Severe Spinal Stenosis Research Articles

Gd-DTPA enhanced MR of the lumbar spinal canal in patients with claudication.

The purpose of this work was to study the findings on intravenous gadolinium-enhanced MRI of the lumbar spinal canal in patients with clinically suspected neurogenic claudication. A prospective gadolinium-enhanced MR evaluation of seven adult patients presenting with clinical claudication thought to be related to the lumbosacral spine was undertaken. Of seven consecutive enhanced conventional SE MRI examinations of the lumbosacral spine in patients presenting with lower extremity claudication, five patients (71.4%) revealed abnormal intrathecal enhancement on MR at and extending craniad from the level(s) of severe spinal stenosis. Each of the seven patients (100%) showed relatively severe central stenosis of the lumbar spinal canal. The enhancement pattern was linear, curvilinear, punctate, and/or diffuse in configuration. Two of the five patients with intrathecal enhancement also showed similar abnormal intrathecal enhancement extending caudal to the severely stenotic levels. The clinically significant intrathecal enhancement on intravenous gadolinium-enhanced MRI identified above the level of a severely stenotic lumbar spinal canal hypothetically might represent enhancement of dilated, obstructed venous structures serving the cauda equina. More likely, however, the major factor in such enhancement at, above, and/or below the stenosis signals blood-nerve barrier breakdown associated with mechanical injury, inflammatory response, and wallerian degeneration/regeneration of axons within chronically compressed nerve roots.

Redundant nerve roots of the cauda equina caused by lumbar spinal canal stenosis.

To investigate pathogenesis of redundant nerve roots of the cauda equina, which were concomitant with severe lumbar spinal canal stenosis, six cadavers were examined anatomically and histopathologically, and quantitative analysis of nerve fibers was performed. In this anatomic study, it was observed that all the redundant nerve roots passed through the constriction of the spinal canal. No significant pathologic change was detected in the spinal ganglia and in the spinal cords except for the posterior column, in which dorsal redundant roots were entering. Redundant nerve roots of unequal length also were observed in the anatomic study. The spatial distribution of redundant nerve roots and the extent of degeneration of nerve fibers in them were established by these histopathologic and quantitative studies. These facts indicated a close causal relationship between redundant nerve roots and constriction of the spinal canal, and that the pathogenesis of redundant nerve roots was a squeezing force acting on the nerve roots at the area of spinal canal constriction.

Spinal cord injury syndrome with motor sparing in the absence of all sensation

This paper describes the anatomic basis for the unusual presentation in a spinal cord injured subject of preservation of motor power in the absence of all sensation. The patient was examined at four hours, and daily thereafter, after a motorcycle accident in which he was thrown over the handle bars. He had trace ankle dorsi and plantar flexors, but light touch, pin, position, and vibratory sensation were absent below the level of C4 bilaterally. There was no physical evidence to differentiate whether he suffered a flexion or extension injury. Cervical spine films showed no evidence of fracture or dislocation, but anterior and posterior osteophytes involving C3 to C4, C4 to C5, and C5 to C6 were present. Magnetic resonance imaging showed evidence of cervical cord edema at C3 to C4 with possible hemorrhage and severe spinal stenosis at C3 to C4 and C4 to C5. This patient received a compression injury with resulting classic anterior spinal artery syndrome. Because of his spinal stenosis with a decreased anterior-posterior (AP) diameter of the canal, the posterior circulation was also compromised. The extensive pial anastomotic network provided relative sparing of the most peripheral components of the lateral corticospinal tracts. This case report demonstrates a unique clinical picture that cannot be anatomically classified by current American Spinal Injury Association (ASIA) standards as central cord syndrome. It can be explained by the lamination of the ascending and descending tracts in relation to the vascular supply of the cervical cord in conjunction with the narrowing of the AP diameter of the canal due to spinal stenosis.

Marshall-Smith syndrome: new radiographic, clinical, and pathologic observations.

