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PubMed1996

Effect of CO2 laser on spinal epidural fibrosis.

In this study the effect of CO2 laser on spinal epidural fibrosis was examined in 24 guinea pigs which were divided into two groups. The first group was the control group, the second one the CO2 laser group. All animals had laminectomies at 3 levels. Re-exploration was performed three months after the laminectomy. In the second group the same procedure was performed but at the end of the re-exploration, CO2 laser irradiation of the epidural fibrotic tissue was done. The wounds in both groups were closed again. Four months later all animals were sacrificed. For verification and quantification of scar formation (postoperative fibrosis) light microscopic examinations and determination of hydroxyproline were done, using Bergman's spectrophotometric method. The differences which were observed between the two groups were statistically significant (U : 134, P < 0.05). This study demonstrates the reducing effect of CO2 laser irradiation on epidural scar formation. The findings encourage its use as an alternative method of prevention of epidural fibrosis after spinal surgery.

Animals↗
PubMed1990

Histological differences between rootlets sectioned during selective posterior rhizotomy by two surgical techniques.

During selective posterior rhizotomy, for the treatment of spasticity in infantile cerebral palsy, the rootlets to be divided are chosen by the type of electromyographic response elicited by intraoperative electrical stimulation. Two different surgical techniques were used for exposing the lumbar roots. The first approach was to expose the conus medullaris through a T 12-L 1 laminectomy, while the other approach to the dorsal roots was distally in the cauda equina through a L 2-L 3 to S1 laminectomy. Although the clinical results obtained with either of them are not very different, there is anatomical evidence that suggests that the histological structure of the divided rootlets may be different in the two techniques. We designed our study to determine of a significant difference in the number of large myelinated fibers was found between rootlets divided close to the conus medullaris and those divided distally in the cauda equina. Two groups of five children with spasticity secondary to cerebral palsy where randomly designed to be operated upon by one of the techniques. The divided rootlets were processed with standard histological techniques and the large myelinated fibers were counted on enlarged (40 x) photomicrograph of the rootlet. A significantly (p less than 0.001) larger number of large myelinated axons was found in the rootlets dissected and divided close to the conus medullaris.

Cauda Equina↗
PubMed1993

Effect of fibrin glue on postlaminectomy scar formation.

An experimental study in rats has been carried out with the aim of studying the scar formation over the spinal dura in the presence of fibrin glue. Although the main action of fibrin glue is the enhancement of wound healing by increasing the fibrous tissue, our present data suggest that this re-absorbable biomaterial diminishes the epidural scar formation, at least the first two weeks after laminectomy. This finding leads us to consider the use of fibrin glue over spinal duramater when it is likely that reoperation may become necessary in a short period of time after a laminectomy.

Animals↗
PubMed1995

Factors influencing the outcome of operative treatment for lumbar spinal stenosis.

96 patients with lumbar spinal stenosis were operated on after two to sixteen years of disabling symptoms. There were 50 women and 46 men with a mean age of 59 years. 33 of the patients had been previously operated on for spinal complaints. A laminectomy was performed in 61 patients; at one level in 31 patients, at two levels in 23 patients, and at three levels in seven patients. A hemilaminectomy was performed in 35 patients: at one level in 28 patients, at two levels in five patients, and at three levels in two patients. There were neither internal fixation devices used, nor spondylodesis performed in these operations. Special attention was focused on the effect of age, sex, body mass index and smoking, as well as previous surgery and extent of surgical intervention on the outcome of operative treatment. The follow-up time was 3-11 years (5.5 mean). Laminectomy at one level resulted in significantly most acceptable results of operative treatment methods. Younger patients and women were more prone to inferior results of operative treatment. Also the extent of surgical intervention, overweight and smoking seemed to have a tendency to worsen the result of operative treatment.

Adult↗
PubMed1989

Evaluation of effectiveness of a facet wiring technique: an in vitro biomechanical investigation.

