Diário da Espinha

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.

Case report of the patient who underwent two-stage surgical treatment due to pathological fracture of vertebral column (L3 due neoplasm infiltration) in the course of kidney cancer is presented. Decompression of vertebral canal from the posterior approach in lumbar segment (L3 and partially L2) was performed due to sudden neurological functions impairment. Lumbar segment of vertebral column was stabilized via the transpedicular approach with Clix system (Synthes). In the second stage anterior approach via laparotomy was performed, urological team excised the kidney tumour, the next team vascular surgeon and neurosurgeon, performed resection of L3 and L2 vertebras (L3 was pathological fractured and compressed of cauda equine structures, L2 was partially cancer infiltrated). During the attempt of anterior column stabilization it was found, that the longest vertebral prosthesis of Synex set (Synthes) is shorter than the distance measured between L1 and L4 vertebras for about 5-7 mm.

The anterior column stabilizing set consisting of two vertebral prostheses from Synex set connected permanently with the crosspieces – crossbars rods used in transpedicular stabilizations was constructed ad hoc using the available elements. Stable set ready to use was obtained. After preparation, the set was placed between the vertebral bodies, than extended .Control X -ray revealed its appropriate location and supporting function. The ad hoc formed set of such type could be only used in normal transpedicular posterior stabilization of the vertebral column, Distance between the vertebral bodies after the resection probably resulted from the constitutional patient traits (app. 200cm tall) The patient was assessed in Out Patient Clinic, his life was improved after the operation, was independently, Lovett score 4/ 5. After the operation was performed four courses of chemotherapy during 18 months.