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PubMed2000

Laminectomy for thoracic spinal canal stenosis.

Stenosis of the thoracic spinal canal is a relatively rare disorder with numerous causes. Clinical manifestations include signs and or symptoms consistent with focal thoracic radiculopathy and/or myelopathy. Several surgical approaches for the decompression of the stenotic thoracic canal have been described. Laminectomy is typically reserved for only those cases in which dorsal compression of the neural elements is demonstrated; it is contraindicated when the epidural compression is primarily ventral in location.

Decompression, Surgical↗

PubMed1975

Prophylactic antibiotics and wound infections following laminectomy for lumber disc herniation.

The authors review 531 consecutive operations for lumbar disc herniation performed on 496 patients by one neurosurgeon to determine the effect of prophylactic antibiotics upon postoperative wound infections. In this retrospective analysis 16 instances of sepsis were found, 11 considered to be major and five minor. In the 128 cases in which no antibacterial agents were given, 11 major and 1 minor infection occurred. Four minor infections developed in the 402 occasions when antibiotics were given in the perioperative period. Men had a significantly greater risk of developing infection than women. These data suggest that pre- and postoperative antibiotic therapy directed at a narrow spectrum of microorganisms reduced the incidence of significant wound infections in patients undergoing laminectomy for lumbar disc herniation.

Adult↗

PubMed1981

Gelfoam paste in experimental laminectomy and cranial trephination: hemostasis and bone healing.

The hemostatic properties and effect on osteogenesis of gelatin foam paste and bone wax were compared on surgical bone lesions in experimental animals. Thirty rabbits each received four trephine craniotomies and four lumbar laminectomies. Alternate bone incisions in each animal were treated with either gelatin foam paste or bone wax. Blood loss was measured by absorbing the blood into dry surgical cottonoids weighed before and after use. Bone healing sites of three rabbits were examined histologically to assess the effect of each agent on osteogenesis. The trephination sites of eight rabbits were subjected to fracture force testing at 6 weeks postoperatively to compare the effect ot the two agents on bone healing. No significant difference was found between gelatin foam paste and bone wax in either effectiveness of hemostasis or effect on osteogenesis.

Animals↗

PubMed2005

Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients.

OBJECT: Despite a history of safety and efficacy, spinal anesthesia is rarely used in lumbar surgery. Application of regional anesthetics is widely preferred for lower-extremity surgery, but general anesthesia is used almost exclusively in spine surgery, despite evidence that spinal anesthesia is as safe and may offer some advantages. METHODS: In this case-controlled study the authors analyzed outcomes obtained in 400 patients in whom either spinal anesthesia or general anesthesia was induced to perform a lumbar decompression. Patients were matched for anesthesia-related class, preoperative diagnosis, surgical procedure, and perioperative protocols. All aspects of surgery, recovery, postanesthesia care, and pain management were uniform irrespective of the anesthetic type. Case complexity was equivalent. An independent observer performed analysis of the data. Data from the intraoperative period through hospital discharge were collected and compared. Two hundred consecutive patients meeting inclusion criteria were included in each group. Patients were treated for either lumbar stenosis or herniated nucleus pulposus. Demographically, both groups were well matched. Anesthetic and operative times were longer for patients receiving a general anesthetic (p < 0.05), in whom more nausea and greater requirements for antiemetics and pain medication were also present during recovery (p < 0.05). Overall complication rates and, specifically, the incidences of urinary retention were significantly lower in spinal anesthesia--induced patients (p < 0.05). There were no neural injuries in either group, and the incidence of spinal headache was lower in patients receiving a spinal anesthetic (1.5% compared with 3%). CONCLUSIONS: Spinal anesthesia was as safe and effective as general anethesia for patients undergoing lumbar laminectomy. Potential advantages of spinal anesthsia include a shorter anesthesia duration, decreased nausea, antiemetic and analgesic requirements, and fewer complications. Successful surgery can be performed using either anesthesia type.

Adult↗

PubMed1986

Postoperative laminectomy pain control using bupivacaine and epidural morphine.

