Functional myelography, applying spinal movements(flexion-extension) in myelography, has been frequently used for accurate diagnosis of posture-related disorders such as herniated lumbar disc or spinal stenosis. Measurements were performed on functional myelographic findings of 62 patients, and in 24 cases surgically verified herniated lumber discs were present. The object of this study was to analyze changes in position and shape of the dural sac in spinal movements and confirm the clinical importance of functional myelography. The present study demonstrated that: 1) The anterior border of the dural sac was straight with flexion, but indented at the level of intervertebral space and this indentation was less prominent at L5-S1. 2) With extension, posterior indentation of the dural sac was more prominent at the level of the intervertebral space than the body, the A-P diameter of the dural sac was narrowed at all levels of the intervertebral spaces except L5-S1, and the dural sac moved anteriorly at the level of L5-S1 and all spinal bodies. 3) In surgically verified disc patients, anterior indentation of the dural sac was persistent in both flexion and extension views, and was more exaggerated with extension, but less prominent at L5-S1. In patient at L5-S1, anterior movement of the anterior dural border at the level of surgery was much decreased.
Diagnosis ; Humans ; Myelography* ; Spinal Stenosis

No abstract available.
Diagnosis* ; Magnetic Resonance Imaging* ; Spinal Stenosis*

OBJECTIVES: To determine if unilateral pedicle screw fixation is comparable to bilateral fixation in one-or two-segment lumbar spinal fusion. METHODS: Eighty-eight patients with spinal stenosis or spondylolisthesis were assigned to either unilateral or bilateral pedicle screw instrumentation groups. Demographic variables, preoperative diagnosis, number of fusion segments, and kinds of instrumentation used were similar between the two treatment groups. RESULTS: There were no significant differences between the two groups in terms of blood loss, clinical results, time at which fusion was complete, fusion rate, and complication rate. There were significant differences between the two groups in terms of duration of operating time, duration of hospital stay, medical expenses. The number of fusion segments or kinds of instrumentation did not affect the fusion rate, time at which fusion was complete, or clinical outcomes. Metal failure rate of unilateral fixation was higher in patients with spondylolytic spondylolisthesis than in patients with spinal stenosis. CONCLUSIONS: Unilateral pedicle screw fixation was as effective as bilateral pedicle screw fixation in lumbar spinal fusion independent of the number of fusion segments (one or two segments) or pedicle screw systems. Unilateral pedicle screw fixation is not recommended for spondylolytic spondylolisthesis patients who were treated with Gill' s decompression.
Decompression ; Diagnosis ; Humans ; Length of Stay ; Spinal Fusion* ; Spinal Stenosis ; Spondylolisthesis

PURPOSE: To compare the effectiveness of Magnetic Resonance Imaging and discography in the diagnosis of internal disc derangement (IDD) . MATERIALS AND METHODS: This study was confined to 90 discs of 30 patients diagnosed as IDD by MRI & disco-CT. We compared the pain nature of discogram, degree of annular tear in the disco-CT and degree of disc degeneration in MRI. The presence of HIZ (High Intensity Zone) in MRI was also compared with the pain of discogram. RESULTS: Those discs with more severe annular tears in the disco-CT showed more definite pain pattern in the discogram. More degeneration in the MRI was also correlated with more anatomical deterioration in disco-CT. Of the 27 discs with normal MRI, 6 (22%) showed severe pain provocation in discography. Of the 63 discs with degeneration in MRI, 14 (22%) showed no pain provocation in discography. Of all discs, HIZ was present in 16% (15/90) . When HIZ was present in a disc of a symptomatic patient, the possibility of it being a painful disc was 93%. CONCLUSION: In the diagnosis of IDD, MRI was helpful is seeing the degree of disc degeneration to rule out disc herniation or spinal stenosis. But the discogram is considered the only way for definite diagnosis of painful discs.
Diagnosis* ; Humans ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging* ; Spinal Stenosis

Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms including neck pain, headache, weakness and parasthesisas. According to previous and recent clinical researches, we investigated the geometric parameters of normal cervical spinal canal including the sagittal and transverse diameters as well as Torg ratio. The mean sagittal diameter of cervical spinal canal at C(1) to C(7) ranges from 15.33 mm to 20.46 mm, the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96. With respect to narrow cervical spinal canal, the following charaterstics are found: firstly, extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly, females sustain cervical spinal canal narrowing more easily than males; finally, the consistent narrowest cervical canal level is at C(4) for all ethnicity, but there is a slight variation in the sagittal diameter of cervical spinal stenosis (less than or equal to 14 mm in Whites, less than or equal to 12 mm in Japanese, less than or equal to 13.7 mm in Chinese). Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic, degenerative and inflammatory conditions and is related with extension of cervical spine, gender, as well as ethnicity. It is hoped that this review will be helpful in diagnosing spinal cord and neurological injuries with the geometric parameters of cervical spine in the future.
Cervical Vertebrae ; injuries ; Humans ; Magnetic Resonance Imaging ; Spinal Canal ; Spinal Cord Injuries ; diagnosis ; Spinal Stenosis

