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Joseph A. Epstein

–4, 9 This report will focus attention on the results of compression of the cauda equina and lumbosacral nerve roots in lumbar spondylosis. Earlier papers have dealt with this subject in a fragmentary manner. 8, 10, 11 This presentation will review all of the accumulated cases and experiences in the diagnosis and treatment. Spondylosis, often referred to as arthrosis or osteophytosis, begins as a degeneration of the intervertebral disc relatively early in life. Progressive dehydration and fibrillation of the annular fibrocartilage is followed by a loss of

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A. Brish, M. A. Lerner and J. Braham

, as well as producing radicular symptoms, as described by Epstein et al. , 4 spondylotic narrowing of the spinal canal appears to contribute to the production of claudication. Claudication is not mentioned in a review by Teng and Papatheodorou 7 of 30 patients described as suffering from compression of the cauda equina by lumbar spondylosis. Two cases which exemplify these two contentions are therefore considered worthy of presentation. Case Reports Case 1 . N.Y., a male aged 36, was referred on Dec. 12, 1962 from the department of vascular surgery. His

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Wesley J. English and George L. Maltby

a spina bifida occulta ( Fig. 1 ). Lumbar myelography ( Fig. 2 ) demonstrated widening of the spinal canal in the lumbosacral region, a bizarre termination of the dural sac, a filling defect in the center of the oil column at L-5, and a partial block at the L1–2 interspace. It was felt that the partial block was due to a transverse bony ridge secondary to lumbar spondylosis. Fig. 1. Case 1. Plain spine film showing calcified nodule in spina bifida defect at L-5. Fig. 2. Case 1. Myelogram showing widening of spinal canal, filling defect at L-5

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William Beecher Scoville, Arthur H. Palmer, Khairy Samra and Gonzalo Chong

. London : North Hill Plastics, Ltd. Harris , P. Spinal fixation using onlay of Simplex-P. In: Surgical Simplex: Types, Properties, and Applications . London: North Hill Plastics, Ltd. 7. Knight , G. Paraspinal acrylic inlays in treatment of cervical and lumbar spondylosis and other conditions. Lancet , 1959 , 2 : 147 – 149 . Knight , G. Paraspinal acrylic inlays in treatment of cervical and lumbar spondylosis and other conditions. Lancet , 1959, 2: 147–149. 8. Mandarino , M. P. The use of polyurethane

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Richard H. Moiel, George Ehni and M. Sidney Anderson

A bnormalities of the ligamentum flavum have been related to the common low back disorder of cauda equina radiculopathy in lumbar spondylosis. 3, 4, 10 Patients with lumbar spondylosis complain of leg fatigue, numbness, and occasionally bladder discomfort and voiding difficulties related to ambulation. Because of these symptoms, attention is often directed to vascular insufficiency of the legs rather than to a spinal abnormality. The ligamentum flavum lies between the vertebral laminae and is attached to the superior margin of the laminal arch below and at

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Day P. McNeel and George Ehni

the sclerosis and erosion of the involved vertebral bodies and lateral displacement of L-3 on L-4. Proliferative changes have led to attempted bony bridging between the involved vertebral bodies. Right: Case 4. Anteroposterior myelogram of a 72-year-old man with tabes dorsalis and neurogenic arthropathy involving L-2 through L-5. In addition to the bony changes compatible with Charcot's joints, note the multiple indentations of the Pantopaque-filled dural sac. This myelogram is similar to those of patients with small spinal canals and multiple levels of lumbar

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George Ehni

other causes is suggested by Highman's report 13 on 91 myelograms done for lumbar symptoms. Among these were 70 patients with spondylosis, 11 with tumors, and one with arachnoiditis. Ten complete blocks resulted from the tumors, whereas only 11 were found among the 70 cases with lumbar spondylosis. Fig. 4. Anteroposterior (left) and lateral (right) myelograms typical of moderately severe spondylotic caudal radiculopathy. The widths of the spinal canal and the subarachnoid space are normal, but their depth is very shallow resulting in prominent root shadows

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Kemp Clark

lumbar spondylosis. Symptoms may be monoradicular; less commonly, compression of several roots, or even of the entire cauda equina may be present. Fig. 1. Drawings of a segment of the lumbar spine. Left: Normal-sized lumbar canal. Right: Abnormal-sized lumbar canal showing coronal narrowing of congenital origin. Physical examination will not disclose the presence of a small canal in patients where lumbar spine disease is aggravated by this condition. A narrow lumbar canal can be appreciated only by careful measurement of the interspinal volume by x

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Charles B. Wilson

spinal cord. Occlusion of a radicular artery at any point from its origin to its termination near the spinal cord leads to ischemia of the portion of the nerve root proximal to the occlusion. Because lumbar spondylosis usually spares the highest lumbar spinal segments, the great anterior medullary artery (which enters most often at the first or second lumbar segment on the left 25 ) is involved only rarely. Reports of ischemic cauda equina claudication give us no reason to suspect involvement of the great anterior medullary artery, whereas impairment of radicular

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George Ehni

and surgeons. Two of these six patients had lumbosacral spondylolisthesis with intact neural arches and have been described elsewhere. 10 In one of these previously described cases, the mechanism producing the harmful lordosis was undoubtedly that described by Hunter, et al. 6 Four patients had acute lordosis-aggravated spondylotic caudal radiculopathy (SCR) due to lumbar spondylosis in developmentally shallow canals. They represent the condition which is the subject of this report. As has been described SCR is capable of simulating many diseases and has many