Narrowing Of Lumbar Spinal Canal Research Articles

Outcome of decompressive operative procedure in the treatment of degenerative lumbar spinal canal stenosis: experience of managing consecutive 25 cases

Background: Lumbar spinal canal stenosis (LSCS) is a common medical disorder due to degenerative changesin the middle age and older individual. In this condition, narrowing of lumbar spinal canal and nerve rootcanal leads to painful, debilitating compression of spinal nerves and blood vessels. Decompressive surgery inlumbar spinal canal stenosis is one of modern methods of treatment.The objective of this study was to evaluate the outcome of decompressive operative management in degenerativelumbar spinal canal stenosis.
 Methods: Thiswas a prospective interventional study carried out at National Institute of Traumatology andOrthopaedic Rehabilitation (NITOR) and City Hospital, Lalmatia, Dhaka from October 2012 to December2014.Total number of patients were 25 who underwent decompressive surgical procedures. Each of patientswas evaluated by the visual analogue scale (VAS) for pain, disability by using Oswestry disability index (ODI)and ModifiedMacnab Criteria (MMC)for assessment of improvement.
 Results: This was a prospective interventional study carried out at National Institute Of Traumatology and OrthopaedicRehabilitation (NITOR) and City hospital, Lalmatia, Dhaka from October 2012 to December 2014. Out of 25patients, 19 patients(76%)were male and 6 patients (24%) were female, age ranged from 38-65 years with the meanage 48.50 ± 8.65 years. Sixteen (64%) patients were manual worker and 9 patients (36%) were sedentary worker.Sixteen (64%) patients had multilevel stenosis and 9 patients (36%) had single level stenosis. The mean follow upduration was 1.5 years (range: 1-3 years). Mean estimated blood loss was 150ml (range : 100-200ml), meansurgery time was 130mutes (range: 80-180min) and average hospital stay was 7 days (range: 4-10 days). Only 1patient (4%) had discitis, 1 patient (4%) had superficial wound infection and 1 patient (4%) had dural tear. AsMMC, 21 (84%) patients was poor before operation and after operation at 12 months follow up 8 patients (32%)had excellent, 12 patients (48%) had good, 4 patients (16%) had fair and 1 patient (4%) had poor functionaloutcome. Mean (SD) ODI were 75.40 (± 5.01) before operation and reduced to 8.36 (± 13.54) after operation at 3rd(12 month) follow up. Mean (SD) VAS was 7.12 (± 0.86) before operation and reduced to 1.46 (± 1.31) afteroperation at 3rd (12 month) follow up. Twenty (80%) patients had satisfactory functional outcome.
 Conclusion: Decompressive operation is an effective, safe and acceptable method of treatment in degenerativelumbar spinal canal stenosis (LSCS).
 Birdem Med J 2020; 10(2): 103-107

A novel MRI classification system for congenital functional lumbar spinal stenosis predicts the risk for tandem cervical spinal stenosis.

The purpose of this study was to develop a simple and clinically useful morphological classification system for congenital lumbar spinal stenosis using sagittal MRI, allowing clinicians to recognize patterns of lumbar congenital stenosis quickly and be able to screen these patients for tandem cervical stenosis. Forty-four subjects with an MRI of both the cervical and lumbar spine were included. On the lumbar spine MRI, the sagittal canal morphology was classified as one of three types: Type I normal, Type II partially narrow, Type III globally narrow. For the cervical spine, the Torg-Pavlov ratio on X-ray and the cervical spinal canal width on MRI were measured. Kruskal-Wallis analysis was done to determine if there was a relationship between the sagittal morphology of the lumbar spinal canal and the presence of cervical spinal stenosis. Subjects with a type III globally narrow lumbar spinal canal had a significantly lower cervical Torg-Pavlov ratio and smaller cervical spinal canal width than those with a type I normal lumbar spinal canal. A type III lumbar spinal canal is a globally narrow canal characterized by a lack of spinal fluid around the conus. This was defined as "functional lumbar spinal stenosis" and is associated with an increased incidence of tandem cervical spinal stenosis.

Can High Dose Metamizol Medication Contribute to Postsurgical Hemorrhage:A Case Report

The use of metamizol significantly increased in the last decade, especially in non US countries [1]. Although metamizol is known to be a non selective COX inhibitor and therefore has platelet inhibiting potential, it is widely used in pain management in postsurgical setting. Methods: We present a case of bleeding after microsurgical decompression of a narrow lumbar spinal canal. Our patient developed a bleeding complication 3 days after the surgery. The bleeding spontaneously resolved after stopping the application of metamizol. Metamizol is a non selective COX inhibitor and is used as standard analgetic drug after surgery in our department, whereas other COX inhibitors are not. We made an intensive literature research to evaluate the prohaemorrhagic potential of metamizol. Metamizol has proven dose dependent platelet inhibiting effect. Conclusions: This is a quite ordinary case and there is no proof of metamizol being responsible for the bleeding in this case, it still poses questions at our daily routine and the question about a dose dependent clinically relevant prohaemorrhagic effect of metamizol remains unanswered. A proper study is needed.

