Laminectomy

Patients undergoing laminectomy face a variety of concerns both pre- and postoperatively which may affect their emotional state and increase surgical risk. A case study of a laminectomy patient who was taught hypnosis for the control of preoperative anxiety and postoperative pain is presented. The benefits of such hypnotic intervention, as well as the long-term effects of hypnotic intervention on a patient who is in a crisis period are discussed.

OBJECTIVES: Manual therapy practitioners commonly assess lumbar intervertebral mobility before deciding treatment regimens. Changes in mechanoreceptor activity during the manipulative thrust are theorized to be an underlying mechanism of spinal manipulation (SM) efficacy. The objective of this study was to determine if facet fixation or facetectomy at a single lumbar level alters muscle spindle activity during 5 SM thrust durations in an animal model. METHODS: Spinal stiffness was determined using the slope of a force-displacement curve.

STUDY DESIGN: A case of symptomatic hematoma of cervical ligamentum flavum. OBJECTIVE: To report the first ligamentum flavum hematoma in the cervical spine and review the reported cases. SUMMARY OF BACKGROUND DATA: A herniated nucleus pulposis, spondylosis, epidural hematoma or abscess, neoplasm, or some pathology of the ligamentum flavum, such as hypertrophy, ossification, or calcification, are the most common causes of spinal cord and nerve root compression.

OBJECTIVE: To report a rare cause of lumbar radiculopathy. CLINICAL FEATURES: A 72-yr-old man suffered from pain that radiated down the posterior thigh and calf for 3 wk. The right foot and first toe extensors were weak and sensation was decreased over the dorsum of the foot. Straight leg raising was positive at 50 degrees on the right. Computed tomography with contrast revealed a large cyst with focal vacuum change with displacement of the dural sac at the L4-5 level. INTERVENTION AND OUTCOME: An L4-5 laminectomy and facetectomy was performed with relief of the patient's complaint.

OBJECTIVE: To review the features of spinal schwannoma in a case that mimicked a lumbar disc herniation. CLINICAL FEATURES: A 37-yr-old woman suffered from a 4-yr history of progressive low back and leg pain, with progressive neurological involvement of several nerve roots. Noteworthy symptomatology included increased pain when lying recumbent and urinary and fecal incontinence. Several health care practitioners diagnosed her with a lumbar disc herniation.

BACKGROUND: Although the mechanisms of spinal manipulation are poorly understood, the clinical effects are thought to be related to mechanical, neurophysiologic, and reflexogenic processes. Animal studies have identified mechanosensitive afferents in animals, and clinical studies in human beings have measured neuromuscular responses to spinal manipulation. Few, if any, studies have identified the basic neurophysiologic mechanisms of spinal manipulation in human beings or animals.

OBJECTIVE: To discuss the presentation of a schwannoma in a 30-year-old man and to discuss the clincial features of this tumor. CLINICAL FEATURES: The patient had lower right back and abdominal pain that was made worse by any jarring motion. Magnetic resonance imaging showed an intradural extramedullary mass of the thoracic spine behind the T10 vertebral body, which was found to be a schwannoma. INTERVENTION AND OUTCOME: A full laminectomy of T10 and partial laminectomies of T9 and T11 allowed removal of the tumor.

STUDY DESIGN: Electrophysiologic recordings were obtained from low threshold primary afferent neurons innervating lumbar multifidus and longissimus muscles in the anesthetized cat. OBJECTIVE: The purpose of this study was to classify sensory nerve endings in lumbar paraspinal muscles and characterize their responses to biomechanical loads applied over a range of durations that encompass those occurring during spinal manipulation.

OBJECTIVE: To present a case of symptomatic, expansile L1 vertebral hemangioma. CLINICAL FEATURES: A 46-year-old man presented with progressive neurologic changes and insidious onset of low back pain. INTERVENTION AND OUTCOME: After a trial of 3 visits of conservative chiropractic care, no improvement was noted. Magnetic resonance imaging was obtained, revealing an expansile hemangioma with extra-osseous component compromising the conus medullaris at the level of the L1 lumbar vertebra. Neurosurgical intervention resulted in clinical improvement.

BACKGROUND: Although the mechanisms of spinal manipulation are poorly understood, the clinical effects are thought to be related to mechanical, neurophysiologic, and reflexogenic processes. Animal studies have identified mechanosensitive afferents in animals, and clinical studies in human beings have measured neuromuscular responses to spinal manipulation. Few, if any, studies have identified the basic neurophysiologic mechanisms of spinal manipulation in human beings or animals.