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PubMed1985

Immunohistochemistry of synaptic input and functional characterizations of neurons near the spinal central canal.

Neurons surrounding the central canal in sacral spinal segments were functionally characterized on the basis of somatic and/or visceral afferent input, then intracellularly marked with horseradish peroxidase (HRP). Tissue sections containing portions of HRP-stained neurons were subsequently immunohistochemically examined for the presence of contacts made by axonal enlargements containing vasoactive intestinal polypeptide (VIP), substance P (SP), somatostatin (SS), Leu-enkephalin (ENK), or serotonin (5-HT). ENK-and 5-HT-containing enlargements were found to contact all neurons examined. SP and SS terminals contacted fewer neurons, and were not associated with specific functional classes. On the other hand, VIP-containing fibers contacted only those neurons receiving visceral afferent input, thus supporting the contention that VIP is contained in a population of visceral afferent fibers projecting to the gray matter surrounding the central canal at sacral levels.

Animals↗
PubMed2003

Posterior approach to the degenerative cervical spine.

Laminoplasty has been gradually accepted as a treatment for choice for cervical compression myelopathy. The historical perspective of laminoplasty is described. The aims of laminoplasty are to expand the spinal canal, to secure spinal stability, to preserve the protective function of the spine, and to preserve spinal mobility. Laminoplasty is indicated in myelopathic patients with a developmentally narrow spinal canal or multiple-level involvement combined with a relatively narrow canal. Several laminoplasty techniques and supplementary techniques are described, together with expected outcomes and complications of surgery.

Adult↗
PubMed2002

Sex discrepancy in the canal/body ratio of the cervical spine implicating the prevalence of cervical myelopathy in men.

STUDY DESIGN: A radiographic analysis of the cervical spine in healthy young adults. OBJECTIVES: To investigate the size correlations among the vertebral height, the anteroposterior diameter of the vertebral body, and the anteroposterior diameter of the spinal canal and to investigate the sex discrepancy of the canal/body ratio. SUMMARY OF BACKGROUND DATA: Narrow spinal canal, large vertebral body, and male gender have been thought to be risk factors for cervical myelopathy. However, the association among those risk factors has been seldom analyzed. METHODS: The height and the anteroposterior diameter of the vertebral body as well as the anteroposterior diameter of the spinal canal were measured on the lateral radiographs of healthy young adults (105 men and 114 women) using a distance-measuring tool of computer software. The canal/body ratio was compared between men and women. RESULTS: The height and the anteroposterior diameter of the vertebral body were both larger in males than in females throughout C3-C7, but the anteroposterior diameter of the spinal canal was similar for both sexes. The height of the vertebral body was not correlated with the spinal canal size at any measured segment in both sexes, whereas the anteroposterior diameter of the vertebral body was significantly correlated with the size of the spinal canal in males but not in females. The canal/body ratio was significantly larger in women than in men. CONCLUSIONS: A significantly small canal/body ratio in men may implicate the male prevalence of cervical myelopathy.

Adult↗
PubMed2007

Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures. Technical note.

Percutaneous balloon kyphoplasty has become a widely adopted treatment option for patients with pain due to pathological compression fractures. One potential risk of the procedure is the displacement of tumor into the spinal canal and resulting spinal cord or cauda equina injury during inflation of the balloon prior to polymethylmethacrylate (PMMA) placement. In addition, the presence of any remaining tumor between the PMMA and the fractured cortical bone can lead to suboptimal improvement in stabilization and subsequent pain relief. The authors describe a technique to remove tumor from within the vertebral body (VB) through a percutaneous working channel prior to kyphoplasty balloon inflation and augmentation. The technique was successfully used in all three patients who had presented with pain, and the pain improved in all three cases. There was no extravasation of PMMA into the spinal canal in any case. A combined VB tumor debulking and kyphoplasty technique offers the ability to improve the placement of PMMA within the diseased vertebral body, potentially leading to increased safety as well as clinical effectiveness for stabilization of these fractures.

