scholarly journals Post-Operative Spinal Epidural Hematoma after Thoracic and Lumbar Spinous Process-Splitting Laminectomy for Thoracic and Lumbar Spinal Stenosis

2019 ◽  
Vol 3 (3) ◽  
pp. 244-248
Author(s):  
Yawara Eguchi ◽  
Munetaka Suzuki ◽  
Takashi Sato ◽  
Hajime Yamanaka ◽  
Hiroshi Tamai ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Epidural Hematoma ◽  
Spinous Process ◽  
Spinal Epidural Hematoma ◽  
Lumbar Spinal ◽  
Spinal Epidural ◽  
Lumbar Spinous Process

Evaluation of postoperative spinal epidural hematoma after microendoscopic posterior decompression for lumbar spinal stenosis: a clinical and magnetic resonance imaging study

2006 ◽  
Vol 5 (5) ◽  
pp. 404-409 ◽  
Author(s):  
Ko Ikuta ◽  
Osamu Tono ◽  
Takayuki Tanaka ◽  
Junichi Arima ◽  
Soichiro Nakano ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Epidural Hematoma ◽  
Posterior Decompression ◽  
Dural Sac ◽  
Group 2 ◽  
Lumbar Spinal ◽  
Spinal Epidural ◽  
Group 1

Object The incidence of postoperative spinal epidural hematoma (SEH) is low, and to the best of the authors’ knowledge, no researchers have evaluated its actual incidence and clinical features. The purpose of this study was to investigate the clinical consequences of SEH after microendoscopic posterior decompression (MEPD) in patients with lumbar spinal stenosis. Methods Data obtained in 30 patients undergoing MEPD for lumbar spinal stenosis were reviewed. At 1 week after surgery, magnetic resonance (MR) imaging documented SEHs in 10 patients (33% [Group 1]) and no evidence of SEHs in 20 patients (67% [Group 2]). The authors compared MR imaging findings, postoperative morbidities, and clinical outcomes between the groups. Three Group 1 patients had symptomatic SEHs. All symptoms were mild without associated neurological deterioration and spontaneously subsided within 3 weeks of surgery. Magnetic resonance imaging demonstrated spontaneous regression of the SEH in all patients at 3 months after surgery. In Group 1 patients, however, the authors observed less expansion of the dural sac after 1 year despite sufficient widening of the osseous spinal canal. Low-back pain within 1 week of surgery was moderate in Group 1 and mild in Group 2. Improvements at the final follow up were greater in Group 2 patients. Conclusions The incidence of postoperative SEHs may be greater than reported. Postoperative SEHs caused poor expansion of the dural sac despite its spontaneous regression. In addition, postoperative SEHs caused a delay in the patient’s recovery and led to a poor clinical improvement. The prevention of postoperative SEHs might be required to prevent not only neurological deterioration but also a delay in the patient’s recovery.

scholarly journals Surgical outcomes of modified lumbar spinous process–splitting laminectomy for lumbar spinal stenosis

2015 ◽  
Vol 22 (4) ◽  
pp. 353-357 ◽  
Author(s):  
Shunsuke Kanbara ◽  
Yasutsugu Yukawa ◽  
Keigo Ito ◽  
Masaaki Machino ◽  
Fumihiko Kato
Keyword(s):  
Blood Loss ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Muscle Atrophy ◽  
Spinous Process ◽  
Intraoperative Blood Loss ◽  
Paravertebral Muscle ◽  
Paravertebral Muscles ◽  
Lumbar Spinal ◽  
Lumbar Spinous Process

The lumbar spinous process–splitting laminectomy (LSPSL) procedure was developed as an alternative to lumbar laminectomy. In the LSPSL procedure, the spinous process is evenly split longitudinally and then divided at its base from the posterior arch, leaving the bilateral paravertebral muscle attached to the lateral aspects. This procedure allows for better exposure of intraspinal nerve tissues, comparable to that achieved by conventional laminectomy while minimizing damage to posterior supporting structures. In this study, the authors make some modifications to the original LSPSL procedure (modified LSPSL), in which laminoplasty is performed instead of laminectomy. The purpose of this study was to compare postoperative outcomes in modified LSPSL with those in conventional laminectomy (CL) and to evaluate bone unions between the split spinous process and residual laminae following modified LSPSL. Forty-seven patients with lumbar spinal stenosis were enrolled in this study. Twenty-six patients underwent modified LSPSL and 21 patients underwent CL. Intraoperative blood loss and surgical duration were evaluated. The Japanese Orthopaedic Association (JOA) scale scores were used to assess parameters before surgery and 12 months after surgery. The recovery rates were also evaluated. Postoperative paravertebral muscle atrophy was assessed using MRI. Bone union rates between the split spinous process and residual laminae were also examined. The mean surgical time and intraoperative blood loss were 25.7 minutes and 42.4 ml per 1 level in modified LSPSL, respectively, and 22.7 minutes and 29.5 ml in CL, respectively. The recovery rate of the JOA score was 64.2% in modified LSPSL and 68.7% in CL. The degree of paravertebral muscle atrophy was 7.8% in modified LSPSL and 22.2% in CL at 12 months after surgery (p < 0.05). The fusion rates of the spinous process with the arcus vertebrae at 6 and 12 months in modified LSPSL were 56.3% and 81.3%, respectively. The modified LSPSL procedure was less invasive to the paravertebral muscles and could be a laminoplasty; therefore, the modified LSPSL procedure presents an effective alternative to lumbar laminectomy.

scholarly journals Spontaneous Resolution of Presumed Acute Epidural Hematoma Formation After Lumbar Epidural Steroid Injection