The effects of facet wiring procedure commonly used for stabilizing cervical spines after laminectomy or bilateral facet dislocation on the motion behavior of whole cervical spines are investigated using a Selspot II system. A fresh human ligamentous intact specimen was potted at T1/T2 vertebra and clinically relevant loads applied to the topmost vertebra (C2) of the specimen. The resulting three rotational components of each of the five vertebral bodies (C3-C7) were recorded. Specimen was injured to mimic total laminectomies at C5 and C6 vertebral levels and tested again. The injured specimen was stabilized, using a facet wiring construct, across C4-C7 segment before testing for the final time. The injured specimens, compared to the intact specimens, demonstrated an increase in flexion-extension of about 10%. Facet wiring imparted stability to the cervical spine by stiffening segments up to roughly four times intact values.

Aged↗
PubMed1987

Early membrane lipid changes in laminectomized and traumatized cat spinal cord.

The effects of surgical exposure (laminectomy) and compression trauma on various aspects of membrane lipid metabolism in the feline spinal cord were determined in this study. Tissue samples were frozen in situ and grossly dissected into gray and white portions prior to lipid analyses. Laminectomy alone resulted in measurable changes in spinal cord lipid metabolism, including increases in gray matter free fatty acids, diacylglycerols, and eicosanoids. A 90-min recovery period greatly reduced the levels of these compounds. Compression of the spinal cord with a 170-g weight (following a 90-min recovery period) caused very large increases in gray matter free fatty acids, diacylglycerols, and eicosanoids, and decreases in cholesterol and ethanolamine plasmalogens. Similar, but time delayed changes in these compounds were also observed in white matter.

Animals↗
PubMedDate not supplied

Can antiemetics really relieve pain?

The analgesic properties of 2 antiemetic agents--metoclopramide and ondansetron--were investigated in studies which showed that metoclopramide may decrease postoperative opioid requirements, but the analgesic effect of ondansetron is controversial. The postoperative effects of metoclopramide and ondansetron on pain in patients undergoing laminectomy were evaluated. Forty six patients were randomized into 3 groups: group M, which consisted of 15 patients who received intravenous (IV) metoclopramide 0.5 mg 30 minutes before surgery; group O, which consisted of 16 patients who received ondansetron IV 0.1 mg 30 minutes before surgery; and group C, which consisted of 15 patients who received the same volume of saline IV 30 minutes before surgery. The efficacy and duration of analgesia were assessed using a visual analogue scale (VAS) at 0, 0.5, 1, 3, 6, and 24 hours after surgery. Hemodynamic parameters, additional analgesic requirements, and adverse effects were recorded for the study groups. Diclofenac 75 mg was administered intramuscularly as a rescue analgesic during the postoperative period. VAS scores were lower in the metoclopramide group than in the ondansetron and control groups (P<.05, each). The patients in the ondansetron and control groups required much more diclofenac than the patients in the metoclopramide group (P<.05). Metoclopramide administered preoperatively provided postoperative analgesia in patients undergoing elective laminectomy.

Adolescent↗
PubMed1980

Effect of total sympathetic blockade on plasma renin activity during surgery.

The interaction of sympathetic blockade and decreased mean arterial pressure on plasma renin activity during surgery was studied in dogs. Plasma renin activity was measured during lumbar laminectomy before and after sympathetic blockade produced by subarachnoid spinal anaesthesia. Plasma renin activity was significantly increased during laminectomy. Twenty minutes after sympathetic blockade there were marked decreases in mean arterial pressure and plasma renin activity; but with mean arterial pressure continuing to decline, plasma renin activity showed moderate increases at 50 minutes after sympathetic blockade. It is concluded that increases in plasma renin activity seen during surgical operations can be attenuated by sympathetic blockade produced by subarachnoid or epidural spinal anaesthesia, although decreases in mean arterial pressure resulting from the sympathetic blockade continue to provide a stimulus for renin secretion.

Animals↗
PubMed2001

Effects of trapidil on ATPase, lipid peroxidation, and correlation with ultrastructure in experimental spinal cord injury.