In a prospective double blind study, 26 patients were evaluated for postoperative pain relief with use of epidural morphine. The variable in this study was the addition of paravertebral bupivacaine used in 14 patients. The addition of the bupivacaine did not have a statistically significant effect on lowering the analgesic requirement during the first 36 hours after surgery, the total dose of medication required during hospitalization, nor the time to the onset of supplemental pain medicine requirement. There were no problems with late respiratory depression. We conclude that the addition of paravertebral bupivacaine is not effective in decreasing the amount of pain medication that is required in lumbar laminectomy patients and adds very little to patients already receiving epidural narcotics.

Bupivacaine↗

PubMed1988

Decompression laminectomy and lateral spinal fusion in patients with previously failed lumbar spine surgery.

Sixty-two patients who had had previous failed lumbar disk surgery (average 1.4 surgeries) were treated with a decompression laminectomy and lateral spinal fusion. Follow up averaged 4.2 years and results were based on pain relief, improved function, and return to work as recorded on a patient questionnaire. Using a scoring system to quantify the change from the patients felt the surgery was very worthwhile, 32% had a good result, 29% had a fair result, and 38% had a poor result. However, 53% of the patients felt the surgery was very worthwhile, 37% rated it somewhat worthwhile, and 10% responded that the surgery was not worthwhile. Factors which statistically correlated with a higher improvement score were the presence of a unilateral radicular pain pattern, a year pain free interval since the previous surgery, and a myelogram which was more indicative of a disk herniation rather than cicatrix formation. Similarly, those patients who were found to have a recurrent or new disk at the time of surgery did better than those whose major finding was scar formation. The quality of the fusion mass was positively correlated with a better final result with questionable statistical significance (P = .06). Finally, those patients who were industrial improved much less and only 14% returned to work as compared to 61% of the non-industrial patients.

Adult↗

PubMed1994

Deep venous thrombosis following lumbar laminotomy and laminectomy.

Sixty consecutive patients undergoing lumbar laminotomy or laminectomy underwent preoperative and postoperative compression ultrasonography of the lower extremities to detect acute deep venous thrombosis (DVT). Compression stockings were the only method of prophylaxis. Three patients (5%) developed postoperative calf DVT. Despite continued treatment with only compression stockings, serial scanning failed to detect propagation of the thrombus proximal to the knee in any patient. The average age of patients who developed DVT, 62 years, was significantly greater (P < .05) than the age of patients who did not, 45 years. There were no statistically significant differences in DVT rates when compared by: sex, addition of one- or two-level fusion, length of procedure, or number of days of bedrest.

Adolescent↗

PubMed1976

Changes in clinical signs after decompressive laminectomy in cervical spondylosis with myelopathy.

One to seven years after decompressive laminectomy a global improvement of symptoms is observed in ten patients out of 17. The importance of the diagnosis criteria is emphasised. Only the complete clinical form of sensitive and motor disablement has been considered. Attempts were made to quantify the degree of handicap and to follow the modifications of the elementary signs in the postoperative state. The operative results were better when the surgical intervention was performed early in the course of the illness.

Cervical Vertebrae↗

PubMed1999

[Acute symptom transverse laminectomy for a benign osteoclastoma of thethoracic spine--case report and review of the literature].

Benign osteoclastomas of the spine above the sacrum are uncommon lesions. Acute paraparesis as the presenting sign of disease is unusual and rarely described in the literature. We report on the case of a 41 yrs old male who underwent acute T3-5 laminectomy for spinal cord decompression from a T4 expansive mass lesion with locally destructive growth. Although a malignant lesion was suspected, definitive histologic examination disclosed a benign osteoclastoma. Therefore, elective trans-thoracic total vertebrectomy T4 with ventral stabilization was performed to allow for marginal total resection of the tumor and reconstruction of the spine. Twenty-four months after the procedure the patient has made a good neurologic recovery with no evidence of tumor recurrence.

Acute Disease↗

PubMedDate not supplied

[Clinical course of post-laminectomy cervical spondylitic myelopathy].

