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PubMed2006

[Perioperative treatment for senile lumbar disease accompanied by internal disease].

OBJECTIVE: To investigate the surgical method and perioperative treatment for senile lumbar disease accompanied by internal disease. METHODS: From June 2000 to December 2003, the complete neurological and physical examinations were performed on the patients before operation, as treatment of internal diseases could improve the patients' conditions. Lumbar operations were performed on 125 patients, among whom 23 had simple lumbar disc herniation, 13 had lumbar spine stenosis, 81 had lumbar disc herniation with lumbar spine stenosis, and 8 had spondylolisthesis. The JOA score was 11.6 +/- 2.5. There were 3 patients undergoing fenestration + discectomy, 16 undergoing semi-laminectomy + discectomy, 82 undergoing total-laminectomy + discectomy, 5 undergoing total-laminectomy+discectomy+pedicle fixation, 11 undergoing lamina decompression+nerve-root pathway decompression, and 8 undergoing pedicle screw fixation+bone graft and fusion in spondylolisthesis. RESULTS: With an effective medical treatment, the internal disease produced little effect on the operation. Improved functions and bone fusions were observed after operation. According to the JOA standards, the average alleviation rate was 87.9%. CONCLUSION: Early neurological examination and proper treatment of internal diseases are the keys to the successful operation on the senile patients with lumbar disease. Radiological data are important in avoidance of mistaken diagnosis.

Aged↗
PubMed1991

Metastatic epidural spinal cord compression.

It is important to remember that ESCC is a complication of systemic malignancy and usually denotes disseminated disease with poor survival rates. Early diagnosis is crucial. The initial symptom is almost always back pain, which is local, radicular, or both. Following neurologic examination and radiography, MRI scanning or myelography/CT is immediately indicated if radiculopathy or myelopathy is present or if the radiographs of the spine are abnormal. In cancer patients with local back pain and normal findings on neurologic examination and radiography of the spine, there is still a probability of 0.1 of significant ESCC. Therefore, urgent CT/MRI scanning is justified. At present, the best treatment for ESCC remains unknown. In the majority of patients, radiotherapy is the most readily available and appropriate option because it is equal in effect to posterior decompressive laminectomy in both radiosensitive and radioresistant tumors. In patients with posterior epidural disease without tissue diagnosis, laminectomy with or without stabilization should be performed. Posterior decompressive laminectomy alone is contraindicated in patients with vertebral collapse. In selected instances of anterior epidural compression without tissue diagnosis or after failure of radiotherapy, an anterior surgical approach or synchronous vertebral decompression with posterior stabilization may be indicated. In the future, after appropriate clinical trials, vertebral body resection may be the optimal approach in de novo selected patients with ESCC with radioresistant tumors and limited systemic spread of the disease.

Combined Modality Therapy↗
PubMedDate not supplied

[Myeloma and epidural invasiveness. Clinical and therapeutic aspects (a study of 22 cases)].

The authors have retrospectively studied 22 cases of spinal cord compression among 184 patients having multiple myeloma or plasmocytoma. Neurological signs were the initial symptoms of the malignant plasmocytosis in 32% of the cases. Seven patients had paraplegia, 13 paraparesia and three had no motor involvement. A laminectomy was performed in half of the cases (with or without local radiotherapy and/or chemotherapy); the 11 other patients were treated by radiotherapy and/or chemotherapy alone. Sixteen patients (72%) improved, 10 in the laminectomy group and six in the other. The improvement seemed to be better after the laminectomy (and/or radiotherapy or chemotherapy) but to a lesser extend if the patients were paraplegic, in case of sudden onset and of compression at the thoracic level. The median of survival was 30 months. They emphasize the utility of magnetic resonance imaging for the diagnosis of epidural involvement before the occurrence of objective neurological complications.

Adult↗
PubMedDate not supplied

Lumbar spinal stenosis by postdiscectomy hyperostosis.

