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PubMed1989

Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals.

We determined the incidence of acute, major complications in a population of 28,395 patients who underwent lumbar laminectomy for discogenic radiculopathy in the United States in 1980. This population was drawn from a broad cross-section of community hospitals and represented 31% of all patients who underwent laminectomy that year for this condition. Our cohort excluded patients with a) operations exceeding two disc levels, b) fusion, c) previous lumbar laminectomy, or d) coexistent discitis, spondylosis, spinal stenosis, myelopathy, or arachnoiditis. The incidence of death was 5.9 per 10,000. The causes of death were septicemia, myocardial infarction, and pulmonary emobolus. The incidence of at least one major complication was 157 per 10,000. The incidences of specific complications were as follows: infection requiring intravenously administered antibiotics, 30.7; major neurological deficit, 29.8; pulmonary embolus, 10.7; and myocardial infarction, 5.6. We studied four additional categories of complication. Patients were counted only when a second operation was required to treat the complication. The categories and incidence per 10,000 were as follows: incisional hematoma, 8.7; cerebrospinal fluid fistula, 10.5; ventral perforation, 1.6; and retention of a foreign body, 0.7. Among the patients whose hospitalizations were otherwise normal, 6.7% received a blood transfusion; of the patients whose hospitalizations were complicated, 24% required transfusion. The demographic characteristics of transfusion. The demographic characteristics of patients with a normal hospitalization were tabulated separately from those whose hospitalizations were complicated. Neurosurgeons performed 60% of the operations, and orthopedic surgeons performed 40%. The speciality of the surgeon was not a factor in determining the risk involved in surgery. Spinal anesthesia was used in 7% of the cases, and no pattern of complications emerged that was uniquely related to that technique.

Demography↗
PubMed1996

The path of a wounding missile along the spinal canal: a case report.

STUDY DESIGN: The authors report a penetrating gunshot injury to the cervical spine at the C6 level, with retention of the missile within the spinal canal at the T10 level. OBJECTIVES: The treatment of this patient involved debridement of entrance wound on the day of admission and laminectomies in the cervical and thoracic levels 3 days after the incident. SUMMARY OF BACKGROUND DATA: The migration of a foreign body along the intracranial part of the central nervous system has been reported in the literature, but we have found no report of an intercanal gunshot wound measuring 30 cm with complete liquefaction of the cord. METHODS: On admission, a 21-year-old man had an entrance wound on the right side of neck. He had complete paraplegia and could not flex the wrist. The cervical spine radiograph revealed a fracture of the C5 arch and metallic fragments in the spinal canal. A radiograph of the thoracic and lumbar spine disclosed a bullet trapped at the T10 level. Laminectomies at C6-C7 and T9-T10 were performed and the bullet and its fragments were removed. The ruptured dura was replaced by lyophilized dura. RESULTS: The wounds healed without infection. On discharges the patient's neurologic status was unchanged. CONCLUSIONS: Laminectomies and removal of metallic foreign bodies were performed to reduce the risk of infection in the spinal canal and to prevent toxic effects of dissolved metals on uninjured parts of the central nervous system.

Adult↗
PubMed1996

Chemonucleolysis.

Even with a history of controversy and troubling complications, chymopapain has endured the test of time to show 30 years of clinical success in the treatment of herniated nucleus pulposus. Strict attention to indications, contraindications, and technique ensures safety and efficacy of treatment. A trend to decreased dosage may result in less postinjection spasm. Between 1982-1991, 121 adverse events in 135,000 patients were reported to the Food and Drug Administration and investigated. Seven cases of fatal anaphylaxis, 24 infections, 32 bleeding problems, 32 neurologic events, and 15 miscellaneous occurrences were found. Overall mortality rate was 0.019%. All categories were of lesser incidence than complications with laminectomy. Long-term results show that improvement after chemonucleolysis is maintained, whereas the outcome after laminectomy is reported to deteriorate with time. Cost savings with chemonucleolysis over laminectomy are largely a matter of shorter hospitalization. A protocol for cervical chemonucleolysis is being developed in the United States after good results have been shown in Spain and France. Other enzymes continue under investigation, but chymopapain remains the standard to which they are compared.

