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Results for “LAMINECTOMY”

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At least 253 records · Page 14Linked to original sources

PubMed1987

Side effects following metrizamide myelography and lumbar laminectomy.

A retrospective study of 50 patients was undertaken to observe the postoperative side effects experienced by patients undergoing metrizamide (Amipaque) myelography followed by laminectomy on the same day and to compare them with side effects experienced if the laminectomy was postponed at least one day. Results documented that the incidence of nausea was statistically greater in Group 1 (myelogram and surgery the same day) than in Group 2 (delayed surgery). While the occurrence of vomiting and headache in Group 1 was also greater, the numbers did not reach statistical significance. Group 1 did require significantly more doses of antiemetics for a longer period of time. The groups did not differ in the length of time an intravenous (IV) infusion was in place, but Group 1 patients required a significantly greater number of urinary catheterizations for retention and residual for longer than three days. The length of stay and the time from surgery to discharge was the same for both groups.

Adult↗

PubMed2006

Intraoperative use of ultrasonography during continuous dorsal laminectomy in two dogs with caudal cervical vertebral instability and malformation ("Wobbler syndrome").

OBJECTIVE: To describe an intraoperative ultrasound imaging technique during dorsal laminectomy in 2 dogs with caudal cervical vertebral instability and malformation (CCVIM, "Wobbler syndrome"). STUDY DESIGN: Clinical case report. SAMPLE POPULATION: Two dogs with CCVIM. RESULTS: On neurologic examination there was tetraparesis with upper motor neuron signs in the thoracic limbs and lower motor neuron signs in the pelvic limbs in dog 1, and hyperreflexia of the rear limbs, normoreflexia of the right front limb, and hyporeflexia of the left front limb of dog 2. Both dogs had signs of marked cervical pain and radiographic signs of cervical spinal cord compression. Intraoperative ultrasonography of the spinal cord revealed protruding intervertebral disc at C5-6 (dog 1) and C6-7 (dog 2), and the parallel borders of the spinal cord and central canal after decompression. Continuous dorsal laminectomy (CDL) resulted in improvement over 16 months (dog 1) and 20 months (dog 2). CONCLUSIONS: Intraoperative ultrasonographic imaging of the cervical spinal cord after CDL was helpful in determining adequate decompression (postlaminectomy) of the spinal cord in relation to the ventral and lateral compressive component(s) and to image the protruding intervertebral disc. CLINICAL RELEVANCE: Intraoperative ultrasonography can be used to provide valuable information on the spinal cord and surrounding soft tissues for the neurosurgeon.

Animals↗

PubMed1992

A comparison of hemilaminectomy (with concomitant disc fenestration) and dorsal laminectomy for the treatment of thoracolumbar disc protrusion in dogs.

The techniques of hemilaminectomy (with concomitant disc fenestration) and dorsal laminectomy were compared statistically in two groups of 30 dogs with thoracolumbar disc disease. On presentation all the dogs were unable to walk and were graded 1 to 3 according to their degree of neurological dysfunction. Nineteen had a previous history of thoracolumbar pain or hindlimb paresis. Radiography showed a narrowed disc space or extruded calcified disc material in 52 of the dogs and lumbar myelography revealed an extradural mass in 57; 24 of the dogs had clinical or myelographic lateralisation of signs. Hemilaminectomy significantly improved the ability to retrieve protruded disc material compared with dorsal laminectomy, and the removal of protruded disc material significantly improved the degree of recovery. Fenestration significantly reduced the recurrence of thoracolumbar disc disease.

Animals↗

PubMed2003

Transient postoperative neurologic deficit after lumbar laminectomy.

