symptoms complicate subsequent laminectomy? It is recognized that there is a need for prospective, controlled, randomized clinical trials comparing APLD with laminectomy to resolve these and other issues.

American Medical Association↗
PubMed1990

[Metastatic spinal compression syndrome. Symptoms, diagnosis, treatment and prognosis].

A retrospective study of 398 patients suffering from metastatic compression of the spinal cord or cauda equina is presented. The study comprised almost all relevant medical records of patients admitted to hospital in the eastern part of Denmark in the period 1979 through 1985. Carcinoma of the lung, prostate, breast and kidney were the most frequent primary malignancies causing spinal compression. Most patients were treated with laminectomy, or radiotherapy or with laminectomy and radiotherapy combined. The effect of the treatment was estimated by evaluation of motor function and sphincter control. Treatment with laminectomy followed by radiotherapy was significantly superior to treatment with laminectomy or radiotherapy alone. But if the patients' motor function and primary tumour were taken into account, no significant difference between the treatments was observed. The efficacy of treatment depended upon the symptoms when the diagnosis was established, and accordingly early diagnosis is of the utmost importance. The incidence of metastatic compression increased during the period covered by the study, and since this condition must not go untreated, awareness of the symptoms, primarily pain, is essential.

Adolescent↗
PubMedDate not supplied

An unusual case infection following spinal surgery.

A case of extensive subcutaneous inflammation infection four months after a spinal operation is presented. The patient had had an extensive laminectomy and foraminotomy for lumbar canal stenosis and protruded discs at L3/L4 and L4/L5 levels. Four months postoperatively, bilateral gluteal abscesses developed and were treated by surgical evacuation. Three months after the evacuation of the abscesses, extensive inflammation and purulent infiltration of the laminectomy wound together with recurrence of the gluteal abscesses were noticed. In spite of reevacuation of the abscesses the inflammation persisted. A syringography disclosed communication of the gluteal abscesses with the laminectomy wound. Eventually this complication was treated by surgical reexploration of the laminectomy wound, during which it was found that the inflammation, although longstanding, did not spread to the intervertebral spaces.

Abscess↗
PubMed1988

[Indication and method for surgical treatment of metastatic spinal tumors].

We studied 38 patients with metastatic spinal tumors and discussed the indications and methods for surgical treatment. Metastatic spinal lesions were from carcinomas (31 cases) and sarcomas (7 cases). 20 patients underwent conventional decompressive laminectomy, 10 patients were treated by posterior decompressive laminectomy with stabilization, which included Harrington or Luque instrumentation. The remaining 8 patients were treated by anterior decompression and stabilization. Anterior decompression and stabilization (effective cases 87.5%) were better than the other procedures (effective cases of posterior decompressive laminectomy and stabilization: 70%: that of conventional laminectomy: 30%) to sustain relief of pain and reduction of paralysis. Our surgical procedures were palliative and directed at relief of pain and prevention of neurological deterioration. But our results suggested that the spinal column stabilization was worthwhile in treatment of metastatic spinal tumors.

Adult↗
PubMed1996

[Metastatic spinal cord compression in patients with lung cancer].

Metastatic spinal cord compression (MSCC) is a disabling complication to cancer for which the optimal treatment of choice is not settled. An analysis was performed in patients with MSCC secondary to lung cancer in order to elucidate clinical symptoms and treatment results according to regression of neurological deficits and survival. The total series consisted of 102 retrospectively evaluated patients referred for treatment, in the Eastern part of Denmark in the period 1979-1988. Patients included 40% cases with Small Cell Carcinoma (SCLC), Adeno-carcinoma (ACL) (26%), Squamous Cell Carcinoma (SQLC) (18%) and Large Cell Carcinoma (LCC) (9%). Symptoms, clinical presentations and therapeutic results are described. The outcome of treatment depended fundamentally on the patient's neurological condition at the time of the diagnosis. All patients with SCLC who were able to walk at the time of MSCC remained ambulatory while 15% of the non-ambulatory SCLC patients regained walking ability; in non-SCLC, 95% of patients retained walking ability while 22% regained the ability to walk. No major differences in the immediate outcome of treatment between the various histological types of lung cancer as to the different treatment modalities were observed, however, 82% of the patients with non-SCLC had benefit from treatment with laminectomy followed by radiotherapy compared with either laminectomy (47%) or radiotherapy (39%) alone (p = .03, Chi-square test). The group of patients treated with laminectomy followed by radiotherapy had a better survival (median value 3.5 months, range 0-132 months) than patients treated with either laminectomy (median value 1.5 months, range 0-32 months) or radiotherapy (median value 1 month, range 0-59 months) alone (p = .03, Log-Rank test). No significant difference was observed in survival between the various histological types of lung cancer (p = .18, Log-Rank test). Despite a short survival, early diagnosis and immediate treatment is crucial, since it may preserve the gait function in 97% of lung cancer patients developing malignant spinal cord compression.