Adult↗
PubMed1986

Transcutaneous sonography of the postoperative spine.

Transcutaneous sonography of the spine was performed in 83 patients with prior laminectomies for tumors of the spinal canal and the spinal cord. These patients presented with signs or symptoms of recurrent tumor. When the spinal cord could be visualized, the sonographic examination provided information about the presence or absence of tumor, the character (solid or complex) of the tumor and its location, and associated findings in the extramedullary space. The correlation of the transcutaneous sonograms with other imaging methods and with intraoperative sonographic and surgical findings was excellent. Nonvisualization of the spinal cord was found to be related to age with a higher success rate (70% visualized) in the pediatric age group (to age 21) than in the adult group (52% visualized). A very short laminectomy was also found to cause problems in visualizing the full extent of a recurrent tumor. Nonetheless, the simplicity of the technique and the amount of information that can be gained from it make it a very valuable adjunct to other imaging methods for the postoperative spine. For the pediatric age group, it should be one of the first diagnostic methods employed.

Adolescent↗
PubMed2000

The role of directly applied hypothermia in spinal cord injury.

STUDY DESIGN: The effect of intense local hypothermia was evaluated in a precision model of spinal canal narrowing and spinal cord injury in rats. The spinal cord injury was cooled with a custom cooling well used over the epidural surface. Basso, Beattie, and Bresnahan (BBB) motor scores and transcranial magnetic motor-evoked potential (tcMMEP) responses were used after injury to accurately evaluate neurologic recovery. OBJECTIVE: This study was undertaken to determine whether the prognosis for neurologic recovery in a standardized rat spinal cord injury model is altered by the direct application of precisely controlled hypothermia to the area of injury. SUMMARY OF BACKGROUND DATA: The role of hypothermia in the treatment of spinal cord injuries with neurologic deficits remains undefined. Hypothermia may decrease an area of spinal cord injury and limit secondary damage, therefore improving neurologic recovery. However, it has been difficult to consistently apply localized cooling to an area of spinal cord injury, and the use of systemic hypothermia is fraught with complications. This fact, along with the unavailability of a precise spinal cord injury model, has resulted in inconsistent results, both clinically and in the laboratory. In a rat model of spinal cord injury, 37 C and 19 C temperatures were used to study the role of hypothermia on neurologic recovery. METHODS: Male Spraque-Dawley rats (n = 52; weight, 277.7 g) were anesthetized with pentobarbital and subjected to laminectomy at T10. The rats were divided into three groups: 1) placement of a 50% spacer in the epidural space (16 rats), 2) severe (25 g/cm) spinal cord injury (16 rats), 3) 50% spacer in combination with spinal cord injury (16 rats). Eight rats in each group were tested at two temperatures: normothermic (37 C) and hypothermic (19 C). With the use of a specially designed hypothermic pool placed directly over the spinal cord for 2 hours, epidural heating to 37 C, and epidural cooling to 19 C was accomplished. Simultaneous measurements of spinal cord and body temperatures were performed. The rats underwent behavior testing using the BBB motor scores and serial tcMMEPs for 5 weeks. Statistical methods consisted of Student's t tests, one-way analysis of variance, Tukey post hoc t tests and chi2 tests. RESULTS: There was a significant improvement in motor scores in rats subjected to hypothermia compared with those that were normothermic after insertion of a 50% spacer. This improvement was observed during the 5-week duration of follow-up. In the severe spinal cord injury group and the spinal cord injury-spacer groups, no significant improvement in motor scores were obtained when the spinal cord was exposed to hypothermia. CONCLUSION: The results demonstrate that there is a statistically significant (P < 0.05) improvement in neurologic function in rats subjected to hypothermia (19 C) after insertion of a spacer that induced an ischemic spinal cord injury. This indicates that directly applied hypothermia may be beneficial in preventing injury secondary to ischemic cellular damage. The data demonstrated minimal therapeutic benefit of hypothermia (19 C) after a severe spinal cord injury.

