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Journal of Orthopaedic Research :... Aug 2021Lumbar developmental spinal stenosis (DSS) refers to multilevel pre-existing narrowed spinal canals, which predispose to neural compromise. The objective of this study...
Lumbar developmental spinal stenosis (DSS) refers to multilevel pre-existing narrowed spinal canals, which predispose to neural compromise. The objective of this study is to identify any inheritance pattern of DSS by utilizing pedigree charts. This was a case series of 13 families with a total of 80 subjects having magnetic resonance imaging (MRI) from L1 to S1. Cases (subjects with DSS) or controls (subjects without DSS) were identified by measuring their anteroposterior (AP) vertebral canal diameters. Multilevel model analyses were also performed to evaluate whether there is substantial clustering of observations within the families, and the effect of multilevel DSS. The intraclass correlation coefficient (ICC) and Akaike information criteria (AIC) were compared between models. Correlations between subject demographics and AP vertebral canal diameter were statistically insignificant at all levels. Only vertebral canal cross-sectional area, and axial and sagittal vertebral canal diameter were found to be statistically different between cases and controls at all levels (all p < .05). Both males and females were affected by DSS and there was no skipping of generation, which highly suggested DSS followed an autosomal dominant inheritance pattern. After accounting for multilevel DSS, there was a drop of more than 10 in AIC and some variances were also explained within families. This is the first study that suggests multilevel lumbar DSS to have an autosomal dominant inheritance pattern. Within families with a background of DSS, subjects had a smaller canal size, contributed by shortened axial and sagittal AP vertebral canal diameter, and smaller canal cross-sectional area.
Topics: Female; Humans; Inheritance Patterns; Lumbar Vertebrae; Male; Pedigree; Spinal Canal; Spinal Stenosis
PubMed: 32902878
DOI: 10.1002/jor.24850 -
Operative Neurosurgery (Hagerstown, Md.) Nov 2022Patients with cervical spondylotic myelopathy (CSM) can be treated with posterior approaches for spinal canal decompression.
BACKGROUND
Patients with cervical spondylotic myelopathy (CSM) can be treated with posterior approaches for spinal canal decompression.
OBJECTIVE
We compared the patients' outcome after 2 different unilateral and a bilateral posterior approach for decompression to elucidate feasibility and potential procedure-related differences.
METHODS
Medical records of 98 patients with CSM undergoing posterior decompression between 2012 and 2018 were assessed. Patients were divided into 3 groups: (1) unilateral interlaminar fenestration with over-the-top "undercutting" (laminotomy) for compression limited to a ligamentum flavum hypertrophy, (2) unilateral hemilaminectomy for lateralized compression with a combination of ligamentous hypertrophy and osseus stenosis, and (3) laminectomy/laminoplasty for circular osseous-ligamentous spinal canal narrowing.
RESULTS
The mean age was 73 years (m:f = 1.4:1), and most frequent symptoms (mean duration: 15 months) were ataxia (69%) and sensory changes (57%). Main location of stenoses (median Naganawa Score = 3; mean anteroposterior spinal canal diameter = 7.7 ± 2.2 mm) was C3 to C6. Thirty-one percent of the patients were assigned for a laminotomy procedure, 20% for a hemilaminectomy, and 49% for a laminectomy/laminoplasty. There were no significant differences of patients' characteristics, blood loss, and operation time between the 3 groups. Independent from the mode of surgery, the spinal canal was significantly widened (median Naganawa Score = 0; mean anteroposterior diameter = 11.4 ± 3.6 mm) and myelopathy (mJOA Score) improved ( P < .001); a higher body mass index was significantly correlated with a worse mJOA improvement (r = 0.293/ P = .003). Quality of life (Short-Form 36v2 Health Survey/Neck Disability Index) and reduction of the neck pain level were similar in the 3 groups at last follow-up (mean: 28 months).
CONCLUSION
To minimize patients' periprocedural burden in CSM with dorsal compression, individual tailoring of the posterior approach according to the underlying compressive pathology achieves sufficient decompression and comparable long-term results.
Topics: Aged; Decompression; Feasibility Studies; Humans; Hypertrophy; Quality of Life; Spinal Canal; Spinal Cord Diseases; Spinal Stenosis
PubMed: 36227256
DOI: 10.1227/ons.0000000000000364 -
Acta Neurochirurgica Dec 2021Spontaneous spinal epidural hematoma (SSEDH) is a rare condition with potentially devastating consequences. Known prognostic factors are short time to surgery,...
BACKGROUND
Spontaneous spinal epidural hematoma (SSEDH) is a rare condition with potentially devastating consequences. Known prognostic factors are short time to surgery, preoperative neurologic condition, and age. The aim of this study was to investigate the impact of the transversal hematoma extent with its subsequent spinal canal obliteration on outcome in patients with SSEDH.