Radiographic, clinical, and histologic findings in two infants and a neonate with a syndrome of profoundly accelerated skeletal maturation included features closely resembling those of Marshall-Smith (MS) syndrome, but patients had dysmorphic ears as well as distinctive generalized skeletal abnormalities suggestive of a bone dysplasia. Among these was an instability at the craniocervical junction with severe spinal stenosis. These previously unrecognized abnormalities may represent uncommon manifestations within the spectrum of MS syndrome or indicate the existence of a separate disorder.

Quadriparesis in the Laurence-Moon-Biedl-Bardet syndrome: case report

A 36 year old patient known to suffer from the Laurence-Moon-Biedl-Bardet syndrome (LMBBS) developed spastic quadriparesis. The typical features of the syndrome, presented by this patient were polydactyly, obesity, hypogonadism, retinitis pigmentosa and relative mental retardation. Severe spinal cervical and lumbar canal stenosis imaged by plain X-rays and computerised tomography was found. Magnetic resonance imaging showed significant atrophy of the spinal cord, indicating that the cause of the quadriparesis was cervical myelopathy. The patient underwent laminoplasty with some improvement.

Severe cervical stenosis due to ossification of the posterior longitudinal ligament without neurological manifestations (“silent OPLL”)

We report a case of severe cervical spinal stenosis due to ossification of the posterior longitudinal ligament (OPLL) whose clinical examination showed no symptoms or signs of neurological damage ("silent OPLL"). Questions about the diagnosis and the treatment of silent OPLL are discussed in the light of published data.

Intra-spinal New Bone Formation and Spinal Cord Compression in Familial Hypophosphataemic Vitamin D Resistant Osteomalacia

Four patients with familial hypophosphataemic vitamin D resistant osteomalacia and spinal cord compression are reported. Three of these patients were treated by decompressive laminectomy and each made a good recovery. At surgery new bone formation in the ligamentum flavum and thickening of laminae were found to be responsible for the canal stenosis and cord compression. Two of these four patients, and 10 others were examined by computed tomography to determine the incidence, site and extent of any intra-spinal new bone formation. Facet joint hypertrophy and thickened laminae were observed at some level in all the patients, but much the most important cause of spinal canal stenosis was new bone formation in the ligamentum flavum, in the mid and lower thoracic spine, occurring at several, but mainly contiguous vertebral levels. Severe spinal canal stenosis was found in eight of the 12 patients scanned. No obvious relation was found between the presence of intra-spinal new bone formation and the clinical severity of the disease or the presence of extra-skeletal ossification in para-spinal and other sites. Computed tomography offers a simple, non-invasive technique for identifying those patients at risk of cord compression from new bone formation.

Flexed sitting maneuver for complete lumbar myelography in patients with severe spinal stenosis and apparent block.

A new technique has been designed to improve myelography examinations of the entire lumbar spinal canal in patients with severe spinal stenosis using a single needle puncture. When a high-grade obstruction to the caudal flow of contrast material is encountered, the patient is placed in a flexed sitting position for 1 minute. This technique was performed in eight patients with severe lumbar spinal stenosis. It successfully helped depict the lower lumbosacral canal below an apparently complete block in four patients and resulted in improved visualization of the lower sac in four patients with partial block.

Multiplanar ct in the evaluation of degenerative spondylolisthesis. A review of 150 cases

Degenerative spondylolisthesis (pseudospondylolisthesis) is a degenerative disorder of the intervertebral motion segment. It can be divided into two types: forward subluxation and backward subluxation. Forward subluxation is primarily a disease of the posterior joints and is found most commonly at L4/5. Retrolisthesis is a primary disorder of the disc space and is noted more commonly at 1–3/4. This paper reviews the CT findings in 150 patients with degenerative forward and backward subluxation. Proper evaluation of these disorders is extremely important because of the frequency of severe symptomatic spinal stenosis or foraminal encroachment.

けい部せきつい骨軟骨症（せき髄症）の術後遠隔成績に影響を及ぼす因子の検討 術後５年以上

Postoperative long-term follow-up studies were conducted on patients with cervical myelopathy. In this report the authors described the clinical and radiographic observations on 91 cases who were followed for more than 5 years. Results at the time of final follow-up were excellent in 57%, good in 28%, fair in 9%, unchanged in 3%, and worsened in 3%, indicating that satisfactory results were maintained for long period in most cases. Long-term results were influenced by the factors of the age, duration of the history, results at the time of discharge, spinal canal stenosis and operative methods.Results were deteriorated in 19% of the cases and the deterioration tended to occur nearly 3 to 7 years after surgery. Radiographic examination indicated that nonunion at the level of fusion and spondylotic change at the adjacent levels of fusion appeared in some cases. However, these findings varely influenced the clinical results, except in cases with severe spinal canal stenosis.

