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PubMedDate not supplied

[Cauda equina compression syndrome (CECS): retrospective study of surgical treatment with partial dorsal laminectomy in 86 dogs with lumbosacral stenosis].

We report our results of partial lumbosacral laminectomy for treatment of canine Cauda equina Compression Syndrome due to a lumbosacral stenosis. Opposite to conventional techniques of dorsal laminectomy, only widening of the Spatium interarcuale is performed. This is achieved by exstirpation of the Lig. flavum and partial dorsal laminectomy of the first sacral segment. The Proc. spinosi and integrity of facet joints are fully maintained by this technique. In 96.5% of 86 dogs treated with this method relief of dorsal pressure and permanent rapid regression of clinical symptoms was achieved. In two cases recurrence of clinical symptoms was observed during follow up and one case showed no improvement at all. In conclusion partial dorsal laminectomy is a minimal invasive technique for treatment of Cauda equina compression syndrome expressed by pain reaction accompanied by minor neurological deficits caused by lumbosacral stenosis. Maintained spinal stability allows short reconvalescence and the unrestricted use of dogs immediately post operation.

Animals↗
PubMed2004

The results of posterolateral lumbar fusion with bone chips from laminectomy in patients with lumbar spondylolisthesis.

BACKGROUND: This study was undertaken to assess the radiologic outcome of spinal fusion, with bone chips from laminectomy in patients with lumbar spondylolisthesis. METHODS: From January 1993 to September 2001, 95 patients with lumbar spondylolisthesis were managed and followed up well at our Orthopedic Division. All patients presented with persistent low back pain, radiculopathy and claudication. The diagnosis of lumbar spondylolisthesis was confirmed by plain radiographs of the lumbar spine, with lumbar spine computed tomography scan (CT-scan) performed to identify other associated conditions. A near total posterior decompression laminectomy with foraminotomy and posterolateral lumbar fusion using bone chips from laminectomy as bone graft and reduction of the vertebral slip using transpedicle screws with Arbeitsgemeinschaft für Osteosynthesefragen spinal fixators and Trifix Reduction Fixation spinal system implants, were instituted. Additional disectomies were performed in several patients with disc rupture as confirmed by CT-scan. Fusion was then assessed by plain lumbar radiographs done at 4, 8, and 24 months after operation. RESULTS: The outcome was good, with 88 (92.6%) cases attaining solid fusion, while failed fusion was noted in 7 (7.4%) cases. CONCLUSIONS: Proper decortication of the posterolateral vertebral gutter with removal of all soft tissues attached to the bone chips prior to the placement of bone graft were noted to be the most significant factors for spinal fusion. Fusion rate with bone chips from laminectomy was shown to be comparable to that of the iliac crest bone graft.

Adolescent↗
PubMed2006

Effect of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits.

OBJECTIVE: To determine the efficacy of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits. METHODS: Twenty-four Japanese white rabbits underwent laminectomy (including the attached ligaments) at L(2 ) and L(5). After laminectomy at L(5), polylactic acid glue was sprayed on the dura and nerve roots and this segment was taken as the experimental group. After laminectomy at L(2), nothing was used and this segment was enrolled as the self control group. Four rabbits were killed every two weeks postoperatively till the end of the experiment at 12 weeks. Then the operated spine was observed grossly, histologically and ultrastructurally to check the degree of scar formation, the status of epidural scar adhesion, the absorption of the glue, and the intracellular structure of fibroblasts. RESULTS: The glue coagulated immediately after spraying and showed excellent hemostatic effect. The glue membrane was easy to be taken away from the dura mater of the samples for 2 weeks and there were no cells in the epidural space in the experimental group. But the dura mater was covered by hematoma in the control group, which formed mild adhesion, with fibroblasts proliferating actively. In the 4th week, some glue shivers remained in the epidural space with fibroblasts increasing a little, and the dura mater was smooth in the experimental group. However, in the control group, the formed scar was fragile and conglutinated with the dura mater diffusely and fibroblasts were much more than those in the experimental group. In the 6th-12th weeks, there was a potential interspace between the scar and the dura mater, and the polylactic acid glue was absorbed completely in the experimental group. Much tough scar was found in the control group, which was very difficult to dissect from the dura mater and the surrounding tissues. From the ultrastructural observation of the fibroblasts, the nucleus became much bigger and the rough endoplasmic reticulum was much more plentiful in the control group than that in the experimental group. CONCLUSIONS: Polylactic acid glue can effectively reduce epidural cicatrization and adhesion.

