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Results for “LAMINECTOMY”

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At least 181 records · Page 10Linked to original sources

PubMed2006

Impact of intraoperative normovolemic hemodilution on transfusion requirements for 68 patients undergoing lumbar laminectomies with instrumented posterolateral fusion.

STUDY DESIGN: To determine whether the normovolemic hemodilution (NH) technique would limit postoperative homologous blood transfusion requirements in 68 patients having multilevel lumbar laminectomies (3-6 levels) with predominant 1- or 2-level instrumented fusions. OBJECTIVE: In this setting, to define postoperative homologous blood transfusion requirements using NH. SUMMARY OF BACKGROUND DATA: NH limits postoperative homologous blood transfusion requirements following various types of surgical procedures including those on the spine. METHODS: NH was used in an attempt to limit postoperative homologous transfusion requirements in 68 patients undergoing lumbar surgery. NH involves the removal of 1 to 2 U of blood replaced with crystalloid (2-4 mL per milliliter of blood harvested). Multiple variables contributing to homologous transfusion requirements were analyzed. RESULTS: Using NH, no homologous blood transfusions were required in 52 patients with a mean preoperative hematocrit of 41.3 undergoing average 3.7 level laminectomies with 1.5 level fusions. However, 16 patients with an average preoperative hematocrit of 38.5 undergoing average 4.3 level laminectomies with 1.6 level fusions required transfusion of 31 U of homologous blood after surgery. CONCLUSIONS: Using NH, 16 (23.5%) patients required 31 postoperative homologous blood transfusions. By contrast, the remaining 52 patients with similar procedures were able to avoid the use of homologous transfusion.

Adult↗

PubMed1985

Cord compression and carcinoma of the prostate: is laminectomy justified?

Metastatic carcinoma of the prostate is a common cause of spinal cord compression. In this review of 37 men who underwent laminectomy for this condition this was the first presentation of previously undiagnosed cancer in 11 (29%). One year after decompression 17 (50%) were alive. Twenty patients (59%) could walk after laminectomy. All but 8 were relieved of pain and bladder function was improved in 13 (38%). Those ambulant before laminectomy (7) and those with occult prostate cancer did particularly well. Poor results were associated with a rapid onset of paraparesis and pre-operative progression to paraplegia. A delay in diagnosis was detrimental to outcome. A high index of suspicion in patients with carcinoma of the prostate is essential so that early diagnosis can be made before paraplegia is established. Carcinoma of the prostate must always be excluded in men with cord compression of unknown aetiology.

Aged↗

PubMedDate not supplied

Healing characteristics of free and pedicle fat grafts after dorsal laminectomy and durotomy in dogs.

Dorsal laminectomy and durotomy were performed at thoracic vertebrae 12 and 13 (T12-T13) and lumbar vertebrae 1 and 2 (L1-L2) in 12 normal dogs. A free fat graft harvested from subcutaneous tissue adjacent to the incision was placed over the T12-T13 laminectomy site. A 75 X 25 X 5 mm pedicle fat graft harvested from a similar location was placed over the L1-L2 laminectomy site. Three dogs each were euthanatized at weeks 2, 4, 8, and 16. With both types of fat grafts, an initial inflammatory stage reduced the size of the graft approximately 50%. Axonal degeneration and demyelination of the spinal cord resolved by week 16. At week 16, the durotomy sites had healed, but the dura mater was adhered to the spinal cord. No difference between the grafts could be demonstrated by antemortem myelography and cerebrospinal fluid analysis. There was no demonstrable advantage to the use of pedicle fat grafts.

Adipose Tissue↗

PubMedDate not supplied

Suboccipital craniectomy, dorsal laminectomy of C1, durotomy and dural graft placement as a treatment for syringohydromyelia with cerebellar tonsil herniation in Cavalier King Charles spaniels.

