Study of lumbar canal stenosis and its outcome after surgical management in central India

Background: Lumbar canal stenosis is a painful and potentially disabling condition often encountered in adults. Treatment of lumbar canal stenosis may consist of conservative approach to lumbar canal stenosis consists of rest, lumbar bracing, activity modification and analgesics. Surgical management consists of decompressive laminectomy, laminotomy or facetectomy. In the present study, authors evaluate the outcome in patients of lumbar canal stenosis managed surgically with decompressive laminectomy.Methods: A 50 patients with degenerative lumbar canal stenosis visiting Kasturbha hospital, Sewagram, Wardha from November 2016 to April 2017 were taken up for the study. Patients were taken up for laminectomy and decompression of the affected nerve roots using medial facetectomy. Post operatively patients were regularly followed up at monthly intervals. The ODI score was calculated at the end of 6 months and compared with the baseline score.Results: Fifty patients (mean age-42.9 years) underwent laminectomy and decompression. Baselines ODI score was 71.2±6.4. After 6 month follow up, the score improved significantly to 21±15.6 which was statistically significant.Conclusions: Operative treatment in patients of degenerative lumbar canal stenosis yields excellent functional results as observed based on the ODI score provided case selection is done properly

Surgical treatment of lumbar canal stenosis with concomitant aggressive vertebral haemangioma

Vertebral hemangiomas are the most common benign spinal tumours which are asymptomatic, slow-growing benign vascular malformations. They usually involve the vertebral body. However, the involvement of the posterior elements may present with spinal cord compression. Vertebral hemangiomas exist as a continuum of manifestations and lesions ranging from the common asymptomatic forms to rare compressive lesions. Presence of multilevel spinal canal stenosis along with an atypical vertebral hemangioma with cord is a rare condition and represents a treatment challenge. We report a case of spinal canal stenosis at L2 to L4 spinal levels along with an atypical vertebral hemangioma at L3 vertebra with extension to bilateral pedicles. This tumour caused neurological manifestations and was surgically treated with posterior decompression and stabilization with transpedicular screws and rods along with vertebroplasty for the hemangioma. Presence of an atypical hemangioma with co-existing spinal canal stenosis is a rare indication of spinal fusion. Vertebroplasty for the treatment of hemangioma in such cases is imperative

Morphological characteristics of motor neurons do not determine their relative susceptibility to degeneration in a mouse model of severe spinal muscular atrophy

Spinal muscular atrophy (SMA) is a leading genetic cause of infant mortality, resulting primarily from the degeneration and loss of lower motor neurons. Studies using mouse models of SMA have revealed widespread heterogeneity in the susceptibility of individual motor neurons to neurodegeneration, but the underlying reasons remain unclear. Data from related motor neuron diseases, such as amyotrophic lateral sclerosis (ALS), suggest that morphological properties of motor neurons may regulate susceptibility: in ALS larger motor units innervating fast-twitch muscles degenerate first. We therefore set out to determine whether intrinsic morphological characteristics of motor neurons influenced their relative vulnerability to SMA. Motor neuron vulnerability was mapped across 10 muscle groups in SMA mice. Neither the position of the muscle in the body, nor the fibre type of the muscle innervated, influenced susceptibility. Morphological properties of vulnerable and disease-resistant motor neurons were then determined from single motor units reconstructed in Thy.1-YFP-H mice. None of the parameters we investigated in healthy young adult mice - including motor unit size, motor unit arbor length, branching patterns, motor endplate size, developmental pruning and numbers of terminal Schwann cells at neuromuscular junctions - correlated with vulnerability. We conclude that morphological characteristics of motor neurons are not a major determinant of disease-susceptibility in SMA, in stark contrast to related forms of motor neuron disease such as ALS. This suggests that subtle molecular differences between motor neurons, or extrinsic factors arising from other cell types, are more likely to determine relative susceptibility in SMA