Until recently, thoracic spinal stenosis has been thought to be an uncommon disease because the diagnosis has been obscured by its many different clinical manifestations and also there has been a lack of radiographic sensitivity and specificity in the evaluation of the thoracic spine. Fortunately, the significant advancements made in the radiographic evaluation of the thoracic spine has enabled a more accurate diagnosis and thus, there has been an increasing number of reports of thoracic spinal stenosis in the literature. The authors analyzed thirty cases of thoracic spinal stenosis over an 11-year period. These patients comprised 0.33% of all the spinal operations that were performed in our department during the same period. The patients in our series averaged 50.6 years of age(range 21~76) consisting of 2 men and 8 women who had been symptomatic for an average of 21 months. The common presenting symptoms were motor weakness(86.7%), sensory change(86.7%), bladder/bowel dysfunction(76.7%), and pain(70.0%). Diagnosis was made from plain x-rays, myelography, computerized tomography(CT), myelography-CT, and magnetic resonance imaging(MRI). The underlying causes of thoracic spinal stenosis were ossification of ligamentum flavum(OLF) (30.0%), hypertrophied facet(20.0%), herniated nucleus pulposus(13.3%), bony spur(10.0%), and mixed lesion(6.8%). Most instances of OLF were ound in the distal thoracic spinal canal and were degenerative in nature. All patients underwent operations and the surgical outcome was excellent in 36.7% and good in 40.0%. The results of our study suggest that the occurrence of thoracic spinal stenosis is more common than is currently recognized in the literature and that early diagnosis and proper surgical management is essential in obtaining a better surgical result.
Diagnosis ; Early Diagnosis ; Female ; Humans ; Male ; Myelography ; Sensitivity and Specificity ; Spinal Canal ; Spinal Stenosis* ; Spine

The thoracic portion of the spinal cord is susceptible to compression by hypertrophic ossification of the spinal ligament in the thoracic spinal canal. Unlike ossification of the posterior longitudinal ligament(OPLL) in the cervical spine, however, thoracic myelopathy due to ossification of the ligamentum flavum(OLF) may be overlooked, misdiagnosed, or treated inappropriately. This is mainly because of lack of knowledge of this condition. We therefore describe our experience with 22 cases of thoracic myelopathy secondary to ossification of the ligamentum flavum among 45 cases of thoracic stenosis. The clinical manifestations of this condition and the results of its surgical treatment are described. The most common cause of thoracic stenosis was OLF(48.9%) and the most common symptoms were numbness or tingling in the legs(81.8%) and motor weakness of the lower extremities(72.7%). Radiologically, OLF occurred mainly at intervertebral segments T9-T10 through T12-L1(86.2%), the most prevalent site was T11-T12(31.0%). Most OLF involved multiple intervertebral segments(81.8%) particularly two or three segments (59.1%). Eleven of the 22 patients were also suffering from other ossified conditions such as OPLL(45.5%) at other spinal sites, suggesting that ossification has a common underlying etiology. According to the authors' experience, surgical treatment, particularly laminectomy, was usually successful and outcomes were very promising(excellent, 27.3% ; good, 45.5%). OLF of the thoracic spine is no longer an uncommon condition and the authors believe that early diagnosis and appropriate surgical treatment, before irreversible damage to the spinal cord has occurred, may be the key to better results.
Constriction, Pathologic* ; Early Diagnosis ; Humans ; Hypesthesia ; Laminectomy ; Ligaments ; Ligamentum Flavum* ; Spinal Canal ; Spinal Cord ; Spinal Cord Diseases ; Spinal Stenosis ; Spine

