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PubMed2006

An aneurysmal bone cyst in the cervical spine of a 10-year-old girl: a case report.

STUDY DESIGN: An aneurysmal bone cyst in the neural arch of the fourth cervical vertebra of a 10-year-old girl is reported, along with a brief review of the literature on the topic. OBJECTIVE: To report the presentation and diagnosis of this disorder along with a discussion of the major pitfalls of treatment. SUMMARY OF BACKGROUND DATA: An aneurysmal bone cyst occurs commonly in the second decade, with a predilection for the lumbar spine. With occurrence in the neural arch of a cervical vertebra, the potential for instability following surgical excision is high. METHODS: A 10-year-old white female presented with neck pain of 3 months' duration. Diagnostic imaging revealed an expansile lytic lesion in the spinous process and lamina of the fourth cervical vertebra. Surgical treatment consisted of excisional biopsy and a segmental instrumented posterior fusion from C3-C5. The histopathology was consistent with an aneurysmal bone cyst. RESULTS: Surgical excision consisting of laminectomy and instrumented segmental fusion provided a good clinical result, and minimized the risk and degree of the 2 most common complications: recurrence of the tumor; and postlaminectomy kyphosis, a frequent occurrence in the pediatric population. CONCLUSIONS: In pediatric patients who develop a bone tumor of the posterior elements of the cervical spine, careful clinical and radiologic evaluation is necessary to narrow the differential diagnosis. In most cases, a complete excision should be performed if possible. The risk of postlaminectomy kyphosis is high in the pediatric age population. As such, a fusion should be considered whenever a laminectomy is performed in the immature cervical spine. Risk factors for kyphosis include a high cervical level, multiple laminectomy levels, and postoperative irradiation.

Bone Cysts, Aneurysmal↗
PubMed2006

United States' trends and regional variations in lumbar spine surgery: 1992-2003.

STUDY DESIGN: Repeated cross-sectional analysis using national Medicare data from the Dartmouth Atlas Project. OBJECTIVE: To describe recent trends and geographic variation in population-based rates of lumbar fusion spine surgery. SUMMARY OF BACKGROUND DATA: Lumbar fusion rates have increased dramatically during the 1980s and even more so in the 1990s. The most rapid increase appeared to follow the approval of a new surgical implant device. METHODS: Medicare claims and enrollment data were used to calculate age, sex, and race-adjusted rates of lumbar laminectomy/discectomy and lumbar fusion for fee-for-service Medicare beneficiaries over age 65 in each of the 306 US Hospital Referral Regions between 1992 and 2003. RESULTS: Lumbar fusion rates have increased steadily since 1992 (0.3 per 1000 enrollees in 1992 to 1.1 per 1000 enrollees in 2003). Regional rates of lumbar discectomy, laminectomy, and fusion in 1992-1993 were highly correlated to rates of discectomy, laminectomy (R2 = 0.44), and fusion (R2 = 0.28) in 2002-2003. There was a nearly 8-fold variation in regional rates of lumbar discectomy and laminectomy in 2002 and 2003. In the case of lumbar fusion, there was nearly a 20-fold range in rates among Medicare enrollees in 2002 and 2003. This represents the largest coefficient of variation seen with any surgical procedure. Medicare spending for inpatient back surgery more than doubled over the decade. Spending for lumbar fusion increased more than 500%, from 75 million dollars to 482 million dollars. In 1992, lumbar fusion represented 14% of total spending for back surgery; by 2003, lumbar fusion accounted for 47% of spending. CONCLUSIONS: The rate of specific procedures within a region or "surgical signature" is remarkably stable over time. However, there has been a marked increase in rates of fusion, and a coincident shift and increase in cost. Rates of back surgery were not correlated with the per-capita supply of orthopedic and neurosurgeons.

Aged↗
PubMed2005

Influence of cervical disc degeneration after posterior surgical techniques in combined flexion-extension--a nonlinear analytical study.

