scholarly journals Percutaneous endoscopic limited-lumbosacral-dorsal laminectomy in eight dogs – A cadaveric study

2021 ◽  
Author(s):  
SB Yang ◽  
HS Moon ◽  
YH Hwang ◽  
HC Lee ◽  
D Lee ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Instruments ◽  
Ct Scans ◽  
Intervertebral Disc Herniation ◽  
Disc Disease ◽  
Technical Feasibility ◽  
Dorsal Laminectomy ◽  
The Mean ◽  
Spinal Cord Decompression ◽  
Surgical Option

This study aimed to investigate the technical feasibility of a percutaneous endoscopic limited-dorsal laminectomy (PELDL) and to evaluate if the decompression and examination of the lumbosacral vertebral canals could be achieved using an endoscope in small dogs. A total of eight fresh canine cadavers were used for the study. Following the injection of a barium and agarose mixture (BA-gel), which simulates intervertebral disc herniation, a PELDL was performed over L7–S1 in these animals. Computed tomography (CT) scans were obtained pre- and postoperatively to evaluate the surgical outcomes. All the procedures were completed with a clear visualisation of the spinal cord and removal of the BA-gel. The mean surgery time for the PELDL was 30.00 ± 12.01 minutes. In two dogs, iatrogenic nerve root injuries were caused by the surgical instruments during the operation. The CT scans showed that the amount of BA-gel removed was sufficient for a spinal-cord decompression. A PELDL could be used for the BA-gel removal to decompress the spinal cord and provide a clear view of the spinal canal. Therefore, it could be used as an alternative surgical option to treat lumbosacral disc disease in dogs.

scholarly journals Efficacy of posterior decompression and fixation based on ossification-kyphosis angle criteria for multilevel ossification of the posterior longitudinal ligament in the thoracic spine

2018 ◽  
Vol 29 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Hiroshi Uei ◽  
Yasuaki Tokuhashi ◽  
Masashi Oshima ◽  
Masafumi Maseda ◽  
Masahiro Nakahashi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Thoracic Spine ◽  
Free Space ◽  
Posterior Longitudinal Ligament ◽  
Kyphosis Angle ◽  
Posterior Decompression ◽  
Significant Difference ◽  
The Mean ◽  
Spinal Cord Decompression

OBJECTIVEThe range of decompression in posterior decompression and fixation for ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) can be established using an index of spinal cord decompression based on the ossification-kyphosis angle (OKA) measured in the sagittal view on MRI. However, an appropriate OKA cannot be achieved in some cases, and posterior fixation is applied in cases with insufficient decompression. Moreover, it is unclear whether spinal cord decompression of the ventral side is essential for the treatment of OPLL. In this retrospective analysis, the efficacy of posterior decompression and fixation performed for T-OPLL was investigated after the range of posterior decompression had been set using the OKA.METHODSThe MRI-based OKA is the angle from the superior margin at the cranial vertebral body of the decompression site and from the lower posterior margin at the caudal vertebral body of the decompression site to the prominence of the maximum OPLL. Posterior decompression and fixation were performed in 20 patients. The decompression range was set so that the OKA was ≤ 23° or the minimum if this value could not be achieved. Cases in which an OKA ≤ 23° could and could not be achieved were designated as groups U (13 patients) and O (7 patients), respectively. The mean patient ages were 50.5 and 62.1 years (p = 0.03) and the mean preoperative Japanese Orthopaedic Association (JOA) scores were 5.9 and 6.0 (p = 0.9) in groups U and O, respectively. The postoperative JOA score, rate of improvement of the JOA score, number of levels fused, number of decompression levels, presence of an echo-free space during surgery, operative time, intraoperative blood loss, and perioperative complications were examined.RESULTSIn groups U and O, the mean rates of improvement in the JOA score were 50.0% and 45.6% (p = 0.3), the numbers of levels fused were 6.7 and 6.4 (p = 0.8), the numbers of decompression levels were 5.9 and 7.4 (p = 0.3), an echo-free space was noted during surgery in 92.3% and 42.9% of cases (p = 0.03), the operative times were 292 and 238 minutes (p = 0.3), and the intraoperative blood losses were 422 and 649 ml (p = 0.7), and transient aggravation of paralysis occurred as a perioperative complication in 2 and 1 patient, respectively.CONCLUSIONSThere was no significant difference with regard to the recovery rate of the JOA score between patients with (group U) and without (group O) sufficient spinal cord decompression. The first-line surgical procedure of posterior decompression and fixation with the range of posterior decompression set as an OKA ≤ 23° before surgery involves less risk of postoperative aggravation of paralysis and may result in a better outcome.

