Efficacy and safety of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar spinal stenosis combined with osteoporosis

SUMMARY OBJECTIVE: To investigate the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar spinal stenosis (LSS) combined with osteoporosis. METHODS: Eighty patients with LSS combined with osteoporosis were divided into a control and PTED group, which received conventional transforaminal lumbar interbody fusion and PTED, respectively. The surgical indications, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores, bone mineral density (BMD), and adverse reactions were observed. RESULTS: Compared with the control group, in the PTED group, the operation time, bleeding loss and hospitalization duration, incision VAS scores at postoperative 12, 24 and 48 h and lumbar and leg pain VAS and lumbar ODI scores on postoperative 6 months were significantly decreased (P < 0.01), and the lumbar JOA score on postoperative 6 months was significantly increased (P < 0.05). There was no significant difference in BMD between two groups (P > 0.05). Compared with the control group, in the PTED group, the total effective rate was significantly higher (P < 0.05), and the incidence of adverse reactions was significantly lower (P < 0.05). CONCLUSIONS: PTED is safe and effective in the treatment of LSS combined with osteoporosis.

RESUMO: OBJETIVO: Investigar a eficácia e segurança da discectomia endoscópica percutânea transforaminal (DEPT) no tratamento da estenose lombar (EL) combinada à osteoporose. MÉTODOS: Oitenta pacientes com EL combinada à osteoporose foram divididos entre um grupo de controle e um grupo de DEPT, que receberam tratamento convencional com fusão intersomática lombar transforaminal e DEPT, respectivamente. As indicações cirúrgicas, a escala analógica visual (VAS) da incisão e de dor lombar e nas pernas, os escores lombares de acordo com a Associação Ortopédica Japonesa (JOA) e o Oswestry Disability Index (ODI), a densidade mineral óssea (DMO) e possíveis reações adversas foram observados. RESULTADOS: Em comparação com o grupo de controle, no grupo de DEPT o tempo de operação, a perda de sangue e duração de internação, os escores VAS da incisão no pós-operatório após 12, 24 e 48 h, o VAS para dor lombar e nas pernas e os escores ODI lombares após 6 meses de pós-operatório foram significativamente menores (P < 0,01); já o escore JOA lombar após 6 meses de pós-operatório foi significativamente maior (P < 0,05). Não houve diferença significativa na densidade mineral óssea entre os dois grupos (P > 0,05). Em comparação com o grupo de controle, o grupo de DEPT teve uma taxa efetiva total significativamente maior (P < 0,05), e a incidência de reações adversas foi significativamente menor (P < 0,05). CONCLUSÕES: A discectomia endoscópica percutânea transforaminal é segura e eficaz no tratamento de EL combinada à osteoporose.

Treatment of subcutaneous fistula secondary to cerebrospinal fluid leakage in thoracic spinal stenosis cases / 北京大学学报(医学版)

OBJECTIVE@#To investigate the treatment strategy for subcutaneous fistula secondary to cerebrospinal fluid leakage (CSFL) in thoracic spinal stenosis (TSS) cases.@*METHODS@#In the study, 186 CSFL cases diagnosed with TSS and operated in general spine group of Department of Orthopedics, Peking University Third Hospital from January 2005 to December 2014 were retrospectively reviewed, of which eleven had subcutaneous fistula secondary to CSFL and were regularly followed up. Treatment strategy for subcutaneous fistula depended on the severity of CSFL and the recovery rate of thoracic myelopathy. Japanese Orthopedic Association (JOA) score was utilized to evaluate the neurologic status of these patients preoperatively and postoperatively. Statistical analysis was conducted between preoperative and postoperative JOA scores.@*RESULTS@#All of the 11 patients were regularly followed up for at least 24 months. Six of them had ossification of the posterior longitudinal ligament (OPLL) combined with ossification of ligamentum flavum (OLF), all of them undertook "cave-in" 360° circumferential decompression of the spinal cord with instrumentation. Five cases had OLF only, and received En bloc resection of lamina and OLF and fixation. The follow-up period ranged from 30 months to 131 months, and averaged at (85±34) months. Preoperative symptoms lasted from 3 months to 8 years, and the median was 18 months. Drainages were placed for 2-6 days, and averaged at (4.2±1.1) days. Ten cases appeared with fever during the perioperative period, the maximum body temperature was (37.3-39.7) °C. Prolonged antibiotics were applied in two cases with high fever. Ten cases were treated with conservative methods, CSFL were completely absorbed during the follow-up time, of which compressive dressing was utilized in 8 cases, and punctures combined with compressive dressing were used in 2 cases. For only 1 case, conservative therapy failed and reoperation was required because of neurological deterioration arising from CSF pseudocyst. For these 11 cases, preoperative JOA score arose from (3.8±1.6) preoperatively to (8.9±1.2) at the end of the final follow-up, the recovery rate was 70.8%. No infection of wound or central nerve system were noticed, and neither were unhealing wound.@*CONCLUSION@#Most TSS cases with subcutaneous fistula secondary to CSFL could be cured by conservative methods, and reoperation is required only if myelopathy caused by cerebrospinal fluid pseudocyst is identified.