Adult↗
PubMed1994

Differences between men and women undergoing major orthopedic surgery for degenerative arthritis.

OBJECTIVE: To determine whether women have worse functional status than men at the time of laminectomy for degenerative spinal stenosis or total joint arthroplasty for degenerative arthritis of the hip and knee. METHODS: Consecutive patients undergoing laminectomy for degenerative lumbar spinal stenosis or unilateral, primary hip or knee arthroplasty for advanced degenerative arthritis were recruited. Functional status was measured with self-administered questionnaires. We compared preoperative functional status scores of men and women, using linear regression models that adjusted for age, comorbid conditions, work status, education, living arrangement, and body mass index. We also compared the rates of in-hospital complications and 6-month followup functional status scores for men and women. RESULTS: Women had much worse functional status than men prior to laminectomy for spinal stenosis (P < 0.01) and prior to total hip arthroplasty (P < 0.001) and total knee arthroplasty (P < 0.0001). These differences persisted after statistical adjustment for demographic and clinical characteristics. Women had comparable or greater functional improvement following surgery and experienced a similar number of complications compared with men. CONCLUSIONS: The observed gender differences in functional status prior to major orthopedic surgery indicate that women are operated on at a more advanced stage in the course of their disease. These results are not due to gender differences in demographic or clinical characteristics of the patients, and cannot be justified by differences between men and women in the outcome of surgery. The role of patient preferences and differential access to these procedures should be explored in future studies.

Aged↗
PubMed1993

Localized dumbbell neuroblastoma: a study of 25 cases treated between 1982 and 1987 using the same protocol.

Among the 108 non-metastatic neuroblastomas treated at the Institut Gustave Roussy between 1982 and 1987, 25 dumbbell neuroblastomas were observed. Therapeutics included: 1) an initial laminectomy in forms with neurological deficit; 2) surgical excision of the primary tumor; 3) preoperative chemotherapy in children in which the primary tumor was considered as unresectable at diagnosis and postoperative chemotherapy in cases of incomplete resection; and 4) radiation therapy on macroscopic residual disease. Fifteen out of 25 (60%) presented a neurological deficit. A laminectomy was performed in 14 cases. Neurological recovery was good in 4 cases, partial in 4 cases, and absent in 4 cases. Two patients were worse after the procedure. The event-free survival was 88%. This high survival rate is linked: 1) to the non-metastatic stage; 2) to a high proportion of children under 1 year of age (18/25) (median age = 7 months); and 3) to a high proportion of thoracic location (12/25). The high incidence of macroscopically incomplete excision (13/25) did not jeopardize the prognosis. Out of the 22 survivors, there were 8 cases of major neurological sequellae (36%) and 5 cases of major orthopedic ones (26%). The coexistence of a serious functional prognosis and an excellent vital prognosis for these patients has led us to analyse the therapeutic modalities, to reevaluate the necessity of routine initial neurosurgical removal by laminectomy and to discuss the use of first line chemotherapy.

Abdominal Neoplasms↗
PubMed1995

Epidural scar tissue formation after spinal surgery: an experimental study.

