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PubMed1999

Expansive laminoplasty for myelopathy in ossification of the longitudinal ligament.

Laminectomy, which had long been used for treatment of cervical spondylotic myelopathy, including ossification of the longitudinal ligament in the cervical spine, had numerous complications such as postoperative malalignment of the cervical spine and vulnerability of the spinal cord caused by total removal of the posterior structures. In 1977 Hirabayashi devised an open door expansive laminoplasty, which is a relatively easier and safer procedure than laminectomy, that eliminated such problems by preserving the posterior elements. The decompression effect of the expansive laminoplasty against a compressed spinal cord is comparable with that of laminectomy and anterior decompression followed by fusion, whereas the expansive laminoplasty has no structural problems and adverse effects on adjacent disc levels that often are associated with anterior decompression followed by fusion. Average recovery rate of expansive laminoplasty for cervical spondylotic myelopathy has been reported to be approximately 60% (Japanese Orthopaedic Association score) and with long term stability. At present, authors consider all patients with cervical spondylotic myelopathy candidates for expansive laminoplasty except for those having preoperative kyphosis and single level lesion without canal stenosis. Two remaining problems of expansive laminoplasty to be solved are prevention of C5,C6 radicular pain and/or paresis, the most frequent complication that occurs in approximately 5% to 10% of the patients, although most complications resolve spontaneously within 2 years, and correction of nonlordotic alignment to lordosis which are essential for posterior decompression effect of expansive laminoplasty by allowing the spinal cord to shift dorsally.

Cervical Vertebrae↗
PubMed1996

Spinal stability after war missile injuries of the spine.

OBJECTIVE: Spinal stability after surgery for war missile wound to the spine is addressed in this study. DESIGNS: A retrospective 4-year analysis of 21 patients. MATERIAL AND METHODS: The most common injuries were of the thoracic and lumbar spine. The injuries were frequently associated with the lesions of other organs. We registered extensive initial neurologic deficit in 47.6% of cases. All the patients were treated surgically. MEASUREMENTS AND MAIN RESULTS: A decompressive laminectomy was performed in 80.9% of cases. Internal stabilization after laminectomy was performed in only one patient in our series. None had clinical signs of instability. There were no radiologic signs of postoperative spinal instability found on mean follow-ups of 15 months. CONCLUSIONS: Wound debridement with or without removal of bony and foreign body fragments from the spinal canal was performed. A laminectomy is considered a method of choice. The spine was not stabilized in most patients because the facet joints were left intact.

Blast Injuries↗
PubMed1998

Anterior cervical corpectomy for cervical spondylotic myelopathy.

OBJECTIVE: To evaluate the efficacy of anterior surgery for the treatment of cervical spondylotic myelopathy, we have reviewed our experience with anterior cervical corpectomy (ACC) at the University of Florida, specifically analyzing neurological outcomes and complications. These results have been compared with historical control subjects receiving laminectomy or "no treatment." METHODS: Between 1982 and 1992, 93 ACC operations were performed for the primary diagnosis of cervical spondylotic myelopathy. This consecutive series of patients was reviewed retrospectively. Age, gender, pre- and postoperative myelopathy severity, number of levels decompressed, and neurological complications were assessed. Myelopathy severity was graded using the Nurick myelopathy grading system. The average follow-up period was 39 months (range, 2-137 mo). RESULTS: Symptomatic improvement was achieved for 92% of patients (F = 28.9, df = 2172, P < 0.001). Nurick scores reflected improvement for 86% of patients, with the conditions of 13% remaining unchanged and only one patient showing worsening. Preoperative myelopathy severity was weakly correlated with age (P < 0.05) but was not correlated with gender or number of levels decompressed. Similarly, postoperative myelopathy severity was not significantly correlated with age, gender, preoperative myelopathy severity, or number of levels decompressed. ACC-treated patients showed an average improvement of 1.24 points on the Nurick scale, compared with an improvement of 0.07 points for patients treated with laminectomy (P < 0.001) and a deterioration of 0.23 points for patients undergoing conservative treatment (P < 0.001). Complications were slightly more likely to occur in older patients (P < 0.05). The number of levels decompressed was not significantly correlated with complications. Only one permanent neurological complication was seen in this series of patients. CONCLUSION: We conclude that ACC is a safe and effective treatment for cervical spondylotic myelopathy. In an average of 39 months, ACC showed improved results in terms of myelopathy scores, compared with historical control subjects receiving either no treatment or laminectomy. Age, gender, preoperative myelopathy severity, and extent of disease were not negative predictors of clinical outcomes.

