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PubMed1980

Histological features of congenital lipomas of the lower spinal canal.

A study of 20 children with lipomyelomeningocele and two with intradural lipoma who underwent surgery revealed that five children had unusual and previously unreported histological findings. In each, the characteristic densely fibrous lipoma was present. One patient with an intradural lipoma had an ependymal-lined canal resembling a terminal ventricle. The subependymal layer was neuroglial and striated muscle fibers were scattered throughout adjacent connective tissue and lipoma. Three other children presented with lipomyelomeningoceles. In each case, the lipoma tapered to a firm fibrous tract which blended into conus medullaris. Microscopic examination of this fibrous tract showed it to contain not only a relatively acellular connective tissue stroma, but, in one case, sheets or islands of neuroglia and scattered nerve cells, in another, an epithelial cyst with a smooth muscle and fibrous tissue wall, and in a third case, a fragment of embryonic bone. These findings support the theory that there is a secondary phase to caudal neural tube development, and that congenital lipomas are formed by persistence and differentiation of ordinarily vestigial pluripotential embryonic cells. The fifth case, with extradural lipoma, diastematomyelia, and congenital dermal sinus, had a cyst at the junction of these structures. The cyst was lined by ciliated respiratory-like epithelium, and had mucous and serous glands in its wall. This finding supports the concept that formation of diastematomyelia depends on the prior existence of an accessory neurenteric canal.

Adolescent↗
PubMed1990

[Segmental instability and lumbar spinal canal stenosis. Theoretical, clinical and surgical aspects].

Clinical, radiological, surgical and experimental observations make it possible to construct a rational theory of the segmental lumbar instability which explains the pathogenesis of spondylosis, of stenosis and of several cases of disc displacement as well. This theory helps us to choose the right surgical procedure. Spinal stenosis, degenerative spondylolisthesis and some cases of disc displacement are seen as part of a degenerative process with its starting point in regressive changes of the intervertebral disc and lateral joint. This leads to a marked instability of the affected mobile segment. Signs and symptoms of unstable lumbar spine are discussed. In such cases, if decompression of the roots by laminectomy, facetectomy or discectomy is performed without fusion, the consequences are usually treated but not the main cause of the trouble, namely the instability. Finally, we describe a procedure which we prefer as the safest and best of all, using selected decompression by means of joint screws (spondylodesis) as suggested by F. Magerl (41-44).

Humans↗