目的探讨Intraspine椎板间动态稳定系统治疗腰椎间盘突出症(lumbar disc herniation,LDH)的疗效。方法本研究对象为2016年4月~2018年4月本院收治的80例LDH患者,男48例,女32例;年龄(51.67±4.89)岁,L_(3~4)10例,L_(4~5)48例,L_(5)~S_...目的探讨Intraspine椎板间动态稳定系统治疗腰椎间盘突出症(lumbar disc herniation,LDH)的疗效。方法本研究对象为2016年4月~2018年4月本院收治的80例LDH患者,男48例,女32例;年龄(51.67±4.89)岁,L_(3~4)10例,L_(4~5)48例,L_(5)~S_(1)22例,均采用髓核摘除联合Intraspine治疗,随访(34.12±6.35)个月。结果80例患者均完成手术,手术出血量(41.82±8.71)mL,手术时间(58.71±9.29)min,住院时间(4.88±0.68)d;术中无硬脊膜、神经损伤,随访期无残留腰腿痛;2例患者复发。术后3个月、末次随访时,患者的患病椎间隙高度(intervertebral space height,ISH)和节段活动度(range of motion,ROM)均较术前显著升高,腰、腿痛VAS评分和ODI指数较术前显著降低(P<0.05);患者末次随访时的ISH、ROM与术后3个月相比较,差异无统计学意义(P>0.05)。结论Intraspine治疗LDH操作简便,出血量少,并发症发生率低,近期疗效确切,能够提升并维持椎间隙高度,降低术后LDH复发率。展开更多
BACKGROUND Primary intraspinal malignant melanoma is a very rare tumor that most often occurs in the cervical,thoracic,or thoracolumbar segment.CASE SUMMARY A rare case of primary thoracolumbar malignant melanoma is d...BACKGROUND Primary intraspinal malignant melanoma is a very rare tumor that most often occurs in the cervical,thoracic,or thoracolumbar segment.CASE SUMMARY A rare case of primary thoracolumbar malignant melanoma is described.A 45-year-old female patient complained of low back pain with numbness and fatigue in both lower limbs.MR revealed an intradural space-occupying lesion at the thoracic 12 to lumbar 1 level.The tumor was partially excised,and a malignant melanoma was confirmed by histopathology.CONCLUSION Primary intraspinal malignant melanoma has rarely been reported,and surgical resection and related characteristics and diagnoses have been discussed.展开更多
Pneumorrhachis(PR)is defined as presence of free air in the spinal canal.Trau-matic PR is very rare,and its exact incidence and pathogenesis is unknown.A comprehensive literature search was performed using the PubMed,...Pneumorrhachis(PR)is defined as presence of free air in the spinal canal.Trau-matic PR is very rare,and its exact incidence and pathogenesis is unknown.A comprehensive literature search was performed using the PubMed,Cochrane Library,Google Scholar and Scopus databases to identify articles relevant to traumatic PR published till January 2023.A total of 34 resources were selected for inclusion in this narrative review.Traumatic PR can be classified anatomically into epidural and intradural types.In the epidural type,air is present peripherally in the spinal canal and the patients are usually asymptomatic.In contrast,in intradural PR,air is seen centrally in the spinal canal and patients present with neurological symptoms,and it is a marker of severe trauma.It is frequently associated with traumatic pneumocephalus,skull fractures or thoracic spine fracture.Computed tomography(CT)is considered to be the diagnostic modality of choice.Epidural PR is self-limited and patients are generally managed conser-vatively.Patients with neurological symptoms or persistent air in spinal canal require further evaluation for a potential source of air leak,with a need for surgical intervention.Differentiation between epidural and intradural PR is important,because the latter is an indication of severe underlying injury.CT imaging of the entire spine must be performed to look for extension of air,as well as to identify concomitant skull,torso or spinal injuries Most patients are asymp-tomatic and are managed conservatively,but a few may develop neurological symptoms that need further evaluation and management.展开更多
Current management for spinal cord injury aims to reduce secondary damage and recover sensation and movement.Acute spinal cord injury is often accompanied by spinal cord compartment syndrome.Decompression by durotomy ...Current management for spinal cord injury aims to reduce secondary damage and recover sensation and movement.Acute spinal cord injury is often accompanied by spinal cord compartment syndrome.Decompression by durotomy and/or myelotomy attempts to relieve secondary damage by completelyrelieving the compression of the spinal cord,removing the necrotic tissue,decreasing edema,reducing hemorrhage,and improving blood circulation in the spinal cord.However,it is controversial whether durotomy and/or myelotomy after spinal cord injury are beneficial to neurological recovery.This review compares the clinical effects of durotomy with those of myelotomy in the treatment of