Indications

Laminoplasty is indicated for myelopathy secondary to - Developmental spinal canal stenosis (an anteroposterior canal diameter less than 13 mm) - Continuous or mixed type of OPLL - Multisegmental spondylosis associated with a relatively narrow spinal canal(13-14mm) 32, 35 - Distal type of cervical spondylotic amyotrophy 3 with canal stenosis For younger patients laminoplasty should be borne in mind. Laminoplasty is preferable to laminectomy because it can be lessen postoperative kyphosis and...

References

Bohlman HH (1977) Cervical spondylosis with moderate to severe myelopathy. Spine 2 151-162 2. Cloward RB (1958) The anterior approach for removal of ruptured cervical discs. J Neurosurg 15 602-617 3. Ebara S, Yonenobu K, Fujiwara K, Ya-mashita K, Ono K (1988) Myelopathy hand characterized by muscle wasting. A different type of myelopathy hand in patients with cervical spondylosis. Spine 13 785-791 4. Graham JJ (1989) Complications of cervical spine surgery. In Shark HH, et al (eds) The cervical...

Circulating factors that influence bone cell function

A number of circulating substances influence the activity of bone cells. As alluded to above, these are mostly directed towards osteoblasts. PTH is secreted by the parathyroid glands and has direct effects on osteoblasts, as these cells have receptors for this hormone. However, PTH also acts to increase bone resorption in response to low serum levels of calcium. It does this by inducing a rounding of the osteoblast, so that it has less surface area contact with the surrounding bone and allows...

Aging of the facet joint

The facet joints are the only synovial joints in the spine, with hyaline cartilage overlying subchondral bone. Kirkaldy Willis and associates have described a three-joint complex consisting of the intervertebral disc and the two facet joints 7, 9 . In a normal healthy spinal unit, the disc is the major anterior load-bearing structure. The facet joints provide a posterior load-bearing helper, stabilizing the motion segment in flexion and extension and also pro tecting the disc from excessive...

Diagnosis of osteoporosis

Commonly used in vivo imaging techniques do not capture cancellous bone volume fraction and architecture. Therefore, assessment of bone density occurs at the whole bone level. Areal bone mineral density (g cm2), measured by dual x-ray absorptiometry (DXA), is a single measure that captures both mineral content and bone size 10 . Studies have reported good correlation between bone mineral density, as measured by DXA, and vertebral body failure load 71 . There is a higher risk factor of fracture...

Agerelated bone loss and osteoporosis

Primary osteoporosis related to aging has been classified as type II, or senile, osteoporosis. The type I disorder is related to the onset of menopause, and is thus termed postmenopausal osteoporosis. Other causes of osteoporosis can be secondary, such as that caused by long-term corticosteroid use or endocrinopathy. Peak bone mass is achieved between the ages of 16 to 25 years in most people. After this age, bone mass slowly, but continuously, decreases. The greater the amount of bone achieved...

Results

Forty-five publications resulted from the search of the medical databases. Six publications were excluded because they reported on total number of fractures and the number of patients with at least one fracture was not published and could not be derived from published data 34, 46, 73, 76, 80, 85 . Sixteen publications were excluded because the duration of observation was less than 36 months 5, 7, 15, 21, 29, 32, 33, 36, 41, 53, 55, 59, 66, 67, 90, 92 . Twenty-three publications matched all...

Natural history of the aging spine

Hopital Beaujon, 100 Bd du Gal Leclerc, Abstract The unrelenting changes associated with aging progressively affects all structures of the spinal units. The degenerative process starts early during the first decade of life at the disc level. Discal degeneration is associated with biochemical changes followed by macroscopic alterations including tears and fissures, which may lead to discal herniation, the main cause of radiculopathy in the young adult. Moreover, nociceptive nerve fibers have...

The vertebral endplate

The vertebral endplate forms a structural boundary between the intervertebral disc and the cancellous core of the vertebral body. Comprised of a thin layer of semi-porous subchondral bone, approximately 0.5 mm thick, with an overlying cartilage layer of similar thickness, the principal functions of the endplate are to prevent extrusion of the disc into the porous vertebral body, and to evenly distribute load to the vertebral body. With its dense cartilage layer, the endplate also serves as a...

Osteoporosis

Vertebrae Double Wedge Fracture

Surgical treatment of osteoporosis is still not widely accepted by orthopedic surgeons, nor well known among the medical community at large. However, recently, it has been gaining support for two main reasons. The first is that more in-depth studies, which are detailed below, have shown that osteoporosis is not an innocent disease characterized by minor complications and disabilities, but a serious health problem that can create devastating complications with substantial morbidity and...

A

Irradiation mostly palliativeipain control in ca. 75 Fig.3 Surgery ideally should be carried out before irradiation 1 . Irradiation which preceding surgery 2 has a significantly higher complication rate 21 perience with the introduction of instrumentation shows that the realignment of a multiply involved collapsing spine has significantly improved the neurological deficit of patients with spinal metastases (Fig. 2) 5, 6, 10, 13, 32, 41, 48, 57 . Today the debated question is whether irradiation...

Techniques of laminoplasty and supplementary procedures

Double Door Laminoplasty

Although several types of laminoplasty have been reported, most of them can be classified into two types the open-door type of Hirabayashi 7 and the French-door type of Kurokawa 10 . The basic concept of most of procedures is similar to one of these two procedures (Fig. 1). Hence these two procedures are described in more detail. For For the expansive open-door laminoplasty of Hirabayashi 7, 9 , the spinous processes are exposed from C2 to T1, with care being taken not to damage the...

Aims advantages and disadvantages of laminoplasty

The aims of laminoplasty are to expand the spinal canal, to secure spinal stability, and to preserve the protective function of the spine. Preservation of spinal mobility is also the goal of this procedure. Nuchal muscles and spinal ligaments which were totally or partially detached to expose laminae can be reat-tached to preserved posterior spinal structures, and this may prevent development of the cervical instability which often happens after laminectomy, particularly in those subjects below...

Pagets disease of the spine

The second part of this paper looks at Paget's disease, another osteometabolic disorder that can affect the aging spine. It describes the spinal involvement of Paget's disease in bone and outlines best treatment options. The original disease was described by Sir John Paget 100 in 1877, and despite recent intensive studies, its etiology remains obscure. Paget's disease of bone (PD), a mono-ostotic or polyostotic non-hormonal osteometabolic disorder, is postulated to be caused by a viral...