Diagnosis and clinical manifestations of subacute combined degeneration of the spinal cord: Analysis of 21 cases

BACKGROUND： Subacute combined degeneration of the spinal cord is caused by vitamin B12 deficiency and is a kind of degenerative disease owing the characteristics of nervous system diseases. In addition, different patients have variously clinical manifestations and various prognoses after vitamin B12 therapy. OBJECTIVE： To investigate and analyze diagnosis, clinical manifestations and prognosis of subacute combined degeneration of the spinal cord. DESIGN： Case analysis. SETTING： Department of Neurology, the Third Hospital of Peking University. PARTICIPANTS： A total of 21 subacute combined degeneration of the spinal cord patients including 14 males and 7 females aged from 33 to 82 years were selected from Department of Neurology, the Third Hospital of Peking University from January 1999 to December 2005. Duration from onset to final diagnosis lasted for 1.5 - 108 months. All patients had typically clinical manifestations; meanwhile, level of serum vitamin B12 was decreased and/or vitamin B12 therapy was effective. All patients provided the confirmed consent. METHODS： Clinical data of 21 subacute combined degeneration of the spinal cord patients were retrospectively analyzed, while general data and clinical characteristics were recorded at the same time. Levels of blood routine, serum vitamin B12 and homocysteine were measured at the phase of hospitalization. Normal value of serum vitamin B12 was 187 - 1 059 ng/L and normal value of serum homocysteine was 5 - 15μ mol/L. All patients received neuroelectrophysiological examination and 15 patients received MRI examinations of spinal cord. After final diagnosis, patients were given vitamin B12 therapy. And follow-up was performed to investigate the prognosis. MAIN OUTCOME MEASURES： （1） Levels of blood routine, serum vitamin B12 and homocysteine; （2） results of neuroelectrophysiological examination; （3） results of MRI examination of spinal cord; （4） prognosis. RESULTS： Clinical data of 21 patients and follow-up data of 20 patients were involved in the final analysis and 1 patient was lost because of living in the other province. （1） Clinical manifestations： All 21 patients had typically clinical manifestations. The original symptoms included numbness of lower and/or upper limbs （5 cases）, unstable gait （3 cases）, limb asthenia （4 cases）, limb numbness combined with light asthenia （5 cases）, limb numbness combined with unskillful activity （3 cases）, and limb numbness combined with unstable gait （1 case）. （2） Experimental results： Eight subacute combined degeneration of the spinal cord patients accompanied with mild-severe anemia and mean corpuscular volume of 13 patients were increased. Among 13 subacute combined degeneration of the spinal cord patients not administrating vitamin B12 before hospitalization, the levels of serum vitamin B12 of 2 patients were not measured but those of other patients were decreased. After vitamin B12 therapy,the levels of serum vitamin B12 of 8 patients were normal or increased. In addition, the levels of serum homocysteine of 6 patients were not measured but those of 7 patients were increased. While, the levels of homocysteine of 5 following-up patients were normal. The levels of serum vitamin B12 of 8 patients who received with vitamin B12 therapy before hospitalization were normal or increased. Among them,the levels of bomocysteine were not measured in 4 patients, those of 3 patients were increased, and that of 1 patient was normal. （3） Results of neuroelectrophysiological examination： Among all patients, 95% （20/21） patients had abnormal sensory-evoked potential, 89% （8/9） patients had abnormal motor evoked potential, 67% （10/15） patients had abnormal nerve conduction, 13% （2/15） patients had neurogenic muscle injury showed by electromyography （EMG）, 70% （7/10） patients had abnormal brain-stem auditory evoked potential, and 40% （4/10） patients had abnormal visual evoked potential. （4） Results of MRI examination of spinal cord： MRI examination demonstrated that 40% （6/15） patients had spinal cord lesion, but spinal cord lesion disappeared in 2 patients during follow up. In addition, clinical manifestations of patients were improved after standard vitamin B I2 therapy. CONCLUSION： Nervous system lesion caused by vitamin B 12 deficiency is not only involved in spinal cord, also in peripheral nerve, optic nerve, auditory pathway, etc. Diagnosis of the lesion depends on clinical characteristics and level of serum vitamin BI2. Especially, neuroelectrophysiological examination, measurement of homocysteine and MRI examination of spinal cord are beneficial for diagnosis and evaluation of therapeutic effects.