Adult↗
PubMedDate not supplied

Transcutaneous electrical neurostimulation in postlaminectomy pain.

Transcutaneous electrical neurostimulation (TENS) has been shown to be very effective in providing acute postoperative and delivery pain relief. We specifically applied this modality ot Northwestern Memorial Hospital using constant postoperative neurostimulation to patients who had had cervical or lumbar laminectomies for a variety of reasons, but mainly for herniated intervertebral discs and osteoarthritic spurs. The results in both groups were compatible with earlier findings by Hymes and co-workers, who reported decreased narcotic intake, decreased pain behavior or subjective complaints, and increased physical recovery. Patients who responded to TENS showed an average 50% decrease in dosage of narcotic analgesics, expressed fewer complaints of pain, and appeared to show more rapid postoperative physical recovery than the patients who were not treated with TENS. Seventy-nine percent of the lumbar laminectomy group and 87.5% of the cervical laminectomy group showed 50% or greater relief of acute, severe postlaminectomy pain. Other advantages of using TENS included ease of application and lack of major complaints.

Electric Stimulation Therapy↗
PubMedDate not supplied

Thoracolumbar spine fractures. Results of treatment.

Sixty-three patients with thoracolumbar spine fractures treated between 1972 and 1978 were placed into six treatment groups: fusion and instrumentation alone, laminectomy with fusion and instrumentation, laminectomy alone, laminectomy with fusion without instrumentation, fusion alone, and no operation. Patients were interviewed and examined and their histories reviewed; new radiographs were obtained, and a detailed questionnaire was answered. No treatment method improved neurologic function. Fusion with instrumentation allowed earliest ambulation with least spinal deformity. Most patients in all treatment groups adjusted effectively to their injuries and remained active in employment and hobbies. A detailed, thorough rehabilitation program gave best functional results and patient attitudes.

Adolescent↗
PubMed1983

Expansive open-door laminoplasty for cervical spinal stenotic myelopathy.

Although the operative results have been improving since the air drill was introduced for cervical laminectomy instead of an ordinary rongeur, post-laminectomy complications, such as postoperative fragility of the cervical spine to acute neck trauma, posterior spur formation at the vertebral body, and malalignment of the lateral curvature have still remained as unsolved problems. In order to avoid these disadvantages, a new surgical technique called "expansive open-door laminoplasty" was devised by the author in 1977, which is relatively easier, safer, and better than the ordinary laminectomy from the standpoint of structural mechanics of the cervical spine. The operative procedure is described in detail. Operative results in the patients with cervical OPLL, spondylosis, and canal stenosis were satisfactory, and optimal widening of the AP diameter of the spinal canal is considered to be over 4 mm. From this procedure a bilateral, open-door laminoplasty has been devised for extensive exploration at the intradural space.

Animals↗
PubMed1986

An experimental study on prevention of postlaminectomy scar formation by the use of new materials.

An experimental study was performed to investigate the prevention of scar formation after lumbar laminectomy, using Elastase and the new polylactic acid (PLA) membrane containing Elastase. The experimental animals consisted of four groups: control group, E group (using intravenous administration of Elastase), P group (covering the laminectomy defect with PLA membrane), and P-E group (covering the laminectomy defect with "PLA" + Elastase" membrane). The animals were killed at varying intervals (2-12 weeks) and changes in the lumbar spines were evaluated histologically. Scar formation was suppressed most significantly in the P-E group, followed in order by the E group, the P group, and the controls.