spinal cord injury.We found that durotomy has been performed more than myelotomy in the clinic,and that durotomy may be safer and more effective than myelotomy.Durotomy performed in humans had positive effects on neurological function in 92.3% of studies in this review,while durotomy in animals had positive effects on neurological function in 83.3% of studies.Myelotomy procedures were effective in 80% of animal studies,but only one clinical study of myelotomy has reported positive results,of motor and sensory improvement,in humans.However,a number of new animal studies have reported that durotomy and myelotomy are ineffective for spinal cord injury.More clinical data,in the form of a randomized controlled study,are needed to understand the effectiveness of durotomy and myelotomy.展开更多
The currently recommended management for acute traumatic spinal cord injury aims to reduce the incidence of secondary injury and promote functional recovery.Elevated intraspinal pressure(ISP)likely plays an important ...The currently recommended management for acute traumatic spinal cord injury aims to reduce the incidence of secondary injury and promote functional recovery.Elevated intraspinal pressure(ISP)likely plays an important role in the processes involved in secondary spinal cord injury,and should not be overlooked.However,the factors and detailed time course contributing to elevated ISP and its impact on pathophysiology after traumatic spinal cord injury have not been reviewed in the literature.Here,we review the etiology and progression of elevated ISP,as well as potential therapeutic measures that target elevated ISP.Elevated ISP is a time-dependent process that is mainly caused by hemorrhage,edema,and blood-spinal cord barrier destruction and peaks at 3 days after traumatic spinal cord injury.Duraplasty and hypertonic saline may be promising treatments for reducing ISP within this time window.Other potential treatments such as decompression,spinal cord incision,hemostasis,and methylprednisolone treatment require further validation.展开更多
Typically situated posterolateral in the spinal canal, intraspinal facet cysts often cause radicular symptoms. Rarely, the midline location of these synovial or ganglion cysts may cause thecal sac compression leading ...Typically situated posterolateral in the spinal canal, intraspinal facet cysts often cause radicular symptoms. Rarely, the midline location of these synovial or ganglion cysts may cause thecal sac compression leading to neurogenic claudication or cauda equina syndrome. This article summarizes the clinical presentation, radiographic appearance, and management of three intraspinal, midline facet cysts. Three patients with symptomatic midline intraspinal facet cysts were retrospectively reviewed. Documented clinical visits, operative notes, histopathology reports, and imaging findings were investigated for each patient. One patient presented with neurogenic claudication while two patients developed partial, subacute cauda equina syndrome. All 3 patients initially responded favorably to lumbar decompression and midline cyst resection; however, one patient required surgical stabilization 8 mo later. Following the three case presentations, we performed a thorough literature search in order to identify articles describing intraspinal cystic lesions in lateral or midline locations. Midline intraspinal facet cysts represent an uncommon cause of lumbar stenosis and thecal sac compression. Such entities should enter the differential diagnosis of midline posterior cystic lesions. Midline cysts causing thecal sac compression respond favorably to lumbar surgical decompression and cyst resection. Though laminectomy is a commonly performed operation, stabilization may be required in cases of spondylolisthesis or instability.展开更多
