Microdecompression without fusion for radiculopathy associated with lytic spondylolisthesis

1996 ◽  
Vol 85 (4) ◽  
pp. 582-585 ◽  
Author(s):  
Bradley K. Weiner ◽  
John A. McCulloch
Keyword(s):  
Back Pain ◽  
Nerve Root ◽  
Therapeutic Option ◽  
Radicular Pain ◽  
Nerve Root Compression ◽  
Surgical Morbidity ◽  
Content Type ◽  
Transpedicular Instrumentation ◽  
Limited Surgery ◽  
Fine Print

✓ Patients with symptomatic L-5 nerve root compression and associated lytic spondylolisthesis are commonly treated by bilateral wide posterior decompression and concomitant fusion, often accompanied by transpedicular instrumentation. More limited surgery aimed solely at the relief of nerve root compression offers the potential for significant relief of radicular pain while avoiding iatrogenic instability, thereby alleviating the need for arthrodesis with its increased surgical morbidity. Nine patients with unilateral radicular symptoms referable to the L-5 nerve root, minimal back pain, and a lytic pars lesion with mild spondylolisthesis underwent unilateral microdecompression on their symptomatic side without associated fusion. All patients obtained relief of radicular pain at both short- and long-term follow-up examination. One patient demonstrated increased back pain and, accordingly, the procedure is now recommended only for patients with no greater than a 25% spondylolisthesis. Unilateral microdecompression without stabilization is an effective and safe method for relieving radicular pain in patients with a lytic pars defect, a mild spondylolisthesis, and minimal back pain. This therapeutic option should be considered in select cases as an alternative to bilateral wide decompression with fusion and instrumentation.

Lumbar nerve root compression at the intervertebral foramina caused by arthritis of the posterior facets

1973 ◽  
Vol 39 (3) ◽  
pp. 362-369 ◽  
Author(s):  
Joseph A. Epstein ◽  
Bernard S. Epstein ◽  
Leroy S. Lavine ◽  
Robert Carras ◽  
Alan D. Rosenthal ◽  
...  
Keyword(s):  
Nerve Root ◽  
Herniated Disc ◽  
Nerve Root Compression ◽  
Degenerative Arthritis ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Intervertebral Foramina ◽  
Pain Patients ◽  
Unusual Stress ◽  
Fine Print

✓ The authors report their experience with 12 cases in which the roots of the sciatic nerve were compressed at the intervertebral foramina by degenerative arthritis (arthrosis) of the posterior facets, and in which foraminotomy and facetectomy brought relief of pain. Patients with disc narrowing, spondylolisthesis, and transitional vertebrae place unusual stress on the posterior facets. This may lead to hypertrophy and the development of marginal osteophytes that project downward with eventual constriction of the intervertebral foramen and entrapment of the nerve root. Such alterations are common in patients over 40, and when found in the presence of unremitting sciatic pain without evidence of a herniated disc or other etiology, a causal relationship must be considered.

Lumbar nerve root compression by synovial cysts of the ligamentum flavum

1984 ◽  
Vol 60 (3) ◽  
pp. 617-620 ◽  
Author(s):  
Adel F. Abdullah ◽  
Robert W. Chambers ◽  
Dennis P. Daut
Keyword(s):  
Nerve Root ◽  
Ligamentum Flavum ◽  
Nerve Root Compression ◽  
Nerve Roots ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Synovial Cysts ◽  
Fine Print

✓ Synovial cysts of the ligamentum flavum, measuring 1 cm in diameter, caused compression of the lumbar nerve roots in four patients. The authors discuss the association of these cysts with advanced focal spondylosis, and speculate on their etiology.

Surgical treatment of nerve root compression caused by scoliosis of the lumbar spine

1974 ◽  
Vol 41 (4) ◽  
pp. 449-454 ◽  
Author(s):  
Joseph A. Epstein ◽  
Bernard S. Epstein ◽  
Leroy S. Lavine
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Elderly Patients ◽  
Recovery Of Function ◽  
Radicular Pain ◽  
Surgical Decompression ◽  
Nerve Root Compression ◽  
Pathological Anatomy ◽  
Content Type ◽  
Fine Print

✓ Effective relief of radicular pain and recovery of function is reported in four elderly patients with lumbar scoliosis following surgical decompression of the lateral recesses of the spinal canal. The operation includes laminectomy or hemilaminectomy with unroofing of the lateral recesses and foramina by medial facetectomy or facetectomy. The patients tolerated surgery without morbidity, were walking within 2 or 3 days, and recovered without incident. The pathological anatomy and operative criteria are discussed.

