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European Spine Journal : Official... Jun 2003Although multiple studies have concluded operative decompression of a traumatically narrowed spinal canal is not indicated because of spontaneous remodeling,...
Although multiple studies have concluded operative decompression of a traumatically narrowed spinal canal is not indicated because of spontaneous remodeling, instrumental decompression is frequently used as part of the operative treatment of spinal fractures. To investigate the process of remodeling, we studied the diameter of the spinal canal in 95 patients with burst fractures at the thoracolumbar junction (T9-L2). To measure and compare the spinal canal's diameter we used either computed tomography (CT) scans or radiographs, made preoperatively, postoperatively, after 9 months and after 24 months. In lateral plain radiographs we found that the initial percentage of cases with bony canal narrowing preoperatively of 76.5 was reduced to 18.4% postoperatively, to 8.2% at 9 months, and to 2.4% at 24 months. In CT scans in a selection of patients, the mean residual diameter of the spinal canal was 53% preoperatively and 78% at 24 months. The posterior segmental height increases during operation and decreases in the respective periods after operation. So ligamentotaxis can only play a role in the perioperative period. We conclude that a significant spontaneous remodeling of the spinal canal follows the initial surgical reduction. Two years after operation, bony narrowing of the spinal canal is only recognizable in 2.4% of the patients on plain lateral radiographs. The remodeling of the spinal canal can be seen on plain radiographs, although not as accurately as on CT scans.
Topics: Bone Remodeling; Humans; Internal Fixators; Lumbar Vertebrae; Recovery of Function; Spinal Canal; Spinal Fractures; Spinal Fusion; Thoracic Vertebrae; Time Factors; Tomography, X-Ray Computed; Traction; Treatment Outcome
PubMed: 12800000
DOI: 10.1007/s00586-002-0499-2 -
Canadian Medical Association Journal Nov 1963
Topics: Adolescent; Geriatrics; Hematoma, Epidural, Spinal; Hemorrhage; Humans; Pathology; Radiography; Spinal Canal
PubMed: 14081790
DOI: No ID Found -
AJNR. American Journal of Neuroradiology Oct 2012Cervical spinal canal tapering may increase CSF velocities and pressures. One report suggests that the cervical spinal canal tapers more steeply in patients with Chiari...
BACKGROUND
Cervical spinal canal tapering may increase CSF velocities and pressures. One report suggests that the cervical spinal canal tapers more steeply in patients with Chiari I than in healthy subjects. The goal of this study was to test the conclusion by measuring spinal canal tapering in another cohort of patients.
MATERIALS AND METHODS
Consecutive patients with scoliosis and MR imaging were selected. The MR images were evaluated for tonsillar herniation and syringomyelia. On a midline T2-weighted MR image, the anteroposterior diameter of the spinal canal was measured at each cervical level, and a linear trend line was fit by least-squares regression. The slope of this line was recorded as the taper ratio in millimeters/level. Patients with >5 mm of tonsillar herniation (with or without syrinx) were compared with those without tonsillar herniation (with or without syrinx). Differences in taper ratios for the 2 groups were tested for significance by the Kruskal-Willis test with significance set at .05.
RESULTS
Fifty-four patients with scoliosis were identified; 22 had a Chiari malformation and 32 did not. Syringomyelia was identified in 20 of the patients with Chiari and in 8 of the others. The taper ratios averaged -0.9 mm/level for the patients with a Chiari malformation (with or without a syrinx) and -0.4 mm/level for those without it, significant at P = .035. Syringomyelia did not substantially alter the taper ratio in either group.
CONCLUSIONS
Patients with scoliosis with a Chiari malformation have more steeply tapering cervical spinal canals than those without it.
Topics: Adolescent; Arnold-Chiari Malformation; Child; Child, Preschool; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Reproducibility of Results; Scoliosis; Sensitivity and Specificity; Spinal Canal; Spinal Stenosis; Young Adult
PubMed: 22499845
DOI: 10.3174/ajnr.A3046 -
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 -
The Spine Journal : Official Journal of... Jun 2013Lumbar degenerative spondylolisthesis (DS), typically characterized by the forward slippage of the superior vertebra of a lumbar motion segment, is a common spinal...
BACKGROUND CONTEXT
Lumbar degenerative spondylolisthesis (DS), typically characterized by the forward slippage of the superior vertebra of a lumbar motion segment, is a common spinal pathological condition in elderly individuals. Significant deformation and volume changes of the spinal canal can occur because of the vertebral slippage, but few data have been reported on these anatomic variations in DS patients. Whether to restore normal anatomy, such as reduction of the slippage and restoration of disc height, is still not clear in surgery.