Myelography in achondroplasia: value of a lateral C1-2 puncture and non-ionic, water-soluble contrast medium.

Because of technical difficulties and diagnostic limitations encountered with other myelographic techniques in patients with achondroplasia, the authors employed a lateral C1-2 puncture and non-ionic, water-soluble contrast medium in 18 achondroplastic patients with spinal compression (21 procedures). This technique proved most appropriate for identifying the upper limit of degenerative osteophytes causing exacerbation of congenital spinal stenosis, which is crucial in planning decompressive surgery. A potentially important additional finding was the presence of degenerative lower cervical spine disease in the majority of patients. There were no serious complications. The authors recommend this technique as safe and effective in achondroplastic patients with severe congenital spinal stenosis.

Diffuse posterior hyperostosis of the cervical spine with cord compression: A forestier (dish) variant

A patient presented with signs and symptoms of cervical spinal cord compression. Computed tomography (CT) scan showed diffuse idiopathic hyperostosis of the posterior vertebral border of C4, C5, C6, and C7 cervical vertebrae, with severe spinal stenosis at C5 and C6 level. Computed tomography scan is the single most useful instrument for demonstrating the extent of bony proliferation and severity of spinal stenosis.

Paraplegia from Operating Position and Spinal Stenosis in Non-Spinal Surgery

A 61-year-old patient with pre-existing but asymptomatic spinal stenosis was placed in the lateral position on the operating table for hip surgery. The lumbar spine was in a position of extension and lateral bend. This position, combined with severe spinal stenosis (proven later at surgery), caused enough compression on the neural elements to produce permanent paraplegia. Similar cases have been reported but remain an infrequent cause of postoperative paraplegia.

Management of critical valvular outflow obstruction in neonates.

OBJECTIVE: To present a case of metastatic esthesioneuroblastoma (ENB) involving the spine. BACKGROUND: Esthesioneuroblastoma (also known as olfactory neuroblastoma) is a rare malignancy of the olfactory epithelium. Although local invasion beyond the nasal cavity and adjacent sinuses is common, distant metastases are extraordinarily rare. To date, fewer than thirty documented cases involving the spine, spinal cord, or leptomeninges have been reported. DEISGN/METHODS: Case report. Review of clinical notes, pathology, and imaging studies. RESULTS: A 67 year-old woman presented with recurrent epistaxis. Computer tomography (CT) revealed an expansile right nasal mass causing remodeling of the nasal cavity and medial orbital wall. She underwent a gross total resection and was diagnosed with ENB - Kadish Stage C (extension beyond the nasal cavity and paranasal sinuses). Post-operatively, she was treated with 59.4 Gy of radiation delivered over 33 fractions. Post treatment surveillance consisted of frequent nasal endoscopies. Twenty months after diagnosis she presented with complaints of left shoulder pain as well as lower back pain affecting her ability to walk. Neurological examination was limited by discomfort but was notable for hyperreflexia at the knees and decreased rectal tone. X-ray revealed a pathological fracture of the left humerus. Magnetic resonance imaging (MRI) of the spine showed destructive lesions at T12 and L1 with prominent extraosseous extension into the epidural and paraspinal spaces resulting in severe spinal canal stenosis, neural foraminal effacement and cord compression. CT-guided biopsy provided the diagnosis of metastatic ENB. The patient underwent a multilevel posterior laminectomy and fusion to decompress the spine. She had a full neurological recovery. CONCLUSIONS: Distant metastases from ENB are rare, but can occur despite careful surveillance for local recurrence. Patients with ENB who present with back pain should be imaged early to investigate the possibility of drop metastases. <b>Disclosure:</b> Dr. Armand has nothing to disclose. Dr. Welch has nothing to disclose.