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PubMed2000

Intraoperative sonography for spinal tumors. Correlations with MR findings and surgery.

BACKGROUND: To investigate the role of intraoperative ultrasonography during surgery for spinal tumors and the correlation between echographic, magnetic resonance and surgical findings. METHODS: Twenty patients with spinal tumor, explored by MRI of the spine, have been treated with ultrasound-guided surgery. The ultrasound exploration has been performed during laminectomy on the dural surface in all cases and, after the dural opening, on the spinal cord surface for intramedullary tumors. RESULTS: In all patients the ultrasound exploration has allowed to exactly define the extent of the laminectomy, the dural opening and the myelotomy. Meningiomas were hyperechoic and homogeneous, with well defined margins and often visible hyperechoic dural attachment; neurinomas were less hyperechoic and less homogeneous than meningiomas. Intramedullary tumors showed hyperechoic solid and hypoechoic cystic-necrotic components, although a specific tissue characterization (tumor infiltration, gliosis, edema) is not possible. CONCLUSIONS: Intraoperative ultrasonography should be used routinely during surgery for spinal tumors in order to reduce the extent of the laminectomy, dural opening and myelotomy. A good correlation exists between signal intensity on T1-weighted images of MR, the echographic aspect of the tumor and the pathological findings at operation.

Adolescent↗
PubMed1975

Electromyography in paraspinal muscles following surgery for root compression.

The paraspinal muscles were examined by electromyography (EMG) in 20 patients who had undergone laminectomy for root compression in the lumbosacral region. Cases were carefully selected to include only those in which there was no evidence of recurrent radiculopathy. The precise anatomic sites having electromyographic (EMG) abnormalities (fibrillation potentials and positive sharp waves) were determined. These data were obtained to determine if EMG of paraspinal muscles following laminectomy is useful in patients with a suspected recurrence. EMG was done 1 cm and 3 cm lateral from the midline at each vertebral level from L3 through S2. The interval between surgery and EMG ranged from 3-1/2 to 41 months. Seventeen of the 20 cases showed EMG abnormalities; and of these, 15 were abnormal at three or more vertebral levels and 13 at both 1 cm and 3 cm from the midline. It was shown that patients who have undergone laminectomy for root compression may demonstrate EMG changes in the paraspinal muscles for periods of up to 41 months postoperatively even without recurrent radiculopathy. The abnormalities are usually present at both 1 and 3 cm lateral from the midline and at multiple vertebral levels.

Adult↗
PubMed2000

[Diagnosis and treatment of thoracic myelopathy due to degenerative thoracic spine disease].

OBJECTIVE: To summarize the experience in the early diagnosis and treatment of chronic thoracic myelopathy due to the compression of degenerative thoracic spine disease. METHODS: 21 patients with thoracic spinal stenosis were operated on from January 1995 to April 2000. Etiologically 16 patients were found to have ossification of the ligamentum flovum, 3 Scheuermann's disease, and 2 DISH. They were confirmed by CT, CTM, MRI and Magnetic MEP. Decompression was performed by en block unroof laminectomy for the posterolateral wall of the thoracic canal. The epstein criteria were used to judge the operative results. RESULTS: In the 21 patients 5 belonged to localized type, 10 continuous type, and 3 skip type in 21 cases. Three patients showed a compression from the anterior side, and 3 were complicated by OPLL of the cervical spine. Results were excellent in 4 patients, good in 8, improved in 2, and poor in 1. One patient was operated on two times because the extent of laminectomy was not enough for the first operation. CONCLUSIONS: Early diagnosis can be made if orthopedists are familiar with the clinical characteristics of thoracic myelopathy, and are alert to thoracic spine stenosis. En block unroof laminectomy is effective and safe to treat thoracic spine stenosis.

Adult↗
PubMed1975

The clinical syndromes and surgical treatment of thoracic intervertebral disc prolapse.

