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Results for “LAMINECTOMY”

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At least 199 records · Page 11Linked to original sources

PubMed1999

Laminectomy with posterior wiring and fusion for cervical ossification of the posterior longitudinal ligament, spondylosis, ossification of the yellow ligament, stenosis, and instability: a study of 5 patients.

Cervical laminectomy with posterior wiring and fusion is valuable for the management of cervical ossification of the posterior longitudinal ligament (OPLL), spondylosis, ossification of the yellow ligament (OYL), stenosis, and instability. Within 1.5 years, five patients averaging 73 years of age developed severe myelopathy. Dynamic radiographs confirmed an intact cervical lordosis with active subluxation and instability at one or two levels, whereas magnetic resonance and computed tomography scans showed OPLL, spondylosis, OYL, and stenosis. After multilevel laminectomy with posterior wiring and fusion and immobilization in cervicothoracic orthoses, patients fused in an average of 3.6 months. All patients improved, showing mild to moderate residual postoperative myelopathy an average of 13 months later (range, 6-19 months). With an intact cervical lordosis, laminectomy with posterior wiring and fusion was used successfully to manage five patients with OPLL, spondylosis, OYL, stenosis, and instability.

Aged↗

PubMed1975

Modified deep dorsal laminectomy in the dog.

Spinal cord compression subsequent to radical laminectomy was investigated. A modified deep dorsal laminectomy technique was devised to allow extensive exposure and decompression of the canine spinal cord without undue hazard of postoperative fibrotic spinal cord compression. A previously described laminectomy technique was modified by the addition of spinal plating to avoid the occurrence of constrictive fibrosis.

Animals↗

PubMed2004

Laminectomy and postero-lateral mass plating for multilevel cervical spondylotic myelopathy.

There are many procedures in treating patients with multilevel cervical spondylotic myelopathy (CSM). Successful treatment of multilevel CSM requires adequate decompression and stability of the cervical spine that prevents further neurological deterioration. Multilevel laminectomy and instrumentation with lateral mass plates is associated with minimal morbidity, provides excellent decompression of the spinal cord, produces immediate stability of the cervical spine, prevents kyphotic deformity, and precludes further development of spondylosis at fused levels. Neurological outcome is equal or superior to multilevel anterior procedures because of minimal complication and prevent spinal deformity associated with laminoplasty or noninstrumented laminectomy. From the study of 7 patients with multilevel CSM who were treated with multilevel laminectomy and posterolateral mass plating. The neurological outcome of all 7 patients was improved without complications after follow-up for 6 months.

Aged↗

PubMed1990

Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis.

The traditional treatment for lumbar stenosis is a wide laminectomy. This procedure has a high success rate and a low, but not insignificant, incidence of complications. Recently, however, a better understanding of the pathophysiology of spondylotic lumbar stenosis has led several authors to propose a more limited decompression directed specifically toward the offending area of compression. Over the past 5 years, we have treated 32 patients with lumbar stenosis using decompressive laminotomies. Our patients all had focal lateral recess stenosis that was diagnosed by computed tomography or magnetic resonance imaging. We performed decompressive laminotomies and foraminotomies at appropriate levels. This procedure is less disruptive than a full laminectomy and, in experienced hands, requires less operating time. At last follow-up, 90% of the patients so treated reported an excellent outcome--namely, total relief of symptoms and/or return to normal daily activities. There was no significant postoperative morbidity or mortality. We conclude that in a selected subgroup of patients with lumbar stenosis, multilevel laminotomies may be an acceptable alternative to laminectomy.

Adult↗

PubMed1989

[Effect of experimental laminectomy on the structure of neurons and conductive pathways of the spinal cord].

