Symptomatic Congenital Spinal Stenosis in a Child

Neurosurgery ◽  
1982 ◽  
Vol 11 (1_pt_1) ◽  
pp. 61-63 ◽  
Author(s):  
Robert C. Dauser ◽  
William F. Chandler
Keyword(s):  
Young Child ◽  
Lower Extremity ◽  
Spinal Stenosis ◽  
Spinal Canal ◽  
Marked Improvement ◽  
Bladder Dysfunction ◽  
Lumbar Stenosis ◽  
Decompressive Laminectomy

Abstract A case of congenital lumbar stenosis producing lower extremity spasticity and bladder dysfunction in a young child is presented. Myelography demonstrated a marked stenosis of the spinal canal at L-2, L-3, and decompressive laminectomy resulted in a marked improvement in symptoms. A discussion of lumbar stenosis in general illustrates that it is extremely rare for this condition to become symptomatic during childhood. The literature on congenital lumbar stenosis is reviewed.

Assessment of bladder function after lumbar decompressive laminectomy for spinal stenosis: a prospective study

1994 ◽  
Vol 80 (6) ◽  
pp. 971-974 ◽  
Author(s):  
H. Gordon Deen ◽  
Richard S. Zimmerman ◽  
Scott K. Swanson ◽  
Thayne R. Larson
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Bladder Dysfunction ◽  
Urine Volume ◽  
Bladder Function ◽  
Leg Pain ◽  
Residual Urine Volume ◽  
Decompressive Laminectomy ◽  
Spinal Segments ◽  
Lumbar Spinal

✓ Lumbar spinal stenosis is a common problem in elderly patients. In its more advanced forms, it typically causes intractable leg pain, but many patients also manifest varying degrees of bladder dysfunction. The goal of lumbar decompressive laminectomy is relief of leg pain and paresthesias, yet some patients also achieve improvement in bladder function. This study prospectively investigated patients with lumbar spinal stenosis to determine whether laminectomy had any effect on urological function. Of the 20 patients in the study, 10 were men and 10 women (average age 70.9 years). All patients had severe lumbar stenosis affecting between two and four spinal segments, and all reported some degree of bladder dysfunction. Cystoscopy and urodynamic testing were completed preoperatively. A standard decompressive laminectomy was performed over the appropriate number of spinal segments. Urodynamic studies were repeated at 2 and 6 months postoperatively. At the 6-month follow-up review, bladder function was subjectively improved in 12 patients (60%) and unchanged in eight (40%). Postvoiding residual urine volume was the urodynamic factor most likely to be improved by laminectomy. In nine patients (45%), baseline postvoiding residual urine volume was elevated and all nine had improvement postoperatively. In the remaining 11 patients (55%), this urine volume was normal before and after surgery. Maximum urine flow rates also improved, but the results of cytometrography and electromyography, urine flow pattern, and bladder capacity were unchanged postoperatively. Cystoscopy detected previously undiagnosed malignancy of the lower urinary tract in two patients (10%). It is concluded that lumbar decompressive laminectomy can have a beneficial effect on bladder function in a significant number of patients with advanced lumbar spinal stenosis.

Unilateral Laminotomy for Bilateral Microsurgical Decompression in Treating Multiple Spinal Stenosis

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Wawan Mulyawan ◽  
Yudi Yuwono Wiwoho ◽  
Syaiful Ichwan
Keyword(s):  
Spinal Stenosis ◽  
Spinal Canal ◽  
Ligamentum Flavum ◽  
Signs And Symptoms ◽  
Complete Removal ◽  
Medial Part ◽  
Decompressive Laminectomy ◽  
Microsurgical Decompression ◽  
Spine Pathology ◽  
Lumbar Area

Multiple spinal stenosis with significant signs and symptoms is one of the complex problems in spine pathology. For a simple reason, many spine surgeons do conservative decompressions, such as decompressive laminectomy or bilateral laminotomy and flavectomy, with one incision (preservation of lamina). Unilateral laminotomy in the lumbar area for bilateral access in spinal canal is quite rare and is performed for the treatment of multiple spinal stenosis.With this technique, microsurgical decompression is done with partial resection of the ipsilateral facet, the medial part of the laminar arch, and the partial contralateral facet, with the complete removal of the ligamentum flavum. By this methods, the aim for complete bilateral flavectomy and partial bilateral facetectomy are the key for the success of clinical improvements in treating multiple spinal stenosis.

