Influence of age, sex, height and lumber stenosis on the position of the conus medullaris in adults / Influencia de la edad, sexo, altura y estenosis lumbar en la posición del cono medular en adultos

Anatomical orientation of the termination level of Conus Medullaris (CM) has imperative role clinically for anesthetists and neurosurgeons which is considered as an objective guide to perform spinal anesthesia and spinal punctures circumspectly with less chance to have serious injuries. The current retrospective study was carried on to determine the location of the CM and how its termination level can be influenced by age, sex, height and lumber stenosis spine disease. The study included 462 participants that consisted of 199 men and 263 women range from 21 to 80 years of age and height range between 150-190 cm. Also, it included 150 lumber stenosis patients. The location of the CM was imaged using a series of magnetic resonance images (MRI) for the lumbosacral spine at different levels including, T12, T12-L1, L1, L1-L2, and L2. The measurements revealed inconsiderable differences in the CM termination level in relation to age, sex and height in a healthy study population. Moreover, the results showed insignificant differences in the CM termination level between men and women whether they are healthy or having lumbar spinal stenosis. In conclusion, the most common level of CM termination is at L1 followed by L1-L2. It is safe to perform a lumbar neuraxial procedures at the level of L3-L4.

La orientación anatómica del nivel de terminación del Conus medullaris (CM) tiene un importante papel clínico para los anestesistas y neurocirujanos, que se considera una guía objetiva para realizar la anestesia espinal y las punciones de la columna circunspectivamente con menos posibilidades de provocar lesiones graves. Se llevó a cabo un estudio retrospectivo para determinar la ubicación del CM y cómo su nivel de terminación puede verse afectado por la edad, el sexo, la altura y una patología de la columna vertebral, la estenosis lumbar. El estudio incluyó 462 participantes que consistían en 199 hombres y 263 mujeres de 21 a 80 años de edad y una altura de entre 150-190 cm. Además, se incluyeron 150 pacientes con estenosis lumbar. La ubicación del CM se determinó mediante una serie de imágenes de resonancia magnética (RM) de la columna lumbosacra a diferentes niveles, incluidos T12, T12-L1, L1, L1-L2 y L2. Las mediciones revelaron diferencias considerables en el nivel de terminación de CM en relación con la edad, el sexo o la altura en una población de estudio saludable. Además, los resultados mostraron diferencias poco significativas en el nivel de terminación de CM entre hombres y mujeres, sanos o con estenosis espinal lumbar. En conclusión, se encontró que el nivel más común de terminación del CM es L1 seguido de L1-L2, considerándose seguro realizar procedimientos neuroaxiales lumbares a nivel de L3-L4.

Sagittal diameter of the lumbar spinal canal and canal/body ratio in normal adult Saudis

The determination of normal sagittal diameter of the lumbar spinal canal in normal adult Saudis, and as to whether there are any racial difference in the morphometry of the lumbar spinal canal which are essential in a reliable evaluation of patients with symptoms of lumbar canal stenosis or low back pain. A retrospective study over a period of 5 years [June 2001 - May 2006] utilizing the computer system [magic web] which saves all x-ray images where computed tomography measurements of the mid-sagittal diameter of the lower three lumbar vertebral canal were made in 170 adults. For the sake of consistency, all measurements were taken by one observer and results were recorded as the mean of two measurements. To evaluate the significance obtained, Student t-test were carried out. The measurements showed that the mean mid-sagittal diameter of the lumbar spinal canal in the Saudi population was smilar to Caucasian and wider than the Far Eastern Asian or African. The mean male mid-sagittal diameters were slightly wider than those of the female but the differences were not statistically significant. The ratio is increased steadily as we go from L3 - L5, especially in the females. The mid-sagittal body/canal ratio is higher in the female in this population, which indicates that the lumbar canal is more capacious in females than that of the males. In age group over 60 years, the mid-sagittal diameters were smaller than those of younger generations at all levels. The mid-sagittal diameter of the lumbar spinal canal among Saudis is similar to the measurement in the Caucasian population; the radiological criteria of spinal canal stenosis should be identical between these two populations

Lumbar spinal stenosis: Evaluation of surgical Results in 100 cases

Although lumbur spinal stenosis syndrome is extremely common, considerable controversy continues to surround its classification, diagnosis and treatment. The aim of this study is evaluation of results of surgical therapy for lumbar spinal stenosis in 100 patients. In this article, we retrospectively analyzed the clinical, radiologicaLand surgical results of 100 patients operated in our neurosurgical clinics with the diagnosis of lumbar spinal stenosis. Surgical therapy and outcome are discussed with respect to the known facts. After clinical and radiological evaluation, 100 patients were diagnosed with lumbar spinal stenosis. All patients underwent laminectomy and bilateral foraminotomy at the stenotic level. Surgical outcomes were evaluated as very good, good,same, and poor according to the clinical findings. Fifty- three of the patients were males and forty-seven were females.More than half were between the ages of 40 and 60.The most frequently operated level was L4-L5. Ninety two percent of the surgically treated patients demonstrated very good and good outcomes. Our conclusion in lumbar spinal stenosis diagnosed by objective clinical and radiological findings is that decompressive laminectomy and extensive foraminotomy without instrumentation allow a good outcome

Myelography in spinal disorders - experience of 1400 cases

To evaluate the diagnostic importance of myelography in spinal disorders, in correlation with clinical presentation of the patients. Patients selected for myelography had presented with history of various spinal disorders such as low backache, neurogenic claudication, paraparesis or paraplegia, quadriparesis or quadriplegia, trauma to spinal region and infective spondylitis. Patients excluded were those with history of allergies to iodinated contrast agents, seizures coagulopathy and pregnant women. Contrast agent was water soluble non ionic agent - Iohexol. Spinal Needles used were of 20,22 and 25 gauge. X-Ray machine with tilltable table was used for myelography. There were 1400 patients of whom 935 were males and 465 females with male to female ratio of 2.1. Age range was 8 to 65 years. Spinal disorders diagnosed on myelography were lumbar disc prolapse 866 [60%] cases, lumbar canal stenosis 113 [8%], thoracic disc protrusions 15 [1%], infective spondylitis 53 [4%] cases, spinal tumors 36 [2.5%], spinal dysraphism 28 [2%] and traumatic spine in 85 [6%] cases. Free flow of contrast agent with no block was found in 149 [10.64%] cases. These were subjected for MRI scan which revealed significant pathological lesion of surgical importance in 23 cases [1.64%] only. Myelography is the least expensive valuable diagnostic test in spinal disorders specially in lumbar disc prolapses and lumbar canal stenosis

Lumbar canal stenosis clinico-radiological evaluation and management

A clinico radiological study conducted on 50 patients including 25 cases of lumbar canal stenosis and 25 cases of frank lumbar disc herniation, is presented. The various causes of lumbar canal stenosis are reviewed. Cases of frank disc herniation is only included for comparison. Radiological study conducted on 50 normal [control] individuals for measurement of normal dimension of the spinal canal. Spinal stenosis is more common in males, predominantly in the sixth decade of life. The patient may present either with claudicant or sciatic type. Evaluation of canal to body ratio, using plain radiography of lumbosacral spine, based on Jones and Thomson technique and radiculography were found, very useful in diagnosing spinal canal pathology pre-operatively. Of various causes, it was found that degenerative stenosis is a major cause of lumber canal stenosis in Basrah. Extensive decompression laminactomy in appropriately selected cases, yielded satisfactory results