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Der Orthopade Oct 2019Lumbar spinal canal stenosis is frequently found among elderly patients and significantly limits their quality of life. Non-surgical therapy is an initial treatment... (Review)
Review
BACKGROUND
Lumbar spinal canal stenosis is frequently found among elderly patients and significantly limits their quality of life. Non-surgical therapy is an initial treatment option; however, it does not eliminate the underlying pathology. Surgical decompression of the spinal canal has now become the treatment of choice.
OBJECTIVE
Minimalization of surgical approach strategies with maintaining sufficient decompression of the spinal canal and avoiding disadvantages of macrosurgical techniques, monolateral paravertebral approach with bilateral intraspinal decompression, specific surgical techniques.
MATERIALS AND METHODS
Minimally invasive decompression techniques using a microscope or an endoscope are presented and different surgical strategies depending on both the extent (mono-, bi-, and multisegmental) and the location of the stenosis (intraspinal central, lateral recess, foraminal) are described.
RESULTS
Minimally invasive microscopic or endoscopic decompression procedures enable sufficient widening of the spinal canal. Disadvantages of macrosurgical procedures (e. g., postoperative instability) can be avoided. The complication spectrum overlaps partially with that of macrosurgical interventions, albeit with significantly less marked severity. Subjective patient outcome is clearly improved.
CONCLUSIONS
Referring to modern minimally invasive decompression procedures, surgery of lumbar spinal canal stenosis represents a rational and logical treatment alternative, since causal treatment of the pathology is only possible with surgery.
Topics: Aged; Constriction, Pathologic; Decompression, Surgical; Humans; Laminectomy; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Outcome Assessment, Health Care; Quality of Life; Spinal Canal; Spinal Cord; Spinal Stenosis; Spondylolisthesis; Treatment Outcome
PubMed: 31053867
DOI: 10.1007/s00132-019-03732-7 -
RoFo : Fortschritte Auf Dem Gebiete Der... Sep 2020
Topics: Cervical Vertebrae; Circle of Willis; Collateral Circulation; Embolization, Therapeutic; Endovascular Procedures; Hemorrhage; Humans; Intervertebral Disc Displacement; Intraoperative Complications; Male; Middle Aged; Neurosurgical Procedures; Pressure; Spinal Canal; Stents; Vertebral Artery; Vertebral Artery Dissection
PubMed: 32408354
DOI: 10.1055/a-1156-4320 -
Journal of Orthopaedic Surgery and... Jun 2023The purpose of this study was to quantify the degree of lumbar spinal stenosis by assessing the anterior and posterior vertebral canal diameter and dural area, determine... (Review)
Review
Effect of the preoperative assessment of the anteroposterior diameters of the spinal canal and dural area on the efficacy of oblique lumbar interbody fusion in patients with lumbar spinal stenosis.
OBJECTIVE
The purpose of this study was to quantify the degree of lumbar spinal stenosis by assessing the anterior and posterior vertebral canal diameter and dural area, determine the sensitivity of the anterior and posterior spinal canal diameter, dural area and dural occupying rate in predicting the postoperative efficacy of oblique lumbar interbody fusion (OLIF) for patients with single-stage lumbar spinal stenosis, and identify the corresponding indicators suggesting that OLIF surgery should not be performed.
METHODS
In a retrospective analysis of patients who had previously undergone OLIF surgery in our hospital, we included a total of 104 patients with lumbar spinal stenosis who had previously undergone single-stage surgery in our hospital. Three independent observers were employed to measure the anterior and posterior diameter of the spinal canal (AD, mm), dural area (CSA, mm), the spinal canal area (SCA, mm), and the ratio of the dural area to the spinal canal area (DM, %) at the disc level with the most severe stenosis on MRI. According to the values of AD and CSA in preoperative MRI, patients were divided into three groups: A, B, and C (Group A: AD > 12 and 100 < CSA ≤ 130, group B: Except A and C, group C: AD ≤ 10 and CSA ≤ 75). Preoperative and postoperative clinical outcome scores (Japanese Orthopaedic Association [JOA] score, VAS score, modified Macnab standard) of 104 patients were statistically.