The femoral stretching test

1982 ◽  
Vol 57 (6) ◽  
pp. 813-817 ◽  
Author(s):  
M. N. Estridge ◽  
Stanley A. Rouhe ◽  
Neil G. Johnson
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Nerve Root Compression ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Upper Lumbar Disc Herniation ◽  
Fine Print

✓ The femoral stretching test is a valuable sign in diagnosing upper lumbar nerve root compression. We believe that it has the same significance for upper lumbar disc herniation as the sciatic stretching test has for the lower.

Low-dose radiotherapy for the inhibition of peridural fibrosis after reexploratory nerve root decompression for postlaminectomy syndrome

2003 ◽  
Vol 99 (3) ◽  
pp. 271-277 ◽  
Author(s):  
Peter C. Gerszten ◽  
John J. Moossy ◽  
John C. Flickinger ◽  
William C. Welch
Keyword(s):  
Nerve Root ◽  
Low Dose ◽  
Radicular Pain ◽  
Control Group ◽  
Preoperative Irradiation ◽  
External Beam Irradiation ◽  
Content Type ◽  
Peridural Fibrosis ◽  
Nerve Root Decompression ◽  
Fine Print

Object. The authors of clinical studies have demonstrated a significant association between the presence of extensive post—lumbar discectomy peridural scar formation and the recurrence of low-back and radicular pain. Low-dose perioperative radiotherapy has been demonstrated to inhibit peridural fibrosis after laminectomy in animal models. The present study was designed to evaluate the clinical efficacy of preoperative irradiation in patients with failed—back surgery syndrome due to peridural fibrosis who underwent reexploration and nerve root decompression. Methods. Ten patients with symptomatic post—discectomy peridural fibrosis were randomized. Half of the patients underwent 700-cGy external-beam irradiation to the operative site 24 hours prior to reexploration and decompressive treatment of their symptomatic nerve root(s) (treatment group) and the other half underwent reexploration and decompressive treatment without preoperative irradiation (control group). All patients underwent simulated irradiation so neither patient nor surgeon was aware of the patient's group. In all patients the antiadhesion product ADCON-L was placed over the affected nerve root at the time of surgery. Clinical outcome was assessed using the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section Lumbar Disc Herniation Study Questionnaire at baseline, 6 weeks, 3 months, and 1 year follow up. Five men and five women (mean age 42 years) underwent randomization and surgery. Three patients underwent reexploration at L4–5, four at L5—S1, and three at both levels. No complication was associated with irradiation, and no new neurological deficits occurred. At 1-year follow-up examination, three irradiation-treated patients were pain free and two experienced improvement. In the control group, three patients experienced improved pain relief and two were unchanged. There was a trend toward better outcome at 1 year in the radiotherapy-treated group (p = 0.056). Conclusions. Preoperative low-dose external-beam irradiation improved clinical outcomes after reexploration and decompression of nerve roots affected by postlaminectomy peridural fibrosis causing radicular pain. The addition of preoperative irradiation may improve outcome in patients who undergo reoperation for recurrent radicular pain associated with a significant amount of peridural fibrosis, particularly now that no antiadhesion product is available for clinical use.

Occipital neuralgia secondary to hypermobile posterior arch of atlas

2001 ◽  
Vol 94 (2) ◽  
pp. 276-278 ◽  
Author(s):  
Alexander F. Post ◽  
Prithvi Narayan ◽  
Regis W. Haid
Keyword(s):  
Nerve Root ◽  
Posterior Arch ◽  
Occipital Neuralgia ◽  
Nerve Root Compression ◽  
Fibrous Band ◽  
Content Type ◽  
Fine Print

✓ The authors report on the management of occipital neuralgia secondary to an abnormality of the atlas in which the posterior arch was separated by a fibrous band from the lateral masses, resulting in C-2 nerve root compression. The causes and treatments of occipital neuralgia as well as the development of the atlas are reviewed.