PURPOSE
This study was designed to determine the volume change of the spinal canal and detect specific anatomic factors affecting the spinal canal volume in DS patients.
STUDY DESIGN/SETTING
A case-control study.
METHODS
Nine asymptomatic volunteers (mean age 54.4) and 9 patients with L4/L5 DS (mean age 73.4) were recruited. All patients had intermittent claudication and different extent low back pain, and two patients also had leg pain. L4/L5 vertebral motion segment unit of each subject was reconstructed using three-dimensional computed tomography or magnetic resonance images in a solid modeling software. In vivo lumbar vertebral motion during functional postures (supine, standing upright, flexion, and extension) was determined using a dual fluoroscopic imaging technique. The volume of the spinal canal was measured at each functional posture. Various anatomic parameters (disc height, cross-sectional area of the canal, left-right diameter of the canal, anterior-posterior diameter of the canal, slippage, posture, intervertebral disc angle [DA], etc.) that may potentially affect the canal volume were also measured, and their correlations with the volume change of spinal canal were analyzed. This study was funded by a 2-year, $275,000 grant from the National Institutes of Health.
RESULTS
On average, spinal canal volume was larger at supine and flexion postures than at stand and extension postures in both the DS and the asymptomatic groups. Spinal canal volume of the DS patients were significantly lower than that of the asymptomatic subjects under all the four postures (p<.05). Correlation analysis showed that spinal canal volume was strongly affected by the posterior disc height (Pearson correlation coefficient γb=0.822) and the slippage percentage (γb=-0.593) and moderately affected by the anterior disc height (γb=0.300) and the DA (γb=-0.237).
CONCLUSIONS
The volume of spinal canal is affected by multiple factors. Increased spinal canal volume at supine and flexion positions may explain the clinical observations of relief of symptoms at these postures in DS patients. The data also suggest that reduction of slipped vertebral body, decrease of DA, intervertebral distraction, and decompression could all be effective to increase the canal volume of DS patients thus to relieve clinical symptoms.
Topics: Aged; Biomechanical Phenomena; Case-Control Studies; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Posture; Spinal Canal; Spondylolisthesis
PubMed: 23541448
DOI: 10.1016/j.spinee.2013.02.017 -
Orthopaedic Surgery Jul 2022Penetrating spinal cord injury (PSCI) with retained foreign bodies (RFB) is rarely observed in clinics and may result in a complete or incomplete neurological deficit....
BACKGROUND
Penetrating spinal cord injury (PSCI) with retained foreign bodies (RFB) is rarely observed in clinics and may result in a complete or incomplete neurological deficit. This study was performed to appraise the treatment effect of laminectomy for PSCI with RFB.
CASE PRESENTATION
This study presented three patients referred to a tertiary hospital between August 2011 and October 2018 due to PSCI with RFB and receiving laminectomy. The first patient was a 25-year-old female with a butcher's knife piercing the T lamina and T vertebral body obliquely; the second was a 49-year-old male who suffered a perforating wound of the cervical spinal canal and injury of vertebral artery from foreign glass, while the third was a 60-year-old male with a wooden stick penetrating stomach and terminating in the L lamina. The first and second patients immediately underwent laminectomy for debridement and removal of RFB, while the third received two-staged operations to remove the retained stick thoroughly. Unfortunately cases 1 and 3 eventually resulted in total paralysis and case 2 revealed no improvement in myodynamia. Then, Medline/PubMed, Embase and the Cochrane Library were systematically searched, and 23 articles involving 25 additional cases with this kind of injury were included for analysis.
CONCLUSIONS
The optimal treatment strategy for penetrating spinal cord injury with retained foreign bodies remains challenging and should be assessed case-by-case. If possible, surgical removal of foreign bodies by laminectomy is preferred immediately to prevent delayed presentation and persistent contamination. Meanwhile, a multidisciplinary team is needed to address concomitant injuries.
Topics: Adult; Female; Foreign Bodies; Humans; Laminectomy; Male; Middle Aged; Spinal Canal; Spinal Cord Injuries; Wounds, Stab
PubMed: 35678132
DOI: 10.1111/os.13332 -
Pediatric Neurosurgery 2023Lipoblastoma and lipoblastomatosis are rare benign mesenchymal adipose tumors that originate from embryonic white adipocytes and occur most commonly in infancy and early...
