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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 -
AJNR. American Journal of Neuroradiology Aug 2012Upper cervical spinal canal dimension may have a role in abnormal CSF dynamics in patients with Chiari I malformation. We attempted to measure spinal canal tapering from...
BACKGROUND AND PURPOSE
Upper cervical spinal canal dimension may have a role in abnormal CSF dynamics in patients with Chiari I malformation. We attempted to measure spinal canal tapering from anteroposterior spinal canal dimensions in patients with Chiari I.
MATERIALS AND METHODS
Twenty-one patients with Chiari I malformation, including 12 with syringomyelia and 7 patients with IS were identified from a local registry. Age- and sex-matched control subjects with cervical spine MR imaging findings reported as normal were selected from the PACS. The anteroposterior diameter of the spinal canal was measured at C1-C7 on T2-weighted sagittal MR images. The taper ratio of the spinal canal was calculated with the regression line. Goodness of fit was calculated as R(2). Differences between patients with Chiari I and other patients were tested for significance with Kruskal-Wallis tests and multivariate analysis.
RESULTS
Taper ratios averaged -0.6 ± 0.3 mm/level in the patients with Chiari and syrinx, -0.4 ± 0.2 mm/level (mean ± 1 SD) in the patients with Chiari without syrinx, and -0.3 ± 0.5 mm/level in the patients with IS; control groups had average taper ratios of -0.3 ± 0.2 mm/level. Mean R(2) equaled 0.43. Taper ratios in patients with Chiari and syringomyelia differed significantly from those in the control group (P = .003). Taper ratios in the patients with Chiari without syrinx and in patients with IS did not differ significantly from their matched control groups (P = .60 and 0.76, respectively).
CONCLUSIONS
Patients with Chiari I and a syrinx have steeper tapering of the upper cervical spinal canal than matched controls.
Topics: Adolescent; Arnold-Chiari Malformation; Cervical Vertebrae; Child; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Male; Reproducibility of Results; Sensitivity and Specificity; Spinal Canal; Spinal Stenosis; Young Adult
PubMed: 22403772
DOI: 10.3174/ajnr.A2948 -
Spine Jun 1996Quasistatic flexion and extension loads were applied in vitro to lower cervical spines. The flexion-extension motion produced was checked for physiologic relevance.
STUDY DESIGN
Quasistatic flexion and extension loads were applied in vitro to lower cervical spines. The flexion-extension motion produced was checked for physiologic relevance.
OBJECTIVES
To examine the changes in the volume of the cervical spinal canal in flexion-extension motion.
SUMMARY OF BACKGROUND DATA
Many papers have been published concerning the cervical canal volume as inferred from standard lateral radiographs. This study compares the inferred (radiographic) volumes and their changes to the physical changes within the spinal canal.
METHODS
The lower cervical spines (C2-C7) from 10 cadavers were subject to stepwise flexion and extension in a purpose-built rig. Before this testing, the spinal cord was removed from the canal space of each specimen and replaced by a thin latex tube stoppered and secured at the opening of the canal (at C2) so that the volume of liquid displaced from the tube could be measured. This was done at each loading stage by means of a graduated glass column, and a radiograph of the spine was also taken to allow angular and displacement readings to be taken from C2 to C7.
RESULTS
The average recorded change in volume of the spinal canal with flexion-extension motion was 1.9 ml, and showed a significant linear correlation with the dynamic canal width (r = 0.868, P < 0.05) and also with the total angle of flexion or extension (r = 0.979, P < 0.005). The volume of liquid displaced from the canal in lateral bending was much lower than that in flexion-extension motion, and only amounted to about 0.2 ml. The angular ranges of motion produced at each level were compared to previous results obtained in vivo, and no significant differences between the angular displacements found in vivo and in vitro under this experimental arrangement were seen.
CONCLUSIONS
The loading regime described in this study causes angular displacements similar to those in vivo, and on this basis is a physiologically relevant loading pattern. The change in the volume of the spinal canal between C2 and C7 shows linear relationships with the angle of flexion and the dynamic canal width.
Topics: Adult; Cadaver; Humans; Male; Motion; Neck; Radiography; Range of Motion, Articular; Spinal Canal
PubMed: 8725922
DOI: 10.1097/00007632-199606010-00006 -
Journal of Manipulative and... 2001
Review
Topics: Biomechanical Phenomena; Chiropractic; Humans; Lumbar Vertebrae; Spinal Canal; Spinal Cord Diseases
PubMed: 11313620
DOI: 10.1016/s0161-4754(01)80003-8 -
Journal of Clinical Anesthesia Mar 2020
Topics: Anesthesia, Spinal; Cadaver; Humans; Nerve Block; Spinal Canal; Ultrasonography, Interventional
PubMed: 31520861
DOI: 10.1016/j.jclinane.2019.09.002 -
Acta Radiologica. Supplementum 1986In 15 cases dynamic studies of cervical spinal cord and canal in flexion and extension were performed by magnetic resonance imaging (MRI). In addition measurements of...
