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At least 1,027 records · Page 57Linked to original sources
PubMed1999

Microdecompression for lumbar spinal canal stenosis.

STUDY DESIGN: A description of the technique for lumbar microdecompression and a prospective study of the outcomes. OBJECTIVE: To describe and analyze a technique that affords an excellent decompression while minimizing damage to surrounding tissues. SUMMARY OF BACKGROUND DATA: Commonly used techniques of lumbar decompression that include bilateral takedown of paraspinal musculature and aggressive bony resection can result in significant iatrogenic sequelae. A less destructive alternative is needed. METHODS: Unilateral limited takedown of multifidus was undertaken, and ipsilateral decompression performed. The contralateral side then was addressed under the midline structures with microscopic visualization--thereby preserving the supra-/interspinous ligament complex and the contralateral musculature. Thirty consecutive patients undergoing the procedure were analyzed prospectively and after a follow-up period by independent observers using a modified validated functional outcome score and patient satisfaction measures. RESULTS: The technique affords an excellent decompression while minimizing destruction to tissues not directly involved in the pathologic process. Functional outcome scores doubled, and 87% of patients reported high satisfaction rates. CONCLUSIONS: Lumbar microdecompression is a minimally invasive technique that appears to provide excellent functional outcomes.

Adult↗
PubMed1991

Computed tomography of the postoperative intervertebral disc and lumbar spinal canal: serial long-term investigation in 19 patients after successful operation for lumbar disc herniation.

The first part of this work, published in 1988, included 25 patients who had computed tomographic (CT) scans without contrast enhancement and plain x-rays of the lumbar spine before, 1 week after, and 6 to 7 weeks after a successful operation for lumbar disc herniation. The present study extends the follow-up period to 3 years in 19 of the 25 original patients. Clinical examinations, lateral plain x-rays, and CT scans without contrast enhancement of the operated disc were repeated. The results indicate a decrease or even a disappearance of the hyperdense extradural material thought to represent fibrosis. An image suggestive of persistent disc herniation was still present in 5 of 8 patients with this finding on early postoperative CT scans. Persistent intradiscal gas was seen in nearly half of the patients. Total normalization of the posterior extraspinal structures was the rule. There was no correlation between CT appearance and residual complaints of the patients. CT scans without contrast enhancement may be sufficient to guide the surgeon in postoperative patients with massive signs and symptoms of recurrent root compression in whom a second operation is indicated on clinical grounds. In all other cases, myelography followed by CT scans is considered appropriate to investigate failed back surgery syndrome.

Adipose Tissue↗
PubMed1998

[Intraoperative ultrasound study of thoracolumbar spinal fractures with spinal canal fragments. Determining canal width and anatomic control of decompression: comparative analysis with CT].

Intraoperative ultrasonography is recommended for operations on the thoracolumbar spine to complement the information provided by standard X-ray, intensifier screen or myelography. There are no unanimates opinions concerning the impaction or exeresis of these fragments. The aim of this study was to show the advantages of intraoperative ultrasonography for anatomic determination and control of the maneuvers used. This study included 46 cases with fractures from T11 to L2. Ultrasonography was performed during the intraoperative reduction provided by the installation and the pedicular instruments. The authors stress the limits of the anatomic and geographic determination, as well as tilting of the fragments because of the size of the ultrasonographic head. The quality of the exeresis may be falsely interpreted in the presence of fragments with a section of less than 4 mm, lateralized, double fragments or in the presence of massive intraoperative haemorrhage. Analysis of the impaction results is more complicated because all of these fragments displaced themselves secondarily. The ligamentum communis vertebralis posterior has no anatomical containing role. The tilting before the impaction and the state of the overlying intervertebral disk represent essential factors for failures. Ultrasonography is better than intraoperative myelography. Nevertheless, it still needs to be complemented by intraoperative profile X-rays and a very precise preoperative CT scan of the intervertebral disk lesions analysis of complicated cases (fragments with residual pedicular attachments--type A 3.1.2.; T-like fractures--type A 3.2.1.).

Adult↗
PubMed1992

[Biomechanical aspects of surgical treatment of secondary stenosis of the spinal canal in the lumbosacral region].

