Diario de columna vertebral

Object: Previous reports have indicated that the level of lumbar spinal canal stenosis (LSCS) often differs from that diagnosed from neurological symptoms, and L5 nerve roots are often affected by stenosis at the L2–L3 or L3–L4 level; however, few cases have been describ

Decompression surgery for upper lumbar spinal canal stenosis (LSCS) of L2–L3 and L3–L4 causing L5 and S1 symptoms was investigated.

Methods: Eight patients with a diagnosis based on L5 or S1 symptoms, but whose MRI or CT-myelography showed only one level of stenosis at L2–L3 or L3–L4 were studied. The level of stenosis was determined by the most narrowing lesion, such as total or subtotal block on CT-myelography and MRI. Selective nerve root block was performed to determine which nerve root was the origin of the pain in these patients. One-level decompression surgery at L2–L3 or L3–L4 was performed in 8 patien

Results: There were 2 cases of stenosis at L2–L3 and 6 cases at L3–L4. The level involved suggested by neurological symptoms was L5 in 6 cases and S1 in 2 cases. L5 symptoms were most often affected by L3–L4. Symptoms in all patients disappeared after one-level decompression sur

Conclusions: Degenerative stenosis of upper levels such as L2–3 and L3–4 involved damage in lower nerve roots such as L5 or S1, and L5 symptoms were most often affected by L3–L4. Decompression surgery for upper- level stenosis improved symptoms in all patients. Physicians should be aware that upper-level stenosis can cause radiculopathy at a lower level.

Ossification of the posterior longitudinal ligament (OPLL) can cause myelopathy. Laminectomy with fusion is one surgical option for the treatment of symptomatic OPLL. In this report, we present 2 illustrative cases of unilateral C5 palsy occurring in a delayed manner after posterior decompression for OPLL. Both patients were successfully treated with conservative management. incidence, potential etiology, management and outcomes for this potentially debilitating complication are reviewed.

Background: Spinal fusion is one of most frequent employed procedures for treating various spinal morbidities. Pseudarthrosis remains a significant complication despite the use of hardware for mechanical stability. The type and proper placement of the bone graft have a fundamental role in achieving solid union. The ideal bone graft material should provide osteogenicity, osteoinductivity and osteoconductivity, an optimal biological reaction and no risk of transmission of diseases.

Methods: We describe a new technique of bone grafting in two patients who suffered from spinal stenosis. Local bone graft which obtained during decompression of the spine was mixed with bone marrow harvested from the posterior iliac crest. The mixture was wrapped in surgicel (Ethicon, Johnson & Johnson Medical Ltd, Somerville, NJ, USA) and given a cylindrical shape. Finally, the handmade cylinders were placed laterally to the rod of the instrumentation, onto the decorticated transverse processes.

Results: The patients were followed radiographically every three months. The x-rays verified proper placement of the graft onto the transverse processes in both patients. Solid fusion was reported in both sides of the first patient at three months and at six months for the second. At one year postoperatively, fusion status was still graded solid.

Conclusion: The aforementioned technique uses the advantages of a bone auto graft which has been enhanced by bone marrow components, avoiding donor site morbidity. Using surgicel (Ethicon, Johnson & Johnson Medical Ltd, Somerville, NJ, USA) we can adapt the graft to the desired size and shape and finally place it with accuracy onto the decorticated transverse processes. This is a promising technique concerning solid fusion and complications; however, it is a pilot study and needs more time and patients to obtain safe results.

Se presenta el caso de un paciente que se sometió a un tratamiento quirúrgico en dos etapas debido a una fractura patológica de la columna vertebral (L3 debido a la infiltración neoplásica) en el curso de un cáncer de riñón. Se realizó una descompresión del canal vertebral desde el abordaje posterior en el segmento lumbar (L3 y parcialmente L2) debido a un deterioro repentino de las funciones neurológicas. El segmento lumbar de la columna vertebral se estabilizó mediante un abordaje transpedicular con el sistema Clix (Synthes). En la segunda etapa se realizó un abordaje anterior por laparotomía, el equipo urológico extirpó el tumor renal, el siguiente equipo, cirujano vascular y neurocirujano, realizó la resección de las vértebras L3 y L2 (L3 estaba fracturada patológicamente y comprimía las estructuras de la cola de caballo, L2 estaba parcialmente infiltrada por cáncer). Durante el intento de estabilización de la columna anterior se encontró que la prótesis vertebral más larga del conjunto Synex (Synthes) es más corta que la distancia medida entre las vértebras L1 y L4 por aproximadamente 5-7 mm.

El conjunto estabilizador de la columna anterior, compuesto por dos prótesis vertebrales de Synex, conectadas permanentemente con las barras transversales utilizadas en las estabilizaciones transpediculares, se construyó ad hoc utilizando los elementos disponibles. Se obtuvo un conjunto estable listo para usar. Después de la preparación, el conjunto se colocó entre los cuerpos vertebrales y luego se extendió. La radiografía de control reveló su ubicación apropiada y su función de soporte. El conjunto formado ad hoc de este tipo solo se pudo utilizar en la estabilización posterior transpedicular normal de la columna vertebral. La distancia entre los cuerpos vertebrales después de la resección probablemente resultó de las características constitucionales del paciente (aprox. 200 cm de altura). El paciente fue evaluado en la Clínica Ambulatoria, su vida mejoró después de la operación, fue independiente, puntaje Lovett 4/5. Después de la operación se realizaron cuatro ciclos de quimioterapia durante 18 meses.