Cauda Equina ; Humans ; Lumbar Vertebrae/diagnostic imaging* ; Spinal Stenosis/diagnostic imaging*

Female ; Humans ; Middle Aged ; Osteitis Deformans ; complications ; diagnostic imaging ; Radiography ; Spinal Stenosis ; complications ; diagnostic imaging ; Thoracic Vertebrae

OBJECTIVETo discuss radiological characteristics and clinical manifestation of isolated lumbar foraminal stenosis.

METHODSFrom March 2011 to March 2014, 21 patients with isolated degenerative lumbar foraminal stenosis accepted lumbar decompression and fusion in Beijing Luhe Hospital. Intervertebral disc space was evaluated by measuring the position of joint-body line on preoperative X-ray. Bilateral foraminal area of the corresponding segment in CT (sagittal view of 2D reconstruction) and MRI (T2W1 sagittal view) were measured by Surgimap software. For patients with unilateral symptoms, foraminal area of the affected side was compared with that of the contralateral side. Foraminal area of the same segment on CT was also compared with that on MRI. Preoperatively and at the final follow-up, visual analogue score (VAS) and Oswestry Disability Index (ODI) were used to evaluate clinical outcomes.

RESULTSAll patients had a follow-up over 6 months and the average follow-up was 16.8 months (7-42 months). Of the 21 patients (26 segments), 12 segments showed gross narrowing and 14 segments showed slight narrowing. After preoperative measurement on MRI, 6 patients had foraminal stenosis of grade 2, and 15 patients had foraminal stenosis of grade 3, showing no significant difference in clinical outcomes. Compared with the foraminal area of the unaffected side, the affected side showed a decrease of 16% on CT and 28% on MRI, and the difference was statistically significant (t = 3.453, P < 0.05). The foraminal area measured on CT was larger than that measured on MRI (P < 0.05). Compared with that preoperatively, VAS (back pain), VAS (leg pain) and ODI showed significant improvement at the final follow-up (P < 0.05).

CONCLUSIONSRadiological examinations as X-ray, CT, MRI and intervertebral foramen block technique play an important role in the diagnosis of foraminal stenosis. Soft oppression caused by hyperplasia and hypertrophy of transforaminal ligment or joint capsule may be important promoters of degenerative lumbar foraminal stenosis. Lumbar foraminal decompression and interbody fusion can satisfactorily improve preoperative symptoms.

Constriction, Pathologic ; diagnostic imaging ; Decompression, Surgical ; Humans ; Lumbar Vertebrae ; surgery ; Lumbosacral Region ; Magnetic Resonance Imaging ; Spinal Fusion ; Spinal Stenosis ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVETo investigate the feasibility and clinical value of intraoperative ultrasonography (IOUS) in thoracic spinal decompression surgery.

METHODSTen patients with confirmed thoracic spinal stenosis underwent thoracic spinal decompression in our center from August 2009 to December 2010. The appearance of the compressed section of spinal cord was observed with IOUS. Before and after the decompression operation, the diameters of dural sac and the spinal cord were recorded respectively. The location and nature of the compression-causing mass were confirmed.

RESULTSIOUS clearly showed the shape of the normal and the compressed sections of dural sac and spinal cord. In the 14 thoracic spinal cord sections of these 10 patients, the anteroposterior diameter, horizontal diameter, and their ratio were bigger than those before decompression. The values of anteroposterior diameter and anteroposterior/horizontal diameter ratio showed significant differences(the P value of dural sac anteroposterior diameter comparison was 0.008, which of spinal cord was 0.007; the P values of these two structures ratio comparison were both 0.002 before and after decompression), while the horizontal diameter presented no significant differences (the P values of both structures were 0.270 and 0.195 respectively before and after decompression).

CONCLUSIONSIOUS can clearly show the morphological changes of the dural sac and spinal cord before and after the decompression. In addition, it helps surgeons to locate and specify the nature of the compression-causing mass on the ventral side of dural sac. Furthermore, IOUS can suggest whether the decompression is sufficient in a real-time manner.

Adult ; Decompression, Surgical ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Intraoperative ; methods ; Spinal Cord ; diagnostic imaging ; Spinal Stenosis ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; Treatment Outcome ; Ultrasonography

BACKGROUNDTopping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration. There are few reports on Topping-off surgery and its rationality and indications remains highly controversial. Our study aims to investigate the short-term and mid-term clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration existed before surgery.