Doubt remains as to the safest surgical approach to the prolapsed thoracic intervertebral disc. Laminectomy, lateral rhachotomy and the transthoracic approach all have their protagonists. Twenty-two patients from the National Hospital for Nervous Diseases, Queen Square, and Atkinson Morley's Hospital have been reviewed. Their clinical presentation is discussed and the ancillary aids to diagnosis assessed. The diagnostic value of disc space calcification is stressed, and the use of air myelography as an adjunct to positive contrast myelography is noted. Fifteen patients were subjected to laminectomy, and seven to lateral rhachotomy. Each group contained patients with a wide range of neurological deficit. Six of the patients who underwent laminectomy were improved, two were unchanged, six deteriorated and one died. Of the patients who had lateral rhachotomy, six were improved, one was unchanged and none deteriorated. The conclusion is drawn that lateral rhachotomy is a safer procedure.

Adult↗
PubMed2002

Spinal epidural lipomatosis.

Epidural lipomatosis is an uncommon disorder defined as a pathologic overgrowth of normal epidural fat. It is most often associated with administration of exogenous steroids of variable duration and dose. However, it can occur in the absence of exposure to steroids. We report two cases of spinal epidural lipomatosis following more than 20 years of steroid use due to asthma. Pathologic compression fracture due to osteoporosis and acute cord compression syndrome were found in these 2 cases. After emergent decompressive laminectomy and fusion surgery, neurological function recovered. From a review of literature, most patients received decompressive laminectomy surgery. But in our additional cases, we performed decompressive laminectomy and fusion surgery which might prevent further spinal deformity and improve the spinal stability, then patients' symptoms subsided completely. Therefore, decompression surgery and fusion surgery may be necessary in patients with symptomatic spinal epidural lipomatosis with compression fracture.

Adrenal Cortex Hormones↗
PubMed2002

Management of spinal trauma in 69 cats.

This study sought to evaluate a series of clinical and radiological findings on spinal trauma in cats and the outcome that emerged from conservative or surgical treatment using 2 types of spinal stapling: stabilization using a Steinmann pin and coated polypropylene. Case records were reviewed for their diagnostic approaches on the basis of physical and neurological conditions, and concurrent disorders in addition to spinal trauma. Radiological examinations of the vertebral column were carried out using survey radiography, myelography and epidurography. All cases were classified according to etiopathogenesis of the disease. Surgical treatment consisted of decompression (laminectomy, hemilaminectomy and durotomy), or decompression with stabilization which was performed by one of two methods. The first one was the employment of translaminar stapling at the base of a spinous process and the other involved spinal stapling at the spinous process. The spinal lesions were identified as cervical (n = 2), thoracic (n = 35), lumbar (n = 22), sacral and caudal (n = 10). While 19 out of 30 conservatively managed cases recovered, the rest had persistent residual paresis and ataxia. Complete recovery was seen in 4 cats that underwent hemilaminectomy and 3 subjected to laminectomy. Partial recovery was observed in 5 cases involving laminectomy; however, there was no improvement observed in another 2 cases. Each animal was followed for at least a 3-month period to evaluate the clinical assessment of the results following treatment. The results of conservative and operative management of spinal trauma indicated that the type and degree of spinal cord degradation strongly influenced any prognosis. The results emerging from decompressive procedures seemed satisfactory for those cases where instability was not an issue. Both stabilization techniques were not ideal in terms of their methodological versatility or regarding weaknesses of bone structure observed in intra- and postoperative periods. However, translaminar stapling at the base of a spinous process was deemed to be the superior technique.

Animals↗
PubMed1976

Operative treatment of spondylolisthesis in young patients.