Animals↗
PubMed1993

The effect of lumbar disc surgery on postoperative pulmonary function and temperature. A comparison study of microsurgical lumbar discectomy with standard lumbar discectomy.

Preoperative and postoperative pulmonary function and body temperature were measured prospectively in 15 patients undergoing either microlumbar discectomy or standard lumbar laminectomy and discectomy for herniated nucleus pulposus. In these otherwise comparable groups patients undergoing standard lumbar laminectomy and discectomy had significant depression in pulmonary function in the first 20 hours postsurgery and febrile temperatures for as long as 48 hours postsurgery. No alteration in pulmonary function or body temperature was observed in those operated on by the microlumbar discectomy technique. We conclude that patients undergoing microlumbar discectomy for lumbar disc herniation have less postsurgical pulmonary morbidity and temperature elevation than those treated by lumbar laminectomy and discectomy.

Adult↗
PubMed1994

The surgical management of ossification of the posterior longitudinal ligament in 43 north americans.

From 1989 to 1992, 43 of 174 (25%) consecutive North Americans had cervical ossification of the posterior longitudinal ligament (OPLL). After the non-random selection of anterior corpectomies and fusions, anterior discectomies and fusions, or five-level laminectomies, the preoperative and postoperative outcomes of the OPLL patients were compared using Ranawat's neurological classes and grades. Patients who had anterior OPLL surgery exhibited superior outcomes compared with those who had laminectomies. Specifically, the 20 patients who underwent corpectomies and had the most severe preoperative deficits, had the best postoperative results; the 13 discectomy patients, with the least severe preoperative deficits, had intermediate recoveries, whereas the ten laminectomy patients, with intermediate preoperative neurologic dysfunction, had biased future surgical choices to favor more anterior approaches.

Adult↗
PubMed1995

Application of polyvinyl alcohol hydrogel membrane as anti-adhesive interposition after spinal surgery.

STUDY DESIGN: Three inflammatory and adhesive changes inside the spinal canal were analyzed histopathologically in cats. OBJECTIVE: To investigate the usefulness of a polyvinyl alcohol hydrogel sheet as an interposition over the dura to prevent inflammatory and adhesive reaction after laminectomy. SUMMARY OF BACKGROUND DATA: A major concern after laminectomy is scar tissue formation that may result in extradural compression or make subsequent surgery to the same area difficult and hazardous. METHODS: Wide laminectomy was performed at L5 in 30 adult cats. The dura was covered with a polyvinyl alcohol hydrogel sheet, free fat graft, or without interposition as a control. Animals were killed at 3 or 12 weeks. RESULTS: In the control group, adhesion of the exposed dura was apparent. Thick, fibrous connective tissue was observed between the dura and the paravertebral muscles. In the fat graft group, the dura was separated from the scar tissue by living grafted fat. However, the dura was adherent to the grafted fat and fibroblasts migrated into the interstitial space. In the polyvinyl alcohol hydrogel group, only a thin synovium-like layer was formed around the polyvinyl alcohol hydrogel sheet. CONCLUSIONS: Polyvinyl alcohol hydrogel is made of water and alcohol, and has been shown to be nontoxic to tissues. This is permeable to low molecular weight, but impermeable to large cells such as fibroblasts. Thus, the polyvinyl alcohol hydrogel sheet prevents migration of inflammatory cells and subsequently reduces intraspinal canal scar tissue formation and adhesive reaction. Other beneficial properties are extreme elasticity and low friction, which eliminate mechanical reaction to the spinal cord. The polyvinyl alcohol hydrogel sheet is believed to be useful in eliminating scar tissue formation and does not interfere with the dynamic gliding movement of the spinal cord and nerve roots.

Adipose Tissue↗
PubMed1995

Intradural metastasis to the cauda equina from carcinoma of the anus.

