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PubMed1992

Decompressive procedures. Indications and techniques.

Hemilaminectomy and dorsal laminectomy are the surgical techniques most suited for decompression of the thoracic, thoracolumbar, lumbar, and lumbosacral spine. Hemilaminectomy is preferred for decompressing the spinal cord before applying fixation devices for fractures/luxations. Dorsal laminectomy is the method of choice for exploration of the spinal canal and for decompression of the lumbosacral region. Either method is applicable to removal of herniated intervertebral disc material and fenestration of other disc spaces.

Animals↗
PubMed1990

[Subarachnoid hematoma and spinal anesthesia].

Two cases of spinal subarachnoid haematoma occurring after spinal anaesthesia are reported. In the first case, lumbar puncture was attempted three times in a 81-year-old man; spinal anaesthesia trial was than abandoned, and the patient given a general anaesthetic. He was given prophylactic calcium heparinate soon after surgery. On the fourth day, the patient became paraparetic. Radioculography revealed a blockage between T10 and L3. Laminectomy was performed to remove the haematoma, but the patient recovered motor activity only very partially. The second case was a 67-year-old man, in whom spinal anaesthesia was easily carried out. He was also given prophylactic calcium heparinate soon after surgery. On the fourth postoperative day, pulmonary embolism was suspected. Heparin treatment was then started. Twelve hours later, lumbar and bilateral buttock pain occurred, which later spread to the neck. On the eighth day, the patient had neck stiffness and two seizures. Emergency laminectomy was carried out, which revealed a subarachnoid haematoma spreading to a level higher than T6 and below L1, with no flow of cerebrospinal fluid, and a non pulsatile spinal cord. Surgery was stopped. The patient died on the following day. Both these cases are similar to those previously reported and point out the role played by anticoagulants. Because early diagnosis of spinal cord compression is difficult, the prognosis is poor, especially in case of paraplegia.

Aged↗
PubMed2005

[A rare cause of cauda equina syndrome: primary epidural lymphoma].

INTRODUCTION: Primary epidural lymphoma is generally manifested by isolated epidural involvement. On rare occasions it can lead to cauda equina syndrome. CASE: A 56-year-old man was hospitalized for lumbago, weakness in the legs and sphincter problems. A dorsolumbar MRI revealed that the anterior and posterior peridural space from D11 to L3 was filled by a mass compressing the marrow and compacting the roots. The L2 to L4 laminectomy revealed an extradural tissue leading to the diagnosis of large B-cell lymphoma. Metastatic workup demonstrated unremarkable findings. DISCUSSION: Primary epidural lymphoma accounts for less than 10% of epidural tumours and less than 1% of non-Hodgkin lymphomas. Its clinical manifestations are related to the tumoral process or involvement of medullar vessels. It can be, but rarely is, manifested by cauda equina syndrome. Diagnosis is based on histological analysis of tissue taken during the decompression laminectomy. Prognosis is relatively good.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Evaluation of acute surgical intervention in traumatic paraplegia.

A retrospective study was conducted over a two-year period of 95 consecutive admissions for traumatic paraplegia. The average age was 32 years. Seventy-two (76%) of these patients had acute surgical intervention. Fifty had Harrington rod placement with posterior fusion, 10 had additional laminectomy and one had rodding and anterior fusion. Seven laminectomies (alone) were performed at other hospitals. For those with rodding and/or fusion, rehabilitation stay was 70 days; for those with no surgery, 81 days. This difference was not statistically significant. However, when days of acute medical/surgical and rehabilitation hospitalization were combined, those having spinal surgery of any kind had a significantly shorter stay than those not having surgery (95 vs. 136 days). Complications were significantly greater in the patients who underwent internal fixation surgery. The neurological condition did not appear to be jeopardized by rodding and fusion.

Adult↗
PubMed2003

Treatment and prognosis of patients with paraplegia or quadriplegia because of metastatic spinal cord compression in prostate cancer.

Metastatic spinal cord compression (MSCC) is a serious complication of metastatic prostate cancer (PCa). This study retrospectively evaluated patients who presented with paraplegia or quadriplegia because of MSCC of PCa. Of 847 patients with PCa who were treated between 1989 and 1998, 26 (3.1%) demonstrated paraplegia or quadriplegia because of MSCC. Characteristics, treatment efficacy, and prognosis of these patients were analyzed. In total, 15 cases became paraplegic despite androgen ablation therapy (Group I). Average time to paraplegia from initial hormonal treatment was 34 months. Out of nine cases who underwent radiation therapy (RT) to spinal lesions with/without chemotherapy, one patient became ambulatory. However, this patient subsequently had recurrent compression. Two cases had remission of paralysis. Two cases underwent laminectomy plus RT and in one case paralysis improved. MSCC was the first indication of PCa in 11 cases (Group II). Two cases underwent laminectomy plus hormone therapy and nine cases underwent hormone therapy alone. Four patients became ambulatory and two cases showed improved motor capacity. Average interval from paraplegia to death was 7.4 months in Group I and 27.1 months in Group II. However, there was no statistical difference in these two groups on disease-specific survival from the start of initial treatment. It is difficult to recover the ability to walk if paraplegia or quadriplegia occurs in PCa patients although decompression surgery plus hormone therapy seemed to impair the prognosis. Stage M1 patients with paraplegia had survival rates as good as stage M1 patients without paralysis. This should encourage an aggressive treatment approach. However, for patients with hormone-independent disease there seems to be no effective treatment and prognosis is poor.