Strategies to avoid a missed diagnosis of co-occurring concussion in post-acute patients having a spinal cord injury

Research scientists and clinicians should be aware that missed diagnoses of mild-moderate traumatic brain injuries in post-acute patients having spinal cord injuries may approach 60-74% with certain risk factors, potentially causing clinical consequences for patients, and confounding the results of clinical research studies. Factors leading to a missed diagnosis may include acute trauma-related life-threatening issues, sedation/intubation, subtle neuropathology on neuroimaging, failure to collect Glasgow Coma Scale scores or duration of posttraumatic amnesia, or lack of validity of this information, and overlap in neuro-cognitive symptoms with emotional responses to spinal cord injuries. Strategies for avoiding a missed diagnosis of mild-moderate traumatic brain injuries in patients having a spinal cord injuries are highlighted in this perspective.

Application value of biofluid-based biomarkers for the diagnosis and treatment of spinal cord injury

Recent studies in patients with spinal cord injuries(SCIs)have confirmed the diagnostic potential of biofluid-based biomarkers,as a topic of increasing interest in relation to SCI diagnosis and treatment.This paper reviews the research progress and application prospects of recently identified SCI-related biomarkers.Many structural proteins,such as glial fibrillary acidic protein,S100-β,ubiquitin carboxy-terminal hydrolase-L1,neurofilament light,and tau protein were correlated with the diagnosis,American Spinal Injury Association Impairment Scale,and prognosis of SCI to different degrees.Inflammatory factors,including interleukin-6,interleukin-8,and tumor necrosis factorα,are also good biomarkers for the diagnosis of acute and chronic SCI,while non-coding RNAs(micro RNAs and long non-coding RNAs)also show diagnostic potential for SCI.Trace elements(Mg,Se,Cu,Zn)have been shown to be related to motor recovery and can predict motor function after SCI,while humoral markers can reflect the pathophysiological changes after SCI.These factors have the advantages of low cost,convenient sampling,and ease of dynamic tracking,but are also associated with disadvantages,including diverse influencing factors and complex level changes.Although various proteins have been verified as potential biomarkers for SCI,more convincing evidence from large clinical and prospective studies is thus required to identify the most valuable diagnostic and prognostic biomarkers for SCI.

Metastatic Spinal Tumors: Diagnostic Methods, Management and Prognosis at the Yaounde Central Hospital and Yaounde General Hospital

Introduction: Metastatic spinal tumors (MST) refer to secondary involvement of the vertebral column by hematogenously-disseminated metastatic cells. They could affect either the bony structures or the spinal cords. Mechanical instability and neurologic deficits resulting from spinal cord compression are the most common manifestations. Surgical intervention remains the most effective treatment for about 20% of patients who present with spinal cord compression. The prognosis is relatively poor. This work has as objectives to describe: the diagnostic tools, the different modalities of management and the prognostic elements of spine metastasis. Methodology: We conducted an ambispective cross-sectional descriptive study;with retrospective data collection from January 2015 to December 2021 and prospective collection from January to April 2022 in the “Neurosurgery” unit of the Yaounde Central Hospital and the “Oncology and Neurosurgery” units of Yaounde General Hospital. Result: We included 101 patients. The M/F sex ratio was 1.66. The average age of the participants was 56.44 years (±14.19 SD) with a median of 58 years. Metastatic spinal tumors were discovered in 61.39% of patients with a previously known primary tumor and 21.78% of patients had newly discovered tumors. The neurologic examination revealed a vertebral syndrome in 79.21% of cases, radicular syndrome in 60.40% and sub-lesional syndrome in 59.89%. Sensory disorders accounted for 39.60% and sphincter disorders accounted for 34.65%. According to the degree of severity, the lesions were classified as Frankel E (37.62%) followed by Frankel D (21.78%). Metastatic lesions were mostly found at the thoracic vertebrae (68.25%) and lumbar vertebrae (22.22%). The most represented primary tumors were: prostate tumors (41.58%) and breast tumors (23.76%);followed by malignant hemopathies (15.84%). Computed-tomography scan (CT-scan) was the most frequent diagnostic imaging technique used (71.28%). Analgesic treatment mostly involved level II analgesia (64.36%). High dose steroid therapy (greater than 80mg/24h) was used in more than half of the patients. Radiation therapy was performed in 24.75% of the patients, chemotherapy in 55.44% and specific surgical interventions performed in 20.79%. The most frequent surgical indication was complete motor deficit according to the Frankel classification (47.21%). One patient in four (23.76%) experienced improvement in functional prognosis with increased muscle strength after a period of 2 weeks to 5 months of treatment. About 1 in 10 patients (8.8%) rather had worsening of their neurologic status. We observed that there was a correlation between spine surgery and improvement in muscle strength (P-value less than 0.05). Patients (12) who had better recovery or preserved gait were those with partial compression (P-value = 0.0143). Four out of five patients (81.18%) of our series had an estimated survival of less than one year according to the Tokuhashi score. Conclusion: MSTs are frequent in our context. Most patients sought consultation late after the first symptoms appeared (principally back pain). The clinical examination revealed a high proportion of patients with spinal cord compression syndrome. Medical treatment was first-line for the management of pain and most patients who underwent surgical treatment had complete neurologic deficits. The functional prognosis was found to be improved by surgery and the vital prognosis depended on the Tokuhashi score, with better accuracy when the prediction is more than 12 months.