STUDY DESIGN: This is a report of a man with carcinoma of the anus and intradural metastasis to the cauda equina. OBJECTIVE: To perform a laminectomy with tumor removal for relief of pain. SUMMARY OF BACKGROUND DATA: Only 25 cases of intradural spinal metastasis have been reported in the English literature. This is the first report of a metastatic case, moving from the carcinoma of the anus to the cauda equina. METHODS: Magnetic resonance imaging showed an ill-defined mass, with central necrosis, to the cauda equina. The possibility of intradural metastasis to the cauda equina was indicated by unique pain symptoms. RESULTS: The patient's back pain subsided after total laminectomy of L3-L5 with subtotal removal of the tumor. The residual tumor became smaller with postoperative radiation. CONCLUSION: Magnetic resonance imaging is a good diagnostic choice in this situation. The cause of the metastasis was unclear, but it was presumed to have occurred through the perineural lymphatic ducts. Laminectomy with tumor removal is feasible for relieving pain and demonstrating pathology.

Anal Canal↗
PubMed1998

Anatomic considerations of pedicle screw placement in the thoracic spine. Roy-Camille technique versus open-lamina technique.

STUDY DESIGN: In this cadaveric study, the outcomes of two techniques for pedicle screw placement in the thoracic spine were compared. OBJECTIVES: To assess the Roy-Camille technique, and to determine whether pedicle screw placement, aided by partial laminectomy, could decrease the incidence of pedicle violations. SUMMARY OF BACKGROUND DATA: Pedicle screw fixation in the thoracic spine remains technically challenging. The Roy-Camille method may be one of the leading techniques of thoracic pedicle screw placement. However, there are few studies evaluating this technique and determining methods to decrease the incidence of thoracic pedicle penetration with screw insertion. METHODS: Ten cadaveric thoracic spines from T1 to T10 were used for pedicle screw placement. Two techniques of transpedicular screw placement were used, the Roy-Camille technique (screw placed on the right side; used in 95 screw placements) and the open-lamina technique screw placement with combined partial laminectomy (screw placed on the left side; used in 94 screw placements). After screw placement, all specimens were evaluated visually to determine violation of the pedicle. RESULTS: The screw placement with the Roy-Camille technique had a higher percentage of pedicle violation (54.7%) than did that with the open-lamina technique (15.9%). No Grade III violation was seen in the screw placement with the open-lamina technique. CONCLUSIONS: The Roy-Camille technique was associated with a high incidence of pedicle violation, whereas screw placement with a partial laminectomy significantly reduced the incidence of pedicle violation. Pedicle screw fixation in the thoracic spine remains a technical challenge and should not be used routinely. Screw placement with the open-lamina technique is recommended if pedicle screw fixation is strongly indicated in the thoracic spine.

Aged↗
PubMed1998

Influence of fibrinolytic factors on scar formation after lumbar discectomy. A magnetic resonance imaging follow-up study with clinical correlation performed 7 years after surgery.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To assess the amount of scar tissue by viewing magnetic resonance images, and to evaluate the correlation between the amount of scar tissue and clinical outcome, surgical technique, and fibrinolytic factors. SUMMARY OF BACKGROUND DATA: The influence of fibrinolytic factors on magnetic resonance images has not been investigated previously. The relation between clinical outcome and findings on magnetic resonance imaging remains uncertain. METHODS: Magnetic resonance imaging at 0.5 Tesla was performed to produce sagittal and axial spin-echo T1-weighted images before and after contrast enhancement on 78 patients 7 years after traditional lumbar discectomy with partial or full laminectomy. Before surgery all patients had been tested for fibrinolytic factors. RESULTS: The overall clinical success rate of the surgery was 73%. No evidence of scar formation was seen in 19 patients, a small amount was seen in 36 patients, a moderate amount in 17 patients, and a large amount was observed in 6 patients. Ten patients who had undergone surgery at two disc levels and 18 who had been treated with full laminectomy exhibited more scar tissue than those patients who had undergone surgery on a single level (P = 0.033) and those who had undergone a partial laminectomy, respectively (P = 0.017). The amount of scar formation also was associated with a poor outcome (P = 0.017) and with low preoperative values of tissue plasminogen activator antigen (P = 0.003) and tissue plasminogen activity (P = 0.048) in samples collected after venous occlusion. The intensity of contrast enhancement, however, was not influenced by these or any other parameters. CONCLUSION: The amount of scar formation after lumbar discectomy seems to be related to the clinical outcome, the size of the surgical exposure, and some fibrinolytic factors.