Klinik und Therapie der Claudicatio spinalis bei Spinalkanalstenosen

Die Claudicatio spinalis ist ein Beschwerdekomplex, dessen Ursache in aller Regel aus dem Bild des engen Spinalkanals entspringt. Die Spinalkanalstenose (SKS) entsteht sekundär auf dem Boden degenerativer Veränderungen mit konsekutiven osteoarthrotischen Verdickungen und Kantenausziehungen der kleinen Wirbelgelenke, aber auch der Ligg. flava mit Kompression der neuralen Strukturen. Häufig finden sich begleitend Bandscheibenvorwölbungen und segmentale Instabilitäten bis hin zu manifesten Pseudospondylolisthesen. Die Beurteilung der Behandlungsmöglichkeiten erfolgt klinisch, da die angefertigte Schnittbildgebung zwar die klinische Diagnose untermauern kann, der radiologische Befund des engen Spinalkanals jedoch nicht hinreichend mit dem Ausmaß der Beschwerden korreliert. Die Patienten leiden unter belastungsabhängigen Beschwerden, wobei Beinschmerzen mit rasch remittierenden neurologischen Symptomen oder Rückenschmerzen im Vordergrund stehen oder sich die Waage halten können. Sofern die konservative Behandlung erfolglos bleibt, der Patient regelhaft einen Schmerz von mehr als 4 Punkten der VAS und eine Gehstrecke von unter 500 m angibt, ist die Operationsindikation legitim, bei Vorliegen von manifesten neurologischen Defiziten auch frühzeitig zu erwägen und bei einer Kaudasymptomatik absolut und dringlich. Die Ergebnisse der operativen Dekompression der SKS sind subjektiv wie objektiv ermutigend bei niedrigen Komplikationsraten. Auch ältere Patienten können unter Berücksichtigung der allgemeinen Operabilität nach einem Eingriff eine erhebliche Besserung der Mobilität erfahren und somit alleinversorgend bleiben.

Postnatal Paraparesis following Epidural Analgesia and Forceps Delivery

Summary A case of temporary postnatal paraparesis following epidural analgesia and Kielland's forceps delivery is described. The patient was found to have a narrow lumbar spinal canal on X-ray. The possible causes of the paraparesis are discussed.

Fibrodysplasia ossificans progressiva.

Three hundred fifty-three previously reported cases of fibrodysplasia ossificans progressiva were reviewed and six new cases were analyzed radiologically. Characteristic findings of fibrodysplasia ossificans progressiva were confirmed and radiographic signs of the disease were demonstrated, including medial cortical thickening of the proximal tibia, narrow lumbar spinal canal, accessory epiphysis of the second phalanx of the fifth finger, and decreased humeral/epicondylar angle.

Spinal Stenosis

This is a report of 7 cases of narrow lumbar spinal canal syndrome encountered in 7 patients in a community hospital in one year. Nerve compression occurred from pressure from enlarged posterior elements. Although the clinical manifestations were unspecific, the lumbar spine radiographs and myelographic features are quite characteristic. Supported by myelography and/or operative findings, surgical management consisted of decompression laminectomy at multiple levels, together with diskectomy at the appropriate levels. The interim results observed at one year follow-up examination were excellent.

The Narrow Lumbar Spinal Canal or Lumbar Spinal Stenosis

Narrow lumbar spinal canal or lumbar spinal stenosis is a not uncommon problem. Thirty-two patients with this disorder have been treated surgically at the Ochsner Medical Center between 1963 and 1973. The best method of diagnosis is a careful history and second is roentgenographic evidence, particularly the myelogram. The surgical treatment consists of total laminectomy and foraminotomy to insure complete decompression of the nerve roots. Eighteen patients have been followed from 14 to 44 months. Sixteen of the 18 considered their operations a success.

Cauda equina compression in acromegaly.

Back pain as well as neurological symptoms and signs may occur in patients with acromegaly simulating a herniated intervertebral disk. Although myelography demonstrates an extradural defect or even complete extradural block, cauda equina compression is found to be secondary to soft-tissue and bony overgrowth superimposed on a narrow lumbar spinal canal.

The narrow lumbar spinal canal syndrome.

The narrow lumbar spinal canal syndrome is characterized by (a) constriction of the interpediculate and anteroposterior diameters of the bony canal, (b) thickening and vertical orientation of the laminae as well as thickening of the facets and pedicles, (c) difficult, often markedly uncomfortable lumbar puncture, (d) prominence of the defects caused by relatively small extradural lesions, with varying degrees of obstruction, and (e) sharp delineation of the nerve roots of the cauda equina. The “cauda equina syndrome” and intermittent neurogenic claudication may be observed. Thirty-three cases are reviewed, with emphasis on diagnostic criteria, myelographic appearance, and clinical aspects.

THE NARROW LUMBAR CANAL

The syndromes associated with a narrow lumbar spinal canal are described and discussed. In thirteen cases two main groups were evident, the larger group having mainly backache and root pain, the smaller group having intermittent claudication. A method of recognising the narrow spinal canal on plain radiographs is described, and a comparison made with normal controls. The findings at operation are reported and the importance is emphasised of making a wide laminectomy for decompression. Our thanks are due to the neurosurgeons of the South-West Neurosurgical Unit, Mr G. L. Alexander, Mr D. G. Phillips and Mr A. Hulme, who kindly allowed us full use of their clinical notes. We would also like to thank Mr G. Banham for the reproductions, Mr E. Turnbull for the drawing and the secretarial staff for their patient co-operation.