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A collapsing cord in six patients with hydromyelia and a collapsing intraspinal arachnoid cyst in one patient are demonstrated. The authors describe the technique for two-position gas myelography and demonstrate that both intra- and extra-medullary intraspinal processes may collapse during myelography.
A retrospective study of 55 patients with acute cervical spinal cord injury caused by trauma was performed. On radiographic examination of the cervical spine in each of 55 cases showed no fracture or dislocation but developmental stenosis determined on lateral view radiograms. Ninety five point nine percent of this cases had block of the dyeing columns myelographically both in prone and supine positions. Eighty point nine percent of 47 cases demonstrated segmental instability of the cervical spine on full extension and flexion radiograms. Thirty eight cases suffered a minor trauma but resulted in incomplete spinal cord injury with moderate neurologic deficits. Most patients who had been treated conservatively for about 3 years demonstrated the neurologic deficits worsened gradually. In the later 50 cases underwent surgical treatment. A follow-up study showed that Robinson's procedure and laminectomy resulted in unsatisfactory outcome, in contrast to those of open-door technic. It is suggested that developmental stenosis may be a potential factor in the spinal cord injury.
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Narrow lumbar spinal canal or lumbar spinal stenosis is a not uncommon problem. Thirty-two patients with this disorder have been treated surgically at the Ochsner Medical Center between 1963 and 1973. The best method of diagnosis is a careful history and second is roentgenographic evidence, particularly the myelogram. The surgical treatment consists of total laminectomy and foraminotomy to insure complete decompression of the nerve roots. Eighteen patients have been followed from 14 to 44 months. Sixteen of the 18 considered their operations a success.
The objective of the presented work was to investigate anatomical structures of the cervial spine and their interrelations on cervical myelograms in a neutral position and in retroflexion. Cervical myelograms were made in 34 patients from a lateral approach between the first and second vertebra. In a neutral position and in retroflexion the relations of the dural sac and spinal canal were investigated in 26 subjects with a normal antero-posterior diameter of the spinal canal and in eight patients with congenital stenosis of the spinal canal. Quantification by means of a computer revealed that in retroflexion the antero-posterior diameters of the dural sac diminishes significantly in subjects with a normal antero-posterior diameter of the spinal canal as well as in subjects with congenital stenosis of the spinal canal. Moreover, the authors provided evidence that the area of the dural sac diminishes significantly in retroflexion, as compared with the neutral position in subjects with a normal spinal canal as well as in subjects with congenital stenosis of the spinal canal.
Authors experience based on 15 cases of iatrogenic stenosis of spinal canal in thoracic and lumbar region. The stenosis was the sequelae of spondylodesis made for spinal tuberculosis, spondylolisthesis traumatic and idiopathic, spinal fractures and assimilation faults. The onset of signs of stenosis appeared from 1 to 7 years after the first operation. The treatment was operative in 8 cases, conservative in 7. The first gave the best results. Observation time was up to 14 years after the second operation.
Serial motor and sensory examinations were conducted on 90 patients with bullet fragments lodged in the spinal canal. Annual follow-up examinations were completed on 66 patients. Despite the fact that approximately 20% of the bullets had perforated the alimentary canal, no cases of infection were noted. Statistical analyses indicated that removal of the bullet fragments made no significant difference with regard to reducing pain or improving the recovery of sensation. However, bullet removal did have an effect on motor recovery, depending on the level at which the lesion occurred. Among those patients with lesions between vertebral levels T12 and L4, there was significantly greater (P less than 0.001) motor recovery in those patients from whom the bullet was removed from than in patients not having bullet removal. Bullet removal from the canal between T1 and T11 had no significant effect on motor recovery.
Relationship between the degree of clinical symptoms and the lateral roentgenograms of the cervical OPLL causing severe spinal canal stenosis was studied among patients whose roentgenological minimum antero-posterior diameters of the available spinal canals were under 9mm. Lateral roentgenograms of 28 clinically mild patients were compared with those of 20 clinically severe patients. The type of ossification, the extent of OPLL, the narrowest level of the available spinal canal, and the minimum a-p diameter were not statistically significant parameters. The degree of canal stenosis at the 1cm cranial and 1cm caudal levels from the narrowest level, and the axial extent of canal stenosis around the narrowest level were less significantly in the group with mild symptoms than in the group with severe symptoms.