INTRODUCTION AND OBJECTIVE: To study the postsurgical clinical course of spondylitic myelopathy. PATIENTS AND METHODS: We assessed 39 patients admitted to the Departments of Neurology and Neurosurgery of the Hospital Clinico Quirúrgico Hermanos Ameijeiras, Cuba, with a confirmed diagnosis of spondylitic myelopathy who had decompressing laminectomies during the period between January 1996 and December 1997. RESULTS: Of the predicted variables, there was predominance of an age under 60 years (51.3%); male sex (71.8%); a history of cervical trauma and habitual dangerous physical activity in 38.5% and 41% respectively. The duration of preoperative symptoms was less than one year in 46.2%. The vertebral level most often involved was C5-C6 (97.4%). In 51.3% three levels were affected: 100% of the patients had stenosis in the zone of maximum compression; 28.2% had congenital stenosis of the canal and 66.7% had partial block shown on myelography or magnetic resonance studies of the cervical spine. There was clinical improvement in 78.4% after one month, in 91.9% after 3 months and in 94.6% after 6 months; only 2 patients had not improved on completion of the study. Motor and sensory function of the legs improved more than motor function of the arms and sphincter. CONCLUSIONS: The variables which influenced the degree of improvement were: age, duration of the symptoms, number of vertebral levels affected, presence of blockage and functional state. After application of the multiple regression model, it was seen that the duration of preoperative symptoms is an important predictor of the postoperative clinical course.

Adult↗

PubMed1975

Sources of failure in laminectomies.

Failures in laminectomy may be due to improper patient selection, of which the largest factor appears to be a lack of recognition of an underlying psychological disorder. Rarely an operative procedure is performed on the wrong side or at the wrong level. A number of elements relating to what might be termed the "wrong operation" fall under the heading of failure to recognize disease, and the largest factor here in our experience has been the inability to explore the wound because of uncontrolled bleeding. The problem also relates to a lack of understanding of the anatomy and potential disorder of the vertebral axis. This then merges with the other factor, failure to deal with disease, which may be unrecognized or, if identified, misinterpreted. Last are those elements for which there is professional responsibility, the most serious being dural or nerve root irritation predisposing to traumatic arachnoiditis.

Hemorrhage↗

PubMed1997

[Materials using in the prevention of scar formation after laminectomy].

The recurrent syndrome after laminectomy is related to the scar formation overlying epidural. To solve this catastrophic problem means to prevent the fibrosis. In the present review a variety of materials used in the inhibition or prevention of that syndrome are introduced, and their effects are reviewed and discussed. Some characteristics of the materials for prevention are summarized, and in our experiments the material point of view is rational.

Animals↗

PubMed2002

Efficacy of topical microfibrillar collagen mixed with steroid hormone and morphine for postoperative pain control during lumbar laminectomy: a preliminary report.

BACKGROUND: Current inpatient management of postoperative pain in lumbar surgery includes the use of intramuscular opioid analgesics, nonsteroidal anti-inflammatory drugs, or patient-controlled analgesia; however, all types of medications are associated with side effects that can limit their usefulness in the inpatient setting. METHODS: In a well-conducted non-randomized prospective trial, 80 consecutive patients who underwent elective multilevel lumbar laminectomy surgery were identified. Two types of trials with different doses of steroids were used. Patients' preoperative medical records, pain scores, narcotics consumption, costs for the regimen, hospital stay, unwanted complications, and walking ability were evaluated postoperatively. RESULTS: Pain in patients after lumbar surgery can be dramatically controlled postoperatively. Seventy-eight patients (97.5%) were able to walk without support on the first postoperative day. Major side effects were found in 5 patients (6.2%). CONCLUSIONS: This experience indicates that pain-control agents with epidural sustained-released preparation seem to be beneficial in early mobilization, are cost effective, and require lower analgesic consumption by patients. Similar pain control can be obtained with lower doses of methylprednisolone. In spite of its clinical attractiveness, improvements in the side effects of complications from epidural morphine and the combination of steroids and microfibrillar collagen have yet to be realized.

Administration, Topical↗

PubMed2002

[Laminectomy for spinal cord compression occurring in hormone refractory prostate cancer].

In many cases of advanced prostate cancer, bone metastasis frequently occurs. Androgen deprivation therapy is very effective for these cases, but this therapy would result in failure, and symptomatic metastasis would develop. Approximately eighty percent of cases with bone metastasis showed epidural metastasis. When these lesions enlarge, spinal cord compression (SCC) occurs in five to ten percent of cases. Many urologist would choose an adequate modality for this problem, based on the prognosis and/or general status of each patient. In this article we overview laminectomy for SCC and present our experience.