UNLABELLED: New neurological deficit after spinal surgery is a rare complication that requires a quick diagnostic and therapeutic approach to reduce the risk of permanent neurological disabilities. We report a patient who presented with transient neurologic deficit after surgery for lumbar disk herniation resulting from bupivacaine diffusion to either the epidural or the subarachnoid space occurring after the anesthetic infiltration of the surgical wound. Early magnetic resonance imaging excluded more serious causes of such neurological deterioration after lumbar laminectomy. This complication should be considered by the anesthesiologist in the differential diagnosis of neurological deficits after operations on the lumbar spine. IMPLICATIONS: We report a patient who presented in the recovery room with a transient neurologic deficit likely resulting from surgical injection of local anesthetic after lumbar laminectomy. This uncommon complication should be considered in the differential diagnosis of postoperative neurological deficits. Early magnetic resonance imaging excluded more serious causes of this complication.

Adult↗

PubMed1994

Management of infected laminectomy wounds.

Wound infection after lumbar, thoracic, or cervical laminectomies is a rare but potentially devastating complication. It can range in severity from superficial wound infection to an extensive wound dehiscence. The usual treatment of these wounds consists of intensive local care, debridement, and appropriate antibiotic therapy. Secondary healing can result in chronic, painful wounds that are difficult to manage and can create the potential for osteomyelitis. Seven cases of infected dehiscent laminectomy wounds are presented. Either critical structures were exposed, or the patients did not heal after secondary or delayed primary closures. In each case, full healing was attained by means of reconstruction with a regional muscle flap. We propose that muscle flap reconstruction offers an excellent alternative for the reconstruction of difficult postlaminectomy wounds.

Adult↗

PubMed2004

Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction?

OBJECTIVE: Preliminary studies have suggested that prolonged retraction of the paraspinal muscle during spinal surgery may produce ischemic damage. We report the continuous measurement of intramuscular pressure (IMP) during decompressive lumbar laminectomy and its relationship to subsequent back pain and disability. METHODS: Twenty patients undergoing two-level decompressive lumbar laminectomy for lumbar canal stenosis were recruited. Back pain and disability were assessed by use of the Visual Analog Score (VAS), Oswestry Disability Index (ODI), and Short-Form 36 (SF-36) Health Survey. During surgery, IMP was recorded continuously from the multifidus muscle by use of a pressure transducer. The intramuscular perfusion pressure (IPP) was estimated as the difference between the patient's mean arterial pressure and IMP. RESULTS: Two muscle retractors were used: the Norfolk and Norwich (n = 10) and the McCulloch (n = 10). The mean duration of deep muscle retraction was 62.7 +/- 8 minutes (range, 19-133 min). On application of deep muscle retraction, there was a rapid and sustained increase in IMP (P < 0.001), and overall, the calculated mean IPP approached 0 mm Hg or less during this period (P < 0.001). On release of deep muscle retraction, there was a rapid decrease in IMP to preoperative levels. The IPP was greater with the Norfolk and Norwich than the McCulloch retractor (P < 0.001). Compared with preoperative values, there was a decrease in ODI (P < 0.001) and VAS for back pain (P < 0.001) at discharge and 4 to 6 weeks and 6 months after surgery. In addition, there was a decrease in SF-36 scores at 6 months compared with preoperative values (P < 0.001). Total duration of muscle retraction greater than 60 minutes was associated with worse VAS scores for back pain and ODI and SF-36 scores for disability at 6 months after surgery (P < 0.05). There was no relationship between the VAS, ODI, and SF-36 scores and other parameters measured, including the mean IPP, retractor type, operating surgeon, and wound length. CONCLUSION: The McCulloch retractor generates a higher IMP than the Norfolk and Norwich retractor. However, postoperative improvement in VAS, ODI, and SF-36 scores in these patients was associated with a shorter duration of muscle retraction and not the degree of IMP or IPP generated. In this respect, periodic relaxation of the paraspinal muscle retractors during surgery to allow muscle perfusion may help to reduce postoperative back pain and disability.

Adult↗

PubMed2007

Cervical laminectomy: technique.