OBJECTIVE: To evaluate retrospectively the efficacy of the suboccipital craniectomy and dorsal laminectomy of C1 with durotomy and placement of a dural graft for treatment of syringohydromyelia (SHM) because of cerebellar tonsil herniation in Cavalier King Charles spaniels (CKCS). This technique is used with great success in human medicine. STUDY DESIGN: Four CKCS diagnosed by Magnetic resonance imaging (MRI) of SHM because of cerebellar tonsil herniation and not responsive to medical therapy underwent a suboccipital craniectomy and dorsal laminectomy of C1 (2 dogs) and of C1 and partial C2 (2 dogs) with durotomy and placement of a dural graft. Three dogs were evaluated neurologically 24 hours, 1 month, and 3 months postoperatively and evaluations were compared with preoperative neurological examination. Repeat MRI took place 3 months postoperatively. RESULTS: Neurological examinations showed neither improvement nor progression of clinical signs 3 months postoperatively. MRI showed no regression of syrinx size 3 months postoperatively. CONCLUSION: Improvement was not seen. Given the progressive nature of the disorder, evaluation over a longer period of time is necessary to detect if progression has stopped. Some modification to the surgical technique is needed to accomplish the same results as in human medicine. A study of a larger population is needed to attain more reliable information. CLINICAL RELEVANCE: Suboccipital craniectomy and dorsal laminectomy of C1 with durotomy and placement of a dural graft is a feasible technique in CKCS, but needs some modification to accomplish the same results as in human medicine.

Animals↗

PubMed1980

Recurrent pain of a pseudotabetic variety after laminectomy for lumbar disc lesion.

A variety of pain resembling the lightning pains of tabes dorsalis is described in patients suffering from persistent sciatica, following laminectomy for lumbar disc disease. It occurs in about 13% of those complaining of post-laminectomy pain and in 5% of all those having a laminectomy for disc disease. It is associated with damage to the nerve root and may be precipitated by nerve root resection. About half the patients may get some relief from carbamazepine or clonazepam and the syndrome shows a tendency to improve gradually over three to five years.

Carbamazepine↗

PubMed1988

Neurological deterioration after laminectomy for spondylotic cervical myeloradiculopathy: the putative role of spinal cord ischaemia.

Most cases of neurological deterioration after laminectomy for cervical radiculomyelopathy occur several weeks to months postoperatively, except when there has been direct trauma to the spinal cord or nerve roots during surgery. Four patients are described who developed episodes of neurological deterioration during the postoperative recovery period that could not be attributed to direct intraoperative trauma nor to epidural haematoma or instability of the cervical spine as a consequence of laminectomy. Following laminectomy for cervical radiculomyelopathy four patients were unchanged neurologically from their pre-operative examinations, but as they were raised into the upright position for the first time following surgery focal neurological deficits referrable to the spinal cord developed. Hypotension was present in all four cases during these episodes and three of the four patients had residual central cervical cord syndromes. These cases represent the first reported instances of spinal cord ischaemia occurring with post-operative hypotensive episodes after decompression for cervical spondylosis.

Adult↗

PubMed1989

Outcome of laminectomy for civilian gunshot injuries of the terminal spinal cord and cauda equina: review of 88 cases.

Case records of 88 patients with low-velocity gunshot injuries of the terminal spinal cord and cauda equina treated by laminectomy at Cook County Hospital between 1969 and 1987 were reviewed. Sixty-one patients were operated upon within 72 hours of injury, 29 of whom (47.5%) experienced neurological improvement or pain relief. Twenty-seven patients were operated upon at a later time for associated injuries, 13 of whom (48.1%) experienced neurological improvement or pain relief. When laminectomy was delayed for more than 2 weeks, either arachnoid adhesions (15%) or occult abscesses (17%) were observed. From this review as well as from the literature, it appears that the timing of laminectomy for gunshot injuries of the thoracolumbar and lumbosacral spine is not essential to neurological recovery. It appears, however, that adequate debridement of these injuries, performed as soon as the patient is stable from any associated injuries, may help to mitigate the late sequelae of arachnoiditis, infection, and pain syndromes in the lower extremities.

Adolescent↗

PubMed2002

The effect of limited interlaminar decompression versus complete laminectomy on intrathecal volume in degenerative lumbar spinal stenosis.

INTRODUCTION: There is a controversial discussion about the adequate surgical procedure for degenerative lumbar spinal stenosis. Due to the observation that the degenerative lumbar spinal stenosis takes place predominantly at the interlaminar region on the level of the disc involving facets and bulging of the ligamentum flavum, resection of the whole lamina might not be necessary. A biomechanical study was designed to assess the effect of different decompression techniques using cadaver lumbar spine models. METHODS: Twelve cadaver spines with CT verified degenerative lumbar spinal stenosis were dissected in order to measure the volume of the dural sac at different flexion and extension angles. Each segment (L3/4, L4/5) was decompressed first by limited interlaminar decompression and second by complete laminectomy. Intrathecal volume measurements were taken initially, after limited interlaminar decompression and after complete laminectomy. RESULTS: Before surgical procedure, the cadaver spines showed an increase of the intrathecal volume in flexion and decrease in extension. After limited interlaminar decompression, there was a significant reduction of volume loss in extension. There was no significant additional reduction of volume loss in extension after complete laminectomy in comparison to limited interlaminar decompression. CONCLUSION: The results allow to conclude that limited interlaminar decompression is efficient for decompression in degenerative lumbar spinal stenosis.

Aged↗

PubMed2001

Predictors of outcome after dorsal decompressive laminectomy for degenerative lumbosacral stenosis in dogs: 69 cases (1987-1997).

OBJECTIVE: To identify predictive factors of long-term outcome after dorsal decompressive laminectomy for the treatment of degenerative lumbosacral stenosis (DLSS) in dogs. DESIGN: Retrospective study. SAMPLE POPULATION: 69 client-owned dogs. PROCEDURE: Medical records of dogs that had undergone dorsal laminectomy at North Carolina State University and the University of Tennessee between 1987 and 1997 were reviewed. Dogs with diskospondylitis, traumatic lesions, or neoplasia of the lumbosacral region were excluded. All dogs had evidence of cauda equina compression on myelography, epidurography, computed tomography, or magnetic resonance imaging, along with subsequent confirmation of the lesion at surgery. Follow-up was performed by telephone inquiries to the referring veterinarian, the owner, or both, using a detailed questionnaire. RESULTS: The outcome was excellent or good in 54 of 69 (78%) dogs over a mean follow-up period of 38+/-22 months. Five of these 54 dogs had been incontinent for a median of 2 weeks prior to surgery. Six of the 15 dogs with a poor outcome had been incontinent for a median of 8 weeks before surgery. A significant correlation was detected between the presence of urinary and fecal incontinence prior to surgery and outcome. When duration of signs was considered, urinary incontinence was the only variable that significantly affected outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Decompressive laminectomy is an effective treatment for DLSS, although dogs with urinary or fecal incontinence have a worse prognosis than dogs that are continent before surgery. Chronic urinary incontinence is a predictor of poor outcome for dogs with DLSS.

Animals↗

PubMed1976

Angiographic study of the effect of laminectomy in the presence of acute anterior epidural masses.

Laminectomies were performed in 16 monkeys to decompress simulated acute epidural masses in front of the spinal cord. When decompression restored normal arterial and venous hemodynamics, the monkeys were neurologically intact in spite of considerable mechanical distortion of the cord. When either the anterior spinal artery or the posterior spinal vein remained obstructed following laminectomy, the monkeys were paraplegic. Acute anterior epidural masses larger than 4 mm in diameter could not be adequately decompressed via the posterior approach. Only minor posterior displacement of the cord is observed following laminectomy in the presence of large anterior masses.

Angiography↗

PubMed1978

Prophylaxis of the laminectomy membrane. An experimental study in dogs.

Sixty laminectomies were performed in dogs to investigate the prevention of the laminectomy membrane and its side effects. These operations were distributed in six groups of 10, one was a control group, and in the others the bone defect was protected with different materials (Oxicel, Silastic, Dacron, methyl methacrylate, and Kiel bone graft). After a survival of 2 months, suboccipital myelography was performed, immediately after which the animals were sacrificed and the operated spinal slice obtained. The different radiographic densities of the tissues of each slice were calculated and the diverse histological nature identified by hematoxylin and eosin, periodic acid Schiff, Masson's trichrome, and Gomori's reticulin strains. Only the acrylic plastic and the Kiel bone graft prevented expansion of the scar tissue inside the spinal canal and adhesions between the dura and the cicatrical overlying muscles. Therefore, the authors suggest that a solid barrier is necessary to effectively prevent the so-called "laminectomy membrane."