Extensive epidural scar formation is a well-known complication after spine surgery. Fibrous adhesions around nerve roots are a major reason for recurrent neurological symptoms following lumbar discectomy. A large variety of materials, implanted onto the dura, have been used to prevent or reduce laminectomy membrane, with conflicting results. We therefore carried out an experimental study in dogs to compare those materials that seemed to be most suitable. In each of 30 adult beagles, three lumbar laminectomies were performed. Each level was covered with a different material--free autologous fat graft, cellulose mesh, Gelfoam or triamcinolone suspension. In a control group nothing was implanted. After 7 days or 1, 3 or 6 months the animals were killed. The lumbar vertebral columns were harvested and prepared for further histological examination. To compare the results, we designed a new classification scheme (scar index). The data were obtained without knowledge of implanted material or time since operation. We found that free autologous fat grafts are able to reduce epidural scar formation in a high proportion of cases, especially after 3 and 6 months; cellulose mesh showed the worst results. We conclude that free autologous fat grafts are superior to other materials because of simple operative handling, good compatibility and effective prevention of laminectomy membrane.

Adipose Tissue↗
PubMed1986

Analysis of 75 operated thoracolumbar fractures and fracture dislocations with and without neurological deficit.

Seventy-five surgically treated patients with thoracolumbar fractures and fracture dislocations, operated on between 1978 and 1982 at the Orthopedic Department of the University of Basel, were analyzed. The follow-up ranged from 18 months to 6 years. There were 45 men and 21 women, and 60% of the patients were not more than 30 years old. Additional injuries were common: 30% of the patients had craniocerebral injuries and 20% were polytraumatized. Ninety-six percent of all patients reached a hospital within 6 h, but only 23% initially presented at a center for spinal surgery. Sixteen patients had anterior surgery (fusion alone or with plating), and two of these had laminectomy as a second operation. Fifty-seven patients had posterior surgery, in 34 cases combined with a laminectomy. The Harrington instrumentation was used 45 times (29 distraction, 14 compression, and two combinations of distraction and compression rods). Luque rods with segmental sublaminar wiring was used seven times, the locking-hook distraction-rod system of Jacobs twice, and miscellaneous procedures five times. A total of 24 patients (greater than 30%) presenting neurological deficits improved postoperatively. None of the 18 patients with normal neurological findings deteriorated during the operation. Neurological improvement was seen more frequently after early than after delayed surgery, but the difference was not statistically significant. Laminectomy had no statistically significant effect on postoperative neurological status. Twenty-two patients required reoperation because of insufficient or failed instrumentation. Luque instrumentation had the highest rate of reoperations. Anterior surgery did not prove superior to posterior procedures. Hospitalization and immobilization time was significantly reduced with surgery for the neurologically normal or minimally damaged patients, but not for completely or incompletely paraplegic patients. Postoperative back pain occurred in 22 patients, of whom 14 had nonanatomic postoperative reductions. Complications directly due to the surgery were rare. It is our conclusion that the instrumentation used in this series was not good enough to be proposed for standardized use. These technically unsatisfactory results induced the development of the internal fixator system in the senior author's (E.M.) department.

Adolescent↗
PubMed1986

Effects of surgery on cervical spondylotic myelopathy.

The results of surgery for treatment of cervical spondylotic myelopathy (CSM) were assessed 3 months (early results) and 2-8 years (late results) postoperatively in 99 patients. Extensive laminectomy as well as anterior decompression and fusion, or the two procedures at staged intervals, were used. Immediate postoperative deterioration was never seen after laminectomy performed under local anaesthesia (84 patients), while transient deterioration occurred after anterior surgery in 2 of 28 patients. Cervical spondylotic radiculopathy (CSR) was found in 73% of the patients. Operative treatment for CSM also improved root symptoms, anterior surgery to a larger extent than posterior decompression. Only 10% of the patients treated with extensive laminectomy needed a second anterior operation for radiculopathy. The progression of myelopathy was arrested in 95% of the patients after surgery. Improvement was obtained in 80% both in the early and late follow-up review when compared to the preoperative functional status. The evaluation disclosed a tendency of rapid improvement during the first 3 months, subsequently followed by slow improvement in 50% and slight deterioration in 15% of the patients. The degree of improvement was in many patients not sufficient to raise the functional capability to a higher level in the employed grading system. In our opinion it is therefore important to operate patients with CSM as early as possible before neurological deficits are too pronounced.

Adult↗