Animals↗
PubMed1989

[The effect of fat tissue autotransplantation on the changes in tissue surrounding the dura mater following laminectomy].

Problems, probably caused by the adhesion of scar tissue to the dural sac or nerve roots, may appear after a laminectomy in which resection was required. In our department, free auto-fatty tissue transplantation has been clinically performed since 1979 in an effort to prevent this phenomenon, and favorable therapeutic results have been obtained. In the present study, the possible influence of extradural tissue on the dura mater over certain periods was investigated in post-laminectomized adult rabbits. Additionally, the inhibitory effect of transplanted fatty tissue on adhesion was examined. In the laminectomy-only subject group, a remarkable development of granulating tissue was observed. This tissue subsequently adhered to the dura mater, often resulting in a delayed repair of the dura mater and its surrounding tissue. In the fatty tissue transplanted group, on the other hand, the transplanted fat preserved its composition morphologically and rapid degeneration was deterred even in free grafts, so scar formation was inhibited at the site of the laminectomy. In comparison with the laminectomy-only group, furthermore, the repair of the tissue surrounding the dura mater was accelerated by the transplanted fatty tissue, beginning in the early postoperative stage.

Adipose Tissue↗
PubMed1979

Gunshot wounds of the spine: the effects of laminectomy.

In a review of 185 patients with gunshot wounds of the spine from low-velocity missiles, 106 were found to have a complete lesion and seventy-nine, an incomplete lesion. Fifty-six patients with complete lesions underwent laminectomy and only one had a partial (sensory) return of function. The fifty patients with complete lesions who had no laminectomy also had no spontaneous improvement. There were forty-five patients with incomplete lesions who had laminectomy and thirty-two (71 per cent) of them showed measurable improvement. For comparison, thirty-four patients with incomplete lesions had no operative treatment and in twenty-six (76.5 per cent) there was some spontaneous return of neural function. Four wound infections and six spinal fistulae developed in the operative group (a complication rate of 10 per cent). Spinal instability developed in six patients because of the laminectomies.

Adolescent↗
PubMedDate not supplied

A comparison of patients treated by chymopapain and laminectomy for low back pain using a multidimensional pain scale.

Seventy-seven patients treated by chymopapain and laminectomy were compared before, and 6 and 14 weeks after, treatment. A standardized, multidimensional scale of low back pain providing scores on 7 independent dimensions of sensory and affective discomfort and one measure of intensity were used. Fourteen weeks after surgery, patients treated by chymopapain were functioning as well as those treated by laminectomy. Major differences, however, characterized the course of recovery. Chymopapain produced rapid change, which was maintained over the 3 1/2-month period. Healing following laminectomy was slower, but the end results were essentially the same. These findings, using sophisticated measurement techniques, support previous research suggesting that chymopapain is an effective alternative to laminectomy in the treatment of lumbar disk disease.

Adult↗
PubMed1994

[Rotational stability of the thoracolumbar spine after interlaminar ultrasound window, hemilaminectomy and laminectomy. A comparative experimental study].

Intraoperative spinal sonography to check whether fragments have been successfully repositioned requires enlargement of the natural interlaminar window to 8 x 10 mm. The present study was performed to measure any rotational instability caused by such a laminotomy and compare it with that resulting when the conventional methods of checking the spinal canal, e.g. hemilaminectomy and laminectomy, are applied. The investigations were carried out in 10 human vertebral columns, in the area of T-12, L-2 and L-4. Torsional loads of up to 20 Nm were applied to the spines and axial rotations were recorded. Laminotomy, hemilaminectomy and laminectomy were done step by step. The loading-unloading cycles were achieved with initial axial rotation and decreasing torsional moment after measurement the dorsal manipulations. It was shown that interlaminar fenestration causes a hardly measurable instability. A laminotomy to 10 x 20 mm, allowing direct repositioning of the posterior vertebral surface, causes a 6% loss of stability. A significant decrease is caused by hemilaminectomy, with a 20% loss and by laminectomy, with 27% loss of rotational stability compared with the intact spine. Rotational instability of the spine causes severe pain and often has to be treated by spondylodesis. The present investigations show that the spinal canal should not be checked by hemilaminectomy or laminectomy. For this we now use intraoperative ultrasound.

Biomechanical Phenomena↗
PubMed1998

[Static and dynamic changes of the cervical spine after laminectomy for cervical spondylotic myelopathy].

