scholarly journals The Usefulness of Percutaneous Endoscopic Technique in Multifocal Lumbar Pathology

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Chul-Woo Lee ◽  
Kang-Jun Yoon
Keyword(s):  
Spine Surgery ◽  
Disc Herniation ◽  
Spinal Canal ◽  
Central Canal ◽  
Minimal Invasive ◽  
Endoscopic Spine Surgery ◽  
Canal Stenosis ◽  
Lateral Recess Stenosis ◽  
Interlaminar Approach ◽  
Disc Herniations

Introduction. The multifocal lumbar pathology including disc herniation and stenosis in the spinal canal or foramen has been considered the most difficult to approach surgically. It often requires mandatory dual approaches and/or fusion techniques. Traditional percutaneous endoscopic lumbar transforaminal and interlaminar approach has been focused on unifocal disc herniation. However, the development of endoscopic spinal instruments and surgical technique has broadened surgical indication and therapeutic boundary in endoscopic spine surgery. Cases Presentation. The authors present outcomes of four patients with multilumbar pathology including highly inferior migrated disc combined with lateral recess stenosis, multifocal disc herniation, bilateral disc herniations in spinal canal and foraminal disc herniation combined with central canal stenosis. They were successfully treated by percutaneous uniportal full endoscopic approach with single incision. Conclusion. Percutaneous endoscopic spine surgery is a safe and effective tool to figure out multilumbar pathology in a minimal invasive way.

Chimney sublaminar decompression for degenerative lumbar spinal stenosis

2006 ◽  
Vol 4 (5) ◽  
pp. 359-364 ◽  
Author(s):  
Swei-Ming Lin ◽  
Sheng-Hong Tseng ◽  
Jiao-Chiao Yang ◽  
Chi-Cheng Tu
Keyword(s):  
Spinal Canal ◽  
Central Canal ◽  
Invasive Technique ◽  
Duration Of Symptoms ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Canal Stenosis ◽  
Lateral Recess Stenosis ◽  
Paravertebral Muscles ◽  
Wound Pain ◽  
Lumbar Spinal

Object The authors evaluated the efficacy and safety of so-called chimney sublaminar decompression, a new technique to decompress the degenerative stenotic lumbar spinal canal without stripping of the paravertebral muscles. Methods Eighteen patients (nine men and nine women whose mean age was 67 years) with symptoms of claudication were selected to undergo chimney sublaminar decompression. The duration of symptoms was greater than 6 months in 17 patients. Two lumbar segments were involved in seven patients, three in eight, and four in the remaining three patients. Central canal stenosis was present in 13 patients, and lateral recess stenosis in five patients. Mild spondylolisthesis was noted in seven patients. All the patients underwent chimney sublaminar decompression. After surgery, mild wound pain developed in 14 patients, moderate wound pain in two, and severe wound pain in two. The postoperative hospital stay was 4 days or fewer in 14 patients. At follow-up examination, excellent, good, and fair outcomes were achieved in 11, five, and two patients, respectively. No patient required a body brace, and no worsening of preexisting spondylolisthesis was detected. The spinal canal was increased to two- to 6.8-fold (mean 4.2-fold) the preoperative size. Conclusions Compared with laminectomy or endoscopic surgery, the aforementioned chimney sublaminar decompression technique was an equally effective and less invasive technique in the treatment of degenerative lumbar canal stenosis.

scholarly journals Intradural Disc Herniation in the Lumbar Spine: A Case Report

2020 ◽  
Vol 58 (225) ◽  
Author(s):  
Tushar Rathod ◽  
Sameer Panchal ◽  
Nandan Marathe ◽  
Yogendra Agrahari ◽  
Ashwin Sathe
Keyword(s):  
Disc Herniation ◽  
Posterior Longitudinal Ligament ◽  
Central Canal ◽  
Low Back ◽  
Rare Presentation ◽  
Lateral Recess Stenosis ◽  
Extensor Hallucis Longus ◽  
Intradural Disc Herniation ◽  
Disc Herniations ◽  
Intradural Extramedullary

Intradural disc herniation is a rare presentation of a common pathology, comprising around 0.28-0.3% of all disc herniations. It occurs when disc material related to an intervertebral disc penetratesthe spinal dura and lies in an intradural extramedullary location. A 60 years old male patientpresented with complaints of low back pain and right lower limb radiculopathy of 2 weeks duration.Neurological examination revealed the weakness of extensor hallucis longus and ankle dorsiflexionwith diminished sensation corresponding to fourth and fifth lumbar (L4-L5) dermatome on the rightside. Magnetic resonance imaging showed a large sequestered fragment with intradural extensionsand posterior longitudinal ligament tear. Intradural nerve root showed significant displacementwith severe central canal and right lateral recess stenosis. Discectomy was performed along with theremoval of the intradural extension. The postoperative course was uneventful.

scholarly journals Detection of Degenerative Changes on MR Images of the Lumbar Spine with a Convolutional Neural Network: A Feasibility Study

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 902
Author(s):  
Nils Christian Lehnen ◽  
Robert Haase ◽  
Jennifer Faber ◽  
Theodor Rüber ◽  
Hartmut Vatter ◽  
...  
Keyword(s):  
Neural Network ◽  
Lumbar Spine ◽  
Diagnostic Accuracy ◽  
Nerve Root ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
Degenerative Changes ◽  
High Diagnostic Accuracy ◽  
Canal Stenosis ◽  
Disc Herniations