Adult↗
PubMed2004

Results of surgical treatment for degenerative cervical myelopathy: anterior cervical corpectomy and stabilization.

STUDY DESIGN: This retrospective study involves 26 patients with degenerative cervical myelopathy who were surgically treated by anterior corpectomy, titanium mesh cage (TMC) filled with autogenous bone, and anterior plate +/- posterolateral plate and fusion. OBJECTIVES: This study was conducted to determine the indications, efficacy, and complication rate associated with performing corpectomy to achieve anterior decompression of neural elements or for removing anterior lesions. SUMMARY OF BACKGROUND DATA: This retrospective study involves patients with degenerative cervical myelopathy who were surgically treated by > or =2-level anterior corpectomy, TMC filled with autogenous bone, and anterior plate +/- posterolateral plate and fusion. The purpose was to evaluate and compare the results in terms of neurologic recovery and function and effectivity of TMC as a structural support. METHODS: Twenty-six patients with degenerative cervical myelopathy who had surgical treatment and average 30 months (range, 24-52 months) follow up were included. The mean age was 64.9 years (range, 55-74 years) and average period between myelopathic symptoms and surgery was 2.8 years (range, 6 months-5 years). Preoperative evaluation of every patient consisted of anterior-posterior, lateral, bilateral oblique, flexion, and extension radiographs, computed tomography reconstructions and magnetic resonance imaging of the cervical spine, Doppler ultrasound of the carotid arteries, vertebral artery magnetic resonance angiography, neurologic examination, and electromyography. Degree of pre- and postoperative myelopathy was determined according to the scoring systems developed by Nurick and Japanese Orthopedic Association (JOA). Twelve patients had a mild balance problem and difficulty while walking but were able to perform their daily activities. Fourteen patients had spastic quadriparesis ambulating on either crutches or with wheelchairs. Of these, 11 experienced bladder disturbance as well. Surgical treatment in 18 patients consisted of anterior decompressive corpectomy, structural TMC, and anterior plate stabilization in 14 patients who had 2-level corpectomy. Posterior plate stabilization without laminectomy was added to this procedure in another 4 patients who had 3- or more level corpectomy. The remaining 8 patients had first laminectomy and posterolateral plate, then anterior corpectomy, TMC, and anterior plate on the same stage. Corpectomy levels were between C3 and T1, and anterior corpectomy, structural TMC, and anterior plating was the procedure that all patients had in common. RESULTS: Mean sagittal Cobb angle (C2-C7) was 9 degrees (range, 0-23 degrees) before surgery, 17.1 degrees (range, 11-22 degrees) on the third postoperative month, and 16.9 degrees (range, 10-22 degrees) at last follow-up. The difference in sagittal alignment on the third month and last follow up was not statistically significant (P > 0.05). Average preoperative Nurick score was 3.5 (range, 2-5) and JOA score was 7 (range, 1-14). Major and statistically significant neurologic recovery was within the first 3 months, and average Nurick and JOA scores at 3 months were 2 (range, 0-3) and 11 (range, 8-17) (P < 0.001), respectively. All patients had improved neurologic status at final follow up. As confirmed by plain radiographs and computed tomography reconstructions, solid fusion was achieved across the TMC with no settling or migration, and we had no implant-related complication or failure. As major complications, 1 (3.8%) early deep posterior infection developed but responded to early debridement and antibiotics. Also, 3 patients (11.5%) had transient C5 nerve root injury. At final follow up, all patients were able to ambulate without support and maintain their daily activities. CONCLUSIONS: Anterior decompression provides good neurologic recovery in patients with degenerative cervical myelopathy. TMC provides good structural support, and solid fusion can be achieved with TMC and anterior plate (for < or =2-level corpectomy) and/or posterior plate (> or =3-level corpectomy). There is increased risk of C5 nerve root injury when first laminectomy and posterolateral plate stabilization are performed.

Aged↗
PubMed2005

Acute quadriparesis caused by calcification of the entire cervical ligamentum flavum in a white female--report of an unusual case and a brief review of the literature: case report.

