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Journal of Orthopaedic Science :... Mar 2020Farming is one of the effective community activities for preventing the need for new long-term care insurance services. This study was conducted to compare spinal canal... (Comparative Study)
Comparative Study
BACKGROUND
Farming is one of the effective community activities for preventing the need for new long-term care insurance services. This study was conducted to compare spinal canal diameters between patients injured during orchard work (i.e., cultivating apples) and other situations that lead to cervical spinal cord injury without major fracture or dislocation and to investigate the frequency of cervical spinal canal stenosis among farmers in a Japanese community.
METHODS
Subjects were 23 patients with cervical spinal cord injury without major fracture and dislocation. Charts and radiographs of these patients were retrospectively reviewed to evaluate the characteristics of the spinal cord injury. The spinal canal diameter at the injury level in the mid-sagittal plane of magnetic resonance imaging (MRI) and mechanism of injury were compared between patients injured by orchard work and other situations. Moreover, 358 Japanese general residents were evaluated for the prevalence of cervical canal stenosis using MRI and comparisons were made between farmers group and non-farmers group.
RESULTS
Spinal canal diameters at the injury level were 5.8 ± 1.4 mm in patients injured during orchard work and 5.6 ± 1.0 mm in those injured in other situations; there were no differences between the two groups. Head contusion as mechanism of injury was more frequent in the orchard work group than in other situations group. Among farmers, the rate of spinal canal stenosis increased with age, and it was 62.3% in men and 66.2% in women.
CONCLUSIONS
The frequency of cervical spinal canal stenosis was high with age regardless of farming work. In addition, head contusion might be a characteristic mechanism that causes spinal cord injury during orchard work. Therefore, screening of cervical degenerative conditions among farmers and education for prevention of cervical spinal cord injury during farming work are necessary.
Topics: Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Farmers; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prevalence; Retrospective Studies; Spinal Canal; Spinal Cord Injuries; Spinal Stenosis
PubMed: 31000376
DOI: 10.1016/j.jos.2019.03.021 -
World Neurosurgery Aug 2018Anatomic shape of the spinal canal (oval, round, trefoil) has been reported to predict outcome of bilateral decompression performed in an undercutting technique via...
BACKGROUND
Anatomic shape of the spinal canal (oval, round, trefoil) has been reported to predict outcome of bilateral decompression performed in an undercutting technique via unilateral laminotomy in monosegmental lumbar spinal stenosis, with poorest results observed in a trefoil spinal canal, leading to the proposal of using bilateral instead of unilateral laminotomy. The aim of this study was to assess whether this anatomic classification into oval, round, and trefoil shapes is relevant to surgical treatment of lumbar spinal stenosis.
METHODS
Retrospective chart review of patients undergoing lumbar decompression surgery was performed. Spinal canal configuration was assessed on preoperative computed tomography based on maximal transverse and anteroposterior diameter, and shapes were classified into oval, round, and trefoil. Associations between spinal canal shape and outcome improvement (aggregate of walking distance and leg pain) were tested.
RESULTS
Decompression of 236 lumbar levels was performed in 159 patients (mean age, 73 ± 8 years; mean body mass index, 29 ± 6). Average number of operated segments was 1.3 ± 0.6. Oval configurations were detected in 155 (65%) levels, round configurations were detected in 11 (5%) levels, and trefoil configurations were detected in 70 (30%) levels. Postoperative improvement was recorded in 91.7% of patients. Spinal canal shape had no influence on surgical outcome (oval, area under the curve 0.529, P = 0.672; trefoil, area under the curve 0.500, P = 0.997; round, area under the curve 0.471, P = 0.670).
CONCLUSIONS
Spinal canal configuration varies in frequency with lumbar segment. Our results do not support the idea that this anatomic classification, particularly the nomenclature of oval, round, and trefoil, should influence surgical decision making.
Topics: Aged; Aged, 80 and over; Constriction, Pathologic; Decompression, Surgical; Female; Humans; Laminectomy; Lumbar Vertebrae; Male; Middle Aged; Neurosurgical Procedures; Retrospective Studies; Spinal Canal; Spinal Stenosis; Treatment Outcome
PubMed: 29602004
DOI: 10.1016/j.wneu.2018.03.137 -
Korean Journal of Anesthesiology Jun 2023
Comment on "Comparison between the coronal diameters of the cervical spinal canal and spinal cord measured using computed tomography and magnetic resonance imaging in Korean patients".