Aged↗

PubMedDate not supplied

Post-laminectomy and post-fusion stenosis of the lumbar spine.

On the basis of a 9-year experience with 231 patients with post-laminectomy and post-spinal fusion stenosis of the lumbar spinal canal, we emphasize the importance of recognizing and adequately decompressing such lesions. In the majority of such patients pain relief has been achieved, but some of the failures can be attributed to technical reasons. Most failures are due to associated lesions and to functional factors. A special surgical techniy be advisable. The indications for fusion however were few and require further investigation and evaluation. The significant failure rate points to the need for continuing research into the causes of low back pain and adequate management programs for the patient with the "multiple operated back" who still has disabling pain and drug dependence.

Constriction, Pathologic↗

PubMed2003

Vascular injury during a lumbar laminectomy.

A lumbar laminectomy is a common and routine operation. Damage to abdominal vascular structures during surgery is a relatively infrequent complication; however, when it does occur, it is sudden and life-threatening. We herein report on 2 cases of abdominal vascular injury which occurred during lumbar microdiscectomies. The first case was a 34-year-old man. A bloody surgical field was noted 45 min into the operation along with an increase in heart rate and a decrease in blood pressure. After fluid resuscitation and an ephedrine injection, his vital signs stabilized. The patient was then sent to the surgical intensive care unit for observation. An emergent abdominal computer tomography scan revealed right retroperitoneal hematoma, and an urgent exploratory laparotomy was performed to check for bleeding and to remove the hematoma. The second case was a 61-year-old woman with recurrent disc herniation. The operation was proceeding smoothly for 90 min, when a large amount of fresh blood suddenly gushed out. Her blood pressure immediately dropped to that of a state of shock. The patient was turned back to a supine position, and an emergent laparotomy was done to repair the injured vessels. Both patients had uneventful recoveries.

Abdomen↗

PubMed1959

Laminectomy for herniated intervertebral disc.

In a study of 59 patients surgically treated by various surgeons for relief of herniated lumbar intervertebral disc accompanied by symptoms that persistently recurred or had become resistant to conservative therapy, it was noted from review of hospital and office records that laminectomy either greatly relieved or entirely abated symptoms in 83 per cent of the cases. Postoperative complications reported by the surgeons who did the operations consisted of one death and five wound infections. Contrast myelography and electromyography, used in almost all cases in the series, appeared to be valuable adjuncts in the diagnosis of herniated lumbar intervertebral discs. The most common site of the lesion in this series was between the fourth and fifth lumbar vertebrae. Strain upon lifting was the most commonly reported precipitating factor.

Humans↗

PubMed1992

Neurologic complications and lumbar laminectomy. A standardized approach to the multiply-operated lumbar spine.

Even the careful and knowledgeable spine surgeon will encounter a variety of neurologic complications during and after routine lumbar laminectomy. These include dural and nerve root injuries; cauda equina syndrome; and formation of scar tissue, extradural and intradural (arachnoiditis). The surgeon must be prepared to identify each of these problems and deal with them effectively at the time of the procedure and in the immediate postoperative and follow-up periods. The physician evaluating the multiply-operated lumbar spine patient must use an organized approach. The origin of the problem in most instances is a faulty decision to perform the original operative procedure. Further surgery on an "exploratory" basis is not warranted in any situation and most likely will lead only to further disability. There should be definite objective findings to substantiate the patient's symptoms. The etiology of each patient's symptoms. must be accurately localized and identified. Medical status and psychosocial situation--as well as orthopedic and neurologic findings--should be evaluated at the time of the initial consultation. Once the spine is identified as the probable source of symptoms, specific features should be sought in the patient's clinical history, physical examination, and roentgenographic studies. The number of previous operations, length of pain-free interval, and predominance of leg versus back pain are the major historic signposts. The presence of a tension sign and the neurologic findings are the focal points of the physical examination. Plain roentgenograms, motion films, water-soluble myelogram, computed axial tomography, and magnetic resonance imaging with contrast have specific roles in the workup.(ABSTRACT TRUNCATED AT 250 WORDS)

Arachnoiditis↗