BACKGROUND Spontaneous spinal epidural hematoma is a rare neurosurgical emergency.CASE SUMMARY A 53-year-old healthy woman suffered from complete paraplegia in both legs and loss of all sensation below the xiphoid pro...BACKGROUND Spontaneous spinal epidural hematoma is a rare neurosurgical emergency.CASE SUMMARY A 53-year-old healthy woman suffered from complete paraplegia in both legs and loss of all sensation below the xiphoid process.She was diagnosed as acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma.The primary lab survey showed all within normal limits.Presence of a posteriorly epidural space-occupying lesion at the T4-T8 level of the spinal canal was confirmed on magnetic resonance imaging.A decompressive laminectomy was performed from the T4 to T7 levels at the sixth hour following abrupt onset of complete paraplegia.The lesion was confirmed as lymphangioma.This patient recovered well within one month.CONCLUSION This study reports a case of acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma with well recovery after surgical intervention.展开更多
Seventy-three patients with spinal nerve sheath tumor who were surgically treated in our hospital during the years 2004-2010 were retrospectively reviewed with respect to recovery of neurological function, recurrence ...Seventy-three patients with spinal nerve sheath tumor who were surgically treated in our hospital during the years 2004-2010 were retrospectively reviewed with respect to recovery of neurological function, recurrence of the tumor and occurrence of kyphotic deformities. Preoperative clinical manifestations, imaging data, surgical records and follow-up results were comprehensively analyzed. The follow-up duration was 12-60 months with an average of 32.0 months. Out of the 73 cases enrolled, 69 had gradual recovery of sensation, motor and sphincter functions 1 week to 3 months after operation. Forty-six cases had incomplete paralysis, whose American Spinal Injury Association （ASIA） grades, however, were gradually increased during the follow-up period, 4 cases had no significant improvement of the clinical symptoms and no change in ASIA grades during the follow-up period. Two cases had postoperative recurrence of the tumor. There were no deaths, no spinal instability, and no kyphotic malformations fotmd in any cases. Our study indicated that complete removal of the tumor is important for good recovery, and an ideal surgical method may reduce the recurrence of the tumor or the occurrence of complications.展开更多
Nonspecific neuronal activity elicited by intraspinal microstimulation in the intermediate and ventral gray matter of thoracic spinal segments caudal to a complete spinal cord transection significantly increased the r...Nonspecific neuronal activity elicited by intraspinal microstimulation in the intermediate and ventral gray matter of thoracic spinal segments caudal to a complete spinal cord transection significantly increased the rat hindlimb Basso, Beattie, Bresnahan locomotor score by activating the central pattem generator located in the lumbar spinal cord. However, the best region for intraspinal microstimulation is unclear. Using an incomplete spinal cord injury model at T8, we compared the use of intraspinal microstimulation to activate the spinal cord in rats with a spontaneous recovery group. The intraspinal microstimulation group recovered sooner and showed three kinds of movement： the left hindlimb, the left hindlimb toes, and the paraspinal muscles and tails. These had different microstimulation thresholds. There was mild hyperplasia of the astrocytes surrounding the tips of the microelectrodes and slight inflammatory reactions nearby. These results indicate that implantation of microelectrodes was relatively safe and induced minimal damage to the lumbar-sacral spinal cord. Intraspinal microstimulation in the lumbar sacral spinal cord may improve leg movements after spinal cord injury. Non-specific intraspinal microstimulation may be a novel technique for the recovery of spinal cord injuries.展开更多
BACKGROUND As an extramedullary form of proliferating myeloblasts,granulocytic sarcoma(GS)is common in patients with acute myeloid leukemia.GS in the central nervous system is rare,and an intraspinal space-occupying l...BACKGROUND As an extramedullary form of proliferating myeloblasts,granulocytic sarcoma(GS)is common in patients with acute myeloid leukemia.GS in the central nervous system is rare,and an intraspinal space-occupying lesion caused by GS is even rarer.Surgical decompression is often necessary to remove the intraspinal space-occupying lesion.To the best of our knowledge,we report,for the first time a case of GS that caused extensive compression in the spinal canal without surgical decompression treatment.CASE SUMMARY A 15-year-old