The mesenchymal repair process of the connective tissue in the surgical wound following lumbar laminectomy presents three aspects: postoperative epidural scar, heterotopic bone formation in the epidural scar and vertebral hyperostosis around laminectomy. Twelve cases of lumbar spine hyperostosis consecutive to laminectomy, confirmed by x-ray findings and surgery are presented. The main symptom at presentation was a recurrent sciatic neuritis. Lumbo-sacral spine films showed a "bright" focal condensation in the previous surgical. Lamina inferior and superior and the articular facets were hypertrophic. Surgery confirmed the hyperostosis and compressive lumbar spine stenosis or foramen stenosis.

Adult↗
PubMed1995

Laparoscopic lumbar diskectomy: preliminary report of a minimally invasive anterior approach to the herniated L5-S1 disk.

Approximately 300,000 patients each year in the United States undergo laminectomy for disabling lumbar disk herniation. Postlaminectomy hospitalization is 3-7 days and convalescence may be prolonged. As an alternative to laminectomy, we have developed a technique for performing L5-S1 lumbar diskectomy laparoscopically. Using an anterior approach, the intervertebral disk space is opened and the diskectomy is performed under direct videolaparoscopic imaging. After pneumoperitoneum is established, the patient is placed in a steep Trendelenburg position. The small bowel is retracted cephalad and the colon moved to the left. The iliac vessels are identified visually and by Doppler probe. Then the presacral space is dissected in the midline to expose the L5-S1 disk. The disk annulus is opened with the Nd:YAG contact laser (four cases) or the harmonic scalpel (three cases). Diskectomy is performed under direct videolaparoscopic vision using standard neurosurgical instruments modified for laparoscopy. The posterior longitudinal ligament can be visualized directly to define the posterior limits of the completed diskectomy. Laparoscopy lumbar diskectomy has been performed on seven patients (five male, two female). No perioperative complications occurred. All seven patients had immediate relief of back pain after laparoscopic lumbar diskectomy. Five patients were discharged the next day and two on the second postoperative day. L5-S1 laparoscopic lumbar diskectomy is feasible and safe. It may be an effective minimally invasive alternative to laminectomy.

Adult↗
PubMed1996

Recurrent spinal stenosis caused by tophaceous gout: a case report and review of literature.

A 57-year-old man with severe gouty arthritis for over 20 years was admitted because of persistent back and leg pain and neurogenic claudication. Lumbar spinal stenosis from the L4 to L5 level was diagnosed after admission and decompressive laminectomy was done. However, about 10 months later, another surgery with laminectomy of L2 and L3 and postero-lateral fusion was performed due to post-laminectomy instability with recurrence of stenosis. The pathology of the resected ligmentum flava had tophi deposition. At the one-year follow-up examination after the second operation, the patient was pain free and had resumed daily activity.

Arthritis, Gouty↗
PubMed1998

3- to 11-year followup of occipitocervical fusion for rheumatoid arthritis.

The relief of myelopathy usually is unsatisfactory by a conventional Gallie type atlantoaxial fusion for patients with rheumatoid arthritis who have irreducible atlantoaxial dislocation. To accomplish a decompressive laminectomy of the atlas in the treatment of myelopathy, the authors have been performing a new surgical procedure since 1985 for occipitocervical fusion using a rectangular rod. The postoperative outcomes for 25 patients with rheumatoid arthritis were evaluated clinically and radiographically with a 3- to 11-year (mean, 6.5 years) followup. A decompressive laminectomy of the atlas accompanied the fusion in 21 of the 25 patients. The incidence of occipital or nuchal pains improved notably in most cases, and myelopathy was relieved in 12 of 18 (67%) cases, showing an improvement of more than one level based on Ranawat's criteria. No serious postoperative complications were seen, except for one case of a failed bone union. The cumulative survival in patients with myelopathy was 79.4% in the first 5 years after operation and 27.5% at 10 years. Occipitocervical fusion using a rectangular rod accompanied by a decompressive laminectomy of the atlas can contribute to the relief of a neurologic deficit in an irreducible atlantoaxial dislocation in rheumatoid arthritis.

