1/7. The effect of Lipo prostaglandin E1 on cauda equina blood flow in patients with lumbar spinal canal stenosis: myeloscopic observation.STUDY DESIGN: Myeloscopic examination was performed to observe the cauda equina in patients with lumbar spinal canal stenosis before and after treatment with Lipo prostaglandin E1, a strong peripheral vasodilator. OBJECTIVES: The purpose of this study was to clarify the effects of Lipo prostaglandin E1 on blood flow in the cauda equina in patients with lumbar spinal canal stenosis. SETTING: japan, Kagoshima methods: We performed myeloscopic observations of morphological changes in blood vessels running along the cauda equina in 11 patients with lumbar spinal canal stenosis before and after treatment with Lipo prostaglandin E1. RESULTS: In six of these patients, dilation of the running blood vessels was observed immediately after administration. In all of the patients who exhibited a dilation of vessels on the surface of the cauda equina, intermittent claudication and lower extremity pain and/or numbness lessened immediately after examination. However, none of the patients who exhibited no morphological changes in the vessels along the cauda equina after administration of Lipo prostaglandin E1 experienced any improvement of symptoms at the time of examination. CONCLUSION: Results of this study suggest that Lipo prostaglandin E1 may enhance blood flow in the cauda equina and improve clinical symptoms in some patients with lumbar spinal stenosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. Neurogenic claudication secondary to vascular disease.Neurogenic claudication is characterized by sensory symptoms which appear during exercise or while maintaining a fixed posture. They are paraesthetic in quality, may be associated with 'march' phenomena, and patients may have bowel and bladder disturbance. The problem is most commonly secondary to lumbar canal stenosis (LCS) but rarely due to aortic disease, as shown in this case report. This report concerns a 66 year old woman who presented with symptoms of paraesthesia radiating from the buttocks to the thigh and, intermittent loss of bladder and bowel function, all associated with walking. There were no associated symptoms of vascular claudication. Clinically, there was evidence of aorto-iliac obstruction with absence of femoral pulses and a vascular index of 0.4 at both ankles. Neurological examination was normal at rest but the left ankle jerk was absent immediately after exercise. Myelogram and computerized tomographic (CT) scan were normal. An aortogram revealed a very tight irregular stenosis of the aorta at the level of the renal and mesenteric arteries. Very few lumbar vessels were seen. An aortic endarterectomy via a thoraco-abdominal approach was performed and an aortobifemoral graft inserted. The patient's symptoms resolved following this procedure. We postulate that her symptoms were caused by a 'steal' from the blood supply to the cauda equinda due to the severe athromatous disease of her upper abdominal aorta.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
3/7. Myeloscopic study on lumbar spinal canal stenosis with special reference to intermittent claudication.Twenty-five cases of lumbar spinal canal stenosis were investigated by dynamic myeloscopy to explain the pathophysiologic mechanism of intermittent claudication, one of the characteristic signs of the disorder. Myeloscopic examination revealed that, in accordance with postural alteration, the diameter of blood vessels on the cauda equinae showed significant changes in many patients in the stenosis group, but showed no changes in control group. In this series, it was suggested that the microcirculatory disturbance of vessels on cauda equinae might play an important role in the development of intermittent claudication.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/7. 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.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
5/7. Acquired spinal stenosis secondary to an expanding thoracic vertebral hemangioma.Intraosseous hemangioma is a slow-growing primary benign neoplasm of capillary, cavernous, or venous origin. The most common type is the cavernous hemangioma, composed of large thin-walled vessels and sinuses lined by endothelial cells. Although found in any bone, hemangioma is most common in the vertebrae, where it represents 2-3% of all radiographically detectable spinal tumors. Most spinal hemangiomas are solitary, asymptomatic lesions of the vertebral body, with 10-15% showing concomitant involvement of the posterior elements. Rarely, the lesion is located to the posterior arch. An unusual case of an expanding vertebral hemangioma isolated to the posterior elements of T9 is presented.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
6/7. Delayed cervical epidural hemorrhage associated with silastic dural implant: case report.OBJECTIVE AND IMPORTANCE: This is the first report of delayed cervical epidural hemorrhage caused by an onlay silastic graft placed over the dura after laminectomy. There are several reports of intracranial hemorrhage associated with silastic implants in the literature. CLINICAL PRESENTATION: A 49-year-old woman suddenly developed severe neck pain and quadriplegia during sexual intercourse. A C5-C7 laminectomy had been performed 17 years earlier for cervical stenosis. INTERVENTION: magnetic resonance imaging showed an epidural mass compressing the cord at the level of the previous laminectomy. laminectomy was performed within 5 hours of symptom onset. Postoperatively, the patient regained leg strength. After 2 months of physical therapy, she had minimal residual leg rigidity and returned to work. TECHNIQUE: At surgery, the cervical cord was compressed by a solid fibrous scar surrounding a silastic onlay graft and the dura. An epidural hematoma was beneath the silastic implant. The dense scar tissue, hematoma, and silastic implant were removed. CONCLUSION: Bleeding associated with silastic sheets starts with movement of this nonadherent implant. The movement disrupts the underlying fine vessels on the surface of an encasing connective tissue membrane. Overgrowth of this membrane can cause mass effect and simulate a tumor, even without associated bleeding, within weeks. Delayed hemorrhage is more common. We recommend removal of these implants electively, especially if a thick membrane surrounding the dura is detected with postcontrast-enhanced magnetic resonance imaging.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
7/7. A new twist to the myocutaneous turnover flap for closure of a spinal defect.We have described the deepithelialized myocutaneous turnover of a gluteus maximus island flap based on the superior gluteal vessels used for closure of an acquired midline defect of the lower back complicated by cerebrospinal fluid fistula. cerebrospinal fluid fistula, although a rare complication of an acquired midline back defect, further adds to the reconstructive challenge of such a wound. As this case illustrates, cerebrospinal fluid fistula can have serious and potentially life-threatening implications and so demands rapid surgical intervention. Dural patching with fascia lata graft having already failed, reconstruction was achieved using a well vascularized deepithelialized cutaneous patch on a gluteus maximus island turnover flap. The technique of deepithelializing a skin island for dural repair could be applied to any myocutaneous flap used in reconstruction of a midline back defect complicated by cerebrospinal fluid leak. This provides a method of dural repair and reconstruction of the defect in one step and obviates the need for cerebrospinal fluid diversion.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |