Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography

Kanbara, Shunsuke; Yukawa, Yasutsugu; Ito, Keigo; Machino, Masaaki; Kato, Fumihiko

doi:10.1007/s00586-013-2873-7

Cited by 18 publications

(15 citation statements)

References 21 publications

(22 reference statements)

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“…Thirdly, and to add complexity, spinal canal stenosis should be perceived as a dynamic phenomenon. A lot of spinal canal stenosis subjects report position-dependent symptoms due to postural changes in the dimensions of the spinal canal[12,37].…”

Section: Spinal Canal Stenosismentioning

confidence: 99%

Imaging of the spine: Where do we stand?

Nouh

2019

WJR

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The number of patients presenting with spine-related problems has globally increased, with an enormous growing demand for the use of medical imaging to address this problem. The last three decades witnessed great leaps for diagnostic imaging modalities, including those exploited for imaging the spine. These developments improved our diagnostic capabilities in different spinal pathologies, especially with multi-detector computed tomography and magnetic resonance imaging, via both hardware and software improvisations. Nowadays, imaging may depict subtle spinal instability caused by various osseous and ligamentous failures, and could elucidate dynamic instabilities. Consequently, recent diagnostic modalities can discern clinically relevant spinal canal stenosis. Likewise, improvement in diagnostic imaging capabilities revolutionized our understanding of spinal degenerative diseases via quantitative biomarkers rather than mere subjective perspectives. Furthermore, prognostication of spinal cord injury has become feasible, and this is expected to be translated into better effective patient tailoring to management plans with better clinical outcomes. Meanwhile, our confidence in diagnosing spinal infections and assessing the different spinal instrumentation has greatly improved over the past few last decades. Overall, revolutions in diagnostic imaging over the past few decades have upgraded spinal imaging from simple subjective and qualitative indices into a more sophisticated yet precise era of objective metrics via deploying quantitative imaging biomarkers.

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Section: Spinal Canal Stenosismentioning

confidence: 99%

Imaging of the spine: Where do we stand?

Nouh

2019

WJR

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“…Specifically, forward flexion and relaxed supine position provide larger spinal canal volume, thus relieving neurological symptom. While extension position can decrease its volume and reduce dural sac cross-sectional area [ 21 – 24 ]. Preoperative images of CT or MRI are often acquired in relaxed supine position, so it may underestimate severity of lumbar canal stenosis to some extent.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Myelography in Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Preliminary Prospective Study

Yang

Zhang

Dong

et al. 2017

BioMed Research International

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Aim To investigate the feasibility and effectiveness of intraoperative myelography in determining adequacy of indirect spinal canal decompression during transpsoas lateral lumbar interbody fusion (LLIF). Methods Seven patients diagnosed with degenerative lumbar spinal stenosis (DLSS) were prospectively included to this study. All patients underwent LLIF and subsequently received intraoperative myelography to determine the effect of indirect spinal canal decompression, which was visualized in both anterior-posterior and lateral images. Those patients with insufficient indirect canal decompression were further resolved by microendoscopic canal decompression (MECD). Radiological parameters, including stenosis ratio and dural sac area of operated levels, were measured and compared before and after operation. Besides, all patients were followed up for at least one year using visual analogue scale (VAS) for back and leg, Japanese Orthopaedic Association score (JOA), and Oswestry disability index (ODI). Results Seven patients with 8 operated levels underwent LLIF safely and demonstrated significant symptom relief postoperatively. Five operated levels showed adequate indirect canal decompression intraoperatively, while the remaining three levels did not achieve the adequacy, and their residual stenosis was resolved following MECD. Radiological parameters were improved statistically when compared with preoperation (P < 0.05). Furthermore, neurological symptoms of all patients were also improved significantly (P < 0.05), shown by improved VAS (back and leg), JOA, and ODI at both two-week and one-year follow-up. Conclusions Intraoperative myelography during LLIF is able to assess adequacy of indirect canal decompression for DLSS, thus promising favorable clinical outcomes.

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“…Some reports have described dynamic changes in the lumbar dural sac [2021222324]. Kanbara et al [21] reported that bulging of the ligamentum flavum had 50%–85% contribution to spinal canal narrowing.…”

Section: Discussionmentioning

confidence: 99%

“…Kanbara et al [21] reported that bulging of the ligamentum flavum had 50%–85% contribution to spinal canal narrowing. Thus, bulging of intervertebral discs is expected to contribute to spinal canal narrowing under loading conditions by approximately 15%–50%.…”

Section: Discussionmentioning

confidence: 99%

Tumor Occupation in the Spinal Canal and Clinical Symptoms of Cauda Equina Schwannoma: An Analysis of 22 Cases

et al. 2016

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Study DesignRetrospective, radiological study.PurposeTo determine the relationship between clinical symptoms and the extent of tumor occupation of the spinal canal by cauda equina schwannoma.Overview of LiteratureLittle is known about the relationship between the size of tumors of the cauda equina and the manifestation of clinical symptoms. We analyzed this relationship by estimating the percentage of tumor occupation (PTO) in the spinal canal in cauda equina schwannomas and by correlating this parameter with the presence and severity of clinical symptoms.MethodsTwenty-two patients (9 men and 13 women; age, 19–79 years; mean age, 55.3 years) who were radiologically diagnosed with schwannomas of the cauda equina between April 2004 and July 2014 were retrospectively analyzed. PTO was measured in axial and sagittal magnetic resonance imaging slices in which the cross-sectional area of the tumor was the largest. Data regarding clinical symptoms and results of physical examinations were collected from patient medical records. PTO differences between symptom-positive and -negative groups were analyzed for each variable.ResultsIn the 4 cases in which tumor presence was not related to clinical symptoms, PTO was 5%–10% (mean, 9%) in axial slices and 23%–31% (mean, 30%) in sagittal slices. In the 18 cases in which symptoms were associated with the tumor, PTO was 11%–86% (mean, 50%) in axial slices and 43%–88% (mean, 71%) in sagittal slices. PTO in axial slices was significantly higher in the presence of Déjèrine symptoms and/or muscle weakness, a positive straight leg raise test, and a positive Kemp sign.ConclusionsPTO >20% in axial slices and >40% in sagittal slices can be an indication of symptomatic cauda equina schwannoma.

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Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography

Cited by 18 publications

References 21 publications

Imaging of the spine: Where do we stand?

Imaging of the spine: Where do we stand?

Intraoperative Myelography in Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Preliminary Prospective Study

Tumor Occupation in the Spinal Canal and Clinical Symptoms of Cauda Equina Schwannoma: An Analysis of 22 Cases

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