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.

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.

Short-segment compression instrumentation for selected thoracic and lumbar spine fractures: the short-rod/two-claw technique

1993 ◽  
Vol 79 (3) ◽  
pp. 335-340 ◽  
Author(s):  
Edward C. Benzel
Keyword(s):  
Lumbar Spine ◽  
Fracture Site ◽  
Spine Fractures ◽  
Short Segment ◽  
Content Type ◽  
Scoliotic Deformity ◽  
Spine Instrumentation ◽  
Thoracic And Lumbar Spine ◽  
Fine Print

✓ The short-rod/two-claw (SRTC) technique of spine instrumentation was recently introduced for the treatment of thoracic and lumbar spine fractures. The use of this technique in 10 patients harboring wedge compression or burst fractures of the thoracic or lumbar spine is described. Of three patients treated with the construct placed in a distraction mode, the average follow-up loss of angle (the difference between the immediate postoperative and follow-up midsagittal angle as measured on x-ray films) was 18.3°. Of the seven patients in whom the instrumentation was placed in a compression mode, the average observed loss of angle at follow-up examination was 1.6°. Two patients had a preoperative scoliotic deformity at the fracture site. and both deformities were exaggerated by the placement of the SRTC technique in compression. Although no patient experienced an adverse outcome and all achieved a solid fusion, the application of the SRTC technique of universal spine instrumentation in distraction was associated with an exaggerated loss of angle. Loss of angle and deformity exaggeration are not desirable and are preventable by strict patient selection and by applying the construct in a compression mode. It is emphasized that few patients are candidates for this form of instrumentation. When applicable. however, the advantages of decreased pain and stiffness and the elimination of the need for instrumentation removal make the SRTC and related short-segment techniques desirable alternatives to traditional methods of spinal fixation.

Minimally invasive retroperitoneal approach for lumbar corpectomy and anterior reconstruction

2000 ◽  
Vol 93 (1) ◽  
pp. 161-167 ◽  
Author(s):  
Manfred Mühlbauer ◽  
Wolfgang Pfisterer ◽  
Richard Eyb ◽  
Engelbert Knosp
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Spinal Fusion ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Content Type ◽  
Anterior Reconstruction ◽  
Fine Print ◽  
Lumbar Corpectomy

✓ The anterior decompressive procedure in which spinal fusion is performed is considered an effective treatment for thoracolumbar fractures and tumors. However, it is also known to be associated with considerable surgery-related trauma. The purpose of this study was to show that lumbar corpectomy and anterior reconstruction can be performed via a minimally invasive retroperitoneal approach (MIRA) and therefore the surgical approach—related trauma can be reduced. The authors studied retrospectively the hospital records and radiological studies obtained in five patients (mean age 67.4 years, range 59–76 years) who underwent lumbar corpectomy and spinal fusion via an MIRA followed by posterior fixation. Four patients presented with osteoporotic compression fractures at L-2 and L-3, and one patient presented with metastatic disease in L-4 from prostate cancer. Neurological deficits due to cauda equina compression were demonstrated in all patients. The MIRA provided excellent exposure to facilitate complete decompression and anterior reconstruction in all patients, as verified on follow-up radiographic studies. All patients improved clinically. A 1-year follow-up record is available for four patients and a 6-month follow-up record for the fifth patient; continuing clinical improvement has been observed in all. Radiography demonstrated anatomically correct reconstruction in all patients, as well as a solid fusion or a stable compound union in the four patients for whom 1-year follow-up records were available. The MIRA allows the surgeon to perform anterior lumbar spine surgery via a less invasive approach. The efficacy and safety of this technique and its potential to reduce perioperative morbidity compared with conventional retroperitoneal lumbar spine surgery should be further investigated in a larger series.

Thoracoscopic microsurgical excision of herniated thoracic discs

1998 ◽  
Vol 89 (2) ◽  
pp. 224-235 ◽  
Author(s):  
Daniel Rosenthal ◽  
Curtis A. Dickman
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Radicular Pain ◽  
Content Type ◽  
Neurological Outcomes ◽  
Intercostal Neuralgia ◽  
The Mean ◽  
Postoperative Atelectasis ◽  
Fine Print