Efficacy of Percutaneous Epidural Neuroplasty Does Not Correlate with Dural Sac Cross-Sectional Area in Single Level Disc Disease

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.

The Importance of Proximal Fusion Level Selection for Outcomes of Multi-Level Lumbar Posterolateral Fusion

BACKGROUND: There are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes. METHODS: We retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either 'good' or 'bad' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors. RESULTS: Twenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203). CONCLUSIONS: The overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered.

Surgical treatment of degenerative lumbar stenosis: comorbidities and complications / Tratamento cirúrgico da estenose degenerativa lombar: comorbidades e complicações / Tratamiento quirúrgico de la estenosis lumbar degenerativa: comorbilidades y complicaciones

Objectives: To study the characteristics of patients who underwent surgical treatment of degenerative spinal stenosis in the last 10 years (2000â€"2010) at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (USP-HCFMR) and correlate the postoperative complications and preoperative comorbidities found in the study population. Methods: Retrospective review of medical records and radiographs of patients with degenerative lumbar stenosis treated surgically. Descriptive analysis of data was done with SAS 9.0. Results: 92 patients were included, 47 (51.08%) males and 45 (48.91%) females, with ages ranging from 32 to 86 years (mean age of 64.27 years). The most prevalent comorbidities were hypertension (47.82%) and diabetes mellitus (25%). Twenty-three patients (25%) had two or more comorbidities. Postoperative infection was the most common complication found in 12 cases (13%). Patients with only one preoperative comorbidity showed similar complication rates compared to the population without comorbidities. However, patients with two or more comorbid conditions had a higher incidence of postoperative complications (p<0.001). Conclusions: Comorbidities negatively influenced the outcome of surgical treatment of degenerative lumbar stenosis with higher rates of postoperative complications. .

Objetivos: Estudar as características dos pacientes que foram submetidos ao tratamento cirúrgico da estenose lombar degenerativa nos últimos 10 anos (2000-2010) no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMR-USP), e correlacionar as complicações pós-operatórias e as comorbidades pré-operatórias encontradas na população estudada. Métodos: Avaliação retrospectiva dos prontuários e exames radiográficos dos pacientes portadores de estenose lombar degenerativa submetidos a tratamento cirúrgico. Análise dos dados descritivos com o programa SAS 9.0. Resultados: Foram incluídos 92 pacientes, sendo 47 (51,08%) do sexo masculino e 45 (48,91%) do sexo feminino, com idade que variou de 32 a 86 anos (média de 64,27). As comorbidades mais prevalentes foram a hipertensão arterial sistêmica (47,82%) e o diabetes mellitus (25%). Vinte e três pacientes (25%) apresentaram duas ou mais comorbidades associadas. A infecção pós-operatória foi a complicação mais comum, encontrada em 12 casos (13%). Os pacientes que tinham apenas uma comorbidade pré-operatória apresentaram iguais índices de complicação frente à população sem comorbidades. No entanto, pacientes com duas ou mais comorbidades apresentaram ...

Objetivos: Estudiar las características de pacientes que se sometieron a tratamiento quirúrgico de la estenosis lumbar degenerativa en los últimos 10 años (2000-2010) en el Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMR-USP) y correlacionar las complicaciones postoperatorias y las comorbilidades preoperatorias encontradas en la población estudiada. Métodos: Revisión retrospectiva de las historias clínicas y las radiografías de pacientes con estenosis lumbar degenerativa tratada quirúrgicamente. Análisis de los datos descriptivos con el programa SAS 9.0. Resultados: Se incluyeron 92 pacientes, 47 (51,08%) hombres y 45 (48,91%) mujeres, con edades entre 32 y 86 años (media 64,27 años). Las comorbilidades más frecuentes fueron la hipertensión arterial (47,82%) y la diabetes mellitus (25%). Veintitrés pacientes (25%) tenían dos o más comorbilidades. La complicación más común, encontrada en 12 casos (13%), fue la infección postoperatoria. Los pacientes que tuvieron sólo una comorbilidad preoperatoria mostraron tasas similares de complicaciones en comparación con la población sin comorbilidades. Sin embargo, los pacientes con dos o más comorbilidades tuvieron una mayor incidencia de complicaciones postoperatorias (p < 0,001). ...

