Inverse laminoplasty for the treatment of lumbar spinal stenosis.

STUDY DESIGN: Fifteen patients with lumbar spinal stenosis were treated by a new technique, inverse laminoplasty, and the results were evaluated clinically and radiologically. OBJECTIVE: To present the advantages of inverse laminoplasty over laminectomy for the treatment of lumbar spinal stenosis. SUMMARY AND BACKGROUND DATA: Laminectomy has been used widely in the treatment of lumbar spinal stenosis. Destruction of the spinal bony structure, instability, and peridural scar formation are the main problems with this procedure. To overcome these disadvantages, a practical technique is presented here. MATERIAL AND METHODS: In a prospective study, 15 patients who underwent surgery with the inverse laminoplasty technique were evaluated clinically and radiologically. The Oswestry Disability Index was used for clinical assessment. L4-L5 spinal stenosis was detected in all patients. As the operative technique, the L4 lamina was elevated en bloc using a high-speed drill and rongeur. After removal of the ligamentum flavum, the roof of the foramina, and/or disc, the lamina was rotated 180 degrees, rested on facets, and reattached by use of a titanium miniplate. RESULTS: All patients improved clinically and neurologically after this procedure. The mean Oswestry Disability Score was 38.33 preoperatively and 7.0 postoperatively. The mean follow-up time was 17.3 months. Spinal canal diameters were calculated by preoperative and postoperative computed tomography, and the mean enlargement was 77.8%. No complications were observed. CONCLUSION: With this technique, the important integrity of the spinal osseous structures is preserved, and a significant enlargement of the spinal canal area is achieved. This technique prevents peridural scar formation after laminectomy caused by a mechanical barrier effect. Long-term follow-up is needed to evaluate spinal stability in these patients

Increase in spinal canal area after inverse laminoplasty: An anatomical study

Study Design. In vitro measurement of the area of the spinal canal in the rostral and caudal portions of lumbar vertebrae before and after application of a new technique called inverse laminoplasty. Objectives. To quantify the normal area of the spinal canal in the rostral and caudal portions of lumbar vertebrae and the amount of enlargement gained after inverse laminoplasty. Summary and Background Data. Other types of laminoplasty have been proven to increase the area of the spinal canal. Inverse laminoplasty has been performed in 10 patients but has not been evaluated in vitro. Methods. The transverse and anteroposterior diameter of the spinal canal was measured in 34 vertebrae from seven cadavers using digital calipers. In each vertebra, the laminae and spinous process were removed en bloc using a high-speed drill. The removed piece was inverted and reattached with titanium mini-plates. The area of the spinal canal was again measured and compared with the prelaminoplasty measurements using paired Student\u27s t tests. Results. The anteroposterior diameter and area of the spinal canal were significantly smaller before surgery in the rostral than in the caudal part of the vertebrae (P \u3c10-3). The rostral and caudal areas of the spinal canal increased by 61% and 17%, respectively, after the laminae were inverted (P \u3c10-3). Conclusion. Because inverse laminoplasty is simple and increases the area of the spinal canal, it may prove to be a useful surgical technique for the treatment of lumbar spinal stenosis. Further studies are needed to determine whether the technique is biomechanically sound and whether it helps prevent perineural scarring

AĞRILI KOKSİKS

AĞRILI KOKSİKS</p

KAN - BEYİN BARİYERİ

Kan - beyin bariyeri, nöral mikroçevrenin düzenlenmesi ve devamlılığının sağlanması açısından önemlidir

Kaudal Lipom Cerrahisine Bağlı olarak Gelişen Geçici Allodini

Kaudal Lipom Cerrahisine Bağlı olarak Gelişen Geçici Allodini</p