OBJECTIVE: To explore short-term effectiveness of floating island laminectomy surgery in treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum. METHODS: A total of 31 patients with thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum between January 2019 and April 2022 were managed with floating island laminectomy surgery. The patients comprised 17 males and 14 females, aged between 36 and 78 years, with an average of 55.9 years. The duration of symptoms of spinal cord compression ranged from 3 to 62 months (mean, 27.2 months). The lesions affected T _1-6 in 4 cases and T _7-12 in 27 cases. The preoperative neurological function score from the modified Japanese Orthopaedic Association (mJOA) was 4.7±0.6. Surgical duration, intraoperative blood loss, and complications were recorded. The thoracic MRI was conducted to reassess the degree of spinal cord compression and decompression after operation. The mJOA score was employed to evaluate the neurological function and calculate the recovery rate at 12 months after operation. RESULTS: The surgical duration ranged from 122 to 325 minutes, with an average of 204.5 minutes. The intraoperative blood loss ranged from 150 to 800 mL (mean, 404.8 mL). All incisions healed by first intention after operation. All patients were followed up 12-14 months, with an average of 12.5 months. The patients' symptoms, including lower limb weakness, gait disorders, and pain, significantly improved. The mJOA scores after operation significantly increased when compared with preoperative scores ( P<0.05), gradually improving with time, with significant differences observed among 1, 3, and 6 months ( P<0.05). The recovery rate at 12 months was 69.76%±11.38%, with 10 cases exhibiting excellent neurological function and 21 cases showing good. During the procedure, there were 3 cases of dural tear and 1 case of dural defect. Postoperatively, there were 2 cases of cerebrospinal fluid leakage. No aggravated nerve damage, recurrence of ligamentum flavum ossification, or postoperative thoracic deformity occurred. CONCLUSION The floating island laminectomy surgery is safe for treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum, effectively preventing the exacerbation of neurological symptoms. Early improvement and recovery of neurological function are achieved.
Humans ; Male ; Spinal Stenosis/diagnostic imaging* ; Female ; Laminectomy/methods* ; Ligamentum Flavum/pathology* ; Middle Aged ; Aged ; Thoracic Vertebrae/surgery* ; Adult ; Decompression, Surgical/methods* ; Treatment Outcome ; Ossification, Heterotopic/surgery* ; Spinal Cord Compression/etiology* ; Spinal Cord Diseases/etiology* ; Magnetic Resonance Imaging