Animals↗

PubMed1994

Outcome after laminectomy for lumbar spinal stenosis. Part I: Clinical correlations.

All patients who underwent decompressive lumbar laminectomy in the Washtenaw County, Michigan metropolitan area during a 7-year period were studied for the purpose of defining long-term outcome, clinical correlations, and the need for subsequent fusion. Outcome was determined by questionnaire and physical examination from a cohort of 119 patients with an average follow-up evaluation interval of 4.6 years. Patients graded their outcome as much improved (37%), somewhat improved (29%), unchanged (17%), somewhat worse (5%), and much worse (12%) compared to their condition before surgery. Poor outcome correlated with the need for additional surgery, but there were few additional significant correlations. No patient had a lumbar fusion during the study interval. The outcome after laminectomy was found to be less favorable than previously reported, based on a patient questionnaire administered to an unbiased patient population. Further randomized, controlled trials are therefore necessary to determine the efficacy of lumbar fusion as an adjunct to decompressive lumbar laminectomy.

Adult↗

PubMed1994

Outcome after laminectomy for lumbar spinal stenosis. Part II: Radiographic changes and clinical correlations.

The pre- and postoperative lumbar spine radiographs of 119 patients who underwent decompressive lumbar laminectomy were studied to evaluate radiographic changes and to correlate them with clinical outcome. An accurate and reproducible method was used for measuring pre- and postoperative radiographs that were separated by an average interval of 4.6 years. Levels of the spine that underwent laminectomy showed greater change in spondylolisthesis, disc space angle, and disc space height than unoperated levels. Outcome correlated with radiographic changes at operated and unoperated levels. This study demonstrates that radiographic changes are greater at operated than at unoperated levels and that some postoperative symptoms do correlate with these changes. Lumbar fusion should be considered in some patients who undergo decompressive laminectomy. The efficacy of and unequivocal indications for lumbar fusion can only be determined from randomized, prospective, controlled trials, however, and these studies have not yet been undertaken.

Age Factors↗

PubMed2000

Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy.

OBJECT: The authors undertook a study to explore the predisposing risk factors, frequency of occurrence, and clinical implications of kyphosis following laminectomy for cervical spondylotic myelopathy (CSM). METHODS: Preoperative radiological studies were available in 46 patients with CSM who had undergone laminectomy. Records were reviewed to obtain demographic data and operative reports. Preoperative radiographs were assessed to determine spinal alignment. In a follow-up interview the authors established clinical outcome and patient satisfaction. Postoperative cervical alignment and mobility was also determined by assessing lateral neutral, flexion, and extension x-ray films. Preoperatively, the cervical spine was shown to be kyphotic in four (9%) of 46, straight in 20 (43%) of 46, and lordotic in 22 (48%) of 46 patients. Nine (21%) of 42 patients with either straight or lordotic alignment demonstrated in the preoperative period developed kyphosis after surgery. Kyphosis developed in six (30%) of 20 patients in whom straight spinal alignment was demonstrated preoperatively and in only three (14%) of 22 patients in whom lordosis was found preoperatively. Clinically, 13 (29%) of 45 patients improved and 19 (42%) of 45 remained unchanged after an average 4-year follow-up period; 36 (80%) patients believed that their surgery was successful (one patient, who was mentally retarded, could not respond to the follow-up questionnaire). Spinal alignment was not predictive of outcome; cervical mobility as demonstrated on flexion and extension, however, correlated with improved functional performance (p = 0.005). CONCLUSIONS: Kyphosis may develop in up to 21% of patients who have undergone laminectomy for CSM. Progression of the deformity appears to be more than twice as likely if preoperative radiological studies demonstrate a straight spine. In this study, clinical outcome did not correlate with either pre- or postoperative sagittal alignment.

Cervical Vertebrae↗

PubMed2005

Endoscopic partial laminectomy for cervical myelopathy.