METHODSThe 25 cases that underwent L5-S1 posterior lumbar interbody fusion (PLIF) + L4-L5 interspinous process surgeries between April 2008 and March 2010 formed Topping-off group. The 42 cases undergoing L5-S1 PLIF surgery formed PLIF group. Both groups matched in gender, age, body mass index and Pfirrmann grading (4 to 6). The patients were evaluated with visual analogue scale (VAS) and Japanese orthopaedic association (JOA) scores before surgery and in the last follow-up. Modic changes of endplates were recorded.

RESULTSThe follow-up averaged 24.8 and 23.7 months. No symptomatic or radiological adjacent segment degeneration was observed. There was no significant difference in intraoperative blood loss or postoperative drainage. VAS and lumbar JOA scores improved significantly in both groups (t = 12.1 and 13.5, P < 0.05). Neither anterior nor posterior disc height was significantly changed. Segmental lordosis of L4-L5 and total lordosis were all increased significantly (Topping-off group: t = -2.30 and -2.24,P < 0.05; PLIF group: t = -2.76 and -1.83, P < 0.01). In the hyperextension and hyperflexion view, Topping-off group's range of motion (ROM) and olisthesis in the L4-L5 segment did not significantly change in flexion, but decreased in extension. In PLIF group, ROM (t = -7.82 and -4.90, P < 0.01) and olisthesis (t = -15.67 and -18.58, P < 0.01) both significantly increased in extension and flexion.

CONCLUSIONSCompared with single segment PLIF surgery, Topping-off surgery can achieve similar symptomatic improvement in cases with pre-existing mild or moderate adjacent segment degeneration, restrict the adjacent segment's ROM in extension and prevent excessive olisthesis of adjacent segment in both extension and flexion.

Adult ; Female ; Humans ; Intervertebral Disc Degeneration ; diagnostic imaging ; surgery ; Lumbar Vertebrae ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Diseases ; diagnostic imaging ; surgery ; Spinal Stenosis ; diagnostic imaging ; surgery ; Young Adult

OBJECTIVETo study the degree and changes of cervical spinal canal stenosis by MRI scans in flexion and extension of the cervical vertebrae.

METHODSThirty cases of cervical stenosis included 13 male and 17 female with an average age of 39 years ranging from 28 to 66 years. The sagittal diameter of cervical spinal canal were below 10 mm (absolute stenosis) in 12 cases,within 10 to 12 mm (correspondence stenosis) in 18 cases. MRI scans in neutrality, flexion, extension performanced and the degree of cervical spinal canal stenosis and the changes of spinal cord compression were evaluated after MRI scans obtained.

RESULTSNineteen patients of extension occurrenced stenosis more serious, 8 patients of flexion occurrenced (P < 0.05).

CONCLUSIONFor the cervical stenosis imaging diagnostic, flexion and extension of cervical MRI scan can be used to supplement conventional MRI examination neutral position, and the extension of MRI is more sensitivity than neutral position and flexion bit.

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Radiography ; Spinal Stenosis ; diagnosis ; diagnostic imaging ; physiopathology

OBJECTIVETo investigate value of X-ray, CT and MRI for the diagnosis of lumbar spinal stenosis.

METHODSThe data of 130 patients with clinical diagnosis and typical imaging signs of lumbar spinal stenosis were analyzed. The present study included 83 males and 47 females with an average age of 43.5 years (range from 27 to 75 years). CT examination was performed in all patients, routine X-ray examination in 23 patients and routine MRI in 57 patients.

RESULTSThe lumbar spinal stenosis showed at L(3,4) plane in 25 patients, L(4,5) in 48 patients and L5S1 in 57 patients. CT showed hyperostosis of lumbar posterior marginal, vertebral lamina, inferior articular process in 46 patients, hypertrophy of superior and inferior articular processsus in 7 patients, calcification or ossification of ligamentum flavum in 13 patients, vertebral body spondylolisthesis in 5 patients, lateral recess stenosis in 24 patients, and intervertebral foramen stenosis in 35 patients. MRI showed intervertebral disk hernia with disc associated with ligamentum flavum hypertrophy in 23 patients, ligamentum flavum symmetrical hypertrophy in 18 patients,extensive multi-segmental ligamentum flavum hypertrophy in 9 patients,and local ligamentum flavum hypertrophy in 7 patients.