PURPOSE OF THE STUDY: Extensive cervical laminectomy has been widely used in the treatment of progressive myelopathies secondary to stenotic conditions. Complications of this procedure such as spinal instability, accelerated spondylotic changes, postoperative spinal deformity and constriction of the dura mater by extradural scar tissue formation have been recognized. However, the frequency of these complications is probably overestimated and their consequences on the clinical outcome remain unknown. The purpose of this report was to describe the incidence and consequences of cervical spinal deformity and instability after multilevel laminectomy in adult patients with myelopathy caused by cervical spondylosis and to determine the usefulness of preoperative dynamic films in the prevention of postoperative destabilization. MATERIALS AND METHODS: 30 patients older than 30 years who underwent a laminectomy of more than 3 levels without fusion for myelopathy secondary to cervical spondylosis were reviewed retrospectively with an average follow-up of 5 years. Functional results were evaluated according to the Japanese Orthopaedic Association scoring system. Lateral views in neutral position, in flexion and in extension of the preoperative cervical roentgenograms were analyzed in comparison with the last follow-up one in order to identify the changes in the curvature of the cervical column, in the range of motion of the neck, in the intervertebral angular mobility and antero-posterior displacement of the vertebral bodies, and finally to identify the incidence of spinal instability. RESULTS: 18 patients (31 per cent) developed postoperative changes in cervical spine curvature. 15 patients (25 per cent) had one or more destabilized levels. Deformities of the cervical spine occurring after surgery do not appear to cause any symptom or neurologic abnormalities. Destabilization required repeat surgery in 3 patients. All the levels found destabilized on the postoperative films were hypermobile on the preoperative dynamic radiographs. A preoperative olisthesis without hypermobility was not a risk factor for postoperative destabilization. CONCLUSION: The use of preoperative dynamic radiographs should improve the selection of patients undergoing laminectomy for the treatment of multilevel cervical cord compression. Dynamic X-rays may also reinforce the need for possible adjunctive procedures such as fusion and instrumentation, in order to prevent a postoperative destabilization. A preoperative olisthesis with a hypermobility in sagittal or horizontal planes must be fused and instrumented.

Aged↗
PubMed2001

Contribution of facet joints to chronic low back pain in postlumbar laminectomy syndrome: a controlled comparative prevalence evaluation.

Postlumbar laminectomy syndrome, or pain following operative procedures of the lumbar spine, is increasingly a common entity in modern medicine. Multiple causes proposed for recurrence of pain after lumbar laminectomy are: epidural fibrosis, recurrent disc herniation, instability, and facet joints. Even though the prevalence of persistent low back pain secondary to the involvement of lumbosacral facet joints has been described in controlled studies from 15% to 45%, the prevalence of facet joint mediated pain in postlumbar laminectomy syndrome has not been studied. This prospective, randomized, controlled comparative evaluation was performed to determine the prevalence of facet joint mediated pain in persistent low back pain in postlumbar laminectomy patients with a comparative non-surgical group. One hundred patients with fifty patients in each group were randomly assigned with group I consisting of fifty patients without history of previous surgery and group II consisting of fifty patients with history of previous surgery. Results showed that the prevalence of facet joint mediated pain in non-surgical patients was 44% compared to 32% in post surgical patients determined by comparative controlled local anesthetic blocks utilizing lidocaine and bupivacaine. This study also showed a false positive rate of 36% in non-surgical group and 24% in post-surgical group. In conclusion, this study shows that facet joint mediated symptomatology in chronic low back pain is prevalent, both in non-surgical as well as post-surgical patients even though prevalence was somewhat higher in the non-surgical group compared to post-surgical group.

Journal Article↗
PubMed2000

A retrospective analysis of spinal canal endoscopy and laminectomy outcomes data.

Disability from back pain has continued to increase at a steady pace since the 1950's. While no study has associated chronic disability with physical factors, numerous studies have correlated chronic disability with psychological factors and surgical intervention. Even though most common surgical interventions for spinal pain pertain to the herniated disc, numerous studies have indicated that only 1% of severe episodes of low back pain is attributable to herniated discs. With the advent of spinal canal endoscopy, an additional option is available for medical management of disc disease, which facilitates irrigation, dilution, and removal of inflammatory mediators, thus decreasing the chance of reactivity to chemical and biological mediators, and facilitating administration of corticosteroid medication with specificity to site of action. This pilot study included two groups of patients, Group 1 with 22 patients treated via spinal endoscopy and Group 2 with 13 patients treated via laminectomy. After spinal canal endoscopy, only 31.8% of Group 1 patients were continued on opioid medication, whereas, 92.3% of Group 2 patients were continued on opioid medication after laminectomy. In addition, 72% from spinal canal endoscopy group and only 28% from laminectomy group returned to work. In conclusion, this study suggested remarkable differences in outcomes when comparing patients who underwent spinal canal endoscopy to a similar population who underwent lumbar laminectomy.

