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Utility of intraoperative ultrasound for tumors of the cauda equina - Point of view [Editorial]

Raynor, RB
ISI:000180859300016
ISSN: 0362-2436
CID: 34093

Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy? Point of view

Raynor, RB
ISI:000079029900009
ISSN: 0362-2436
CID: 1358662

Postoperative gas bubble foot drop. A case report [Case Report]

Raynor RB; Saint-Louis L
STUDY DESIGN: An unusual case of foot drop occurring 10 days after disc surgery is reported. Imaging studies identified a gas bubble compressing the nerve root. OBJECTIVE: To describe the origin and management of a radiculopathy caused by an intraspinal gas bubble. SUMMARY OF BACKGROUND DATA: A recurrent lumbar disc herniation was diagnosed by clinical and imaging studies. A vacuum disc also was noted at the same level. These are common and not considered to be of pathologic significance. METHODS: The patient underwent a microdiscectomy for a lumbar disc extrusion. The postoperative course was excellent, with relief of symptoms and no neurologic deficit. Ten days later, the awoke with a foot drop and pain in the leg. Imaging studies showed a 4-mm gas bubble compressing the nerve root. Oral steroids were given for 10 days. RESULTS: Progressive improvement occurred, and the patient was asymptomatic 6 weeks later. Although in some instances it may be necessary to evacuate intraspinal gas, an initial period of observation is warranted, because the gas and its resulting symptoms may disappear spontaneously. CONCLUSION: Intradiscal gas accumulation, better known as vacuum disc, is considered to be a benign indication of degenerative disc disease. On occasion it can be a cause of symptoms. A case is reported in which gas leaked after surgery into the spinal canal, causing a foot drop. The symptoms and gas disappeared spontaneously without further treatment
PMID: 10025027
ISSN: 0362-2436
CID: 7432

Intraoperative ultrasound for immediate evaluation of anterior cervical decompression and discectomy

Raynor RB
STUDY DESIGN: An evaluation of whether the immediate operative results can be improved in anterior cervical surgery in patients in whom disc fragments could remain hidden behind a vertebral body or far laterally in the foramen or in canal stenosis that involved a significant amount of a vertebral body. OBJECTIVES: To determine whether intraoperative ultrasonography can provide immediate evaluation of the decompression. SUMMARY OF BACKGROUND DATA: The anterior cervical approach has anatomic limitations that prevent good visualization of deep structures. Sequestered disc fragments can be hidden behind the bone of the vertebral body. Even careful preoperative measurements cannot ensure adequate length and width of decompression for stenotic lesions. METHODS: Three groups of patients were studied. Group 1 contained seven patients with soft disc herniations that were either behind the vertebral body or extended laterally into the neural foramen. Group 2 consisted of five patients with canal stenosis involving at least one third of the length of a vertebral body and causing myelopathic signs and symptoms. Group 3 consisted of four patients with radicular and cord symptoms. All were studied with either magnetic resonance imaging or computed tomography myelography or both. The size of the desired decompression was measured from these studies. A standard anterior decompression using magnification was performed that satisfied the surgeon's visual and tactile evaluation. The operative site was imaged ultrasonically and the decompression extended until preset imaging criteria were met. These criteria were clear root visualization for radiculopathy and good dural pulsations for stenotic lesions. RESULTS: Twelve of the 16 patients did not meet the set criteria on initial imaging, and 11 had their decompression extended. A hidden lateral disc fragment was found in one. In this selected group of 16 patients with complicated cervical pathology, 14 improved neurologically after the use of ultrasonic guidance intraoperatively. One error of interpretation was made. One patient who did not meet the ultrasonic decompression criteria and did not have the decompression extended did not improve after surgery. CONCLUSIONS: In complicated anterior cervical decompressions, intraoperative ultrasonic imaging provides immediate evaluation of the extent of the decompressive procedure and may improve the operative result
PMID: 9055365
ISSN: 0362-2436
CID: 12380

Newly diagnosed rheumatoid with lower cranial nerve abnormalities - Discussion [Editorial]

Menezes, AH; Sonntag, VKH; Maiman, DJ; Bolesta, MJ; Gamache, FW; Pierce, DS; Raynor, RB; Saunders, RL
ISI:A1997WH72000012
ISSN: 0895-0385
CID: 1358692

BIOMECHANICAL ALTERATIONS INDUCED BY MULTILEVEL CERVICAL LAMINECTOMY - POINT-OF-VIEW [Note]

RAYNOR, RB
ISI:A1995TE79500005
ISSN: 0362-2436
CID: 52671

NEUROGENIC BLADDER AND NERVE ROOT CYSTS [Discussion]

RAYNOR, RB
ISI:A1995QD53000016
ISSN: 0895-0385
CID: 1358682

Cervical spine strength after facet injury and spine plate application

Raynor, R B; Carter, F W
Although metallic plates are used for cervical spine stabilization, few biomechanical studies have been done to evaluate their efficiency. A previous study indicated that one half of the facet joint may be destroyed before compromise in strength occurs. Isolated motion segments in which one half of the facet joint was resected bilaterally were used. A two-hole Roy-Camille plate was attached bilaterally with 3.5-mm-diameter, 16-mm-long screws and the construct loaded in shear. Failure occurred at 415.6 N by fracture through the screw holes of the damaged joint, compared to a failure load of 699.6 N in specimens without screws and plates but in which 75% of the joint had been destroyed. Results were significant at the 95% confidence level. A second group of specimens using C2-3-4 and C5-6-7 was tested after 50% facet resection and application of a three-segment plate. Failure again occurred by fracture through the screw hole at the damaged joint. We conclude that, if significant facet destruction is present, screw holes for plate application further weakens the bone. The desired biomechanical stability may not be present.
PMID: 1801272
ISSN: 0362-2436
CID: 1358502

Alterations in primary and coupled neck motions after facetectomy

Raynor RB; Moskovich R; Zidel P; Pugh J
Normal neck motion is a complicated phenomenon. A primary motion results from an applied force or torque. Secondary coupled motions also result as a consequence of the primary motion. These resulting coupled motions were measured in isolated cervical motion segments using three-dimensional videophotogrammetry with a coordinate system fixed in space. A cross coupling algorithm provided error correction and conversion from local to true cartesian coordinates. The data were analyzed by computer, and the true coupled motions resulting from any applied force were obtained. A second group of specimens was facetectomized, and the experiments were repeated. After facetectomy, a moment about the anteroposterior axis resulted in marked reduction in lateral displacement, decrease in vertical displacement, and decrease in rotation about the vertical axis. Results were significant at P less than 0.01 and represent a significant decrease in coupled motions resulting from lateral bending. At P less than 0.05, a laterally applied force causes less lateral displacement and lateral flexion, but more longitudinal displacement. Flexion and extension movements are not significantly altered after facetectomy
PMID: 3696402
ISSN: 0148-396x
CID: 11321

Charcot's spine with neurological deficit: computed tomography as an aid to treatment [Case Report]

Raynor, R B
A patient with Charcot's disease of the lumbar spine presented with weakness of one extremity. Myelographic and x-ray film studies indicated stenosis and compression due to degenerative changes. Although decompression and fusion were considered, computed tomographic scans indicated the wide extent and location of the destructive changes. Nonoperative treatment was elected because of the high risk of fusion failure and instability.
PMID: 3748330
ISSN: 0148-396x
CID: 1358512