Spinal stenosis.
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Decompression, Surgical↗
Biomedical subjects
S Mirkovic
Publications and source records attributed to S Mirkovic.
Lymphatic drainage after lumbar surgery.
STUDY DESIGN: A case report of lymphatic drainage after anterior retroperitoneal debridement and reconstruction for lumbar osteomyelitis. OBJECTIVES: To report a case of protracted lymphatic drainage after anterior lumbar surgery, a complication that has not been reported previously. SUMMARY OF BACKGROUND DATA: Lymphatic drainage after transthoracic surgery is a well-recognized complication. The possibility of lymphatic drainage after anterior lumbar surgery is less likely to be considered. METHODS: The cause, clinical symptoms and appearance, treatment, and differential diagnosis are reviewed. RESULTS: Lymphangiography is useful in diagnosis and should be performed early if the diagnosis is in doubt. Percutaneous drainage can facilitate early wound healing. CONCLUSION: Lymphatic drainage should be considered in the differential diagnosis of postoperative wound drainage, particularly after surgical debridement for osteomyelitis.
Adult↗
Results of operative treatment of idiopathic scoliosis in adults.
We compared the results in eighty-one patients (average age, fifty-six years; range, forty-three to eighty-three years) who had had operative treatment of idiopathic scoliosis with those in thirty patients (average age, fifty-eight years; range, forty-five to seventy years) who had declined operative treatment. Seventy-six individuals (average age, forty-eight years; range, thirty-five to seventy-four years) who did not have scoliosis served as a control group. The average duration of follow-up was five years (range, two to seventeen years). The population base consisted of 454 patients who were seen between 1970 and 1985. The treated patients were drawn from a group of 160 patients for whom an operation had been recommended; 110 patients agreed to the operation and fifty refused. The remaining 294 patients had curves of insufficient severity to warrant concern about progression, had symptoms unrelated to the scoliosis, or had curves that did not necessitate any intervention. The functional status since the operation (for the treated patients), since recommendation of the operation (for the untreated patients), or within the last ten years (for the control group) was evaluated with a comprehensive questionnaire designed to elicit details regarding pain, fatigue, and any disability in the performance of twenty-six activities of daily living. At the most recent follow-up examination, the treated patients reported a significantly greater decrease in pain and fatigue and significantly more improvement in self-image and in the ability to perform physical, functional, and positional tasks than did the untreated patients (p = 0.0001).
Activities of Daily Living↗
Spinal stenosis: indications for laminectomy.
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Aged↗
Spinal stenosis: history and physical examination.
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Disease Progression↗
A thoracolumbar epidural hematoma simulating a disc syndrome.
Epidural hematoma, a rare entity, may occur spontaneously, although a factor such as anticoagulation therapy is more frequently the cause. Epidural hematomas most commonly manifest with pain and neurologic deficit. Only six cases of lumbar hematoma simulating a herniated disc syndrome have been reported in the literature. In this article a thorough knowledge of the natural history and the differential diagnosis of disc disease as well as the importance of a complete physical examination are emphasized. Sagittal MRI imaging, as shown here, has proved to be an important adjunct in the evaluation of multilevel spinal disorders.
Diagnosis, Differential↗
Pathophysiology of spinal stenosis.
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Collagen↗
Anatomic consideration for sacral screw placement.
Instrumentation of the lumbosacral spine increasingly involves screw fixation to the sacrum. Recommended locations and techniques for screw placement vary, particularly when bicortical purchase of the sacrum is performed. The purpose of this study was to describe the critical anatomy and potential injuries to neurovascular and visceral structures anterior to the sacrum. Lack of awareness can lead to life-threatening complications. The study included 22 fresh human cadavers with no prior spinal surgery. Specimens were placed in a prone position, and the lumbosacral spine was exposed. Two 6.5-mm screws were inserted using one of two techniques, respectively: Starting just inferior to the S1 facet one screw was angled 25 degrees caudally and 30 degrees laterally; in the second technique, lateral inclination was increased to 45 degrees. In addition, all specimens had screws placed in the S2 pedicles. An anterior dissection was performed to allow evaluation of the neurovascular and visceral structures at risk for injury by, or adjacent to, the screw tips. All significant neurovascular structures in the area of concern were constant in position. The internal iliac vein and the lumbosacral nerve trunk were most at risk for injury by the 30 and 45 degrees laterally directed screws. The sigmoid colon, though close to the S2 screw, was protected by its mesentery. Screws placed in the S1 pedicle were least likely to injure the neurovascular bundle. A lateral and a midline safe zone were identified.
Aged↗
Radiographic assessment of sacral screw placement.
Sacral screw penetration of the anterior sacral cortex runs the risk of injury to neural, vascular, and visceral structures. This study examined the accuracy of the standard anteroposterior (AP) and lateral roentgenographic views as compared to a modified pelvic inlet (MPI) view in determining sacral screw penetration and angulation. Ten human cadaveric specimens were studied. Screw depth and screw angulation in the transverse plane were best evaluated with the MPI view. Screw penetration was overestimated by 0.4 mm (+/- 2.2 mm) on the MPI view, whereas the lateral view overestimated screw penetration by 2.8 mm (+/- 4.7 mm). Screw angulation in the sagittal plane could only be evaluated by the lateral view. The standard anteroposterior view provided little useful information on sacral screw orientation. To study all parameters of sacral screw placement, the radiographic series should include a modified pelvic inlet view and a lateral sacral view.
Bone Screws↗
Treatment of the isolated lumbar intervertebral disc herniation: microdiscectomy versus chemonucleolysis.
A long-term goal of spine surgeons has been to reduce the morbidity, cost, and recuperative period of primary lumbar disc surgery. In this paper, microdiscectomy and chemonucleolysis are evaluated and compared with respect to achieving these goals. Two groups of successive, noncompensation patients numbering 50 each were studied. All patients met standard clinical and imaging criteria for an isolated lumbar vertebral disk herniation. One group was treated with chemonucleolysis and the second with micodiscectomy. Average follow-up exceeded 3 years. While both treatment groups achieved the stated goal when compared with traditional laminectomy, the microdiscectomy groups demonstrated statistically superior treatment results, with reduced time to return to work, and fewer required subsequent surgical procedures.
Follow-Up Studies↗
Cerebrospinal fluid leak treated by aspiration and epidural blood patch under computed tomography guidance.
BACKGROUND AND OBJECTIVES: Cerebrospinal fluid (CSF) leakage secondary to surgery of the spine is usually treated by drainage of CSF through a subarachnoid catheter or surgical repair of the dural tear. We present 2 cases in which the pseudomeningocele was treated by aspiration of the leaked CSF and blood patch under computed tomography (CT) guidance. CASE REPORT: Two patients had headache after spine surgery. Physical examination showed a bulging accumulation of fluid at the laminectomy site. Aspiration of the fluid followed by injection of the patients' blood was performed aseptically under CT guidance. The patients had resolution of their headache, and follow-up showed no recurrence of the CSF leak. CONCLUSIONS: CSF leak secondary to a surgical tear of the dura can be successfully treated by aspiration of the fluid followed by injection of the patient's blood. CT guidance is recommended to assess the extent of the CSF leakage, determine the degree of evacuation of the leaked CSF, and to confirm the injection of the blood into the epidural space and the space created by the pseudomeningocele.
Adult↗