Ligamentum flavum hematoma

1992 ◽  
Vol 76 (3) ◽  
pp. 534-537 ◽  
Author(s):  
Thomas A. Sweasey ◽  
Hans C. Coester ◽  
Harish Rawal ◽  
Mila Blaivas ◽  
John E. McGillicuddy
Keyword(s):  
Nerve Root ◽  
Epidural Hematoma ◽  
Ligamentum Flavum ◽  
Signs And Symptoms ◽  
Normal Function ◽  
Neurological Deficits ◽  
Nerve Root Compression ◽  
Content Type ◽  
Fine Print

✓ Two patients presenting with signs and symptoms suggestive of nerve root compression secondary to extradural masses were found to have ligamentum flavum hematomas. Both patients had neurological deficits preoperatively and regained normal function postoperatively. There was no significant antecedent injury in either case. The symptom course was longer than that for spontaneous epidural hematoma. In one case, there was remodeling of bone, initially suggesting either infection or tumor.

Posterior epidural migration of sequestered lumbar disc fragments

1999 ◽  
Vol 90 (2) ◽  
pp. 264-266 ◽  
Author(s):  
Pierre Robe ◽  
Didier Martin ◽  
Jacques Lenelle ◽  
Achille Stevenaert
Keyword(s):  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Contrast Material ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Content Type ◽  
Diagnostic Pitfalls ◽  
Fine Print

✓ The posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. The authors report two such cases in which patients presented with either intense radicular pain or cauda equina syndrome. The radiological characteristics were the posterior epidural location and the ring enhancement of the mass after injection of contrast material. The major diagnostic pitfalls are discussed.

Chondroblastoma of the lumbar spine

2005 ◽  
Vol 2 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Raphaël Vialle ◽  
Antoine Feydy ◽  
Ludovic Rillardon ◽  
Carla Tohme-Noun ◽  
Philippe Anract ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Local Recurrence ◽  
Osteolytic Lesion ◽  
Radicular Pain ◽  
Appendicular Skeleton ◽  
Lumbar Region ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

✓ Chondroblastoma is a benign cartilaginous neoplasm that generally affects the appendicular skeleton. Twenty-six cases of spinal chondroblastoma have been reported in the past 50 years, only six of which were located in the lumbar region. The authors report two cases involving this exceptional location. In both patients, low-back pain, in the absence of radicular pain, was the presenting symptom. In both cases, plain radiography and computerized tomography scanning revealed an osteolytic lesion surrounded by marginal sclerosis. Magnetic resonance imaging allowed the authors to study the tumor's local extension. Examination of a percutaneous fluoroscopy-guided biopsy sample revealed the following typical histological features of chondroblastoma: chondroid tissue, focally alternating with cellular areas, and no nuclear atypia or pleomorphism. To reduce the risk of local recurrence, vertebrectomy and anterior—posterior fusion were performed in both cases. In one case, a structural lumbar scoliosis was corrected during the posterior procedure. There was no postoperative complication. No recurrence was observed during the 3- to 6-year follow-up period. The surgery-related results were deemed successful. Although exceptional, the diagnosis of chondroblastoma is possible in lesions involving the lumbar spine. Other spinal locations are described in the literature, and frequency of recurrence is stressed. A vertebrectomy is advised to reduce the risk of local recurrence.

Intervertebral disc space cyst simulating a recurrent herniated nucleus pulposus

1988 ◽  
Vol 69 (1) ◽  
pp. 137-139 ◽  
Author(s):  
Jordan C. Grabel ◽  
Raphael Davis ◽  
Rosario Zappulla
Keyword(s):  
Intervertebral Disc ◽  
Preoperative Diagnosis ◽  
Relevant Literature ◽  
Radicular Pain ◽  
Lumbar Region ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Content Type ◽  
Herniated Nucleus Pulposus ◽  
Fine Print

✓ The case presented is of a patient with an intervertebral disc space cyst producing recurrent radicular pain following microdiscectomy in the lumbar region. Difficulties with the preoperative diagnosis of this and other recurrent radicular syndromes are discussed, and a review of the relevant literature is presented.

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