In 12 dogs the effect of experimental laminectomy on the structure of motor and sensitive neurons, as well as on the structure of the conductive pathways in the spine cord has been investigated. The experimental laminectomy with a subsequent durotomy results in an increase (in 1.5-5 days of the experiment) of both hyperchromatophilic and hyperchromatophobic neurons. This demonstrates their functional reconstruction (inhibitory chromophilia, inhibited activity, fatigue and exhaustion chromatophobia). Restoration of the neuronal structure and that of the spinal cord nervous fibers takes place by the end of 10 days after the experimental laminectomy with residual foci of reversible changes in the conductive pathways system.

Animals↗

PubMed1986

[Osteoplastic laminectomy using hydroxyapatite ceramic implants].

Cervical osteoplastic laminectomy using ceramic or apatite beads as implants was performed in 31 patients with symptomatic cervical bony canal stenosis. Patients with degenerative changes such as osteochondrosis or disc herniation are included in this study but those with spinal cord tumor, arachnoid cyst or ossification of the posterior longitudinal ligament are not. Initially foraminotomies were performed at the C5-8 levels in an attempt at preventing worsening of radicular signs caused by posterior displacement of the cord and resultant tethering effect on the nerve root. Connecting the medial borders of the foraminotomies, laminae were removed in a single piece. A small suboccipital craniectomy and C1-2 laminectomy were added when necessary. Laminae were replaced maintaining an increased anteroposterior diameter of the bony canal, by means of interposition of apatite or ceramic beads of appropriate size between the cut surfaces of the laminae. Results were excellent in 13 (42%), good in 10 (32%), fair in 4 (13%), no change in 2 (6.5%) and worse in 2 (6.5%). Literature on the osteoplastic laminectomy (laminoplasty) for cervical canal stenosis was reviewed and the advantage of the present method was briefly discussed.

Adult↗

PubMed1988

Biomechanical analysis of posterior instrumentation systems after decompressive laminectomy. An unstable calf-spine model.

Mechanical non-destructive cyclical testing in rotation, axial compression, and flexion were performed on twelve fresh spinal segments from calves. Each segment contained five motion segments. Each spine was destabilized with bilateral laminectomy and facetectomy of the fourth and fifth lumbar vertebrae, resection of the pars interarticularis of the fourth lumbar vertebra, and resection of the disc between the fourth and fifth lumbar vertebrae. Sequential stabilization of each spine was used to compare the stiffness of: (1) Harrington distraction instrumentation of five levels, (2) Luque rectangular instrumentation of five levels, (3) modified Steffee transpedicular notched-rod instrumentation of three and five levels, and (4) Cotrel-Dubousset transpedicular instrumentation of three and five levels with and without transverse approximating rods. This in vitro study of a calf-spine model led to three reproducible conclusions: (1) after laminectomy and discectomy, the instrumented spine was more unstable in rotation and flexion than when it was subjected to axial compressive loads; (2) the most rigid implant was the Cotrel-Dubousset transpedicular instrumentation of five vertebral levels (p less than 0.05); and (3) with the Steffee or the Cotrel-Dubousset transpedicular instrumentation of three vertebral levels, it was possible to restore torsional, compressive, and flexural rigidity to the destabilized spine of the calf. Furthermore, transpedicular fixation of only three vertebral levels provided more in vitro stability than either traditional Harrington or Luque rectangular instrumentation, which require fixation of five vertebral levels to stabilize a spine after laminectomy.

Animals↗

PubMed1987

[Experimental study on pedicle fat grafts after laminectomy: comparison of pedicle fat and free fat grafts].

Scar formation adherent to the dura and nerve roots causes recurrent symptoms following laminectomy. Free and pedicle fat grafts have been performed in low-back surgery as a preventive measure. An experimental study in rats was designed to compare pedicle fat grafts and free fat grafts after wide laminectomy, for efficacy in preventing scar formation and for effects on the spinal cord. The following results were obtained. 1) Dense scar formation over the dura and degeneration of the cord were seen at control laminectomy sites. 2) Free fat grafts, examined at 2 and 4 weeks postoperatively, showed death of portions of the graft, whereas pedicle fat grafts always demonstrated the presence of living fat. 3) At 4 months postoperatively, pedicle fat grafts were statistically superior to free fat grafts, which showed scarring over the dura and degeneration of the cord. In conclusion, pedicle fat grafts were more effective in preventing dural scar formation and protecting the cord than free fat grafts.