METHODS
A retrospective study including all patients that underwent surgery due to SSEDH at the University Hospital of St. Poelten between 1/7/2005 and 30/6/2020 was conducted. The percentage of spinal canal obliteration at the level where the hematoma was most prominent was calculated and correlated to functional outcome.
RESULTS
A total of 17 patients could be included in this study. Preoperative ASIA impairment scale showed positive correlation with postoperative outcome (p = 0.005). Patients with a favorable outcome (ASIA D and E) showed a statistically significant lower mean obliteration of the spinal canal by the hematoma with 46.4% (± 8%) in comparison to patients with an unfavorable outcome with 62.1% (± 6%, p = 0.001). A cut-off of 51% yielded a sensitivity and specificity for favorable outcome of 100% and 70% respectively (area under the ROC 0.93, p < 0.001).
CONCLUSION
Preoperative percentage of spinal canal obliteration is statistically significant lower in patients with favorable outcome in surgically treated patients with spontaneous spinal epidural hematoma.
Topics: Hematoma, Epidural, Spinal; Humans; Magnetic Resonance Imaging; Prognosis; Retrospective Studies; Spinal Canal; Spine
PubMed: 34633546
DOI: 10.1007/s00701-021-05011-x -
Journal of Orthopaedic Science :... May 2021Locomotive syndrome is a condition of reduced mobility due to problems with locomotive organs. Although lumbar spinal canal stenosis is one of the major diseases...
BACKGROUND
Locomotive syndrome is a condition of reduced mobility due to problems with locomotive organs. Although lumbar spinal canal stenosis is one of the major diseases constituting locomotive syndrome, only few studies have focused on the association between the two pathologies. We aimed to investigate the effect of surgery on lumbar spinal canal stenosis with respect to locomotive syndrome using various physical function tests, including locomotive syndrome risk tests, before and after surgery.
METHODS
Clinical data of 101 consecutive patients (male = 46; female = 55; mean age, 69.3 years) who underwent surgery for lumbar spinal canal stenosis at our institute were prospectively collected. Results of physical function tests, including stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale, and the sagittal vertical axis were evaluated before and 1 year after surgery. The association between several parameters and improvement of risk level in locomotive syndrome was evaluated.
RESULTS
In the total assessment, 93.1% of cases were in stage 2 and 6.9% in stage 1 preoperatively, while 72.4% were in stage 2, 22.4% in stage 1, and 5.2% in stage 0 at 1 year postoperatively. Postoperative improvement in the total assessment was observed in 28.7% of cases. Several physical function tests and sagittal vertical axis showed significant improvement after surgery. On multiple logistic regression analysis, age >75 years (odds ratio = 10.9, confidence interval = 1.09-109) and postoperative sagittal vertical axis >40 mm (odds ratio = 17.8, confidence interval = 1.78-177) were significant risk factors associated with non-improvement in risk level of locomotive syndrome.
CONCLUSIONS
Surgical treatment for lumbar spinal canal stenosis improved physical function, including locomotive syndrome. Risk factors associated with non-improvement of locomotive syndrome were later-stage elderly and postoperative sagittal balance impairment.
Topics: Aged; Constriction, Pathologic; Decompression, Surgical; Female; Humans; Lumbar Vertebrae; Male; Spinal Canal; Spinal Stenosis; Syndrome
PubMed: 32354576
DOI: 10.1016/j.jos.2020.03.021 -
Neurology India 2018Accurate and detailed measurements of spinal canal diameter (SCD) and transverse foraminal morphometry are essential for understanding spinal column-related diseases and...
BACKGROUND
Accurate and detailed measurements of spinal canal diameter (SCD) and transverse foraminal morphometry are essential for understanding spinal column-related diseases and for surgical planning, especially for transpedicular screw fixation. This is especially because lateral cervical radiographs do not provide accurate measurements.
AIM:
This study was conducted to measure the dimensions of the transverse foramen sagittal and transverse diameters (SFD, TFD), SCD, and the distance of spinal canal from the transverse foramina (dSC-TF) at C1-C7 level in the Indian population.
MATERIALS AND METHODS:
The study population comprised 84 male and 42 female subjects. The mean age of the study group was 44.63 years (range, 19-81 years). A retrospective study was conducted, and data were collected and analyzed for patients who underwent cervical spine computed tomography (CT) imaging for various reasons.