Spinal canal decompression via cervical laminectomy with or without foraminotomy is a mainstay of treatment of cervical spondylotic myelopathy and myeloradiculopathy. The goal of this surgery is to expand the cervical canal dorsally by removing the spinous processes, laminae, ligamentum flavum, and bony hypertrophy that are contributing to the canal stenosis. In selecting this particular approach to decompression, the surgeon must take into account the spinal geometry and the primary pathology of the patient: an "effective" cervical kyphosis is a contraindication to a dorsal approach, and spinal canal compromise secondary to ventral compression is best addressed through a ventral or a combined ventral and dorsal approach. This technique is technically facile and versatile in application. Complications with this procedure are relatively rare, with postoperative spinal instability being the primary concern. With proper patient selection and attention to surgical technique, laminectomy is a safe and effective approach to the management of cervical myelopathy in selected patients.

Cervical Vertebrae↗

PubMed1999

[Prognostic factors related to gunshot wounds to the spine in patients submitted to laminectomy].

The spinal trauma related to civilian gunshot missile still remains a serious neurological event that carries a dismal prognosis almost in all cases. Its surgical indication also is a matter of discussion. Our goal is to identify the aspects that could influence the prognosis after surgery to this kind of lesions. We conducted a retrospective study of 45 consecutive patients submitted to laminectomy at Hospital de Base do Distrito Federal (Brasília, Brazil), testing the following aspects: initial neurological status, level of the deficit, surgical timing, use of methilprednisolone and presence of dural tearing. Among those, the initial clinical presentation and the level of the lesion (60% of the patients with cauda equina syndrome and 53% of that with lesions in the lombar region improved their neurological status after laminectomy) were the most important factors affecting the outcome. Seventy percent of the patients experienced a pain relief after the surgical procedure.

Adolescent↗

PubMed2002

Fracture of L7 vertebral articular facets and pedicles following dorsal laminectomy in a dog.

A 6.5-year-old German Shepherd Dog underwent decompressive surgery for cauda equina syndrome. On the basis of intraoperative findings, the dorsal laminectomy was extended from L6 to S2. Partial dorsal annulectomies were also performed on the L6-7 and L7-S1 intervertebral disks. Two weeks following discharge, the dog had an acute onset of signs of pain and worsening of the neurologic status. Radiography and surgical exploration revealed bilateral fractures of the vertebral pedicles and caudal articular facets of L7. Vertebral stabilization was achieved with intramedullary pins and methylmethacrylate. The dog fully recovered. Although the destabilizing effect of various procedures on the vertebral column has been documented in vitro, vertebral fractures associated with instability have not been reported. Our description of a vertebral fracture following a cauda equina decompressive procedure in a dog emphasizes the need for caution when performing multi-level dorsal laminectomy and diskectomy.

Animals↗

PubMed1995

Voiding dysfunction and urodynamic findings in patients with lumbar spinal stenosis and the effect of decompressive laminectomy.

Eighteen consecutive patients (12 men and 6 women, mean age 55) with clinically and radiologically verified lumbar spinal stenosis underwent urodynamic examinations before decompressive laminectomy (n = 16) and 15 afterwards. Twelve of the patients (67%) had symptoms of voiding dysfunction preoperatively but urodynamic findings were normal in most cases only one patient showing detrusor hyperreflexia and one obstruction. Three patients reported an improvement in voiding postoperatively. Three patients showed obstructive voiding postoperatively, one undergoing TURP with a good outcome. One patient developed detrusor areflexia after the operation, with difficulties in bladder emptying. The only statistically significant changes in urodynamic parameters were rises in the maximum urethral pressure and urethral closure pressure. When considering the radicular symptoms and back pains the overall outcome was assessed as excellent or good in 6 cases, 6 had a fair outcome and 4 poor. Decompressive laminectomy gives acceptable results but the effects on bladder and urethral function remain controversial and unexpected. Electrophysiological investigations are needed for more detailed analysis of these cases.

Adult↗

PubMed1994

Post-operative central sleep apnoea complicating cervical laminectomy: case report.

Breathing disorders following decompressive laminectomy for cervical stenosis are rare. We report a case of postoperative central apnoea following cervical laminectomy, and discuss the aetiology, management and potential relationship between upper cervical surgery and sleep apnoea. Preoperative evaluation of respiratory function, intraoperative monitoring and caution with sedative and anaesthetic drug use is important and the need for postoperative apnoea monitoring in cases with critical upper cervical compression with compromised breathing is emphasized.

