Spinal Cord and Nerve Root Monitoring in Spine Surgery and Related Procedures

Abstract After spontaneous remission of nerve root compression, a myelographic defect may persist. Similarly, myelopathy may remain nonprogressive for long periods despite appreciable myelographic deformity. Although operation may arrest or improve the symptoms of cervical disc lesions and spondylosis, the ultimate confirmation that entrapped neural elements have been relieved permanently can only be provided by postoperative myelography. Preoperative and postoperative myelography documents the significant improvement that can be achieved by using posterolateral and posterior approaches to the cervical spine in patients with nerve root or spinal cord compression. The results in this group of patients were achieved with none of the disadvantages or complications of cervical spine fusion or of the interbody removal of cervical disc tissue, also leading to cervical fusion.

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Spinal Intradural Juxtamedullary Cysts in the Adult: Surgical Management and Outcome

Neurosurgery ◽

10.1227/01.neu.0000143031.98237.6d ◽

2004 ◽

Vol 55 (6) ◽

pp. 1352-1360 ◽

Cited By ~ 35

Author(s):

Hischam Bassiouni ◽

Anja Hunold ◽

Siamak Asgari ◽

Uwe Hübschen ◽

Hermann-Josef König ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Management ◽

Nerve Root ◽

Pain Syndrome ◽

Radicular Pain ◽

Arachnoid Cysts ◽

Cervical Nerve Root ◽

Cervical Nerve ◽

Neuroepithelial Cysts

Abstract OBJECTIVE: Intradural nonneoplastic cysts compressing the spinal cord are rare lesions. We retrospectively analyzed a series of patients harboring this entity with regard to clinical and radiological features, surgical management, and follow-up results. METHODS: In a retrospective study, we reviewed the medical charts, radiological investigations, and follow-up data of 11 women and 10 men (mean age, 43.6 yr) with intradural juxtamedullary spinal cysts, which were consecutively treated microsurgically at our institutions between January 1995 and January 2003. All lesions were approached via a laminectomy, hemilaminectomy, or laminoplasty at the corresponding vertebral levels and histopathologically verified. The patients were routinely scheduled for clinical follow-up 2 and 6 months after surgery. Baseline postoperative magnetic resonance imaging (MRI) was ordered 6 months after surgery. Thereafter, follow-up was performed at 1-year intervals, with neurological examination and MRI. RESULTS: According to presenting symptomatology, two main patient groups could be differentiated: one group with a myelopathic syndrome (10 patients) and another group with a predominant radicular pain syndrome (8 patients). Histopathological examination revealed 16 arachnoid cysts, 4 neuroepithelial cysts, and 1 cervical nerve root cyst. Most arachnoid cysts (12 cases) were located on the dorsal aspect of the thoracic spinal cord. The mean craniocaudal extension of these cysts was 3.7 vertebral levels, and complete resection was performed. In four patients, the arachnoid cyst was situated ventral to the spinal cord and involved up to 17 vertebral levels. These patients had a history of major spinal trauma, and the cyst was generously fenestrated at its greatest circumference as depicted on preoperative MRI scans. The four neuroepithelial cysts and the cervical nerve root cyst were located on the ventral or ventrolateral aspect of the spinal cord, and their maximum sagittal extension was two spinal vertebral levels. Symptoms in all but two patients demonstrated major improvement; in particular, radiating pain disappeared immediately after surgery. There was no cyst recurrence on MRI after a mean follow-up period of 3.2 years. CONCLUSION: Intradural cysts should be considered in the differential diagnosis of lesions causing myelopathy and/or a radicular pain syndrome. Microsurgical resection or generous fenestration in cysts with large craniocaudal extensions effectively ameliorated patients' symptomatology. A description of the first documented case of a surgically treated intradural cervical nerve root cyst is provided.

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Commentary on Selective Detrusor Activation by Electrical Sacral Nerve Root Stimulation in Spinal Cord Injury

The Journal of Urology ◽

10.1016/s0022-5347(01)64922-x ◽

1997 ◽

Vol 157 (4) ◽

pp. 1196-1196 ◽

Cited By ~ 5

Author(s):

E.A. Tanagho

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Nerve Root ◽

Sacral Nerve Root ◽

Sacral Nerve ◽

Cord Injury ◽

Root Stimulation

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Physiology of Spinal Cord, Nerve Root and Peripheral Nerve Compression

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1956.185.1.217 ◽

1956 ◽

Vol 185 (1) ◽

pp. 217-229 ◽

Cited By ~ 104

Author(s):

Samuel Gelfan ◽

I. M. Tarlov

Keyword(s):

