Three patients with complete lumbar spondyloptosis and 8 patients with fourth-degree spondylolisthesis suffering from radicular signs and symptoms are reported. There were 8 female and 3 male ...patients in the study. A high incidence of neurogenic intermittent claudication was noted in this condition. Decompressive laminectomy and foraminectomy were performed on all patients followed by transabdominal console fusion. Length of follow-up varied from 3 to 17 years, with a mean value of 13.5 years, and results are reported. Radicular signs and symptoms had completely subsided in all cases. Nine of 11 patients are free from signs and symptoms and 2 suffer from residual pain, although less severe than before surgery. All 3 males fathered children after surgery, which is in contrast to the opinion that anterior lumbosacrial fusion is followed by infertility in males. Special attention was given to individuality of remodeling of the lumbosacral junction over the course of time. Solid fusion was obtained in 10 of the 11 patients, while the console fusion collapsed because of failure to follow instructions after surgery in 1 patient.
Computerized axial tomography (CAT) in cases of stenosis of the lumbar bony vertebral canal may demonstrate features of diagnostic significance in the shape of the canal and the bony structures ...surrounding it. The distinguishing features are the measurements. Standardized measurements of the midsagittal diameters at the cephalad and caudad borders of the laminas of the vertebral canal are proposed as a means of furthering both surgical and comparative studies. Identification of these borders in CAT scans is described, as is the procedure for taking measurements. One or two interlaminar, transarticular CAT scans are also made. In these scans, the midsagittal diameters cannot be measured because the ligamentum flavum forms the posterior wall in the midline. The scans may, however, demonstrate narrow lateral recesses and deformities of the articular processes and joint spaces. Errors in measurement of midsagittal diameters result from the inability of CT body scanners to show the angle between axial sections and the anterior vertebral canal wall, and from the partial volume phenomenon. The diameters are then too large. Errors in the angle of axial sections also lead to distortion in reconstructions of sagittal sections of the vertebral canal from the soft material obtained from axial sections. New precision designs are described. The principal indication for the intrathecal injection of water-soluble contrast media in CAT scanning is the determination of the thickness of the ligamentum flavum. Apart from its value in distinguishing various forms of stenosis, CAT scanning may also reveal inadequacies in surgical decompression.
A descriptive quantitative evaluation was done of the transverse orientation of the lower lumbar facet joints as measured by computed tomography scanning.
To evaluate a new parameter for facet joint ...angulation in the transverse plane (the "facet orientation circle") and to obtain reference values for this new parameter.
In other studies, both in vitro and in vivo, the angulation of the facet joints has been measured in degrees relative to the frontal or sagittal plane. These methods have some limitations. The parameter used in the present study has not been described in the literature.
Lower lumbar facet joint orientation was measured in 212 vertebral levels of 123 consecutive patients using the facet orientation circle parameter. Patients with degenerative or developmental abnormalities of the lumbar spine were excluded, as were those with technically inadequate computed tomography studies.
Mean facet orientation circle diameters (+/-SD) were: L3-L4, 43.7 +/- 10.5 mm; L4-L5, 63.8 +/- 26.4 mm; and L5-S1, 82.3 +/- 23.5 mm. Differences between right and left sides were: L3-L4, 6.3 +/- 7.1 mm; L4-L5, 13.9 +/- 25.3 mm; and L5-S1, 17.9 +/- 16.2 mm, intra-observer variability was 2.3%.
Measurement of facet joint angulation using the facet orientation circle is possible and reproducible. The morphometric data presented may be useful as a reference for biomechanical and clinical research of facet joint orientation and asymmetry.
The relationship between the angulation of the facet joints and that of the caudad parts of the corresponding laminae in the transverse plane was investigated with computed tomography (CT) at the ...vertebral levels L3-L4, L4-L5, and L5-S1. At the level of L3-L4, both the facet joints and the caudad portions of the laminae tend toward a sagittal orientation, while at L5-S1 this is more toward the frontal plane. At the level of L4-L5, they occupy an intermediate position. A highly significant correlation between the orientation of these structures is demonstrated. The caudad parts of the laminae may be considered buttresses for the inferior articular processes of the same vertebra.