An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China

This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview （one item）; pre-hospital care （one item）; evaluation and diagnosis （13 items）; treatment （23 items）; prevention and treatment of major com- plications （12 items）; and rehabilitation （four items）. This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with ＂1＂ cor- respondJng to neutrality and ＂5＂ representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.

Imaging and clinical properties of inflammatory demyelinating pseudotumor in the spinal cord

Inflammatory demyelinating pseudotumor usually occurs in the brain and rarely occurs in the spinal cord. On imaging, inflammatory demyelinating pseudotumor appears very similar to intramedullary tumors such as gliomas. It is often misdiagnosed as intramedullary tumor and surgically resected. In view of this, the clinical and magnetic resonance imaging manifestations and the pathological fea- tures of 36 cases of inflammatory demyelinating pseudotumer in the spinal cord were retrospec- tively analyzed and summarized. Most of these cases suffered from acute or subacute onset and exhibited a sensofimotor disorder. Among them, six cases were misdiagnosed as having intrame- dullary gliomas, and inflammatory demyelinating pseudotumor was only identified and pathologically confirmed after surgical resection. Lesions in the cervical and thoracic spinal cord were common. Magnetic resonance imaging revealed edema and space-occupying lesions to varying degrees at the cervical-thoracic junction, with a predominant feature of non-closed rosette-like reinforcement （open-loop sign）. Pathological examination showed perivascular cuffing of predominantly dense lymphocytes, and demyelination was observed in six of the misdiagnosed cases. These re- sults suggest that tumor-like inflammatory demyelinating disease in the spinal cord is a kind of special demyelinating disease that can be categorized as inflammatory pseudotumor. These solitary lesions are easily confused with intramedullary neoplasms. Patchy or non-closed reinforcement （open-ring sign） on magnetic resonance imaging is the predominant property of inflammatory de- myelinating pseudotumor, and inflammatory cell infiltration and demyelination are additional patho- logical properties.

Intramedullary spinal cord metastasis from pancreatic neuroendocrine tumor

Intramedullary spinal cord metastasis(ISCM) is very rare and its optimal treatment remains controversial. Pancreatic neuroendocrine tumor(pNET) is a rare tumor that usually presents with hepatic metastasis. Hepatic failure due to tumor progression is the major cause of death in cases of pNET. To date,no report has described a case of ISCM from pNET. Although spinal cord metastasis of a solid tumor is uncommon,it is a critical condition that can cause a potentially irreversible loss of neurologic function. Here,we report the case of a 45-year-old man who presented with leg weakness and voiding difficulty,and was found to have ISCM from pNET. Surgical treatment prevented further neurological deterioration. This is the first case report of ISCM from pNET.