male suddenly developed numbness and weakness in his lower limbs for 10 d,which affected his walking ability.Acute myeloid leukemia was later diagnosed in the Department of Hematology.Magnetic resonance imaging revealed that multiple segmental space-occupying lesions were causing severe spinal cord compression in the thoracic spinal canal.As a result,the patient received routine chemotherapy before surgery.Interestingly,the intraspinal space-occupying lesions completely diminished on magnetic resonance imaging after a course of chemotherapy,and the sensation and strength in his lower limbs markedly recovered.CONCLUSION An intraspinal space-occupying lesion could be the first symptom of acute myeloid leukemia,causing spinal nerve compression without any other symptoms.Following standard chemotherapy,spinal canal compression can be quickly relieved,and the spinal cord and nerve function restored,avoiding emergency surgery.展开更多
To the Editor: The incidence of community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection and reports of CA-MRSA infection have been increasing yearly. But community-acquired intraspinal methi...To the Editor: The incidence of community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection and reports of CA-MRSA infection have been increasing yearly. But community-acquired intraspinal methicillin-resistant Staphylococcus aureus (MRSA) infection has never been reported. We describe a case of intraspinal abscess due to CA-MRSA infection.展开更多
文摘目的探讨Intraspine椎板间动态稳定系统治疗腰椎间盘突出症(lumbar disc herniation,LDH)的疗效。方法本研究对象为2016年4月~2018年4月本院收治的80例LDH患者,男48例,女32例;年龄(51.67±4.89)岁,L_(3~4)10例,L_(4~5)48例,L_(5)~S_(1)22例,均采用髓核摘除联合Intraspine治疗,随访(34.12±6.35)个月。结果80例患者均完成手术,手术出血量(41.82±8.71)mL,手术时间(58.71±9.29)min,住院时间(4.88±0.68)d;术中无硬脊膜、神经损伤,随访期无残留腰腿痛;2例患者复发。术后3个月、末次随访时,患者的患病椎间隙高度(intervertebral space height,ISH)和节段活动度(range of motion,ROM)均较术前显著升高,腰、腿痛VAS评分和ODI指数较术前显著降低(P<0.05);患者末次随访时的ISH、ROM与术后3个月相比较,差异无统计学意义(P>0.05)。结论Intraspine治疗LDH操作简便,出血量少,并发症发生率低,近期疗效确切,能够提升并维持椎间隙高度,降低术后LDH复发率。
文摘BACKGROUND Primary intraspinal malignant melanoma is a very rare tumor that most often occurs in the cervical,thoracic,or thoracolumbar segment.CASE SUMMARY A rare case of primary thoracolumbar malignant melanoma is described.A 45-year-old female patient complained of low back pain with numbness and fatigue in both lower limbs.MR revealed an intradural space-occupying lesion at the thoracic 12 to lumbar 1 level.The tumor was partially excised,and a malignant melanoma was confirmed by histopathology.CONCLUSION Primary intraspinal malignant melanoma has rarely been reported,and surgical resection and related characteristics and diagnoses have been discussed.
文摘Pneumorrhachis(PR)is defined as presence of free air in the spinal canal.Trau-matic PR is very rare,and its exact incidence and pathogenesis is unknown.A comprehensive literature search was performed using the PubMed,Cochrane Library,Google Scholar and Scopus databases to identify articles relevant to traumatic PR published till January 2023.A total of 34 resources were selected for inclusion in this narrative review.Traumatic PR can be classified anatomically into epidural and intradural types.In the epidural type,air is present peripherally in the spinal canal and the patients are usually asymptomatic.In contrast,in intradural PR,air is seen centrally in the spinal canal and patients present with neurological symptoms,and it is a marker of severe trauma.It is frequently associated with traumatic pneumocephalus,skull fractures or thoracic spine fracture.Computed tomography(CT)is considered to be the diagnostic modality of choice.Epidural PR is self-limited and patients are generally managed conser-vatively.Patients with neurological symptoms or persistent air in spinal canal require further evaluation for a potential source of air leak,with a need for surgical intervention.Differentiation between epidural and intradural PR is important,because the latter is an indication of severe underlying injury.CT imaging of the entire spine must be performed to look for extension of air,as well as to identify concomitant skull,torso or spinal injuries Most patients are asymp-tomatic and are managed conservatively,but a few may develop neurological symptoms that need further evaluation and management.
