scholarly journals The Posterior Epidural Ligaments: A Cadaveric and Histological Investigation in the Lumbar Region

ISRN Anatomy ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
M. J. Connor ◽  
S. Nawaz ◽  
V. Prasad ◽  
S. Mahir ◽  
R. Rattan ◽  
...  
Keyword(s):  
Dura Mater ◽  
Spinal Surgery ◽  
Ligamentum Flavum ◽  
Dorsal Surface ◽  
Lumbar Region ◽  
Intraoperative Awareness ◽  
Cross Sectional ◽  
Poorly Differentiated ◽  
Lumbar Spinal ◽  
Incidental Durotomy

Purpose. Incidental durotomy is a relatively common complication for patients undergoing posterior spinal surgery. Delineating anatomical variants in the posterior lumbar spinal canal is crucial in reducing future rates of incidental durotomy. Materials and Methods. The ligamentous attachments between the dura mater and ligamentum flavum in the lumbar region of 17 soft-fixed cadavers were investigated. The lumbar vertebral columns were removed, and cross-sectional dissection was performed at levels L1-S1. Anterior retraction of the dorsal dura mater identified attachments between the dorsal surface of the dura mater and the ligamentum flavum. Histological staining of the ligamentous attachments was carried out with hematoxylin and eosin (H&E) and elastic van Gieson (EVG). Results. Posterior epidural ligaments were present in 9 (52.9%) cadavers. Nine (9) separate ligaments were identified in these cadavers, with 3 (33.3%) at L3/L4, 5 (55.5%) at L4/L5, and 1 (11.1%) at L5/S1. Histology confirmed the presence of poorly differentiated collagen-based connective tissue, distinct from the normal anatomy. Conclusions. This study confirms the presence of multiple dorsomedial posterior epidural ligaments at the main sites for posterior spinal surgery (L3-S1). An intraoperative awareness of the variability of such connections may be an important step in reducing static rates of incidental durotomy.

scholarly journals Management of CSF Leak Following Incidental Durotomy during Lumbar Spinal Surgery: Is Flat Bed Necessary?

2017 ◽  
Vol 4 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Mohamed Abdelsadig ◽  
◽  
Avinash Kumar Kanodia ◽  
Khaled Badran ◽  
Khalid Abdelsadig ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Csf Leak ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal ◽  
Incidental Durotomy

scholarly journals Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery

2009 ◽  
Vol 18 (8) ◽  
pp. 1169-1174 ◽  
Author(s):  
Brian T. Jankowitz ◽  
Dave S. Atteberry ◽  
Peter C. Gerszten ◽  
Patricia Karausky ◽  
Boyle C. Cheng ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Spinal Surgery ◽  
Cerebral Spinal Fluid ◽  
Spinal Fluid ◽  
Fluid Leakage ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal ◽  
Incidental Durotomy

scholarly journals Hypertrophy of the ligamentum flavum and expression of transforming growth factor beta

2017 ◽  
Vol 45 (6) ◽  
pp. 2036-2041 ◽  
Author(s):  
Aierken Amudong ◽  
Aikeremujiang Muheremu ◽  
Tuerhongjiang Abudourexiti
Keyword(s):  
Growth Factor ◽  
Transforming Growth Factor Beta ◽  
Transforming Growth Factor ◽  
Ligamentum Flavum ◽  
Inflammatory Cells ◽  
Lumbar Region ◽  
Cellular Apoptosis ◽  
Growth Factor Beta ◽  
Immunohistochemical Studies ◽  
Lumbar Spinal