Incidence of Nocturnal Leg Cramps in Patients with Lumbar Spinal Stenosis before and after Conservative and Surgical Treatment

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.

Transverse Process and Needles of Medial Branch Block to Facet Joint as Landmarks for Ultrasound-Guided Selective Nerve Root Block

BACKGROUND: Selective lumbar nerve root block (SNRB) is generally accepted as an effective treatment method for back pain with sciatica. However, it requires devices producing radioactive materials such as C-arm fluoroscopy. This study evaluated the usefulness of the longitudinal view of transverse process and needles for medial branch block as landmarks under ultrasonography. METHODS: We performed selective nerve root block for 96 nerve roots in 61 patients under the guidance of ultrasound. A curved probe was used to identify the facet joints and transverse processes. Identifying the lumbar nerve roots under the skin surface and ultrasound landmarks, the cephalad and caudal medial branch blocks were undertaken under the transverse view of sonogram first. A needle for nerve root block was inserted between the two transverse processes under longitudinal view, while estimating the depth with the needle for medial branch block. We then injected 1.0 mL of contrast medium and checked the distribution of the nerve root with C-arm fluoroscopy to evaluate the accuracy. The visual analog scale (VAS) was used to access the clinical results. RESULTS: Seven SNRBs were performed for the L2 nerve root, 15 for L3, 49 for L4, and 25 for L5, respectively. Eighty-six SNRBs (89.5%) showed successful positioning of the needles. We failed in the following cases: 1 case for the L2 nerve root; 2 for L3; 3 for L4; and 4 for L5. The failed needles were positioned at wrong leveled segments in 4 cases and inappropriate place in 6 cases. VAS was improved from 7.6 +/- 0.6 to 3.5 +/- 1.3 after the procedure. CONCLUSIONS: For SNRB in lumbar spine, the transverse processes under longitudinal view as the ultrasound landmark and the needles of medial branch block to the facet joint can be a promising guidance.

Forensic identification of cervical spinal cord injury without fracture or dislocation in 25 cases / 法医学杂志

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.

One-year Outcome Evaluation after Interspinous Implantation for Degenerative Spinal Stenosis with Segmental Instability

The authors hypothesized that the placement of the interspinous implant would show a similar clinical outcome to the posterior lumbar interbody fusion (PLIF) in patients having spinal stenosis with mild segmental instability and that this method would be superior to PLIF without significantly affecting degeneration at the adjacent segments. Forty two adult patients having degenerative spinal stenosis with mild segmental instabilit who underwent implantation of Coflex(TM) (Spine motion, Germany) or PLIF at L4-5 between January 2000 and December 2003 were consecutively selected and studied for one-year clinical outcome. At 12 months after surgery, both groups showed a significant improvement in the visual analogue scale score and Oswestry disability index score for both lower extremity pain and low back pain. However, the range of motion at the upper adjacent segments (L3-4) increased significantly after surgery in the PLIF group, which was not manifested in the Coflex(TM) group during the follow-up. The authors assumed that interspinous implantation can be an alternative treatment for the spinal stenosis with segmental instability in selected conditions posing less stress on the superior adjacent level than PLIF.

Transforaminal Epidural Steroid Injection for Lumbosacral Radiculopathy: Preganglionic versus Conventional Approach

OBJECTIVE: The present study was undertaken to evaluate the effectiveness of transforaminal epidural steroid injection (TFESI) with using a preganglionic approach for treating lumbar radiculopathy when the nerve root compression was located at the level of the supra-adjacent intervertebral disc. MATERIALS AND METHODS: The medical records of the patients who received conventional TFESI at our department from June 2003 to May 2004 were retrospectively reviewed. TFESI was performed in a total of 13 cases at the level of the exiting nerve root, in which the nerve root compression was at the level of the supra-adjacent intervertebral disc (the conventional TFESI group). Since June 2004, we have performed TFESI with using a preganglionic approach at the level of the supra-adjacent intervertebral disc (for example, at the neural foramen of L4-5 for the L5 nerve root) if the nerve root compression was at the level of the supra-adjacent intervertebral disc. Using the inclusion criteria described above, 20 of these patients were also consecutively enrolled in our study (the preganglionic TFESI group). The treatment outcome was assessed using a 5-point patient satisfaction scale and by using a VAS (visual assessment scale). A successful outcome required a patient satisfaction scale score of 3 (very good) or 4 (excellent), and a reduction on the VAS score of > 50% two weeks after performing TFESI. Logistic regression analysis was also performed. RESULTS: Of the 13 patients in the conventional TFESI group, nine showed satisfactory improvement two weeks after TFESI (69.2%). However, in the preganglionic TFESI group, 18 of the 20 patients (90%) showed satisfactory improvement. The difference between the two approaches in terms of TFESI effectiveness was of borderline significance (p = 0.056; odds ratio: 10.483). CONCLUSION: We conclude that preganglionic TFESI has the better therapeutic effect on radiculopathy caused by nerve root compression at the level of the supra-adjacent disc than does conventional TFESI, and the diffence between the two treatments had borderline statistical significance.