INTRODUCTION
Lipoblastoma and lipoblastomatosis are rare benign mesenchymal adipose tumors that originate from embryonic white adipocytes and occur most commonly in infancy and early childhood. Lipoblastomas occur in the extremities and trunk, including the retroperitoneum and peritoneal cavity. Therefore, infiltration into the spinal canal has rarely been reported.
CASE PRESENTATION
A 4-year-old girl presented to our clinic because of difficulty sitting on the floor with her legs straight. She also complained of enuresis and constipation for the past 6 months with persistent headaches and back pain evoked by body anteflexion. A magnetic resonance imaging revealed a massive lesion of the psoas major muscle, retroperitoneal, and subcutaneous spaces, extending into the spinal epidural space between L2 and S1. The patient underwent surgery which resulted in gross total removal of the tumor from the spinal canal. The mass was yellowish, soft, lobulated, fatty, and easily removed from the surrounding structures. Pathology confirmed the diagnosis of lipoblastoma. The postoperative course was uneventful, and the patient was discharged without any signs of neurological deficit.
CONCLUSION
We herein discuss a rare case of lipoblastoma extending into the spinal canal, resulting in neurological symptoms. Although this tumor is benign with no potential for metastasis, it is prone to local recurrence. Therefore, close postoperative observation should be performed.
Topics: Female; Humans; Child; Child, Preschool; Lipoblastoma; Magnetic Resonance Imaging; Spinal Canal
PubMed: 37315552
DOI: 10.1159/000531548 -
JNMA; Journal of the Nepal Medical... Apr 2022Lumbar spinal canal stenosis is assumed to be one of the chief causative factors for low back pain. The measurement of lumbar canal and body dimensions has thus become...
INTRODUCTION
Lumbar spinal canal stenosis is assumed to be one of the chief causative factors for low back pain. The measurement of lumbar canal and body dimensions has thus become an important tool for the diagnosis and treatment of spinal stenosis. This study aims to find out the mean canal-body ratio among specimens of dried lumbar vertebrae in a medical college.
METHODS
A descriptive cross-sectional study was done in a medical college from May, 2021 to July, 2021. Ethical clearance was taken from the Institutional Review Committee (Reference number: 0502202103) and whole sampling was done. Seventy-three intact dried lumbar vertebrae were studied for the dimensions of the body and canal in transverse and anteroposterior planes. The findings were recorded and the canal body ratio was calculated using the transverse diameters of the spinal canal and vertebral body. The data obtained were computed and analysed using Microsoft Excel 2013. Point estimate at 95% Confidence Interval was calculated along with mean and standard deviation for continuous data.
RESULTS
The mean canal-body ratio was observed to be 0.53±0.032. The vertebral canal-body ratio was observed to be 0.58 in L1 followed by 0.53 in L2, 0.51 in L3, 0.49 in L4 and 0.53 in L5.
CONCLUSIONS
The mean canal-body ratio observed in the present study was comparable to studies done in similar settings.
KEYWORDS
anatomy; bones; lumbar vertebrae.
Topics: Cross-Sectional Studies; Humans; Low Back Pain; Lumbar Vertebrae; Spinal Canal; Spinal Stenosis
PubMed: 35633217
DOI: 10.31729/jnma.7328 -
Orthopaedic Surgery Feb 2021To describe the effectiveness of T -T discectomy and per pedicel-ligament flavum tunnel outside-in foraminoplasty protocols under percutaneous endoscope.
OBJECTIVE
To describe the effectiveness of T -T discectomy and per pedicel-ligament flavum tunnel outside-in foraminoplasty protocols under percutaneous endoscope.
METHODS
This retrospective study from September 2017 to June 2019 comprised 10 patients (mean age was 64.7 years, with 7 men and 3 women) with symptomatic thoracic disc herniation. Patients who had 12 months of follow-up and no cervical and lumbar spine surgery or trauma during the follow up period were included in the study. Patients underwent surgery at different levels: 3 patients for T -T and 7 patients for T -T . Percutaneous endoscopic thoracic discectomy was performed following under-vision foraminoplasty, which was based on lower pedicel-ligament flavum tunnel detection. Patients who presented with symptomatic soft disc herniation of the thoracic spine and did not respond to conservative treatments were included. Patients with calcified disc herniation or concomitant ossification of the posterior longitudinal ligament were excluded. The surgery involves four steps: (i) facet joint reaching procedures; (ii) sliding the working sleeve caudally to attach the pedicel, rotating the scope to detect the lower border of the superior articular process, the pedicel, and the lower pedicel-ligamentum flavum tunnel (PEFT) under vision, respectively; (iii) milling the superior articular process under vision; and (iv) finding and removing the disc protrusion after the posterior longitudinal ligament is resected. Patient outcomes were evaluated using vision analog scale scores, Oswestry disability index scores, and Japanese Orthopaedic Association scores. The VAS scores, Oswestry disability index scores, and Japanese Orthopaedic Association scores before and after the operation were compared by t-test for statistical analysis. MRI, CT, and plain X-rays were performed in of all the patients before and after surgery.