Objective To explore the relationship between cellular apoptosis and hypertrophy of the ligamentum flavum in the lumbar region. Methods Thirty patients with lumbar spinal stenosis were evaluated. Hypertrophy of the ligamentum flavum was present in 15 patients and absent in 15. Hematoxylin–eosin staining and transforming growth factor beta (TGF-β) immunohistochemical testing were applied to compare these two groups. Results Derangement of fibrous alignment, fibrocartilage changes, and infiltration of inflammatory cells were observed in the patients with hypertrophy of the ligamentum flavum, while fibrous alignment was normal and few inflammatory cells were observed in patients without hypertrophy. Immunohistochemical studies showed positive expression of TGF-β in patients with hypertrophy, while expression was negative in patients without hypertrophy. The integrated optical density was 2.6556708 in the hypertrophy group and 23104671 in the normal controls. Conclusions Expression of TGF-β was closely related to hypertrophy of the ligamentum flavum. Appropriate application of the TGF-β expression level can be used to predict progression of hypertrophy of the ligamentum flavum.

scholarly journals Awareness About Spinal Anaesthesia Among Dental Students

2020 ◽  
Vol 11 (SPL3) ◽  
pp. 1065-1068
Author(s):  
Nithyanandham Masilamani ◽  
Dhanraj Ganapathy
Keyword(s):  
College Students ◽  
Spinal Cord ◽  
Spinal Anaesthesia ◽  
Educational Programs ◽  
Dental Students ◽  
Lumbar Region ◽  
Cross Sectional ◽  
Upper Cervical ◽  
Spinal Region ◽  
Lumbar Spinal

Spinal anaesthesia is administered in the lumbar spinal region and utilized for surgeries, including the lower midsection, pelvis and lower extremities. Spinal anaesthesia is acted in the lumbar region, explicitly the mid to low lumbar levels to maintain a strategic distance from harm to the spinal cord and furthermore to forestall intrathecally-administered drugs from having any action in the upper cervical and thoracic areas. The aim of the study is to assess the awareness about spinal anaesthesia among dental students. This was a questionnaire based cross-sectional type of study comprising 100 dental college students in Chennai. A self-designed questionnaire contains ten questions based on the knowledge and awareness about spinal anaesthesia among dental college students. Questionnaires were circulated through an online website survey planet. The questions explored the awareness on spinal anaesthesia, indications, contraindications, mechanism of administration and side complications. After the responses were received from 100 participants, data was collected and analysed.18% are aware about spinal anaesthesia. 15% are aware of the mechanism of administration of spinal anaesthesia. 13% are aware of the indications of spinal anaesthesia. 11% are aware of the contraindications of spinal anaesthesia.9%.are  aware of the complications of spinal anaesthesia. The awareness about spinal anaesthesia was less among dental students. Increased awareness and educational programs should be initiated to spread knowledge about applications of spinal anaesthesia.

scholarly journals The Role of the Ligamentum Flavum Area as a Morphological Parameter of Lumbar Central Spinal Stenosis

2017 ◽  
Vol 3 (20;3) ◽  
pp. E419-E424
Author(s):  
Jeong Hun Suh
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Ligamentum Flavum ◽  
Facet Joint ◽  
Control Group ◽  
Morphological Parameter ◽  
Roc Curve Analysis ◽  
Cross Sectional ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal

Background: Hypertrophy of the ligamentum flavum (LF) has been considered as a major cause of lumbar central spinal stenosis (LCSS). Previous studies have found that ligamentum flavum thickness (LFT) is correlated with aging, disc degeneration, and lumbar spinal stenosis. However, hypertrophy is different from thickness. Thus, to evaluate hypertrophy of the whole LF, we devised a new morphological parameter, called the ligamentum flavum area (LFA). Objectives: We hypothesized that the LFA is a key morphologic parameter in the diagnosis of LCSS. Study Design: Retrospective observational study. Setting: The single center study in Seoul, Republic of Korea. Methods: LF samples were collected from 166 patients with LCSS, and from 167 controls who underwent lumbar magnetic resonance imaging (MRI) as part of a routine medical examination. T1- weighted axial MR imageswere acquired at the facet joint level from individual patients. We measured the LFA and LFT at the L4-L5 intervertebral level on MRI using a picture archiving and communications system. The LFA was measured as the cross-sectional area of the whole LF at the L4-L5 stenotic level. The LFT was measured by drawing a line along the side of the ligament facing the spinal canal and along the laminar side of the ligament curve and then measuring the thickest point at the L4-L5 level. Results: The average LFA was 96.56 ± 30.74 mm2 in the control group and 132.69 ± 32.68 mm2 in the LCSS group. The average LFT was 3.61 ± 0.72 mm in the control group and 4.24 ± 0.97 mm in the LCSS group. LCSS patients had significantly higher LFA (P < 0.001) and LFT (P < 0.001). Regarding the validity of both LFA and LFT as predictors of LCSS, Receiver Operator Characteristics (ROC) curve analysis showed that the best cut-off point for the LFA was 105.90 mm2 , with 80.1% sensitivity, 76.0% specificity, and area under the curve (AUC) of 0.83 (95% CI, 0.78 – 0.87). The best cut off-point of the LFT was 3.74 mm, with 70.5% sensitivity, 66.5% specificity, and AUC of 0.72 (95% CI, 0.66 – 0.77). Limitations: The principal methodological limitation was the retrospective observational nature. Anatomically, degenerative lumbar spinal stenosis can involve the central canal, foramina, and lateral recess. However, we focused on LCSS only. Conclusions: Although the LFT and LFA were both significantly associated with LCSS, the LFA was a more sensitive measurement parameter. Thus, to evaluate LCSS patients, the treating doctor should more carefully analyze the LFA than LFT. Institutional Review Board (IRB) approval number: S2015-1328-0001 Key words: Ligamentum flavum, ligamentum flavum area, ligamentum flavum thickness, lumbar central spinal stenosis, hypertrophy of the ligamentum flavum, morphological parameter, crosssectional area, optimal cut-off point

Vertebral Body Hounsfield Units as a Predictor of Incidental Durotomy in Primary Lumbar Spinal Surgery

Spine ◽  
2014 ◽  
Vol 39 (9) ◽  
pp. E593-E598 ◽  
Author(s):  
Jerry Y. Du ◽  
Alexander Aichmair ◽  
Haruki Ueda ◽  
Federico P. Girardi ◽  
Frank P. Cammisa ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Spinal Surgery ◽  
Hounsfield Units ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal ◽  
Incidental Durotomy

Correlation of axial loaded magnetic resonance imaging with clinical symptoms in lumbar spinal canal stenosis patients

MedPharmRes ◽  
2019 ◽  
Vol 2 (4) ◽  
pp. 15-19
Author(s):  
Son Nguyen ◽  
Son Vi ◽  
Hoat Luu ◽  
Toan Do
Keyword(s):  
Spinal Canal ◽  
Clinical Symptoms ◽  
Axial Loading ◽  
Spinal Canal Stenosis ◽  
Leg Pain ◽  
Cross Sectional ◽  
Canal Stenosis ◽  
Conventional Mri ◽  
Frame System ◽  
Lumbar Spinal

There are cases when symptoms are available but no abnormal stenosis is found in MRI and vice versa. Axial-loaded MRI has been shown that it can demonstrate more accurately the real status of spinal canal stenosis than conventional MRI. This is the first time we applied a new system that we have recreated from the original loading frame system in order to fit with the demands of Vietnamese people. Sixty-two patients were selected from Phu Tho Hospital in Phu Tho Province, Vietnam, who fulfilled the inclusion criteria. The Anterior-posterior diameter (APD), Dura Cross-sectional Area (DSCA) in conventional MRI and axial loaded MRI, and changes in APD and DCSA were determined at the single most constricted intervertebral level. The APD and DCSA in axial loaded MRI had very good significant correlations with VAS for back pain (rs=0.83, 0.79), leg pain (rs=0.69, 0.57) and JOA score (rs=0.70, 0.65). APD and DCSA in axial loaded MRI significantly correlated with the severity of symptoms. Our axial loading MRI provides more valuable information than the conventional MRI for assessing patients with LSCS.

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