Journal Article↗
PubMed1988

Kinematics of the cervical spine: effects of multiple total laminectomy and facet wiring.

The effect of multiple-level total laminectomies followed by stabilization on the load-deformation behavior of the cervical spine is described. Fresh human ligamentous cervical spines (C2-T2) were potted and clinically relevant load types applied via a loading frame attached to the C-2 vertebra of the specimen. A set of three infrared light-emitting diodes (LEDs) were attached rigidly to each of five vertebrae (C3-7) to record their spatial locations after each load step application, using a Selspot II system. The specimen was tested again after total laminectomy performed on C5. The supraspinous, interspinous, and flavum ligaments between the C4-5 and C5-6 motion segments were cut; thereafter, the vertebral arch was removed. The specimen testing was resumed after inducing injury at C-6 in a similar fashion. The specimen was stabilized, using a facet wiring construct, across the C4-7 segment before testing for the final time. The load-deformation data of the injured and stabilized tests were normalized with regard to the corresponding results of the intact test. In flexion-extension mode, an increase in motion of about 10% after laminectomies was observed. Facet wiring was found to be an effective technique to stabilize injured cervical spines (approximately equal to 80% reduction in motion, compared with intact spines, was observed.

Biomechanical Phenomena↗
PubMed1990

Incidence of spinal deformity in children after multiple level laminectomy for selective posterior rhizotomy.

Fifty-five children with cerebral palsy had multiple-level laminectomies for selective posterior rhizotomies for the relief of spasticity. They were followed up clinically and radiologically to assess their spinal stability and the possible development of post-laminectomy deformity of the spine. The majority of the deformities found were related to cerebral palsy and did not appear to be due to the laminectomy: 16% had scoliosis, 5% kyphosis, 7% lordosis, and 9% spondylolysis/spondylolisthesis. Spondylolysis is the only abnormality that appeared to be more common in this group than in children with cerebral palsy.

Adolescent↗
PubMed1996

Spinous process-plasty following lumbar laminectomy as a contributing factor to spine stability.

A 10-year retrospective study of 41 consecutive patients who underwent "spinous process-plasty" is presented. We carried out laminectomy of the lumbar spine in cases of spinal stenosis, dorsomedial herniated disc and recurrent disc herniation with firm scars (traumatic and tumour cases are not included). To forestall the development of laminectomy's negative effects on spine stability, we initiated the spinous processes' reconstruction. Two groups of patients who underwent laminectomy form the basis of this presentation, one group with "spinous process-plasty" (41 patients) and the other (11 patients) without it. On postoperative neutral and dynamic X-ray films we paid attention to horizontal displacements larger than 3 mm and to negative intervertebral angular displacement. Considering such criteria, only 3.8% of those with "spinous process-plasty" developed a radiographic instability in contrast to 25% of patients without "spinous process-plasty". These results support the use of this technique, which provides postlaminectomy lumbar spine stability.

Adult↗
PubMed1975

The effect of surgical immobilization after laminectomy in the treatment of advanced cases of cervical spondylotic myelopathy.

Surgical immobilization of the cervical spine after laminectomy is proposed for the treatment of severe cervical spondylotic myelopathy (CSM) occurring with diffuse stenosis of the spinal canal (congenital or acquired). In 20 consecutive patients showing advanced CSM and cord compression at various levels, a laminectomy with posterior fixation was made, in most cases with the aid of a metal plate. In the evaluation of the severity of the myelopathy a slight modification of the Nurick scale was used. With the exception of three patients who developed complications unrelated to the technique, the results were very good as demonstrated by the long lasting improvement in the performance of the patients. The results emphasize the role which mechanical factors may play both, in the genesis of the disease and in the failures of the plain laminectomy.

Adult↗
PubMed1993

Prevention of adhesions after laminectomy: an experimental study in dogs.