In 1934 Elsberg and Dyke published normal values for interpediculate distances as determined on roentgenograms of adult human spine. It has since proved invaluable in the roentgenologic diagnosis of spinal abnormalities and meningeal or cord lesion. Since 1942 the attempts at obtaining the interpediculate distances of children have been made. In 1943 Landmesser & Heublein prepared measurements of interpediculate distances using roentgenograms of selected children from the population of a home and hospital for crippled children, and in 1955 Simril and Thurston published maximum & minimum normal interpediculate distances of infants and children. But Schwarz published extreme upper limits of normal interpediculate disctances in children and adults adding measurements of the sacral spinal canal. Nagashima reported that sagittal & transverse diameters of spinal canal were measured in dried speciemens of normal adults vertebras. Many pioneer studies have established the clinical values of the interpediculated measurements in the diagnosis of intraspinal diseases at all ages. The present investigation was undertaken to provide refined maximal normal interpediculate measurements for use in diagnosis of intraspinal tumor and anomalies and minimem norms for recognition of spinal stenosis. It was also decided to show the results of normal interpediculate distances in adult Korean. The results were the followings : 1) The interpediculate distances from T1 to T12 in male were 22.6, 19.9, 18.3, 17.6, 16.9, 17.1, 17.3, 17.3, 17.3, 18.1, 19.8 and 22.7mm respectively, and in female 21.3, 18.4, 17.7, 17.4, 17.2, 17.0, 17.0, 16.9, 17.0, 17.1, 18.4, and 21.5mm. In male and female combined these were 22.3, 19.4, 18.1, 17.5, 17.0, 17.1, 17.2, 17.2, 17.4, 17.8, 19.4, and 22.3mm respectively. 2) The contour of thoracic canal was biconcave due to the fact that the interpediculate distances of T1 to T4 and T9 to T12 were generally larger than those of T5 to T8. 3) Average measurements in male were consistently larger than in female by about 1mm. 4) Compared with the measurements of Nagashima and Hinck, the IPD mean values for male were 1.1mm smaller than those of Hinck, and 0.6mm smaller than those of Nagashima, but for female 1.2mm smaller than those of Hinck, 0.3mm larger those of Nagashima. For male and female combined IPD were 0.8mm and 0.3mm smaller than those of Hinck and Nagashima respectively.
Adult* ; Child ; Diagnosis ; Female ; Humans ; Infant ; Male ; Reference Values ; Spinal Canal ; Spinal Stenosis ; Spine*

Since Di Chiro et al. first reported on computed tomography(CT) in syringomyelia, spinal CT has slowly but steadily gained in importance. Recently, application of advanced scanning equipment has led to considerable progress in the evaluation of spinal canal and disc diseases. Since April to December 1982 we have evaluated 96 spine patients by a high-resolution GE 8800 CT scanner. 1) High-resolution non-enhanced CT images provide clear visualization of soft tissue as well as bony structures of the spine, particularly of the lumbar spine. 2) Unenhanced CT of the lumbar spine is highly effective in the diagnosis of herniated disc or the evaluation of bony entrapment syndrome. 3) High-resolution CT aids in the evaluation of destructive neoplastic disease and of burst fracture of the spine. 4) So high-resolution CT is considered the most important noninvasive primary screening test in the diagnosis of herniated lumbar disc or spinal stenosis as well as in the evaluation of primary or metastatic spinal lesion.
Diagnosis ; Humans ; Intervertebral Disc Displacement ; Mass Screening ; Spinal Canal ; Spinal Stenosis ; Spine ; Syringomyelia

The significance of measurement of the spinal canal size was well recognized in case of detection of intraspinal tumor as well as diagnosis of spinal stenosis. The measurement of sagittal diameter of the lumber spinal canal by plain x-ray film is not always easy. However, the new method designed by Eisenstein made the measurement of sagittal diameter of the lumber spinal canal by plain x-ray film very easy. In order to study the range of normal values of the sagittal diameter of lumber spinal canal in Korean adults, authors measured antero-posterior and transverse diameter of the lumbar spinal canal in 290 normal Korean adults by Eisensteins method. The results obtained are as follows: 1. Mean values of sagittal diameter of the normal Korean adults male was 17.37±1.05mm at Ll, 16.43±1.12mm at L2, 15.89±1.20mm at L3, 15.45±1.24mm at L4, and 17.34±1.13mm at L5 vertebra and in female, 17.41±1.23mm at Ll, 16.45±1.20mm at L2, 16.14±1.41mm at L3, 15.40±1.32mm at L4, and 17.25±1.20mm at L5 vertebra. 2. Mean values of transverse diameter of the normal Korean adults male was 23.54±1.18mm at Ll, 24.61±1.17mm at L2, 25.78±1.41mm at L3, 27.72±1.86mm at L4, and 30.42±2.23mm at L5 vertebra and in female, 23.06±1.45mm at Ll, 23.90±1.48mm at L2, 25.21±1.53mm at L3, 26.62±1.88mm at L4, and 29.70±2.41mm at L5 vertebra. 3. In transverse diameter, it was increased more and more to the lower lumber level, the widest at L5 vertebra. 4. In sagittal diameter, it was decreased less and less to the lower lumbar level, the narrowest at L4, and increased again at L5 vertebra. 5. The difference of sagittal and transverse diameter of lumbar spinal canal at each level of lumbar spine was very significant statistically. 6. The difference of the transverse diameter of the lumber spinal canal between male and female was significant statistically but that of the sagittal diameter was not. 7. The difference of the sagittal and transverse diameter between each age group was not significant statistically.
Adult ; Diagnosis ; Female ; Humans ; Male ; Methods ; Reference Values ; Spinal Canal ; Spinal Stenosis ; Spine ; X-Ray Film