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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
Magnetic resonance imaging (MRI), with and without IV contrast, is critical to determine areas of compression of neural elements. The addition of gadolinium can help distinguish peridural fibrosis from recurrent disc herniation or residual stenosis. Additionally, MRI will show an asymptomatic contained pseudomeningocele, which may need to be avoided or addressed. MRI imaging must also be carefully examined to determine the site of stenosis: central, lateral recess, or foraminal. Examination of the residual bony anatomy (both normal and previously altered) to establish how much additional bony resection may be required. This distinction will allow an appropriate surgical plan to maximize chances of success. MRI will show the transition zone between native and previously operated anatomy in order to find a safe entry point for dissection (Figure 3.1). In patients with previous instrumentation, visualization of neural elements is obscured due to artifacts. In these situations, computed tomography (CT) myelogram can be useful.
The back
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Anatomically, spinal stenosis is categorized as central, lateral or foraminal. Central spinal stenosis involves the area between the facet joints and contains the dural sac and nerve roots. The lateral border of the dura to the medial border of the pedicle defines the lateral recess containing the traversing nerve root. The foraminal region is situated under the pars and contains the exiting nerve root. Lateral to the pars and facet joints lies the extraforaminal region where a nerve root may be compressed by a ‘far lateral’ disc protrusion (Figure 18.40).
Neuropathic Low Back Pain
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
Joseph F. Audette, Walker Joseph, Alec L. Meleger
Structural narrowing of the subarticular or lateral recesses (lateral recess entrapment neuropathy) can involve the exiting spinal nerve, a descending spinal nerve that exits at the level below, a combination of both, or a sinuvertebral nerve. This can be caused by a far lateral disk protrusion, a large diffuse disk bulge, facet joint or ligamentum flavum hypertrophy, facet joint cyst, spondylolisthesis, Tarlov or a combination of these.
Uniportal versus biportal endoscopic spine surgery: a comprehensive review
Published in Expert Review of Medical Devices, 2023
Six articles were identified using an earlier search strategy [23–28]. All studies were retrospective, comparative cohort studies. The characteristics of each study are summarized in Tables 1 and 2. The standard surgical indications for endoscopic decompression were: 1) single-level lumbar central and lateral recess stenosis, 2) manifestation of typical clinical symptoms and signs, and 3) failed conservative therapy for at least 12 weeks. Cases with foraminal stenosis, segmental instability, spondylolisthesis, infection, tumor, trauma, history of previous surgery, or multilevel disease were excluded. The surgical procedure was determined based on the surgeon’s preference and experience.
Endoscopic transforaminal lumbar interbody fusion: a comprehensive review
Published in Expert Review of Medical Devices, 2019
Yong Ahn, Myung Soo Youn, Dong Hwa Heo
Common indications for endoscopic TLIF include the following: (i) lumbar foraminal stenosis with segmental instability, (ii) lumbar lateral recess stenosis with segmental instability, (iii) lumbar disc herniation with segmental instability, (iv) grade 1 lumbar degenerative/isthmic spondylolisthesis, and (v) postoperative instability or failed back surgery syndrome. Contraindications to endoscopic TLIF include the following: (i) severe lumbar central stenosis, high-grade spondylolisthesis (grade >2), (iii) severe disc space narrowing, and (iv) any condition potentially decreasing the safety and effectiveness of a spinal implant, such as osteoporosis, vertebral fracture, infection, or congenital abnormality.
Canalostomy is an ideal surgery route for inner ear gene delivery in big animal model
Published in Acta Oto-Laryngologica, 2019
Xiao-Jun Ji, Wei Chen, Xiao Wang, Yue Zhang, Qian Liu, Wei-Wei Guo, Jian-Guo Zhao, Shi-Ming Yang
Although mouse models have been used with great success for better inner ear gene therapy for human hearing loss, there are many limitations: some models cannot faithfully reproduce human hearing loss, and there are huge differences in inner ear size, gestation period, and physiology between human and mouse [12]. Compared with traditional mice models, the miniature pig has several advantages for biomedical research, including the similarities of numerous physiological functions with the human. Its similarities to the human regarding the temporal bone include the middle and inner ear and the lateral recess and provide opportunities for its application in otological research [16].