Adipose Tissue↗

PubMed1977

Cervical facet fusion for control of instability following laminectomy.

Cervical laminectomy may compromise the stability of the spine. Posterolateral facet fusion can be used to stabilize the spine after laminectomy and prevent progressive deformity. The procedure includes passing wires through drill holes in the articular processes and binding two longitudinal struts of bone to the posterior columns of the articular processes. Sixty-three p atients with cervical laminectomy and facet fusion were reviewed, and fifty-two of them were followed for one to seventeen years. The reasons for fusion were to control overt spinal instability and deformity or to eliminate motion which may contribute to spondylosis. Solid fusion occurred in fifty of fifty-two patients at a mean of 6.5 months and provided continuing stability without progressive deformity. Although facet fusion is a complex procedure, it provides secure stabilization, does not interfere with decompression, and permits early mobilization of the patient.

Adolescent↗

PubMed1977

Post-laminectomy kyphosis.

Post-laminectomy spinal deformity occurs in 50% of children undergoing laminectomies for cord tumors. Kyphosis is the most frequent deformity found. The integrity of the facet joints appears to be one of the most important factors in the development of this kyphosis. More children are surviving after treatment of these tumors and a pessimistic attitude is not warranted. Observation of a progressing deformity is not acceptable treatment. When kyphosis develops, early prompt bracing must be started. For a progressive or severe kyphosis, an anterior spine fusion is indicated. This is reinforced by a posterior fusion with Harrington instrumentation. Surgical reconstruction is indicated in children recovering from extensive laminectomies but with a good prognosis.

Adolescent↗

PubMed1980

[Instability and kyphosis following cervical laminectomy and occipital craniectomy in children (author's transl)].

The authors analyse the various factors of spinal instability and their respective importance in a series of 113 patients in which, either the occipital cerebellar pits or the cervical spine had been approached surgically. The essential cause was mechanical failure consecutive and related to the number of levels of laminectomies performed, even when the articular processes and their capsule were left intact. While craniectomy and ablation of the posterior arch of the Atlas was rarely, if ever, responsible for instability, the frequency rises to 25% once the Axis, the spinous processes and laminae have been removed. Instability was present in 80% of the cases in which three or more levels are involved. Moreover, cervical laminectomy was nearly always followed by instability, above all when the cervico-dorsal transitional zone was involved and even when only a small number of vertebral levels had been operated on. Location of the instability was always at the limit between the lowest level of laminectomy and the lover lying intact vertebra. Diagnosis has gone unrecognized until presently: the severity of the possible complications have led the authors to propose preventive surgical management. It this serie, an anterior vertebral bone graft was prefered. Consciousness of the risks involved should lead to better prevention, be it at the moment of neurosurgical surgery or in the follow-up period. However, preventive treatment creates several problems, which may only be solved by a currently undertaken prospective study.

Adolescent↗

PubMed1981

The management of pain following laminectomy for lumbar disc lesions.

Assessment of the results of laminectomy for lumbar disc lesions is unsatisfactory, but it seems that some degree of recurrent pain is virtually inevitable. The clinical features and incidence of the various painful syndromes seen in these patients, including one, the sacro-spinalis insertion syndrome, which has not previously been described, are outlined and the management of each is discussed with reference to two personal series, one of 98 patients consecutively undergoing laminectomy and the other of 35 patients referred because of recurrent pain following laminectomy. Finally, problems of prophylaxis are considered.

Back Pain↗

PubMedDate not supplied

Cervical spine changes following laminectomy. Clinico-radiological study.