Adolescent↗
PubMed2002

Inverse laminoplasty for the treatment of lumbar spinal stenosis.

STUDY DESIGN: Fifteen patients with lumbar spinal stenosis were treated by a new technique, inverse laminoplasty, and the results were evaluated clinically and radiologically. OBJECTIVE: To present the advantages of inverse laminoplasty over laminectomy for the treatment of lumbar spinal stenosis. SUMMARY AND BACKGROUND DATA: Laminectomy has been used widely in the treatment of lumbar spinal stenosis. Destruction of the spinal bony structure, instability, and peridural scar formation are the main problems with this procedure. To overcome these disadvantages, a practical technique is presented here. MATERIAL AND METHODS: In a prospective study, 15 patients who underwent surgery with the inverse laminoplasty technique were evaluated clinically and radiologically. The Oswestry Disability Index was used for clinical assessment. L4-L5 spinal stenosis was detected in all patients. As the operative technique, the L4 lamina was elevated en bloc using a high-speed drill and rongeur. After removal of the ligamentum flavum, the roof of the foramina, and/or disc, the lamina was rotated 180 degrees, rested on facets, and reattached by use of a titanium miniplate. RESULTS: All patients improved clinically and neurologically after this procedure. The mean Oswestry Disability Score was 38.33 preoperatively and 7.0 postoperatively. The mean follow-up time was 17.3 months. Spinal canal diameters were calculated by preoperative and postoperative computed tomography, and the mean enlargement was 77.8%. No complications were observed. CONCLUSION: With this technique, the important integrity of the spinal osseous structures is preserved, and a significant enlargement of the spinal canal area is achieved. This technique prevents peridural scar formation after laminectomy caused by a mechanical barrier effect. Long-term follow-up is needed to evaluate spinal stability in these patients.

Adolescent↗
PubMed2002

The biomechanical effects of multilevel posterior foraminotomy and foraminotomy with double-door laminoplasty.

The aim of this study is to evaluate the biomechanical effects of multilevel foraminotomy and foraminotomy with double-door laminoplasty compared with foraminotomy with laminectomy. Using fresh human cadaveric specimens (C2-T1), sequential injuries were created in the following order: intact, bilateral foraminotomies (C3-C4, C4-C5, C5-C6), laminoplasty (C3-C6) using hydroxyapatite spacer, removal of the spacers, and laminectomy. Changes in the rotations of each vertebra in each injury status were measured in six loading modes: flexion, extension, right and left lateral bending, and right and left axial rotation. Foraminotomy alone and following laminoplasty showed no significant differences in motion compared with intact except in axial rotation. After removal of the spacers and following laminectomy, the motion increased significantly in flexion and axial rotation. The ranges of initial slack showed similar trends when compared with the results at maximum load. Clinical implications of these observations are presented.

Aged↗
PubMed2003

Utility of intraoperative ultrasound for tumors of the cauda equina.

STUDY DESIGN: A retrospective chart review of patients with tumors of the cauda equina was performed. OBJECTIVES: To assess the role of intraoperative ultrasound for detecting tumor migration and modifying the approach to cauda equina tumors. SUMMARY OF BACKGROUND DATA: Rostral migration of cauda equina tumors relative to preoperative imaging is well described. The utility of intraoperative ultrasound to identify tumor migration and to modify the surgical approach was analyzed. METHODS: The medical records of nine consecutive patients undergoing biopsy or resection of a cauda equina tumor diagnosed by magnetic resonance imaging at the authors' institution from January 1994 through December 2000 were reviewed. Four patients with tumors of the cauda equina underwent transdural sonography of the intraspinal compartment after initial laminectomy and before durotomy. RESULTS: In three patients, the findings on intraoperative ultrasound showed rostral migration of the lesion with respect to the preoperative magnetic resonance imaging, necessitating additional laminectomy and modifying the site of durotomy. One tumor had migrated rostrally one full bony vertebral segment, whereas two tumors each had migrated one half of a bony vertebral segment. Pathology examination in the three patients whose lesions had migrated rostrally demonstrated a schwannoma in every case. In one patient, intraoperative ultrasound showed no lesion migration with respect to the preoperative magnetic resonance imaging, and no modifications to the surgical approach were needed. Pathology examination of this patient demonstrated an ependymoma. CONCLUSIONS: Intraoperative ultrasound was useful in documenting rostral migration of cauda equina tumors, and facilitated appropriate laminectomy and durotomy. The technique may be particularly valuable for schwannomas of the cauda equina, which seem to have a greater potential for rostral migration.