Laminectomy and facetectomy are surgical techniques used for decompression of the cervical spinal stenosis. Recent in vitro and finite element studies have shown significant cervical spinal instability after performing these surgical techniques. However, the influence of degenerated cervical disk on the biomechanical responses of the cervical spine after these surgical techniques remains unknown. Therefore, a three-dimensional nonlinear finite element model of the human cervical spine (C2-C7) was created. Two types of disk degeneration grades were simulated. For each grade of disk degeneration, the intact as well as the two surgically altered models simulating C5 laminectomy with or without C5-C6 total facetectomies were exercised under flexion and extension. Intersegmental rotational motions, internal disk annulus, cancellous and cortical bone stresses were obtained and compared to the normal intact model. Results showed that the cervical rotational motion decreases with progressive disk degeneration. Decreases in the rotational motion due to disk degeneration were accompanied by higher cancellous and cortical bone stress. The surgically altered model showed significant increases in the rotational motions after laminectomies and facetectomies when compared to the intact model. However, the percentage increases in the rotational motions after various surgical techniques were reduced with progressive disk degeneration.

Biomechanical Phenomena↗
PubMed1988

Analysis of cervical spine curvature in patients with cervical spondylosis.

Computer-aided design techniques were used to analyze the degree of spinal curvature shown on cervical spine radiograms of 28 patients. On films standardized as to size, a geometrical chord was constructed from the 2nd to the 7th cervical vertebrae (C2 to C7), and an arc was drawn along the posterior margin of the vertebrae. The resulting area was used as an index of curvature, and the spinal canal diameter was measured. Severity of myelopathy as well as clinical improvement was related to the geometrical data. There was no clear correlation between severity of the preoperative myelopathy and degree of curvature. Severe myelopathy was seen in association with straight, lordotic, and hyperlordotic spines. Neck pain was most severe in patients with reversed cervical curvature. The degree of curvature, however, seems to relate to the postoperative clinical outcome. Patients with relatively normal curvature showed the greatest improvement in symptoms and signs. Postoperative magnetic resonance scanning confirms that posterior migration of the spinal cord after laminectomy may be inadequate to clear osteophytes in patients with straightened or reversed curvature of the cervical spine. Spinal geometry should be considered in the selection of the best surgical procedure and the extent of laminectomy for patients with spondylotic myelopathy. Significant abnormalities of spinal curvature may account for some instances of poor outcome after laminectomy.

Aged↗
PubMed2005

Using Dermabond for wound closure in lumbar and cervical neurosurgical procedures.

OBJECTIVE: 2-Octylcyanoacrylate (Dermabond; Ethicon, Inc., Somerville, NJ) is a liquid adhesive being used with increasing frequency for the closure of lacerations and surgical incisions. Dermabond provides excellent cosmetic closure, and recent studies have demonstrated very low infection risks when it is properly applied. There are no published studies using Dermabond on lumbar or cervical procedures. This study was undertaken to determine whether Dermabond is safe and efficacious to use in these common neurosurgical procedures. METHODS: Records of 200 consecutive patients with Dermabond closure after anterior cervical discectomy, microlumbar discectomy, or lumbar laminectomy by the senior author (JEB) with a mean follow-up time of 5.42 months were retrospectively reviewed. Suspected infections with or without confirmatory cultures, erythema, and incisional drainage were documented. RESULTS: Of 200 patients, 85 underwent microlumbar discectomy, 22 lumbar laminectomy, and 93 anterior cervical discectomy. There was only 1 definitive infection, which was a culture-proven discitis in a microlumbar discectomy patient. Of the remaining 85 microlumbar discectomies, there was 1 transient incisional erythema. Of the 22 lumbar laminectomies, there was 1 patient with clinical superficial wound infection with negative cultures and 4 patients with transient incisional drainage without infection. Of the 93 anterior cervical discectomies, 2 had transient incisional drainage without infection. CONCLUSION: This study demonstrates that Dermabond is safe to use in neurosurgery patients undergoing lumbar or cervical procedures, with only 1 patient of 200 having a proven infection. Patients are able to shower and do not have sutures or staples to remove. Patient responses are overwhelmingly positive.

Cervical Vertebrae↗
PubMed1984

Surgical treatment of cervical spondylotic myelopathy complicating athetoid cerebral palsy.