Unilateral Laminotomy for Bilateral Microsurgical Decompression in Treating Multiple Spinal Stenosis

2018 ◽  
Vol 1 (2) ◽  
pp. 31
Author(s):  
Wawan Mulyawan ◽  
Yudi Yuwono Wiwoho
Keyword(s):  
Spinal Stenosis ◽  
Spinal Canal ◽  
Ligamentum Flavum ◽  
Signs And Symptoms ◽  
Complete Removal ◽  
Medial Part ◽  
Decompressive Laminectomy ◽  
Microsurgical Decompression ◽  
Spine Pathology ◽  
Lumbar Area

Multiple spinal stenosis with significant signs and symptoms is one of the complex problems in spine pathology. For a simple reason, many spine surgeons do conservative decompressions, such as decompressive laminectomy or bilateral laminotomy and flavectomy, with one incision (preservation of lamina). Unilateral laminotomy in the lumbar area for bilateral access in spinal canal is quite rare and is performed for the treatment of multiple spinal stenosis.With this technique, microsurgical decompression is done with partial resection of the ipsilateral facet, the medial part of the laminar arch, and the partial contralateral facet, with the complete removal of the ligamentum flavum. By this methods, the aim for complete bilateral flavectomy and partial bilateral facetectomy are the key for the success of clinical improvements in treating multiple spinal stenosis. 

scholarly journals The role of spinal fusion in surgery for lumbar spinal stenosis: a review

1997 ◽  
Vol 3 (2) ◽  
pp. E5 ◽  
Author(s):  
Anthony J. Caputy ◽  
Caple A. Spence ◽  
Ghassan K. Bejjani ◽  
Alfred J. Luessenhop
Keyword(s):  
Spinal Fusion ◽  
Spinal Stenosis ◽  
The Elderly ◽  
Lumbar Stenosis ◽  
Medical Problems ◽  
Decompressive Laminectomy ◽  
Spine Instrumentation ◽  
Flexion Extension ◽  
Lumbar Spinal

The authors undertook a review of the literature and analysis of the local surgical experience for lumbar stenosis to define the role of simultaneous arthrodesis in the treatment of patients undergoing decompression for spinal stenosis. The restrained use of spinal fusion is recommended in spinal stenosis surgery because of the coexisting medical problems in the elderly patient population and the higher associated complication rate with spinal fusion and instrumentation. A spinal fusion is recommended when decompression is performed in an area of segmental instability as manifested by gross movement on flexion-extension radiographs; when the decompression coincides with an area of degenerative instability, as with scoliosis or spondylolisthesis; or when the decompression creates an iatrogenic instability by the disruption of the posterior elements. The use of spine instrumentation as an adjunct to fusion is recommended when an area of degenerative instability shows evident gross instability or has had additional destabilizing procedures, such as a discectomy or a facetectomy. Spinal fusion is not recommended for a routine decompressive laminectomy for lumbar stenosis or in the case of stable degenerative deformities. New fusion techniques may improve the outcome and decrease the morbidity associated with contemporary methods of spinal fusion and instrumentation.