Adult↗

PubMed1977

Unilateral and bilateral partial laminectomy in lumbar disc prolapse. A follow-up study of 156 patients.

The results of two comparable groups of in all 156 operated patients with lumbar disc prolapse were evaluated 4-9 years postoperatively. Sixty-seven patients had received bilateral and 89 unilateral partial laminectomy. At follow-up, the results of the bilaterally operated were all excellent or good, whereas 15% with unilateral exposure were unchanged or worse. The unilaterally operated presented a significantly higher incidence of low back pain and recurrences of sciatica than the bilaterally operated. There were no reoperations for recurrent prolapses following the bilateral approach compared with four after unilateral approach. It is concluded that bilateral partial laminectomy affords a good view of the disc pathology and a greater possibility for obtaining relief of the symptoms without reducing the stability of the column.

Adult↗

PubMed2004

Use of polylactide resorbable film as a barrier to postoperative peridural adhesion in an ovine dorsal laminectomy model.

OBJECT: The purpose of this study was to evaluate the performance of a resorbable polylactide film in the sheep posterior spine in the presence of a combined laminectomy and durotomy defect. METHODS: A resorbable polylactide film was used to cover the combined defects in the eight sheep used in this study. Two surgical levels were performed in each animal, with randomly assigned control and treated sites. Each surgical level consisted of a full laminectomy followed by a needle-induced durotomy. The treated levels received a resorbable polylactide film cut to size and tucked in under the laminar defect. At 8 to 10 weeks postoperatively, results of myelography and visual dye infiltration showed complete healing of the durotomies for all sites. In addition, evaluation of gross dissection based on volume and tenacity scores as well as histological findings indicates decreased posterior dural adhesions for sites treated with resorbable polylactide film. CONCLUSIONS: The results of this investigation support previous studies in which the use of a resorbable polylactide film was found to be effective in reducing posterior dural adhesions in the spine with no apparent safety issues related to impaired dural healing.

Absorbable Implants↗

PubMed1980

Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy.

Metastases to the spinal epidural space with compression of the spinal cord or cauda equina are commonly encountered by physicians in a variety of clinical field. In the recent past, decompressive laminectomy followed by radiotheray was thought to be the best available treatment. More recently, radiotherapy alone has been advocated as an alternative treatment mode with a similar rate of effectiveness. This study compares laminectomy followed by radiotherapy to radiotherapy alone in the treatment of spinal epidural metastases in a randomized, prospective clinical trial. No significant difference was found in the effectiveness of the two treatment methods in regard to pain relief, improved ambulation, or improved sphincter function. Patients with an incomplete myelographic block fared well regardless of treatment, and those with a complete block fared poorly. Because of the limited size of this study and because of certain unforeseen design defects, the results are suggestive but not conclusive. Suggestions are made for a future randomized, prospective multicenter study that would conclusively answer the perplexing question as to the most efficacious method for treating spinal epidural metastases.

Adult↗

PubMed1981

Effects of anesthesia and laminectomy on regional spinal cord blood flow in conscious sheep.

Blood flow for the whole spinal cord (SCBF), central cord (largely gray matter), and peripheral cord (largely white matter) has been measured at all segmental levels using radioactive microspheres in conscious sheep. Whole SCBF was greatest in the lower cervical and lumbar enlargements and least in the upper cervical and thoracic regions. This was attributable partly to regional variations in gray-matter blood flow but principally to regional variations in the proportion of gray and white matter present. Whole SCBF for the total cord was 14.5 +/- 0.8 ml/100 gm/min, central cord flow was 40.6 +/- 3.5 ml/100 gm/min, and peripheral cord flow was 9.7 +/- 1.9 ml/100 gm/min. Blood flow was not affected by sodium pentobarbital provided the level of anesthesia, arterial pressure, and blood gases was carefully regulated. Laminectomy usually resulted in a marked increase in central cord blood flow at the site of cord exposure, lasting about 90 minutes; this increase was not necessarily reflected in whole SCBF because of the absence of any change in blood flow in the relatively large proportion of peripheral cord. This effect of laminectomy could adversely influence results obtained from studies using invasive techniques to measure SCBF.

