Acute cauda equina syndrome secondary to free fat graft following spinal decompression. (73/503)

A 63-year-old man developed acute cauda equina syndrome due to fat graft compression. Following decompressive laminectomy and posterior instrumented fusion with pedicle screw fixation for spinal stenosis of L5 and S1 vertebral levels, free fat grafting was performed to cover the exposed dura. The patient developed gradual neurological deficit three days postoperatively. This started with sensory loss and weakness of the affected dermatomes and myotomes, followed by bowel incontinence on the 12th postoperative day. Intraoperatively, significant dural compression by the fat graft was confirmed. Immediate removal of the fat graft resulted in recovery from cauda equina syndrome.  (+info)

Spinal stenosis re-operation rate in Sweden is 11% at 10 years--a national analysis of 9,664 operations. (74/503)

Re-operation rates in spinal stenosis surgery vary between 5 and 23%. Most previous studies have been based on selected patients groups. We analysed the 10-year lumbar spinal stenosis re-operation rate from comprehensive Swedish national data during 1987-1999. The mean length of stay decreased from 2 weeks in 1987 to 1 week in 1999. Of 9,664 patients, 628 (6.5%) were re-operated. Within 30 days after the first spinal stenosis operation, 0.15% of the patients were re-operated. The 1-, 2-, 5-, and 10-year re-operation rates were 2, 5, 8 and 11%, respectively. The rate lowered by 31% over time. Adding a fusion may lower the re-operation risk, an observation which can only be evaluated in randomised trial.  (+info)

Correlative radiological, self-assessment and clinical analysis of evolution in instrumented dorsal and lateral fusion for degenerative lumbar spine disease. Autograft versus coralline hydroxyapatite. (75/503)

This prospective longitudinal randomized clinical and radiological study compared the evolution of instrumented posterolateral lumbar and lumbosacral fusion using either coralline hydroxyapatite (CH), or iliac bone graft (IBG) or both in three comparable groups, A, B and C, which included 19, 18 and 20 patients, respectively, who suffered from symptomatic degenerative lumbar spinal stenosis and underwent decompression and fusion. The patients were divided randomly according to the graft used and the side that it was applied. The spines of group A received autologous IBG bilaterally; group B, IBG on the left side and hydroxyapatite mixed with local bone and bone marrow on the right side; group C, hydroxyapatite mixed with local bone and bone marrow bilaterally. The age of the patients in the groups A, B and C was 61+/-11 years, 64+/-8 years and 58+/-8 years, respectively. The SF-36, Oswestry Disability Index (ODI), and Roland-Morris (R-M) surveys were used for subjective evaluation of the result of the surgery and the Visual Analogue Scale (VAS) for pain severity. Plain roentgenograms including anteroposterior, lateral and oblique views, and lateral plus frontal bending views of the instrumented spine and CT scan were used to evaluate the evolution of the posterolateral fusion in all groups and sides. Two independent senior orthopaedic radiologists were asked to evaluate first the evolution of the dorsolateral bony fusion 3-48 months postoperatively with the Christiansen's radiologic method, and secondly the hydroxyapatite resorption course in the spines of groups B and C. The diagnosis of solid spinal fusion was definitively confirmed with the addition of the bending views, CT scans and self-assessment scores. The intraobserver and interobserver agreement (r) for radiological fusion was 0.71 and 0.69, respectively, and 0.83 and 0.76 for evaluation of CH resorption. T(12)-S(1) lordosis and segmental angulation did not change postoperatively. There was no radiological evidence for non-union on the plain roentgenograms and CT scans. Radiological fusion was achieved 1 year postoperatively and was observed in all groups and vertebral segments. Six months postoperatively there was an obvious resorption of hydroxyapatite granules at the intertransverse intersegmental spaces in the right side of the spines of group B and both sides of group C. The resorption of hydroxyapatite was completed 1 year postoperatively. Bone bridging started in the third month postoperatively in all instrumented spines and all levels posteriorly as well as between the transverse processes in the spines of the group A and on the left side of the spines of group B where IBG was applied. SF-36, ODI, and R-M score improved postoperatively in a similar way in all groups. There was one pedicle screw breakage at the lowermost instrumented level in group A and two in group C without radiologically visible pseudarthrosis, which were considered as having non-union. Operative time and blood loss were less in the patients of group C, while donor site complaints were observed in the patients of the groups A and B only. This study showed that autologous IBG remains the "gold standard" for achieving solid posterior instrumented lumbar fusion, to which each new graft should be compared. The incorporation of coralline hydroxyapatite mixed with local bone and bone marrow needs adequate bleeding bone surface. Subsequently, hydroxyapatite was proven in this series to not be appropriate for intertransverse posterolateral fusion, because the host bone in this area is little. However, the use of hydroxyapatite over the decorticated laminae that represents a wide host area was followed by solid dorsal fusion within the expected time.  (+info)

Crystal arthropathy of the lumbar spine: a series of six cases and a review of the literature. (76/503)