In experimental studies and on clinical material, behaviour was checked of intervertebral discs and vertebrae under the axial pressure: which is the being exerted by the trunk weight, as well as the behaviour of the adjacent mobile segments after "diskoplasty" operation or vertebral interbody stiffening. The material pertaining to the experimental part comprises 6 undamaged spine preparations of the lumbosacral segment, while the clinical part consists of 60 patients out of 143 subjects having been operated on by "diskoplasty" or vertebral interbody stiffening from the approach through fenestration, hemilaminectomy, or plastic laminectomy. The results of performed experimental studies and spodylometric analysis of radiograms in patients treated operatively by decompressing the vertebral canal and by "diskoplastic" stabilization of the vertebrae, or vertebral interbody stiffening permit the following observations. The most favourable localization of the transplant is the medial and posterior parts of the vertebral interbody space, since in both segments L4/L5 and L3/L4 it reproduces the height of the vertebral interbody space, the height and width of intervertebral foramen, widens the intervertebral foraminis, and reduces the lumbar lordosis, which advantageously changes the biomechanic relations, transferring loads of the posterior to the anterior vertebral column. The localization of the transplant in the anterior part of the vertebral interbody space, in fact, increases the anterior vertebral interbody space, but decreases the height of posterior interbody space, the vertebral interbody angle alpha as well as the height and width of the intervertebral foramen. The retroshifting of vertebral L4 indicates mobile segment instability. By implementing a transplant of matching height and appropriate localization in vertebral interbody space, it is possible to increase or reduce the angle between the vertebral bodies at the operative level, widening the vertebral interbody space in anterior and posterior parts. The localization of the bony transplant in the anterior part of vertebral interbody space, involving the clinical material, caused in 65% constriction of intervertebral foraminis, retroshifting of vertebrae L4 and L3, and recurrence of algesic complaints, which may be elucidated by instability of the operated on or adjacent mobile segments.

Adult↗
PubMed1997

Lumbar spinal canal stenosis examined electrophysiologically in a rat model of chronic cauda equina compression.

STUDY DESIGN: A model of chronic cauda equina compression with conductive stress was studied electrophysiologically. OBJECTIVE: To analyze the pathophysiology arising from chronic compression electrophysiologically. SUMMARY OF BACKGROUND DATA: This rat model of cauda equina compression that is chronic, not acute, has been reported elsewhere. METHODS: A stainless steel wire and plate were fastened to the spine at L5 of 8 rats 3 weeks old. One year later, the ascending and descending nerve action potentials were recorded and the conduction velocities (CVs) were measured. Electrophysiologic changes after high-frequency stimulation (HFS) were observed. RESULTS: The waveform of the ascending cauda equina action potential at the cauda equina had three peaks, and that at the conus medullaris had a peak followed by a broad wave. The waveform of the descending nerve action potential had two peaks. The mean ascending and descending CVs of the treated rats were slower (P < 0.001) than those of the control rats. In the control rats, the mean CV and mean amplitude after HFS decreased slightly and returned to normal within 30 seconds, and the waveform was unchanged. In treated rats, the mean CV decreased after HFS but returned to normal within 10 minutes. The mean amplitude decreased after HFS and did not return to normal within 10 minutes. The waveform was unchanged. CONCLUSIONS: Because the differences between treated and control rats in amplitude (and CVs) were greater before HFS than after HFS, we concluded that treated rats had disturbance of the blood flow in vessels around the nerves of the cauda equina with histologic damage. In human patients, such disturbance may be one cause of intermittent claudication.

Action Potentials↗
PubMed1999

Intraoperative somatosensory evoked potential findings in acute and chronic spinal canal compromise.

STUDY DESIGN: Early and long-term postoperative outcome were analyzed by retrospective record review and compared with results of intraoperative somatosensory evoked potential (SEP) findings in 70 patients with chronic lumbar stenosis. SUMMARY OF BACKGROUND DATA: Adverse SEP changes occur in up to 2% of patients during scoliosis surgery and may reverse with intraoperative intervention. Little is known about the short- or long-term results of intraoperative intervention based on adverse SEP changes in patients with chronic lumbar stenosis during lumbar decompression and fusion. OBJECTIVE: To compare intraoperative SEP changes with immediate and long-term neurologic outcome in patients undergoing lumbar decompression, instrumentation and fusion for chronic lumbar stenosis and to determine whether the early correlation between intraoperative SEP deterioration and clinical outcome persisted. METHODS: Monitoring SEPs using an alternating arm and leg stimulation paradigm allowed rapid identification of intraoperative changes. Retrospective record review was conducted without knowledge of intraoperative SEP findings. Clinical and SEP findings were then compared, to determine whether the strong association between intraoperative SEP results and early clinical outcome persisted. RESULTS: Nine of 12 patients who had unilateral intraoperative SEP deterioration that resolved with intervention had no adverse sequelae; the remaining three had new ipsilateral weakness that persisted during a 9-24-month follow-up. Intraoperative SEPs deteriorated in 15% of patients with normal and abnormal baseline SEPs. Intraoperative SEP deterioration could not be predicted by preoperative radicular pain, focal symptomatology or baseline SEP findings. 80% of patients with normal SEPs but only 54% with abnormal SEPs had immediate and sustained pain relief. SEP deterioration that reversed with surgical intervention or high-dose steroids resulted in no adverse neurologic outcome. CONCLUSIONS: Acute, unilateral, unresolved intraoperative SEP deterioration was associated with long-term ipsilateral weakness not predicted by clinical or neurologic findings before surgery. Clinical improvement persisted in 92% of patients, 4% were unchanged, and 4% had persistent neurologic changes during an average 12-month follow-up period. The findings underscore the need for monitoring SEPs during surgery in all patients undergoing invasive lumbar surgery and for rapid identification and intervention should a unilateral SEP change persist.