Operative treatment was performed in nine patients with cervical spondylotic myelopathy complicating athetoid cerebral palsy. The first two patients were treated by laminectomy, and the other seven by anterior interbody fusion. The symptoms in both the laminectomy patients improved after operation, but became worse again when cervical instability developed; they then had to have an anterior fusion in addition. In six of the seven patients who had primary anterior fusion a halo-cast (or a halo-vest) was used to keep the cervical spine immobile, and good bony fusion was obtained with satisfactory results. However, in one patient no halo apparatus was used, bony union did not occur and the radiculopathy reappeared. In cervical myelopathy complicating athetoid cerebral palsy laminectomy is contra-indicated; anterior fusion combined with a halo apparatus is, however, satisfactory.

Adult↗
PubMed1999

Surgical treatment of lumbar canal stenosis in the elderly.

The effectiveness of spinal surgery for lumbar canal stenosis was investigated in the elderly. 164 patients with lumbar canal stenosis were surgically treated over 8 years. 125 patients were followed up by letter questionnaire. The outcome and patient satisfaction with the surgical procedures were compared between the 73 younger patients (< or = 64 years of age) and the 52 elderly patients (> or = 65 years of age). Intermittent claudication was satisfactorily improved in both the younger and the elderly groups. Both simple laminectomy and laminectomy with fusion could equally improve the symptoms of intermittent claudication. Although statistically not significant, there was tendency that laminectomy plus fusion effectively improved the symptoms of back pain and leg pain in both groups. 75% of the younger patients and 67% of the elderly were pleased with the outcome. The present study shows that elderly patients with lumbar canal stenosis should be actively considered for surgical treatment.

Adult↗
PubMedDate not supplied

Cerebrospinal fluid retrieval in the conscious dog: a methods development study.

A chronic cerebrospinal fluid access system is described for use in the conscious sling-restrained dog. In a pilot study of ten dogs, a fenestrated barium-impregnated silastic catheter was surgically implanted in the subarachnoid space of the second cervical vertebra through a dorsal laminectomy. This fenestrated catheter was coupled to a subcutaneous access port. Following surgery, cerebrospinal fluid was sampled weekly and evaluated for protein content and cytology. The cerebrospinal fluid albumin to serum albumin ratio was calculated for each sample to evaluate blood-brain barrier integrity. The instrumentation was successfully implanted in five of the first eight dogs using a midbody dorsal laminectomy. Cerebrospinal fluid access was maintained in these dogs for 21 +/- 10 days. Using a slight modification of the original technique, the final two dogs were instrumented through a caudodorsal laminectomy of the second cervical vertebra. The cerebrospinal fluid access system remains patent after 444 days of study in these two dogs. Necropsy evaluation suggested that catheter failure in the immediate postoperative period was due to gross malposition of the catheter. Chronic catheter failure occurred secondary to obstruction by local fibrous tissue reaction. Using this instrumentation, a pharmacokinetic evaluation of the plasma and cerebrospinal fluid deposition of an intravenous bolus of acyclovir was successfully performed twice in a single dog without complications. This instrumentation could provide chronic cerebrospinal fluid access for multiple pharmacokinetic studies in the conscious dog.

Acyclovir↗
PubMed1990

Management of dumbbell tumours. Reports of seven cases.

Seven dumbbell tumours were histologically diagnosed as neurilemmoma (4), echinococcus cyst (1), chondrosarcoma (1) or neuroblastoma (1). Radical removal was achieved by thoracotomy and enlargement of the intervertebral foramen in two cases. Thoracotomy and laminectomy were performed on separate occasions in three cases. One patient, in whom the extent of the pathologic process was known preoperatively, underwent concomitant 'minithoracotomy' and laminectomy. Postoperative bleeding required reoperation in one case. The patient with chrondrosarcoma died of local recurrence 16 months postoperatively, and the patient with neuroblastoma died of metastatic spread after 6 years. The five survivors are well. Preoperative recognition of intraspinal extension should be obtainable if a high index of suspicion is maintained in cases of paravertebral tumour. Computed tomography is the diagnostic method of choice. Single-stage removal of the intrathoracic and intraspinal portions of the tumour is desirable. The recommended procedure is posterior minithoracotomy with rib resections for exposure and possibly also laminectomy, with the patient in prone position.