Spinal Cord ◽

Peripheral Nerve ◽

Nerve Root ◽

Peripheral Nerves ◽

Compressive Force ◽

Mechanical Deformation ◽

Dorsal Column ◽

Neuronal Structure ◽

Mechanical Pressure ◽

Wide Range

The reversible conduction block produced by maintained mechanical pressure around small segments of spinal cord, nerve root or peripheral nerve (dog) is due to mechanical deformation of the neuronal tissue and not to lack of O2. The compressed segment, although ischemic, is not anoxic; O2 from adjacent nonischemic tissue reaches it, presumably by diffusion. The entire pattern of modification of neuronal responses by compression and the postdecompression recovery pattern are distinctly different from the patterns observed during anoxia and recovery from the latter, indicating the difference in mechanisms by which mechanical deformation and O2 lack block conduction. The largest fibers in dorsal columns, roots and peripheral nerves are most susceptible to pressure and the smallest ones are relatively most resistant. Secondary neurons are less vulnerable than the primary afferent ones to light and moderate, but suprasystolic, circumferential spinal cord pressure. All components of the composite spinal cord potential are blocked at about the same time by larger compressive forces. Anoxia, on the other hand, always inactivates secondary neurons before dorsal column fibers and blocks smaller A fibers in peripheral nerves before the larger ones. The latency for complete blocking in each neuronal structure is specific and irreducible in the case of anoxia, whereas in compression it varies over a wide range, depending upon the magnitude of the compressive force.

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Incidence and predictive factors of spinal cord stimulation treatment after lumbar spine surgery

Journal of Pain Research ◽

10.2147/jpr.s143633 ◽

2017 ◽

Vol Volume 10 ◽

pp. 2405-2411 ◽

Cited By ~ 6

Author(s):

Merja Vakkala ◽

Voitto Järvimäki ◽

Hannu Kautiainen ◽

Maija Haanpää ◽

Seppo Alahuhta

Keyword(s):

Spinal Cord ◽

Lumbar Spine ◽

Spine Surgery ◽

Predictive Factors ◽

Spinal Cord Stimulation ◽

Lumbar Spine Surgery

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Long-Term Systematic Outcome Assessment of Patients Following Spine Surgery in Rwanda: The Use of Patient Reported Outcome Tools

Neurology and Neurobiology ◽

10.31487/j.nnb.2020.04.02 ◽

2020 ◽

pp. 1-11

Author(s):

Steven Nshuti ◽

Beryl Guterman ◽

David Hakizimana ◽

Eric Buramba ◽

...

Keyword(s):

Spinal Cord ◽

Spine Surgery ◽

Patient Reported Outcome ◽

Severe Disability ◽

Assessment Tools ◽

Trauma Patients ◽

Patient Reported ◽

Injured Patients ◽

Spinal Cord Injured ◽

Trauma Group

Background: We conducted a systematic evaluation of neurological, functional, quality of life and pain outcomes of patients who underwent spine surgery in our neurosurgery unit using patient reported outcome (PRO) assessment tools. Methods: The study was performed by assessing outcome of all the patients who underwent spine surgery at our department in a cross-sectional fashion using a 5-year operative database. This was an all-inclusive spine outcome study with 2 main groups; a trauma group composed of spinal cord injured patients and a non-trauma group composed of patients with spinal degenerative diseases, spinal tumors, deformity, infection, and vascular malformations. Results: Our analysis included 197 patients who met inclusion criteria for the study. The overall study population was mainly dominated by spinal cord injured patients and spinal degenerative disease patients; 34 % and 60.9 % respectively. The average age was 42 years (range: 15-78 years) with patients in the trauma group being substantially younger than the rest of the cohort. Eighty five percent of trauma patients presented with spinal cord injury causing neurological deficit, of which 58% had no preservation of motor function below the level of injury; ASIA IS A and B (35.8% and 22% respectively). Additionally, 68% of patients in the non-trauma group underwent surgery with severe disability. Overall, 60% of all trauma patients showed improvement of their neurological status as per ASIA IS. Of note, 40% of patients with preoperative ASIA IS B and 8% of patients with preoperative ASIA IS A gained full neurological recovery postoperatively (ASIA IS E). Using the Core outcome measurement Index (COMI) from patient’s perspective, 78.6% of patients reported to have no pain significant enough to make them stop their normal daily activities. Rate of overall return to work (RTW) in the non-trauma group was 77% with 52% of patients being fully functional without condition-related work interruptions. Conclusion: Careful selection of patients for surgery is key for good outcome of patients undergoing spine surgery. In contradiction to most other patients’ groups, patients with severe disability with spinal degenerative conditions might benefit most from surgery. Postoperative outcome of spinal cord injured patients with severe neurological deficits might be better than commonly believed. Controlled prospective data is likely to draw stronger conclusions.

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