Animals↗
PubMed2002

Cervical Spine Stenosis Measures in Normal Subjects.

OBJECTIVE: To compare 2 methods of determining cervical spinal stenosis (Torg ratio, space available for the cord [SAC]); determine which of the components of the Torg ratio and the SAC account for more of the variability in the measures; and present standardized SAC values for normal subjects using magnetic resonance imaging (MRI). DESIGN AND SETTING: The research design consisted of a posttest-only, comparison-group design. The independent variable was method of measurement (Torg ratio and SAC). The dependent variables were Torg ratio and SAC scores. SUBJECTS: Fourteen men (age = 24.4 +/- 2.5 years, height = 181.0 +/- 5.8 cm, weight = 90 +/- 13.5 kg) participated in this study. The C3 to C7 vertebrae were examined in each subject (n = 70). MEASUREMENTS: The Torg ratio was determined by dividing the sagittal spinal-canal diameter by the corresponding sagittal vertebral-body diameter. The SAC was determined by subtracting the sagittal spinal-cord diameter from the corresponding sagittal spinal-canal diameter. The Torg ratio and SAC were measured in millimeters. RESULTS: The SAC ranged from 2.5 to 10.4 mm and was greatest at C7 in 71% (10 of 14) of the subjects. The SAC was least at C3 or C5 in 71% (10 of 14) of the subjects. A Pearson product moment correlation revealed a significant relationship between the Torg ratio and SAC (r =.53, P <.01). Regression analyses revealed the vertebral body (r (2) =.58) accounted for more variability in the Torg ratio than the spinal canal (r (2) =.48). Also, the spinal canal (r (2) =.66) accounted for more variability in the SAC than the spinal cord (r (2) =.23). CONCLUSIONS: The SAC measure relies more on the spinal canal compared with the Torg ratio and, therefore, may be a more effective indicator of spinal stenosis. This is relevant clinically because neurologic injury related to stenosis is a function of the spinal canal and the spinal cord (not the vertebral body). Further research must be done, however, to validate the SAC measure.

Journal Article↗
PubMed1997

A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: Five-year follow-up by an independent observer.

STUDY DESIGN: A prospective and consecutive study of surgical results obtained during serial follow-up investigations in patients who underwent surgery for central lumbar spinal stenosis. OBJECTIVES: To evaluate the result after surgical decompression for lumbar spinal stenosis, at regular intervals after surgery, and to correlate these results with values for preoperative parameters; special interest was focused on the results in relation to the degree of constriction of the spinal canal. SUMMARY OF BACKGROUND DATA: The outcome after surgery for spinal stenosis is debatable; long-term follow-up investigations have indicated deterioration with passing time. Results of studies in nonsurgical patients have demonstrated that the symptoms do not progress with time. Results of a meta-analysis of the literature on surgical results have demonstrated a wide variation of outcomes. MATERIAL AND METHODS: In a prospective study, 105 consecutive patients who underwent surgical decompression (laminectomy with facet-preserving technique, but no fusion) were evaluated at follow-up examinations 4 months and 1, 2, and 5 years after surgery. At the follow-up examinations, the patient's opinion on the surgical result was registered, using a four-grade scale. The occurrence of pain at rest and at night was registered, as well as the patient's walking ability. Statistical analysis was performed, relating the surgical results to patient age, gender, preoperative duration of symptoms and radiographically observed constriction as described in Part I of this study. The radiologist was blinded to patient outcome. Logistic regression analysis was performed. RESULTS: During the follow-up period, 19 patients underwent reoperation, consisting of fusion to treat lumbar pain (n = 4), repeat decompression because of progressive stenosis (n = 13), and repairs in response to surgical complications (n = 2). Follow-up results: The result, related to the recurrence of leg symptoms, deteriorated with passing time. Excellent results were reported by 63% to 67% at 4-month and 2-year follow-ups compared with 52% at the 5-year follow-up. There was a correlation between the constriction of the spinal canal and the outcome at all intervals. Patients with an anteroposterior diameter of 6 mm or less at the narrowest site had significantly better results. The logistic regression analysis demonstrated a significant correlation between a severe reduction of the anteroposterior diameter and excellent results and a tendency toward better results in patients with a shorter preoperative duration of symptoms. Improvement of walking ability was also associated with a pronounced constriction of the spinal canal. CONCLUSION: The results after surgical decompression in patients with central spinal stenosis deteriorated with time. There was a significant correlation between good result and pronounced constriction of the spinal canal. Patients with a preoperative duration of symptoms of less than 4 years and patients with no preoperative back pain tended to have better surgical outcomes. The reoperation rate was 18% within 5 years. When surgery for spinal stenosis is contemplated, these prognostic factors should be taken into consideration: The "ideal patient" has a pronounced constriction of the spinal canal, insignificant lower back pain, no concomitant disease affecting walking ability, and a symptom duration of less than 4 years.