Adolescent↗
PubMed1979

Studies of experimental cervical spinal cord transection. Part II: Plasma norepinephrine levels after acute cervical spinal cord transection.

Plasma concentrations of norepinephrine (NE) were measured by a radioenzymatic assay technique before and serially after laminectomy at the C-6 level in 14 anesthetized dogs. In half the animals, no further procedures were carried out (control group); in the other dogs, cervical cord transection was performed in addition to laminectomy (experimental group). Mean plasma NE levels were similar in both groups after laminectomy and before cord interruption. In the control group, NE levels increased gradually for 2 hours after the procedure. In the group with cord transection, however, NE rose immediately after transection to 267% of the baseline value, then fell to 25% of the plasma NE level in the control group at 30 minutes, 29% at 60 minutes, and 15% at 120 minutes. Cervical spinal cord transection, therefore, results in an abrupt but short-lived increase in plasma NE concentrations. These changes in plasma NE levels may explain, at least in part, the hemodynamic alterations and the acute central hemorrhagic necrosis that occur after high spinal cord trauma.

Animals↗
PubMed1991

Pediatric spinal epidural metastases.

A total of 2259 children with solid malignant tumors were treated at St. Jude Children's Research Hospital between the years 1962 and 1987. Of these, 112 (5%) developed spinal epidural metastasis with spinal cord compression during the course of their disease process. Metastatic epidural spinal cord compression was caused most commonly by Ewing's sarcoma and neuroblastoma, followed by osteogenic sarcoma, rhabdomyosarcoma, Hodgkin's disease, soft-tissue sarcoma, germ-cell tumor, Wilm's tumor, and (rarely) hepatoma. There was no significant difference in outcome between patients with small-cell tumors (neuroblastoma, Hodgkin's disease, and germ-cell tumors) who received only chemotherapy and/or radiation therapy and the patients with similar lesions who received a decompressive laminectomy alone or prior to chemotherapy and/or radiation therapy. Patients with spinal cord compression from metastatic sarcoma (Ewing's sarcoma, soft-tissue sarcoma, osteogenic sarcoma, and rhabdomyosarcoma) showed a significant improvement with decompressive laminectomy alone or before medical therapy, compared to those who received radiation therapy and/or chemotherapy without posterior decompression. Pediatric tumors invade the spinal canal via the neural foramen, compressing the spinal cord in a circumferential manner, allowing decompressive laminectomy (posterior approach) to be an effective surgical approach. Sixty-six percent of children who had no evidence of motor or sensory function below the level of the compression became ambulatory after surgical decompression and medical treatment, regardless of tumor type.

Adolescent↗
PubMed1999

Cervical cord compression caused by a pillow in a postlaminectomy patient undergoing magnetic resonance imaging. Case report.

A 66-year-old man, who had undergone osteoplastic laminectomy for posttraumatic cervical myelopathy, underwent a second operation in which the replaced laminae were removed because of postoperative deep wound infection. Follow-up dynamic magnetic resonance imaging with flexion and extension views of the neck 1 year postsurgery demonstrated that the cervical cord was markedly compressed from behind in the extended position, although a wide subarachnoid space was observed in this region when the neck was in the flexed position. The cause of cord compression was the pillow that was placed underneath the patient's neck for maintaining the extended position, not the neck extension itself. This finding indicates that care must be taken during neuroradiological examination not to place a pillow under the neck of a patient who has undergone laminectomy. Nuchal compression could lead to cervical cord injury after laminectomy. Laminoplasty benefits the patient by protecting the cervical cord from secondary injury.

Aged↗
PubMed2003

Topical mitomycin C-induced inhibition of postlaminectomy peridural fibrosis in rabbits.

OBJECT: The authors conducted a study to determine the effectiveness of mitomycin C in preventing postlaminectomy peridural fibrosis in rabbits. METHODS: Laminectomies were performed at L-4 in 12 rabbits. Color-coded cotton pads soaked either with 0.02% mitomycin C or saline were applied in a blinded fashion to the operative sites, with saline-treated laminectomy sites serving as controls. The rabbits were killed 30 days after surgery. The extent of peridural fibrosis was evaluated by histological analysis. The mitomycin C-treated sites showed significantly decreased peridural fibrosis. CONCLUSIONS: Peridural fibrosis can be a devastating condition that develops after laminectomy. Topical application of mitomycin C may be a successful method of preventing postlaminectomy peridural fibrosis.