STUDY DESIGN: Case report. OBJECTIVES: To describe an extremely unusual case of acute quadriparesis in a white female caused by calcification of the ligamentum flavum (LF) from C1 to T2, and to review briefly the pertinent literature. SUMMARY OF BACKGROUND DATA: Diseases characterized by abnormal calcium deposition on the spinal ligaments have an unclear etiology. The overwhelming majority of these cases has been reported in people of Asian descent and has a predilection for the thoracic spine. Multilevel involvement of the cervical LF in white patients is exceptionally rare. To our knowledge, complete calcification of the entire cervical LF has not been previously reported in the literature. METHODS: The history, physical examination, and radiographic studies of a 64-year-old white female with a history of scleroderma are described. The patient presented with neck pain and acute quadriparesis caused by spinal cord impingement by calcified cervical LF from C1 to T2. The patient underwent emergent C3-C7 laminectomy and C2-C7 posterior spinal fusion. RESULTS: Operative intervention resulted in marked neurologic improvement and relief from neck pain. Histopathologic examination of the calcified LF showed that the deposits consisted of hydroxyapatite crystals exclusively with no heterotopic bone. However, kyphosis did develop in the patient after laminectomy. CONCLUSION: To our knowledge, this unusual case of complete calcification of the entire cervical LF has not previously been described. Multilevel laminectomy and fusion can improve neurologic function but may result in kyphosis.

Acute Disease↗
PubMed2006

Effects of resveratrol and methylprednisolone on biochemical, neurobehavioral and histopathological recovery after experimental spinal cord injury.

AIM: To investigate the neuroprotective effect of resveratrol in an experimental spinal cord injury (SCI) model in rats. METHODS: Male Wistar albino rats weighing 200-250 g were randomized into six groups. Weight-drop trauma was performed for SCI. Group 1 underwent laminectomy alone. Group 2 underwent laminectomy followed by SCI. Groups 3, 4, 5, and 6 underwent laminectomy followed by SCI and received resveratrol (100 mg/kg), methylprednisolone (MP) (30 mg/kg), resveratrol (100 mg/kg) plus MP (30 mg/kg), and ethanol (2%), respectively. The rats were divided into two subgroups for biochemical analysis (killed at 24 h after surgery) and for neurobehavioral and histopathological evaluation (killed at 6 weeks after surgery). Posttraumatic neurological recovery after surgery was recorded weekly. RESULTS: Groups 3 and 5 revealed significantly lower malon-dialdehyde, nitric oxide, xanthine oxidase, and higher glutathione levels than group 4 (P<0.05). Neurological recovery rates were significantly better in groups 3 and 5 than group 4 (P<0.05). When spinal trauma size ratios were compared, there was no significant difference between treatment groups. CONCLUSION: Resveratrol treatment revealed better biochemical recovery in the acute stage of trauma than MP treatment. Although resveratrol and combined treatment revealed better neurobehavioral recovery than MP treatment; resveratrol, MP, and combined treatment modalities improved histopathological recovery at the same level in the final stage of the experiment. Future studies involving different doses of resveratrol and different doses combinations with MP could promise better results as each drug has a different anti-oxidative mechanism of action.

Animals↗
PubMed2006

Thoracic myelopathy caused by ossification of ligamentum flavum of which fluorosis as an etiology factor.

PURPOSE: To evaluate the clinical feature, operative method and prognosis of thoracic ossification of ligamentum flavum caused by skeletal fluorosis. METHODS: All the patients with thoracic OLF, who underwent surgical management in the authors' hospital from 1993-2003, were retrospectively studied. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis existed. The neurological statuses were evaluated with the Japanese Orthopaedic Association (JOA) scoring system preoperatively and at the end point of follow up. Also, the recovery rate was calculated. RESULTS: 23 cases have been enrolled in this study. Imaging study findings showed all the cases have ossification of ligamentum flavum together with ossification of many other ligaments and interosseous membranes, i.e. interosseous membranes of the forearm in 18 of 23 (78.3%), of the leg in 14 of 23 (60.1%) and of the ribs in 11 of 23 (47.8%). Urinalysis showed markedly increased urinary fluoride in 14 of 23 patients (60.9%). All the patients were followed up from 12 months to 9 years and 3 months, with an average of 4 years and 5 months. The JOA score increased significantly at the end of follow up (P = 0.0001). The recovery rate was 51.83 +/- 32.36%. Multiple regression analysis revealed that the preoperative JOA score was an important predictor of surgical outcome (p = 0.0022, r = 0.60628). ANOVA analysis showed that patients with acute onset or too long duration had worse surgical result (P = 0.0003). CONCLUSION: Fluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. En bloc laminectomy decompression was an effective method. Preoperative JOA score was the most important predictor of surgical outcome. Patients with acute onset or too long duration had worse surgical outcome.