In a series of 91 patients under 20 years of age with lytic spondylolisthesis treated by different operations, 66 (73%) showed a displacement of more than 30 per cent at admission. If the displacement exceeds 30 per cent, it often progresses to a subtotal olisthesis. Spinal fusion should be performed before the displacement exceeds a third of the length of the vertebra. A posterior fusion with two massive tibial grafts was carried out in 78 patients (87.5%). Concurrent with fusion laminectomy was performed in 18 patients. Anterior vertebral body fusion was performed in 3 patients and posterolateral fusion in 10, in 4 of these as a secondary operation. Laminectomy alone was carried out in 4 patients, 3 of these having a total olisthesis. Laminectomy without fusion should be performed only in exceptional cases in young patients. Non-union or uncertain union after the primary operations occurred in 17 cases (19.5%); 15 reoperations were performed in 13 patients. The degree of displacement at operation did not influence the results. A progression of displacement despite dorsal fusion was observed in 14 patients. The final results of operative treatment were: good in 55 patients (60.4%); satisfactory in 23 (24.1%); unsatisfactory in 13 (15.5%). Posterolateral fusion seems to be preferable to posterior fusion.

Adolescent↗
PubMed2003

[Diagnosis and treatment of spinal dural arteriovenous fistulas: 110 cases report].

OBJECTIVE: To discuss the diagnosis, treatment and prognosis of spinal dural arteriovenous fistulas (SDAVF). METHODS: The clinical and following-up date from 110 patients with SDAVF diagnosed by spinal MRI and spinal angiography were analyzed retrospectively. RESULTS: Draining vein between fistula and spinal cord was interrupted by laminectomy approach as first choice in 61 patients, by hemi-laminectomy approach in 37, and by endovascular embolization in 12, and re-operation due to recurrence after embolization in 3. Anticoagulation, hydration and early rehabilitation were used postoperatively. Complete disappearance of SDAVF was confirmed in all 106 patients who received postoperative spinal angiography. The para-medullary tortuous flow voids fully disappeared in 74 patients and partly disappeared in 15 on postoperative T(2)-weighted MRI. Follow up of 98 patients showed complete recovery in 54 patients, improvement in 34, and no change in 10. Three of the 10 patients were reoperated on because of recurrence 1 to 5 years after embolization. CONCLUSIONS: SDAVF can produce good outcome after early diagnosis and treatment. Interruption of the draining vein between fistula and spinal cord by hemi-laminectomy approach is the first choice for the treatment of SDAVF.

Adult↗
PubMed2003

[Continuous bilateral sacral neuromodulation as a minimally invasive implantation technique in patients with functional bladder changes].

OBJECTIVE: Up to 50% of patients with bladder dysfunctions undergoing sacral neuromodulation treatment are non-responders. The most common treatment method today is the implantable neuromodulation system described by Tanagho and Schmidt; which allows unilateral sacral nerve stimulation. Our aim was to increase the number of responders and to improve the general efficiency of chronic sacral neuromodulation; therefore we have developed the bilateral electrode implantation by minimally invasive laminectomy. METHODS: PNE-tests were carried out to assess which patients were likely to be good responders. Thirty patients (16 with detrusor instability, 14 with hypocontractile detrusors) were subjected to minimally invasive laminectomy and received implants of bilateral electrodes. RESULTS: In those patients with a hyopcontractile detrusor, the level of residual urine of initially 350 ml was reduced to 58 ml, and the maximum detrusor pressure during micturition increased from initially 12 cMH2O to 34 cmH2O. In the other patient group with detrusor instability, the average number of incontinence incidences could be reduced from initially 7.2 to 1 per day, while the bladder capacity rose from 198 ml to 348 ml. The modulation effect did not show any signs of deteriorating in any of the patients. The follow-up period was 28 months on average. CONCLUSIONS: Clinical experience has shown that optimal neuromodulation in patients with bladder dysfunction can be achieved by this new approach involving bilateral electrode implantation. Moreover, the laminectomy implantation method guarantees a minimum of invasive trauma and enables optimal placement and fixation of the electrode.

Electric Stimulation Therapy↗
PubMed2004

Thoracic myelopathy secondary to ligamentum flavum ossification.