Administration, Topical↗
PubMed2003

Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases.

OBJECT: Thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) is a rare entity, most evident in Japan. The authors studied the clinical manifestations, radiological aspects, surgical treatment, and pathogenesis of this disease. METHODS: Eighteen patients with OLF-induced thoracic myelopathy underwent laminectomy. The severity of myelopathy varied. Complete paraplegia was seen in three cases. Compression of the upper and middle third of the thoracic spine was evident in six cases and of the lower third in 12 cases. Multilevel OLF was demonstrated in 13 cases. In most cases, the ossified ligamentum flavum appears as a V-shaped lesion on computerized tomography and magnetic resonance images. In all patients the diameter of the posterior spinal canal, already narrowed, was further exacerbated by the OLF. Laminectomy was limited to the levels of compression, and the ligamentum flavum was resected in all cases. The symptoms and signs improved in 13 cases and stabilized in four cases. In one case symptoms recurred as a result of ossified lesions forming at other sites. Histological examination showed that the mode of development of the ossified ligaments was endochondral ossification. CONCLUSIONS: Reports of OLF-induced myelopathy are rare and mainly described in Japan. The incidence also seems high in North Africa. An early laminectomy limited to the level of compression is recommended. Ossified ligamentum flavum is different from the calcification of the ligamentum flavum, which is due to crystal deposits.

Adult↗
PubMed2006

Investigation of the dose-dependent neuroprotective effects of agmatine in experimental spinal cord injury: a prospective randomized and placebo-control trial.

OBJECT: No definitive treatment for spinal cord injuries (SCIs) exists, and more research is required. The use of agmatine [4-(aminobutyl)-guanidine-NH2-CH2-CH2-CH2-CH2-NH-C(-NH2)(=NH)], a guanidinium compound formed by decarboxylation of L-arginine by arginine decarboxylase, is a neurotransmitter-neuromodulator with both N-methyl-D-aspartate receptor (NMDAR)-antagonizing and nitric oxide synthase (NOS)-inhibiting activities. The purpose of this study was to demonstrate the dose-dependent activity of agmatine, an inducible NOS (iNOS) inhibitor and selective NMDAR antagonist, on biochemical and functional recovery in an experimental rat SCI model. METHODS: This study involved 40 Wistar albino male rats. The rats were subjected to sleep-awake cycles for 7 days before surgery. In each group, general anesthesia was induced by a 60-mg/kg ketamine injection. For the surgical SCI model, a Yaşargil aneurysm clip was placed in the spinal cord. The study was conducted in the following four main groups: Group I (control group) laminectomy only; Group II, trauma-only group and SCI; Group III, laminectomy, SCI and agmatine 50 mg/kg for 10 days; and Group IV, laminectomy, SCI, and agmatine 100 mg/kg for 10 days. On Day 1, no statistical difference was observed in any group (p < 0.005, analysis of variance [ANOVA] and the Fisher protected least significant difference [PLSD]). On Day 2, no statistical difference was noted among Groups II, III, and IV (p = 0.27, p = 0.42, and p = 0.76, respectively; ANOVA and Fisher PLSD). Beginning on Day 3, recovery in Groups III and IV differed significantly from that in Group II (p < 0.005, ANOVA and Fisher PLSD), and a statistically significant difference between Groups III and IV was observed, which also was present on Days 5, 7, and 10 (p = 0.003, p = 0.0024, and p = 0.0036, respectively; ANOVA and Fisher PLSD). Several observations were noteworthy: motor function scores were reduced significantly in the spinal cord-injured rats compared with the controls (p < 0.005); on Day 1, the agreement of motor function scores in rats in each SCI group indicated that the traumatic event had been replicated equally across all groups (p = 0.59, p = 0.59, and p = 0.28); a statistically significant difference in motor function scores developed on Day 3 between the rats subjected to trauma alone (Group II) and those treated with agmatine (Groups III and IV) (p < 0.005); and no statistically significant intergroup difference in motor function existed at any postinjury interval between the 50- and 100-mg/kg/day agmatine-treated rats (p > 0.005). CONCLUSIONS: Agmatine administration following SCI was shown to reduce NO levels significantly. No statistically significant intergroup difference in the reduction of NO levels was found between rats treated with 50- and 100-mg/kg/day doses of agmatine. Administration of a 100-mg/kg/day dose of agmatine reduced the NO levels to those measured in controls. The authors conclude that with additional studies into the role of agmatine, this drug may be helpful in the treatment of patients with SCIs.

