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

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...

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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...