Aged↗
PubMedDate not supplied

[Lumbar spinal stenosis. Symptomatology and methods of treatment].

INTRODUCTION: Lumbar spinal stenosis (LSS) may be defined as any type of the narrowing of the spinal nerve root canal (the lateral recess), intervertebral foramina, or its combination. It may be local, segmental or generalized; it can be caused by bone or soft tissue, and the narrowing can involve the bony canal or the dural sac or both. The normal sagital diameter of the lumbar canal is 15 to 25 mm and measurements below this are regarded as suggestively abnormal; a diameter less than 12 mm confirms the presence of stenosis. On the other hand, the lateral recess height less than 3 mm is suggestive, and less than 2 mm is a diagnostic sign of stenosis. There are two large groups of LSS: congenital-developmental stenosis and acquired stenosis with many subgroups (Scheme 1). The number of surgical operations due to LSS is increased during the ensuing years especially in elderly persons. This is why we would like to emphasize the important role of this phenomenon as there are only a few published papers in domestic literature. MATERIAL AND METHODS: In a consecutive series of 38 patients with LSS diagnosed for the last five years (January 1990-December 1994), aged from 20 to 70 years (average age 48.55) there were 21 males (Table 1); 34 of them had LSS as a result of bony changes, while the rest of 4 were iatrogenic (3 after disc extirpation and one after laminectomy) (Fig. 1). Herniation of the nucleus pulposus in combination with LSS was found in 12 patients (31.57%). Local segmental stenosis was identified in 16 patients (42.10%). (Graph. 1) (Fig. 2); the others had the generalized type of stenosis involving two levels (17 patients-44.7%); three levels (4 patients-10.52%) or 4 levels (one patient-2.63%) (Fig. 3). As far as symptomatology is concerned 31 patients had low-back pain with acute radicular complaints and motor weakness as the result of lesion of one or two spinal roots (20 patients). There were no neurogenic claudication or cauda equina compression syndromes. Electromyoneurographic studies (EMNG) in surgically treated patients revealed preoperative signs of muscle denervation in 15 patients (7.42%) (Table 2); the rest of them had signs of chronic irritative lesions of the corresponding root. RESULTS: Twenty one patients were operated on: 19 with signs and symptoms of generalized type of LSS and only two with lateral recess stenosis (Table 2). Congenital developmental stenosis was identified in 6 young patients (20 to 40 years of age) (Fig. 4). Single-level laminectomy with medial facetectomy and nerve root decompression was performed in 10 patients, and the rest of them had two level or three level decompressive laminectomies with medial facetectomy and roots decompression (Fig. 5). Dissectomy was done in 8 patients (Graph 2). None of our patients had concomitant arthrodesis, or needed reoperation. Postoperative EMNG improvement was confirmed in 13 patients of 15 (86.66%); this is about 61.90% in comparison to all operated patients (Table 3). The main complaints after the operation were: low-back pain (70%), leg numbness (70%), slight walking difficulties (60%); however all were able to walk more than 500 meters. The answer to the question how they felt after the operation, 15 patients responded to feel better or much better (71.42%), 3 felt the same (14.28%), and 3 felt worse than before the operation. Five patients retired before the operation, 7 changed their occupation taking an easier job, 9 returned to the same job, and none retired after the operation (Table 3). DISCUSSION: A certain number of patients had congenital-developmental stenosis with thickening of the laminae and development of short, squat pedicles with a decreased anterior-posterior diameter of the spinal canal. There are numerous variations of this pattern which remain asymptomatic until later developmental changes precipitate the typical radiculopathy and cauda equina changes in LSS. (ABSTRACT TRUNCATED)

Adult↗
PubMed1977

Combined therapy for metastatic extradural tumors of the spine.