Agmatine↗
PubMed1990

An experimental study on prevention of postlaminectomy scar formation.

In repeat lumbar surgery for failed back syndrome, well organized fibrous scar tissue is often noted, binding together the dura, nerve roots, and paraspinal muscles. An animal experimental study was done to investigate the prevention of scar formation after lumbar laminectomy by using dacron and sodium hyaluronate. The experimental animals consisted of three groups: 1) control group, 2) D group (covering the laminectomy defect with dacron sheet), and 3) H group (covering the laminectomy defect with sodium hyaluronate gel). Animals were sacrificed at varying intervals (3-12 weeks) and the lumbar spines were evaluated with histologic preparations. Scar adhesion to the dura was most significantly suppressed in the D group, followed by the H group and the control group.

Animals↗
PubMed1998

Spinal fusion and pedicle screw instrumentation in the treatment of spondylolisthesis over the age of 60.

BACKGROUND: Spinal fusion or instrumentation for the treatment of spondylolisthesis in elderly people is still an issue of controversy. The purpose of this study was to assess the clinical results of laminectomy, posterolateral fusion, and pedicle screw instrumentation in patients over age 60. MATERIALS AND METHODS: From 1993 through 1994, 94 spondylolisthesis patients over age 60 underwent laminectomy, posterolateral fusion and pedicle screw instrumentation. All the patients had follow-up examinations 3 months, 6 months, 1 year and then annually after the operation. At each follow-up visit, the clinical results and complications were evaluated and a radiographic assessment was performed. The follow-up period ranged from 2 to 4 years. At the final follow-up visit, we administered a questionnaire designed for clinical evaluation. RESULTS: Seventy-five patients (80%) obtained improvement in back pain, 75 patients (80%) got improvement in leg pain, and 65 patients (69%) needed no medications. The average distance the patients were able to walk, at one time was 2.2 km. Sixty-seven patients (71%) could walk more than 500 m at a time. Seventy-four patients (79%) showed solid fusion, 20 patients inadequate fusion, and no psuedoarthrosis was found. Complications were rare. CONCLUSION: Laminectomy with spinal fusion and instrumentation is a good method for the treatment of spondylolisthesis in elderly people, and it can achieve a satisfactory clinical outcome.

Age Factors↗
PubMed1999

[Surgical technique and long-term follow-up of laminoplasty using titanium miniplates].

Problems concerning a spinal deformity due to simple laminectomy and the usefulness of laminoplasty are often reported recently. In our hospital, laminoplasty with titanium miniplates for spinal operations has been used in all cases since 1992. We started to use this method after we encountered several cases of post-operative spinal deformity following multiple-level laminectomy. We reviewed two different subgroups of patients. Group A consisted of 38 cases who were operated on using simple laminectomy. Group B consisted of 32 cases who were operated on using laminoplasty with titanium miniplates. Postoperative spinal deformity occurred in 5 patients of Group A (13%), and in none of Group B (0%). In particular, postoperative spinal deformity occurred in one child case of Group A (33%), and in none of Group B (0%). Laminoplasty is a very simple and efficient technique, and advantages are the presentation of stability of the posterior column and curvature of the laminae, as well as protection of the spinal cord. Compatibility with magnetic resonance imaging (MRI) is another advantage of titanium miniplates, because long follow-up using MRI is always necessary in these cases. In conclusion, laminoplasty with titanium miniplates for spinal operations are a very useful and safe technique.

Aged↗