Morphological features and clinical significance of the Epidural membrane and Epiradicular sheath in Cervical Spondylotic Myelopathy
Joint Event on 3rd International Conference on Spine and Spine Disorders & International Conference on Addiction Research and Therapy
November 26-27, 2018 | Dubai, UAE
Akira Miyauchi, Shin-ichi Saka, Hiroshi Terayama, Yoshifumi Fuse, Nobukazu Okimoto and Mayumi Kaneko
Saka-midorii Hospital, Japan Hiroshima City Asa Hospital, Japan
Posters & Accepted Abstracts : J Neurol Neurorehabil Res
Abstract:
Introduction/Aim: The morphology and clinical significance
of the Epidural Membrane (EM) and Epiradicular Sheath (ERS)
have been discussed in the context of the entire spine; however,
there has been less research on these entities in the cervical
spine versus the lumbar spine. This prospective study aimed to
elucidate the morphological features and clinical significance
of the EM and ERS in a Degenerative Cervical Spine Disorder.
Materials and Methods: This study included 151 patients
with Cervical Spondylotic Myelopathy (CSM) who underwent
expansive open-door Laminoplasty or Laminectomy using
a microscope with a follow-up period of at least 2 years. The
most damaged spinal segment (D-segment) was determined
in each patient using the preoperative neurologic and image
findings along with the remaining symptoms at follow-up. The
morphological features of the EM and ERS were recorded in each
patient during surgery. Specimens of EM and ERS were obtained
for histological analysis from 17 patients selected at random.
Results: The average age at surgery was 63.2 years; there were
105 men and 46 women. The D-segments were located in the
spine as follows: 21 cases at C3-4, 56 at C4-5, 67 at C5-6, and
7 at C6-7. The EM and ERS were adipo-fibro-vascular tissues,
and their morphology ranged from delicate fibrous strands to
substantial membranous structures over the dural tube. There
was adhesion to both the ligamentum flavum and the dura to
varying degrees. Some samples showed structures that caused
Neural Compression: obstruction of dural tube expansion (21
cases, 13.9%), compression or impairment of the mobility
of a nerve root (4 cases, 2.6%), or a combination (1 case,
0.7%). Except for one case, these structures were all located
at the D-segment and/or its adjacent levels. Interestingly, the
analysis of the EM and ERS showed that some harbored many
small arteries, calcified debris, metaplastic bone fragments, or
pseudo-angiomatous structures.
Conclusion: The EM and ERS are important structures that can
undergo clinically relevant degenerative changes in response to
aging and various mechanical stresses. Some of these changes
can cause an inadequate neural decompression despite an
adequate bony decompression, leading to unsatisfactory
surgical outcomes in CSM.
Biography:
Akira Miyauchi is an Orthopaedic Surgeon, specializing in Spine Disorders. He earned his MD and PhD at Hiroshima University in 1993 and 2012, respectively. He has over 3500 surgical cases of spine diseases using a microscope, about 200 – 250 cases every year. He has much interest in less invasive surgery and the anatomy in the epidural space and around the nerve root. He has performed neural decompression alone for almost all surgical cases; for example, decompression without spinal fusion even though patients have Degenerative Lumbar Spondylolisthesis or the so-called unstable spine.
E-mail: lahlw@success.name
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