Adult ; Aged ; Female ; Humans ; Joint Instability ; complications ; diagnosis ; physiopathology ; surgery ; Lumbar Vertebrae ; pathology ; physiopathology ; Male ; Middle Aged ; Spinal Canal ; pathology ; physiopathology ; Spinal Stenosis ; complications ; diagnosis ; physiopathology ; surgery

OBJECTIVETo explore the causes, methods and outcomes of reoperative treatment after lumbar disc surgery.

METHODSNine hundred and twenty eight patients with lumbar disc herniation were treated surgically from January 1995 to January 2004, of whom 43 patients (4.6%) underwent reoperation due to persistent pain or recurrence of symptoms. Forty patients were followed up from 3 months to 84 months (mean 30 months).

RESULTSAccording to Macnab's criteria, outcomes were excellent in 11 cases (27.5%), good in 16 cases (40%), fair in 8 cases (20%), and poor in 5 cases (12.5%).

CONCLUSIONSThe major causes of reoperation after lumbar disc surgery included incomplete removal of herniating discs and recurrent disc herniation of primary interspace, secondary lumbar canal stenosis, and adhesion of nerve roots. Prior to primary surgical treatment of lumbar disc herniation, operative indications must be strictly accurate, surgical methods should be correctly selected, and improved and refined surgical skills should be guaranteed. Satisfactory outcomes can be gained with reoperation for patients who still requiring treatment.

Diskectomy ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; complications ; surgery ; Lumbar Vertebrae ; pathology ; surgery ; Male ; Middle Aged ; Recurrence ; Reoperation ; Spinal Stenosis ; etiology ; surgery

OBJECTIVETo investigate the perioperative characteristics and surgical methods in treating the old with degenerative lumbar spinal stenosis.

METHODSFrom January 2000 to October 2007, 36 patients with degenerative lumbar spinal stenosis with the age more than 60 years,including 16 males and 20 females, the age from 60 to 81 years with an average of 67.5 years. Of all patients, 6 cases were treated by simple surgical decompression, 16 cases by decompressive laminectomy, 20 cases by decompressive laminectomy combined with internal fixation and fusion.

RESULTSNo death cases occurred during perioperation and complication occurred in 14 cases, including cerebrospinal fluid leakage in 3 cases, incision late healed in 1 case, heart abnormal symptom in 1 case, respiratory infection in 1 case, gastrointestinal symptom in 4 cases, urinary system infection in 1 case, spirital symptom in 1 case. After symptomatic treatment, all complications improved. All the cases were followed up from 6 months to 5 years with an average of 2.5 years. Oswestry scoring improved from preoperative 45.66 +/- 7.12 to postoperative 16.80 +/- 5.75, there was significant difference between before and after operation (P < 0.05).

CONCLUSIONThe age and heath condition are not operative absolute contraindication in treating old with degenerative lumbar spinal stenosis,with the proper operation modus after controlling concomitant diseases, the surgical treatment could guarantee the satisfactory therapeutic effect.

Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; pathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies ; Spinal Stenosis ; physiopathology ; surgery ; therapy ; Treatment Outcome

Adult ; Aged ; Diskectomy ; methods ; Endoscopy ; methods ; Female ; Humans ; Intervertebral Disc Displacement ; complications ; pathology ; surgery ; therapy ; Lumbar Vertebrae ; pathology ; surgery ; Male ; Middle Aged ; Spinal Stenosis ; complications ; pathology ; surgery ; therapy ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore forensic identification of causality between injury and the consequence in cases of cervical spinal cord injury without fracture or dislocation. METHODS: Twenty-five cases of cervical spinal cord injury without fracture or dislocation were collected. The age, mode of injury, imaging reports, cervical vertebral degeneration, clinical manifestations, diagnosis, treatment and injury consequences were summarized. The causality between injury and its consequence were classified as direct cause, main cause, same cause, minor cause and no cause. RESULTS: Age, mode of injury, cervical vertebral degeneration and spinal stenosis were important factors in the analysis of causality. In the injured younger than 8-year-old trauma was generally the direct cause to the damage. While in other injured, it was needed to analyze the various factors comprehensively. CONCLUSION Comprehensive analysis of age, mode of injury, cervical vertebral degeneration, spinal stenosis and other factors would contribute to accurate identification of the causality between the injury and the consequences in cases of cervical spinal cord injury without fracture or dislocation.
Accidents, Traffic ; Adolescent ; Adult ; Age Factors ; Cervical Vertebrae ; Child ; Child, Preschool ; Female ; Forensic Medicine ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Injuries/pathology* ; Spinal Stenosis/complications* ; Spondylosis/complications* ; Young Adult