Topics: Humans; Spinal Cord; Spinal Canal; Magnetic Resonance Imaging; Neck; Republic of Korea
PubMed: 36617950
DOI: 10.4097/kja.22706 -
Neurology India 2023There have been reports on the significant canal cross-sectional area (CSA) expansion difference between pre- and post-operation, but no comparison of CSA expansion...
BACKGROUND
There have been reports on the significant canal cross-sectional area (CSA) expansion difference between pre- and post-operation, but no comparison of CSA expansion between the hinge-side area (Area H) and the open-side area (Area O) has been reported. This study aimed to measure the spinal CSA expansion between Area H and Area O retrospectively after open-door laminoplasty using new titanium spacers and evaluated this common decompression procedure's effectiveness.
MATERIALS AND METHODS
This study included 27 patients diagnosed with cervical spondylotic radiculopathy or myelopathy, ossification of the posterior longitudinal ligament, and developmental canal stenosis from February 2021 to October 2022. The CSA difference between pre- and post-cervical laminoplasty (C4-C6 levels) was measured with cervical transverse computed tomography scan images. The CSA difference in Area H and Area O between pre- and post-laminoplasty was similarly calculated.
RESULTS
The spinal canal areas of each segment after open-door laminoplasty were significantly enlarged (P < 0.05). Area O was also significantly enlarged compared to that of Area H (P < 0.05).
CONCLUSION
Area O was more enlarged than Area H, and both sides were statistically enlarged after open-door laminoplasty.
Topics: Humans; Laminoplasty; Retrospective Studies; Spinal Cord Compression; Cervical Vertebrae; Spinal Canal; Laminectomy; Spondylosis; Treatment Outcome
PubMed: 37635499
DOI: 10.4103/0028-3886.383874 -
Spine Feb 2001An experimental study was performed using cadaveric lumbar spines to evaluate the effect of anteriorly or laterally placed interbody distraction implants on the...
STUDY DESIGN
An experimental study was performed using cadaveric lumbar spines to evaluate the effect of anteriorly or laterally placed interbody distraction implants on the alteration of spinal canal and neuroforaminal dimensions.
OBJECTIVES
To quantify changes in the spinal canal and neuroforaminal dimensions using interbody fusion devices inserted at various configurations in cadaveric lumbar spines exhibiting degenerative spondylolisthesis.
SUMMARY OF BACKGROUND DATA
Although several clinical studies have demonstrated successful treatment of degenerative spondylolisthesis with anterior interbody fusion, no study has shown the role of interbody distraction in improving lumbar spinal canal and foraminal stenosis.
METHODS
Five fresh cadaver lumbar spines exhibiting a degenerative spondylolisthesis or retrospondylolisthesis were used for the study. Computed tomography scans of each specimen and a silicon mold of the left intervertebral foramens were repeated in a consistent manner after pure compressive load (150 lb) was applied to simulate physiologic load (intact case), after two BAK (Sulzer SpineTech Inc., Minneapolis, MN) distraction plugs were anteriorly inserted into the intervertebral disc space (anterior distraction cases), and after one long BAK cage was laterally inserted from the left side (lateral distraction case). The cross-sectional area of the spinal canal was measured from computed tomography images using National Institutes of Health image software (Bethesda, MD). The spinal canal volume was calculated using the cross-sectional area and total scan thickness. Left intervertebral foraminal volumes were calculated from the weight of the silicon mold injected into the foramen. Descriptive statistics and a Student's t test were used to detect statistical differences in the spinal canal and neuroforaminal volumes before and after interbody distraction.
RESULTS
The cross-sectional canal area was significantly increased after anterior distraction (35.11%) and lateral distraction (33.14%). The spinal canal volume was markedly increased with anterior distraction (19.92%) and lateral distraction (21.96%). Left foraminal volume was also enhanced by 40.25% for anterior distraction and 41.03% for lateral distraction.
CONCLUSIONS
Interbody distraction either by anteriorly inserted plugs or laterally inserted threaded cagescan immediately improve the narrowed canal area and increase spinal canal, as well as foraminal volume for lumbar degenerative spondylolisthesis or retro- spondylolisthesis.