Object. The authors began using thoracoscopy to treat pathological conditions of the spine in 1992. In this study they delineate their clinical experience in which this procedure was used to resect herniated thoracic discs. Methods. Fifty-five patients underwent thoracoscopy for the resection of herniated thoracic discs. Thirty-six patients presented with myelopathies and 19 with incapacitating thoracic radicular pain. Forty-three patients underwent a single-level, 11 a two-level, and one a three-level discectomy. The mean operative time for thoracoscopic microdiscectomy was 3 hours and 25 minutes (range 80–542 minutes) and the mean blood loss was 327 ml (range 124–1500 ml). Compared with thoracotomy, which was performed in 18 patients, thoracoscopy was associated with a mean of 1 hour less operative time and less than one-half of the blood loss, duration of chest tube drainage, usage of pain medication, and length of hospitalization. Compared with costotransversectomy, which was performed in 15 patients, thoracoscopy permitted more complete resection of calcified and midline thoracic discs because it provided a direct view of the entire anterior surface of the dura. Thoracotomy was associated with a significantly greater incidence of prolonged, disabling intercostal neuralgia compared with the mild transient episodes of intercostal neuralgia associated with thoracoscopy (50% compared with 16%). Thoracotomy also was associated with a significantly higher incidence of postoperative atelectasis and pulmonary dysfunction than thoracoscopy (33% compared with 7%). Clinical and neurological outcomes were excellent (mean follow-up period 15 months). Among the 36 myelopathic patients, 22 completely recovered neurologically; five improved functionally but had some residual myelopathic symptoms; and nine stabilized. Among the 19 patients with isolated thoracic radiculopathies, 15 recovered completely and four improved moderately; no patient had worsened radicular pain. Conclusions. Thoracoscopic microdiscectomy is a reliable surgical technique that can be performed safely with excellent clinical and neurological results.

Gas-filled intradural cyst of the lumbar spine

2001 ◽  
Vol 95 (2) ◽  
pp. 257-259 ◽  
Author(s):  
Satoshi Kawaguchi ◽  
Toshihiko Yamashita ◽  
Kazunori Ida ◽  
Tatsuru Ikeda ◽  
Osamu Ohwada
Keyword(s):  
Lumbar Spine ◽  
Epidural Space ◽  
Radicular Pain ◽  
Content Type ◽  
Free Gas ◽  
Fine Print

✓ The authors describe the case of a gas-filled intradural cyst of the lumbar spine that caused radicular pain. The cyst was similar to an intervertebral vacuum disc phenomenon and the cystic gas collection resembled the features of gas-containing pseudocyst, herniated intradiscal gas, or free gas, all of which have been found in the epidural space.

Surgical correction of lumbar kyphotic deformity: posterior reduction “eggshell” osteotomy

2000 ◽  
Vol 92 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Olumide A. Danisa ◽  
Dennis Turner ◽  
William J. Richardson
Keyword(s):  
Back Pain ◽  
Thoracolumbar Spine ◽  
Cauda Equina ◽  
Surgical Correction ◽  
Kyphotic Deformity ◽  
Lumbar Region ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. Progressive kyphotic deformity of the lumbar or thoracolumbar spine may lead to back pain, cosmetic deformity, and risk of neurological compromise. The authors describe a series of patients in whom they performed a singlestage, posterior reduction (“eggshell”) osteotomy procedure to improve sagittal contour by creating lordosis within a single vertebral body. Methods. From 1995 to 1997 the authors performed 12 osteotomy procedures in 11 patients with thoracolumbar or lumbar kyphosis. Seven patients presented with iatrogenic deformity, three with deformity secondary to traumatic injury, and one patient with ankylosing spondylitis. Their mean age at time of surgery was 46.6 years (range 23–78 years). All patients suffered from back pain and were unable to stand upright, but in only one patient were neurological findings demonstrated. The mean preoperative deformity was −26° (range −90 to 0°). At 6-month follow-up examination the mean sagittal contour measured 17.5° (range −17 to 44°), indicating that the mean surgical correction was 40.1° (range 25 to 58°). All patients reported decreased back pain at follow up, and none required narcotic analgesic medication. Complications included a dense paresis that developed immediately postoperatively in a patient who was found to have residual dural compression, which was corrected by emergency decompressive surgery. One elderly patient suffered a perioperative cerebrovascular accident, and three patients suffered neurapraxia with transient muscle weakness of the quadriceps. There was one case of a dural tear. There were no deaths, and prolonged intensive care stays were not required. Conclusions. Single-level posterior reduction osteotomy provides excellent sagittal correction of kyphotic deformity in the lumbar region, with a risk of cauda equina and root and plexus compromise due to the extensive neural exposure.