Acute Disease↗
PubMedDate not supplied

Percent spinal canal compromise on MRI utilized for predicting the need for surgical treatment in single-level lumbar intervertebral disc herniation.

BACKGROUND CONTEXT: There is limited information describing the correlation between the initial quantitative measurements on magnetic resonance imaging (MRI) scans of disc herniation area, canal cross-section areas, percent canal compromise, and disc herniation location to the need for surgery. PURPOSE: Our aim is to determine if the size of disc herniation area, canal cross-section area, percent canal compromise, and disc herniation location taken from MRI images of patients with symptomatic single-level lumbar herniated intervertebral discs upon initial presentation to a spine surgeon, were predictive of the need for surgical treatment. STUDY DESIGN/SETTING: This is a retrospective case matched study of patient MRI images in the senior author's private practice. PATIENT SAMPLE: From a pool of 332 patients with sciatica caused by lumbar intervertebral disc herniations at our institution, 65 patients had surgery, of which MRI images were available and analyzed on 44 patients. Forty-four additional patients were randomly selected from the remaining 267 original group as nonoperative controls. METHODS: The axial MRI image showing the largest canal compromise by the herniated disc was selected for measurements. Using T1- and T2-weighted images, the areas of interest were digitally scanned at high resolution. The canal area and disc herniation area measurement were calculated from the total number of pixels per cross-sectional area, multiplied by a scan correction factor, mm(2) /pixel. Disc herniation locations were classified into either central or paracentral. The percent canal compromise was obtained by disc herniation area divided by canal cross-section area and multiplied by 100. RESULTS: The surgical group's overall mean herniated disc area was 219.6 square millimeter (mm(2)), 179.8 at L4-5, and 267.4 at L5-S1. The nonoperative group's overall mean herniated disc area was 178.4 mm(2), 135.1 at L2-3, 160.3 at L4-5, and 207.4 at L5-S1. The surgical group's overall mean canal cross-sectional area was 471.8 mm(2), 418.6 at L4-5, and 535.6 at L5-S1. The nonoperative group's overall mean canal cross-sectional area was 541.3 mm(2), 518.1 at L2-3, 446.8 at L4-5, and 669.9 at L5-S1. The overall percent canal compromise ratio in the surgery group was 46.7%, 44.1% at L4-5, and 49.8% at L5-S1. The overall percent canal compromise in the nonoperative group was 34.2%, 34.1% at L2-3, 36.1% at L4-5, and 31.8% at L5-S1. The percent canal compromise in central herniations at L4-5 level was 53.0% in the surgical group, and 32.8% in the nonoperative group; at the L5-S1 level surgical group percent canal compromise was 64.1% and in the nonoperative group canal compromise was 27%. L4-L5 level paracentral herniations canal compromise was 36.7% in the surgical group compared with 42.5% canal compromise in the nonoperative group. At the L5-S1 level the canal compromise was 45% in the surgical group and 34.8% in the nonoperative group. CONCLUSIONS: Our findings show a trend for patients treated with surgery to have larger disc herniation areas and smaller canal cross-section areas, corresponding to larger percent canal compromise than the nonoperative group. Centrally located herniations followed this trend closely at all levels studied. However, the paracentral herniation at the L4-5 level does not follow this trend, possibly because paracentral disc herniation clinical course is determined more by herniation location rather than the overall herniation size.

Adult↗
PubMed1976

[Intermittent claudication by the narrowing of the spinal canal].

The cases of four patients with intermittent claudication due to compression of the cauda equina are reported. The cause of this syndrome is considered to be a compression of the cauda equina by a thickening of the ligamentum flavum. The clinical, neuro-radiological and surgical characteristics are discussed.

Adult↗
PubMed1993

[Cytologic aspects of intracranial and spinal canal tumors].

We present the cytologic aspects of 137 tumors operated by neurosurgeons, including 12 astrocytomas, 4 anaplastic astrocytomas, 26 glioblastomas, 7 oligodendrogliomas, 5 medulloblastomas, 8 schwannomas, 17 meningiomas, 13 pituitary adenomas, 20 metastatic tumors and 18 assorted tumors and nonneoplastic lesions. We have also analysed cytologically samples of normal nervous tissue obtained from autopsies, aiming at its recognition and distinction from the neoplastic tissue in biopsies. The tumors were analysed in smears which were subsequently compared with the histological sections. Although it is important to observe cytological details in the tumor, occasionally cells are arranged in such a way, that an overview of the smear practically allows the diagnosis of the tumor.

Biopsy, Needle↗
PubMed1992

Epidural compression in the spinal canal caused by excessive adipose tissue. A case report.

Excessive deposition of fat in the epidural space is rare. In a recent review of the literature, there were 15 reported cases, 14 were associated with steroid use and one was attributed to hypothyroidism. This report reviews treatment of a patient with symptoms of cauda equina compression caused by epidural adipose tissue. He had no history of steroid use or obvious evidence of an underlying endocrinopathy.

Adipose Tissue↗