The present study was performed to investigate the effect of trapidil on ischemic damage of cells after spinal cord injury. The injury was produced by extradural clip compression of the exposed spinal cord in rats according to Rivlin and Tator. The ten rats in group 1 were used to determine normal findings without any surgery or medication. On the 15 rats in group 2, only six-level laminectomy was performed to determine the influence of the total laminectomy on the biochemical factors measured and the, light and ultrastructural findings. The 15 rats each in groups 3 and 4 were used as trauma and trapidil (40 mg/kg) treatment groups, respectively. The injury actually produced a significant decrease in Na+-K+/Mg+2 ATPase activity of the injured segments as early as 10 min after trauma. Trapidil attenuated Na+-K+/Mg+2 ATPase inactivation in the traumatized rats for 120 min after treatment (P<0.05) and significantly reduced the malone dialdehyde content below that in the traumatized group at all determined times (P<0.05). Light and electron microscopic findings supported the biochemical results.

Adenosine Triphosphatases↗
PubMed2001

Surgical therapy for lumbar spinal stenosis: evaluation of 300 cases.

Although lumbar spinal stenosis syndrome is extremely common, considerable controversy continues to surround its classification, diagnosis, and treatment. In this article, we retrospectively analyzed the clinical, radiological, and surgical characteristics of 300 patients operated on in our clinics with the diagnosis of lumbar spinal stenosis. Surgical therapy and outcome are discussed with respect to the known facts. After clinical and radiological evaluation, 300 patients were diagnosed with lumbar spinal stenosis. All patients underwent laminectomy and bilateral foraminotomy at the stenotic level. Surgical outcomes were evaluated as very good, good, same, and poor according to the clinical findings. Ninety percent of the surgically treated patients demonstrated very good and good outcomes. Our conclusion in lumbar spinal stenosis diagnosed by objective clinical and radiological findings is that decompressive laminectomy and extensive foraminotomy without instrumentation allow a good outcome.

Adolescent↗
PubMed2001

[Special considerations in therapy of injuries of the cervical spine in ankylosing spondylitis (Bechterew disease)].

Cervical spine changed by Bechterew's disease is severely endangered with any increased load. Even decent trauma is enough to produce a fracture with affection of spinal cord. Because of little knowledge in these special items, late diagnosis of overlooked injury is not rare, especially in two-level injuries. Neurolesions following secondary fracture dislocations may occur ("fatal pause"). From january 1990 to february 2000 12 patients underwent surgery (dorsoventral stabilisation, ventral stabilisation, laminectomy). Diagnostic procedures, levels of injury, pre- and postoperative neurostatus (following Frankel's score), operative technique, typical complications and follow-up (Ø 17.8 months) were analyzed and compared with the literature. 11 patients showed preoperative neurodeficits. They were better in five cases and disappeared at all in another five cases after surgery (83% positive neurological outcome). There was no increase of neurology failure. Two patients died (ARDS and cerebral ischemia with destruction of vertebral arteries). One patient had to be reoperated because of implant dislocation. MRI is obvious in diagnostic for these lesions. There is also an absolute need for total (both clinical and radiological) examination of the whole spinal column, because there is often injury of more than one level (three times in our study). Therapy should be operative (dorsoventral stabilisation, in certain cases only anterior procedure or laminectomy). Late diagnosis and therapy with secondary worsening after fracture dislocation is not rare because of "overlooked injury". There were four patients, that would not have suffered cervical spine fracture (minimal injury force) without Bechterew's changes. There is often pulmonary failure through limitation of thoracic movement and cerebral ischemia following rupture of vertebral arteries as typical complications. Mortality (2 cases; 16%) in our collective is less than literature's medium rates (35-57%).

Adult↗
PubMed2003

Percutaneous drainage of a postoperative intraspinal hematoma using a Tuohy needle.

A 78-year-old man developed a large subdural hematoma extending from T12 to L3 levels following L3 laminectomy and L3-5 posterior spinal fusion. He had associated neurological signs and symptoms. MR imaging showed typical signal characteristics of a subacute intraspinal subdural hematoma. Percutaneous drainage was successfully performed under CT guidance by inserting a Tuohy needle through the L3 laminectomy defect. The catheter packaged with the Tuohy needle was inserted cranially into the hematoma and 30 ml of blood was aspirated. Follow-up MR imaging confirmed resolution of the hematoma and the patient made a rapid recovery.

Aged↗
PubMed1998

Sacrospinalis muscle-pedicle bone graft in posterolateral fusion for spondylolisthesis.

