Kyphotic deformity of thoracic or lumbar spine is generally developed as a consequence of Scheuerman's kyphosis, ankylosing spondylitis, congenital kyphosis, tuberculous kyphosis, spinal tumor, senile kyphosis, trauma and extensive laminectomy etc. The method of treatment is usually conservative. However, in severe kyphosis, gross abnormaility and neurologic complications, and the compression of cardiopulmonary system are resulted and then surgery may be indicated. Since the report of spinal osteotomy by Smith-Peterson, several treatment options have been reported. Despite improved techniques for treating spinal kyphotic deformities, correction of severe and acutely angled deformities are less effective and resulting many complications. We propose the use of a new method of posterior closing spinal osteotomy for the treatment of severe and acutely angled kyphotic deformity to minimize the complications and for effective correction. We report the technique and results of this method in two cases of tuberculous kyphosis and a case of ankylosing spondylitis.
Congenital Abnormalities ; Kyphosis ; Laminectomy ; Methods ; Osteotomy ; Spine ; Spondylitis, Ankylosing

OBJECTIVETo evaluate the effects and mechanism of radiation-sterilized allogeneic bone sheets in inducing vertebral plate regeneration after laminectomy in sheep.

METHODSTwelve adult male sheep (aged 1.5 years and weighing 27 kg on average) provided by China Institute for Radiation Protection underwent L3-4 and L4-5 laminectomy. Then they were randomly divided into two groups: Group A (n=6) and Group B (n=6). The operated sites of L4-5 in Group A and L3-4 in Group B were covered by "H-shaped" freeze-drying and radiation-sterilized allogeneic bone sheets (the experimental segments), while the operated sites of L3-4 in Group A and L4-5 in Group B were uncovered as the self controls (the control segments). The regeneration process of the vertebral plate and the adhesion degree of the dura were observed at 4, 8, 12, 16, 20 and 24 weeks after operation. X-ray and CT scan were performed in both segments of L3-4 and L4-5 at 4 and 24 weeks after operation.

RESULTSIn the experimental segments, the bone sheets were located in the anatomical site of vertebral plate, and no lumbar spinal stenosis or compression of the dura was observed. The bone sheets were absorbed gradually and fused well with the regenerated vertebral plate. While in the control segments, the regeneration of vertebral plate was not completed yet, the scar was inserted into the spinal canal, compressing the dura and the spinal cord, and the epidural area almost disappeared. Compared with the control segments, the dura adhesion degree in the experimental regenerated segments was much milder (P less than 0.01), the internal volume of the vertebral canal had no obvious change and the shape of the dura sack remained well without obvious compression.

CONCLUSIONSFreeze-drying and radiation-sterilized allogeneic bone sheets are ideal materials for extradural laminoplasty due to their good biocompatibility, biomechanical characteristics and osteogenic ability. They can effectively reduce formation of post-laminectomy scars, prevent recurrence of post-laminectomy spinal stenosis, and induce regeneration of vertebral plates.

Animals ; Bone Transplantation ; methods ; Laminectomy ; methods ; Regeneration ; Sheep ; Spinal Stenosis ; prevention & control ; Spine ; physiology ; Transplantation, Homologous

Adult ; Aged ; Female ; Humans ; Laminectomy ; methods ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged

During last 10 years we experienced 25 cases of C.N.S. cysticercosis. Now clinical analysis and evaluation of our cases were made and the results are followings; 1. Prevalence in man and women are nearly same and about 70% of cases are distributed between 20-50 years old. 2. According to Nieto's classification, mostly are ventricular (44%) and parenchymal type (36%). 3. Clinical manifestations were IICP (92%), focal neurological deficits (68%), seizure (48%), altered mental status (36%) and others listed on table 7. 4. In ventricular type, IICP and cerebellar dysfunction signs were predominated but seizure and focal neurological deficits were commonly seen in parenchymal type. 5. Subcutaneous cysticercus nodules were palpated in 32% of cases. 6. Positive stool ova was observed in 29% of cases. 7. Radiologic studies revealed as followings: 16% of cases showed abnormal findings on plain film, 84% on angiography, 94% on ventriculography and 100% on computed tomography and myelography. Computed tomography looks like most helpful diagnostic method for C.N.S. cysticercosis, they usually revealed lucent cystic lesion, hydrocephalic findings and contrast enhancement. 8. Suboccipital craniectomy, craniotomy with removal of parenchymal cyst or laminectomy were done according to location and types of lesion. 72% of operated cases revealed good results and mortality was 4% of cases.
Angiography ; Cerebellar Diseases ; Classification ; Craniotomy ; Cysticercosis* ; Cysticercus ; Female ; Humans ; Laminectomy ; Methods ; Mortality ; Myelography ; Ovum ; Prevalence ; Seizures

Since April 1972, we have used the method of continuous intravenous infusion of thiopentoned tubocurarine mixture in 74 cases which were not required fully muscular relaxation during operation such as orthopedic operation, laminectomy, and mastoidectomy etc. The results were as follows. 1. The average needs of thiopentone and d-tubocurarine were 430mg/hr and 6.5mg/hr. 2. There were no specific changes on blood pressure, pulse rate and respiration. 3. The average recovery time was 20 minutes. 4. This method was very simple, economic and no risk of explosion.
Blood Pressure ; Explosions ; Heart Rate ; Infusions, Intravenous* ; Laminectomy ; Methods* ; Orthopedics ; Relaxation ; Respiration ; Thiopental ; Tubocurarine

OBJECTIVETo assess the influence of different hinge positions on clinical results of expansive open-door laminoplasty (EOLP) for cervical spondylotic myelopathy (CSM).

METHODSA total of 102 CSM patients who underwent EOLP from February 2006 to February 2007 were enrolled in this randomized controlled trial. Using a random digits table, 57 patients with the hinge located at the inner margin of the lateral mass were classified as wide-open group, while 45 patients with the hinge positioned at the lamina margin served as narrow-open group. All patients were observed over 24 months, and the clinical and radiological results were analyzed statistically.

RESULTSThere were no significant differences in operation duration, intraoperative bleeding volume, Japanese Orthopaedic Association (JOA) scores, cervical curvature index, range of motion and neural function recovery rate. The neural functions were satisfactorily improved after surgery in both groups, while the severity of axial symptoms was significantly lower in the narrow-open group than in the wide-open group (P equal to 0.003). The incidence of C(5) palsy in the wide-open group was higher than that in the narrow-open group (5.3% vs 0), even though the difference did not reach statistical significance (one tailed Fisher's exact test, P equal to 0.17).

CONCLUSIONSProper inward shift of the hinge can ensure effectiveness of surgical decompression, avoid an excessive backward shift of the spinal cord, decrease the incidence of C(5) palsy and alleviate the severity of axial symptoms.

Aged ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Spondylosis ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo discuss clinical effects and methods of mini-incision posterior laminectomy by fenestration in the treatment of huge lumbar disc herniation.

METHODSFrom 1999 to 2008,107 patients with huge protruded lumbar intervertebral disc were retrospectively analyzed including 78 males and 29 females with an average age of 38.5 years ranging from 26 to 59 years. The patients were operated with mini-incision posterior laminectomy by fenestration. The affected region of patients were L4.5 (36 cases), L5S1 (71 cases). The herniation rate of nucleus was more than 40%. The patient's scores based on low back pain improved JOA standard were retrospectively analyzed.

RESULTSThe 107 patients were followed-up for from 0.5 to 4 years with an average of 1.75 years. The scores by low back pain improved JOA standard were improved from (1.500 +/- 1.200) before operation to (12.700 +/- 0.950) after operation. The average improvement rate was (82.96 +/- 6.85)%.

CONCLUSIONIt is a reliable method in the treatment of huge lumbar disc herniation with mini-incision posterior laminectomy by fenestration. The treatment method have advantage with less trauma, good spinal stability, conducive to patient recovery and maintain clinical efficacy.