CONCLUSIONThe main cause of secondary lumbar spinal stenosis is degeneration. Traditional X-ray examination has great limitations in diagnosis of lumbar spinal stenosis. CT and MRI have advantages of multi-directional imaging and the high resolution. CT can show well ligament calcification and ossification and other bone change which are showed not well on MRI, so CT is recommended to lumbar spinal stenosis.

Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Stenosis ; diagnosis ; diagnostic imaging ; Tomography, X-Ray Computed

Female ; Humans ; Ligamentum Flavum ; diagnostic imaging ; surgery ; Lumbar Vertebrae ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; diagnostic imaging ; surgery ; Spinal Stenosis ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUNDThe surgical outcomes of decompression for thoracic spinal stenosis (TSS) are unfavorable. The purpose of this study was to determine the efficacy of intraoperative ultrasonography during "cave-in" 360° circumferential decompression surgery in patients with TSS.

METHODSThirteen patients with TSS underwent "cave-in" 360° circumferential decompression surgery between May 2010 and November 2010. Intraoperative ultrasonography was used after removal of the posterior wall of thoracic spinal canal to assess the morphologic restoration of the spinal cord and the anterior surface of the spinal canal. In seven patients, ultrasonography was used again after circumferential decompression to compare the cross-sectional area of the spinal cord before and after circumferential decompression.

RESULTSThe average period of follow-up was (12 ± 2) months (range 9 - 15 months). The Japanese Orthopedic Association score was significantly higher at the final follow-up (8.5 ± 2.1, range 3 - 10) than preoperatively (5.2 ± 1.1, range 3 - 7; P < 0.01). The cross-sectional area of the spinal cord was (30.8 ± 6.6) mm2 before and (53.6 ± 19.1) mm2 after circumferential decompression (P < 0.01). For five patients with TSS caused by thoracic disc herniation, the levels of circumferential decompression performed corresponded to those expected preoperatively. In contrast, for eight patients with TSS caused by ossification of the posterior longitudinal ligament, on average 1.6 ± 0.9 fewer levels of circumferential decompression were performed than expected preoperatively.

CONCLUSIONS"Cave-in" 360° circumferential decompression is an effective therapeutic option for TSS. Intraoperative ultrasonographic evaluation may reduce the levels of circumferential decompression and ensure sufficient decompression, and increase the efficacy of this surgical technique.

Adult ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Stenosis ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; surgery ; Ultrasonography ; Young Adult

OBJECTIVETo assess the clinical outcomes of Coflex interspinous dynamic internal fixation and the imaging changes for degenerative lumbar spinal stenosis.

METHODSFrom October 2007 to February 2009, 30 patients with degenerative lumbar spinal stenosis were treated with Coflex interspinous dynamic internal fixation, including 17 males and 13 females with an average age of 45 years (range, 39 to 65 years). The operation level at L4,5 were 20 cases, L5S1 9 cases and 1 case was in both the two levels. The ODI scores and JOA questionnaires were assessed before and after operation. The radiological measurement included ventral and dorsal intervertebral space height, segmental intervertebral angles formed by lines drawn on the upper and lower endplates of the instrumented and adjacent levels on flexion-extension radiographs; the area of spinal canal, dural sac, the sagittal and transverse diameter of the spinal canal and dural sac on CT scan. All the patients were treated with limited laminectomy and were implanted with Coflex device.

RESULTSAll the patients were followed up for 5 to 19 months. There were significant differences in the ODI scores and the JOA questionnaires by paired t-test (P<0.01). All the patients were satisfied with surgical outcomes except 3 patients whose pain were not obviously relieved and need drugs or block therapy; 3 patient complaining of progressive hypoesthesia. There were no complications associated with the Coflex device. The height of dorso-intervertebral disc was increased obviously while the range of motion in adjacent levels was not increased on flexion-extension radiographs; the area of spinal canal and dural sac were significantly increased.

CONCLUSIONIt shows a good clinical result to release the degenerative lumbar spinal stenosis symptoms and decrease short-term complications by using Coflex device. It is available for patients with increasing the intervertebral space, area of spinal canal and preventing the adjacent segment degeneration.

Adult ; Aged ; Decompression, Surgical ; methods ; Female ; Humans ; Internal Fixators ; Lumbar Vertebrae ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography ; Spinal Stenosis ; diagnostic imaging ; surgery ; Treatment Outcome