Journal Article↗
PubMed2004

Hypertrophic neuropathy of the cauda equina: case report.

OBJECTIVE AND IMPORTANCE: Hypertrophic neuropathy of the cauda equina (HNCE) is a rare form of peripheral neuropathy. The diagnosis is complicated by an insidious clinical presentation and complex radiographic images. We present a case of HNCE caused by chronic inflammatory demyelinating polyneuropathy with symptomatic improvement after decompressive lumbar laminectomy and dural expansion. CLINICAL PRESENTATION: A 54-year-old woman with a history of back pain since she was in her 20s presented with low back and radicular pain that had increased during a period of 6 months, bilateral lower-extremity weakness, and sensory loss in the right thigh. Magnetic resonance imaging of the lumbosacral spine revealed multiple, poorly enhancing mass lesions and apparent intrathecal nerve root thickening from L1 to L5. INTERVENTION: An L1-L5 decompressive laminectomy, performed with continuous somatosensory evoked potential and electromyographic monitoring, revealed multiple segmentally enlarged nerve roots. One nerve root that did not respond to high levels of stimulation was identified. This root was resected and submitted for pathological analysis. The dura was expanded with an 11-cm-long dural patch. The pathological examination revealed hypertrophic neuropathy, with extensive S-100-positive "onion bulb" formation. The patient's symptoms improved postoperatively. CONCLUSION: HNCE is a rare disorder that can cause radicular pain and lower-extremity weakness, sensory loss, and hyporeflexia. One possible cause is demyelinating polyneuropathy. Although medical management is typically effective in the treatment of demyelinating polyneuropathy, it has little effect on compressive symptoms caused by intradural nerve root enlargement. As this case demonstrates, surgical management of symptomatic radiculopathy by lumbar laminectomy is a reasonable and effective approach to the treatment of HNCE.

Cauda Equina↗
PubMed2005

Effects of antithrombin III on myeloperoxidase activity, superoxide dismutase activity, and malondialdehyde levels and histopathological findings after spinal cord injury in the rat.

OBJECTIVE: Among the many possible mechanisms of the secondary spinal cord injury (SCI), microcirculatory disturbances as a result of activated leukocyte-induced endothelial cell injury is important because it is potentially treatable and reversible. Currently, clinically available pharmacological agents for treatment of acute SCI do not inhibit neutrophil activation. The effect of antithrombin III (AT-III) on neutrophil activation was studied in rats with SCI produced with an aneurysm clip on the T2-T7 segments. METHODS: Forty rats were randomly allocated to four groups. Group I (10 rats) was killed to provide normal spinal cord tissue for testing. Group II (10 rats) underwent a six-segment laminectomy for the effects of total laminectomy to be determined. In Group III, 10 rats underwent a six-segment laminectomy and SCI was produced by extradural compression of the exposed cord. The same procedures were performed in 10 rats in Group IV, but they also received one (250 IU/kg) intraperitoneal injection of AT-III immediately after the injury and a second dose 24 hours later. The animals from Groups II through IV were killed 48 hours after the trauma. The effect of AT-III on the myeloperoxidase activity, superoxide dismutase activity, and malondialdehyde levels and histopathological findings were studied. RESULTS: Myeloperoxidase activity, superoxide dismutase activity, and malondialdehyde levels were significantly lower and there was less histopathological damage in the AT-III treatment group than in the trauma group. CONCLUSION: The results demonstrate that AT-III treatment may reduce secondary structural changes in damaged rat spinal cord tissue by inhibiting leukocyte activation.

Animals↗
PubMed1998

Results of surgical treatment for ossification of the posterior longitudinal ligament of the thoracic spine.