Adenocarcinoma↗
PubMed2001

One-stage posterior decompression and fusion using a Luque rod for occipito-cervical instability and neural compression.

STUDY DESIGN: Original article. OBJECTIVE: The authors present seven cases who underwent one-stage suboccipital, C1 and/or C2 posterior decompression and fusion by Luque rod, wiring and autogenic bone graft for occipito-cervical instability and neural compression. SETTING: Chang Gung University and Medical Center at Kaohsiung, Taiwan. METHOD: Since January 1996, 20 cases of craniovertebral and upper cervical spinal instability were encountered. Seven of these cases had no neurological improvment under Cone-Barton Skeletal traction. Imaging studies revealed poor reduction with persistent neural compression. One patient underwent unsuccessful anterior trans-oral vertebrectomy for decompression. All patients underwent posterior suboccipital craniectomy, C1 and/or C2 laminectomy for decompression. Contoured Luque rod with wiring and autogeneic bone graft was used for craniocervical fusion. After surgical treatment, halo-vest or sterno-occipito-mandibular immobilizer (SOMI) was used for 3-6 months. RESULTS: Suboccipital craniectomy and C1 laminectomy could afford a 30-50% increment of anteroposterior diameter in the neural canal and effective decompression of the low medulla and cord. All patients made neurological improvement. The ASIA-MIS scores improved from pre-operative 49 (mean) to 78. Four patients can walk without any support. There were no major complications except for one case requiring readjustment of the halo-vest brace. CONCLUSION: The authors recommend this procedure as one choice for relieving craniocervical instability with neurological compromise. A programmed rehabilitation will afford better neurological improvement.

Adult↗
PubMed2005

Oxidised regenerated cellulose as a cause of paraplegia after thoracotomy: case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVE: To report an unusual case of paraplegia. SETTING: University Hospital Bursa, Turkey. CASE REPORT: A 22-year-old woman presented with paraplegia following a left-sided thoracotomy. Magnetic resonance imaging showed a dorsal epidural mass at the level of T6. The patient underwent an emergency T6/7 laminectomy and removal of a tuft of oxidised regenerated cellulose, which had migrated through the intervertebral foramen causing spinal cord compression. CONCLUSION: In cases of neurological deficits after surgery at the posterolateral edge of a thoracotomy, the clinician should be aware of the above possibility. Urgent radiological diagnosis and decompressive laminectomy is the treatment of choice.

Adolescent↗
PubMedDate not supplied

Surgical treatment of degenerative lumbosacral stenosis in dogs.

OBJECTIVE: To study the epidemiology, clinical findings, and long-term outcome of surgical treatment of degenerative lumbosacral stenosis (DLSS) in dogs. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: 131 client-owned dogs with DLSS. METHODS: The medical records of dogs with DLSS treated by dorsal laminectomy and dorsal fenestration were reviewed. The clinical diagnosis had been verified by diskography, epidurography or myelography, or a combination thereof. RESULTS: The German shepherd breed was over-represented (56.5%), and males were more often affected than females (2:1). Historically, reluctance or pain when jumping, rising from a prone position, or climbing stairs (92.4%) and signs of pain or stiffness during extensive physical activity (85.5%) were the most frequent concerns. The most common physical and neurologic examination findings were pain in the lumbosacral area during hyperextension (97.7%) and on direct digital palpation (84.7%). A total of 93.2% of the dogs were improved clinically within the follow-up period (mean 26 +/- 17 months). Recurrence of clinical signs resembling DLSS was reported by the owner or diagnosed by clinical examination in 17.6% of the dogs with a mean onset of signs at 18 +/- 13 months postoperatively. CONCLUSIONS: Surgical treatment of DLSS with dorsal laminectomy and fenestration generally resulted in good to excellent clinical outcome.

Animals↗
PubMed2001

Acute neurologic deterioration after surgical treatment for thoracic spinal stenosis.

