Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery

2004 ◽  
Vol 100 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Akihiko Takeuchi ◽  
Kei Miyamoto ◽  
Hideo Hosoe ◽  
Katsuji Shimizu
Keyword(s):  
Thoracic Spine ◽  
Spinal Cord Tumor ◽  
Decompressive Surgery ◽  
Magnetic Resonance Imaging Examination ◽  
Radiographic Examination ◽  
Decompression Surgery ◽  
Content Type ◽  
Canal Stenosis ◽  
Lumbar Spinal ◽  
Lumbar Spinal Decompression

✓ The authors discuss the cases of three patients in whom thoracic paraplegia developed after lumbar spinal decompressive surgery for slight lumbar spinal canal stenosis. Careful computerized tomography myelography and magnetic resonance imaging examination of the thoracic spine revealed another compressive lesion (spinal cord tumor, disc herniation, osteophyte of vertebral body, and ossification of the ligamentum flavum). Additional thoracic decompressive surgery provided partial amelioration of each patient's neurological condition. The authors suggest that to avoid such a complication physical and radiographic examination of the thoracic spine should be performed preoperatively if the lumbar imaging is inconclusive.

Intermittent cauda equina compression due to narrow spinal canal

1972 ◽  
Vol 37 (1) ◽  
pp. 83-88 ◽  
Author(s):  
Hiroshi Yamada ◽  
Masaki Ohya ◽  
Tsuguo Okada ◽  
Zenji Shiozawa
Keyword(s):  
Spinal Canal ◽  
Ligamentum Flavum ◽  
Cauda Equina ◽  
Disc Protrusion ◽  
Complete Obstruction ◽  
Content Type ◽  
Canal Stenosis ◽  
Cauda Equina Compression ◽  
Narrow Spinal Canal ◽  
Lumbar Spinal

✓ Five patients with intermittent claudication due to compression of the cauda equina in the presence of lumbar spinal canal stenosis or midline intervertebral disc protrusion are described. The characteristic myelographic evidence was complete obstruction during extension of the spine and release of the block with flexion. The cause of this syndrome is considered to be intermittent bulging of the ligamentum flavum into a narrow spinal canal so as to compress the cauda equina during extension of the back.

scholarly journals Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance

2015 ◽  
Vol 23 (4) ◽  
pp. 451-458 ◽  
Author(s):  
Tomohiro Hikata ◽  
Kota Watanabe ◽  
Nobuyuki Fujita ◽  
Akio Iwanami ◽  
Naobumi Hosogane ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Sagittal Imbalance ◽  
Decompression Surgery ◽  
Spinopelvic Alignment ◽  
Canal Stenosis ◽  
Coronal Imbalance ◽  
Health Related ◽  
Vas Scores ◽  
Group B ◽  
Lumbar Spinal

OBJECT The object of this study was to investigate correlations between sagittal spinopelvic alignment and improvements in clinical and quality-of-life (QOL) outcomes after lumbar decompression surgery for lumbar spinal canal stenosis (LCS) without coronal imbalance. METHODS The authors retrospectively reviewed data from consecutive patients treated for LCS with decompression surgery in the period from 2009 through 2011. They examined correlations between preoperative or postoperative sagittal vertical axis (SVA) and radiological parameters, clinical outcomes, and health-related (HR)QOL scores in patients divided according to SVA. Clinical outcomes were assessed according to Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores. Health-related QOL was evaluated using the Roland-Morris Disability Questionnaire (RMDQ) and the JOA Back Pain Evaluation Questionnaire (JOABPEQ). RESULTS One hundred nine patients were eligible for inclusion in the study. Compared to patients with normal sagittal alignment prior to surgery (Group A: SVA < 50 mm), those with preoperative sagittal imbalance (Group B: SVA ≥ 50 mm) had significantly smaller lumbar lordosis and thoracic kyphosis angles and larger pelvic tilt. In Group B, there was a significant decrease in postoperative SVA compared with the preoperative SVA (76.3 ± 29.7 mm vs 54.3 ± 39.8 mm, p = 0.004). The patients in Group B with severe preoperative sagittal imbalance (SVA > 80 mm) had residual sagittal imbalance after surgery (82.8 ± 41.6 mm). There were no significant differences in clinical and HRQOL outcomes between Groups A and B. Compared to patients with normal postoperative SVA (Group C: SVA < 50 mm), patients with a postoperative SVA ≥ 50 mm (Group D) had significantly lower JOABPEQ scores, both preoperative and postoperative, for walking ability (preop: 36.6 ± 26.3 vs 22.7 ± 26.0, p = 0.038, respectively; postop: 71.1 ± 30.4 vs 42.5 ± 29.6, p < 0.001) and social functioning (preop: 38.7 ± 18.5 vs 30.2 ± 16.7, p = 0.045; postop: 67.0 ± 25.8 vs 49.6 ± 20.0, p = 0.001), as well as significantly higher postoperative RMDQ (4.9 ± 5.2 vs 7.9 ± 5.7, p = 0.015) and VAS scores for low-back pain (2.68 ± 2.69 vs 3.94 ± 2.59, p = 0.039). CONCLUSIONS Preoperative sagittal balance was not significantly correlated with clinical or HRQOL outcomes after decompression surgery in LCS patients without coronal imbalance. Decompression surgery improved the SVA value in patients with preoperative sagittal imbalance; however, the patients with severe preoperative sagittal imbalance (SVA > 80 mm) had residual imbalance after decompression surgery. Both clinical and HRQOL outcomes were negatively affected by postoperative residual sagittal imbalance.