基金financially supported by the National Key Research and Development Program of China,No.2016YFC1100100(to XDG)
文摘Current management for spinal cord injury aims to reduce secondary damage and recover sensation and movement.Acute spinal cord injury is often accompanied by spinal cord compartment syndrome.Decompression by durotomy and/or myelotomy attempts to relieve secondary damage by completelyrelieving the compression of the spinal cord,removing the necrotic tissue,decreasing edema,reducing hemorrhage,and improving blood circulation in the spinal cord.However,it is controversial whether durotomy and/or myelotomy after spinal cord injury are beneficial to neurological recovery.This review compares the clinical effects of durotomy with those of myelotomy in the treatment of spinal cord injury.We found that durotomy has been performed more than myelotomy in the clinic,and that durotomy may be safer and more effective than myelotomy.Durotomy performed in humans had positive effects on neurological function in 92.3% of studies in this review,while durotomy in animals had positive effects on neurological function in 83.3% of studies.Myelotomy procedures were effective in 80% of animal studies,but only one clinical study of myelotomy has reported positive results,of motor and sensory improvement,in humans.However,a number of new animal studies have reported that durotomy and myelotomy are ineffective for spinal cord injury.More clinical data,in the form of a randomized controlled study,are needed to understand the effectiveness of durotomy and myelotomy.
基金supported by a grant from Chongqing Yingcai Plan Project,No.cstc2021ycjh-bgzxm0041(to ZXQ).
文摘The currently recommended management for acute traumatic spinal cord injury aims to reduce the incidence of secondary injury and promote functional recovery.Elevated intraspinal pressure(ISP)likely plays an important role in the processes involved in secondary spinal cord injury,and should not be overlooked.However,the factors and detailed time course contributing to elevated ISP and its impact on pathophysiology after traumatic spinal cord injury have not been reviewed in the literature.Here,we review the etiology and progression of elevated ISP,as well as potential therapeutic measures that target elevated ISP.Elevated ISP is a time-dependent process that is mainly caused by hemorrhage,edema,and blood-spinal cord barrier destruction and peaks at 3 days after traumatic spinal cord injury.Duraplasty and hypertonic saline may be promising treatments for reducing ISP within this time window.Other potential treatments such as decompression,spinal cord incision,hemostasis,and methylprednisolone treatment require further validation.
文摘Typically situated posterolateral in the spinal canal, intraspinal facet cysts often cause radicular symptoms. Rarely, the midline location of these synovial or ganglion cysts may cause thecal sac compression leading to neurogenic claudication or cauda equina syndrome. This article summarizes the clinical presentation, radiographic appearance, and management of three intraspinal, midline facet cysts. Three patients with symptomatic midline intraspinal facet cysts were retrospectively reviewed. Documented clinical visits, operative notes, histopathology reports, and imaging findings were investigated for each patient. One patient presented with neurogenic claudication while two patients developed partial, subacute cauda equina syndrome. All 3 patients initially responded favorably to lumbar decompression and midline cyst resection; however, one patient required surgical stabilization 8 mo later. Following the three case presentations, we performed a thorough literature search in order to identify articles describing intraspinal cystic lesions in lateral or midline locations. Midline intraspinal facet cysts represent an uncommon cause of lumbar stenosis and thecal sac compression. Such entities should enter the differential diagnosis of midline posterior cystic lesions. Midline cysts causing thecal sac compression respond favorably to lumbar surgical decompression and cyst resection. Though laminectomy is a commonly performed operation, stabilization may be required in cases of spondylolisthesis or instability.