Conservative treatment is ineffective for ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine, and surgical treatment is indicated for most cases, while such cases are not often experienced. In the present study, the results of surgical management involving mainly posterior decompression for this disease were evaluated clinically. The study included 9 patients (1 man and 8 women) who underwent surgical treatment for OPLL of the thoracic spine between 1984 and 1993. Laminectomy was performed in 5 patients, and laminectomy plus anterior decompression of the OPLL via the posterior approach based on Otsuka's method was performed in 2 patients. In 1 patient, laminoplasty for OPLL of the cervical spine was combined with laminectomy of the symptomatic lesion in the thoracic spine. One patient underwent anterior decompression and fusion. The results were evaluated using the Japanese Orthopaedic Association score (JOA score) and recovery rate. The postoperative follow-up period ranged from 1 year to 10 years and 3 months (mean, 4 years and 6 months). The mean JOA score was 4.8 before surgery and improved to 7.6 at the final examination. This was a mean recovery rate of 50.1%. Symptoms caused by OPLL in the thoracic spine can be alleviated by posterior decompression where OPLL extends from the upper to the middle thoracic spine or extends from the middle to the lower thoracic spine. It seems, however, that OPLL localized to the middle thoracic spine requires anterior decompression.

Adult↗
PubMed1996

Peroneal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors.

Thirty-two postoperative peroneal-nerve palsies in thirty patients were documented in a retrospective review of 10,361 consecutive total knee arthroplasties performed at one institution from 1979 through 1992. The mean age of the thirty patients was sixty-five years (range, twenty-eight to seventy-eight years). Four of these patients had had a previous proximal tibial osteotomy and five had had a previous lumbar laminectomy. Ten knees (ten patients) had preoperative valgus alignment of 12 degrees or more. A control group of 100 patients who had had total knee arthroplasty during the same period was computer-matched to the patients by age, sex, and operating surgeon. Comparison of this control group with the thirty patients showed that epidural anesthesia for postoperative control of pain (p < 0.03), previous laminectomy (p < 0.04), and preoperative valgus deformity (p < 0.0001) were significantly associated with peroneal nerve palsy. The relative risk for patients who had had a previous proximal tibial osteotomy was doubled, but this was not significant (p < 0.4). To determine risk factors associated with anesthesia better, a subgroup of 4388 total knee arthroplasties performed during a five-year period (1988 through 1992) was also studied. In this sample, twenty-five peroneal-nerve palsies were documented. Eighteen occurred after epidural anesthesia (p < 0.03); five, after general anesthesia; and two, after spinal anesthesia. An important finding of this study is the high frequency of delayed presentation of peroneal nerve palsy. We believe that epidural anesthesia for postoperative control of pain leads to decreased proprioception and sensation postoperatively. It is postulated that positioning of the limb in this unprotected state may be a factor in the late development of palsy. The concept of the so-called double-crush phenomenon may partially explain the palsy seen in the patients who had had a lumbar laminectomy and asymptomatic peripheral neuropathy.

Adult↗
PubMed1994

Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2-7) years.

We report the outcome of 71 consecutive posterolateral lumbar fusions without spinal instrumentation. The indication for the operation was spondylolysis-olisthesis, degenerative disc disease/facet joint arthrosis, or pain after prior laminectomy. Concerning pain relief, 29/43 patients with spondylolysis-olisthesis were classified as good. The corresponding figures in the group with degenerative disc disease and/or facet joint arthrosis were 8/16 patients and in the group with pain post-laminectomy, 6/12 patients. No surgical complications were noted. In the total material 54 patients had a solid fusion, as defined by radiographic osseous trabecular bridging at all intended levels. One-level fusions tended to heal solidly in a higher frequency than two-level fusions. For the spondylolysis-olisthesis group, healed fusion correlated with a good clinical result. Such a correlation could not be verified for the other diagnostic groups. We conclude that non-instrumented posterolateral lumbar fusion is a valid method for treating low-grade spondylolysis-olisthesis, especially when the aim is to fuse a single level. Improved patient selection methods are required in fusion for degenerative disc disease and pain after laminectomy.

Adolescent↗
PubMed1977

Indications for nonoperative treatment of spinal cord compression due to breast cancer.