The authors performed follow-up examinations on 84 patients who had undergone cervical laminectomy in order to relieve the pressure caused by tumors, malformations, leptomeningeal cysts and spondylarthrosis. In an attempt to quantify the post-laminectomy cervical spine changes on plain X-ray films, the authors used an original radiological grading. A clinical evaluation was made and graded either as improved, unchanged and worsened. The authors found significant clinico-radiological correlations and concluded that a neuromuscular imbalance may determine the most severe post-laminectomy cervical spine changes.

Cervical Vertebrae↗

PubMed1996

A biomechanical evaluation of internal lumbar laminoplasty: the preservation of spinal stability during laminectomy for degenerative spinal stenosis.

The long-term success of surgical management of spinal stenosis by decompressive lumbar laminectomy is predicated partly by the maintenance of intervertebral stability. Excessive bone removal, especially of the pars interarticularis, may predispose the spine to iatrogenic segmental instability and spondylolisthesis. Removal of too little bone may be inadequate to relieve stenotic or radicular symptoms. Wide decompression with concomitant arthrodesis has been advocated, but arthrodesis compounds the surgical complexity and increases the risks of surgical treatment. Internal lumbar laminoplasty obviates the problem of too little or too much bone removal in the surgical management of spinal stenosis. The spinal canal is enlarged internally by an undercutting facetectomy performed through a narrow central laminectomy. The pars interarticularis is left completely intact. Twenty five adult human cadaveric spinal units were subjected to biomechanical testing following hemilaminectomy, total laminectomy, internal laminoplasty, partial facetectomy, or disk transection and internal laminoplasty. Analysis was performed after video and computer acquisition of data from specimen testing on an Instron machine. Internal laminoplasty demonstrated more intrinsic stability than the other surgical procedures.

Biomechanical Phenomena↗

PubMed1997

New laminoplasty after thoracic and lumbar laminectomy.

We report the development of a new laminoplasty for the thoracic and lumbar spine. In this method, after two or three laminae are subjected to en bloc laminectomy using a surgical air drill, median longitudinal incisions are made in the laminae from the ventral side with a microsurgical saw and then the resected laminae are put back in place, like pitching a tent. Because fixation is accomplished with silk thread, magnetic resonance imaging is unaffected. In 39 cases in which this method was used, the spinal canal was adequately enlarged and bony union was also satisfactory starting after a mean of 4.3 months. This method is useful as a form of anatomical repair after laminectomy. Because it preserves the posterior element, it helps to prevent shrinkage of the laminectomy membrane mass and postoperative spinal column deformity.

Adolescent↗

PubMed1976

Late instability in cervical spine fractures secondary to laminectomy.

Of 256 patients with a major spinal cord injury as a result of fracture of the cervical spine, 38 per cent had a laminectomy. Three months after injury, 33 per cent of the patients with laminectomy required fusion for instability compared to 22 per cent of the nonlaminectomy group. There were no cases of late instability in pure flexion or extension fracture groups. Ninety per cent of the late instability cases were in the groups with hyperflexion and flexion compression fractures. Laminectomy should be avoided for these fractures, but early fusion may be necessary to prevent progressive deformity.

Adolescent↗

PubMed1997

[Long-term osseous changes in the posterior arch after laminectomy for lumbar stenosis].