同型半胱氨酸在诊断脊髓亚急性联合变性中的预测价值

目的研究同型半胱氨酸(homocysteine,Hcy)在诊断脊髓亚急性联合变性(subacute combined degeneration of spinal cord,SCD)中的预测价值。方法采用回顾性分析研究,选取2014年11月至2023年6月在柳州市人民医院神经内科住院的SCD患者74例及同期住院非SCD患者71例为对照组,收集两组的血清Hcy水平。采用SPSS 26.0统计学软件进行相关数据统计分析。采用接收者操作特征评价曲线评价血Hcy对SCD的预测价值。结果SCD患者Hcy水平[53.35(13.40~106.83)μmol/L]明显高于对照组[13.20(10.00~14.90)μmol/L],两组间差异具有统计学意义(P<0.001)。采用接收者操作特征评价曲线血浆Hcy浓度对SCD的预测价值,曲线下面积AUC为0.805(95%CI:0.728~0.882)。结论SCD患者Hcy均较对照组显著升高,在预测SCD发病风险方面有潜在应用价值。

短程高颈段脊髓电刺激术治疗脑损伤意识障碍患者10例

目的:分析短程高颈段脊髓电刺激术治疗脑损伤重度意识障碍患者的技术要点及该术式的临床诊疗价值。方法:回顾性总结南京医科大学第一附属医院神经外科于2023年6—9月开展的10例短程高颈段脊髓电刺激手术,解析手术过程技术要点,并结合随访分析其临床应用价值。结果:全麻下取俯卧位在胸8椎间隙经皮行硬脊膜外腔穿刺,在X线透视下动态调整脊髓刺激电极可顺利将其顶端置入颈2水平,进行为期2~3周的刺激治疗。刺激参数选择:频率5/70 Hz电压1~5 V;刺激小周期:开15 min,关15 min;刺激大周期:8点开机,20点关机。在术后4周进行随访,8例术前植物状态(vegetative state,VS)患者中1例到达微小意识状态(minimally conscious state,MCS)+,5例MCS-,2例仍为VS状态;2例术前MCS-患者中1例脱离微小意识,1例MCS+,均无手术相关并发症出现。结论:短程高颈段脊髓电刺激术微创、安全并且有效,有短程的治疗价值和诊断价值,在意识障碍促醒诊疗中有着广泛的应用前景,手术过程需要注意穿刺置入电极特有的难点和技术操作要领。

脊髓损伤后神经源性膀胱的康复进展

脊髓损伤(Spinal Cord Injury,SCI)中,神经源性膀胱(Neurogenic Bladder,NB)是一种常见的并发症。这种疾病通常会导致患者出现尿液滞留、尿失禁、输尿管扩张、肾积水等症状,进一步引发肾功能衰退,给患者的生命健康构成威胁。随着近代医学的发展,NB的治疗方法以及管理水平日趋完善。本文通过整理近年治疗SCI后NB的相关文献,对临床诊疗以及康复现状进行综述,期望能为相关研究的开展提供思路,以及为提高临床管理水平提供理论依据。

Imaging diagnosis of cervical spine and spinal cord injuries in children

Objective: To provide the experience in imaging diagnosis of cervical spine and spinal cord injuries in children. Methods: Imaging data of cervical spine and spinal cord injuries in 62 children were retrospectively reviewed. The routine radiography including the lateral, anteroposterior and open-mouth odontoid views were performed in all the patients. Tomography was available for 25 patients, and flexion-extension lateral views for 28 patients, CT scanning for 21 patients, MRI for 26 patients. Results: Of these patients, 46 patients were identified with injuries of upper cervical spine (9 with atlantal arch fracture, seven with axial fracture, 21 with odontoid fracture, 1 with atlantal arch fracture combining with odontoid fracture, and 1 with atlantal transverse ligament disruption); 7 patients sustained injuries of lower cervical spine (3 fractures of vertebral body, 2 dislocations and 6 fracture-dislocations); 2 patients had multiple noncontiguous cervical injuries; and 3 had cervical spinal cord injury without radiographic abnormalities (SCIWORA). Conclusions: Imaging assessment is of great importance in the diagnosis of cervical spine and spinal cord injuries in children. Whenever cervical spine and spinal cord injuries are suspected for children patients, and the three-views should be routinely indicated. MRI should be routinely performed in all children with cervical SCIWORA.