Our objective was to evaluate the diagnostic performance of a convolutional neural network (CNN) trained on multiple MR imaging features of the lumbar spine, to detect a variety of different degenerative changes of the lumbar spine. One hundred and forty-six consecutive patients underwent routine clinical MRI of the lumbar spine including T2-weighted imaging and were retrospectively analyzed using a CNN for detection and labeling of vertebrae, disc segments, as well as presence of disc herniation, disc bulging, spinal canal stenosis, nerve root compression, and spondylolisthesis. The assessment of a radiologist served as the diagnostic reference standard. We assessed the CNN’s diagnostic accuracy and consistency using confusion matrices and McNemar’s test. In our data, 77 disc herniations (thereof 46 further classified as extrusions), 133 disc bulgings, 35 spinal canal stenoses, 59 nerve root compressions, and 20 segments with spondylolisthesis were present in a total of 888 lumbar spine segments. The CNN yielded a perfect accuracy score for intervertebral disc detection and labeling (100%), and moderate to high diagnostic accuracy for the detection of disc herniations (87%; 95% CI: 0.84, 0.89), extrusions (86%; 95% CI: 0.84, 0.89), bulgings (76%; 95% CI: 0.73, 0.78), spinal canal stenoses (98%; 95% CI: 0.97, 0.99), nerve root compressions (91%; 95% CI: 0.89, 0.92), and spondylolisthesis (87.61%; 95% CI: 85.26, 89.21), respectively. Our data suggest that automatic diagnosis of multiple different degenerative changes of the lumbar spine is feasible using a single comprehensive CNN. The CNN provides high diagnostic accuracy for intervertebral disc labeling and detection of clinically relevant degenerative changes such as spinal canal stenosis and disc extrusion of the lumbar spine.

scholarly journals Sudden Quadriplegia after Acute Cervical Disc Herniation

2005 ◽  
Vol 32 (3) ◽  
pp. 356-358 ◽  
Author(s):  
Venkatraman Sadanand ◽  
Michael Kelly ◽  
George Varughese ◽  
Daryl R. Fourney
Keyword(s):  
Disc Herniation ◽  
Spinal Canal ◽  
Imaging Study ◽  
Spinal Canal Stenosis ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Canal Stenosis ◽  
History Of ◽  
External Trauma ◽  
Acute Neurological Deterioration

ABSTRACT:Background:Acute neurological deterioration secondary to cervical disc herniation not related to external trauma is very rare, with only six published reports to date. In most cases, acute symptoms were due to progression of disc herniation in the presence of pre-existing spinal canal stenosis.Case report:A 42-year-old man developed weakness and numbness in his arms and legs immediately following a sneeze. On physical examination he had upper motor neuron signs that progressed over a few hours to a complete C5 quadriplegia. An emergent magnetic resonance imaging study revealed a massive C4/5 disc herniation. He underwent emergency anterior cervical discectomy and fusion. Postoperatively, the patient remained quadriplegic. Eighteen days later, while receiving rehabilitation therapy, he expired secondary to a pulmonary embolus. Autopsy confirmed complete surgical decompression of the spinal cord.Conclusions:Our case demonstrates that acute quadriplegia secondary to cervical disc herniation may occur without a history of myelopathy or spinal canal stenosis after an event as benign as a sneeze.

scholarly journals Criteria for selection of patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis

2021 ◽  
Vol 23 (6) ◽  
pp. 828-833
Author(s):  
T. А. Ksenzov ◽  
M. V. Khyzhniak ◽  
A. Ю. Ksenzov ◽  
V. О. Tyshchenko
Keyword(s):  
Intervertebral Disc ◽  
Disc Herniation ◽  
Spinal Canal ◽  
Disease Duration ◽  
Spinal Canal Stenosis ◽  
Intervertebral Disc Herniation ◽  
Mri Findings ◽  
Lumbar Intervertebral Disc ◽  
Canal Stenosis ◽  
Lumbar Intervertebral Disc Herniation

Aim – to evaluate clinical and instrumental correlation (MRI data) in patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis for optimizing the indications for differentiated surgical treatment. Materials and methods. Clinical and neurological manifestations and MRI data in 80 patients (men – 36, women – 44), aged 27 to 72 years with a diagnosis of intervertebral disc herniation complicated by spinal canal stenosis were retrospectively analyzed. Depending on the size of the spinal canal, there were 2 groups: the first – with relative spinal canal stenosis (n = 20) – 75–100 mm2, and the second group – with absolute spinal canal stenosis (n = 60) – less than 75 mm2. We examined the correlation between the clinical and neurological presentations and MRI findings. Results. Our retrospective analysis has found that the first group consisted mainly of younger patients (46 years) and with a mean intervertebral disc herniation of 8.35 mm, while the second group included older patients (51.7 years) and the mean size of intervertebral disc herniation was 7.3 mm. The group of relative spinal canal stenosis was dominated by patients with radiculopathy syndrome (70 %) and pain in one lower limb (85 %). Radiculoischemia syndrome (50 %), pain in both lower extremities (33 %), neurogenic intermittent claudication syndrome (46.6 %), knee reflex disorders (58.3 %), pelvic organ dysfunction (11.6 %) were more common in the second group of patients. In addition, the longest disease duration (more than 24 months) was observed among patients of this group. We have found a relationship between pain syndrome (according to VAS), muscle strength, the disease duration and the spinal canal area. Conclusions. The correlation of clinical and instrumental methods of examination in patients with intervertebral disc herniation complicated by spinal canal stenosis allows the indications for differentiated surgery to be optimized.

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