2017 ◽  
pp. 189-193
Author(s):  
Christopher M. Lam
Keyword(s):  
Spinal Stenosis ◽  
Epidural Hematoma ◽  
Steroid Injection ◽  
Fluid Collection ◽  
Epidural Steroid Injection ◽  
Spinal Epidural Hematoma ◽  
Epidural Steroid Injections ◽  
Lumbar Spinal ◽  
Epidural Steroid ◽  
Spinal Epidural

Epidural steroid injections are interventional pain procedures often used to treat lumbar radicular pain. The most serious complication of this procedure is the formation of a spinal epidural hematoma, which can result in profound permanent neurologic deficits if left untreated. A 76-year-old woman with mild lumbar spinal stenosis (L4-L5, L5-S1) and lumbar dextroscoliosis, previously on 81mg of aspirin daily (discontinued at 14 days prior to procedure) and not on anticoagulation therapy, underwent a lumbar epidural steroid injection (T12-L1). Post-procedurally, she developed bilateral leg paralysis. A magnetic resonance imaging (MRI) study revealed a fluid collection concerning for hematoma. Neurosurgery was consulted, but at the time of evaluation, she had near resolution of her presenting symptoms and the decision was made to monitor her for 48 hours. Three months after discharge, MRI revealed no persistent symptoms or radiographic evidence of sequelae from epidural hematoma. The frequency of spinal epidural hematomas after epidural steroid injections is unknown. This patient did not have traditional risk factors of severe spinal stenosis or the use of anticoagulant or antiplatelet agents. A radiographic fluid collection was seen, which may represent blood or persistent injectate. A formal surgical diagnosis was not obtained, as her symptoms spontaneously improved without further need for intervention. We report the first case of presumed persistent injectate compression of the lumbar spinal cord, resulting in bilateral lower extremity weakness in a patient with dextroscoliosis, mimicking spinal epidural hematoma with spontaneous resolution without intervention. Key words: Epidural steroid injection, spinal epidural hematoma, dextroscoliosis, lumbar radiculopathy, spinal stenosis, lower extremity paralysis

scholarly journals Does the drain placement technique affect the amount of postoperative spinal epidural hematoma after microendoscopic decompressive laminotomy for lumbar spinal stenosis?

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986902 ◽  
Author(s):  
Abdullah Merter ◽  
Motohide Shibayama
Keyword(s):  
Spinal Stenosis ◽  
Epidural Hematoma ◽  
Spinal Epidural Hematoma ◽  
Cross Sectional ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Lumbar Spinal ◽  
Spinal Epidural ◽  
Group 1

Objective: To prospectively evaluate with magnetic resonance imaging (MRI), the relationship between the distance from the incision of the drain output location and postoperative spinal epidural hematoma (SEH) in patients performed with microendoscopic decompressive laminotomy (MEDL) for lumbar spinal stenosis. Methods: Between January 2016 and June 2018, three different kinds of drain placement techniques, according to the drain output location, were performed to a total of 184 patients after MEDL for single-level spinal stenosis. The location of the drain output was within the incision in group 1, 1 cm lateral of the incision in group 2, and 5 cm lateral of the incision in group 3. At 24 h postoperatively, before removal of the drain, MRI examination was carried out in patients. A specific classification was developed by the authors to measure SEH, and the groups were evaluated by comparison. Results: The mean postoperative dural sac cross-sectional area was 1.73 cm2 (standard deviation (SD): 0.711) in group 1, 1.66 cm2 (SD: 0.732) in group 2, and 1.52 cm2 in group 3 (SD: 0.841).The mean cross-sectional area of the postoperative hematoma was 1.45 cm2 (SD: 1.007) in group 1, 1.57 cm2 (SD: 1.053) in group 2, and 2.11 cm2 (SD: 1.024) in group 3. Four grades were defined according to the specific classification. According to this classification, grades C and D postoperative hematomas were determined at a statistically significantly higher rate in group 3 patients (drain output 5 cm lateral from the incision) compared to the other groups ( p = 0.000). No significant difference was determined between groups 1 and 2 in respect of hematoma classification. Conclusion: In conclusion, it was determined that better drainage was provided in groups 1 and 2, where the drain output location was in the incision or close to it.

scholarly journals Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal stenosis: radiological results from a randomized controlled trial in the NORDSTEN study

2020 ◽  
Vol 29 (9) ◽  
pp. 2254-2261
Author(s):  
Erland Hermansen ◽  
Ivar Magne Austevoll ◽  
Christian Hellum ◽  
Kjersti Storheim ◽  
Tor Åge Myklebust ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Controlled Trial ◽  
Spinous Process ◽  
Surgical Techniques ◽  
Posterior Decompression ◽  
Clinical Trial Registration ◽  
Dural Sac ◽  
Radiological Results ◽  
Lumbar Spinal

Abstract Purpose To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Summary of background data Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. Methods The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. Results No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm2 in the UL-group, 71.9 (SD 37.1) mm2 in the BL-group and 68.1 (SD 41.0) mm2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. Conclusion For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area. Clinical trial registration The study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083.

Spinous Process Distractive Devices for Lumbar Spinal Stenosis

2007 ◽  
pp. 353-364
Author(s):  
Dimitriy Kondrashov ◽  
Ken Y. Hsu ◽  
James F. Zucherman
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinous Process ◽  
Lumbar Spinal

Modified Marmot Operation Versus Spinous Process Transverse Cutting Laminectomy for Lumbar Spinal Stenosis

Spine ◽  
2013 ◽  
Vol 38 (23) ◽  
pp. E1461-E1468 ◽  
Author(s):  
Mamoru Kawakami ◽  
Shin-ichi Nakao ◽  
Daisuke Fukui ◽  
Yasunori Kadosaka ◽  
Toshiko Matsuoka ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinous Process ◽  
Lumbar Spinal
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