Subtotal Laminectomy Research Articles

Comparison of the Clinical and Radiological Outcomes of Full-Endoscopic Laminotomy and Conventional Subtotal Laminectomy for Lumbar Spinal Stenosis: A Randomized Controlled Trial.

Randomized controlled trial. The primary objective of this study was to compare the short-term clinical and radiological outcomes of full-endoscopic lumbar laminotomy (FEL) with those of subtotal lumbar laminectomy (STL) for lumbar spinal stenosis (LSS). In this prospective randomized trial a total of 52 patients were enrolled from May 2016 to September 2021 after providing written informed consent. The authors investigated 45 patients who were followed up for more than 6 months. There were significant improvements in visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores after the operation in both groups. The FEL group tended to have significantly shorter hospital stay. Interestingly, a statistically significant increase in postoperative lumbar lordosis and segmental angle was observed in the FEL group and both groups, respectively. Spondylolisthesis was exacerbated or newly developed in five of the 21 patients (24%) in the STL group. In contrast, improvement in spondylolisthesis was observed in two of the 24 patients (8%) in the FEL group. There were no complications that resulted in fatal sequelae and no significant difference in the complication rate. The clinical results of FEL were similar to those of STL. In addition, the results of FEL were superior to those of STL in terms of a decrease in the postoperative length of stay and radiologic instability, such as iatrogenic spondylolisthesis. The results of this study indicate that FEL is a comparable surgical method to STL for LSS.

Transdiscal C7 Pedicle Subtraction Osteotomy With a Strut Graft and the Correction of Sagittal and Coronal Imbalance of the Cervical Spine.

Cervical spine deformity negatively affects patients' quality of life. Pedicle subtraction osteotomy (PSO) has reported to correct cervical deformity but it is challenging and carries a significant risk of morbidity. To report transdiscal C7 PSO with a strut graft for the correction of sagittal and coronal imbalance in patients with fixed cervical deformity. After standard exposure, the spine was instrumented from C2 to T3. T1 subtotal laminectomy, and C6 to C7 total laminectomies were necessary for C7 PSO. Osteotomy was initiated with removal of C6-7 and C7-T1 facet joints to isolate C7 pedicles and identify bilateral C7/C8 roots. Bilateral C7 pediculectomies and transdiscal PSO were performed. A rectangular strut allograft was then inserted into the PSO site. The location of the strut graft was used as a fulcrum of sagittal and coronal correction. The head fixator was released and the head was extended under intraoperative neuromonitoring, and then detailed sagittal and coronal balances were controlled by compressing or distracting between the pedicle screws above and below the osteotomy. This technique was applied in 2 patients with fixed subaxial cervical deformities. Transdiscal PSO could add more amount of correction and provide the additional fusion surface. The strut graft prevented sagittal translation, foraminal narrowing, and excessive focal cord kinking during PSO. Both patients showed radiologic and clinical improvements after surgery, and no neurovascular complication occurred after the surgery. Transdiscal C7 PSO with a strut graft placement provided a safe way of correcting sagittal and coronal imbalance simultaneously and reduced neurological complication by preventing sagittal translation, foraminal narrowing and spinal cord kinking.

Preservation of the Posterior Ligaments for Preventing Postoperative Spinal Instability in Posterior Decompression of Lumbar Spinal Stenosis: Comparative Study between Port-Hole Decompression and Subtotal Laminectomy

Preservation of the Posterior Ligaments for Preventing Postoperative Spinal Instability in Posterior Decompression of Lumbar Spinal Stenosis: Comparative Study between Port-Hole Decompression and Subtotal Laminectomy

Cauda Equina Syndrome: A case study and review of the literature

Spinal pathology commonly features in physiotherapy caseloads and a detailed knowledge of the features of Cauda Equina Syndrome (CES) is essential. While CES is a rare presentation, if missed the consequences of permanent bladder, bowel and sexual dysfunction are devastating. CES has a varied presentation in terms of chronology and symptomatology, leading to difficulty in accurate diagnosis in a clinical setting. The case study of a 48 year old female who developed CES while attending physiotherapy is presented. Her subjective and physical examination findings together with her lumbar Magnetic Resonance Imaging (MRI) findings are outlined. The patient underwent an L5/S1 subtotal laminectomy and discectomy and the patient's status at eight months post-operatively is presented. A comprehensive review of the aetiology, sub-classifications and clinical features of CES is also provided.

