This journal is
indexed in Scopus
Year 2018 Vol. 26 No 6
P.S. REMOV 1, 2, M.V. ALIZAROVICH 1, 2
FEATURES OF X-RAY DIAGNOSTICS OF CENTRAL DISTROPHIC STENOSIS OF THE SPINAL CANAL
Gomel State Medical University 1,
Gomel Regional Clinical Hospital 2, Gomel,
The Republic of Belarus
Objective. To assess the x-ray anatomic parameters of the spinal canal at the lumbosacral level and to suggest the method for their application in the diagnosis and surgical treatment of central dystrophic stenosis.
Methods. 64 patients operated on because of the degenerative-dystrophic pathology of the lumbosacral spine were included in the study. The main group consisted of patients with the combination of herniated intervertebral disc and central dystrophic stenosis of the spinal canal. The control group included patients with herniated discs without stenosis. The anteroposterior, interarticular ligamentous parameters, the area of the dural sac, and thickness of the ligamentum flavum were investigated. The method of determining of the surgical decompression dimension for cases of central stenosis of the spinal canal has been developed.
Results. The study revealed a statistically significant difference between the groups in the anteroposterior, interarticular ligamentous distance and dural sac area. Isolated hypertrophy of the ligamentum flavum with anteroposterior size value of 12 mm and more was the most common cause of dystrophic stenosis (38.2%). There was a strong correlation between interarticular ligamentous distance and area of the dural sac (in the main group – rs=0.72 at p<0.00001; in the group of control – rs=0.70 at p<0.00001). Cases of thickening of the ligamentum flavum more than 4 mm are noted both in the stenotic segments, and in the segments with herniated discs without stenosis.
Conclusions. Interarticular ligamentous distance has confirmed its diagnostic significance and the possibility of using as a criterion for a deficiency of free space in the spinal canal in cases of hypertrophy of the ligamentum flavum and/or articular processes. The fact of thickening of the ligamentum flavum does not in all cases indicate the presence of its compressive effect on the dural sac and is not sufficient to establish the diagnosis of dystrophic stenosis. The developed measurement procedure according to the 7 specified plans allows performing a reasonable, selective resection of the elements of the posterior support complex in cases of combination of herniated disc and central dystrophic stenosis.
- Chung S, Kang M, Shin Y, Baek O, Lee S. Postoperative expansion of dural sac cross-sectional area after unilateral laminotomy for bilateral decompression: correlation with clinical symptoms. Korean J Spine. 2014 Dec; 11(4):227-31. Published online 2014 Dec 31. doi: 10.14245/kjs.2014.11.4.227
- Morgalla MH, Noak N, Merkle M, Tatagiba MS. Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression? J Neurosurg Spine. 2011 Mar;14(3):305-12. doi: 10.3171/2010.10.SPINE09708
- Pedachenko YuE. Lumbar spinal stenosis. Ukrain Neirokhirurg Zhurn. 2009;(4):9-14. https://elibrary.ru/item.asp?id=18884456. (in Russ.)
- Ul'rikh EV, Mushkin AIu. Vertebrologiia v terminakh, tsifrakh, risunkakh. Saint-Petersburg, RF: ELBI-SPb; 2004. 179 p. (in Russ.)
- Cehla AI. Маgnetic-resonant visualization of neurologic displays of an osteochondrosis of lumbo-sacral department of a backbone. Tavr Med-Biol Vestn. 2012;15(1):287-90. http://dspace.nbuv.gov.ua/handle/123456789/45010 (in Russ.)
- Sobottke R, Schlüter-Brust K, Kaulhausen T, Röllinghoff M, Joswig B, Stützer H, Eysel P, Simons P, Kuchta J. Interspinous implants (X Stop, Wallis, Diam) for the treatment of LSS: is there a correlation between radiological parameters and clinical outcome? Eur Spine J. 2009 Oct;18(10):1494-503. Published online 2009 Jun 27. doi: 10.1007/s00586-009-1081-y
- Shmirjev VI, Morozov SP, Voinov DA. Clinical and radial correlations in stenoses of the spinal canal. Kremlev Meditsina. 2009;(4):76-79. https://elibrary.ru/item.asp?id=1307519. (in Russ)
- Sorokovikov VA, Gorbunov AV, Koshkareva ZV, Briukhanov VG, Pozdeeva NA. Klassifikatsii stenozov pozvonochnogo kanala v poiasnichnom otdele pozvonochnika. Biul VSNTs RAMN. 2010;2(72):243-47. https://cyberleninka.ru/article/v/klassifikatsii-stenozov-pozvonochnogo-kanala-v-poyasnichnom-otdele-pozvonochnika-obzor-literatury. (in Russ)
- Shevelev IN, Kornienko VN, Konovalov NA, Cherkashov AM, Nazarenko AG, Asiutin DS. Analysis of correlation of radiological criteria and clinical manifestation of central lumbosacral spinal stenosis. Vopr Neirokhirurgii. 2012; (3): 61-68. https://www.mediasphera.ru/issues/zhurnal-voprosy-nejrokhirurgii-imeni-n-n-burdenko/2012/3/downloads/ru/030042-8817201236 (in Russ.)
- Karabekir HS, Yildizhan A, Atar EK, Yaycioglu S, Gocmen-Mas N, Yazici C. Effect of ligamenta flava hypertrophy on lumbar disc herniation with contralateral symptoms and signs: a clinical and morphometric study. Arch Med Sci. 2010 Aug 30;6(4):617-22. doi: 10.5114/aoms.2010.14477.
- Olizarovich MV, Remov PS. Microsurgical intervention on the spine using computer calculation and graphic visualization. Novosti Khirurgii. 2016;(6):592-600. doi: 10.18484/2305-0047.2016.6.592. (in Russ.)
- Hermansen E, Moen G, Barstad J, Birketvedt R, Indrekvam K. Laminarthrectomy as a surgical approach for decompressing the spinal canal: assessment of preoperative versus postoperative dural sac cross-sectional areal (DSCSA). Eur Spine J. 2013 Aug;22(8):1913-19. doi: 10.1007/s00586-013-2737-1
- Abbas J, Hamoud K, May H, Hay O, Medlej B, Masharawi Y, Peled N, Hershkovitz I. Degenerative lumbar spinal stenosis and lumbar spine configuration. Eur Spine J. 2010 Nov;19(11):1865-73. doi: 10.1007/s00586-010-1516-5
- Haig AJ, Adewole A, Yamakawa KS, Kelemen B, Aagesen AL. The ligamentum flavum at L4-5: relationship with anthropomorphic factors and clinical findings in older persons with and without spinal disorders. PMR. 2012 Jan;4(1):23-29. doi: 10.1016/j.pmrj.2011.07.023
246000, The Republic of Belarus,
Gomel, Lange Str., 5,
Gomel State Medical University,
Department of Neurology and Neurosurgery
With the Course of Medical Rehabilitation,
Mob. tel. :+375 44 597 04 76,
Pavel S. Remov
Remov Pavel S., Assistant of the Department of Neurology and Neurosurgery with the Course of Medical Rehabilitation, Gomel State Medical University, Gomel, Republic of Belarus.
Alizarovich Mikhail V., PhD, Associate Professor of the Department of Neurology and Neurosurgery with the Course of Medical Rehabilitation, Gomel State Medical University, Gomel, Republic of Belarus.