211/360. An unusual case infection following spinal surgery. A case of extensive subcutaneous inflammation infection four months after a spinal operation is presented. The patient had had an extensive laminectomy and foraminotomy for lumbar canal stenosis and protruded discs at L3/L4 and L4/L5 levels. Four months postoperatively, bilateral gluteal abscesses developed and were treated by surgical evacuation. Three months after the evacuation of the abscesses, extensive inflammation and purulent infiltration of the laminectomy wound together with recurrence of the gluteal abscesses were noticed. In spite of reevacuation of the abscesses the inflammation persisted. A syringography disclosed communication of the gluteal abscesses with the laminectomy wound. Eventually this complication was treated by surgical reexploration of the laminectomy wound, during which it was found that the inflammation, although longstanding, did not spread to the intervertebral spaces. ( info) |
212/360. Non-corresponding radiological and surgical diagnoses in patients operated for sciatica. One hundred and nine patients with radicular leg-pain underwent both computer-tomography and myelography and were subsequently operated upon. The diagnoses on computer-tomogram, myelogram and surgery failed to correspond in 41 cases. Stenosis of the bony spinal canal, scar formation, and an intra- or extraforaminal herniation were the most frequent causes of discrepancy in the diagnoses. In cases of spinal stenosis and previous disc surgery both computer-tomography and myelography have to be performed. Certain precautions taken during computer-tomography and myelography may reduce the number of discrepant findings. ( info) |
213/360. Clinical results following enlargement of the cervical spinal canal by means of laminoplasty. Since 1978, cervical spinal canal laminoplasty has been performed on 75 patients in our hospital with cervical radiculomyelopathy and followed with studies of from 6 months to 8 years (average 4 years and 6 months). overall results: the pre-operative score, using the Japanese Orthopaedic association Scoring System, was 7.4 and the post-operative score was 15.2; the improvement was 81.0%. In congenital spinal stenosis, the average pre-operative score was 6.3 while the post-operative score was 14.2; the improvement was 66.9%. The pre-operative score of multiple disc lesions was 7.9 and the post-operative score was 15.2; the improvement was 82.8%. And the pre-operative score of OPLL was 7.3 and the post-operative score was 15.3; the improvement was 81.9%. Improvement may be due not only to the degree of enlargement of the spinal canal, but also to improvement in the circulation within the spinal cord and nerve roots. No case worsened after the surgery. ( info) |
214/360. Oxalosis: cause of degenerative spinal stenosis. A case report and review of the literature. The case presented illustrates an unusual entity. The differential diagnosis of degenerative spinal stenosis is voluminous, although incomplete without including oxalosis. Oxalosis as a cause of spinal stenosis has not yet been reported in the orthopedic literature. ( info) |
215/360. Surgical treatment of achondroplastic dwarfs with paraplegia. A retrospective study was done to evaluate the results of surgical intervention on the neurological symptoms associated with achondroplastic dwarfs. Between 1971 and 1979, laminectomy was performed on three patients with thoracolumbar spinal canal stenosis associated with achondroplasia. Simultaneous spondylodesis using Harrington instrumentation in conjunction with extensive laminectomy was performed in the most recent case, and excellent results were obtained. We emphasize, therefore, that neurological deficit caused by kyphotic deformity and instability secondary to extensive laminectomy for achondroplasia can be prevented by this procedure, and thus good results can be anticipated. ( info) |
216/360. Degenerative spondylolisthesis. Pathophysiology and results of anterior interbody fusion. With special attention to the articular facets, an inspection of dry human spinal columns, microradiographic studies of cadaveric specimens, and animal experiments revealed that development of degenerative spondylolisthesis is attributable to rotational strain on the facetal joints at the level of involvement. Disc degeneration predisposes to intersegmental instability and rotational strain, which result in secondary osteoarthritic change of the articular processes and segmental canal stenosis. Thirty-six patients with degenerative spondylolisthesis were treated with anterior interbody fusion (AIF) for segmental canal stenosis at the authors' hospital during 1958-1985. The surgical results of these patients reveal that AIF corrects malalignment of the lumbar spine by complete discectomy, reduces the slip and restores the disc height, and resolves nerve compression, both from the front and from behind, by enlargement of the stenosing canal. In addition, AIF has consistent and satisfactory clinical results at long-term follow-up evaluation because it resolves intersegmental instability, an important problem of degenerative spondylolisthesis. AIF is a reasonable and reliable treatment for patients younger than 60 years of age with segmental stenosis. ( info) |
217/360. Spinal arteriovenous malformations and neurogenic claudication. Report of two cases. Spinal arteriovenous malformations (AVM's) can present with symptoms of neurogenic claudication indistinguishable from those of lumbar spondylosis. Spinal AVM's occur most frequently in males of middle age or older; lumbar spondylosis is often also present in these patients. The myelographic appearance of the abnormal vessels may resemble that of the dilated veins or redundant nerve roots sometimes seen adjacent to regions of spinal block, obscuring the diagnosis. Two patients are described who presented with clinical histories and myelographic findings that led to laminectomies for presumed spinal stenosis; ultimately, both were found to have an AVM. Treatment of the AVM arrested the neurological decline in one patient, and resulted in dramatic improvement in the other. A hypothesis related to hemodynamic consequences of venous hypertension is presented in an attempt to link the pathophysiology of the two conditions. ( info) |
218/360. Postmyelographic cauda equina syndrome in an asymptomatic acquired spinal stenosis of a young acromegalic. Early postmyelographic cauda equina syndrome in an asymptomatic young acromegalic is presented. The patient was asymptomatic for more than 1 yr despite myelographic evidence of acquired spinal stenosis at the L2-L4 level. Radiographic and/or myelographic findings should be clinically correlated. It is postulated that, in acromegaly, the combined simultaneous bony apposition-remodeling resorption mechanism is involved in the spine as platyspondyly, hyperostosis of spinous processes and vertebral scalloping to counteract soft tissue hyperplasia within the spinal canal; entrapment myelopathy, cauda equina syndrome and/or radiculopathy are ascribed to a soft tissue edematous mechanism superimposed on congenital or degenerative spinal stenosis, traumatic or postoperative spondylolisthesis, postmyelographic and/or postoperative arachnoiditis and a traumatic swollen or protrused intervertebral disc. ( info) |
219/360. Neurological deterioration after laminectomy for spondylotic cervical myeloradiculopathy: the putative role of spinal cord ischaemia. Most cases of neurological deterioration after laminectomy for cervical radiculomyelopathy occur several weeks to months postoperatively, except when there has been direct trauma to the spinal cord or nerve roots during surgery. Four patients are described who developed episodes of neurological deterioration during the postoperative recovery period that could not be attributed to direct intraoperative trauma nor to epidural haematoma or instability of the cervical spine as a consequence of laminectomy. Following laminectomy for cervical radiculomyelopathy four patients were unchanged neurologically from their pre-operative examinations, but as they were raised into the upright position for the first time following surgery focal neurological deficits referrable to the spinal cord developed. hypotension was present in all four cases during these episodes and three of the four patients had residual central cervical cord syndromes. These cases represent the first reported instances of spinal cord ischaemia occurring with post-operative hypotensive episodes after decompression for cervical spondylosis. ( info) |
220/360. Posterior central cord syndrome following a hyperextension injury: case report. Throughout the spinal cord literature, a posterior central cord syndrome has been noted to be a rare occurrence. Furthermore, it has never been correlated with a specific type of injury. A patient with clinical signs consistent with a posterior central cord syndrome is discussed, and hyperextension is suggested as a possible mechanism for this type of injury. ( info) |