scholarly journals Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation

2018 ◽  
Vol 1 (1) ◽  
pp. 158-164 ◽  
Author(s):  
Dionne Telemacque ◽  
Fengzhao Zhu ◽  
Kaifang Chen ◽  
Lin Chen ◽  
Zhengwei Ren ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Control Group ◽  
Cord Injury ◽  
Prevention And Treatment ◽  
The Mean ◽  
Spinal Cord Decompression ◽  
Experimental Group

Introduction:We developed the method of cervical spinal cord decompression through durotomy followed by duroplasty and analyzed its efficacy.Purpose:To develop a tactic of decompression durotomy and duroplasty for the treatment of severe spinal cord injury(SCI) with extensive edema of the spinal cord and without intramedullary hematoma, and to demonstrate the effectiveness of this method.Methods:From October 2016 to January 2018, 17 decompression operations were performed in the cervical spine in patients with SCI. Decompression laminectomy was done without durotomy in the first group of patients. In the second group, duroplasty of the spinal cord was performed after decompression durotomy. A total of 17 patients, 16 males (94%) and 1 female (6%), were operated on (ages from 32 to 66 years). The patients were divided into two groups: a control group and an experimental group. We used the ASIA scale for assessing the patients. The mean follow up time is 12 months (8−24 months).Results:The first group, i.e., the control group consisted of 10 patients who underwent decompression laminectomy without durotomy. The second group, i.e., the experimental group consisted of 7 patients who underwent durotomy followed by duroplasty. In this group, the positive dynamics were observed in 6 patients. Out of 2 patients with ASIA grade “A”, one showed improvement to ASIA grade “C”, and one improved to ASIA “D”. Two patients with ASIA grade “B” showed recovery to ASIA “D”. Two patients with ASIA grade “C” improved to grade “D” while one patient showed no change from ASIA “C”. Durotomy and duroplasty was effective in the experimental group.Conclusion:The performance of durotomy and duroplasty is an efficient method for the full-scale decompression of the spinal cord and the prevention of edema. This method aims at decreasing intraspinal pressure, as well as preventing ischemia and apoptosis, which is possible for the prevention and treatment of the spinal cord compartment syndrome or spinal cord intramedullary hypertension.

scholarly journals Microendoscopic decompression for cervical spondylotic myelopathy

2013 ◽  
Vol 35 (1) ◽  
pp. E8 ◽  
Author(s):  
Nader S. Dahdaleh ◽  
Albert P. Wong ◽  
Zachary A. Smith ◽  
Ricky H. Wong ◽  
Sandi K. Lam ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Retrospective Study ◽  
Cobb Angle ◽  
Cervical Spondylotic Myelopathy ◽  
Elderly Population ◽  
The Elderly ◽  
The Mean ◽  
Spinal Cord Decompression ◽  
Cervical Degenerative Disease

Object Cervical spondylotic myelopathy (CSM) is a common cervical degenerative disease that affects the elderly population. Spinal cord decompression is achieved through various anterior and posterior approaches including anterior cervical decompression and fusion, laminectomy, laminoplasty, and combined approaches. The authors describe another option, minimally invasive endoscopically assisted decompression of stenosis (MEDS), which obviates the need for muscle dissection and disruption of the posterior tension band, a cause of postlaminectomy kyphosis. Methods The authors conducted a retrospective study of 10 patients with CSM who underwent MEDS from January 2002 through July 2012. Data were collected on demographics, preoperative and postoperative Nurick scores, postoperative Odom scores, and preoperative and postoperative Cobb angles. Results The mean patient age (± SD) was 67 ± 7.7 years; 8 patients were male. The average number of disc levels operated on was 2.2 (range 1–4). The mean Nurick score was 1.6 ± 0.7 preoperatively and improved to 0.3 ± 0.7 postoperatively (p < 0.0005). The postoperative Odom scores indicated excellent outcomes for 4 patients, good for 3, fair for 2, and poor for 1. The average preoperative focal Cobb angle at the disc levels operated on was −0.43º ± 1.9º. The average Cobb angle at the last follow-up visit was 0.25° ± 1.6° (p = 0.6). The average follow-up time was 18.9 ± 32.1 months. There were no intraoperative or postoperative complications. Conclusions For selected patients with CSM, whose pathologic changes are primarily posterior and who have acceptable preoperative lordosis, MEDS is an alternative to open laminectomy and laminoplasty.

scholarly journals Is there a right time for surgery in paraplegic patients secondary to non traumatic spinal cord compression?