Topics: Anthropometry; Cadaver; Humans; Internal Fixators; Lumbar Vertebrae; Osteogenesis, Distraction; Radiography; Spinal Canal; Spinal Fusion; Spondylolisthesis; Weight-Bearing
PubMed: 11224873
DOI: 10.1097/00007632-200102010-00004 -
The Journal of Comparative Neurology Jun 2014The persistence of proliferative cells, which could correspond to progenitor populations or potential cells of origin for tumors, has been extensively studied in the... (Comparative Study)
Comparative Study
The persistence of proliferative cells, which could correspond to progenitor populations or potential cells of origin for tumors, has been extensively studied in the adult mammalian forebrain, including human and nonhuman primates. Proliferating cells have been found along the entire ventricular system, including around the central canal, of rodents, but little is known about the primate spinal cord. Here we describe the central canal cellular composition of the Old World primate Macaca fascicularis via scanning and transmission electron microscopy and immunohistochemistry and identify central canal proliferating cells with Ki67 and newly generated cells with bromodeoxyuridine incorporation 3 months after the injection. The central canal is composed of uniciliated, biciliated, and multiciliated ependymal cells, astrocytes, and neurons. Multiciliated ependymal cells show morphological characteristics similar to multiciliated ependymal cells from the lateral ventricles, and uniciliated and biciliated ependymal cells display cilia with large, star-shaped basal bodies, similar to the Ecc cells described for the rodent central canal. Here we show that ependymal cells with one or two cilia, but not multiciliated ependymal cells, proliferate and give rise to new ependymal cells that presumably remain in the macaque central canal. We found that the infant and adult human spinal cord contains ependymal cell types that resemble those present in the macaque. Interestingly, a wide hypocellular layer formed by bundles of intermediate filaments surrounded the central canal both in the monkey and in the human, being more prominent in the stenosed adult human central canal.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Animals; Cell Proliferation; Epithelial Cells; Female; Humans; Macaca; Macaca fascicularis; Male; Species Specificity; Spinal Canal; Spinal Cord
PubMed: 24638933
DOI: 10.1002/cne.23501 -
Korean Journal of Anesthesiology Jun 2023
Response to "Comment on Comparison between the coronal diameters of the cervical spinal canal and spinal cord measured using computed tomography and magnetic resonance imaging in Korean patients".
Topics: Humans; Spinal Cord; Spinal Canal; Magnetic Resonance Imaging; Neck; Republic of Korea
PubMed: 36617949
DOI: 10.4097/kja.22749 -
European Spine Journal : Official... May 2014Microsurgical bilateral decompression via a unilateral approach for lumbar spinal stenosis is a less invasive technique compared to conventional laminectomy. Although...
PURPOSE
Microsurgical bilateral decompression via a unilateral approach for lumbar spinal stenosis is a less invasive technique compared to conventional laminectomy. Although many technical reports have demonstrated acceptable overall surgical outcomes for this approach, no studies have attempted to clarify the clinical outcomes thereof in regard to anatomical variance of the spinal canal. This study was conducted to analyze the clinical outcomes of microsurgical bilateral decompression via a unilateral approach according to spinal canal morphology in degenerative lumbar spinal stenosis.
METHODS
Between January 2008 and December 2009, 144 patients with single-level spinal lumbar stenosis underwent microsurgical bilateral decompression via a unilateral approach by a single surgeon. Patients were categorized into three groups according to spinal canal shape: round (n = 42), oval (n = 36), and trefoil (n = 66), and clinical parameters were assessed both before and after surgery with 2-3 years of follow-up.
RESULTS
Mean visual analog scale (VAS) and Oswestry disability index (ODI) decreased after surgery, respectively, from 8.1 and 59.8 % to 2.1 and 19.1 % in the round shaped spinal canal group, from 7.2 and 47.1 % to 2.2 and 15.1 % in the oval shaped spinal canal group, and from 6.8 and 53.6 % to 3.6 and 33.3 % in the trefoil shaped spinal canal group. In all groups, VAS and ODI scores significantly improved postoperatively (p < 0.01), although less improved VAS and ODI scores were observed in the trefoil shaped spinal canal group (p < 0.01). The overall patient satisfaction rate was 66.7 %; however, statistically significant lower satisfaction rates were reported in the trefoil shaped spinal canal group (p < 0.01).
CONCLUSIONS
Microsurgical bilateral decompression via a unilateral approach may be a good modality for treating round or oval shape spinal canal stenosis, but is not recommended for trefoil-shaped-stenosis. The current authors recommend performing the bilateral decompression technique in cases of trefoil-shaped-spinal canal stenosis.
Topics: Aged; Constriction, Pathologic; Decompression, Surgical; Female; Follow-Up Studies; Humans; Laminectomy; Lumbar Vertebrae; Male; Microsurgery; Middle Aged; Pain Measurement; Patient Satisfaction; Postoperative Complications; Radiography; Retrospective Studies; Spinal Canal; Spinal Stenosis; Treatment Outcome
PubMed: 24292345
DOI: 10.1007/s00586-013-3116-7 -
Spine May 2011Multicenter retrospective study.
