Spinal Surgery

1.  AUTHORPorter-R-W.
INSTITUTIONRoyal College of Surgeons of Edinburgh.
TITLESpinal surgery and alleged medical negligence.
SOURCEJ-R-Coll-Surg-Edinb 1997 Dec, VOL: 42 (6), P: 376-80, ISSN: 0035-8835 0 Refs.
ABSTRACTMore than 20,000 spinal operations are carried out in the UK each year. The decision when and whether to operate requires mature judgement. Spinal surgery is technically difficult, demanding a high level of surgical skill. It is learnt only by lengthy apprenticeship. The after-care is equally important. The personal supervision of the surgeon who leads a coordinated team of clinicians, nurses and physiotherapists will ensure the best results. It is inevitable and unfortunate that mistakes will occasionally be made and only careful attention to detail in the pre-operative assessment, meticulous surgical care and supervised post-operative management will ensure consistently good results. The spinal surgeon needs to remain up-to- date, be disciplined with a systematic and careful approach and lead a coordinated team to maintain the highest standards. Author.
2.  AUTHORHellstrom-P-A, Tammela-T-L, Niinimaki-T-J.
INSTITUTIONDepartment of Surgery, Oulu University Hospital, Finland.
TITLEVoiding dysfunction and urodynamic findings in patients with lumbar spinal stenosis and the effect of decompressive laminectomy.
SOURCEScand-J-Urol-Nephrol 1995 Jun, VOL: 29 (2), P: 167-71, ISSN: 0036-5599.
ABSTRACTEighteen consecutive patients (12 men and 6 women, mean age 55) with clinically and radiologically verified lumbar spinal stenosis underwent urodynamic examinations before decompressive laminectomy (n = 16) and 15 afterwards. Twelve of the patients (67%) had symptoms of voiding dysfunction preoperatively but urodynamic findings were normal in most cases only one patient showing detrusor hyperreflexia and one obstruction. Three patients reported an improvement in voiding postoperatively. Three patients showed obstructive voiding postoperatively, one undergoing TURP with a good outcome. One patient developed detrusor areflexia after the operation, with difficulties in bladder emptying. The only statistically significant changes in urodynamic parameters were rises in the maximum urethral pressure and urethral closure pressure. When considering the radicular symptoms and back pains the overall outcome was assessed as excellent or good in 6 cases, 6 had a fair outcome and 4 poor. Decompressive laminectomy gives acceptable results but the effects on bladder and urethral function remain controversial and unexpected. Electrophysiological investigations are needed for more detailed analysis of these cases. Author.
3.  AUTHORDeen-H-G-Jr, Zimmerman-R-S, Swanson-S-K, Larson-T-R.
INSTITUTIONSection of Neurologic Surgery, Mayo Clinic Scottsdale, Arizona.
TITLEAssessment of bladder function after lumbar decompressive laminectomy for spinal stenosis: a prospective study.
SOURCEJ-Neurosurg 1994 Jun, VOL: 80 (6), P: 971-4, ISSN: 0022-3085.
ABSTRACTLumbar spinal stenosis is a common problem in elderly patients. In its more advanced forms, it typically causes intractable leg pain, but many patients also manifest varying degrees of bladder dysfunction. The goal of lumbar decompressive laminectomy is relief of leg pain and paresthesias, yet some patients also achieve improvement in bladder function. This study prospectively investigated patients with lumbar spinal stenosis to determine whether laminectomy had any effect on urological function. Of the 20 patients in the study, 10 were men and 10 women (average age 70.9 years). All patients had severe lumbar stenosis affecting between two and four spinal segments, and all reported some degree of bladder dysfunction. Cystoscopy and urodynamic testing were completed preoperatively. A standard decompressive laminectomy was performed over the appropriate number of spinal segments. Urodynamic studies were repeated at 2 and 6 months postoperatively. At the 6-month follow-up review, bladder function was subjectively improved in 12 patients (60%) and unchanged in eight (40%). Postvoiding residual urine volume was the urodynamic factor most likely to be improved by laminectomy. In nine patients (45%), baseline postvoiding residual urine volume was elevated and all nine had improvement postoperatively. In the remaining 11 patients (55%), this urine volume was normal before and after surgery. Maximum urine flow rates also improved, but the results of cytometrography and electromyography, urine flow pattern, and bladder capacity were unchanged postoperatively. Cystoscopy detected previously undiagnosed malignancy of the lower urinary tract in two patients (10%). It is concluded that lumbar decompressive laminectomy can have a beneficial effect on bladder function in a significant number of patients with advanced lumbar spinal stenosis. Author.
4.  AUTHORAndersen-J-T, Bradley-W-E.
TITLENeurogenic bladder dysfunction in protruded lumbar disk and after laminectomy.
SOURCEUrology 1976 Jul, VOL: 8 (1), P: 94-6, ISSN: 0090-4295.
ABSTRACTBladder and urethral innervation was studied in 18 patients with protruded lumbar disk or persistent back pain after laminectomy. A high incidence of neurogenic dysfunction of the detrusor muscle was found, whereas impaired function of the striated external urethral sphincter was rare. The lesions were encountered among the patients with protruded lumbar disk as well as among the patients with sequelae after laminectomy, suggesting that neurogenic bladder dysfunction in cauda equina injury due to protruded disk is often irreversible. Author.

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