Transverse axial tomography of the spine

Jacobson, Robert E; Gargano, Fredie P.; Rosomoff, Hubert L.

doi:10.3171/jns.1975.42.4.0412

Cited by 28 publications

(4 citation statements)

References 38 publications

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“…In studying axial CT or MRI images of the normal lumbar spinal canal, it is clear that the canal has a flat ventral base and an elevated laminar arch forming a triangle over the dura [3-4]. This creates a larger posterior epidural space between the dorsal laminar arch and the dura.…”

Section: Discussionmentioning

confidence: 99%

“…With ligamentous stenosis, the majority of soft tissue compression is caused by either unilateral or bilateral hypertrophy of the dorsal and lateral positioned yellow ligament, and with age, the ligament becomes thicker, looses elasticity and becomes composed of more collagen than elastin [2, 4, 7]. As the ligament enlarges, it fills the posterior and lateral epidural space that is normally filled with epidural fat and more laterally progressively narrows the foramina [2, 4] (Figure 8).…”

Section: Discussionmentioning

confidence: 99%

“…As the ligament enlarges, it fills the posterior and lateral epidural space that is normally filled with epidural fat and more laterally progressively narrows the foramina [2, 4] (Figure 8). Progressive thickening of the capsule and ligamentum flavum subsequently compresses the dura more medially and the nerve root laterally as it enters the neural foramina.…”

Section: Discussionmentioning

confidence: 99%

“…This leads to additional compression by a decrease in vertical height of the foramina between the pedicles above and below (Figure 7). As the space narrows, the superior facet of the lower vertebra, and part of the facet joint, forming the posterior wall of the foramina, ‘rides up’ creating narrower foramina and even more compression [2, 4, 8-9]. …”

Section: Discussionmentioning

confidence: 99%

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Targeted Intraspinal Radiofrequency Ablation for Lumbar Spinal Stenosis

Granville

2017

Cureus

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IntroductionBy using a combination of magnetic resonance imaging (MRI) and computed tomography (CT) of the lumbar spine, it is possible to distinguish between spinal stenosis caused by bone compression and specific soft tissue epidural intraspinal lesions that cause localized spinal canal stenosis and neural compression. Examples include facet cysts and yellow ligament hypertrophy. Many of these patients are elderly with medical comorbidities that make open surgery problematic.Materials & MethodsThis is a study of patients with predominantly soft tissue stenosis being treated with targeted intraspinal radiofrequency (RF) heat ablation. This novel procedure is performed under local anesthesia in an outpatient setting using intra-operative imaging. Fine tip 20 gauge RF electrodes (Stryker® PA, USA) are precisely placed under radiologic guidance in the identified soft tissue causing the posterior compression of the lumbar spinal canal. After sensory and motor testing to make sure there is a safe distance of the needle tip from the nearby nerve roots to avoid any neural effect, multiple targeted lesions correlated by the MRI or CT scan are made in the fibrous and cystic soft tissue. Lesions are created using a focused 2 or 5 mm tip at 60 degrees centigrade (°C) for either 30 or 60 seconds. This heat causes sufficient shrinking of the targeted soft tissue resulting in relative reduction of the soft tissue component of the stenosis. This relative reduction in the stenosis of the spinal canal, similar to that measured with interspinous devices, provides long-term relief of symptoms, signs, and improvement of spinal motion in patients with lumbar stenosis. This report will review the spinal anatomy, and development and history of using RF in and around the nerve roots and epidural space, as it relates to lumbar stenosis. Examples of before and after MRI scans demonstrate the radiologic reduction in the size of the lesions. This soft tissue reduction correlates with patients' improvement in pain and clinical symptoms. Follow-up of the patients up to 30 months shows that the effect of RF heat on the soft tissue is long lasting.ResultsIn our long-term follow-up of greater than six months, 58% of RF treated patients had lasting relief of clinical symptoms, back pain, and claudication with increased spinal movement. This reduction in pain and improvement in motion allows patients to continue more aggressive physical therapy and muscle strengthening that secondarily can improve their symptoms. Post-procedure follow-up MRI scans in multiple patients have shown a clear reduction in soft tissue lesion size. Long-term follow-up demonstrated that 58% of patients treated with RF targeted ablation have not required further intervention and 22% went on to other surgical treatments for lumbar spinal stenosis.ConclusionBy reducing the soft tissue component of the stenosis with RF ablation and creating relatively more epidural space, targeted intraspinal RF may be a possible minimally invasive, percutaneous non-surgical alternative to tr...

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Section: Discussionmentioning

confidence: 99%