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We recorded dermatomaly somatosensory evoked potentials(DSSEPs)in 30 healthy subjects and 50 patients with a herniated lumbosacral disc. DSSEPs normally consists of three negative peaks, N_(38) N_(55) N_(75) and N_(42) N_(59) N_(78) by bilateral stimulation of L_(5) and S₁ dermatome, respectively. In the patient group, both first & second peak of DSSEPs are often abnormal whereas the third peak tends to remain normal. Of the 20 patients who underwent laminectomy, 17 (85%) patients demonstrated positive findings of the lesion corresponding to myelographic finding. However, 19(95%) patients of the 20 surgical cases showed operative findings identical with DSSEPs. Follow -up study with DSSEPs in the patients of 20 surgical cases and 30 cases treated with either RF rhizotomy or physiotherapy resulted in returning to normal waveform from abnormal one. In comparing to other electro-diagnostic test, DSSEPs are more valuable noninvasive diagnostic tool in the evaluation of herniated lumbosacial disc.
We have experienced a rare case of leukemic 1esion (chloroma) in the lower spinal canal which was confirmed by the surgery and histologic examination of the tumor. A farmer, aged 39, was admitted to the Department of Neurosurgery, St. Paul Hospital in December 1974 with chief complaints of low back pain with radiating pain in the right lower extremity and voiding difficulty for one month. On admission, neurologically, the patient exhibited weakness of the right anterior tibialis, extensor hallucis longus and peroneus longus and brevis muscles and sensory involvement of the right third, fourth and fifth sacral dermatomes. He was disclosed the positive signs of the Naffziger's and Lasegue's and severe tenderness on the spinous process of the fifth lumbar and first sacral vertebrae. Lumbar myelogram demonstrated a total block at lower level of the fifth lumbar vertebra and a filling defect of the right fifth lumbar root area. Through the laminectomy of fourth lumbar to first sacral lamina, an extradural greenish soft mass located at the ventral aspect of the right fifth lumbar to upper sacral roots, and the mass was removed. The biopsy specimen disclosed chloroma with leukemic infiltration of the meninges.
Somatosensory evoked potential (SEP) responses in patients with spinal diseases are checked and analysed. Data from 20 normal subjects are given for comparision with the abnormal SEP responses obtained from 13 patients with spinal diseases showed low amplitude and delayed latency in early and late components compared as normal one. So we were able to predict the degree of spinal cord injury with SEP responses. The SEP pattern was changed to normal one according to recovery of cord injury. Some cases revealed normal wave pattern in spite of neurologically paralytic signs. It has suggested that SEP has been responsed abnormal interruption of the sensory pathway of the central nervous system. However, in spite of the lesion of the motor pathway of the central nervous system the SEP is normal. According to above results, we have found the SEP is most useful method to evaluate of sensory pathway of the central nervous system.
During recent 3 years, 10 patients with epidural cord compression from a lesion in the anterior portion of the thoracic or upper lumbar area have been treated surgically by an anterolateral approach combined with modified posterolateral approach for decompression. Of 10 patient-two cases of OPLL (ossification of posterior longitudinal ligament) with herniated disc, two cases of metastatic tumor, one case of neurilemmoma, one case of pyogenic osteomyelitis of the vertebral body, two cases of herniated disc, one case of traumatic fracture-dislocation, and one case of congenital hemivertebra-5 patients with mild paraparesis improved postoperatively and returned to normal neurologically, 4 patients with moderate gait disturbance were ambulatory without any device, and one completely paraplegic patient was able to walk with device at 1 year after the operation. This approach could be used for removal of disc material, transverse process, lamina, or pedicle through one stage operation. This point is an advantage of this method compared to postero-lateral approach, lateral approach, or anterolateral approach. Anterior decompression by a modified anterolateral approach should be considered for management of spinal cord compressions such as tumor, infective lesion, traumatic lesion, or congenital malformation.
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