A retrospective series of 12,478 patients with breast cancer included 2467 patients with spinal metastases. Local treatment was not necessary in 688 patients. Neurological dificit did not develop in 1735 patients who underwent radiotherapy. Forty-four patients developed myelopathy due to spinal cord compression as demonstrated by neurological examination and myelography. Twenty-six of these patients were initially treated by laminectomy and 18 were initially treated with radiotherapy. The two groups did not significantly differ in their outcome with respect to motor power, pain relief, or ability to walk. Six patients who underwent radiotherapy deteriorated during 2 months of treatment. Four of these patients were not operative candidates because of poor general condition (three patients) or long duration of paraplegia (one patient). Of two patients who underwent emergency laminectomy, one became paraplegic; however, the other patient was significantly improved. For this reason it is essential that patients undergoing radiotherapy for spinal cord compression be followed closely by a neurosurgeon. The authors believe that in appropriate cases radiotherapy alone can yield results as good as laminectomy combined with radiotherapy.

Adult↗
PubMed1984

Harrington rod stabilization for pathological fractures of the spine.

Nineteen patients with tumors involving the thoracolumbar spine were treated by Harrington rod stabilization following laminectomy. Sixteen patients had metastatic neoplasms, and three had primary tumors of the vertebral column. In five patients, extensive decompressive laminectomy and Harrington distraction rods to provide immediate stability were used as initial treatment; postoperative irradiation was then given. All five patients were ambulatory, and the four patients with preoperative pain all noted relief of pain following treatment. The remaining 14 patients had received radiation therapy to the spine prior to surgery; in these 14, indications for surgery included a combination of pain and weakness (10 patients), pain alone (two patients), or weakness alone (two patients). Of 12 patients with preoperative pain, after surgery pain relief was noted in nine patients, and eight were ambulatory. Major wound breakdowns occurred in two of the 14 patients who had received radiation prior to surgery. These results suggest that Harrington rod instrumentation is useful in providing postoperative stability and restoring alignment following laminectomy for tumors involving the spine, but carries an increased risk of wound-related complications if used in a previously irradiated region.

Adolescent↗
PubMed2001

Effect of anti-rat interleukin-6 antibody after spinal cord injury in the rat: inducible nitric oxide synthase expression, sodium- and potassium-activated, magnesium-dependent adenosine-5'-triphosphatase and superoxide dismutase activation, and ultrastructural changes.

OBJECT: The inflammatory cells that accumulate at the damaged site after spinal cord injury (SCI) may secrete interleukin-6 (IL-6), a mediator known to induce the expression of inducible nitric oxide synthase (iNOS). Any increased production of NO by iNOS activity would aggravate the primary neurological damage in SCI. If this mechanism does occur, the direct or indirect effects of IL-6 antagonists on iNOS activity should modulate this secondary injury. In this study, the authors produced spinal cord damage in rats and applied anti-rat IL-6 antibody to neutralize IL-6 bioactivity and to reduce iNOS. They determined the spinal cord tissue activities of Na+-K+/Mg++ adenosine-5'-triphosphatase (ATPase) and superoxide dismutase, evaluated iNOS immunoreactivity, and examined ultrastructural findings to assess the results of this treatment. METHODS: Seventy rats were randomly allocated to four groups. Group I (10 rats) were killed to provide normal spinal cord tissue for testing. In Group II 20 rats underwent six-level laminectomy for the effects of total laminectomy alone to be determined. In Group III 20 rats underwent six-level T2-7 laminectomy and SCI was produced by extradural compression of the exposed cord. The same procedures were performed in the 20 Group IV rats, but these rats also received one (2 microg) intraperitoneal injection of anti-rat IL-6 antibody immediately after the injury and a second dose 24 hours posttrauma. Half of the rats from each of Groups II through IV were killed at 2 hours and the other half at 48 hours posttrauma. The exposed cord segments were immediately removed and processed for analysis. CONCLUSIONS: The results showed that neutralizing IL-6 bioactivity with anti-rat IL-6 antibody significantly attenuates iNOS activity and reduces secondary structural changes in damaged rat spinal cord tissue.

Animals↗
PubMed2006

Spinal cord compression secondary to bone metastases from hepatocellular carcinoma.