Spondylotic changes in the thoracic spine resulting in a myelopathic syndrome is a rare condition. Surgical treatment consists of removal of the hypertrophied ligaments, facet joints and laminae (laminectomy). In this report, we review our experience in treating 12 cases of thoracic spinal stenosis (TSS). From 1989-1998, we identified 12 surgical cases treated by the Department of Neurosurgery at Temple University Hospital. For this report, we reviewed both inpatient and outpatient records and radiographic studies. We also reviewed the world's literature regarding this entity. After reviewing our own cases of TSS and the world's literature, we identified a higher than expected incidence of acute neurologic deterioration (AND) after surgical treatment of TSS (14.5%). This incidence is compared to an expected incidence of AND (0-5.5%) after laminectomy for cervical spinal stenosis (CSS). The seemingly higher incidence of AND after surgical treatment of TSS has implications for discussion of risks with patients undergoing surgical treatment.

Acute Disease↗
PubMed1984

Intrauterine treatment of spina bifida: primate model.

A spina-bifida-like condition was induced in 8 Macaca mulatta fetuses by intra-uterine lumbar laminectomy (L3-L5) followed by displacement of the spinal cord from the central canal. This condition was repaired in utero in 5 animals. A key feature of the repaired in utero in 5 animals. A key feature of the repair method was the use of allogeneic bone paste made from fetal bone particles suspended in an agar-thickened modified Dulbecco's medium. The bone paste was used to correct the bone deficit produced by the laminectomy. All of the monkey babies were delivered by cesarean section at near term (160-164 days of gestation). Neurological test on the neonates and subsequent morphological studies indicated that the in utero treated animals developed normally. In contrast, 3 control animals, which had the induced spinal dysraphism but were left untreated, showed severe spina-bifida-like abnormalities, including paraplegia, incontinence and somatosensory loss.

Animals↗
PubMedDate not supplied

[Lumbar diskectomy without or with spondylodesis? Revival of an old dilemma].

Indications for spine fusion in combination with removal of a lumbar intervertebral disc are not as well defined or as widely accepted. Extreme opinions have been expressed on both side of this issue, but it seems unreasonable that every segment should be fused after removal of a disc or that none should be. The indication for fusion or for no fusion is often based on the specialist to whom the patient is referred. Orthopedists perform often fusion, neurosurgeons rarely. The problem is not the superiority of combined operation or simple disc excision, but the right indication for one or other procedure. It is clear that for the patient with acute disc displacement with leg-pain as the predominant symptom, simple laminectomy and disc excision will yield good results in most cases. Basically the are two indications for combined operation: the first of this is a strong history of instability troubles prior to the disc prolapse; second indication is the bilateral hemilaminectomy and discectomy, which can lead the spine quite instable. Indication for secondary spinal fusion are: 1) the presence after disc excision of complain of pain in the back with relatively little sciatic radiation, sometimes as intermittent claudication; 2) the overproduction of scar tissue is seen very often in instable segment after disc excision and partial or complete facetectomy. Decompression of the nerve root and fusion may result in a great benefit. Finally we recall the possibility to perform simple fusion in flexion without excision of the disc and without laminectomy in cases with median protrusion of the disc, seen in CT in patients with chronic low back pain and inconstant radicular pain radiation. We describe our own technic of combined operation.

Humans↗
PubMedDate not supplied

[Functional sequelae of surgical decompression of the lumbar spine--a biomechanical study in vitro].

PURPOSE: Dorsal decompression has become accepted as the standard surgical treatment for spinal stenosis. However, no consensus has been reached to date concerning the extent of resectioning required or the ensuing functional impairment of the segment. As a result, a discussion is now underway on the necessity of employing various additional methods for instrumented stabilisation. The aim of this biomechanical in vitro study is to objectify the functional impact of various defined decompression techniques. METHODS: With the aid of a universal spine tester, the increasing defect situations following left hemifacetectomy, bilateral hemifacetectomy, left hemilaminotomy and laminectomy of the functional spinal unit L4/5 were assessed. A three-dimensional motion analysis was performed on six human lumbar spine specimens under the loading conditions flexion/extension, left/right bending and right/left rotation. RESULTS: The results showed an increase in both the neutral zone and the range of motion under all the loading components. No significant differences were observed in coupled motions following decompression. CONCLUSIONS: Laminectomy leads to a distinct instability and the question arises of how much additive stability achieved by instrumented stabilization will be adequate.

Adult↗
PubMed1988

Postoperative cervical pseudomeningocele.

A case of postoperative cervical pseudomeningocele in a woman submitted to laminectomy for protruded disc is reported. The patient was investigated by myelography and metrizamide computed tomography and surgically treated with a good neurological result. The other eight reported cases of postoperative cervical pseudomeningocele are reviewed and the role of metrizamide CT scan in diagnosing this unusual complication of cervical laminectomies is emphasized.

Adult↗
PubMed2001

Schwannoma: challenging diagnosis.

