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PubMed1977

[Postoperative spinal canal stenosis (author's transl)].

Four cases of postoperative spinal canal stenosis were presented in which compression of cauda equina was observed. The lesion was found in 5.8% of operated spinal stenosis (four out of 69 cases). One must pay attention to differentiate the lesion from the recurrence of initial disorder, because the symptoms of the postoperative spinal stenosis is no always typical but sometimes resemble to the symptoms of the initial disorder which needed the operation. Myelography is the only reliable method to decide the extent of the spinal canal stenosis.

Adult↗
PubMed1993

Imaging anatomy of the lateral lumbar spinal canal.

This article reviews the normal anatomy of the bony and soft tissue structures of the lateral lumbar spinal canal. Thorough knowledge of these imaging anatomy helps in making the correct diagnosis of the lumbar spinal lesions. CT and MRI are excellent tools to diagnose lateral lumbar spinal canal stenosis. Both CT and MRI provide the accurate measurements of the midsagittal and lateral spinal canals and show the abnormalities of the nerve root course. This review provides anatomic and radiographic descriptions of the lateral lumbar spinal canal and the anatomically related joints.

Humans↗
PubMed2005

[Paraparesis following stable L4 burst fracture Possible correlation with preexisting degenerative stenosis of the spinal canal].

A patient with degenerative stenosis of the lumbar spinal canal developed paraparesis of both legs following a stable L4 burst fracture. However, neither the stenosis nor the fracture have caused a significant narrowing of the spinal canal. Surgical decompression and dorsal stabilization has led to relief of the neurological deficit. This case demonstrates that even a stable burst fracture may cause paraparesis and that a degenerative spinal canal stenosis is a predisposing factor.

Aged↗
PubMed1997

Restoration of the spinal canal by the internal fixator and remodeling.

It has been observed that after reduction of an unstable vertebral fracture, treated either conservatively or operatively, the encroachment of the spinal canal remaining after reduction can decrease considerably with time. A series of 31 cases, each with a set of CT scans taken preoperatively, immediately after surgery and after implant removal respectively, was assessed using computer-aided planimetry. The mean initial narrowing of the spinal canal was 44.6%. Through surgery this was decreased by 20.4%, leaving a remaining deficit of 24.2%. After implant removal, 15 months after trauma and surgery, the area of the spinal canal increased a further 17.4%, leaving a remaining deficit of only 6.8%. Comparing the values of the spinal canal for T12-L5 directly after surgery and after implant removal, an almost identical degree of restoration for each level can be seen. This additional and gradual restoration of the spinal canal is termed remodeling. This study demonstrates that a residual postoperative narrowing of the spinal canal of up to 25% can be ignored, provided there is no initial neurologic damage.

Adolescent↗
PubMed1975

[Constitutional narrowing of the cervical spinal canal. Radiological and clinical findings].

A constitutional narrowing of the cervical spinal canal was seen in 31 patients with neurological disorders. The ratio of the inner diameter of the spinal canal to the diameter of the vertebral body was smaller than 1 (normal greater than 1). Clinical signs were observed from 45 years upwards where reactivedegenerative changes cause additional narrowing. The majority of patients were male, predominantly heavy manual labourers. There is often a trauma preceding. On myelography multilocular deformations of the spinal subarachnoid space and nerve roots are seen. On the mechanical narrowing of the spinal canal a vascular factor supervenes, caused by exostoses, intervertebral disc protrusions, and fibrosing processes. Clinically a chronic progressive spinal transection syndrome (cervical myelopathy) dominates besides a multilocular root involvement. Posterior column sensibility is predominantly lost. Pain in the extemities and the cervical column is an early symptom. Non-specific CSF changes occur frequently. In case of root involvement the electromyogram is pathological. The prognosis is bad. Operation can only remove reactive processes but not the constitutional anomaly.

Adult↗
PubMed1999

The fetal spinal canal--a three-dimensional study.

The size of the lumbar spinal canal was evaluated in a prospective cross-sectional ultrasound (US) study to determine normal size values for lumbar part of the vertebral canal. A total of 88 patients undergoing routine obstetric US were studied between 16-41 weeks gestation. Structural anomalies or growth restriction were excluded. Area and volume of the vertebral canal in L1, L3 and L5 were calculated by three-dimensional (3-D) US. The size of the spinal canal correlated well with gestational age and no major differences could be found between upper and lower lumbar spine. By 3-D US, in vivo assessment of the spinal canal becomes possible. Further studies are needed to confirm our findings.

Cross-Sectional Studies↗
PubMed2000

Impalement injuries involving the spinal canal.

