Burst fractures of the thoracolumbar spine: changes of the spinal canal during operative treatment and follow-up.
(25/243)
Although multiple studies have concluded operative decompression of a traumatically narrowed spinal canal is not indicated because of spontaneous remodeling, instrumental decompression is frequently used as part of the operative treatment of spinal fractures. To investigate the process of remodeling, we studied the diameter of the spinal canal in 95 patients with burst fractures at the thoracolumbar junction (T9-L2). To measure and compare the spinal canal's diameter we used either computed tomography (CT) scans or radiographs, made preoperatively, postoperatively, after 9 months and after 24 months. In lateral plain radiographs we found that the initial percentage of cases with bony canal narrowing preoperatively of 76.5 was reduced to 18.4% postoperatively, to 8.2% at 9 months, and to 2.4% at 24 months. In CT scans in a selection of patients, the mean residual diameter of the spinal canal was 53% preoperatively and 78% at 24 months. The posterior segmental height increases during operation and decreases in the respective periods after operation. So ligamentotaxis can only play a role in the perioperative period. We conclude that a significant spontaneous remodeling of the spinal canal follows the initial surgical reduction. Two years after operation, bony narrowing of the spinal canal is only recognizable in 2.4% of the patients on plain lateral radiographs. The remodeling of the spinal canal can be seen on plain radiographs, although not as accurately as on CT scans. (+info)
Pseudomeningoceles are uncommon complications of lumbar surgery. They are encapsulated cerebrospinal fluid collections developing extradurally as a consequence of incidental dural tears. They are typically located in the paraspinal compartment and occasionally reach the subcutaneous space. We describe the case of a patient in whom a postlaminectomy pseudomeningocele developed over a 10-year period within the L5 spinous process and remained completely encircled within its bony boundaries. The surgical implications of this finding are discussed. (+info)
Morphology of the lumbar spinal canal in normal adult Turks.
(27/243)
Pathological changes can occur in the diameters of the lumbar spinal canal. Therefore, assessing the canal size an important diagnostic procedure. Two hundred plain anterioposterior radiographs of the lumbar spine were examined. The sample consisted of 100 males and 100 females. The transverse diameter of the bony spinal canal (interpedicular distance), which was measured as the minimum distance between the medial surfaces of the pedicles of a given vertebra, was measured. In addition, the transverse diameter of the vertebral body, which was measured as the minimum distance across the waist of the vertebra, was measured. The distances were measured to the nearest one tenth of a millimetere using a Vernier caliper. At all levels (L1 - L5) the transverse diameters of the lumbar spinal canal were approximately 1 - 1.5 mm higher in males than in females. The intersegmental differences increased proximodistally, in both sexes. The ratio of the transverse diameter canal to the width of the vertebra ranged from 0.55 to 0.60 mm in both sexes. The distribution of the different lumbar canal types were 47% A, 42% B, 11% C. Additionally, subtypes were determined and classified. (+info)
Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal. A review of twenty-seven years' experience.
(28/243)
Between 1948 and 1975 147 patients were treated surgically for developmental stenosis of the lumbar vertebral canal, measurement of the mid-sagittal diameters in the whole area of stenosis being performed in 116 patients. Ninety-two of these patients were followed up for periods varying between one and twenty years. About two-thirds were completely relieved fo symptoms and signs. Sciatica and intermittent claudication were more frequently cured than radicular deficit and lumbago, the latter being the most frequent persisting symptom. A permanent neural deficit as a result of the surgical procedure was noted in two cases. A detailed presentation of the technique, complications and results is given. (+info)
Lumbar spine dimensions in paraparetic patients: a 10 year follow up study.
(29/243)
Lumbar spinal AP radiographs of 13 C3-T11 paraparetic patients taken at about a 10 year interval were compared. The height (H) and maximum width (W) of the interapophysolaminar spaces (IALS), the width of the vertebral bodies at their waist (V) and the relationship between them showed minimal change over the follow up period. The difference between the late and early mean IALS height values increased caudally but was statistically significant only below L5. Subjective evaluation of the consecutive x-ray films revealed few new degenerative abnormalities. It is concluded that the normal aging process, which includes horizontal spreading of the lumbar vertebral bodies and narrowing of the lumbar spinal canal, is not accelerated by paraparesis and may even be retarded by relative immobilization. (+info)
Intradural bronchogenic cysts.
(30/243)
The pathological findings of an intradural and extramedullary cyst in the mid cervical spinal canal are described in a 55 year old woman who presented with a short history of pain and paraesthesia of the right arm. Intradural well defined solitary cystic lesions in the spinal canal are uncommon, their pathogenesis is poorly understood, and their nomenclature is confusing. In this case the cyst was a bronchogenic cyst; these are a rare form of such cysts and they are thought to be a malformation arising from a split notochordal syndrome and not a teratoma. (+info)
Combined laminoplasty with posterior lateral mass plate for unstable spondylotic cervical canal stenosis--technical note.
(31/243)
A technique of combined expanding laminoplasty using longitudinal interspinous iliac bone graft with posterior lateral mass plate is described for the treatment of cervical canal stenosis associated with spinal instability. A 52-year-old male and a 76-year-old female presented with cervical myelopathy. Imaging studies demonstrated spondylotic cervical canal stenosis associated with spinal instability. Posterior stabilization with lateral mass plate by the Axis Fixation System was performed after expanding laminoplasty using interspinous iliac bone graft. The symptoms improved and instability and malalignment (in the female patient) also improved after surgery. This combined surgical technique allows decompression of the spinal cord, immediate internal fixation by plate fixation, and subsequent long-term stabilization by interspinous bony fusion. This technique is indicated in selected patients with multiple segment spondylotic cervical canal stenosis associated with instability and/or malalignment of the spinal column for which simultaneous decompression and stabilization are required. (+info)
Purely extradural cavernous hemangiomas of the spinal canal are extremely rare. Their occurrence at the lumbosacral level is a true exception. We describe a case of lumbosacral extradural hemangioma and review the behaviour and MR imaging characteristics of these lesions. Cavernous hemangioma should be considered in the differential diagnosis of an enhancing extradural periradicular mass causing chronic lumbar radiculopathy especially in fertile women. Lumbar extradural hemangiomas appear and behave differently, not only from intramedullary cavernous hemangiomas but also from extradural hemangiomas of other spinal locations. (+info)