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A collapsing cord in six patients with hydromyelia and a collapsing intraspinal arachnoid cyst in one patient are demonstrated. The authors describe the technique for two-position gas myelography and demonstrate that both intra- and extra-medullary intraspinal processes may collapse during myelography.
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Narrow lumbar spinal canal or lumbar spinal stenosis is a not uncommon problem. Thirty-two patients with this disorder have been treated surgically at the Ochsner Medical Center between 1963 and 1973. The best method of diagnosis is a careful history and second is roentgenographic evidence, particularly the myelogram. The surgical treatment consists of total laminectomy and foraminotomy to insure complete decompression of the nerve roots. Eighteen patients have been followed from 14 to 44 months. Sixteen of the 18 considered their operations a success.
Authors experience based on 15 cases of iatrogenic stenosis of spinal canal in thoracic and lumbar region. The stenosis was the sequelae of spondylodesis made for spinal tuberculosis, spondylolisthesis traumatic and idiopathic, spinal fractures and assimilation faults. The onset of signs of stenosis appeared from 1 to 7 years after the first operation. The treatment was operative in 8 cases, conservative in 7. The first gave the best results. Observation time was up to 14 years after the second operation.
A spinal dermoid cyst with an invasive sweat-gland tumour in its wall is reported. This appears to be the first of this type to be reported in the nervous system.
Direct measurements of 1,340 lumbar vertebrae in 275 skeletons in two racial groups are reported. The average figure, and the upper and lower limits of normal are reported for the anteroposterior diameter of the canal and for Spinal Index. Radiological studies have established a technique for defining the posterior margin of the spinal canal on plain X-ray films. It is formed by a line joining the apex of the superior to the inverted apex of the inferior articular facet. The Spinal Index is not a reliable factor. The anteroposterior diameter alone is the essential parameter in assessing spinal stenosis. The negroid canal is marginally less spatial than that of the caucasoid.
Four cases of postoperative spinal canal stenosis were presented in which compression of cauda equina was observed. The lesion was found in 5.8% of operated spinal stenosis (four out of 69 cases). One must pay attention to differentiate the lesion from the recurrence of initial disorder, because the symptoms of the postoperative spinal stenosis is no always typical but sometimes resemble to the symptoms of the initial disorder which needed the operation. Myelography is the only reliable method to decide the extent of the spinal canal stenosis.
A constitutional narrowing of the cervical spinal canal was seen in 31 patients with neurological disorders. The ratio of the inner diameter of the spinal canal to the diameter of the vertebral body was smaller than 1 (normal greater than 1). Clinical signs were observed from 45 years upwards where reactivedegenerative changes cause additional narrowing. The majority of patients were male, predominantly heavy manual labourers. There is often a trauma preceding. On myelography multilocular deformations of the spinal subarachnoid space and nerve roots are seen. On the mechanical narrowing of the spinal canal a vascular factor supervenes, caused by exostoses, intervertebral disc protrusions, and fibrosing processes. Clinically a chronic progressive spinal transection syndrome (cervical myelopathy) dominates besides a multilocular root involvement. Posterior column sensibility is predominantly lost. Pain in the extemities and the cervical column is an early symptom. Non-specific CSF changes occur frequently. In case of root involvement the electromyogram is pathological. The prognosis is bad. Operation can only remove reactive processes but not the constitutional anomaly.
The syndrom of the narrow spinal canal is today to be separated from other lumbar diseases by its nosological entity. It starts slowly and becomes manifest in middle and advanced age. Claudicatio intermittens is the characteristic symptom of this disease the aetiology of which is multifactory. Most patients show in the myelogram konstitutionell alterations combined with localized or generalized degenerative narrowing of the spinal canal. The clinical findings correspond to the lumbar segments affected. With localized narrowing the differential diagnosis of disc herniation is generally possible by myelography. This is of therapeutic consequence because in this cases a removal of the disc is unnecessary.