Two cases of impalement injury involving the spinal canal are presented. In the first patient septic bacteria were carried into the spinal canal along the track of the impaling rod. This patient died of sepsis. In the second patient a steel rod penetrated the patient's trunk on the right side, traversing his body obliquely, impaling the L1 vertebral body and coming to lie in the left retroperitoneal space. This injury was not complicated by infection and the patient recovered without any neurological deficit. The principles of managing these injuries and factors influencing their outcomes are discussed.

Adult↗
PubMed1986

Developmental narrowing of the spinal canal in the lumbar region.

Developmental narrowing of the spinal canal in the lumbar region is one of the most controversial subjects from the point of view of the significance of the neurological syndrome, the value of spondylometric assessment and methods of treatment. Among 1,196 patients operated on in our neurosurgical centre during the last 18 years because of symptomatic sciatica the authors diagnosed developmental narrowing of the spinal canal in 29 cases (2.4%). The diagnosis was made mainly on routine X-ray plates, functional X-rays, X-ray contrast examination and tomograms with indicator of known size placed at the level of the spinal canal. Among operative methods we used laminectomy and fenestration. The choice of a suitable method for a given case depended mainly on the condition during operation but the extent of the operation depended on myelography. The results of treatment during a 10 years following-up were assessed as satisfactory.

Adult↗
PubMed2004

Analysis of screw placement relative to the aorta and spinal canal following anterior instrumentation for thoracic idiopathic scoliosis.

STUDY DESIGN: Axial computed tomographic (CT) evaluation of the position of anterior vertebral body screws placed thoracoscopically in patients with adolescent idiopathic scoliosis (AIS). OBJECTIVE: To evaluate the position of the anterior vertebral body screws relative to the spinal canal and the thoracic aorta following anterior spinal fusion and instrumentation for AIS. SUMMARY OF BACKGROUND DATA: Thoracoscopic anterior instrumentation and fusion is gaining more widespread use in the treatment of idiopathic scoliosis. However, the accuracy in the positioning of instrumentation has not been previously studied for this technically difficult surgery. METHODS: CT examinations were performed following thoracoscopic anterior spinal fusion and instrumentation in 14 patients with right thoracic AIS. The vertebral body width (transverse dimension) and depth (anterior-posterior dimension) was measured for each thoracic vertebra. At each instrumented level, the position of the screw was analyzed to determine its proximity to the spinal canal and the aorta. The distance from the anterior cortex of the spinal canal to the posterior edge of the screw was measured. The position of each screw relative to the aorta was determined: D, the screw tip was distant to the aorta; A, the screw tip was adjacent to the aorta; C, the screw tip was felt to be against the aorta and creating some contour deformity on the outer wall of the aorta. RESULTS: All 14 patients were female and had a single right thoracic curve. The average age of the patients was 13.3 years (range 12.4-15.1 years). The average preoperative coronal Cobb measurement was 55.9 degrees (bending 26.4 degrees) with correction to 8.9 degrees at 2 years after surgery. The average number of levels fused was 6.6 (range 5-8) and a total of 106 screws were used (average 7.6/patient). The width of the vertebral bodies increased from T4 (24.0 mm) to T12 (33.6 mm), increasing an average of 1.2 mm per level, while the depth increased from 17.7 mm at T4 to 25.5 mm at T12. The average distance from the posterior aspect of the screw to the spinal canal was 5.3 mm (range-1.2 to 11.4 mm). There were no neurologic deficits in any patient. When analyzing the position of the screw tip relative to the aorta, 78 (73.6%) screws were distant from the aorta, 15 (14.2%) were adjacent to the aorta, and there were 13 (12.3%) screws that were thought to create a contour deformity of the aorta. There were no vascular complications at 2 years after surgery. CONCLUSIONS: Thoracoscopic instrumentation and fusion is technically demanding and relies on adequate visualization for accurate screw placement. The vertebral body width and depth are consistent between patients, with the vertebral body width increasing approximately 1.2 mm when progressing down the thoracic spine. Safe screw placement was achieved with adequate distance from the spinal canal; however, close screw proximity to the aorta was seen. The aorta was positioned on the left lateral aspect of the vertebral body in these patients, making anterior screw placement challenging in right thoracic AIS.

Adolescent↗
PubMed1977

[Clinical signs of the narrow lumbar spinal canal (author's transl)].

The syndrom of the narrow spinal canal is today to be separated from other lumbar diseases by its nosological entity. It starts slowly and becomes manifest in middle and advanced age. Claudicatio intermittens is the characteristic symptom of this disease the aetiology of which is multifactory. Most patients show in the myelogram konstitutionell alterations combined with localized or generalized degenerative narrowing of the spinal canal. The clinical findings correspond to the lumbar segments affected. With localized narrowing the differential diagnosis of disc herniation is generally possible by myelography. This is of therapeutic consequence because in this cases a removal of the disc is unnecessary.