Adult↗
PubMed2005

Traumatic central cord syndrome: analysis of factors affecting the outcome.

BACKGROUND: The indications and timing of treatment, as well as the best treatment method for traumatic central cord syndrome (CCS), remain controversial. The aims of this study are to determine the prognostic factors of traumatic CCS and to determine appropriate surgical indications. METHODS: We reviewed the clinical and radiological data of 47 patients with this syndrome. The data collected included age, neurological status as measured on a scale defined by the Japanese Orthopaedic Association (JOA), anteroposterior (AP) diameter of the spinal canal on computed tomography, signal intensity change of the spinal cord on T2-weighted magnetic resonance imaging (MRI), associated spinal diseases, and the type of treatment received. The correspondence between the clinical and radiological findings and the neurological outcome was investigated. RESULTS: The patient's age, JOA score on admission, signal intensity change of the spinal cord on MRI, and associated spinal diseases were not significant in predicting the patient's recovery. On the other hand, the AP diameter of the spinal canal (P = .0402) and the interval between injury and surgery (P < .0001) were factors predictive of excellent recovery. In the surgical treatment group, timely surgery was found to improve the outcome, while conservative treatment did not improve the outcome of patients with a low JOA score, a relatively small AP diameter of the spinal canal, or a positive signal intensity change of the spinal cord on T2-weighted MRI. CONCLUSION: The AP canal diameter of the spinal canal and the interval between injury and surgery may be reliable predictors of excellent recovery in patients with CCS. We recommend timely surgery, preferably within 2 weeks of injury, to achieve a better functional outcome in selected patients.

Central Cord Syndrome↗
PubMed2001

Laminar hook instrumentation in the cervical spine. An experimental study on the relation of hooks to the spinal cord.

Several anterior and posterior methods are today available for stabilization of the cervical spine. Factors such as level and degree of instability, method of decompression, bone quality, length of fixation and safety factors influence the choice of method for a particular patient. The use of laminar hooks in the cervical spine has been restricted by fear of cord compression with the potential of tetraplegia. The aim of the present study was to assess the safety and determine the anatomical relation between hooks inserted in the cervical spinal canal and the dura and spinal cord. Thirteen cadavers from seven women and six men with no evidence of cervical spine disorder were included. The mean age was 81.3 years (range 65-101 years). The cervical spine was instrumented with cervical Compact Cotrel Dubousset hooks and rods. The effect of the hook on the dura was studied by myelography in nine cadavers. The deformation of the dural sac was quantified by measurement of the maximal width of the indentation of the contrast column at each level. A CT myelography scan was obtained in three cadavers. The ratio between the distance of maximal hook intrusion into the spinal canal and the canal diameter in the direction of the hook was calculated. The relation between inserted hooks and the spinal cord and dura was documented in a fresh cadaver studied with CT myelography. A hemilaminectomy was performed at all levels in three cadavers with direct visual inspection and photography of the hook sites before and after excision of the dura. A dural deformation of 2 mm or less, as observed by myelography, was found at four out of 77 (5%) hook sites. The deformation was caused by a supralaminar hook at C3, C6 and C7 and by an infralaminar hook at C6. The mean hook intrusion in the spinal canal, as observed on CT, was 27% (range 8-43) of the canal diameter. On visual inspection, 14 out of 18 hooks were in contact with the dura. After removal of the dura, two out of the 18 hooks in the same cadaver were in contact with the spinal cord. However, no deformation of the cord was observed. To our knowledge this is the first study systematically documenting the relation between hooks and the spinal cord in cadavers. In 95% of the hooks no deformation of the dural sac was observed and there was no evidence of spinal cord deformation. From an anatomical point of view, laminar hook instrumentation can be considered a safe procedure. The study shows, however, that hooks inserted in the cervical spine have a close anatomical relationship with the neuraxis, and at stenotic levels the use of other techniques is therefore recommended.