中医手诊及其在脊髓病变中的应用

手部掌色、纹理、光泽度等变化是身体健康状况及疾病转归的外在体现。通过系统归纳与总结中医手诊源流、内容及理论方法,论述中医手诊在脊髓病变临床诊断中的指导作用。根据中医手诊辨证方法以及分区理论,拇指桡侧和大鱼际赤白肉际处代表人体脊柱区,与颈椎、胸椎、腰椎、骶骨、尾骨、盆腔以及腿部、膝部依次对应;结合此区的岛纹、菱形纹等病理纹可将手诊作为脊髓病变的辅助诊断手段。

Guidelines for management of pediatric acute hyperextension spinal cord injury

Pediatric acute hyperextension spinal cord injury(SCI)named as PAHSCI by us,is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training,which has been increasingly reported.At present,it has become the leading cause of SCI in children,and brings a heavy social and economic burden.Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards,specifications or guidelines.In order to provide standardized guidance,the expert team formulated this guideline based on the principles of science and practicability,starting from the diagnosis,differential diagnosis,etiology,admission evaluation,treatment,complications and prevention.This guideline puts forward 23 recommendations for 14 related issues.

原发性颈胸髓内生殖细胞瘤1例

患者女,47岁,颈后及背部疼痛伴四肢麻木、无力1月余;既往体健。查体:颈椎及上段胸椎压痛、叩击痛阳性,四肢皮肤感觉减退,病理征未引出。颈胸椎CT/MRI:C7、T2椎体水平椎管内分别见10 mm×16 mm×20 mm、9 mm×11 mm×13 mm稍高欠均匀密度团块影,不规则欠均匀T1等信号(图1A),T2等或稍高信号(图1B),病变段脊髓增粗,其上下段脊髓水肿呈片状稍低T1、高T2信号。

颈段椎管肿瘤患者围术期加速康复护理方案的应用效果

目的 探讨对颈段椎管肿瘤患者围术期应用加速康复(ERAS)护理方案的效果。方法 本研究为前瞻性研究。根据研究纳入和排除标准,纳入2020年8月—2022年12月在本院行手术治疗的颈段椎管肿瘤患者80例,采用随机数字表法分为干预组和对照组,每组40例。干预组采用本研究自制的《脊髓肿瘤ERAS管理手册》护理方案,对照组采用常规护理模式护理,比较两组患者一般资料(术后首次下床时间、住院时间、住院费用)、疼痛评分、焦虑评分、生活质量评分、日常生活活动能力评分、日本颈椎功能学会评分、徒手肌力评分及术后并发症的发生率。计量资料符合正态分布的使用独立样本t检验、不符合正态分布的采用Mann-Whitney U检验;计数资料以例(%)表示,行χ^(2)或Fisher精确检验。结果 干预组术后首次下床时间、住院时间较对照组均明显缩短;出院前1 d,干预组患者生活质量评分、日常生活活动能力评分均高于对照组,焦虑评分、疼痛评分均低于对照组;术后电解质紊乱、血栓形成相关指标升高、发热、便秘的发生率均显著低于对照组,日本颈椎功能学会评分较对照组改善,以上指标两组差异均有统计学意义(P均<0.05)。两组住院费用、徒手肌力评分、疼痛发生率差异均无统计学意义(P均>0.05)。结论 颈段椎管肿瘤患者ERAS康复护理方案的应用,可有效缩短手术至首次下床时间、减少术后并发症发生率、缓解患者焦虑、提高患者日常生活能力。ERAS用于颈段椎管肿瘤患者的临床护理具有实用性和可行性。

小切口半椎板入路切除椎管内肿瘤

目的探讨小切口半椎板入路显微手术切除椎管内肿瘤之优缺点。方法回顾分析2008年8月-2013年4月采用小切口半椎板入路手术切除椎管内肿瘤患者的临床资料。结果共19例患者,肿瘤均全切除,病理分型分别为神经鞘瘤(12例)、神经纤维瘤(1例)、脊膜瘤(5例)和血管母细胞瘤(1例)。术后患者症状与体征明显改善,随访6~60个月无一例肿瘤复发或出现脊柱失稳并发症。术中测量获得半椎板切除可显露胸腰椎骨窗面积为(15±2)mm×(32±5)mm。结论采取小切口半椎板入路显微手术切除椎管内肿瘤,创伤小、有利于维持脊柱稳定性,而且患者术后住院时间短、反应轻微、远期疗效良好,但对手术技术要求较高。