Clinical and Radiographic Correlation (According to CT) in Patients with Degenerative Lumbar Spinal Stenosis

2017 ◽  
pp. 124-130 ◽  
Author(s):  
S. G. Mlyavykh ◽  
A. Y. Aleynik ◽  
A. E. Bokov ◽  
M. V. Rasteryaeva ◽  
M. A. Kutlaeva
Keyword(s):  
Ct Scan ◽  
Spinal Canal ◽  
Clinical Manifestations ◽  
Intervertebral Discs ◽  
Morphometric Parameters ◽  
Neurogenic Claudication ◽  
Clinical Group ◽  
Lumbar Stenosis ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal

Сomputed tomography (CT) is widely used in the diagnosis of  degenerative pathology of the lumbar spine, but the relationship  between clinical manifestations of lumbar stenosis and its anatomical prerequisites has not been sufficiently studied to date.The objective: to determine the significance of the morphometric  parameters of lumbar stenosis according to CT scans and to  establish their relationship with the prevailing symptoms of the disease.Material and methods. Seventy-five consecutive patients with  clinically significant lumbar stenosis who underwent CT scan before  surgery were enrolled in this study. The average values of thirteen  different morphometric parameters were calculated at LIII–SI levels of the intervertebral discs and of the pedicels in the axial and sagittal views. The possibility of classification of clinical observations and the correlation of morphometric parameters with the clinical forms of lumbar stenosis were investigated using discriminant and logistic regression analysis. Results. CT scan with high probability allocates patients with  predominant symptoms of neurogenic claudication or bilateral  radiculopathy. The most significant morphometric predictors of this  clinical group are the depth of the lateral recesses and the cross-sectional area of the spinal canal.Conclusion. CT scan significantly expands the informative value of  magnetic resonance imaging and can be used in planning the  decompressive stage of the surgery intervention in patients with lumbar spinal canal stenosis.

The profile of the spinal column in subjects with lumbar developmental spinal stenosis

2021 ◽  
Vol 103-B (4) ◽  
pp. 725-733
Author(s):  
Marcus Kin Long Lai ◽  
Prudence Wing Hang Cheung ◽  
Dino Samartzis ◽  
Jaro Karppinen ◽  
Kenneth M. C. Cheung ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Spinal Stenosis ◽  
Vertebral Body ◽  
Spinal Canal ◽  
Facet Joint ◽  
Spinal Column ◽  
Stepwise Logistic Regression ◽  
Diagnostic Study ◽  
Vertebral Canal ◽  
Dural Sac

Aims The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort. Methods This was a radiological analysis of 2,387 participants who underwent L1-S1 MRI. Means and ranges were calculated for age, sex, BMI, and MRI measurements. Anteroposterior (AP) vertebral canal diameters were used to differentiate those with DSS from controls. Other imaging parameters included vertebral body dimensions, spinal canal dimensions, disc degeneration scores, and facet joint orientation. Mann-Whitney U and chi-squared tests were conducted to search for measurement differences between those with DSS and controls. In order to identify possible associations between DSS and MRI parameters, those who were statistically significant in the univariate binary logistic regression were included in a multivariate stepwise logistic regression after adjusting for demographics. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported where appropriate. Results Axial AP vertebral canal diameter (p < 0.001), interpedicular distance (p < 0.001), AP dural sac diameter (p < 0.001), lamina angle (p < 0.001), and sagittal mid-vertebral body height (p < 0.001) were significantly different between those identified as having DSS and controls. Narrower interpedicular distance (OR 0.745 (95% CI 0.618 to 0.900); p = 0.002) and AP dural sac diameter (OR 0.506 (95% CI 0.400 to 0.641); p < 0.001) were associated with DSS. Lamina angle (OR 1.127 (95% CI 1.045 to 1.214); p = 0.002) and right facet joint angulation (OR 0.022 (95% CI 0.002 to 0.247); p = 0.002) were also associated with DSS. No association was observed between disc parameters and DSS. Conclusion From this large-scale cohort, the canal size is found to be independent of body stature. Other than spinal canal dimensions, abnormal orientations of lamina angle and facet joint angulation may also be a result of developmental variations, leading to increased likelihood of DSS. Other skeletal parameters are spared. There was no relationship between DSS and soft tissue changes of the spinal column, which suggests that DSS is a unique result of bony maldevelopment. These findings require validation in other ethnicities and populations. Level of Evidence: I (diagnostic study) Cite this article: Bone Joint J 2021;103-B(4):725–733.

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