2012 ◽  
Vol 10 (4) ◽  
pp. 508-511 ◽  
Author(s):  
Leonardo Giacomini ◽  
Roger Neves Mathias ◽  
Andrei Fernandes Joaquim ◽  
Mateus Dal Fabbro ◽  
Enrico Ghizoni ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Prognostic Factor ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Lower Limbs ◽  
Motor Deficit ◽  
Indication For Surgery ◽  
Sensory Deficits ◽  
Sensory Involvement ◽  
Spinal Cord Decompression

Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement. The cause of paraplegia usually guides treatment, however, some controversies remain about the time and benefits for spinal cord decompression in nontraumatic paraplegic patients, especially after 48 hours of the onset of paraplegia. The objective of this study was to evaluate the benefits of spinal cord decompression in such patients. We describe three patients with paraplegia secondary to non-traumatic spinal cord compression without sensory deficits, and who were surgically treated after more than 48 hours of the onset of symptoms. All patients, even those with paraplegia during more than 48 hours, had benefits from spinal cord decompression like recovery of gait ability. The duration of paraplegia, which influences prognosis, is not a contra-indication for surgery. The preservation of sensitivity in this group of patients should be considered as a positive prognostic factor when surgery is taken into account.

scholarly journals Metacarpal Bony Dimensions Related to Headless Compression Screw Sizes

2019 ◽  
Vol 12 (S 01) ◽  
pp. S39-S44
Author(s):  
Michael Okoli ◽  
Kevin Lutsky ◽  
Michael Rivlin ◽  
Brian Katt ◽  
Pedro Beredjiklian
Keyword(s):  
Computed Tomography ◽  
Fracture Fixation ◽  
Ct Scans ◽  
Compression Screw ◽  
Metacarpal Head ◽  
Headless Compression Screw ◽  
Metacarpal Bones ◽  
Headless Compression Screws ◽  
The Mean ◽  
Distal Aspect

Abstract Introduction The purpose of this study is to determine the radiographic dimensions of the finger metacarpals and to compare these measurements with headless compression screws commonly used for fracture fixation. Materials and Methods We analyzed computed tomography (CT) scans of the index, long, ring, and small metacarpal bones and measured the metacarpal length, distance from the isthmus to the metacarpal head, and intramedullary diameter of the isthmus. Metacarpals with previous fractures or hardware were excluded. We compared these dimensions with the size of several commercially available headless screws used for intramedullary fixation. Results A total of 223 metacarpals from 57 patients were analyzed. The index metacarpal was the longest, averaging 67.6 mm in length. The mean distance from the most distal aspect of the metacarpal head to the isthmus was 40.3, 39.5, 34.4, and 31 mm for the index, long, ring, and small metacarpals, respectively. The narrowest diameter of the isthmus was a mean of 2.6, 2.7, 2.3, and 3 mm for the index, long, ring, and small metacarpals, respectively. Of 33 commercially available screws, only 27% percent reached the isthmus of the index metacarpal followed by 42, 48, and 58% in the long, ring, and small metacarpals, respectively. Conclusion The index and long metacarpals are at a particular risk of screw mismatch given their relatively long lengths and narrow isthmus diameters.

Association between cervical disc disease and lesions of multiple sclerosis

2021 ◽  
pp. 197140092098356
Author(s):  
Marwan Alkrenawi ◽  
Michael Osherov ◽  
Azaria Simonovich ◽  
Jonathan Droujin ◽  
Ron Milo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Group 4 ◽  
Demyelinating Lesions ◽  
Grade Ii ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Cervical discopathy and demyelinating lesions often co-exist in patients with multiple sclerosis (MS). Our study examines the possible association between these two pathologies. Methods Medical records and cervical magnetic resonance imaging scans of MS patients with cervical discopathy who were seen at our MS clinic during 2018 were retrospectively reviewed. The severity of the disc disease was classified as grade I (no compression), grade II (compression of the dural sac) and grade III (cord compression). The spinal cord in each scan was divided into six segments corresponding to the intervertebral space of the spine (C1–C6). Each segment was defined as containing demyelinating lesion and disc pathology (group 1), demyelinating lesion without disc pathology (group 2), disc pathology without demyelinating lesion (group 3) and no demyelinating lesion or disc pathology (group 4). Fisher’s exact test was used to test the association between demyelinating lesions and disc pathology. Results Thirty-four MS patients with cervical discopathy were included in the study (26 females; average age 42.9 ± 13.7 years; average disease duration 8.4 ± 5.4 years). A total of 204 spinal cord segments were evaluated. Twenty-four segments were classified as group 1, 27 segments as group 2, 52 segments as group 3 and 101 segments as group 4. There was no association between demyelinating lesions and the grade of disc disease ( p = 0.1 for grade I, p = 0.3 for grade II and p = 1 for grade III disc disease). Conclusion Our study did not find any association between cervical disc disease and demyelinating spinal cord lesion.