In 15 cases dynamic studies of cervical spinal cord and canal in flexion and extension were performed by magnetic resonance imaging (MRI). In addition measurements of the complete spinal cord were made in 5 cases. As compared with extension the cervical spinal canal and spinal cord lengthen 12 mm in average during flexion, whereas the spinal canal lengthens 28 mm in average, which means a difference of about 15 mm. We feel that these results indicate that adverse mechanical tension may occur in the cervical spinal cord during flexion. The impact of these results on surgical treatment for chronic cervical myelopathy is discussed.
Topics: Humans; Magnetic Resonance Imaging; Movement; Spinal Canal; Spinal Cord
PubMed: 2980608
DOI: No ID Found -
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 -
Brain : a Journal of Neurology Mar 1959
Topics: Cervical Vertebrae; Humans; Spinal Canal; Syringomyelia
PubMed: 13651491
DOI: 10.1093/brain/82.1.23 -
American Journal of Veterinary Research Jan 2018OBJECTIVE To compare the percentage of the C3-C7 vertebral canal occupied by the spinal cord in small-breed dogs with that in Doberman Pinschers and Great Danes with and... (Comparative Study)
Comparative Study
Comparison of the percentage of the C3-C7 vertebral canal occupied by the spinal cord in small-breed dogs with that in Doberman Pinschers and Great Danes with and without cervical spondylomyelopathy.
OBJECTIVE To compare the percentage of the C3-C7 vertebral canal occupied by the spinal cord in small-breed dogs with that in Doberman Pinschers and Great Danes with and without cervical spondylomyelopathy (CSM). ANIMALS 30 small-breed dogs (body weight, < 15 kg), 15 clinically normal Doberman Pinschers, 15 Doberman Pinschers with CSM, 15 clinically normal Great Danes, and 15 Great Danes with CSM. PROCEDURES In a retrospective study, sagittal and transverse T2-weighted MRI images of the cervical (C3 to C7) vertebral column obtained from dogs that met study criteria and were free of extensive abnormalities that could affect the spinal cord diameter between January 2005 and February 2015 were reviewed. The area and height of the vertebral column and spinal cord were measured at the cranial and caudal aspect of each vertebra from C3 to C7, and the percentage of the vertebral canal occupied by the spinal cord at each location was calculated and compared among groups of dogs. RESULTS Mean percentage of the vertebral canal occupied by the spinal cord was greatest for small-breed dogs and lowest for Great Danes, but did not differ between Doberman Pinschers and small-breed dogs at approximately half of the locations evaluated or between Doberman Pinschers with and without CSM or between Great Danes with and without CSM. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the percentage of the vertebral canal occupied by the spinal cord, although expected to increase with vertebral canal stenosis, may not have a primary role in the pathogenesis of CSM.
Topics: Animals; Cervical Vertebrae; Dog Diseases; Dogs; Female; Magnetic Resonance Imaging; Male; Retrospective Studies; Spinal Canal; Spinal Cord Diseases
PubMed: 29287165
DOI: 10.2460/ajvr.79.1.83 -
Spine Apr 1994Although the extent of injury after cervical spine fracture can be visualized by imaging, the deformations that occur in the spinal canal during injury are unknown.
SUMMARY OF BACKGROUND DATA
Although the extent of injury after cervical spine fracture can be visualized by imaging, the deformations that occur in the spinal canal during injury are unknown.
STUDY DESIGN
This study compared spinal canal occlusion and axial length changes occurring during a simulated compressive burst fracture with the residual deformations after the injury.
METHODS
Canal occlusion was measured from changes in pressure in a flexible tube with fluid flowing through it, placed in the canal space after removal of the cord in cadaver specimens. To measure canal axial length, cables were fixed in C1 and led through the foramen transversarium from C2-T1, then out through the base, where they were connected to the core rods of linearly variable differential transformers (LVDT). Axial compressive burst fractures were created in each of ten cadaveric cervical spine specimens using a drop-weight, while force, distraction, and occlusion were monitored throughout the injury event. Pre- and post-injury radiographs and computed tomography scans compared transient and post-injury spinal canal geometry changes.
RESULTS
In all cases, severe compressive injuries were produced. Three had an extension component in addition to compression of the vertebra and retropulsion of bone into the canal. The mean post-injury axial height loss measured from radiographs was only 35% of that measured transiently (3.1 mm post-injury, compared with 8.9 mm measured transiently), indicating significant recovery of axial height after impact. Post-injury and transient height loss were not significantly correlated (r2 = 0.230, P = 0.16) demonstrating that it is not a good measure of the extent of injury. Similarly, mean post injury canal area was 139% of the minimum area measured during impact, indicating recovery of canal space, and post-injury and transient values were not significantly correlated (r2 = 0.272, P = 0.12). Mean post-injury midsagittal diameter was 269% of the minimum transient diameter and showed a weak but significant correlation (r2 = 0.481, P = 0.03).
CONCLUSIONS
Two potential spinal cord injury-causing mechanisms in axial bursting injuries of the cervical spine are occlusion and shortening of the canal. Post-injury radiographic measurements significantly underestimate the actual transient injury that occurs during impact.
Topics: Biomechanical Phenomena; Cadaver; Cervical Vertebrae; Humans; Spinal Canal; Spinal Cord Injuries; Spinal Fractures; Tomography, X-Ray Computed
PubMed: 8009357
DOI: 10.1097/00007632-199404150-00017