Nota técnica y casos clínicos: manejo de brechas meningeas postoperatorias espinales con la ayuda de un parche de sangre local / Technical notes and clinical cases: management of postoperatory spinal meningeal gap with local blood patch

Se presenta una alternativa terapéutica para el tratamiento de las brechas espinales mediante el uso del concepto de parche de sangre y la creación de un espacio que lo contenga con la sutura de un injerto de aponeurosis. El método demostró ser eficaz y útil en dos casos clínicos. Su real utilidad como técnica quirúrgica deberá ser evaluada con una serie con mayor número de casos.

Efficacy and results of expansive laminoplasty in patients with severe cervical myelopathy due to cervical canal stenosis.

AIMS AND OBJECTIVES: To assess the efficacy and results of expansive laminoplasty in advanced (Nurick's Grade III or greater) cervical myelopathy. MATERIALS AND METHODS: We reviewed data in 24 patients who underwent cervical laminoplasty from January 1999 to December 2002. Nuricks grading was used for quantifying the neurological deficits and outcome analysis was done using Odom's criteria. A modified Hirabayashi's open door laminoplasty was done using Titanium miniplates and screws in 22 patients, autologous bone in one and hydroxyapatite spacer in one patient. OBSERVATIONS: There were 3 females and 21 males with a mean age of 56 years (range 39-72 years). Four patients presented in Nuricks Grade III, 15 in Grade IV and five in Grade V. MR imaging showed MSCS in 21 cases, OPLL in nine cases and ligamentum flavum hypertrophy in nine cases with cord signal changes being present in 19 cases. RESULTS: All patients with duration of symptoms less than three years, and 50 % with duration ranging from three to six years had improvement by at least one Nurick's grade following surgery. Eighty-seven per cent Grade IV patients (ambulatory with support) improved to Grade III (ambulatory without support) following laminoplasty. Using Odom's criteria, 23 patients (95.8%) had a good to fair outcome. CONCLUSIONS: Cord decompression with expansive laminoplasty using titanium miniplate fixation may improve the neurological outcome even in patients presenting late, and improvement by even one grade may have major 'quality of life' benefits for these patients.

Significance of thoracolumbar spinal canal dimensions in prediction of neurologic injury in patients with burst fractures

The relation between the spinal canal dimensions and its association with neurologic sequelae after cervical spine injuries has been established. A similar relation at the thoracolumbar spine is debated in the literature. The aim of this work is to determine the relation between the spinal canal dimensions and their association with neurologic sequale after thoracolumbar burst fractures. In a prospective study between January 1999 and December 2001, 48 patients with thoracolumbar burst fractures [T11-L2] 22 with neurologic deficit and 26 without neurologic deficit were included in our study. There were 30 males and 18 females, their age ranged from 18 to 62 years with a mean age of 37 years. Computed tomographic [CT] scans were done for all the patients to evaluate the pattern of the fracture and to measure the sagittal, the transverse diameters and the surface areas of the spinal canal at the level of injury, as well as one level above and one level below the fracture level. The type of neurological deficit in all patients was scored on the scale of Frankel et al 1969. All the patients with burst fractures of the thoracolumbar junction, with and without neurologic deficit, were compared in sagittal diameter, transverse diameter, sagittal-to-transverse diameter ratio and cross sectional area [CSA]. Statistical analysis was performed using Student s t-test. We found that the ratio of sagittal-to-transverse diameter at the level of injury was significantly smaller in patients with neurological deficit than those without a neurologic deficit. The mean transverse diameter at the level of injury was significantly larger in patients with neurological deficit than in the neurologically intact patients. The surface area of the canal at the level of the injury was significantly smaller in patients with neurological deficit than in those without a deficit. There was no significant statistical relation between spinal canal measurements above and below the level of injury with the neurologic deficit. We concluded that. There were no anatomic factors at the thoracolumbar junction that predisposed to neurologic injury after burst fracture, however the shape and the size of the canal after injury were predictive of neurologic deficit

The effectiveness of lumbosacral corset in symptomatic degenerative lumbar spinal stenosis.