Functional and clinical evaluation for the surgical treatment of degenerative stenosis of the lumbar spinal canal

2009 ◽  
Vol 11 (3) ◽  
pp. 347-352 ◽  
Author(s):  
Bariş Yaşar ◽  
Serkan Şimşek ◽  
Uygur Er ◽  
Kazim Yiğitkanli ◽  
Emel Ekşioğlu ◽  
...  
Keyword(s):  
Decompressive Surgery ◽  
Decompression Surgery ◽  
Cross Sectional ◽  
Radiological Criteria ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Before And After ◽  
The Difference ◽  
Severity Of The Disease ◽  
Lumbar Spinal ◽  
Lumbar Decompression Surgery

Object This study was designed to evaluate the efficacy of decompressive surgery for degenerative lumbar spinal stenosis (LSS) on a functional and clinical basis. Methods A prospective analysis and follow-up of 125 consecutive patients with degenerative LSS between 2000 and 2006 were performed. All patients underwent surgery for lumbar stenosis. Functional evaluations of the patients were performed using a treadmill, the visual analog scale, and the Oswestry Disability Questionnaire (ODQ). These parameters were recorded before surgery and the 3rd month and 1st and 2nd years after treatment. The first symptom time (FST), maximal walking duration (MWD), and thecal sac cross-sectional area (CSA) before and after surgery were also recorded. Statistical relations between variables were calculated. Results As patient ages increased, the CSA of the thecal sac decreased. Decompressive surgery reached the target according to the difference between the preoperative and postoperative thecal sac CSA. A correlation between the CSA of the thecal sac and FST, and between the CSA of the thecal sac and MWD could not be established. There was a significant correlation between the FST and MWD, and a negative correlation could be established between the MWD and the ODQ score. Surgery led to significant decreases in the ODQ score. Maximal improvement was observed in the 3rd month after decompressive surgery. Conclusions The treatment for LSS should be decided using functional criteria; radiological criteria may not correlate with the severity of the disease. Improvements following lumbar decompression surgery continued within 1 year of treatment according to the ODQ and did not change significantly thereafter.

Lumbar spinal stenosis: postoperative results in terms of preoperative posture-related pain

1990 ◽  
Vol 72 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Jeremy C. Ganz
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Selection Criteria ◽  
Decompressive Surgery ◽  
Leg Pain ◽  
Postoperative Result ◽  
Content Type ◽  
Lumbar Spinal ◽  
Exacerbation Of Symptoms ◽  
Fine Print

✓ Thirty-three consecutive patients with lumbar spinal stenosis were treated with decompressive surgery aimed at relieving pain. The selection criteria for surgery included marked symptoms and lumbar spinal stenosis demonstrated by myelography. Preoperatively, only 15 patients had claudication; however, 23 experienced relief or exacerbation of symptoms related to changes in posture. A good postoperative result was obtained in 82% of the entire series, but in only 50% of patients whose symptoms were not affected by posture. Of those whose symptoms did have a postural component, a good result was obtained in 96%. The relief of back pain by decompressive surgery was significantly less successful than the relief of leg pain. It is therefore suggested that surgery be restricted to as few levels as possible.

Reliability of postoperative MR imaging in the determination of level and side of lumbar spinal decompression surgery

2016 ◽  
Vol 58 (5) ◽  
pp. 581-585
Author(s):  
Florian Wanivenhaus ◽  
Florian M Buck ◽  
Michael Betz ◽  
Nadja A Farshad-Amacker ◽  
Mazda Farshad
Keyword(s):  
High Reliability ◽  
Surgical Decompression ◽  
Time Interval ◽  
Decompression Surgery ◽  
Mr Images ◽  
Spinal Decompression ◽  
Lumbar Spinal ◽  
Lumbar Spinal Decompression ◽  
Musculoskeletal Radiologist

Background Magnetic resonance imaging (MRI) is the diagnostic modality of choice in defining soft tissue compromise of the spinal canal. Purpose To evaluate the reliability of postoperative MRI in the determination of level and side of lumbar spinal decompression surgery, investigated by two reviewers, in different levels of training and specialization. Material and Methods Postoperative MR images of 86 patients who underwent spinal decompression (single level, n = 70; multilevel, n = 16; revision decompression, n = 9) were reviewed independently by an experienced musculoskeletal radiologist and a fourth-year orthopedic surgery resident. The level (single or multiple) and side of previous surgical decompression were determined and compared to the surgical notes. We examined factors that may have influenced the reliability, including demographics, type of surgical decompression, use of a drain, and time interval from surgery to MRI. Results Significantly fewer levels were correctly determined by the resident (77/86 cases, 89.5%) compared with the radiologist (84/86 cases, 97.7%) ( P = 0.014). The resident interpreted significantly more MR images incorrectly in cases where a drain was used (n = 8; P < 0.001). Re-decompression cases were interpreted incorrectly significantly more often by both the radiologist (n = 2, P = 0.032) and the resident (n = 4, P = 0.014). Conclusion Determination of the level and side operated on in previous lumbar spinal decompression surgery on MRI has a high reliability, especially when performed by a musculoskeletal radiologist. However, this reliability is decreased in cases involving surgical drainage and same-level revision surgery.

Sign in / Sign up

Export Citation Format

Share Document