PURPOSE OF THE STUDY: Many studies have indicated favorable results of decompressive surgery for symptomatic lumbar spinal stenosis. However, little is known about the osseous changes that occur at the operative sites. Postacchini in 1992 and Chen in 1994 have studied, only from plain radiographs, osseous changes at the operative sites, and have suggested that bone regrowth possibly affects the neurologic result. The aims of this study were: to assess bone regrowth at the operative site, to compare the bone regrowth rate calculated from plain radiographs and CT-Scan examinations, to determine the effects of bone regrowth on clinical outcome, to investigate the factors promoting the bone regrowth. MATERIAL AND METHOD: 28 patients who underwent decompressive surgery for lumbar spinal stenosis were retrospectively studied with an average follow-up of 8.4 years. In order to evaluate the degree of bone regrowth at the posterior arch, early postoperative radiographs and CT images of the operative sites were compared with those obtained at final follow-up. Bone regrowth at the sites operated upon was evaluated as a percentage of regrowth of the original laminectomy site based upon plain radiographs and CT images. RESULTS: Decompressive lumbar spinal stenosis is responsible for bone regrowth at the operative site in most patients. However, this regrowth was mild, the mean bone regrowth rate evaluated from plain radiographs was 12 per cent in average and the obtained from CT images was 8.2 per cent in average. Changes were found to be predominant at the facet joint level compared to the pedicle level. The evaluation of regrowth obtained from plain films and CT image examinations were compared. Radiographs seem to overestimate bone regrowth. Postoperative spinal instability was statistically significantly associated with new bone development. This variable was the only factor that affected the degree of bone regrowth. No relationship between bone regrowth and clinical outcome was found. DISCUSSION AND CONCLUSION: Natural course of laminectomy defect includes probably new bone formation in most patients. New bone results from gradual regrowth of the laminae and articular processes partially resected at surgery and from coalescence of islets of bone tissue within the tissue filling the laminectomy defect. In the present study bone regrowth rate was moderate but in other ones it was marked. If some factors (like postoperative destabilization) promoting bone regrowth were identified many remain unknown. Factors influencing rapidity of regrowth progression remain also unknown. Patient's intrinsic features such as spinal stenosis characteristics are probably closely related to quantitative and kinetic characteristics of regrowth. Consequences of bone regrowth are also variable: in some cases regrowth may reproduce pathological conditions identical previous ones, in other ones new bone spreads around the dura a mater without any nerves roots compression. Study of bone regrowth requires further research including prospective studies and using a more precise method for the regrowth evaluation.

Adult↗

PubMed1999

Non-endoscopic and endoscopic adhesiolysis in post-lumbar laminectomy syndrome: a one-year outcome study and cost effectiveness analysis.

Post lumbar laminectomy syndrome with its resultant chronic low back pain is estimated to occur in 20% to 50% of the patients. Among various procedures available, lysis of epidural adhesions is considered as one of the effective therapeutic modalities of management in these patients, and may be performed either non-endoscopically or endoscopically. This retrospective evaluation included 120 post lumbar laminectomy patients who underwent either non-endoscopic adhesiolysis (Group I) or endoscopic adhesiolysis (Group II) with 60 consecutive patients in each group. The quality of pain relief when greater than 50% was considered significant. Results showed all patients experienced significant relief following both procedures even though the number of patients experiencing significant relief decreased with both techniques over a time period. Overall relief with the first procedure (mean + SEM) was 12 + 3.2 weeks for Group I, and it was 20 + 2.9 weeks for Group II with significantly longer improvement in Group II than Group I. At one year follow up, the results showed that with repeat procedures, 72% in Group I and 40% in Group II experienced significant relief at 6 months, whereas at 12 months, it decreased to 52% in Group I and 22% in Group II, with a significantly greater number of patients experiencing relief at 6 months and 12 months in Group I, than Group II, even though Group I patients underwent a greater number of procedures. Cost effectiveness analysis showed Group I patients experiencing significant relief at a cost of $40 per week, with one year quality of life improvement for $2,080, whereas it was $135 per week improvement in Group II with a one year quality of life improvement at a cost of $7,020 with significant difference noted in cost effectiveness. In conclusion, non-endoscopic epidural adhesiolysis and administration of corticosteroids and hypertonic saline is a safe and cost effective procedure for relieving chronic intractable pain in post lumbar laminectomy patients who failed to respond to other modalities of treatment. Similarly, endoscopic adhesiolysis with the administration of corticosteroids is also a safe and possibly cost-effective technique for relief of chronic intractable pain failing to respond to other modalities of treatments.

Journal Article↗