A spinal dermoid cyst with an invasive sweat-gland tumour in its wall is reported. This appears to be the first of this type to be reported in the nervous system.
Direct measurements of 1,340 lumbar vertebrae in 275 skeletons in two racial groups are reported. The average figure, and the upper and lower limits of normal are reported for the anteroposterior diameter of the canal and for Spinal Index. Radiological studies have established a technique for defining the posterior margin of the spinal canal on plain X-ray films. It is formed by a line joining the apex of the superior to the inverted apex of the inferior articular facet. The Spinal Index is not a reliable factor. The anteroposterior diameter alone is the essential parameter in assessing spinal stenosis. The negroid canal is marginally less spatial than that of the caucasoid.
Seven patients who underwent posterior spinal fusion with Harrington instrumentation and sublaminar wires, and subsequently had these implants removed, were evaluated for evidence of spinal canal compromise with magnetic resonance imaging (MRI) at the sites of the sublaminar wires. All fusions were solid. The sites of 33 wires (27 levels) were evaluated with MRI. The average time the wires were in the spinal canal was 24.6 months. The average time following wire removal at the time of MRI was 61.7 months. Twenty-eight of 33 (85%) wire sites had no evidence of spinal canal compromise. Five sites had minimal (less than 15%) spinal canal compromise. The permanent structural changes in the spinal canal attributable to sublaminar wires appears to be quite modest.
Sixteen cases of cervical spinal cord injury with developmental stenosis of cervical spinal canal were treated. The numbness and quadriplegia of the patients were caused by hyperextension X-ray of the cervical spine showed no fracture or dislocation but the sagittal diameter of the canal and that of the corresponding cervical vertebral body was less than 0.75. All of the patients were treated by operation including laminoplasty on 12 cases. The numbness and quadriplegia in most of the patients were improved obviously after operation. The mechanism of hyperextension injury on the cervical spinal cord was discussed. When spinal column was extended, annulus fibrosus of disk and ligamentum flavum would enfold into the spinal canal and only a slight force would do severe on the cord. Laminoplasty is the recommended treatment for this kind of lesions.
Twenty-two patients with clinical symptoms suggesting lumbar spinal canal stenosis underwent myelography, computed tomography (CT), and magnetic resonance imaging (MRI). Patients were divided into two groups according to myelographic findings. Group I included 19 cases in which myelograms showed spinal canal stenosis, and group II consisted of 3 patients with myelograms negative for this condition. MRI showed uniform narrowing of the dural sac, indentations on the posterior aspect, or interruption of the outline of the sac in the sagittal scans and reduced area of the sac in the transverse scans. In group I patients, the diagnostic accuracy of MRI was greater than that of CT and myelography. In Group II patients, all of whom had moderate or severe lumbar scoliosis, MRI suggested spinal canal stenosis in contrast with myelography. In spinal canal stenosis surgery may be planned on the basis of MRI findings alone, except in scoliotic patients.
Although the benefit of spinal canal decompression of traumatic thoracolumbar burst fractures is controversial, it remains a desirable procedure, as many reports describe improved neurologic outcome with spinal canal reconstruction. The optimal type of posterior instrumentation for reconstructing the spinal canal is unclear. This study focused on the efficacy of posterior distraction rods versus transpedicular screw fixation implants in decompressing the spinal canal and on the relationship between the amount of canal decompression and subsequent neurologic recovery. A medical records review was conducted to identify all patients surgically treated for traumatic burst fractures of the thoracolumbar spine from January 1, 1987 to June 30, 1989. Sixty-seven patients were selected by this review, and, of these, 30 had had both preoperative and postoperative CT scans. We could find no bias among patients who received both preoperative and postoperative CT scans as compared to those who did not, therefore the 30 patients were considered to be a random sample of the total population of 67. A retrospective study was then conducted on the 30 patients with surgically treated burst fractures--15 treated with posterior distraction rods and 15 treated with AO Fixator Interne transpedicular screw fixation implants. Preoperative and postoperative spinal canal cross-sectional areas were measured directly from the scaled CT scans. The area of most severe compromise was compared with an internal standard defined as the next, caudal, uncompromised spinal level, and the percentage of preoperative and postoperative canal compromise was calculated.(ABSTRACT TRUNCATED AT 250 WORDS)
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.
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.
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.