STUDY DESIGN
Multicenter retrospective study.
OBJECTIVE
To examine whether posttraumatic cervical spinal canal compromise and spinal cord compression are responsive to changes in motor and sensory functions.
SUMMARY OF BACKGROUND DATA
The maximum canal compromise (MCC) and maximum spinal cord compression (MSCC) were developed to quantitatively assess canal stenosis and spinal cord compression using computed tomographic (CT) scan and magnetic resonance imaging (MRI) in the setting of acute spine trauma.
METHODS
We included 100 consecutive patients with acute spine trauma. Patients were classified into three groups as follows: patients with acute spine trauma without spinal cord injury (group 1), patients with incomplete spinal cord injury (group 2), and patients with complete spinal cord injury (group 3). We studied three quantitative imaging parameters given as follows: MCC using CT-based measurements, MCC using T1-MRI based measurements, and MSCC using T2-MRI based measurements.
RESULTS
There were 78 male patients and 22 female patients with ages from 17 to 82 years (mean age = 45 years). In group 1, there were no significant differences regarding the mean MRI-MCC and MSCC among the spine levels. Although most spine levels were statistically comparable regarding the CT-MCC in patients of group 1, the C7 level significantly differed from the C3 level. Comparisons among all three patient groups showed significant differences regarding the mean MRI-MCC and MSCC, but no significant differences were observed in the mean CT-MCC between groups 1 and 2, and between groups 1 and 3. Data analyses using operating characteristics of each radiologic parameter indicated that only the MRI parameters had consistently optimal cutoff points to distinguish between groups 1 and 2, and between groups 2 and 3.
CONCLUSION
Our results suggest that the MRI-based measurements of canal compromise and spinal cord compression are responsive to changes in motor and sensory functions. However, the MCC using CT-based measurements provides inconsistent results that can result in misdiagnosis in the clinical setting.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Constriction, Pathologic; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Spinal Canal; Spinal Cord Compression; Spinal Injuries; Tomography, X-Ray Computed; Trauma Severity Indices; Young Adult
PubMed: 21192294
DOI: 10.1097/BRS.0b013e3181e7be3a -
Pain Practice : the Official Journal of... Jan 2024Neurologic deficit is known as a rare complication of thoracic spinal cord stimulator (SCS) paddle lead implantation, but many believe its incidence after SCS paddle...
BACKGROUND
Neurologic deficit is known as a rare complication of thoracic spinal cord stimulator (SCS) paddle lead implantation, but many believe its incidence after SCS paddle lead placement is under-reported. It is possible that imaging characteristics may be used to help predict safe paddle lead placement.
OBJECTIVE
This imaging study was undertaken to determine the minimum canal diameter required for safe paddle lead placement.
METHODS
Patients who underwent thoracic laminotomy for new SCS paddle lead placement from January 2018 to March 2023 were identified retrospectively. Preoperative thoracic canal diameter was measured in the sagittal plane perpendicular to the disc space from T5/6 to T11/12. These thoracic levels were chosen because they span the most common levels targeted for SCS placement. Patients with and without new neurologic deficits were compared using a Mann-Whitney U-test.
RESULTS
Of 185 patients initially identified, 180 had thoracic imaging available for review. One (0.5%) and 2 (1.1%) of 185 patients complained of permanent and transient neurologic deficit after thoracic SCS placement, respectively. Patients with neurologic deficits had average canal diameters of <11 mm. The average canal diameter of patients with and without neurologic deficits was 10.2 mm (range 6.1-12.9 mm) and 13.0 mm (range 5.9-20.2), respectively (p < 0.0001).
CONCLUSION
Postoperative neurologic deficit is an uncommon complication after thoracic laminotomy for SCS paddle lead placement. The authors recommend ensuring a starting thoracic canal diameter of at least 12 mm to accommodate a SCS paddle lead measuring 2 mm thick to ensure a final diameter of >10 mm. If canal diameter is <12 mm, aggressive undercutting of the lamina, a second laminotomy, or placement of smaller SCS wire leads should be considered.
Topics: Humans; Retrospective Studies; Electrodes, Implanted; Spinal Cord; Electric Stimulation Therapy; Spinal Canal; Spinal Cord Stimulation
PubMed: 37626446
DOI: 10.1111/papr.13289