INTRODUCTION: Focal ossification of the ligamentum flavum (OLF) is a rare cause of thoracic myelopathy. The lower thoracic spine is most frequently affected and the patients present initially with posterior column disturbances followed by progressively increasing spastic paraparesis. The pathogenesis of OLF has not been conclusively established. MATERIALS AND METHODS: Five patients with thoracic myelopathy due to OLF underwent decompressive laminectomy and excision of the ligamentum flavum. Magnetic resonance (MR) images consistently revealed a linear or beak-like excrescence, uniformly hypodense on T1- and T2-weighted images, situated posterior to the thecal sac. A comparison of the preoperative neurological status and at followup was done using the Japanese Orthopaedic Association and Nurick scores modified for thoracic myelopathy. RESULTS: Decompressive laminectomy with excision of the OLF resulted in significant improvement in motor weakness and gait in 4 (1 excellent, 2 good, and 1 fair) patients who had slow-onset, but progressive compression, OLF. The patient who had acute traumatic spinal injury did not recover despite decompression and rehabilitation. All improved in their gait and spasticity, but 4 patients had persistent sensory deficit. CONCLUSION: OLF can significantly contribute to a spatial reduction of the thoracic spinal canal, resulting in slowly progressive paraparesis or acute paraplegia after trauma to the back. The T2-weighted sagittal image of MR imaging is the modality of choice for screening the longitudinal extent of OLF, with increased diagnostic accuracy when combined with computed tomographic myelogram. Neurological improvement usually occurs following decompression laminectomy with or without excision of the OLF. However, the persistence of residual numbness or weakness at follow-up may be due to irreversible changes within the cord as a result of severe thecal compression and the delay between the onset of initial symptoms/signs and surgical decompression. Prognosis remains poor for acute myelopathy with pre-existing OLF, despite surgery.

Aged↗
PubMed2006

[Experimental research of allogeneic bone sheet in preventing epidural adhesion].

OBJECTIVE: To study the effect of the allogeneic bone sheet that has been treated by the freeze-drying and radiation sterilization in preventing the epidural adhesion after laminectomy in sheep. METHODS: Laminectomy was performed on L(3,4) and L(1,5) of 12 adult male sheep. After operation, one site of L(3,4) or was covered by the allogeneic bone sheet in "H" shape after the freeze-drying and radiation sterilization treatment; and the other site was used as a control. The sheep were killed and the specimens were retrieved at 4, 8, 12, 16, 20 and 24 weeks after operation to observe the scar formation process. X-ray and CT scan were performed in the segments of L(3,4) and L(4,5) at 4 and 24 weeks. RESULTS: Four weeks after operation, the position and the shape of the allogeneic bone sheet were good in condition, and no lumbar spinal stenosis or compression of the dura was found in the experimental sections. Twenty-four weeks after operation the examination on the experimental sections revealed that the vertebral canal reconstruction was completed, the allograft was absorbed almost completely, and inoculation with the lamina of the vertebra and the shape of the lumbar spine were good, with no fibroid tissues found in the epidural area. Compared with the control segment, the dura adhesion degree in the laminoplasty segment was significantly decreased (P < 0.01), and the dura sac remained in a good shape. There was no obvious compression on the dura. CONCLUSION: The allogeneic bone sheet after the treatment of freeze-drying and radiation sterilization can effectively reduce the scar formation after laminectomy and prevent postoperative recurrence of the spinal stenosis.

Animals↗
PubMed1991

[Dumbbell neuroblastoma. Experience at the Gustave Roussy Institute in 38 cases treated from 1982 to 1987].

Among the 282 neuroblastomas treated at the Institut Gustave-Roussy between 1982 and 1987, 38 dumbbell forms were observed. Therapeutic approaches included: 1) An initial laminectomy in forms with neurological deficit; 2) Surgical excision of the primary tumor; 3) Preoperative chemotherapy for metastatic forms and non-metastatic forms in which primary tumors considered unresectable at diagnosis; 4) Radiation therapy on macroscopic residual disease. Twenty three of 38 children presented with a neurological deficit. A laminectomy was performed in 21 cases. Neurological recovery was good in 8 cases, partial in 5 cases and absent in 5 cases. Three patients were aggravated after the procedure. The event free survival was 76%. This high survival rate is linked with: 1) The predominantly non metastatic stages (25/38); 2) A high proportion of children under 1 year of age (25/38); 3) A high proportion of thoracic locations. Out of the 29 survivors, there were 10 cases of major neurological sequelae (34%) and 9 cases of major orthopedic sequelae (31%). The coexistence of a serious functional prognosis and an excellent vital prognosis led us to analyse the therapeutic modalities and reevaluate the necessity of routine initial neurosurgical excision by laminectomy, and using a first line chemotherapy in selected indications.