OBJECTIVE: To explore decompression strategies for lateral lumbar spinal stenosis under unilateral biportal endoscopy (UBE) assistance. METHODS: A clinical data of 86 patients with lateral lumbar stenosis treated with UBE-assisted intervertebral decompression between September 2022 and December 2023 was retrospectively analyzed. There were 42 males and 44 females with an average age of 63.6 years (range, 45-79 years). The disease duration ranged from 6 to 14 months (mean, 8.5 months). Surgical levels included L _{2, 3} in 3 cases, L _{3, 4} in 26 cases, L _{4, 5} in 42 cases, and L ₅, S ₁ in 15 cases. According to Lee's grading system, there were 21 cases of grade 1, 37 cases of grade 2, and 28 cases of grade 3 for lumbar spinal stenosis. Based on the location of stenosis and clinical symptoms, the 33 cases underwent interlaminar approach, 7 cases underwent interlaminar approach with auxiliary third incision, 26 cases underwent contralateral inclinatory approach, and 20 cases underwent paraspinal approach; then, the corresponding decompression procedures were performed. Visual analogue scale (VAS) score was used to evaluate lower back/leg pain before operation and at 1 and 3 months after operation, while Oswestry disability index (ODI) was used to evaluate spinal function. At 3 months after operation, the effectiveness was evaluated using the modified MacNab evaluation criteria. The spinal stenosis and decompression were evaluated based on Lee's grading system using lumbar MRI before operation and at 3 months after operation. RESULTS: All procedures were successfully completed with mean operation time of 95.1 minutes (range, 57-166 minutes). Dural tears occurred in 2 cases treated with interlaminar approach with auxiliary third incision. All incisions healed by first intention. All patients were followed up 3-10 months (mean, 5.9 months). The clinical symptoms of the patients relieved to varying degrees. The VAS scores and ODI of lower back and leg pain at 1 and 3 months after operation significantly improved compared to preoperative levels ( P<0.05), and the indicators at 3 months significantly improved than that at 1 month ( P<0.05). According to the modified MacNab evaluation criteria, the effectiveness at 3 months after operation was rated as excellent in 52 cases, good in 21 cases, and poor in 13 cases, with an excellent and good rate of 84.9%. No lumbar instability was detected on flexion-extension X-ray films during follow-up. The Lee's grading of lateral lumbar stenosis at 2 days after operation showed significant improvement compared to preoperative grading ( P<0.05). CONCLUSION For lateral lumbar spinal stenosis, UBE-assisted decompression of the spinal canal requires the selection of interlaminar approach, interlaminar approach with auxiliary third incision, contralateral inclinatory approach, and paraspinal approach based on preoperative imaging findings and clinical symptoms to achieve better effectiveness.
Humans ; Spinal Stenosis/diagnostic imaging* ; Female ; Male ; Middle Aged ; Decompression, Surgical/methods* ; Aged ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To evaluate early effectiveness of posterior 180-degree decompression via unilateral biportal endoscopy (UBE) in the treatment of lumbar spinal stenosis (LSS) combined with Michigan State University (MSU)-1 lumbar disc herniation (LDH). METHODS: A retrospective analysis was conducted on clinical data from 33 patients with LSS combined with MSU-1 LDH, who met selection criteria and were treated between March 2022 and January 2024. All patients underwent UBE-assisted 180-degree spinal canal decompression. The cohort comprised 17 males and 16 females, aged 37-82 years (mean, 67.1 years). Preoperative presentations included bilateral lower limbs intermittent claudication and radiating pain, with disease duration ranging from 5 to 13 months (mean, 8.5 months). Affected segments included L _{3, 4} in 4 cases, L _{4, 5} in 28 cases, and L ₅, S ₁ in 1 case. LSS was rated as Schizas grade A in 4 cases, grade B in 5 cases, grade C in 13 cases, and grade D in 11 cases. LDH was categorized as MSU-1A in 24 cases, MSU-1B in 2 cases, and MSU-1AB in 7 cases. Intraoperative parameters (operation time, blood loss) and postoperative hospitalization length were recorded. The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to assess the lower limb pain and functional outcomes after operation. Clinical efficacy was evaluated at last follow-up via modified MacNab criteria. Quantitative radiological assessments included dural sac cross-sectional area (DSCA) measurements and spinal stenosis grading on lumbar MRI. Morphological classification of lumbar canal stenosis was determined according to the Schizas grading, categorized into four grades. RESULTS: The operation time was 60.4-90.8 minutes (mean, 80.3 minutes) and intraoperative blood loss was 13-47 mL (mean, 29.9 mL). The postoperative hospitalization length was 3-5 days (mean, 3.8 days). All patients were followed up 12-16 months (mean, 13.8 months). The VAS score and ODI improved at immediate and 3, 6, and 12 months after operation compared to before operation, and the differences between different time points were significant ( P<0.05). At last follow-up, the clinical efficacy assessed by the modified MacNab criteria were graded as excellent in 23 cases, good in 9 cases, and poor in 1 case, with an excellent and good rate of 96.97%. Postoperative lumbar MRI revealed the significant decompression of the dural sac in 32 cases, with 1 case showing inadequate dural expansion. DSCA measurements confirmed progressive enlargement and stenosis reduction over time. The differences were significant ( P<0.05) before operation, immediately after operation, and at 6 months after operation. At 6 months after operation, Schizas grading of spinal stenosis improved to grade A in 27 cases and grade B in 6 cases. CONCLUSION Posterior 180-degree decompression via UBE is a safe and feasible strategy for treating LSS combined with MSU-1 LDH, achieving effective neural decompression while preserving intervertebral disc integrity.
Humans ; Spinal Stenosis/diagnostic imaging* ; Male ; Female ; Aged ; Lumbar Vertebrae/surgery* ; Middle Aged ; Intervertebral Disc Displacement/complications* ; Decompression, Surgical/methods* ; Retrospective Studies ; Endoscopy/methods* ; Adult ; Aged, 80 and over ; Treatment Outcome