RESULTS
One hundred and twenty-six patients were included in the study. Detailed readings were taken at all levels from C1-C7 for SCD, SFD, TFD, and dSc-TF. Values for male and female subjects were separately calculated and compared. For both the groups, the widest SCD were measured at the C1 level and the narrowest SCD at the C4 level. The narrowest SFD was measured at C7 for both male and female subjects on the right and left sides. The widest SFD was measured at C1 both for male and female subjects on the right and left side. The narrowest TFD on the left side was measured at C7 for male and at C1 for female subjects. The narrowest mean distance of dSC-TF was found to be at C4 for both male and female subjects on both left and right side.
CONCLUSION
The computed tomographic (CT) imaging is better than conventional radiographs for the preoperative evaluation of cervical spine and for better understanding cervical spine morphometry. Care must be taken during transpedicular screw fixation, especially in female subjects, more so at the C2, C4, and C6 levels due to a decrease in the distance of dSC-TF.
Topics: Adult; Aged; Aged, 80 and over; Bone Screws; Cervical Vertebrae; Female; Foramen Magnum; Humans; India; Male; Middle Aged; Orthopedic Procedures; Retrospective Studies; Spinal Canal; Spinal Cord Diseases; Tomography, X-Ray Computed
PubMed: 29547171
DOI: 10.4103/0028-3886.227277 -
British Journal of Anaesthesia Nov 2017The primary aim of this study was to objectively assess the different spinal and caudal volumes that are of interest for caudal block volume dosing.
Volumes of the spinal canal and caudal space in children zero to three years of age assessed by magnetic resonance imaging: implications for volume dosage of caudal blockade.
BACKGROUND
The primary aim of this study was to objectively assess the different spinal and caudal volumes that are of interest for caudal block volume dosing.
METHODS
Three directly assessed (volume of spinal canal/caudal space, volume of the dural sac and volume of spinal cord) and two derived volumes (volume of the epidural space and cerebrospinal fluid volume) were determined from magnetic resonance images (MRI) in 20 children (zero - three yr of age). The assessed volumes were correlated to age, height and weight. Furthermore, the volumes of the epidural space from caudal canal to three different clinically relevant target levels (L 1, Th 10 and Th 6) and the epidural volume of each individual spinal segment at the caudal, lumbar and thoracic levels were calculated.
RESULTS
All volumes correlated in a linear manner to length and weight (R2 0.614 - 0.867) whereas a curvilinear correlation was associated with best curve fit for age (R2 0.696 - 0.883). The median volumes of the epidural space from caudal canal to L 1, Th 10 and Th 6 were 1.30 ml kg-1 (95%CI 1.08-1.51), 1.57 ml kg-1 (95%CI 1.29-1.81) and 1.78 ml kg-1 (95%CI 1.52-2.08), respectively. The median volumes of the epidural space per vertebral segment were Thoracic: 0.60 ml (95%CI 0.38-0.75); Lumbar: 1.18 ml (95%CI 0.94-1.43) and Caudal: 0.85 ml (95%CI 0.56-1.18).
CONCLUSIONS
The spinal volumes of interest show a linear correlation to height and weight whereas a curvilinear correlation was found for age. The volume of the epidural space per segment was found to be significantly higher at the lumbar level compared with the caudal and thoracic levels.
Topics: Anesthesia, Caudal; Child, Preschool; Drug Dosage Calculations; Epidural Space; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Retrospective Studies; Spinal Canal
PubMed: 29028948
DOI: 10.1093/bja/aex280 -
Japanese Journal of Clinical Oncology Apr 2021
Topics: Brain Stem; Fluorodeoxyglucose F18; Histiocytic Sarcoma; Humans; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Spinal Canal
PubMed: 33550372
DOI: 10.1093/jjco/hyaa267 -
Spine Jun 2021This study defined different anatomic zones within the cervical spinal canal and provides detailed anatomical quantitative data for an accurate diagnosis of cervical...
Intradural Neuroanatomy in the Cervical Spinal Canal: Importance of a New Anatomic Zone Division and Accurate Assessment of Neural Compression in Myeloradiculopathy Patients.
This study defined different anatomic zones within the cervical spinal canal and provides detailed anatomical quantitative data for an accurate diagnosis of cervical spondylosis and a safe and effective anterior decompression surgery.
Topics: Cervical Vertebrae; Decompression, Surgical; Humans; Spinal Canal; Spinal Cord Diseases
PubMed: 33394981
DOI: 10.1097/BRS.0000000000003906 -
BMC Geriatrics Mar 2023Polypharmacy is a growing public health problem occurring in all healthcare settings worldwide. Elderly patients with lumbar spinal canal stenosis (LSS) who manifest low...
BACKGROUND
Polypharmacy is a growing public health problem occurring in all healthcare settings worldwide. Elderly patients with lumbar spinal canal stenosis (LSS) who manifest low back and neuropathic pain and have a high frequency of comorbidity are predicted to take many drugs. However, no studies have reported polypharmacy in elderly patients with LSS. Thus, we aimed to review the polypharmacy among elderly LSS patients with elective surgeries and examine how the surgical treatment reduces the polypharmacy.