Adolescent↗
PubMed1991

Degenerative lumbar spondylolisthesis. II. Surgical treatment.

The authors analyze the results of operative treatment in 32 cases of degenerative spondylolisthesis with various degrees of compression of the nervous structures. Five types of surgery were performed: unilateral laminotomy; bilateral laminotomy with or without transverse process fusion; bilateral laminectomy with or without spinal fusion; and laminectomy, spinal fusion, and interspinous wiring. Satisfactory results were achieved in 84% of the cases. Seventy-six percent of the patients had further vertebral displacement, and 81% showed varying degrees of articular process regeneration more than two years after surgery; these findings concern both patients who had been treated with spinal fusion and those who had not. Bilateral laminotomy is indicated in patients with isolated nerve root canal stenosis; as the olisthesis is mild and lateral flexion-extension radiographs show no vertebral hypermobility, spinal fusion is not necessary. When central spinal canal stenosis is present, bilateral laminectomy, extensive lateral decompression, and spinal fusion are recommended. Interspinous wiring may be useful for immediate vertebral stabilization.

Aged↗
PubMed1991

The older athlete after lumbar spine surgery.

Surgery consists of spinal decompression for predominately leg pain problems. The most commonly performed surgery in older patients is the lumbar laminectomy. Total laminectomy is the procedure recommended for central canal stenosis. More commonly, central canal, lateral recess, and foraminal stenosis occur in the same patient. Lateral recess stenosis may be the major offending blockage in the canal. This may be treated with a total laminectomy or a bilateral medial facetectomy performed through the microscope with excellent decompression of the lateral recess. Foraminal stenosis can also be decompressed from a paraspinous position with the foraminotomy performed from the outside in. This can be combined with a microscopic medial facetectomy. Essentially, all these operations remove bone and redundant tissue to allow the nerve adequate freedom in the spinal canal and/or intervertebral foramina. Fusions are performed predominantly for degenerative spondylolisthesis to prevent the recurrence of radiculopathy. Internal fixation may be indicated in any situation in which the surgeon feels that the fusion rate is potentially compromised, but he or she must be aware that internal fixation does not guarantee spine fusion. Spinal instrumentation certainly increases the complication rate. The number of levels fused and the inclusion of the sacrum are important in predicting the fusion rate.

Aged↗
PubMed1990

"Silent" spinal dislocation in a Charcot spine occurring postlaminectomy: case report and review of literature.

A 45-year-old man with transverse myelitis developed an unstable neuropathic spinal arthropathy manifesting as a "silent" L1-L2 dislocation after laminectomy and rhizotomies performed for increased spasticity. Treatment consisted of reduction, posterolateral spinal fusion with Cotrel-Dubousset instrumentation utilizing hooks and pedicular screws, and a posterior lumbar interbody fusion. The authors conclude that laminectomy on a chronic paralytic through the insensate area should be coupled with fusion and instrumentation even if the facet joints and capsules are preserved during the laminectomy.

Adult↗
PubMedDate not supplied

Gd-DTPA enhancement of posterior epidural scar: an experimental model.