脊髓髓内转移性肿瘤的MRI诊断及鉴别诊断

目的分析脊髓髓内转移性肿瘤(ISCM)MRI表现及其同髓内常见肿瘤的鉴别要点,提高对脊髓内肿瘤的认识和诊断水平。方法回顾性分析11例临床及病理证实的ISCM病例的临床与MRI资料,所有病例均行MRI平扫及增强检查。结果4例经手术病理证实,7例经临床确诊[平均发病年龄(46.4±2.8)岁],6例为多发病灶:颈、胸髓、圆锥、马尾均可多节段发生;5例为单发病灶:3例位于圆锥,1例位于颈髓,1例位于颈髓、延髓交界部。MR平扫T1WI多表现为等、低信号,T2WI多表现为不均匀高信号,增强后病灶均明显强化,可表现为斑片状、环形、斑点状及结节状强化,伴随征象包括脊髓增粗、周围水肿、脊髓空洞等。结论MRI能较好地显示ISCM的内部结构及信号特点、明确肿瘤的范围及进展情况,有助于本病的诊断及鉴别诊断,但缺乏明确特征表现,确诊需结合临床资料综合分析。

椎管内肿瘤的临床与MRI表现特点分析

为了探讨椎管内肿瘤的临床诊断与外科治疗,回顾性分析1990-01~2007-06收治的56例不同部位的椎管内肿瘤患者的临床表现和诊断及手术治疗。结果:术前56例患者进行X线、脊髓造影、CTM和MRI明确诊断,术后1~15年(平均4.5年)随访中47例患者感觉及运动功能恢复或基本恢复正常,优良率83.9%。初步研究结果提示,椎管内肿瘤患者的临床表现早期不典型性,术前主要依赖CT、MRI确诊肿瘤的部位及其大小范围,对肿瘤诊断和鉴别诊断具有重要价值。椎管内肿瘤一经确诊,应尽早手术。

支气管动脉化疗栓塞术导致脊髓损伤的原因与对策

目的探讨肺部病变支气管动脉介入治疗致脊髓损伤的因素及对策。方法常规组采用支气管动脉灌注化疗或加栓塞术治疗肺癌,采用支气管动脉明胶海绵颗粒栓塞术治疗大咯血;试验组术前加行利多卡因脊髓功能诱发试验。结果常规组583例中,肺癌373例,发生脊髓损伤11例;大咯血210例(其中支气管扩张150例、肺结核44例、肺血管畸形12例和肺隔离症4例),未发生脊髓损伤,两者相比差异显著(P<0.05)。试验组403例(肺癌318例和大咯血85例)中,脊髓功能诱发试验阳性58例,经微导管超选择治疗无一例发生脊髓损伤。结论支气管动脉介入治疗中,肺癌较易并发脊髓损伤,可能主要与高浓度的毒性药物损伤有关,而颗粒性栓塞影响较小。术前应用利多卡因脊髓功能诱发试验判断支气管动脉是否与脊髓根动脉共干,能有效避免脊髓动脉损伤。

脊柱手术后迟发脊髓损伤的早期诊断和治疗

目的:探讨颈胸椎管狭窄症患者手术后出现迟发性脊髓损伤的原因,提出脊髓手术后缺血再灌注损伤的临床诊断参考依据、预处理和早期治疗方法。方法:回顾性分析我科近5年内收治的523例颈椎和胸椎管狭窄症患者中手术后2￣3h出现脊髓损伤患者的临床资料及处理方法,并对其预后进行客观评估。结果:5年中,在所有收治并手术的颈胸椎管狭窄症患者中,15例患者于手术后2￣3h出现不同程度的脊髓损伤,主要表现为在手术后3h之内出现严重的进行性脊髓功能丧失,经即刻给予大剂量甲基强的松龙(MP)冲击、脱水药及神经营养药,3例患者症状改善不理想,4例患者症状部分改善,生活可完全自理,8例患者基本恢复正常。结论:颈胸椎管狭窄症患者手术后2￣3h出现的脊髓损伤可能是脊髓缺血再灌注损伤引起,再灌注损伤在临床上虽然少见,诊断有一定的困难,但损害是灾难性,妥善的处理可望改善患者的生存质量。