Lumbosacral corset is a spinal support widely used for patients suffering from low back pain due to various conditions. To evaluate the effectiveness of the corset in symptomatic degenerative lumbar spinal stenosis, twenty one patients (mean age 62.5 +/- 5.2 years) with neurogenic claudication (mean onset 9.0 +/- 9.3 months) were recruited for and completed a self controlled comparative study (with and without a corset). Quantitative and qualitative assessment in terms of walking distance and pain score (0-10 point visual analog scale) in daily activities respectively, compared between wearing and not wearing the corset were measured. The outcome of the study showed statistically significant improvement in walking distance (393.2 +/- 254.0 m and 314.6 +/- 188.8 m) and decrement of pain score in daily activities (4.7 +/- 1.4 and 5.9 +/- 1.0) with and without corset dressing respectively. This result supports the positive effect of the lumbosacral corset in pain relief and functional improvement of the degenerative lumbar spinal stenosis condition.

Methylcobalamin as an adjuvant medication in conservative treatment of lumbar spinal stenosis.

To find out the clinical effects of methylcobalamin on the conservative treatment of degenerative lumbar spinal stenosis, the study was carried out as a control single blind trial with 2 year follow-up in 152 patients, 68 males and 84 females, whose ages ranged from 55 to 85 years, average 67 +/- 18.1 years. They were randomly allocated into 2 groups, the control group, 82 patients, and the methylcobalamin group, 70 patients. All had classical history, and physical and radiographic findings which confirmed the diagnosis of spinal stenosis. Conventional management, including patient education, physical therapy and medication, were carried out in every patient and in addition methylcobalamin 0.5 mg was given orally three times a day in the methylcobalamin group for 6 months. All patients were followed up periodically for 2 years. Most of the patients in both groups showed improvement but there was no significant difference between the 2 groups in terms of pain improvement and neurological signs, except neurogenic claudication distance which was better in the M-group.

Atlantoaxial dislocation associated with stenosis of canal at atlas.

Three rare cases of stenosis of spinal canal at the level of atlas associated with atlantoaxial dislocation are presented. An atlantoaxial lateral mass fixation with plate and screws after posterior midline bony decompression was successfully performed in these cases.

Tetraparesia transitória durante prática esportiva / Transient tetraparesis during practice of sports

Os autores apresentam quatro casos de tetraparesia transitória ocorridos durante prática esportiva, sendo dois no rúgbi, um no futebol e um no voleibol. Alertam para a relaçäo deste tipo de sintoma com a estenose do canal cervical e para o risco dos pacientes desenvolverem mielopatia se persistirem na prática de esportes de contato.

Estenose lombar / Lumbar stenosis

O autor apresenta uma revisäo sobre estenose lombar. Procura definir melhor os elementos ósseos envolvidos na compressäo da raiz e o quadro clínico. É destacada a importância da meilografia no diagnóstico por imagem. No tratamento, säo abordados detalhes considerados importantes para o ato cirúrgico

La RNM en las lesiones raquimedulares / Nuclear magnetic resonance imaging of the spinal cord and spine canal

Presentamos nuestra experiencia en 109 casos estudiados con esta técnica con corroboración quirúrgica. La población estuvo constituida por 74 varones y 35 mujeres con edad media de 44,76 años y un rango etario entre 16 y 80 años; en la discriminación etaria el 37,6 por ciento se ubicó en la cuarta década. Los estudios se realizaron con un equipo superconductivo de 0,35 T mediante secuencias apropiadas para la ponderación de T1 y T2 y cortes multiplanares. La RNM resultó un método adecuado para el estudio de los tumores del conducto (6 casos), no así para la patología del hueso que no comprometía la médula ósea (2 osteomas osteoides). El grupo de los tumores junto a las hernias discales y conductos estrechos representaron el 87 por ciento de las etiologías que motivaron el estudio, con neto predominio de la patología discal (73,8%). La RNM resultó sumamente efectiva en el diagnóstico de la patología de la región cervical, obteniéndose una coincidencia del 100 por ciento con los hallazgos operatorios (9casos). Los exámenes del raquis lumbar fueron el grueso de la muestra (99 casos). En esta región, la RNM presentó coincidencia con los hallazgos quirúrgicos en 87 casos (87,87%). En la población se incluyeron 19 casos ya intervenidos quirúrgicamente en oportunidades anteriores. En 16 casos (84,2%) existió coincidencia entre RNM y cirugía. Concluimos que la RNM es el método de elección para el estudio de la patología que afecta al conducto raquídeo especialmente hernias y tumores