Aged↗
PubMed2005

Close radiographic landmarks for spinal cord localization in treatment of thoracic malignancy.

BACKGROUND: On simulation radiographs of oblique fields, the spinal canal is estimated to be located on the deep surface of the tangential parts of the vertebral laminae within a width of the oblique diameter of the spinal canal. The aim of this study was to evaluate the accuracy of the estimated location of the spinal canal. MATERIALS AND METHODS: Beam's eye view digital simulation radiographs were produced using actual patient data from a computed tomography (CT) scanner. The spinal canal was projected onto the Beam's eye view image, and measurement of the distance between the tangential parts of the vertebral laminae and the anterior border of the spinal canal was performed. The oblique diameter on the axial CT image was compared to the measured distance. RESULTS: In all 10 patients, the tangential parts of the vertebral laminae were detectable on the Beam's eye view image. At all levels in all patients, the oblique diameter was slightly larger than or equal to the distance. With a gantry angle of 30 degrees the difference ranged from 0 to 2.5 mm (mean, 1.2 mm), from 0 to 1.0 mm (mean, 0.4 mm), and from 0 to 1.5 mm (mean, 0.4 mm) at levels T-1, T-4, and T-7, respectively. With a gantry angle of 45 degrees the difference ranged from 0 to 1.5 mm (mean, 0.8 mm), from 0 to 0.5 mm (mean, 0.3 mm), and from 0 to 1.0 mm (mean, 0.4 mm), respectively. CONCLUSION: The tangential parts of the vertebral laminae are useful landmarks, since the spinal canal location estimated using the tangential parts and measured oblique diameter of the spinal canal on the axial CT image is sufficiently accurate.

Aged↗
PubMed2003

Split laminotomy in pediatric neurosurgery.

TECHNIQUE: A novel technique of multilevel opening of the spinal canal is introduced into pediatric neurosurgery. Split laminotomy helps to preserve the spinal column integrity in cases of posterior exposure of the spinal canal. The spinal processes are cut in the midline and the laminae are separated and retracted while the lesion in the spinal canal is explored. At closure the lamina are simply sutured. RESULTS AND DISCUSSION: Excellent postoperative results were obtained in patients from different age groups. Pediatric peculiarities of the new method are discussed.

Child↗
PubMed2004

Morphometry of the thoracic spine in German shepherd dog: a computed tomographic study.

Computed tomographic images of the thoracic spine of 13 German shepherd dogs were examined in order to determine the thoracic spine morphometry. Examinations were carried out in the transverse plane both intervertebral and mid-vertebral levels of the each thoracic vertebrae. The dorsoventral and interpedicular diameters of the spinal canal, the dorsoventral and transverse diameters of the vertebral body, the dorsoventral and transverse diameters of the spinal cord and also the cross-section area of the spinal canal were measured. The maximum values were found to be at the level of C7-T1. The shapes of the spinal canal and cord were circular in middle part, the shape became transverse oval in the cranial and caudal parts of the thoracic spine. The most significant correlation between the diameters was found to be in male dogs, except between dorsoventral diameters of the spinal canal and that of the vertebral body and between dorsoventral diameters of the spinal canal and transverse diameters of the vertebral body.