A case of craniopharyngioma with a large cyst extending through the posterior fossa down into the upper cervical spinal canal was reported. The patient is a 14-year-old female who was operated on for the first time in 1970, because of a suprasellar calcified mass. Histological examination verified craniopharyngioma of adamantinomatous type. Since then, she had been operated three times because of deterioration of visual acuity. She was admitted for the fifth time in January, 1977, complaining of severe neck pain radiating bilaterally to the shoulders. Radiological examination demonstrated, besides the suprasellar tumor, a huge mass extending along the clivus down to the level of C3 of spinal canal. Anteroposterior diameter of bony spinal canal evidently enlarged in upper cervical region. Interpedicular distance also widened markedly in the same region. Laminae of C1-C3 vertebrae were abnormally stretched and the spinal cord was compressed posteriorly by the tumor. Suboccipital craniectomy verified a cystic tumor in the region of foramen magnum and cervical spinal canal. The medulla oblongata was pushed backward by the tumor. The cystic tumor was evacuated and the capsule of the tumor was partly resected, which was histologically verified as craniopharyngioma of squamous type. The patient was relieved from the neck pain after operation and discharged in April 1977.
Radiological measurements of the sagittal diameter of the bony cervical spinal canal were performed on 120 children, aged 3 to14 years old. For the age groups 3 to 6, 7 to 10 and 11 to 14 years the appropriate mean values were calculated with standard deviations. In addition the relation between body height and width of the spinal canal was investigated. The values show a continuous increase with advancing years and increasing body height. In all age groups the sagittal diameter decreases slightly from the foramen magnum to C.3 and then remains nearly constant. There are no statistically significant differences between boys and girls. The "normal values" obtained facilitate the detection of pathological cases where there may be widening or narrowing of the cervical spinal canal.
To investigate pathogenesis of redundant nerve roots of the cauda equina, which were concomitant with severe lumbar spinal canal stenosis, six cadavers were examined anatomically and histopathologically, and quantitative analysis of nerve fibers was performed. In this anatomic study, it was observed that all the redundant nerve roots passed through the constriction of the spinal canal. No significant pathologic change was detected in the spinal ganglia and in the spinal cords except for the posterior column, in which dorsal redundant roots were entering. Redundant nerve roots of unequal length also were observed in the anatomic study. The spatial distribution of redundant nerve roots and the extent of degeneration of nerve fibers in them were established by these histopathologic and quantitative studies. These facts indicated a close causal relationship between redundant nerve roots and constriction of the spinal canal, and that the pathogenesis of redundant nerve roots was a squeezing force acting on the nerve roots at the area of spinal canal constriction.
With the advent of computerized tomography (CT), a new method of visualizing the spinal canal in cross-section has been created. Before the introduction of CT scanning, evaluation of the cross-sectional anatomy of the spinal canal was accomplished chiefly by the Toshiba unit. This study compares these two forms of tomography and discusses their relative effectiveness in diagnosing constrictive lesions of the spinal canal.
Attention has recently been directed to decrease in size of the spinal canal, notably in relation to production of posterior osteophytes in spondylosis. Tumors of the cord, roots, or meninges, syringolmyelia and hydromyelia may enlarge sufficiently in size or be critically located so that expansile change of the cervical spinal canal may result.
The value of computed tomography (CT) in cases of spinal dysraphism, spinal canal narrowing and widening, and spinal bony abnormalities is discussed. With further experience, CT may become a valuable modality for the diagnosis of spinal diseases.
Thirty four cases of spondylosis and narrow spinal canal were analysed and the possible mechanism of the syndrome of the narrow canal discussed. In spondylotic cases early operation is advisable.
Hemangiopericytoma is a vascular neoplasm consisting of capillaries outlined by an intact basement membrane that separates the endothelial cells of the capillaries from the spindle-shaped tumor cells in the extravascular area. These neoplasms are found in soft tissues but have rarely been shown to involve the spinal canal. This is a report of three such cases. Surgical removal of the tumor from the spinal canal was technically difficult. A high risk of recurrence has been reported but in these three cases adjunctive radiotherapy appeared to be of benefit in controlling the progression of the disease. These cases, added to the six cases in the literature, confirm the existence of hemangiopericytoma involving the vertebral column with extension into the spinal canal. This entity should be included in the differential diagnosis of lesions of the spinal canal. The risk of intraoperative hemorrhage should be anticipated.