Anesthesia, Intravenous↗

PubMed1987

Closure of extensive and complicated laminectomy wounds. Operative technique.

Fifty-eight patients with previously irradiated intramedullary spinal cord astrocytomas underwent laminectomy for radical excision of their tumors. A high incidence of postoperative cutaneous cerebrospinal fluid fistulas and large pseudomeningoceles following routine closure prompted the development of an alternative method of wound closure using mobilized musculofascial flaps. The authors describe the surgical techniques and pitfalls to be avoided during the closure of complicated laminectomy wounds.

Astrocytoma↗

PubMed1996

Bilateral multilevel laminectomy with or without posterolateral fusion for cervical spondylotic myelopathy: relationship to type of onset and time until operation.

The authors retrospectively evaluated the relationship of several preoperative factors in 69 patients who had myelopathy due to multilevel cervical spondylosis without ossification of the posterior longitudinal ligament treated with Kirita's bilateral wide laminectomy. In 34 patients with focal instability or malalignments, posterolateral fusion was also combined. The clinical results at an average follow-up period of 3.5 years (range 1-10 years) after operation in the groups that had and had not undergone fusion were equally satisfactory, and preoperative focal instability was believed to be the sole useful indication for adding posterolateral fusion. The patients were classified in three groups according to the acuteness of the onset. The type of onset and time until operation were found to be the factors most strongly related to prognosis, and clinical outcome was correlated with the duration after onset when plotted as days in the acute, months in the subacute, and years in the insidious onset groups. Wide laminectomy with or without posterolateral fusion is a simple operation that is recommended, provided that it is performed early enough according to the type of onset.

Aged↗

PubMed1998

Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study.

OBJECT: Decompressive laminectomy for stenosis is the most common operation performed in the lumbar spine in older patients. This prospective study was designed to evaluate long-term results in patients with symptomatic lumbar stenosis. METHODS: Between January 1984 and January 1995, 170 patients underwent surgery for lumbar stenosis (86 patients), lumbar stenosis and herniated disc (61 patients), or lateral recess stenosis (23 patients). The male/female ratio for each group was 43:43, 39:22, and 14:9, respectively. The average age for all groups was 61.4 years. For patients with lumbar stenosis, the success rate was 88.1 % at 6 weeks and 86.7% at 6 months. For patients with lumbar stenosis and herniated disc, the success rate was 80% at 6 weeks and 77.6% at 6 months, with no statistically significant difference between the two groups. For patients with lateral recess stenosis, the success rate was 58.7% at 6 weeks and 63.6% at 6 months; however, the sample was not large enough to be statistically significant. One year after surgery a questionnaire was sent to all patients; 163 (95.9%) responded. The success rate in patients with stenosis had declined to 69.6%, which was significant (p = 0.012); the rate for patients with stenosis and herniated disc was 77.2%; and that for lateral recess stenosis was 65.2%. Another follow-up questionnaire was sent to patients 1 to 11 years after surgery (average 5.1 years); 146 patients (85.9%) responded, 10 (5.9%) were deceased, and 14 (8.2%) were lost to follow-up review. At 1 to 11 years the success rate was 70.8% for patients with stenosis, 66.6% for those with stenosis and herniated disc, and 63.6% for those with lateral recess stenosis. Eleven patients who underwent reoperation were included in the group of patients whose surgeries proved unsuccessful, regardless of their ultimate outcome. There was no statistically significant difference in outcome between 1 year and 1 to 11 years with respect to stenosis, stenosis with herniated disc, and lateral recess stenosis. CONCLUSIONS: In conclusion, long-term improvement after laminectomy was maintained in two-thirds of these patients.

Adult↗