Twenty three patients with lumbar spondylolisthesis (6 Grade I, 14 Grade II and 3 Grade III) with low back pain, and radicular pain in 14, were treated surgically when they failed to respond to conservative treatment. Their average age was 33.2 years. Bilateral posterolateral spinal fusions with autologous iliac bone chips, supplemented by a sacrospinalis muscle-pedicle bone graft on the left side, were undertaken after laminectomy and foraminotomy in all except in two adolescents, where laminectomy and foraminotomy were avoided. The period of follow-up varied from 26 to 126 months (average 65.3 months). The results in 11 (48%) patients were excellent, 9 (39%) were good, 2 (9%) fair and one (4%) poor. There was a higher incidence (87%) of good quality of osseous fusion on the left side, where the sacrospinalis muscle-pedicle bone graft was used, compared to the right, where 70% of fusions were satisfactory. Function improved in 91% of the patients. Neither scoliosis nor weakness of the extensor muscles of the back developed due to reanchorage of the sacrospinalis muscle to the lumbosacral spines.

Activities of Daily Living↗
PubMed2001

Spontaneous spinal epidural abscess in a neonate. With a review of the literature.

Spinal epidural abscess is uncommon in neonates and infants, and is usually related to previous lumbar puncture or epidural anaesthesia. Diagnosis is often delayed because of the non-specific presentation. We present a 7-week-old girl who developed paraplegia 3 weeks after transient fever and a self-limiting skin rash. MR imaging revealed an epidural contrast-enhancing lesion compressing the spinal cord. At operation, an organised granulated abscess was identified with Staphylococcus aureus the causative organism. Laminectomy and removal of the organised abscess and systemic intravenous antibiotics resulted in complete neurological recovery. The patient did not develop late spinal deformity following the decompressive laminectomy. The rapid onset of paraplegia can often be missed in such a young child but should be promptly investigated, as surgical treatment of cord compression carries an excellent prognosis for neurological recovery. We review the literature on the initial presentation, usual investigations, causative organisms and surgical management of paediatric spinal epidural abscesses.

Epidural Abscess↗
PubMed2000

Ossification of the yellow ligament causing thoracic cord compression.

Ossification of the yellow ligament (OYL) is not infrequent in the cervical and lumbar regions but is very rare in the thoracic spine, with no more than 40 cases reported in the literature. We describe a 50-year-old male with progressive paraparesis and sensory dysfunction, secondary to OYL at T10-T11, studied by computed tomography (CT) and magnetic resonance imaging (MRI). Decompressive laminectomy and removal of the ligament resulted in marked clinical improvement. Patients with OYL may initially develop sensory dysfunction associated with leg weakness. This pathological entity can be well defined by CT and MRI, and surgery by decompressive laminectomy is advised for all cases. The OYL should be removed both posteriorly and laterally to the dural sac to obtain sufficient decompression of the spinal canal.

Decompression, Surgical↗
PubMed2002

Clinical and psychofunctional measures of conservative decompression surgery for lumbar spinal stenosis: a prospective cohort study.

Less invasive decompressive surgery has emerged as a logical surgical treatment alternative to wide decompression of spinal stenosis. The clinical outcomes of such conservative surgical treatment, however, are not well known. The aim of the study was to evaluate short-term psychometric and functional outcomes after conservative decompressive surgery for lumbar canal stenosis. Forty patients had a lumbar laminectomy procedure, which preserved the integrity of the neural arches, facet joints and most muscle attachments. Pre-operative clinical evaluation of the patients included: Waddell's non-organic signs (NOS) performed by an independent surgeon observer; three self-report questionnaires--the Waddell Disability Index (WDI), the Oswestry Low Back Pain Disability Questionnaire (ODI), and the Low Back Outcome Score (LBOS); and a general questionnaire that included a visual analog pain intensity scale (VAS). Post-operative clinical evaluations and questionnaires were obtained in 36 subjects (mean age 59.8 years) after a 1.7-year follow-up (range 1-2.6 years). Pre-operative versus post-operative statistical comparisons of the data were performed using adjusted error rates within families of predictors. Successful surgical outcome was defined as an improvement in at least three of the following four criteria: self-reported pain on a VAS, self-reported functional status measured by LBOS, reduction of pain during walking and reduction of leg pain. At follow-up, there was a statistically significant improvement in VAS pain intensity, ODI, WDI, and LBOS. Patients classified as having mixed stenosis had a higher incidence of continuous pain symptoms in comparison with acquired stenosis, but there was no differential improvement with treatment depending upon stenosis classification and/or number of operative levels. Overall, 58% (21/36) of patients met the successful surgical outcome criteria, including 14 subjects who met all four success criteria. Based upon a stringent definition of successful surgical outcome, the results of a conservative laminectomy were as good as those of more aggressive decompressive procedures presented in the literature. Our findings indicate that, even in a highly organic disorder such as spinal stenosis, illness behavior plays an important role in predicting surgical outcome.