Symptomatic adjacent segment degeneration at the L3-4 level after fusion surgery at the L4-5 level: evaluation of the risk factors and 10-year incidence.

There have been few studies on revision surgery for clinically symptomatic adjacent segment degeneration (CASD). We aimed to find the incidence of revision surgery due to CASD and to analyze the factors that affected CASD at the L3-4 level after L4-5 or L4-5-S1 level fusion surgery over a long-term follow-up period. Between January 2001 and October 2009, fusion surgeries were performed on 401 patients with spondylolisthesis at the L4-5 or L4-5-S1 level; 378 patients were followed up for a minimum of 2 years. We assessed CASD-free survival using Kaplan-Meier survival analysis. We also analyzed factors affecting the development of CASD, including sex, age, pelvic incidence, overall lordosis, segmental lordosis, lamina inclination angle, facet tropism, and the extent of disc and facet degeneration. Isthmic spondylolisthesis treated using total laminectomy or degenerative spondylolisthesis treated using subtotal laminectomy and interbody fusion (IBF) or posterolateral fusion (PLF) were also included in the risk factor analysis. The difference in disc height before and after initial surgery was also analyzed, as was inclusion of the sacrum in the fusion level. Fusion extension surgery was performed on 33 of these patients due to CASD at the L3-4 level during the follow-up period. Kaplan-Meier survival analysis indicated 3-, 5-, and 10-year disease-free survival rates of 99.20, 96.71, and 76.93 %. Statistically significant factors affecting CASD included old age, low overall lordosis, low segmental lordosis, progression of facet degeneration, total laminectomy-treated isthmic spondylolisthesis, and PLF-alone rather than IBF alone or IBF + PLF. We determined six significant factors affecting CASD development. Among these risk factors, facet degeneration, isthmic-type spondylolisthesis, and the type of fusion show higher hazard ratios and seem to be clinically more relevant than the other three factors (age, overall lordosis, and segmental lordosis).

Seizure After Laminectomy Associated with Pneumocephalus

Forty-year-old female patient was examined due to the onset of clonic seizures on the left half of the face and left arm starting a day after L4 and L5 subtotal laminectomy. In the computerized tomography, there were numerous air bubbles on the right temporal lobe, fourth ventricle and perimesencephalic region (Figure 1). After observing the intravenous administration of 10 mg diazepam did not suppress the seizures, the status was determined as partial seizure and she was given a loading dose of 20mg/kg phenytoin. In the maintenance treatment 300 mg/ day phenytoin divided into 3 doses was given. Following bed rest, hydration and close monitoring, the patient was discharged 3 days after neurological stability was achieved. There were no additional neurological symptoms in the 3-month follow-ups. Antiepileptic treatment was planned to continue for another 6 months. Pneumocephalus describes the presence of air pockets in the intracranial cavity. Spinal causes include lumbar puncture, infections, tumors, spinal traumas and surgery (1). Even though there have been multiple reports of symptomatic pneumocephalia following lumbar punction in the literature, seizure is not a common complication of it. The symptoms of pneumoscephalia are generally non-specific and varied and this possible complication should also be kept in mind to prevent severe outcomes.

Extent of Decompression and Incidence of Postoperative Epidural Hematoma Among Different Techniques of Spinal Decompression in Degenerative Lumbar Spinal Stenosis