PURPOSE: Percutaneous epidural neuroplasty (PEN) is a minimally invasive treatment. The efficacy of PEN has been relatively well investigated; however, the relationship between the clinical effectiveness of PEN and the severity of spinal canal stenosis by disc material has not yet been established. The purpose of this study was to compare clinical outcomes of PEN according to the dural sac cross-sectional area in single level disc disease. MATERIALS AND METHODS: This study included 363 patients with back pain from single level disc disease with and without radiculopathy. Patients were categorized into groups according to spinal canal compromise by disc material: Category 1, less or more than 50%; and Category 2, three subgroups with lesser than a third, between a third and two thirds, and more than two thirds. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain and Odom's criteria at 1, 3, 6, 12, and 24 months after treatment. RESULTS: The demographic data showed no difference between groups according to spinal canal compromise by disc material except age (older age correlated with more spinal canal compromise). The dural sac cross-sectional area did not correlate with the VAS scores for back and leg pain after PEN in single level disc disease in Groups 1 and 2. Odom's criteria after PEN were also not different according to dural sac cross-sectional area by disc material. CONCLUSION: PEN is an effective procedure in treating single level lumbar disc herniation without affecting dural sac cross-sectional area.
Adult ; Aged ; Back Pain/etiology/*surgery ; Dura Mater/*pathology ; Female ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Spinal Stenosis/complications/*pathology ; Tissue Adhesions/*surgery ; Treatment Outcome ; Visual Analog Scale

PURPOSE: To examine the effects of conservative and surgical treatments for nocturnal leg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS. MATERIALS AND METHODS: The subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatment such as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment. RESULTS: The severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improved in both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122). CONCLUSION: The findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgical treatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associated with spinal nerve compression by LSS.
Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical ; Female ; Humans ; Leg/*pathology ; Low Back Pain/epidemiology/etiology ; Male ; Middle Aged ; Pain/*epidemiology/*etiology ; Prospective Studies ; Questionnaires ; Spinal Stenosis/*complications/*physiopathology/surgery

OBJECTIVETo investigate the clinical characteristics and results of cervical spinal cord injury (SCI) in the patients with ossification of the posterior longitudinal ligament (OPLL).

METHODSNineteen patients with cervical SCI associated with OPLL were retrospectively analyzed. Data collection included: pre- and postoperative neurological function, OPLL-type, MRI signal changes and surgical approaches.

RESULTSSpinal cord associated with OPLL was injured severely by mild trauma. Methylprednisolone sodium succinate was used within 8 h after trauma in 12 cases. Two of them died of complications. The neurological functions were markedly improved in the other 10 cases. Seventeen cases had surgical treatment. The neurological functions (Frankel grade) were improved significantly in the operated patients except for one, who died 27 d after operation.

CONCLUSIONSThe patients with OPLL are prone to have severe SCI, which directly associates with the preexisting OPLL-type and hyper-intensity signal change in the spinal cord on MRI. Both of using methylprednisolone sodium succinate administration within 8 h after trauma and surgical decompression may improve the neurological outcomes.

Aged ; Cervical Vertebrae ; Decompression, Surgical ; Female ; Follow-Up Studies ; Glucocorticoids ; therapeutic use ; Humans ; Longitudinal Ligaments ; pathology ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; complications ; Retrospective Studies ; Spinal Cord ; drug effects ; physiopathology ; surgery ; Spinal Cord Injuries ; diagnosis ; etiology ; therapy ; Spinal Stenosis ; diagnosis ; etiology ; therapy ; Treatment Outcome