OBJECTIVE: To explore prevalence, incidence and possible factors of immediate herniated discs after posterior cervical expansive open-door laminoplasty (EODL). METHODS: Totally 29 patients with cervical spinal stenosis and intervertebral disc herniation who underwent EODL from October 2020 to December 2021 were collected, including 24 males and 5 females, aged from 43 to 81 years old with an average of (61.3±9.0) years old;the courses of disease ranged from 1 to 120 months with an average of (36.4±37.0) months. Three or more intervertebral discs on C₃-C₇ were observed. The clinical efficacy was evaluated according to Japanese Orthopaedic Association (JOA) score before operation, 3 days and 1, 3, 6 and 12 months after operation, respectively. The changes of herniated disc before and after operation were measured by multipoint area method and two-dimensional distance method, and incidence and percentage of herniated disc regression were further calculated. Cervical imaging parameters such as Cobb angle (C₃-C₇), intervertebral angle, T₁ slope (T₁S), spinal canal sagittal diameter, K-line angle, dural sac sagittal diameter were measured and compared before and after operation. Pearson correlation was used to analyze correlation between cervical sagittal imaging parameters and disc herniation changes before and after operation. RESULTS: All patients obtained grade A wound healing, and 14 of them were followed up for 3(1.00, 5.25) months. There were no immediate or long-term postoperative complications. Totally 101 herniated intervertebral discs were measured, of which 79 regression numbers were obtained by area measurement. The number of intervertebral disc regressions by distance measurement was 77. There was no statistically significant difference in Cobb angle, intervertebral angle, T₁S and K-line angle of C₃-C₇ (P>0.05), however, there were statistically significant differences in sagittal diameter of spinal canal, sagittal diameter of dural sac, and JOA score before and after operation(P<0.05). The regression ratio of disc herniation ranged from 5% to 50%, and regression ratio of disc herniation was greater than 25% in 45.57%(36/79). Disc herniation in C_4,5 was positively correlated with sagittal plane diameter in C₅(r=0.423, P=0.028). There was a negative correlation between changes of C_3,4 and C_3,4 intervertebral angle (r=-0.450, P=0.041). The improvement rate of cervical JOA score immediately after operation was (59.54±15.07) %, and postoperative follow-up improved to (76.57±14.66) %. CONCLUSION Herniated disc regression immediately after EODL is a common occurrence, and EODL should be selected as far as possible under the premise of satisfying surgical indications. The regression of disc herniation is positively correlated with spinal canal sagittal diameter, and spinal canal should be enlarged as far as possible in the appropriate scope during EODL, so as to create more opportunities and conditions for disc regression and achieve better clinical results.
Humans ; Female ; Male ; Intervertebral Disc Displacement/diagnostic imaging* ; Spinal Stenosis/diagnostic imaging* ; Laminoplasty/methods* ; Middle Aged ; Aged ; Cervical Vertebrae/diagnostic imaging* ; Adult ; Aged, 80 and over ; Intervertebral Disc/surgery*

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

STUDY DESIGN: Case report. OBJECTIVES: We report the case of a long, solitary, rosary-shaped neurofibroma that was misdiagnosed as another disease due to the patient's surgical history involving repetitive procedures and its abnormal appearance. SUMMARY OF LITERATURE REVIEW: Neurofibroma is an intradural-extramedullary spinal tumor. It is generally not difficult to diagnose due to its frequent occurrence and specific magnetic resonance imaging (MRI) findings. However, to date, neurofibromatosis stigmata and long, solitary, rosary-shaped neurofibromas have rarely been reported. MATERIALS AND METHODS: A 60-year-old woman was admitted to our hospital due to persistent pain, despite previous surgery and repetitive procedures. On physical examination, vision loss, hearing loss, skin discoloration, or subcutaneous nodules were not observed. A neurologic examination revealed normal motor and sensory function and voiding sensation. No pathologic reflexes such as the Babinski sign were observed. Previous sequential MRIs revealed intradural lesions that progressed from the thoracic vertebra 11 to the lumbar vertebra 3. She had no signs of neurofibromatosis stigmata, and the neurologic examination was unremarkable. The initial diagnosis was based on serial MRIs, which revealed a parasite infestation, a spinal cord tumor (myxopapillary-type ependymoma with hemorrhage), arachnoiditis, and vascular malformations. Total mass excision was performed, and the final diagnosis was neurofibroma. RESULTS: There were no signs of a tumor remnants or local recurrence in a 1-year follow-up MRI study. CONCLUSIONS: Although intradural spinal tumors are very rare, their clinical features are nonspecific and resemble other degenerative spinal diseases, including spinal stenosis and disc herniation. These diseases may easily be overlooked by physicians.
Arachnoid ; Arachnoiditis ; Christianity ; Diagnosis ; Diagnostic Errors ; Ependymoma ; Female ; Follow-Up Studies ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurofibroma* ; Neurofibromatoses ; Neurologic Examination ; Parasites ; Physical Examination ; Recurrence ; Reflex ; Reflex, Babinski ; Sensation ; Skin ; Spinal Cord Neoplasms ; Spinal Diseases ; Spinal Stenosis ; Spine ; Vascular Malformations

BACKGROUNDLaminectomy is a major method to treat lumbar spinal stenosis (LSS), but it has lots of flaws such as scar tissue can form around the dura again or spinal instability. This study aimed to investigate the feasibility of transverse rotation laminoplasty (TRL) in the treatment of LSS.