Adenocarcinoma↗
PubMed2004

Extended cervicolumbar spinal epidural abscess associated with paraparesis successfully decompressed using a minimally invasive technique.

STUDY DESIGN: A case of a multisegmental, cervicothoracolumbar epidural abscess, in an 80-year-old man, successfully decompressed by using a minimally invasive technique, is presented. OBJECTIVE: To review risk factors, diagnosis, treatment, decompression techniques, and morbidity and mortality regarding spinal epidural abscess. SUMMARY OF BACKGROUND DATA: Extended spinal epidural abscess is a rate entity. To our knowledge, this is the first report of a multilevel spinal epidural abscess, completely decompressed by limited laminectomies in combination with the use of a silicon catheter, epidurally. METHODS: The clinical and radiographic features associated with spinal epidural abscess, as well as decompression technique, are presented. The 80-year-old man, with a one week history of urinary tract infection, presented with fever and low back pain, mild weakness in his legs and jaundice. He underwent bilateral limited laminectomies at T2-T3 and a right hemilaminectomy at L1-L2 and the pus was drained, under mild continuous suction, using a 2.7 mm outer and 1.3 mm inner diameter silicon catheter, inserted caudally and cranially into the epidural space, at both the laminectomy sites. RESULTS: The patient experienced immediate relief of the low back pain, gradual fever subsidence and full neurological recovery during the next 3 weeks. CONCLUSION: In cases of suspected acute epidural abscess, especially in elderly debilitating patients: the whole spine should be scanned by MRI to exclude the possibility of multilevel involvement and adequate pus drainage, when indicated, could be performed with the above described minimally invasive technique.

Aged↗
PubMed2006

Controlling bone morphogenetic protein diffusion and bone morphogenetic protein-stimulated bone growth using fibrin glue.

STUDY DESIGN: An in vitro and in vivo study. OBJECTIVE: To evaluate the ability of fibrin glue to limit diffusion of recombinant human bone morphogenetic protein (rhBMP)-2 and its ability to protect spinal nerves from rhBMP-2 stimulated bone growth. SUMMARY OF BACKGROUND DATA: Studies have shown bone morphogenetic protein (rhBMP-2) stimulated bone growth can encroach on the spinal canal and nerves, causing neural compression. More recently, rhBMP-2 use in the cervical spine has been associated with life-threatening swelling. Fibrin glue has been used as a biologic carrier but has not been evaluated for its ability to limit rhBMP-2. METHODS: In phase 1 of the study, rhBMP-2 soaked absorbable collagen sponges (ACS) were encapsulated in fibrin glue and immediately incubated in physiologic lactated ringers solution at 38 degrees C. Samples of solution were tested for rhBMP-2 concentration. In phase 2 of the study, rats were surgically treated with laminectomy and placement of rhBMP-2/ACS versus laminectomy and placement of fibrin glue before placement of rhBMP-2/ACS. After 8 weeks, animals were euthanized and imaged using micro-computerized tomography. RESULTS: The diffusion study showed a significant limitation in rhBMP-2 diffusion when encapsulated in fibrin glue. The laminectomy study revealed blockage of bone formation by fibrin glue and protection of the spinal canal. CONCLUSIONS: Fibrin glue can limit the diffusion of rhBMP-2, and, thus, it can be used to help protect the spinal canal and nerve roots from rhBMP-2 stimulated bone growth.

Animals↗