OBJECT: The authors report the results of endoscopic partial laminectomy performed in 10 patients with degenerative cervical compressive myelopathy. METHODS: Endoscopic partial laminectomy was performed safely in 10 patients with cervical myelopathy. All of the patients experienced symptomatic improvement with slight postoperative wound pain. The mean operative duration was 164+/-35 minutes and the mean intraoperative blood loss was 45.5+/-27 ml. CONCLUSIONS: Endoscopic partial laminectomy may be used as a minimally invasive alternative for the treatment of cervical compressive myelopathy.

Adult↗

PubMed2005

Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy.

OBJECT: Recently, limited decompression procedures have been proposed in the treatment of lumbar stenosis. The authors undertook a prospective study to compare the safety and outcome of unilateral and bilateral laminotomy with laminectomy. METHODS: One hundred twenty consecutive patients with 207 levels of lumbar stenosis without herniated discs or instability were randomized to three treatment groups (bilateral laminotomy [Group 1], unilateral laminotomy [Group 2], and laminectomy [Group 3]). Perioperative parameters and complications were documented. Symptoms and scores, such as visual analog scale (VAS), Roland-Morris Scale, Short Form-36 (SF-36), and patient satisfaction were assessed preoperatively and at 3, 6, and 12 months after surgery. Adequate decompression was achieved in all patients. The overall complication rate was lowest in patients who had undergone bilateral laminotomy (Group 1). The minimum follow up of 12 months was obtained in 94% of patients. Residual pain was lowest in Group 1 (VAS score 2.3 +/- 2.4 and 4 +/- 1 in Group 3; p < 0.05 and 3.6 +/- 2.7 in Group 2; p < 0.05). The Roland-Morris Scale score improved from 17 +/- 4.3 before surgery to 8.1 +/- 7, 8.5 +/- 7.3, and 10.9 +/- 7.5 (Groups 1-3, respectively; p < 0.001 compared with preoperative) corresponding to a dramatic increase in walking distance. Examination of SF-36 scores demonstrated marked improvement, most pronounced in Group 1. The number of repeated operations did not differ among groups. Patient satisfaction was significantly superior in Group 1, with 3, 27, and 26% of patients unsatisfied (in Groups 1, 2, and 3, respectively; p < 0.01). CONCLUSIONS: Bilateral and unilateral laminotomy allowed adequate and safe decompression of lumbar stenosis, resulted in a highly significant reduction of symptoms and disability, and improved health-related quality of life. Outcome after unilateral laminotomy was comparable with that after laminectomy. In most outcome parameters, bilateral laminotomy was associated with a significant benefit and thus constitutes a promising treatment alternative.

Aged↗

PubMed2004

Transient paraparesis after laminectomy in a patient with multi-level ossification of the spinal ligament.

Acute neurologic deterioration is not a rare event in the surgical decompression for thoracic spinal stenosis. We report a case of transient paraparesis after decompressive laminectomy in a 50-yr-old male patient with multi-level thoracic ossification of the ligamentum flavum and cervical ossification of the posterior longitudinal ligament. Decompressive laminectomy from T9 to T11 was performed without gross neurological improvement. Two weeks after the first operation, laminoplasty from C4 to C6 and additional decompressive laminectomies of T3, T4, T6, and T8 were performed. Paraparesis developed 3 hr after the second operation, which recovered spontaneously 5 hr thereafter. CT and MRI were immediately performed, but there were no corresponding lesions. Vascular compromise of the borderlines of the arterial supply by microthrombi might be responsible for the paraparesis.

Cervical Vertebrae↗

PubMed1999

Cervical myelopathy due to dynamic compression by the laminectomy membrane: dynamic MR imaging study.

Dynamic magnetic resonance (MR) imaging is useful in assessing delayed neurologic deterioration after multilevel cervical laminectomy. The authors report a case of a 75-year-old woman who deteriorated 24 years after a C4-C7 laminectomy. When the extension MR demonstrated marked spinal cord compression attributable to a laminectomy membrane, the patient had an anterior diskectomy and fusion performed, after which she demonstrated significant neurologic improvement. In this and other cases, the dynamic MR may be a useful tool in discerning the etiology of the delayed neurologic changes occurring in postoperative patients.

Aged↗