The effectiveness of combined modality therapy was studied in 29 patients with metastatic extradural spinal tumor who had had a previous diagnosis of malignancy. Dexamethasone was begun upon suspicion of the diagnosis in a dose of 40 mg daily. Following emergency myelography, in all patients without rapid progression, dexamethasone in combination with radiotherapy and chemotherapy, when appropriate, was instituted. If deterioration occurred, decompressive laminectomy was performed. Five ambulatory patients had neurological function preserved and the condition of seven nonambulatory patients was improved to ambulation at discharge with a combination of dexamethasone, radiation therapy, and chemotherapy. These were patients with prostatic carcinoma, Hodgkin's disease, or breast carcinoma. In five patients who failed medical therapy decompressive laminectomy was successful. In patients with metastatic bronchogenic carcinoma, nonsurgical therapy failed and all underwent surgical decompression with a favorable outcome in only two of 10 patients.

Adult↗
PubMed1978

Epidural spinal cord compression from metastatic tumor: diagnosis and treatment.

The clinical findings in 130 conseucutive cases of spinal cord compression by metastatic extradural tumors were analyzed. These 130 patients were combined with a previous survey of 105 patients to compare the effectiveness of radiation therapy (RT) alone with that of surgical decompression followed by RT. Ambulation after treatment was considered a successful outcome. The most common primary tumors producing spinal cord compression were (in order) breast, lung, prostate, and kidney. In 68% of these tumors the thoracic region was involved. Pain was the primary symptom of 96% of the patients, while motor or sensory deficits (or both) were found in 82% of them. Therapy consisted of surgery and RT in 65 patients and RT alone in 170 patients. There were no differences in outcome between those treated by surgery combined with RT and those managed by RT alone. Patients with radiosensitive tumors and those ambulatory at the onset of treatment benefited whether treated by surgery or by RT. Seventy-five percent of living patients who improved from treatment remained ambulatory at 6 months, and approximately 50% of living patients were ambulatory at 1 year. We conclude that RT without decompressive laminectomy is as effective as decompressive laminectomy in treating epidural spinal cord compression from systemic cancer.

Adolescent↗
PubMed2006

Estrogen treatment of spinal cord injury attenuates calpain activation and apoptosis.

Spinal cord injury (SCI) is a devastating neurologic injury, and currently, the only recommended pharmacotherapy is high-dose methylprednisolone, which has limited efficacy. Estrogen is a multi-active steroid with anti-oxidant and anti-apoptotic effects. Estrogen may modulate intracellular Ca2+ and prevent inflammation. For this study, male rats were divided into three groups. Sham-group animals received a laminectomy at T12. Injured rats received both laminectomy and 40 gram centimeter force SCI. Estrogen-group rats received 4 mg/kg 17beta-estradiol (estrogen) at 15 min and 24 hr post-injury, and vehicle-group rats received equal volumes of dimethyl sulfoxide. Animals were sacrificed at 48 hr post-injury, and 1-cm segments of the lesion, rostral penumbra, and caudal penumbra were excised. The degradation of 68 kD neurofilament protein (NFP) and estrogen receptors (ER) was examined by Western blot analysis. Protein levels of calpain and the activities of calpain and caspase-3 were also examined. Levels of cytochrome c were determined in both cytosolic and mitochondrial fractions. Cell death with DNA fragmentation was examined using the TUNEL assay. At the lesion, samples from both vehicle and estrogen treated animals showed increased levels of 68 kD NFP degradation, calpain content, calpain activity, cytochrome c release, and degradation of ERalpha and ERbeta, as compared to sham. In the caudal penumbra, estrogen treatment significantly attenuated 68 kD NFP degradation, calpain content, calpain activity, levels of cytosolic cytochrome c, and ERbeta degradation. At the lesion, vehicle-treated animals displayed more TUNEL+ cells, and estrogen treatment significantly attenuated this cell death marker. We conclude that estrogen may inhibit cell death in SCI through calpain inhibition.

Analysis of Variance↗
PubMed1982

Metastatic epidural tumors in children.