Transforaminal arthroscopic decompression of lateral recess stenosis

1996 ◽  
Vol 84 (3) ◽  
pp. 462-467 ◽  
Author(s):  
Parviz Kambin ◽  
Kenneth Casey ◽  
Evan O'Brien ◽  
Linqui Zhou
Keyword(s):  
Lumbar Spine ◽  
Postoperative Morbidity ◽  
Arthroscopic Technique ◽  
Disc Space ◽  
Content Type ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Functioning Level ◽  
Fine Print

✓ The purpose of this study was to evaluate the feasibility and efficacy of arthroscopic decompression of lateral recess stenosis, determine potential associated complications, and present an alternative method to access the lateral recess of the lumbar spine. Forty patients were selected in whom the authors found clinical and computerized tomography evidence of lateral recess stenosis and sequestered foraminal herniations. All 40 were treated with a posterolateral arthroscopic technique, and 38 were available for this follow-up evaluation. A satisfactory result was obtained in 31 patients (82%). No neurovascular complications were encountered; however, other complications included an infection of the disc space in one patient and a causalgic-type pain in the involved extremity in four patients. The associated postoperative morbidity in this group of patients was minimal and resulted in rapid rehabilitation and return of patients to preoperative functioning level.

Percutaneous automated discectomy: a new method for lumbar disc removal

1987 ◽  
Vol 66 (1) ◽  
pp. 143-146 ◽  
Author(s):  
Joseph C. Maroon ◽  
Gary Onik
Keyword(s):  
Lumbar Disc ◽  
Surgical Excision ◽  
Radicular Pain ◽  
Disc Space ◽  
Content Type ◽  
A New Technique ◽  
Herniated Discs ◽  
Fine Print

✓ A new technique for percutaneous lumbar disc removal is described. The specially designed 2-mm blunt-tipped suction/cutting probe (nucleotome) is similar to the automated vitrectomy instrumentation used by ophthalmic surgeons. The procedure is performed under local anesthesia, with the patient in the prone position and with fluoroscopic guidance. The nucleotome is inserted into the appropriate disc space with specially designed instrumentation, guided by landmarks similar to those used in needle placement for chemonucleolysis. The technique has been evaluated in 20 patients with herniated discs (one at the L3-4 level and 19 at the L4-5 level) confirmed by myelography and/or computerized tomography scans after all conservative therapy for primarily radicular pain had failed. From 1 to 7 gm of disc material was removed in an average total operative time of approximately 1 hour. Eighty percent of the patients had good to excellent results in a short-term follow-up period of 6 months. Four patients subsequently required standard surgical excision of free disc fragments. No significant complications occurred. The procedure is contraindicated in patients with extruded or free fragments of disc in the spinal canal or in patients with herniations at the L5-S1 level pending development of additional instrumentation for insertion at that level. More extensive long-term studies are needed to further evaluate this procedure.

Chemonucleolysis versus discectomy: a randomized multicenter trial

1989 ◽  
Vol 70 (6) ◽  
pp. 869-875 ◽  
Author(s):  
H. August M. van Alphen ◽  
Reinder Braakman ◽  
P. Dick Bezemer ◽  
Gijs Broere ◽  
M. Willem Berfelo
Keyword(s):  
Clinical Trial ◽  
Contrast Medium ◽  
Disc Herniation ◽  
Multicenter Trial ◽  
Radicular Pain ◽  
Complication Rates ◽  
Content Type ◽  
Treatment Groups ◽  
Fine Print

✓ A randomized clinical trial was carried out to compare the results of open discectomy with those of chemonucleolysis in 151 patients suffering from a disc herniation at L4–5 or L5–S1. All patients fulfilled strict entry criteria; 78 patients underwent open discectomy and 73 were subjected to chemonucleolysis. An increase in radicular pain immediately after treatment was encountered in 16 patients (22%) in the chemonucleolysis group, as compared to none in the discectomy group. The efficacy of discectomy appeared to be definitely superior to that of chemonucleolysis. Within a follow-up period of 1 year, 18 patients (25%) required open discectomy following failed chemonucleolysis; two patients (3%) in the discectomy group needed a second operation. Open discectomy following previous chemonucleolysis was successful in only 44% of cases. Comparison of the final results of the two modes of treatment 12 months after the last intervention (including second treatment) did not reveal any significant differences. The duration of the preoperative symptoms, the level of disc herniation, and the leakage of contrast medium out of the disc appeared to be of no relevance to the final outcome. The complication rates in both treatment groups were low.

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