METHODSThe mimic operations of TRL were performed both in the computerized image processing and on the lumbar specimen. Computed tomography (CT) images were either collected from 80 clinical patients with complaints of lumbago or obtained from 40 sets of lumbar specimens after rebuild of spinal canals. In the CT image processing the heights of the spinous process and laminae at L3-L5 were measured. The total length of the spinous process plus one side laminae after the operation was evaluated and compared with the length of inner margin of pedical before the operation. The areas of the vertebral canal were examined before and after the operation.

RESULTSIn the CT images, the height of spinous process of L3, L4 and L5 was 24.74 ± 3.45, 22.68 ± 5.96 and 21.54 ± 4.12 mm respectively, and that of laminae was 23.66 ± 2.32, 22.68 ± 5.36 and 20.99 ± 3.67 mm respectively (P > 0.05). Distance of inner border of pedical of L3, L4 and L5 was 23.01 ± 6.59, 24.65 ± 5.54 and 26.03 ± 7.34 mm respectively, and length of spinous process with laminae of those was 29.76 ± 4.91, 29.31 ± 6.43 and 32.53 ± 5.76 mm respectively (P < 0.05). Preoperative area of spinal canals of L3, L4 and L5 was 299.81 ± 10.09, 297.66 ± 9.54 and 308.22 ± 10.04 mm2 respectively, and postoperative area was 480.01 ± 9.33, 487.32 ± 8.65 and 501.03 ± 9.12 mm2 respectively (P < 0.05). In the human lumbar vertebrae specimen, the data similar to the former.

CONCLUSIONSThe excised canal posterior was covered, and the lumbar canals enlarged by TRL. The TRL provided a new alternative in the treatment of LSS.

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

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

BACKGROUNDAdjacent segment disease (ASD) is common after cervical fusion. The aim of this study was to evaluate the risk factors for ASD on X-ray and magnetic resonance imaging (MRI).

METHODSPatients included in this study had received revision surgeries after developing symptomatic ASD following anterior decompression and fusion. A control group that had not developed ASD was matched 1:1 by follow-up time and fusion segments. Plate-to-disc distances (PDDs), developmental cervical canal stenosis on X-ray, cervical disc degeneration grading, and cervical disc bulge impingements on preoperative MRI were measured and compared between the ASD group and the control group.

RESULTSThirty-four patients with complete radiographic data were included in the ASD group. The causative segments of ASD included nine cases of C3-4, 18 cases of C4-5, three cases of C5-6, and four cases of C6-7. The ASD occurred at the upper adjacent segments in 26 patients and at the lower adjacent segments in eight patients. PDD distributions were similar between the ASD group and the control group. Developmental cervical canal stenosis was a risk factor for ASD, with an odd ratio value of 2.88. Preoperative cervical disc degenerations on MRI were similar between the ASD group and the control group. In the upper-level ASD group, the disc bulge impingement was (19.7±9.7)%, which was significantly higher than that of the control group of (11.8±4.8)%.

CONCLUSIONSASD was more likely to develop above the index level of fusion. Developmental cervical canal stenosis and greater disc bulge impingement may be risk factors for the development of ASD.

Cervical Vertebrae ; pathology ; surgery ; Decompression, Surgical ; adverse effects ; Humans ; Intervertebral Disc Degeneration ; diagnosis ; etiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Risk Factors ; Spinal Fusion ; adverse effects ; Spinal Stenosis ; diagnostic imaging

STUDY DESIGN: Case report. OBJECTIVES: We report two cases regarding epidural air pseudocyst at the lumbar spine. SUMMARY OF LITERATURE REVIEW: Epidural air pseudocyst at the lumbar spine that provokes radiating pain and neurologic symptoms can be misdiagnosed as an epidural tumor or HIVD. Consequently, proper diagnosis and treatment of the epidural air pseudocyst at the lumbar spine is necessary. MATERIALS AND METHODS: We report on two patients with radiculopathy and neurologic symptoms resulting from epidural air pseudocysts. In one patient, the epidural air pseudocyst was found within the epidural ligament flavum area on an MRI, and fluoroscopic-guided FNA (fine needle aspiration) was performed. In the other, the epidural air pseudocyst was found behind the posterior longitudinal ligament and was accompanied by spinal stenosis. In this patient, we conducted open cystectomy and posterior decompression surgery. Results: After treatment, all patients have showed symptom improvement and they are currently living without discomfort. RESULTS: After treatment, all patients have showed symptom improvement and they are currently living without discomfort. CONCLUSIONS: Due to frequent misdiagnosis, the careful diagnosis of lumbar epidural air pseudocyst is necessary. Physicians should select a proper treatment plan concerning the patient's condition and the location of the lesion.
Biopsy, Fine-Needle ; Cystectomy ; Decompression ; Diagnosis ; Diagnostic Errors ; Epidural Neoplasms ; Humans ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Needles ; Neurologic Manifestations ; Radiculopathy ; Spinal Stenosis ; Spine*