Adult↗
PubMed2006

[Surgical treatment for spinal canal stenosis of retrograde degeneration].

OBJECTIVE: To investigate the surgical effect on different types of spinal canal stenosis of retrograde degeneration. METHODS: The retrospective analysis was performed on 96 patients (85 males, 11 females; average age 54, range 39-71) admitted from September 2001 to January 2004 for spinal canal stenosis of retrograde degeneration. The patients were divided into five groups according to their clinical symptoms and signs and the imaging of the spinal cord. In group A, 39 patients had one segment of the spinal canal stenosis and they underwent the recessively expanding operation through the intervertebral canal by opening a window between the vertebral plates. In group B, 21 patients had stenosis of the central vertebral canal of one segment and they underwent excision of the intervertebral disc through the window opened between the vertebral plates and the recessively expanding operation. In group C, 18 patients had degenerative spinal derangement of one segment and they underwent decompression through the window opened between the bilateral vertebral plates and the recessively expanding operation, and then underwent the internal fixation and bone grafting. In group D, 11 patients had the mixed stenosis of the vertebral canal of more than 2 segments and they underwent the recessively expanding operation through the window opened bilaterally on the diseased segment and excision of the yellow ligament and the intervertebral disc. In group E, 7 patients had degenerative lateral curvature of the spine and they underwent the combined surgical procedures including decompression, internal fixation, and bone grafting. All the patients were followed up after operation. RESULTS: The follow-up of the 96 patients for 6-36 months with an average of 12.2 months showed that they had no postoperative complications. According to the JOA Scoring, 85 patients had an excellent result, 9 had a good result, 1 had a fair result, and only 1 had a poor result. The X-ray films revealed no mistaken placing of the nails on the vertebral arch, broken nails or loosened nails. CONCLUSION: The limited surgery and effective decompression can improve curative effects and reduce complications of spinal canal stenosis of retrograde degeneration. The imaging of the spinal cord has an important value in the choice of surgical protocols for spinal canal stenosis of retrograde.

Adult↗
PubMed1997

The cross-sectional area of the cervical spinal canal in patients with cervical spondylotic myelopathy. Correlation of preoperative and postoperative area with clinical symptoms.

STUDY DESIGN: Retrospective analysis of routine computed tomography investigations. OBJECTIVE: To investigate whether the extent of clinical symptoms in patients undergoing surgery for cervical spinal myelopathy depends on the transsectional area of the cervical spinal canal. METHODS: Forty-five patients underwent surgery using different techniques to enlarge the width of the spinal canal. For clinical evaluation before and after surgery, a modified score of the Japanese Orthopedic Association was used (mean follow-up period, 19.6, 9.1 months). The cross-sectional area of the spinal canal in computed tomography scans (C4-C6) was quantified 1 day before and 1 week after surgery using pixel-dependent area calculation software for three different density ranges given in Hounsfield units. RESULTS: After surgery, a significant enlargement of the cervical spinal canal of 78.2 +/- 55.9% could be achieved. The Japanese Orthopedic Association score increased significantly by 3.7 +/- 2.2 points from a median preoperative score of 10 to a score of 14 after surgery. Patients with a preoperative Japanese Orthopedic Association score > or = 10 achieved a significantly better outcome after surgery. Conversely, no patient with a postoperative area larger than 1.6 cm2 achieved a score of less than 12 Japanese Orthopedic Association-points. No significant linear correlation, however, was found between the postoperative transsectional area and the postoperative Japanese Orthopedic Association score of all patients. CONCLUSION: The preoperative clinical presentation of the patient was found to be the only prognostic hint for improvement after surgery. Preoperative area measurements of the spinal canal cannot be used as a prognostic tool for surgical outcome. Further, the postoperative measurements do not correlate with the clinical outcome. These data, however, which refer to C4 to C6, provide evidence that every surgical procedure to enlarge the cervical spinal canal should result in an area of 1.6 cm or more.

Cervical Vertebrae↗
PubMed1978

[Cystic craniopharyngioma extending down into the upper cervical spinal canal (author's transl)].

A case of craniopharyngioma with a large cyst extending through the posterior fossa down into the upper cervical spinal canal was reported. The patient is a 14-year-old female who was operated on for the first time in 1970, because of a suprasellar calcified mass. Histological examination verified craniopharyngioma of adamantinomatous type. Since then, she had been operated three times because of deterioration of visual acuity. She was admitted for the fifth time in January, 1977, complaining of severe neck pain radiating bilaterally to the shoulders. Radiological examination demonstrated, besides the suprasellar tumor, a huge mass extending along the clivus down to the level of C3 of spinal canal. Anteroposterior diameter of bony spinal canal evidently enlarged in upper cervical region. Interpedicular distance also widened markedly in the same region. Laminae of C1-C3 vertebrae were abnormally stretched and the spinal cord was compressed posteriorly by the tumor. Suboccipital craniectomy verified a cystic tumor in the region of foramen magnum and cervical spinal canal. The medulla oblongata was pushed backward by the tumor. The cystic tumor was evacuated and the capsule of the tumor was partly resected, which was histologically verified as craniopharyngioma of squamous type. The patient was relieved from the neck pain after operation and discharged in April 1977.