Bone metastases are rare in primary hepatocellular carcinoma (HCC). Spinal cord compression (SCC) due to bone metastases occur commonly in patients with lung and breast carcinomas, and metastatic HCC is an unusual cause of SCC. Spinal cord compression is an oncologic emergency and treatment delays can lead to irreversible consequences. Thus, the awareness that SCC could be a potential complication of bone metastases due to HCC is of significance in initiation of early treatment that can improve the quality of life and survival of the patients, if diagnosed earlier. This paper describes four cases of primary HCC with varied manifestations of SCC due to bone metastases. The first patient presented primarily with the symptoms of bone pains corresponding to the bone metastases sites rather than symptoms of associated hepatic pathology and eventually developed SCC. The second patient, diagnosed as having HCC, developed extradural SCC leading to paraplegia during the course of illness, for which he underwent emergency laminectomy with posterior fixation. The third patient developed SCC soon after the primary diagnosis and had to undergo emergency laminectomy. Post laminectomy he had good neurological recovery. The Fourth patient presented primarily with radicular pains rather than frank paraplegia as the first manifestation of SCC.

Aged↗
PubMed1999

Treatment of syringomyelia after posttraumatic paraparesis or tetraparesis.

This retrospective study of 12 patients with syringomyelia related to spinal cord trauma with paraplegia or tetraplegia and secondary progressive neurologic deficits was conducted to evaluate various surgical treatments. Judging by the results of postoperative neuroradiologic examinations, 75% had incomplete reduction of the spinal fracture at the time of initial surgery. The secondary neurologic deterioration occurred within a delay of 146 +/- 16 months and included ascending sensory deficits in 92%, deafferentation pain in 83%, and increased motor weakness in 33%. There was a positive correlation between the severity of symptoms, incomplete reduction of spinal fracture, and the degree of arachnoid scarring in preoperative neuroradiologic examinations. Syringoperitoneal shunting was performed in 83% of patients, and laminectomy with arachnoid lysis and dural grafting were performed in 17%. Pain was improved in 75%, sensory deficits in 25%, and motor weakness in 8%. During the follow-up period of 44 +/- 25 months, 30% of patients with syringoperitoneal shunting required repeated operation for obstruction or infection, whereas the syringomyelia remained collapsed in the two patients with laminectomy with arachnoid lysis and dural grafting, but this did not require additional surgery. In conclusion, laminectomy with arachnoid lysis and dural grafting seems to be a promising alternative treatment for patients with secondary neurologic deterioration after traumatic paraplegia or tetraplegia. Syringoperitoneal shunting may be reserved for patients without severe arachnoid scarring.

Adult↗
PubMed2004

Surgical approach to C1-C2 nerve sheath tumors.

BACKGROUND: C1 and C2 nerve sheath tumors (NST) are unique in presentation, relationship to neighbouring structures and surgical approaches when compared to their counterparts in other regions of the spine. AIM: The strategies involved in the surgery for C1-C2 NST are discussed SETTING AND DESIGN: Retrospective study. METHODS: 21 patients with C1 (n=6) and C2 (n=15) NST were operated based on their position with respect to the cord i.e. anterior (4), anterolateral (10), posterolateral (5), and posterior (2). The tumors had extra- and intradural components in 20 patients; while in one, the tumor was purely intradural. The operative approaches included the extreme lateral transcondylar approach (3); laminectomy with partial facetectomy (5); laminectomy (11); and, suboccipital craniectomy and laminectomy (2). RESULTS: Total excision was performed in 13 patients; while in 7, a partial extraspinal component, and in 1, a small intradural component were left, in situ. Thirteen patients showed improvement by one or more grades in the Harsh myelopathy score; 2 patients with normal power had significant decrease in spasticity; while 5 maintained their grade. One poor-grade patient succumbed to septicemia. CONCLUSIONS: C1-C2 NST may have exuberant growth due to the capacious spinal canal and the absence of a "true" intervertebral foramen at this level. Surgical approaches are determined by its relationship to the cord. A "T incision" on the dura, the partial drilling of the facets, sectioning of the denticulate ligament, rotating the operating table 15 to 30 degrees, and at times sectioning the posterior nerve roots are all useful adjuncts for facilitating access.

Adolescent↗