Because of the tremendous clinical and physiological importance of anterior epidural scar, an easily produced and reproducible model to assess potential pathways for lessening its formation is a necessity. We speculated whether posterior epidural scar (produced by the less complex surgery of laminectomy alone) could be considered equivalent to anterior scar from an imaging standpoint; that is, enhancement following Gd-DTPA irrespective of scar age. Posterior epidural scar in dogs showed the highest degree of enhancement 1 month after surgery, with a rapid decline thereafter out to 4 months postsurgery to a level equivalent to that of paraspinal muscle. Gd-153-DTPA time/activity curves paralleled the Gd-DTPA findings. Light microscopy showed granulation tissue after 1 month, and mature scar with large amounts of collagen 4 months after surgery. Electron microscopy showed tight capillary endothelial junctions. An appropriate model for epidural scar, which has imaging characteristics similar to human anterior scar, necessitates an extensive lumbar laminectomy with anterior epidural dissection. A simple laminectomy, while easily performed, does not provide a physiologically correct time course of enhancement.

Animals↗
PubMed1989

[Dumbbell neurogenic tumors. 5 cases (4 thoracic, 1 lumbar)].

Benign in more than 90% cases, dumbbell neurogenic tumors are rare. It was 3 thoracic schwannome and 1 thoracic ganglioneuroma and 1 lumbar schwannoma are reported. In 2 cases complete removal was performed by thoracotomy, in another case thoracic removal was incomplete with leateag of spinal fluid, laminectomy was necessary 3 months later and in a third case laminectomy was performed first because of paraplagia and thoracotomy one month later. In lumbar case a two ways procedure in 3 weetes space permitted complete removal, a monoparesia and sphincters troubles, regressive spontaneously in 5 months, complicated first performed laminectomy. Schwannome and benign neurofibroma are the most frequent tumors. Latero vertebral situation in chest radio or in abdominal ultrasonography must induce neurogenic tumors diagnosis. Myelography or tomodensitometry confirms intraspinal extension when osseous signs are present on vertebral radiographies. In thoracic localization a one stage combined resection gives the lowest morbidity. In lumbo-sacral localization tumoral large size requires a combined approach, which can be performed in a single stage. Recklinghausen's association in neurofibroma (4 to 16%) exposes to malign evolution risk (12 to 13%).

Adult↗
PubMed1989

Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting.

Between 1976 and 1984, fourteen patients who had severe cervical kyphosis and myelopathy were treated with anterior decompression and arthrodesis. Eight had had spondylosis; five, a traumatic injury; and one, a benign intradural tumor. In eight of the fourteen patients, the severe kyphosis and myelopathy had developed after a laminectomy of three, four, or five cervical vertebrae. The laminectomy had been done for the treatment of spondylosis in five patients, of a traumatic lesion in two, and of a tumor in one. Considering all fourteen patients, an average of 2.25 vertebral bodies was removed from each, and the average extent of the subsequent fusion was 3.25 levels. Eight patients (six of whom had spondylosis; one, a traumatic lesion; and one, a tumor) were treated with a fibular graft that spanned an average of 4.10 levels, and six patients (four of whom had a traumatic lesion and two, spondylosis) were treated with an iliac graft that spanned an average of 2.70 levels. Of the five patients who had a traumatic lesion, four were treated with anterior decompression and arthrodesis, combined with posterior arthrodesis that was performed during the same period of anesthesia. In three patients, the anterior graft dislodged during the immediate postoperative period. Two of the three patients had posterior instability due to a prior laminectomy, and in the third the graft dislodged because of technical difficulties. Two of these grafts were revised to restore stability. At the latest follow-up, twelve of the fourteen fusions were solid. In the other two patients, who died six and ten months postoperatively, the fusion had been solid, as shown by radiographs, before the time of death. The average amount of correction of the kyphotic deformities was 32 degrees, a reduction from an average of 45 degrees to an average of 13 degrees. All but one patient had some recovery of neural function; nine had complete and four, partial recovery. The remaining patient had relief of pain, but he continued to be completely quadriplegic although he had some sensory sparing. Of the four patients who had been unable to walk preoperatively, three were able to walk postoperatively. No patient lost neural function after the anterior decompression and arthrodesis. We concluded that, in the presence of severe cervical kyphosis and myelopathy, adequate anterior decompression of the spinal cord, correction of the kyphosis, and anterior arthrodesis using a strut graft can yield excellent results without undue risk.

Adult↗