OBJECTIVE: To discuss the presentation of a schwannoma in a 30-year-old man and to discuss the clincial features of this tumor. CLINICAL FEATURES: The patient had lower right back and abdominal pain that was made worse by any jarring motion. Magnetic resonance imaging showed an intradural extramedullary mass of the thoracic spine behind the T10 vertebral body, which was found to be a schwannoma. INTERVENTION AND OUTCOME: A full laminectomy of T10 and partial laminectomies of T9 and T11 allowed removal of the tumor. CONCLUSION: When undiagnosed abdominal pain is present, spinal tumor should be considered one possible diagnosis.

Abdominal Pain↗
PubMed2003

Cauda equina syndrome: outcome and implications for management.

A retrospective review of all patients who had surgery for cauda equina syndrome (CES) due to a herniated lumbar disc between January 1996 and November 1999 was undertaken. All underwent laminectomy and discectomy, and had been admitted as emergencies with cauda equina syndrome. Ten women and 10 men with a mean age of 45 years (range 33-67) had their diagnosis verified with MRI in 19 cases and CT in one case. Only half the patients had been catheterized at the time of admission to the neurosurgical unit. Nine patients had emergency decompressive surgery within 5 h of presentation to our unit. The others had surgery on the next available list, but within 24 h of admission. No difference was found between urgently operated patients and those operated on the next available list when urological outcome and quality of life assessments were made using a validated questionnaire at a mean time of 16 months after surgery (range10-48). Twenty per cent of a control group who had undergone laminectomy and discectomy for large disc herniations, but without CES had new urological symptoms when questioned postoperatively, but similar quality of life status. Emergency decompressive surgery did no significantly improve outcome in CBS compared with a delayed approach.

Adult↗
PubMed1997

Idiopathic syringomyelia and the importance of occult arachnoid webs, pouches and cysts.

Syringomyelia is the condition in which longitudinal cavities are found within the spinal cord. The use of drainage procedures has been widely practised with good short term results. However, the long-term results in some large series have been less favourable. There are many associated conditions and in most forms a blockage to the normal flow of CSF, either at the foramen magnum or in the spinal canal, can be identified. Most surgeons would now direct their efforts to the establishment of normal CSF flow rather than a shunting procedure. In a certain group of patients, even with the advent of sophisticated MRI, no associated abnormality or CSF block is easily identified. This type of syringomyelia is often termed idiopathic. We report 10 patients with symptomatic syringomyelia without readily recognized predisposing factors. In eight patients preoperative myelography revealed a block to the flow of contrast compatible with subarachnoid obstruction. Eight patients underwent laminectomy and division of the obstructing arachnoid webs. Five experienced good improvement and three only moderate improvement. Two of the patients underwent syrinx shunting procedures only, which resulted in a worsening of their symptoms. At operation one patient was found to have an arachnoid cyst. We believe that patients with idiopathic symptomatic syringomyelia may need myelography to identify such arachnoid abnormalities. Subsequent surgery should be directed at the establishment of normal CSF flow by laminectomy and excision of the offending lesion.

Adult↗
PubMed1998

Limited unilateral approach for extramedullary spinal tumours.

Traditionally, spinal extramedullary tumours are approached by a wide multilevel laminectomy and a midline dural incision. This exposure may result in immediate or delayed instability of the spine, and exposes the spinal cord to the possibility of inadvertent injury during surgery. To avoid these complications the authors have, in 27 patients, used a limited unilateral approach to remove extramedullary tumours. The approach entails bone removal which is limited to the lateral half of the lamina on the side of the tumour and may or may not include the medial part of the facet joint. A lateral dural flap exposes the tumour without exposing the cord. Extraspinal extensions of the lesion may be approached by extending the laminectomy further laterally to the facet joint. This technique has been used in the cervical, thoracic and the lumbar spine to radically remove the lesion in all cases. There were no complications. The authors conclude that extramedullary lesions of the spine can be removed radically by this approach which allows direct access without cord or root retraction, and with little disturbance to the normal anatomy.

Adult↗
PubMed2001

Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use.

Postoperative wound infection after laminectomy is uncommon. In February 1997, 3 patients were confirmed to have postlaminectomy deep wound infections due to Candida albicans. No similar case had been seen during the previous 10 years. The infections were indolent, with a mean time from initial operation to diagnosis of 54 days (range, 26-83 days). All patients were successfully treated. Pulsed-field gel electrophoresis revealed the Candida isolates to be identical. A case-controlled study and medical record review revealed that a single operating room technician scrubbed on all 3 infected case patients but on only 32% of the uninfected controls. The technician had worn artificial nails for a 3-month period that included the dates of laminectomy site infections, and C. albicans was isolated from her throat. She was treated with fluconazole and removed from duty. No subsequent cases have occurred during the ensuing 3 years. Artificial nails are known to promote subungual growth of gram-negative bacilli and yeast. This may be clinically relevant, and hospitals should enforce policies to prevent operating room personnel from wearing artificial nails.

Adult↗