RESULTS
There were significant differences in the preoperative and postoperative clinical correlation scores among the mild, moderate and severe lumbar spinal stenosis groups. The improvement rate of the post treatment JOA score, the difference between the preoperative and postoperative VAS score, and the modified Macnab standard were compared pairwise. There was no statistical significance in the improvement rate of the post treatment JOA score, the difference between the preoperative and postoperative VAS score, and the modified Macnab standard between Group A and Group B (P = 0.125, P = 0.620, P = 0.803). There were statistically significant differences between Group A and Group C and between Group B and Group C in the improvement rate of the JOA score, the difference in the pre- and postoperative VAS score, and the modified Macnab standard. The anterior and posterior vertebral canal diameter and dural area are sensitive predictors of the postoperative efficacy of OLIF surgery for single-stage lumbar spinal stenosis. Moreover, when the anterior and posterior vertebral canal diameter was less than 6.545 mm and the dural area was less than 34.43 mm, the postoperative effect of OLIF surgery was poor.
CONCLUSIONS
All the patients with mild, moderate, and severe lumbar spinal stenosis achieved curative effects after OLIF surgery. Patients with mild and moderate lumbar spinal stenosis had better curative effects, and there was no significant difference between them, while patients with severe lumbar spinal stenosis had poor curative effects. Both the anteroposterior diameter of the spinal canal and the dural area of the spinal canal were sensitive in predicting the curative effect of OLIF surgery for single-stage lumbar spinal stenosis. When the anterior and posterior vertebral canal diameter was less than 6.545 mm and the dural area was less than 34.43 mm, the postoperative effect of OLIF surgery was poor.
Topics: Humans; Spinal Stenosis; Retrospective Studies; Treatment Outcome; Lumbar Vertebrae; Spinal Canal; Spinal Fusion
PubMed: 37337281
DOI: 10.1186/s13018-023-03913-3 -
World Neurosurgery Oct 2023Narrowing of the lumbar spinal canal, or lumbar stenosis (LS), may cause debilitating radicular pain or muscle weakness. It is the most frequent indication for spinal...
BACKGROUND
Narrowing of the lumbar spinal canal, or lumbar stenosis (LS), may cause debilitating radicular pain or muscle weakness. It is the most frequent indication for spinal surgery in the elderly population. Modern diagnosis relies on magnetic resonance imaging and its inherently subjective interpretation. Diagnostic rigor, accuracy, and speed may be improved by automation. In this work, we aimed to determine whether a deep-U-Net ensemble trained to segment spinal canals on a heterogeneous mix of clinical data is comparable to radiologists' segmentation of these canals in patients with LS.
METHODS
The deep U-nets were trained on spinal canals segmented by physicians on 100 axial T2 lumbar magnetic resonance imaging selected randomly from our institutional database. Test data included a total of 279 elderly patients with LS that were separate from the training set.
RESULTS
Machine-generated segmentations (MA) were qualitatively similar to expert-generated segmentations (M, M). Machine- and expert-generated segmentations were quantitatively similar, as evidenced by Dice scores (MA vs. M: 0.88 ± 0.04, MA vs. M: 0.89 ± 0.04), the Hausdorff distance (MA vs. M: 11.7 mm ± 13.8, MA vs. M: 13.1 mm ± 16.3), and average surface distance (MAvs. M: 0.18 mm ± 0.13, MA vs. M 0.18 mm ± 0.16) metrics. These metrics are comparable to inter-rater variation (M vs. M Dice scores: 0.94 ± 0.02, the Hausdorff distances: 9.3 mm ± 15.6, average surface distances: 0.08 mm ± 0.09).
CONCLUSION
We conclude that machine learning algorithms can segment lumbar spinal canals in LS patients, and automatic delineations are both qualitatively and quantitatively comparable to expert-generated segmentations.
Topics: Humans; Aged; Constriction, Pathologic; Spinal Canal; Machine Learning; Magnetic Resonance Imaging; Algorithms; Image Processing, Computer-Assisted
PubMed: 37437805
DOI: 10.1016/j.wneu.2023.07.009 -
Pediatric Radiology Apr 2021There are no published normal values for spinal cord and canal diameters in newborns. Spinal cord and spinal canal diameters are assessed subjectively by radiologists...