Adolescent↗
PubMed2003

A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1-year results.

Patients suffering from neurogenic intermittent claudication secondary to lumbar spinal stenosis have historically been limited to a choice between a decompressive laminectomy with or without fusion or a regimen of non-operative therapies. The X STOP Interspinous Process Distraction System (St. Francis Medical Technologies, Concord, Calif.), a new interspinous implant for patients whose symptoms are exacerbated in extension and relieved in flexion, has been available in Europe since June 2002. This study reports the results from a prospective, randomized trial of the X STOP conducted at nine centers in the U.S. Two hundred patients were enrolled in the study and 191 were treated; 100 received the X STOP and 91 received non-operative therapy (NON OP) as a control. The Zurich Claudication Questionnaire (ZCQ) was the primary outcomes measurement. Validated for lumbar spinal stenosis patients, the ZCQ measures physical function, symptom severity, and patient satisfaction. Patients completed the ZCQ upon enrollment and at follow-up periods of 6 weeks, 6 months, and 1 year. Using the ZCQ criteria, at 6 weeks the success rate was 52% for X STOP patients and 10% for NON OP patients. At 6 months, the success rates were 52 and 9%, respectively, and at 1 year, 59 and 12%. The results of this prospective study indicate that the X STOP offers a significant improvement over non-operative therapies at 1 year with a success rate comparable to published reports for decompressive laminectomy, but with considerably lower morbidity.

Aged↗
PubMed2004

Failed back surgery syndrome: the role of symptomatic segmental single-level instability after lumbar microdiscectomy.

Segmental instability represents one of several different factors that may cause or contribute to the failed back surgery syndrome after lumbar microdiscectomy. As segmental lumbar instability poses diagnostic problems by lack of clear radiological and clinical criteria, only little is known about the occurrence of this phenomenon following primary microdiscectomy. Retrospectively, the records of 2,353 patients were reviewed according to postoperative symptomatic segmental single-level instability after lumbar microdiscectomy between 1989 and 1997. Progressive neurological deficits increased (mean of 24 months; SD: 12, range 1-70) after the initial surgical procedure in 12 patients. The mean age of the four men and eight women was 43 years (SD: 6, range 40-77). The main symptoms and signs of secondary neurological deterioration were radicular pain in 9 of 12 patients, increased motor weakness in 6 of 12 patients and sensory deficits in 4 of 12 patients. All 12 symptomatic patients had radiological evidence of segmental changes correlating with the clinical symptoms and signs. All but one patient showed a decrease in the disc height greater than 30% at the time of posterior spondylodesis compared with the preoperative images before lumbar microdiscectomy. All patients underwent secondary laminectomy and posterior lumbar sponylodesis. Postoperatively, pain improved in 8 of 9 patients, motor weakness in 3 of 6 patients, and sensory deficits in 2 of 4 patients. During the follow-up period of 72+/-7 months, one patient required a third operation to alleviate spinal stenosis at the upper end of the laminectomy. Patients with secondary segmental instability following microdiscectomy were mainly in their 40s. Postoperative narrowing of the intervertebral space following lumbar microdiscectomy is correlated to the degree of intervertebral disc resection. It can therefore be concluded that (1) patients in their 40s are prone to postoperative narrowing of the intervertebral disc space and hence subsequent intervertebral instability and (2) that a small extent of intervertebral disc resection and preservation of the "segmental frame" may be beneficial in those patients. The present study demonstrated for the first time that the degree of extensive operative techniques in microdiscectomy increased the risk of subsequent segmental instability. In addition, narrowing of the intervertebral space of more than 30% represents a clear radiological sign of segmental instability.

Adult↗