An experimental study was designed to compare the efficacy of Vicryl mesh and autogenous fat in minimizing postoperative epidural scar formation. Three-level noncontiguous laminectomies were performed on ten adult dogs. Exposed dura at the three levels was covered with (1) nothing (control group), (2) fat, and (3) Vicryl mesh. Animals were sacrificed 6 and 12 weeks postoperatively and the specimens were examined histologically. Compared with the use of free fat grafts after laminectomy in dogs, Vicryl mesh produced slightly more scarring, but consistently less than observed in controls. Although no surgical zone treated with Vicryl mesh exhibited evidence of neural compression, one of the ten fat-grafted zones showed gross evidence of neural compression. These findings indicate that the use of Vicryl mesh at laminectomy sites may be an alternative method of minimizing postoperative epidural scar formation.

Adipose Tissue↗
PubMed2002

[Undercutting decompression versus laminectomy. Clinical and radiological results of a prospective controlled trial].

The aim of the current study was to evaluate the clinical outcome after laminectomy or undercutting decompression in patients with lumbar spinal stenosis (LSS) without apparent signs of instability. In a prospective controlled, nonrandomized trial 1 year after operation, two groups of patients were compared. Out of 85 consecutive patients, treated from 1998 to 1999 in an orthopedic university clinic for symptomatic LSS, decompression without simultaneous fusion was performed in 40 cases. In group I ( n=13) a laminectomy was done and in group II ( n=27) an undercutting of the vertebral arch and facet joints. The main outcome measure was the Oswestry Low Back Disability Score. Subjective complaints, visual analog scale (VAS), claudication distance, analgesic demands, and radiomorphometric parameters following the procedure of Dupuis and Nash/Moe at 6 and at 12 months after the operation were secondary objective criteria. One year postoperatively the main outcome measure showed no significant difference between the two groups, although group II had shown better results ( p=0.0195) 6 months postoperatively. The required analgesics could be significantly lowered in group II compared with group I at 12 months ( p=0.0011). The remaining secondary outcome measures showed no statistically significant differences. The extent of decompression in LSS without apparent instability did not influence the outcome. If there is any doubt intraoperatively about the adequate amount of decompression of the lumbar spinal canal, undercutting decompression should be extended to laminectomy without fear of consecutive segmental instability.

Aged↗
PubMed2000

Laminectomy performed using a micro bone saw.

In 154 clinical cases requiring laminectomy at any part of the spinal column, the laminae were removed using a micro bone saw. Immediately after the laminectomy two surgeons using a microscope examined the field for any damage to the dura, the spinal cord, the nerve roots and the epidural vessels. No injury to the spinal cord or the nerve roots was observed. In 5 patients the dura were lacerated for a length of up to 10 mm, and in all the patients adhesions were present due to previous operations. Epidural vessels were severed in 18 cases. The method is useful and less time-consuming than conventional laminectomy.

Adolescent↗
PubMed2005

Effectiveness of multiple-level decompression in laminoplasty and simultaneous C1 laminectomy for patients with cervical myelopathy.

A retrospective study to investigate the relationship between the surgical levels and decompression effects was performed in patients with cervical myelopathy who had undergone Tension-band laminoplasty (TBL) with/without simultaneous C1 laminectomy. One hundred and sixty-eight patients (115 males, 53 females; age: 31-80 years, average 58.9 years; follow-up period: 12-120 months, average 20 months) were divided into three groups according to the range of the surgical levels: seventy-two patients in group A underwent TBL at the C2-C7 levels with C1 laminectomy; 60 patients in group B underwent TBL at the C2-C7 levels; 36 patients in group C underwent TBL at the C3-C7 levels. Neurological evaluation was performed by using the Japanese Orthopedic Association (JOA) scoring system. The alignment changes of the spinal column and the spinal cord were analyzed using pre- and post-operative roentgenograms and MRIs. The differences in the pre- and post-operative anterior subarachnoid spaces (D-ASAS), the spinal cord diameters (D-CORD), and the dural sleeve diameters (D-DURA) at the C1-C7 levels were also analyzed by using MRIs. The JOA scores improved in all groups. As for the spinal alignment, neither significant changes between pre- and post-operation in any group nor significant differences among the three groups were found. The lordosis of the cervical spinal cord was decreased in all groups. D-ASAS of group A was larger than that of group B at the C1-C5 levels (P<0.05), as were those of D-CORD and D-DURA at the C1-C2 and C4-C5 levels (P<0.05). D-ASAS of group A was larger than that of group C at the C1-C4 levels (P<0.05), as were those of D-CORD and D-DURA at the C1-C5 levels (P<0.05). In conclusion, laminoplasty including the C2-C7 levels with simultaneous C1 laminectomy was proven to allow the most posterior shift of the spinal cord within the widened dural sleeve at C5 or higher levels without significantly changing the spinal alignment.

Adult↗