BACKGROUND
There are no published normal values for spinal cord and canal diameters in newborns. Spinal cord and spinal canal diameters are assessed subjectively by radiologists without any objective values for the upper limit of normal.
OBJECTIVE
To determine normal values for anteroposterior (AP) diameters of the spinal cord and spinal canal on sonography in healthy term newborns.
MATERIALS AND METHODS
We performed ultrasound of the entire spine on 37 healthy newborns (23 male, 14 female). The AP diameters of the spinal canal and spinal cord were measured at representative levels of the cervical (C4, C5, C6), thoracic (T5, T6, T7, T8) and lumbar spine (lumbar enlargement and above and below the lumbar enlargement level). Statistical analysis was performed to determine the mean and standard deviation of the spinal canal and spinal cord AP diameter at each aforementioned vertebral level, and their correlations with birth weight, length and head circumference.
RESULTS
The mean AP spinal cord diameter was 4.1±0.5 mm at the cervical level, 3.3±0.3 mm at the thoracic level and 4.4±0.6 mm at the lumbar level. The mean AP spinal canal diameter was 7.7±0.7 mm at the cervical level, 6.2±0.8 mm at the thoracic level, and 8.4±0.7 mm at the lumbar level.
CONCLUSION
In this prospective study, we have determined normal values for AP diameters of the spinal cord and spinal canal on sonography in healthy newborns at representative cervical, thoracic and lumbar levels. This data may assist in evaluating the neonatal spine in clinical situations such as suspected spinal cord injury.
Topics: Cervical Vertebrae; Female; Humans; Infant, Newborn; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Prospective Studies; Spinal Canal; Spinal Cord; Ultrasonography
PubMed: 33156429
DOI: 10.1007/s00247-020-04879-8 -
The Journal of Pediatrics Sep 2017
Review
Topics: Antineoplastic Combined Chemotherapy Protocols; Child Development; Decompression, Surgical; Female; Humans; Image-Guided Biopsy; Infant; Magnetic Resonance Imaging; Male; Neoplasm Invasiveness; Neoplasm Staging; Neuroblastoma; Peripheral Nervous System Neoplasms; Prognosis; Risk Assessment; Spinal Canal; Spinal Cord Compression; Spinal Cord Neoplasms; Treatment Outcome
PubMed: 28645442
DOI: 10.1016/j.jpeds.2017.05.051 -
Journal of Medical Imaging and... Aug 2020The spinal epidural and posterior ligamentous complex spaces are important anatomic regions which are the target of various radiologic procedures in the cervical,... (Review)
Review
The spinal epidural and posterior ligamentous complex spaces are important anatomic regions which are the target of various radiologic procedures in the cervical, thoracic and lumbar spine for the purpose of analgesia and anaesthesia. Given the frequency with which procedures are performed in and around the epidural space, a sound understanding of the associated anatomy is paramount to ensure the safety and efficacy of procedural intervention.
Topics: Humans; Injections, Spinal; Radiography, Interventional; Spinal Canal; Tomography, X-Ray Computed
PubMed: 32588507
DOI: 10.1111/1754-9485.13076 -
Journal of Medical Imaging and... Dec 2023Cervical Spondylotic Myelopathy (CSM) is a gradually escalating spinal cord disturbance set in motion by the degenerative narrowing of the vertebral canal. Routine MRI...
BACKGROUND AND PURPOSE
Cervical Spondylotic Myelopathy (CSM) is a gradually escalating spinal cord disturbance set in motion by the degenerative narrowing of the vertebral canal. Routine MRI may fail to detect the subtle early alterations of the cord. MRI Diffusion Tensor Imaging (DTI) possesses the potential to detect these changes. This study intends to estimate the potential of the DTI technique in non-stenotic & stenotic spinal canals in individuals affected with CSM.
METHODOLOGY
Sixty-four subjects who met the requirements of the inclusion criteria were incorporated into the investigation. All subjects underwent routine MRI sequences in addition to DTI of the cervical spine region. Scalars such as Fractional Anisotropy (FA), besides Apparent Diffusion Coefficient (ADC), were computed at each cervical intervertebral fibrocartilaginous disc level for all subjects. DTI fiber tractography was then performed to qualitatively assess the microstructural integrity of the tracts.