RESULTS
The patient was usually able to stand and walk approximately 2 h after the surgery. During the 12-month follow-up, all patients showed a significant improvement in pain. Postoperative thoracic MRI examination of all patients showed full decompression of the spinal cord and no residual pressure. Postoperative back pain and nerve root pain were significantly alleviated in all patients, and spinal cord function was significantly restored. The mean visual analog scale scores of patients postoperation were significantly better than those of patients preoperation (6.10 ± 1.37 vs 1.80 ± 0.79, P < 0.05). The mean ODI scores of patients postoperation were better than those of patients preoperation (13% ± 2.36% vs 55% ± 9.20%, P < 0.05). The mean JOA scores increased from 3.2 ± 0.75 to 9.3 ± 0.64. The JOA improvement rate was 79.6% ± 5.1%. There was 1 patient who had transient intercostal neuralgia.
CONCLUSION
Following pedicel-ligament flavum tunnel outside-in foraminoplasty protocols, T -T discectomy is relatively safe when conducted under percutaneous endoscope.
Topics: Aged; Disability Evaluation; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Ligamentum Flavum; Male; Middle Aged; Pain Measurement; Retrospective Studies; Spinal Canal; Thoracic Vertebrae
PubMed: 33410235
DOI: 10.1111/os.12916 -
PloS One 2017Correlation between magnetic resonance imaging (MRI) and clinical features in cauda equina syndrome (CES) is unknown; nor is known whether there are differences in MRI...
INTRODUCTION
Correlation between magnetic resonance imaging (MRI) and clinical features in cauda equina syndrome (CES) is unknown; nor is known whether there are differences in MRI spinal canal size between lumbar herniated disc patients with CES versus lumbar herniated discs patients without CES, operated for sciatica. The aims of this study are 1) evaluating the association of MRI features with clinical presentation and outcome of CES and 2) comparing lumbar spinal canal diameters of lumbar herniated disc patients with CES versus lumbar herniated disc patients without CES, operated because of sciatica.
METHODS
MRIs of CES patients were assessed for the following features: level of disc lesion, type (uni- or bilateral) and severity of caudal compression. Pre- and postoperative clinical features (micturition dysfunction, defecation dysfunction, altered sensation of the saddle area) were retrieved from the medical files. In addition, anteroposterior (AP) lumbar spinal canal diameters of CES patients were measured at MRI. AP diameters of lumbar herniated disc patients without CES, operated for sciatica, were measured for comparison.
RESULTS
48 CES patients were included. At MRI, bilateral compression was seen in 82%; complete caudal compression in 29%. MRI features were not associated with clinical presentation nor outcome. AP diameter was measured for 26 CES patients and for 31 lumbar herniated disc patients without CES, operated for sciatica. Comparison displayed a significant smaller AP diameter of the lumbar spinal canal in CES patients (largest p = 0.002). Compared to average diameters in literature, diameters of CES patients were significantly more often below average than that of the sciatica patients (largest p = 0.021).
CONCLUSION
This is the first study demonstrating differences in lumbar spinal canal size between lumbar herniated disc patients with CES and lumbar herniated disc patients without CES, operated for sciatica. This finding might imply that lumbar herniated disc patients with a relative small lumbar spinal canal might need to be approached differently in managing complaints of herniated disc. Since the number of studied patients is relatively small, further research should be conducted before clinical consequences are considered.
Topics: Adult; Decompression, Surgical; Diskectomy; Female; Humans; Intervertebral Disc Displacement; Magnetic Resonance Imaging; Male; Middle Aged; Polyradiculopathy; Postoperative Complications; Sciatica; Spinal Canal; Treatment Outcome
PubMed: 29023556
DOI: 10.1371/journal.pone.0186148