Animals↗
PubMed1999

Analysis of dural configuration for evaluation of posterior decompression in cervical myelopathy.

OBJECTIVE: The goal of this study was to establish the criteria for sufficient decompression of the cervical spinal cord in laminoplastic surgery. METHODS: Radiological examinations and neurological evaluations were conducted for 63 patients with cervical spondylotic myelopathy (CSM) and 31 patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent suspension laminotomy. RESULTS: The dural configuration in computed tomographic myelograms was evaluated in comparison with the critical value for the dural configuration established from 36 control subjects. Seventy-six of 94 patients were judged to have achieved full decompression. The neurological improvement of patients with full decompression was significantly better than that of patients with insufficient decompression (P<0.01). The postoperative sagittal diameter of the spinal canal was more than 14 mm in most of the sufficiently decompressed cases of CSM and more than 17 mm in OPLL cases. The laminotomy width was more than 70% of the transverse diameter of the spinal canal in both CSM and OPLL cases. There were four OPLL cases with insufficiently decompressed dura mater in the well-enlarged spinal canal after surgery. In these cases, the ossified posterior longitudinal ligament continuously occupied more than 25% of the preoperative spinal canal area over three or more segments. CONCLUSION: The following conditions were considered critical for sufficient decompression of the spinal cord in laminoplastic operations: postoperative sagittal diameter of the spinal canal of more than 14 mm in CSM cases and more than 17 mm in OPLL cases and laminotomy width of more than 70% of the transverse diameter of the spinal canal in both CSM and OPLL cases. However, in cases of extensive OPLL, sufficient decompression could not be obtained through posterior enlargement of the spinal canal.

Adult↗
PubMed1994

[Morphological study of the axial view of the cervical spinal cord by MR images].

To investigate the morphological changes in the cervical spinal cord in patients with cervical myelopathy, we examined the axial anatomy of the cervical spinal cord and the spinal canal using MRI and CT scans. This study involved 35 patients (mean age = 56.8) with cervical myelopathy and 118 adult normal volunteers (mean age = 48.1) as controls. The transverse area of the spinal cord was measured on MR images (T1 images), while the transverse area of the spinal canal was measured on CT. In normal subjects, the transverse area, the sagittal diameter, and the coronal diameter of the spinal cord showed a significant positive correlation with body height, and a significant negative correlation with age. No significant difference was identified between males and females. The transverse area, the sagittal diameter, the coronal diameter, and the ratio of the sagittal/coronal diameter of the spinal cord and the spinal canal showed significant positive correlations among each other in normal subjects, but no significant correlation was noted in the patients with cervical myelopathy. There was no significant difference between the normal subjects and the patients in the transverse area or in the ratio of the sagittal/coronal diameter of the spinal cord at the levels without cord compression. However, the transverse area of the spinal canal in the patients with myelopathy was significantly smaller than that of normal subjects. In conclusion, a poor or no correlation between the size of the spinal cord and the spinal canal is a frequent finding in patients with myelopathy. Furthermore, this study suggests that patients with myelopathy present a narrow spinal canal more frequently than do normal subjects.

Adult↗
PubMed2006

Spinal implants and radiation therapy: the effect of various configurations of titanium implant systems in a single-level vertebral metastasis model.