scholarly journals Impact of Geometric Uncertainties on Dose Distribution During Intensity Modulated Radiotherapy of Head-and-neck Cancer: The Need for a Planning Target Volume and A Planning Organ-at-Risk Volume

2006 ◽  
Vol 13 (3) ◽  
pp. 108-115 ◽  
Author(s):  
O. Ballivy ◽  
W. Parker ◽  
T. Vuong ◽  
G. Shenouda ◽  
H. Patrocinio
Keyword(s):  
Spinal Cord ◽  
At Risk ◽  
Neck Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Target Volume ◽  
Ct Scans ◽  
Target Coverage ◽  
Geometric Uncertainties ◽  
Intensity Modulated ◽  
Organ At Risk

We assessed the effect of geometric uncertainties on target coverage and on dose to the organs at risk (OARS) during intensity-modulated radiotherapy (IMRT) for head-and-neck cancer, and we estimated the required margins for the planning target volume (PTV) and the planning organ-at-risk volume (PRV). For eight headand- neck cancer patients, we generated IMRT plans with localization uncertainty margins of 0 mm, 2.5 mm, and 5.0 mm. The beam intensities were then applied on repeat computed tomography (CT) scans obtained weekly during treatment, and dose distributions were recalculated. The dose–volume histogram analysis for the repeat CT scans showed that target coverage was adequate (V100 ≥ 95%) for only 12.5% of the gross tumour volumes, 54.3% of the upper-neck clinical target volumes (CTVS), and 27.4% of the lower-neck CTVS when no margins were added for PTV. The use of 2.5-mm and 5.0-mm margins significantly improved target coverage, but the mean dose to the contralateral parotid increased from 25.9 Gy to 29.2 Gy. Maximum dose to the spinal cord was above limit in 57.7%, 34.6%, and 15.4% of cases when 0-mm, 2.5-mm, and 5.0-mm margins (respectively) were used for PRV. Significant deviations from the prescribed dose can occur during IMRT treatment delivery for headand- neck cancer. The use of 2.5-mm to 5.0-mm margins for PTV and PRV greatly reduces the risk of underdosing targets and of overdosing the spinal cord.

scholarly journals Changes of Dorsal Root Ganglion Volume in Dogs with Clinical Signs of Degenerative Myelopathy Detected by Water-Excitation Magnetic Resonance Imaging

Animals ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1702
Author(s):  
Eiji Naito ◽  
Kohei Nakata ◽  
Yukiko Nakano ◽  
Yuta Nozue ◽  
Shintaro Kimura ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Clinical Signs ◽  
Intervertebral Disc Herniation ◽  
Resonance Imaging ◽  
Diagnostic Potential ◽  
Water Excitation ◽  
Spinal Cord Segment ◽  
Degenerative Myelopathy

Canine degenerative myelopathy (DM) is a progressive and fatal neurodegenerative disease. However, a definitive diagnosis of DM can only be achieved by postmortem histopathological examination of the spinal cord. The purpose of this study was to investigate whether the volumetry of DRG using the ability of water-excitation magnetic resonance imaging (MRI) to visualize the DRG in dogs has premortem diagnostic value for DM. Eight dogs with DM, twenty-four dogs with intervertebral disc herniation (IVDH), and eight control dogs were scanned using a 3.0-tesla MRI system, and water-excitation images were obtained to visualize and measure the volume of DRG, normalized by body surface area. The normalized mean DRG volume between each spinal cord segment and mean volume of all DRG between T8 and L2 in the DM group was significantly lower than that in the control and the IVDH groups (P = 0.011, P = 0.002, respectively). There were no correlations within the normalized mean DRG volume between DM stage 1 and stage 4 (rs = 0.312, P = 0.128, respectively). In conclusion, DRG volumetry by the water-excitation MRI provides a non-invasive and quantitative assessment of neurodegeneration in DRG and may have diagnostic potential for DM.