Adult ; Female ; Herniorrhaphy ; Humans ; Intervertebral Disc Displacement ; surgery ; Laminectomy ; methods ; Lumbar Vertebrae ; Male ; Middle Aged ; Prognosis

Harrington Instrumentation is very effective method for treating the unstable thoraco-lumbar spine fracture and fracture-dislocations. Authors performed Harrington Instrumentations in 8 cases of unstable thoraco-lumbar spine fracture and fracture-dlslocations. The results obtained were as follows; 1. Spinal fracture and fracture-dislocations are most common in thoraco-lumbar junction. 2. Laminectomy increases the instability of the spine. 3. Pain was more common in the patient who has severe deformity of the spine. 4. Neurological recovery; a) In case of complete paralysis... returns of useless motor power in 2 of 6 cases. b) In case of incomplete paralysis... complete returns in all 2 patients. 5. Harrington Instrumentation is very effective for restoring the spine stability in unstable fracture and fracture-dislocations. 6. Early mobilization was possible and hospitalization period was shortened by Harrington Instrumentation.
Congenital Abnormalities ; Early Ambulation ; Hospitalization ; Humans ; Laminectomy ; Methods ; Paralysis ; Spinal Fractures ; Spine

Fracture of the vertebral end plate in the lumbar spine has been reported as a rare lesion occurring in the adolescent period. It is characterized by variable degrees of sign and symtom related to the degree of block on myelogram and the level of end plate fracture. Trauma or strenuous sport activity seems to play an improtant role in the production of fracture of vertebral body in the adolescent period. We experienced three cases of fracture of lower lumbar vertebral end plate in teenaged patients, two males and one female. Two patients showed upper end plate fracture with severe neurologic deficit on the involved root level and a strong positive on straight leg raising test, and one patient showed lower end plate fracture with slight neurologic deficit. Two patients with upper end plate fracture were treated with partial laminectomy with removal of fracture fragment and one patient with lower end plate fracture was treated with bilateral laminectomy and posterolateral fusion. The method of treatment will depend upon the type of fracture and the degree of neurologic symptoms. We obtained satisfactory results with posterior decompressive laminectomy and removal of fracture fragment with or without fusion.
Adolescent ; Female ; Humans ; Laminectomy ; Leg ; Male ; Methods ; Neurologic Manifestations ; Spine ; Sports

OBJECTIVETo explore the feasibility and clinical results of circumferential decompression and three-column reconstruction through single-stage posterior transpedicular approach for spinal tumor treatment.

METHODSTotally, 24 patients with spinal tumor underwent tumor resection and spinal reconstruction through single-stage posterior transpedicular approach. Preoperatively, according to the Frankel classification, 12 patients were grade E, 9 grade D, and 3 grade C. Anterior column was reconstructed with non-expandable titanium cages. Posterior segmental instrumentation was used to maintain the stability of spine in all cases. Anterior and posterolateral fusion was performed with autograft and allogenic bone. The following data were followed up in these patients: deformity angle, local recurrence, neurological function, and spinal bony fusion.

RESULTSThe average operating time and blood loss was 5.6 hours and 3,400 ml respectively. No intraoperative and postoperative complications were observed in this group. Postoperatively, 21 patients were Frankel grade E, 2 grade D, and 1 grade C. Four patients reported significant functional restoration and twenty patients reported complete resolution of pain. At follow-up (range, 6-42 months), implant failure or recurrent neurological symptoms was not found.

CONCLUSIONSThe tumor resection and spinal reconstruction through single-stage posterior transpedicular approach is a safe and effective technique for the treatment of spinal tumor. It can fully decompress the neurological structures, correct the kyphosis, and achieve early weight-bearing. This technique can improve life quality for the patients with spinal tumor.

Adult ; Aged ; Decompression, Surgical ; methods ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Reconstructive Surgical Procedures ; methods ; Spinal Neoplasms ; surgery ; Surgical Mesh ; Young Adult