RESULTS
A noteworthy difference (p<0.05) was seen in the FA parameter and ADC parameter values between the stenotic and non-stenotic groups, with the non-stenotic group having a higher mean FA and a lower ADC than the stenotic group (at the level of stenosis). A significant difference in age was seen between both groups, with most of the patients in the stenotic group belonging to 40 years and above. Tractography helped in demonstrating the morphology of the fiber tracts.
CONCLUSION
DTI parameters, namely FA and ADC, are sensitive to damage to the white matter and can be used to detect microstructural changes in the cord. However, standardization of the protocol is necessary when imaging the spinal canal.
Topics: Humans; Adult; Diffusion Tensor Imaging; Constriction, Pathologic; Spinal Cord Diseases; Spinal Canal
PubMed: 37891147
DOI: 10.1016/j.jmir.2023.09.022 -
Scientific Reports Apr 2018The dynamics of human CSF in brain and upper spinal canal are regulated by inspiration and connected to the venous system through associated pressure changes. Upward CSF...
The dynamics of human CSF in brain and upper spinal canal are regulated by inspiration and connected to the venous system through associated pressure changes. Upward CSF flow into the head during inspiration counterbalances venous flow out of the brain. Here, we investigated CSF motion along the spinal canal by real-time phase-contrast flow MRI at high spatial and temporal resolution. Results reveal a watershed of spinal CSF dynamics which divides flow behavior at about the level of the heart. While forced inspiration prompts upward surge of CSF flow volumes in the entire spinal canal, ensuing expiration leads to pronounced downward CSF flow, but only in the lower canal. The resulting pattern of net flow volumes during forced respiration yields upward CSF motion in the upper and downward flow in the lower spinal canal. These observations most likely reflect closely coupled CSF and venous systems as both large caval veins and their anastomosing vertebral plexus react to respiration-induced pressure changes.
Topics: Adult; Cerebral Ventricles; Cerebrospinal Fluid; Female; Humans; Magnetic Resonance Imaging; Male; Respiration; Spinal Canal; Young Adult
PubMed: 29618801
DOI: 10.1038/s41598-018-23908-z -
Journal of Human Evolution Nov 2015The discovery at Nariokotome of the Homo erectus skeleton KNM-WT 15000, with a narrow spinal canal, seemed to show that this relatively large-brained hominin retained...
The discovery at Nariokotome of the Homo erectus skeleton KNM-WT 15000, with a narrow spinal canal, seemed to show that this relatively large-brained hominin retained the primitive spinal cord size of African apes and that brain size expansion preceded postcranial neurological evolution. Here we compare the size and shape of the KNM-WT 15000 spinal canal with modern and fossil taxa including H. erectus from Dmanisi, Homo antecessor, the European middle Pleistocene hominins from Sima de los Huesos, and Pan troglodytes. In terms of shape and absolute and relative size of the spinal canal, we find all of the Dmanisi and most of the vertebrae of KNM-WT 15000 are within the human range of variation except for the C7, T2, and T3 of KNM-WT 15000, which are constricted, suggesting spinal stenosis. While additional fossils might definitively indicate whether H. erectus had evolved a human-like enlarged spinal canal, the evidence from the Dmanisi spinal canal and the unaffected levels of KNM-WT 15000 show that unlike Australopithecus, H. erectus had a spinal canal size and shape equivalent to that of modern humans. Subadult status is unlikely to affect our results, as spinal canal growth is complete in both individuals. We contest the notion that vertebrae yield information about respiratory control or language evolution, but suggest that, like H. antecessor and European middle Pleistocene hominins from Sima de los Huesos, early Homo possessed a postcranial neurological endowment roughly commensurate to modern humans, with implications for neurological, structural, and vascular improvements over Pan and Australopithecus.
Topics: Adolescent; Adult; Africa; Animals; Biological Evolution; Child; Europe; Female; Hominidae; Humans; Male; Middle Aged; Pan troglodytes; Spinal Canal; Young Adult
PubMed: 26553817
DOI: 10.1016/j.jhevol.2015.09.001