Outcome of thoracolumbar surgical feline intervertebral disc disease

2021 ◽  
pp. 1098612X2110280
Author(s):  
Kayla M Fowler ◽  
Theresa E Pancotto ◽  
Stephen R Werre ◽  
Michaela J Beasley ◽  
William Kay ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Intervertebral Disc ◽  
Positive Outcome ◽  
Intervertebral Disc Herniation ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Exact Test ◽  
Imaging Results ◽  
Larger Sample

Objectives The aim of this study was to evaluate the outcome and prognosis of thoracolumbar feline intervertebral disc disease (IVDD) treated by surgical decompression. Methods This was a multi-institutional retrospective study evaluating the age, breed, sex, body weight, presenting complaint, neuroanatomic diagnosis at presentation, diagnostic imaging results, surgery performed and the overall outcome at discharge and at recheck. Bivariable associations between variables were assessed using the Kruskal–Wallis test (age and grade of IVDD at presentation) and Fisher’s exact test (grade of IVDD at presentation and outcome). Results A total of 35 cats met the inclusion criteria for the study. The most frequently reported clinical sign was difficulty walking (54.2%). The majority of cats presented with an L4–S3 localization (57%). The most common site of intervertebral disc herniation (IVDH) was at L6–L7 (34%). The majority of feline patients that received surgery had a positive outcome at the time of discharge (62.5%; n = 20/32) and at the time of the 2-week recheck (91.3%; n = 21/23). No association was identified between the age of the patient and the grade of IVDD. No association was identified between the presenting grade of IVDD and the clinical outcome at the time of discharge or at the time of recheck evaluation. Conclusions and relevance Cats undergoing spinal decompressive surgery for thoracolumbar IVDH appear to have a favorable prognosis independent of the initial presenting grade of IVDD. A larger sample size and a longer length of follow-up is necessary to obtain statistical associations between the presenting grade of IVDD and overall clinical outcome.

scholarly journals Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

2015 ◽  
Vol 23 (4) ◽  
pp. 400-411 ◽  
Author(s):  
Claudio E. Tatsui ◽  
R. Jason Stafford ◽  
Jing Li ◽  
Jonathan N. Sellin ◽  
Behrang Amini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Real Time ◽  
Spinal Cord Compression ◽  
Spinal Metastasis ◽  
Cord Compression ◽  
The Mean ◽  
Interstitial Thermotherapy

OBJECT High-grade malignant spinal cord compression is commonly managed with a combination of surgery aimed at removing the epidural tumor, followed by spinal stereotactic radiosurgery (SSRS) aimed at local tumor control. The authors here introduce the use of spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery prior to SSRS. METHODS Patients with a high degree of epidural malignant compression due to radioresistant tumors were selected for study. Visual analog scale (VAS) scores for pain and quality of life were obtained before and within 30 and 60 days after treatment. A laser probe was percutaneously placed in the epidural space. Real-time thermal MRI was used to monitor tissue damage in the region of interest. All patients received postoperative SSRS. The maximum thickness of the epidural tumor was measured, and the degree of epidural spinal cord compression (ESCC) was scored in pre- and postprocedure MRI. RESULTS In the 11 patients eligible for study, the mean VAS score for pain decreased from 6.18 in the preoperative period to 4.27 within 30 days and 2.8 within 60 days after the procedure. A similar VAS interrogating the percentage of quality of life demonstrated improvement from 60% preoperatively to 70% within both 30 and 60 days after treatment. Imaging follow-up 2 months after the procedure demonstrated a significant reduction in the mean thickness of the epidural tumor from 8.82 mm (95% CI 7.38–10.25) before treatment to 6.36 mm (95% CI 4.65–8.07) after SLITT and SSRS (p = 0.0001). The median preoperative ESCC Grade 2 was scored as 4, which was significantly higher than the score of 2 for Grade 1b (p = 0.04) on imaging follow-up 2 months after the procedure. CONCLUTIONS The authors present the first report on an innovative minimally invasive alternative to surgery in the management of spinal metastasis. In their early experience, SLITT has provided local control with low morbidity and improvement in both pain and the quality of life of patients.

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