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Prophylaxis of the laminectomy membrane

An experimental study in dogs

José Barberá, José Gonzalez, José Esquerdo, Jaime Broseta, and Juan Luis Barcia-Salorio

T he “laminectomy membrane” is a dense fibrous cicatricial tissue that replaces the bone that has been removed at laminectomy and binds the dura to the overlying muscles. The name was first given to it by LaRocca and Macnab 5 when they studied this scar formation in dogs. Recently the laminectomy membrane, or some similar structure, has been reported as the cause of postoperative symptoms in humans, 1, 2 and routine measures for its prevention have been advocated. 6 The purpose of this report is to comment on the results of our experiments attempting to

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Paul W. Detwiler, Christina B. Spetzler, Sara B. Taylor, Neil R. Crawford, Randall W. Porter, and Volker K. H. Sonntag

D ecompressive laminectomy is an efficacious method of surgical management for patients with a history of neurogenic claudication and radiographically confirmed lumbar stenosis. 1, 2, 4, 11, 12, 15, 18, 21, 23–25 The extent of such resection reflects each patient's symptoms, neurological status, neuroimaging findings, and intraoperative observations. The lateral extent of bone removal, however, may vary significantly among surgeons given the same clinical scenario. To ensure that complete decompression is achieved, many surgeons treat lumbar stenosis by

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Shoji Yabuki and Shin-ichi Kikuchi

posterior paraspinal muscles may reduce axial neck pain. The purpose of the present study was to document the results of undertaking MED in 10 patients with cervical myelopathy due to degenerative spine diseases. Prior to clinical application of the present technique, we had gained experience in cadaveric training surgeries. Clinical Material and Methods Patient Population Ten patients underwent endoscopic partial laminectomy involving the use of the METRx system (Medtronic Sofamor Danek, Memphis, TN). There were five men and five women who ranged in age from

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Barry M. Zide, Jeffrey H. Wisoff, and Fred J. Epstein

O ver the past 6 years, 120 patients with intramedullary spinal cord neoplasms have undergone radical resection of their tumors at the New York University (NYU) Medical Center. Approximately one-half of these patients received conventional therapy: laminectomy and dural grafting for decompression followed by radiation therapy (4500 to 5500 rads). In the first 2 years during which radical resection was performed, nine of 21 previously irradiated patients developed cutaneous cerebrospinal fluid (CSF) fistulas and large pseudomeningoceles following reexploration

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Douglas K. Anderson, Gregory R. Nicolosi, Eugene D. Means, and L. Edward Hartley

R ecent interest in experimental spinal cord trauma has stimulated several studies on spinal cord blood flow (SCBF) in both the normal and traumatized spinal cord. 1, 6–8, 10–15 In the majority of these SCBF studies, a laminectomy was performed in order to record the measurements. However, to date no information has appeared concerning what effect exposing spinal cord segments (or the dura overlying the spinal cord) has on total or regional SCBF. Thus, the purpose of this study was to determine the effect of laminectomy on SCBF at two postlaminectomy

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Ralph Jasper Mobbs, Jane Li, Praveenan Sivabalan, Darryl Raley, and Prashanth J. Rao

procedure is still debated. 12 , 20 , 28 The traditional approach is an open laminectomy, medial facetectomy, and foraminotomy, 3 , 6 , 15 which involves wide muscle retraction and extensive removal of posterior spinal structures. 13 While open decompressions have a variable success rate, 18 the extensive bony and muscular disruption has adverse consequences, including flexion instability, muscle weakness and/or atrophy, and failed back surgery syndrome. 2 , 4 , 13 , 15 , 25 As central neural compression occurs primarily at the interlaminar window, there is a trend

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Patrick W. Hitchon, Jeffrey M. Lobosky, Thoru Yamada, and James C. Torner

I n spite of the extensive utilization of laminectomy, both in clinical and experimental settings, the actual effect of laminectomy upon spinal cord physiology is not uniformly accepted. In our quest to study the effect of spinal cord compression upon spinal cord blood flow (SCBF) and function, exposure of the cord is essential. We elected to study the effect of laminectomy upon the SCBF in anesthetized sheep. This question has already been addressed by others; 1, 2, 9 however, without total agreement. The type of species, the anesthetic technique, and the

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Toshimi Aizawa, Tetsuro Sato, Hiroshi Ozawa, Naoki Morozumi, Fujio Matsumoto, Hirotoshi Sasaki, Takeshi Hoshikawa, Chikashi Kawahara, Shoichi Kokubun, and Eiji Itoi

L aminectomy is a basic procedure for decompression of the spinal cord. In addition to directly removing the compressive factors in the posterior spinal canal, it can indirectly decompress the cord by resulting in dorsal shift. 25 Thus, laminectomy has been performed for numerous cases of myelopathy in the cervical and thoracic spine. 1–4 , 9 , 11 , 15 Several postoperative complications have been reported after laminectomy, including cerebrospinal fluid leakage and epidural hematoma. 8 Laminectomy also entails the risk of instability in the form of

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Scott D. Wait, M. Yashar S. Kalani, Andrew S. Little, Giac D. Consiglieri, Jeffrey S. Ross, Matthew R. Kucia, Volker K. H. Sonntag, and Nicholas Theodore

S ymptomatic postoperative lumbar spine epidural hematomas requiring surgical evacuation are infrequent. 1 , 5 , 7 , 8 , 10 Asymptomatic postoperative hematomas are more common, occurring in 33%–100% of cases. 2–4 , 6 , 9 , 11 , 12 The postoperative appearance of epidural hematoma in the lumbar spine has been described, but not specifically in the acute period (< 36 hours) after lumbar laminectomy. 4 , 11 Rarely after lumbar laminectomy a patient will awake with significant leg weakness or pain out of proportion to the operation. The appearance of the

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Kota Watanabe, Toshihiko Hosoya, Tateru Shiraishi, Morio Matsumoto, Kazuhiro Chiba, and Yoshiaki Toyama

I n conventional laminectomy for LCS, bilateral paraspinal muscles are dissected and detached extensively from the spinous process and laminae. Furthermore, the posterior midline ligaments such as the supra- and interspinous ligaments lose their original attachments when the spinous processes are removed. Such intraoperative damage to these posterior lumbar supporting structures can lead to atrophy of paraspinal muscles, which causes trunk extensor weakness 2 and possibly failed—back surgery syndrome. 7 Various authors have developed decompression