Prospective radiographic cohort study. To study the extent of bony decompression and dural sac expansion after laminectomy (including subtotal laminectomy and laminotomy with midline resection), bilateral fenestration, and unilateral fenestration with contralateral undercutting in lumbar spinal canal stenosis. Further, to investigate differences of incidence and extent of early postoperative epidural hematoma in these approaches. There are different techniques of decompression in lumbar spinal stenosis. An overall good clinical outcome has been reported with different biomechanical consequences, but no morphometric comparative reports exist on these approaches. Using the data of a previous prospective study of 30 patients, who underwent lumbar decompression for degenerative stenosis, 49 levels treated with 3 different kinds of surgical approaches were analyzed: (1) laminectomy (including subtotal laminectomy, laminotomy with midline resection); (2) bilateral fenestration; and (3) unilateral fenestration with contralateral undercutting. In all 3 groups, the cross-sectional area of the maximum bony stenosis and dural sac compression (bony margins and dural sac expansion) were measured in each operated level before and after the operation. Occurrence of epidural hematoma and its size were noted in the 3 groups. Median postoperative bony stenosis was not significantly different in the groups, being 330 mm(2), 333.5 mm(2), and 261.5 mm(2), respectively, in groups 1, 2, and 3. There was no statistically significant difference between the median postoperative extension of dural sac areas in the 3 groups, measuring 125 mm(2), 123 mm(2), and 137 mm(2). The incidence of epidural hematoma was similar in the 3 groups. Levels where postoperative epidural hematoma was detected had larger bony decompression independent of the surgical approach compared with the whole group. Unilateral and bilateral approaches achieve a similar amount of dural sac extension by a lesser extent of bony resection in comparison with the laminectomy approach. There is a tendency of increased postoperative hematoma in approaches with greater bony decompression area.

Ossified Ligamentum Flavum causing Cervical Myelopathy.

Ossification of the ligamentum flavum (OLF) causing compressive cervical myelopathy or radiculopathy is rare. A 50-year-old male was admitted for progressive hypesthesia and paresthesia of both hands and a gradually worsening gait. MRI and CT scans demonstrated ossification of the left ligamentum flavum with dural sac and cord compression at the C5-6 level. The ossified ligamentum flavum was removed through a subtotal laminectomy and left side foraminotomy of the C5-6. Postoperatively, his gait improved remarkably and the sensory symptoms gradually resolved.

Cauda equina syndrome after spinal anesthesia in a patient with severe spinal stenosis: A case report.

Cauda equina syndrome is a well-known but rare complication of spinal anesthesia. An 80-year-old man was scheduled for both herniorrhaphy. Spinal anesthesia was performed at the L3-4 interspinous space with 0.5% hyperbaric bupivacaine 12 mg. Eight hours after anesthesia, the patient complained bilateral sensorimotor deficits of the lower extremities and peroneal region. Urinary and fecal incontinence were also observed. MRI and myelography showed severe central spinal stenosis at L3-4 and L4-5. EMG showed cauda equina syndrome. Seven weeks after the procedure, left decompressive subtotal laminectomy L2-L5 was done. The patient still complains the neuropathic pain in the both lower extremities and ambulates using a walker. The local anesthetic was injected into thecal sac between maximum stenoses, and it is likely that there was poor upward spread leading to maldistribution of local anesthetic and resultant local anesthetic toxicity.

Intradural lumbar disc herniation—Is it predictable preoperatively? A report of two cases

Intradural disc herniations are thought to be rare events, and there have been relatively few literature reports of intradural disc herniations available with regard to magnetic resonance imaging findings. The authors describe two patients with intradural lumbar disc herniations, one with and one without preoperative diagnosis, who had different postoperative outcomes. Case study The first patient underwent an extended L3 subtotal laminectomy followed by bilateral medial facetectomy and foraminotomy at L3-L4. A durotomy uncovered large disc fragments comprised of friable disc materials and end plates, after no clear disc herniation was found in the epidural space. The second patient underwent anterior lumbar interbody fusion after a preoperative diagnosis of intradural disc herniation. The first patient experienced a marked reduction of pain and progressive recovery of sensory disturbance, but neurologic examination showed right foot drop postoperatively. Two years after surgery, she can not walk without a cane because the neurologic deficit of the right ankle has shown no improvement. Two days after surgery, the second patient was allowed to ambulate with a lumbar orthosis. Neurologic examination showed no motor deficit. Twenty-one months after surgery, the patient reports minimal back pain when sitting on a chair for prolonged periods of time. Our cases highlight the importance of preoperative diagnosis in the treatment of intradural lumbar disc herniations. The potential presence of an intradural disc herniation must always be considered preoperatively on a patient whose magnetic resonance imaging study demonstrates the "hawk-beak sign" on axial imaging as well as abrupt loss of continuity of the posterior longitudinal ligament (PLL). This association results in an adequate surgical approach, thereby reducing the chance of postoperative neurologic deficit. Finally, anterior lumbar interbody fusion can be a reasonable alternative in the treatment of intradural lumbar disc herniations.