China
Africa
Explore chapters and articles related to this topic
Surgery of the Cervical Spine
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Care should be taken to avoid plunging instruments into the interlaminar space. If required, the ligamentum flavum is detached from the inferior lamina using a spatula, Kerrison punch or triple zero curette. Further laminotomy, laminectomy or laminoplasty are carried out as needed (Figure 3.4).
How to dissect the plane between the scar of a laminectomy defect in the posterior thoracic and lumbar spine
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Nickul S. Jain, Raymond J. Hah
The success of revision surgery is contingent on an accurate diagnosis of the cause of presenting symptoms. A thorough history and physical should focus on previous operations, the reasons for those operations, and the changes in symptoms before and after the index procedures. Additionally, patients should be carefully queried for any potential postoperative complications after each procedure and the way that they were managed. Previous operative reports and hospital records should be obtained to identify previous instrumentation and intraoperative and perioperative complications. Patient-related factors known to affect outcomes should be identified, including pending legal action, workers’ compensation, unmanaged psychiatric comorbidity, nutritional status, opioid abuse or tolerance, tobacco use, and poorly optimized medical comorbidity. Alternative pathologies should be ruled out (i.e., vascular claudication, hip pathology, neuropathy, and peripheral entrapment). Appropriate imaging should be obtained and reviewed for residual neural compression, solid arthrodesis, and evidence of pseudomeningocele or arachnoiditis. Prior laminectomy and laminotomy defects should be noted and carefully approached during exposure. Electrodiagnostics and targeted injections may be useful to establish specific pain generators.
Chronic Back Pain
Published in Andrea Kohn Maikovich-Fong, Handbook of Psychosocial Interventions for Chronic Pain, 2019
Emily J. Ross, Jeffrey E. Cassisi, Kenneth R. Lofland
Invasive treatments initially may be recommended in cases such as disc hernia, spinal instability, and spinal tumor. Specific interventions for these conditions include: laminectomy, laminotomy, spinal fusion therapy, and spinal cord stimulators (SCS). Despite generally positive outcomes, surgical interventions are not without controversy. Spinal surgery is performed in the U.S. at a rate up to five times higher than in other developed countries, even though spinal disease and injury are no more prevalent (Chan & Peng, 2011). In one study, even though surgery was “objectively” successful in 84% of patients, 49% of patients reported worse pain following surgery, 44% were dissatisfied with the outcome, and 38% were significantly disabled at follow-up (LaCaille, DeBerard, Masters, Colledge, & Bacon, 2005). Another study found that opioid pain medication use, taken more than 90 days post-operatively, actually increased following surgery (Nguyen, Randolph, Talmage, Succop, & Travis, 2011). Therefore, even when the surgeon has labeled the spinal surgery a success, it does not necessarily improve patient functioning or satisfaction with care. With every intervention, the probability of success decreases and the pain syndrome can become more complex.
Cervical syringomyelia with caudal thoracic epidural lipomatosis: case report and literature review
Published in International Journal of Neuroscience, 2023
Anthony Michael Alvarado, Zihan Masood, Sarah Woodrow
In all 3 prior cases surgical treatment was pursued after conservative treatment failed. Various techniques were utilized including laminectomy, laminoplasty, and laminotomy with excellent clinical and radiographic outcomes [1, 2, 10]. Noteworthy findings from the 3 prior cases include male predominance (67%) and clinical improvement following spinal cord decompression (100%). More so, syringomyelia reduction or resolution was noted in all patients. Interestingly, the use of corticosteroids or obesity was not a known contributing factor (Table 1). In the case by Saez-Alegre and colleagues conservative treatment was pursued for 10 years as the patient experienced only minor sensory symptoms in the setting of polyneuropathy documented on electromyogram; however, the patient experienced worsening symptoms with radiographic syrinx progression necessitating surgical intervention [1]. This exemplifies the importance of clinical decision making regarding syringomyelia and associated EL, and that management must be individualized and consider neurologic manifestations. In the case presented by Tucer et al., imaging also revealed an arachnoid cyst at the level of the syrinx. In this case, it is difficulty in determining whether the arachnoid cyst caused the syrinx formation or if the presence of EL was the cause [10].
Bilateral laminotomy through a unilateral approach (minimally invasive) versus open laminectomy for lumbar spinal stenosis
Published in British Journal of Neurosurgery, 2021
Jack Horan, Mohammed Ben Husien, Ciaran Bolger
Podichetty et al.15 demonstrated that MI unilateral laminotomy has several other advantages over open approaches. In addition to shorter hospital stays, there was less soft tissue damage and less analgesia used. The incidence of hospital-related complications like infections, pneumonia and urinary retention was also lower in MI approaches. Lower complication rates in MI techniques were recorded in other studies.14,20,25 Khoo et al.21 also reported significantly lower use of analgesia and narcotics post MI unilateral laminotomy. Çelik et al.20 compared laminectomy to MI bilateral laminotomy. They found lower complication rates and spinal instability in MI technique than open laminectomy. Alimi et al.13 postulate that MI methods have lower post-operative instability than open laminectomy. This seems intuitive considering that more structures, in particular midline structures are preserved in MI bilateral laminotomy. While it is conceivable that there is a potential for instability post-operatively due to disruption of the posterior tension band, particularly in the open group, this was not the case in our study. All patients had a lateral flexion-extension radiograph of the lumbar spine at 36 months and no cases of instability were found. A longer follow-up time may demonstrate a difference in stabilities between the modalities. Clinically instability is of critical importance as post-operative instability following open laminectomy is a major contributor to further spinal surgery.
Neuro-urological sequelae of lumbar spinal stenosis
Published in International Journal of Neuroscience, 2018
Jason Gandhi, Janki Shah, Gargi Joshi, Sohrab Vatsia, Andrew DiMatteo, Gunjan Joshi, Noel L. Smith, Sardar Ali Khan
A decompressive laminectomy involves removal of the spinous processes, lamina, ligamentum flavum and medial portions of the facet joints. Post-operatively, the nerve roots and cauda equina can recover physiologically [42]. Thomé et al. concluded that bilateral laminotomy was superior to laminectomy and unilateral laminectomy in regard to back and leg pain, both at rest and while walking [59].