There have been very few reports in the literature of gout and pseudogout of the spine. We describe six patients who presented with acute sciatica attributable to spinal stenosis with cyst formation in the facet joints. Cytopathological studies confirmed the diagnosis of crystal arthropathy in each case. Specific formation of a synovial cyst was identified pre-operatively by MRI in five patients. In the sixth, the diagnosis was made incidentally during decompressive surgery. Surgical decompression alone was undertaken in four patients. In one with an associated degenerative spondylolisthesis, an additional intertransverse fusion was performed. Another patient had previously undergone a spinal fusion adjacent to the involved spinal segment, and spinal stabilisation was undertaken as well as a decompression. In addition to standard histological examination material was sent for examination under polarised light which revealed deposition of urate or calcium pyrophosphate dihydrate crystals in all cases. It is not possible to diagnose gout and pseudogout of the spine by standard examination of a fixed specimen. However, examining dry specimens under polarised light suggests that crystal arthropathy is a significant aetiological factor in the development of symptomatic spinal stenosis associated with cyst formation in a facet joint.  (+info)

Incidental durotomy in lumbar spine surgery: incidence and management. (77/503)

There is increasing awareness of the need to inform patients of common complications that occur during surgical procedures. During lumbar spine surgery, incidental tear of the dural sac and subsequent cerebrospinal fluid leak is possibly the most frequently occurring complication. There is no consensus in the literature about the rate of dural tears in spine surgery. We have undertaken this study to evaluate the incidence of dural tears among spine surgeons in the United Kingdom for commonly performed spinal procedures. Prospective data was gathered for 1,549 cases across 14 institutions in the United Kingdom. The results give us a baseline rate for the incidence of dural tears. The rate was 3.5% for primary discectomy, 8.5% for spinal stenosis surgery and 13.2% for revision discectomy. There was a wide variation in the actual and estimated rates of dural tears among the spine surgeons. The results confirm that prospective data collection by spine surgeons is the most efficient and accurate way to assess complication rates for spinal surgery.  (+info)

Insertion loads of the X STOP interspinous process distraction system designed to treat neurogenic intermittent claudication. (78/503)

An interspinous process implant has been developed to treat patients suffering from neurogenic intermittent claudication secondary to lumbar spinal stenosis. As most patients who suffer from spinal stenosis are over the age of 50 and may have weaker bones, it is imperative to know how bone mineral density (BMD) correlates with lateral spinous process strength. The study was undertaken to characterize the lateral failure loads of the spinous process, correlate the failure loads to BMD, and compare the failure loads to the loads required to insert an interspinous process implant. Spinous process lateral failure loads were assessed, correlated to BMD, and compared to the loads required to insert an interspinous process implant. Mean spinous process failure loads were significantly greater than the lateral insertion load of the interspinous process implant. There was a significant relationship between the BMD and spinous process failure load. The technique used to insert the interspinous implant poses little risk to spinous process failure. There is ample margin of safety between the insertion loads and spinous process failure loads. The significant relationship between BMD and spinous process failure load suggests that patients with lower BMD must be approached with more caution during the implant insertion procedure.  (+info)

Evaluation of the changes in the muscle sympathetic nerve activity and anterior tibial muscle blood flow caused by the Valsalva maneuver in patients with lumbago and healthy subjects. (79/503)

Clinical symptoms affecting the lower extremities are common among lumber spinal disorder patients. Pain, numbness and sensory disturbance are major signs of these symptoms, and have been suggested to be related to sympathetic nerve disturbance. This study was designed to examine whether these patients experience a difference in sympathetic nerve flow in terms of muscle sympathetic nerve activity (MSA) compared to healthy subjects. Five patients with lumbar intervertebral disc herniation of the spine (LIDH) and four patients with lumbar spinal canal stenosis (LSCS) were examined along with six healthy volunteers. Basic MSAs for IDH and SCS patients that were introduced from a common peroneal nerve were found to be statistically higher than those of the control subjects. MSA behavior and muscle blood flow introduced from the tibialis anterior muscle over 30 seconds while performing the Valsalva maneuver, a well-known technique used to artificially facilitate MSA, were examined for all subjects, and showed relatively slower changes for LIDH and LSCS patients compared to the normal subjects. Muscle blood flow was inversely proportional to MSA for the normal subjects, and this relationship was observed for IDH patients as well as SCS patients. However, MSA and the muscle blood flow of patients gradually changed while performing the Valsalva maneuver relative to the control subjects. This suggests that the systemic physiological response to the maneuver is maintained, but that, some local modification mechanisms exist.  (+info)

Cerebellar hemorrhage after spinal surgery: case report and review of the literature. (80/503)

Recent reports indicate that cerebellar hemorrhage after spinal surgery is infrequent, but it is an important and preventable problem. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanisms are unknown. This report details the case of a 48-year-old woman who developed remote cerebellar hemorrhage after spinal surgery. The patient presented with a herniated lumbar disc, spinal stenosis, and spondylolisthesis, and underwent multiple-level laminectomy, discectomy, and transpedicular fixation. The dura mater was opened accidentally during the operation. There were no neurologic deficits in the early postoperative period; however, 12 h postsurgery the patient complained of headache. This became more severe, and developed progressive dysarthria and vomiting as well. Computed tomography demonstrated small sites of remote cerebellar hemorrhage in both cerebellar hemispheres. The patient was treated medically, and was discharged in good condition. At 6 months after surgery, she was neurologically normal. The case is discussed in relation to the ten previous cases of remote cerebellar hemorrhage documented in the literature. The only possible etiological factors identified in the reported case were opening of the dura and large-volume cerebrospinal fluid loss.  (+info)