Biomedical subjects
Publications and source records attributed to W Jarmundowicz.
The authors discuss the tactics in the surgical approach in radical operations on the spinal cord, cauda and spine. The discussion is based on 1972 operations on the spine and spinal cord. The group of radical operations comprises 192 cases. The operative mortality in this material was 1%. The authors believe that the surgical tactics in these diseases should be considerate but also as radical as possible.
In the period 1971-1981 operations were carried out in 1114 cases of discopathy or lumbar spondylosis. Three patients in this group had pains of the type of intermittent claudication as the main symptoms. In all these cases narrowing of the vertebral canal was found in the lumbar part caused in two cases by degenerative changes and herniation of the intervertebral discs, and in a third case it was due to an extensive connective tissue scar at the site of previously done laminectomy. The nerve roots of the cauda were relieved from pressure surgically and in all cases pains disappeared. The authors discuss factors contributing to the development of neurogenic intermittent claudication.
The authors report two cases of Horton's neuralgia treated surgically. In one patient the result is very good, in the other one it is poor. The pathophysiological mechanisms and anatomical-functional basis of this type of headache are discussed stressing the contribution to the knowledge of these mechanisms made by Professor Jerzy Choróbski. It seems that more patients should be referred for this treatment that it is done presently. The operation with sectioning of this nerve is not particularly troublesome and it may be a good supplementation of pharmacological treatment.
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The authors present two cases of inoperable AVM's of thoracic spinal cord successfully treated by embolization with histoacryl glue (B. Brown Melsungen AG). The glue used for embolization is characterized by instant polymerization when comes in contact with blood. A mass of polymer is visible on X-ray thanks to contrast medium Lipiodol and metallic powder Tungsten that are added to glue and injected together with the latter. In the first case, a female who presented with paraparesis and walked only with assistance embolization performed in one session resulted in neurological improvement enabling independent walking at follow-up 2 yrs later. In the second case of a young male not walking for severe paraparesis embolization performed in three sessions resulted in significant neurological recovery. 10 days after the first session the patient became ambulatory. 6 months after treatment he presented with mild paraparesis and was still ambulatory and leading independent life. In each case embolization was performed after balloon occlusion test during which the function of spinal cord was monitored by somatosensory evoked potentials and neurological assessment.
108 patient were operated on the Neurosurgical Department of the Military Clinical Hospital in Wrocław since 1989 till 1991. The stability of the lumbar spine after hemilaminectomy and laminectomy with disc excision and interbody fusion was analysed. The period after operation ranged from 6 months to 2 years. Signs of clinical and radiological instability were the base of the study. Respective segmental motions in maximal ante- and retroflexion were calculated. Horizontal intercorporal dislocation was assessed. No signs of instability where found in the analysed material. The results after laminectomy and hemilaminectomy were similar. The failures were not caused by instability.
The purpose of the study was the assessment of the effect of compression of the spinal cord after traumatic injury on spinal microcirculation disturbances and the evaluation in what degree early decompression of the cord reduces the degree of these changes. The experimental study was carried out on 20 rabbits. The injury to the cord was produced at the Th9-Th10 level with simultaneous compression causing vertebral canal narrowing by 1/3 of its width. The assessment was based on the results of microangiographic qualitative and quantitative studies. The animals were divided into 4 groups depending on the duration of cord compression 2, 4, 6 and 12 hours. In each group microcirculation studies were done 12 hours after decompression. Prolonged compression was found to increase the extent of microcirculation disturbances, which were most pronounced after 6 hours of compression. In the group of 12-hour compression microcirculation improvement was observed near the focal lesion. It is concluded that possibly early decompression up to 6 hours after trauma can reduce the degree of secondary damage caused by ischaemia.
The analysis of early spinal cord decompression influence on the extent of morphological and microvascular changes after traumatic cord injury was the subject of this study, carried out on Polish-breed rabbits divided into two groups. Microvascular changes were evaluated in the first group of 20 animals and morphological changes in the second group of 36 rabbits. The injury causing paraplegia was performed at D9-D10 level by Allen method modified. Every group was subdivided into 4 subgroups depending on the duration of cord compression 2, 4, 6 and 12 hours. Fragments of cord were taken for examination 12 hours after decompression, from sites 0.5, 1.0 and 1.5 cm distant from the injury level. Histopathological analysis was performed by light and electron microscopy and for the analysis of microcirculation with microangiography the Górkiewicz method was used. Great changes were found in nerve fibres, vascular endothelium and microcirculation. The most pronounced lesions were found in the subgroup with 6-hour compression, in the form of haemorrhage, central necrosis and oedema within and around axona as well as destruction of myelin sheaths. Early decompression (within 6 hours) can reduce the extent of morphological and vascular changes.
The aim of this report is to present own experiences in surgical treatment of extremely rare occurring intramedullary spinal cord lipomas without spinal dysraphism. Our experience with such tumours based on 2 cases out of 15 intramedullary spinal cord tumours that were treated at our department from 1984 to 1997. The tumours were located at C4-C7 and C6-Th6 spinal cord region. The patients were 16-year-old woman and 57-year-old woman. Both patients presented with long history of progressive spinal cord damage with rapid deterioration after mild injury. The diagnosis was based on myelography in one case and on MRI in the second one. In first case the tumour was totally removed and we achieved neurological improvement. In the second case the tumour was subtotally removed and after 12 months on MR examination we found relapse of the tumour without neurological deterioration. We found two types of the tumours. The first one was well separated from the normal spinal cord and easy to remove. In the second it closely adhered to the spinal cord without possibility of total excision. The surgical treatment of intramedullary spinal cord lipomas is very difficult and dangerous but only in this way we can protect the patients from total paralysis and to improve their comfort of the life.