BACKGROUND: The combination of surgery and radiation therapy is a common clinical practice in the treatment of spinal tumors. Although it is known that metallic implants disturb radiation therapy beams, it is not known what kind of dose distributions appear with spinal irradiation in the presence of a spinal implant. The aim of the present study was to investigate the effect of various spinal implant constructs on the dose of radiation delivered to the spinal canal in a single-level metastasis model. METHODS: We performed four spinal implant reconstructions on standard sawbones spine models: posterior instrumentation without anterior column reconstruction, posterior instrumentation with anterior column reconstruction with use of a titanium cage, anterior instrumentation with anterior column reconstruction with use of a titanium cage, and anterior instrumentation with anterior column reconstruction with use of chest tubes filled with bone cement. Irradiation with two different radiation therapy units (a cobalt-60 teletherapy unit and a linear accelerator) was performed twice for each model in a posterior-to-anterior direction, and thermoluminescent dosimeters were used to measure the dose changes in the anterior, middle, and posterior portions of the spinal canal. RESULTS: Compared with the sawbones-only model, the posterior instrumentation reconstructions resulted in a 5% to 7% decrease in the radiation dose delivered to the spinal canal with both radiation therapy units, whereas the anterior instrumentation reconstructions resulted in a 1% decrease in the dose delivered with the linear accelerator unit and a < or = 2% increase in the dose delivered with the cobalt-60 teletherapy unit. When thermoluminescent dosimeters in the middle of the spinal canal were evaluated individually, anterior instrumentation with anterior column reconstruction with use of bone cement-filled chest tubes resulted in a 5.5% increase in the radiation dose delivered with the cobalt-60 teletherapy unit, whereas all of the other instrumentation models resulted in a <1% disturbance in the radiation dose delivered with both radiation therapy units. CONCLUSIONS: The posterior instrumentation systems did not result in the delivery of an increased dose of radiation to the spinal cord, suggesting that current radiation therapy regimens may be performed without additional harm. The anterior instrumentation systems also appeared to be relatively safe when irradiation was performed with the linear accelerator unit. However, when irradiation was performed with use of the cobalt-60 teletherapy unit, there was an increase in the dose of radiation delivered to the spinal canal in the presence of the anterior instrumentation systems, particularly the anterior column reconstruction with use of bone cement-filled chest tubes. These dose-perturbation characteristics might be important to consider during the calculation of radiation therapy protocols for patients who are going to receive high doses or recurrent treatments that would reach the tolerance limits of the spinal cord.

Humans↗
PubMed1998

Pharmacokinetics of anticancer drugs in cerebrospinal fluid.

OBJECTIVE: To examine the pharmacokinetics of anticancer drugs in the cerebrospinal fluid (CSF) during chemotherapy by the lumbar-ventricular (LV) and ventricular-lumbar (VL) routes. CASE SUMMARY: A 69-year-old Japanese woman with disseminated glioblastoma received two LV and four VL courses of CSF perfusion chemotherapy with methotrexate, nimustine, and cytarabine hydrochloride. Samples of CSF from the ventricles and lumbar spinal canal were obtained via Ommaya reservoirs during one LV and one VL course. Drug concentrations in the CSF were measured by fluorescence polarization immunoassay or HPLC. RESULTS: During LV CSF perfusion, the highest CSF drug concentrations in both the ventricles and the lumbar spinal canal were observed at the end of perfusion. During treatment, the concentrations of all three drugs in the lumbar spinal canal were higher than those in the ventricles. The CSF AUC of methotrexate in the ventricles was 16.1% of that in the lumbar spinal canal. During VL CSF perfusion, the highest drug concentrations were also observed at the end of perfusion. The drug concentrations in the lumbar spinal canal were initially lower than those in the ventricles. However, the concentrations of methotrexate and cytarabine in the lumbar spinal canal exceeded those in the ventricles 3 hours after perfusion. The AUC of methotrexate in the lumbar spinal canal was 174.9% of that in the ventricles. CONCLUSIONS: The pharmacokinetics of anticancer drugs in ventricular CSF differ from those in lumbar CSF during LV and VL perfusion chemotherapy.

Aged↗
PubMed1977

Cervical spondylotic myelopathy in wide canals.

The anteroposterior diameters of the cervical spinal canal in 21 patients with cervical spondylotic myelopathy were measured. In more than one-third (eight) of these it was found that this diameter of the canal was more than 14 mm, despite a widely held belief that this myelopathy is unlikely if the cervical spinal canal is wider than 14 mm in the AP diameter.

Humans↗