Adolescent↗
PubMedDate not supplied

[Results of radio-anatomic studies of the lumbar spine in patients with intervertebral disk prolapse and in healthy subjects. 2: Spinal canal and intervertebral foramina].

Radioanatomic research on the spinal canal and intervertebral foramina was carried out in 225 patients suffering from disk herniation. The control group numbered 50. Statistically significant differences in spinal canal structure were observed, showing smaller lumina in most patients, and in some also an irregular course along the long axis. The anteroposterior diameter (width) of the intervertebral foramina was also smaller in the patient group. The most evident anatomic differences appeared in the lower lumbar segments, i.e., the area most affected by intervertebral disk herniation. This suggests a relation between the type of spinal structure and the tendency to disk herniation.

Humans↗
PubMed1986

Autosomal dominant osteosclerosis associated with familial spinal canal stenosis.

We studied a family with autosomal dominant osteosclerosis associated with familial spinal canal stenosis. The propositus, a 44-year-old Japanese woman, had a 9-month history of occipitalgia and left tinnitus, and also had a 2-month history of pain and numbness of the right upper limb. Radiographic skeletal survey showed osteosclerotic changes in the neurocranium, diaphysis of the long bone, mandible, shoulder, clavicle, and ribs. Serum alkaline phosphatase was normal, and no periosteal excrescences were seen. The inheritance pattern was autosomal dominant. The propositus and her daughter, both with severe osteosclerosis, showed spinal canal stenosis, but her son, whose osteosclerosis was moderate, did not. This is the first report of autosomal dominant osteosclerosis associated with familial spinal canal stenosis.

Adolescent↗
PubMed1990

[Laminotomy and reconstruction of the spinal canal in an experiment].

Surgical access into the spinal canal allowing reconstruction of the axis of the body is reported. The technique of laminotomy was first tested on 5 dogs which were to be involved in other experiments. Healing of the spinal column and overall outcome were followed up on further 4 dogs surviving three months after the procedure. The operation, carried out in general anesthesia induced by IV administration of thiopental (SPOFA), proved to be relatively simple in all the 9 dogs, weighing 10-24 kg. Plain radiologic, perimyelographic, as well as histologic examinations performed in 4 dogs after three-month survival showed virtually perfect healing of the reconstructed spinal canal and no stenosis at the site of the procedure.

Animals↗
PubMed2004

[Vertebral hemangioma extending into the spinal canal: case report].

A 73-year-old woman was admitted to our hospital presenting slowly progressive hypoesthesia below the 5th thoracic dermatome and spastic paraparesis. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mass lesion in the T3 vertebral body extending into the spinal canal. The spinal cord was compressed to the left side and right T3 and T4 nerve roots were encased in the mass lesion. One week after admission, T2-T4 laminectomy was performed to relieve the spinal cord compression. A highly vascularized tumor was observed in the epidural space at T3 and T4 levels. The tumor in the spinal canal was removed. The histopathological diagnosis was cavernous hemangioma. The patient's symptoms improved after the surgery. Asymptomatic vertebral hemangiomas are common, but its extraosseus extension causing neurologic symptoms (compressive vertebral hemangioma) is rare. The clinical symptoms, the radiological features, and the strategies for the treatment of compressive vertebral hemangiomas were discussed.

Aged↗
PubMed1989

Measurements of the normal adult lumbar spinal canal.

To assess the normal dimensions of the lumbar spinal canal, 100 normal healthy subjects of either sex between 25 and 45 years age were x-rayed for lumber vertebral column in both posteroanterior and lateral views and the canal was measured by Jones and Thomson method. The lumbar spinal canal showed constant dimensions in both sexes in all age groups when studied separately in the male and female subjects. However, no change in relative dimensions was observed between 25 and 45 years. The canal showed gradual decrease in measurement from L1 to L5 vertebral levels in both sexes but relative width of the canal was more in the females than in the males of the same age group. The normal values of the canal to vertebral body ratio (C/B) varies between 1:2.0 and 1:5.0. The ratio 1:2.0 indicates a wider canal whereas any ratio beyond 1:5.0 would be conclusive of stenosis of the lumbar vertebral canal.

Adult↗