Spinal cord compression is a rare but serious complication of malignant diseases in children. Epidural cord compression was noted in 81 patients within the past 17 years at this center. The complication developed at different times during the course of the primary disease. For 29 of our patients, cord dysfunction was one of the initial signs of cancer--Ewing sarcoma, neuroblastoma, Hodgkin disease, and malignant lymphoma. By contrast, for most of the patients with osteosarcoma and rhabdomyosarcoma, it appeared later in their clinical course. The treatment outcome of patients who were paraplegia with complete loss of sensory function for greater than or equal to 48 hours was poor. Only four of 22 in this group became ambulatory. Ten patients with osteosarcoma did not undergo laminectomies because they all had multiple metastases and terminal disease. Paraplegia developed in all ten. There was no difference in ambulatory rates among other patients, with or without laminectomies.

Child↗
PubMed1994

Effect of mianserin on locomotory function after thoracic spinal cord hemisection in rats.

To study the role of serotonin (5-HT) in spinal cord injury, we observed the effects of mianserin (a 5-HT1c and 5-HT2 receptor antagonist) on rat locomotory function after thoracic spinal cord hemisection. Three groups of rats were studied: sham, A, and B. The sham group (n = 4) received laminectomy and a 3-day course of mianserin (5 mg/kg ip); group A (n = 12) had laminectomy, hemisection, and weekly 3-day courses of saline or mianserin; group B (n = 12) was identical to group A except that the rats received saline. The rats were evaluated every other day for 6 weeks using a 0-14 point scale. Hemisection markedly reduced mean ipsilateral hindlimb scores from 14.0 to 4.0 +/- 0.4 and 4.6 +/- 0.2 (mean +/- standard deviation) in groups A and B, respectively. The saline-treated rats recovered to scores of 9 or 10 by Day 7, 12 or 13 by Day 14, and normal by Day 21. Mianserin significantly but transiently depressed mean locomotory scores, from 12.1 +/- 0.6 to 10.0 +/- 0.4 (P < 0.05, Mann-Whitney U test) in the second week and from 14.0 +/- 0.0 to 12.1 +/- 0.6 (P < 0.05, Mann-Whitney U test) in the fourth week after hemisection. Locomotory scores of mianserin-treated rats did not differ significantly from control saline-treated rats by 7 days after treatment. Immunohistological studies of the spinal cords revealed a marked reduction of 5-HT-containing terminals in ipsilateral but not contralateral lumbosacral cord by 2 weeks after hemisection. By 4 weeks after hemisection, 5-HT-immunoreactive fibers and terminals partly returned to the ipsilateral lumbosacral cord, corresponding temporally with locomotory recovery. Thus, 5-HT may play a role in recovery after hemisection. Anti-serotonergic drugs should be cautiously administered to patients recovering from spinal cord injury.

Analysis of Variance↗
PubMed1990

Experimental study of lumbar facet degeneration in monkeys.

Experiments were carried out in young adult monkeys to determine the influence of mechanical stress on degeneration of the lumbar facet joints. Eleven monkeys were used and divided into four groups, the control, upper lumbar laminectomy, discectomy and discectomy + rotation. The monkeys were given fluorochrome agents once a week. After sacrifice, undemineralised sections were studied under fluorescence microscopy. Contact microradiographs were also made. After laminectomy, subperiosteal bony proliferation was seen on the external surface of the superior and inferior articular processes. After discectomy there was localised bony proliferation on the anterior aspect of the superior articular processes. In the group with discectomy + rotation there was evidence of additional proliferation of the calcified cartilage zone at the insertion of the ligamentum flavum which had remodelled to bony tissue. We conclude that rotational stresses are mostly responsible for the development of spinal stenosis.

Animals↗
PubMed1993

Chronic spondylogenic cervical myelopathy. A critical evaluation of surgical treatment after early and long-term follow-up.

