Search

An unusual case of scoliosis, associated with an osteocartilaginous spur producing narrowing of the spinal canal, is reported. Routine physical examination and radiography revealed no abnormality apart form an absent left-ankle reflex. The defect was discovered at autopsy following death during operation. In order to discover this rare associated defect in scoliotic patients, myelography is recommended whenever a minor neurological defect is present.

We studied 23 patients with severe myeloradiculopathy involving multiple (more than three) levels of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, who were treated with laminoplasty to enlarge the spinal canal. The resected spinous processes were used as bone grafts to support the opened laminae. These patients were analyzed pre- and postoperatively with a neurological evaluation according to the Japanese Orthopedic Association (JOA) score system for cervical myelopathy. Follow-up was from 2.0 to 5.3 years with an average of 31.5 months. The results were compared with those in 31 patients with the same degree (multilevel) of OPLL who had been operated upon previously by laminectomy (14 cases) or anterior resection (17 cases). Postoperative neurological recovery by improvement ratio of the JOA score was observed in 81.2% of those who had undergone expansive laminoplasty, in 72.4% of those with laminectomy, and in 63.6% of those with anterior decompression. We concluded that expansive laminoplasty is a safer procedure with fewer complications. Stability is achieved by fixing the expanded laminae permanently with a bone graft. The neurological recovery following our technique of laminoplasty and fusion appears to be superior to that with laminectomy or anterior decompression.

A normal width of the peridural intracanal spinal space has been described as necessary for normal neural tissue mobility. This virtual functional space, called spinal reserve capacity (SRC) is measurable with the aid of computerized tomography. Aging and various lumbar pathological conditions have been described as leading to attenuation or obliteration of this reserve capacity, a phenomenon essential for a symptomatic lumbar canal stenosis. This article discusses delayed, post-traumatic obliteration of the SRC, and its symptoms and signs are illustrated with ten case histories.