The retrodural space of Okada.

By London Spine

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The retrodural space of Okada.
AJR Am J Roentgenol. 2011 Jun;196(6):W784-9
Authors: Murthy NS, Maus TP, Aprill C
Abstract
OBJECTIVE: The retrodural space of Okada is a potential space that can…

Effect of hind limb position on the craniocaudal length of the lumbosacral space in anesthetized dogs.

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Effect of hind limb position on the craniocaudal length of the lumbosacral space in anesthetized dogs.

Vet Anaesth Analg. 2012 Jan;39(1):99-105

Authors: Di Concetto S, Mandsager RE, Riebold TW, Stieger-Vanegas SM, Killos M

Abstract
OBJECTIVE: To investigate whether rostral extension of the hind limbs increases the cranio-caudal dorsal interlaminar distance between the seventh lumbar vertebra and the sacral bone (LS distance) in sternally recumbent anesthetized dogs.
STUDY DESIGN: Prospective clinical study.
ANIMALS: Eighteen dogs (eight neutered males, three intact males, six spayed females, one intact female) of various breeds, weighing 4-34 kg and ranging in age from 1 to 13 years.
METHODS: Each dog was grouped by size: small (≤ 10 kg), medium (15-20 kg) or large (≥ 25 kg). Each dog was anesthetized and positioned in sternal recumbency. Computed tomography (CT) of the lumbosacral area was performed with the hind limbs resting on the stifle and the feet extended posteriorly, and then with the hind limbs extended rostrally. LS distance, craniocaudal dorsal interlaminar distance between sixth and seventh lumbar vertebra (L6-L7 distance), length of L7 vertebral body and lumbosacral angle (LS angle) were measured on a reconstructed mid-sagittal CT image from the two hind limb positions. The measurements from the two hind limb positions for the whole dog population and by size were compared using Student’s T tests. Diagnostic interpretation of the CT images was performed.
RESULTS: The length of L7 was taken as the reference value as it was not affected by hind limb position. LS distance, L6-L7 distance and LS angle were significantly higher when the hind limbs were extended rostrally in all three size groups. The CT images of ten dogs showed clinically undetected osteoarthrosis of the ileo- and lumbosacral area.
CONCLUSIONS AND CLINICAL RELEVANCE: Rostral extension of the hind limbs significantly increases LS and L6-L7 distance and LS angle even in dogs with clinically undetected osteoarthrosis of the ileo- and lumbosacral area, and may enhance the ease of lumbosacral epidural injection in sternally recumbent anesthetized dogs.

PMID: 22117842 [PubMed – indexed for MEDLINE]

The caudal space in fetuses: an anatomical study.

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The caudal space in fetuses: an anatomical study.

J Anesth. 2012 Apr;26(2):206-12

Authors: Aggarwal A, Sahni D, Kaur H, Batra YK, Sondekoppam Vijayashankar R

Abstract
PURPOSE: The caudal epidural space is a popular site for analgesia in pediatrics. High variation in blind needle placement is common during caudal epidurals, increasing the risk of intravascular and intrathecal spread. Knowledge of safe distances and angles for accessing the caudal epidural space in premature infants can improve the safety of caudal epidural blocks.
METHODS: Thirty-nine fetuses with crown-heel length between 33 and 50 cm, corresponding to gestational age of 7-9 months, were included. The dorsal surface of the sacrum from the fourth lumbar vertebra to the tip of the coccyx was dissected, following which measurements were taken on dorsal surface and midsagittal sections. The angle of depression of the needle was measured using a goniometer following the two-step method of needle insertion.
RESULTS: Right and left sacral cornua were palpable in 23 of 39 fetuses (58.97%). Termination of dural sac was at S2 in most of the fetuses (53.84%), whereas the apex of the sacral hiatus was at S3 in most (58.97%). The distance from the apex of the hiatus to the termination of dura ranged from 3 to 13 mm; the anteroposterior distance of the canal at the apex of the hiatus ranged from 1.72 to 4.38 mm. All sacral parameters correlated with crown-heel length except inter-cornual distance, depth of canal at hiatus, and height of sacral hiatus.
CONCLUSION: Distances and angles for accessing the caudal epidural space in fetuses do not provide all parameters for safe performance of caudal epidural blocks in premature and low birth weight infants because the apex of the sacral hiatus and the termination of the dura show wide variation in location.

PMID: 22076688 [PubMed – indexed for MEDLINE]

[Percutaneous interspinous dynamic stabilization (in-space) in patients with degenerative disease of the lumbosacral spine – a prospective study].

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[Percutaneous interspinous dynamic stabilization (in-space) in patients with degenerative disease of the lumbosacral spine – a prospective study].

Rozhl Chir. 2012 Jun;91(6):311-6

Authors: Hrabálek L, Wanek T, Machač J, Vaverka M, Langová K, Kalita O, Krahulík D, Novák V, Houdek M

Abstract
INTRODUCTION: Interspinous spacers are supposed to reduce the segmental extension with a decrease in the expansion of yellow ligaments into the spinal canal, thus avoiding the dynamic narrowing of the spinal canal and compression of nerve roots. The aim of this study was to evaluate clinical outcomes and post-operative complications during one year in patients mostly having suffered from spinal stenosis and treated by In-Space interspinous spacer (Synthes, USA).
MATERIAL AND METHODS: A total of 25 patients aged between 25 and 73 (average age 52.6) years, including 18 males and 7 females, with degenerative disease of the lumbosacral spine were indicated for surgery and prospectively followed up. The patients were operated on under general anaesthesia in the prone position, using a minimally invasive lateral percutaneous approach, under fluoroscopic control. The ODI and VAS values as well as X- rays (Range Of Motion and Sagittal angle of the operated segment) 6 and 12 months after the surgery were compared to each other and to those before surgery. The results were statistically analyzed.
RESULTS: The average ODI of the group was 47.2% before surgery and 17.48% 6 months (22.76% 12 months) after surgery, showing a statistically significant improvement by 63% (52% after 12 months). The average VAS of the group was 6.64 points before surgery and 2.96 points 6 months (2.8 points 12 months) after surgery, which showed a statistically significant improvement by 55.4% after 6 months (57.8% after 12 months) when compared to preoperative status. After surgery the lordotic sagittal angle remained in all cases; one year after surgery the angle increased due to the slight sinking of some implants. The extent of segmental motion was minimally changed (6.1° 6 months and 7.24° 12 months after surgery). No serious complications occurred. The effect of interspinous implants proved insufficient in two cases (one year and two years after surgery) and conversion to arthrodesis or decompression was performed.
CONCLUSIONS: 1. Percutaneous, minimally invasive insertion of an In-Space interspinous spacer is an effective and safe method of dynamic stabilization not accompanied by any serious complications. 2. ODI improved by 63% 6 months after surgery with a decrease in this effect 12 months after surgery. VAS for axial and radicular pain, as reported by patients, improved on average by 55.4% 6 months and by 57.8% 12 months after surgery. 3. In all cases, the lordotic sagittal angle remained after surgery and the extent of segmental motion from flexion to extension was minimally changed.

PMID: 23078223 [PubMed – indexed for MEDLINE]