METHODS
We retrospectively enrolled all the patients aged ≥ 65 years who underwent spinal surgery for LSS between April 2020 and March 2021. The prescribed drugs of participants were directly checked by pharmacists in the outpatient department preoperatively and 6-month and 1-year postoperatively. The baseline characteristics were collected beside the patient-based outcomes including Roland-Morris Disability Questionnaire, Zurich Claudication Questionnaire, and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The cutoff number of drugs for polypharmacy was defined as 6. The prescription drugs were divided into 9 categories: drugs for neuropsychiatric, cardiovascular, respiratory, digestive, endocrine metabolic, and urinary renal diseases; blood products; pain relief medication; and others.
RESULTS
A total of 102 cases were finally analyzed, with a follow-up rate of 78.0%. Of the participants, the preoperative polypharmacy prevalence was 66.7%. The number of drugs 6-month and 1-year postoperatively was significantly less than the preoperative one. The proportions of polypharmacy at 6 months and 1 year after surgery significantly decreased to 57.8% and 55.9%, respectively. When the prescribed drugs were divided into 9 categories, the number of drugs for pain relief and digestive diseases was significantly reduced after surgery. The multi-variable analysis revealed that a higher score in the psychological disorder of JOABPEQ was associated with 3 or more drugs decreased 1-year postoperatively (OR, 2.5; 95% CI: 1.0-6.1).
CONCLUSION
Polypharmacy prevalence was high among elderly LSS patients indicated for lumbar spinal surgery. Additionally, our data showed that lumbar spinal surgery was effective in reducing polypharmacy among elderly LSS patients. Finally, the multi-variable analysis indicated that better psychological condition was associated with the reduction of prescribed drugs after lumbar spinal surgery.
Topics: Aged; Humans; Retrospective Studies; Decompression, Surgical; Constriction, Pathologic; Polypharmacy; Lumbar Vertebrae; Spinal Stenosis; Spinal Canal; Pain; Treatment Outcome
PubMed: 36964497
DOI: 10.1186/s12877-023-03853-x -
Journal of Magnetic Resonance Imaging :... Jul 2021Mechanical compliance of a compartment is defined by the change in its volume with respect to a change in the inside pressure. The compliance of the spinal canal...
Mechanical compliance of a compartment is defined by the change in its volume with respect to a change in the inside pressure. The compliance of the spinal canal regulates the intracranial pressure (ICP) under postural changes. Understanding how gravity affects ICP is beneficial for poorly understood cerebrospinal fluid (CSF)-related disorders. The aim of this study was to evaluate postural effects on cranial hemo- and hydrodynamics. This was a prospective study, which included 10 healthy volunteers (three males, seven females, mean ± standard deviation age: 29 ± 7 years). Cine gradient-echo phase-contrast sequence acquired at 0.5 T, "GE double-doughnut" scanner was used. Spinal contribution to overall craniospinal compliance (CSC), craniospinal CSF stroke volume (SV), magnetic resonance (MR)-derived ICP (MR-ICP), and total cerebral blood flow (TCBF) were measured in supine and upright postures using automated blood and CSF flows quantification. Statistical tests performed were two-sided Student's t-test, Cohen's d, and Pearson correlation coefficient. MR-ICP and the craniospinal CSF SV were significantly correlated with the spinal contribution to the overall CSC (r = 0.83, p < 0.05) and (r = 0.62, p < 0.05), respectively. Cranial contribution to CSC increased from 44.5% ± 16% in supine to 74.9% ± 8.4% in upright posture. The average MR-ICP dropped from 9.9 ± 3.4 mmHg in supine to -3.5 ± 1.5 mmHg. The CSF SV was over 2.5 times higher in the supine position (0.55 ± 0.14 ml) than in the upright position (0.21 ± 0.13 ml). In contrast, TCBF was slightly higher in the supine posture (822 ± 152 ml/min) than in the upright posture (761 ± 139 ml/min), although not statistically significant (p = 0.16). The spinal-canal compliance contribution to CSC is larger than the cranial contribution in the supine posture and smaller in the upright posture. Thereby, the spinal canal plays a role in modulating ICP upon postural changes. The lower pressure craniospinal CSF system was more affected by postural changes than the higher-pressure cerebral vascular system. Craniospinal hydrodynamics is affected by gravity and is likely to be altered by its absence in space. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 2.
Topics: Adult; Cerebrospinal Fluid; Female; Humans; Hydrodynamics; Intracranial Pressure; Male; Posture; Prospective Studies; Spinal Canal; Young Adult
PubMed: 33491833
DOI: 10.1002/jmri.27505