In the past, chronic spondylogenic cervical myelopathy has been thought of being a disease often resistant to neurosurgical therapy. 56 out of 70 patient treated by laminectomy or different ventral fusion procedures improved immediately following operation. Only 36, however, continued to be improved at follow-up 5 to 8 years later, whereas additional 8 had worsened again, and another 5 mean-while had died due to myelopathy. Laminectomy turned out to be the least successful procedure of treatment. Nevertheless, early diagnosis, early operation, appropriate and individual surgical procedures, careful re-evaluation at follow-up, and -- if needed -- an early decision for a second-step operation can impressively improve the prognosis.

Adult↗
PubMed1996

ADCON-L: a review of its development, mechanism of action, and preclinical data.

ADCON-L Anti-Adhesion Barrier Gel is a resorbable gel that is placed into the site of a laminectomy before surgical closure and acts as a barrier to scar and surgical adhesions. The scientific rationale for ADCON products is based on certain properties of glial cells and the nature and role of the basal lamina. ADCON-L was evaluated in laminectomy models using rats and rabbits and a discectomy model in dogs. In all studies, ADCON-L was an effective barrier to peridural scar and surgical adhesions.

Animals↗
PubMed1996

A study of motor and sensory evoked potentials in chronic cauda equina compression of the dog.

Previous experimental studies have shown the effects of acute compression of the spinal cord and peripheral nerve roots. Recently, however, a few studies of chronic compression of the cauda equina in animal models have been reported. The purpose of this study was to determine the long-term electrophysiologic changes resulting from chronic compression of the cauda equina in dogs. An animal model of lumbar spinal stenosis was prepared according to Delamarter's method. Four experimental groups, each containing six dogs, were studied. One group underwent only laminectomy of the sixth and seventh lumbar vertebrae; these animals served as controls. In the three other groups, a laminectomy was performed and the cauda equina was constricted by 25%, 50%, and 75%, respectively, to produce chronic compression. Weekly neurologic examinations were carried out, and the neurologic deficits were graded using a modified Tarlov system. Sensory, and motor evoked potentials were recorded preoperatively, immediately after constriction, and at 2 weeks and 1, 2, and 3 months postoperatively. The animals in the control group showed no changes in sensory or motor evoked potentials. The dogs in which the cauda equina had been constricted by 25% showed no neurologic deficits and only mild changes in sensory and motor evoked potentials. The dogs in which the cauda equina had been constricted by 50% showed mild initial motor weakness, and major changes in the evoked potentials. The dogs in which the cauda equina had been constricted by 75% showed significant weakness, paralysis of the tail, and urinary incontinence; all dogs were partially recovered by the 3rd month, but all still showed neurogenic changes in the evoked potentials. Sensory and motor evoked potentials revealed neurologic abnormalities before the appearance of neurologic signs and symptoms. Constriction of more than 50% was the critical point that resulted in complete loss or reduction of the evoked potentials and in neurologic deficits. Dogs in which motor and sensory evoked potentials recovered also showed gradual disappearance of neurologic symptoms and signs. Recovery of motor evoked potentials in particular was associated with complete disappearance of neurologic symptoms and signs. For accurate prognosis in cases of chronic cauda equina compression, a combined diagnostic study of sensory and motor evoked potentials is recommended.

Analysis of Variance↗
PubMed1984

Long-term results of the surgical treatment of syringohydromyelia.

Long-term results of 26 patients suffering from syringohydromyelia are reported. The patients underwent laminectomy and myelotomy with marsupialisation of the intracord cavity. Two different long term objective examinations have been performed demonstrating favorable results in 65% of patients at the first examination (mean 8 years following the operation) and in 60% of these at a second examination (mean 14 years following the operation). The limitations of posterior fossa decompression and other surgical procedures have also been discussed. The absence of surgical mortality and the length of follow-up period of this series supported the conclusions that laminectomy and myelotomy with marsupialisation of the intracord cavity represents a reliable method to relieve the effects of associated foramen magnum abnormalities avoiding posterior fossa surgery.

Adult↗