文摘BACKGROUND Spontaneous spinal epidural hematoma is a rare neurosurgical emergency.CASE SUMMARY A 53-year-old healthy woman suffered from complete paraplegia in both legs and loss of all sensation below the xiphoid process.She was diagnosed as acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma.The primary lab survey showed all within normal limits.Presence of a posteriorly epidural space-occupying lesion at the T4-T8 level of the spinal canal was confirmed on magnetic resonance imaging.A decompressive laminectomy was performed from the T4 to T7 levels at the sixth hour following abrupt onset of complete paraplegia.The lesion was confirmed as lymphangioma.This patient recovered well within one month.CONCLUSION This study reports a case of acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma with well recovery after surgical intervention.
文摘Seventy-three patients with spinal nerve sheath tumor who were surgically treated in our hospital during the years 2004-2010 were retrospectively reviewed with respect to recovery of neurological function, recurrence of the tumor and occurrence of kyphotic deformities. Preoperative clinical manifestations, imaging data, surgical records and follow-up results were comprehensively analyzed. The follow-up duration was 12-60 months with an average of 32.0 months. Out of the 73 cases enrolled, 69 had gradual recovery of sensation, motor and sphincter functions 1 week to 3 months after operation. Forty-six cases had incomplete paralysis, whose American Spinal Injury Association （ASIA） grades, however, were gradually increased during the follow-up period, 4 cases had no significant improvement of the clinical symptoms and no change in ASIA grades during the follow-up period. Two cases had postoperative recurrence of the tumor. There were no deaths, no spinal instability, and no kyphotic malformations fotmd in any cases. Our study indicated that complete removal of the tumor is important for good recovery, and an ideal surgical method may reduce the recurrence of the tumor or the occurrence of complications.
基金the National Natural Science Foundation of China,No.30770744
文摘Nonspecific neuronal activity elicited by intraspinal microstimulation in the intermediate and ventral gray matter of thoracic spinal segments caudal to a complete spinal cord transection significantly increased the rat hindlimb Basso, Beattie, Bresnahan locomotor score by activating the central pattem generator located in the lumbar spinal cord. However, the best region for intraspinal microstimulation is unclear. Using an incomplete spinal cord injury model at T8, we compared the use of intraspinal microstimulation to activate the spinal cord in rats with a spontaneous recovery group. The intraspinal microstimulation group recovered sooner and showed three kinds of movement： the left hindlimb, the left hindlimb toes, and the paraspinal muscles and tails. These had different microstimulation thresholds. There was mild hyperplasia of the astrocytes surrounding the tips of the microelectrodes and slight inflammatory reactions nearby. These results indicate that implantation of microelectrodes was relatively safe and induced minimal damage to the lumbar-sacral spinal cord. Intraspinal microstimulation in the lumbar sacral spinal cord may improve leg movements after spinal cord injury. Non-specific intraspinal microstimulation may be a novel technique for the recovery of spinal cord injuries.
基金Supported by Shandong Medical and Health Science and Technology Development Plan Project,No.202004071188Shandong Province Traditional Chinese Medicine Science and Technology Project,No.M-2022133+3 种基金Practical Teaching Reform and Research Project of Binzhou Medical College,No.SJJY201927Scientific Research Project of Affiliated Hospital of Binzhou Medical College,No.BY2020KJ74the National Natural Science Foundation of China,No.82002325the Natural Science Foundation of Shandong Province,No.ZR2020QH075,ZR2021MH167 and ZR2021LZY004.
文摘BACKGROUND As an extramedullary form of proliferating myeloblasts,granulocytic sarcoma(GS)is common in patients with acute myeloid leukemia.GS in the central nervous system is rare,and an intraspinal space-occupying lesion caused by GS is even rarer.Surgical decompression is often necessary to remove the intraspinal space-occupying lesion.To the best of our knowledge,we report,for the first time a case of GS that caused extensive compression in the spinal canal without surgical decompression treatment.CASE SUMMARY A 15-year-old male suddenly developed numbness and weakness in his lower limbs for 10 d,which affected his walking ability.Acute myeloid leukemia was later diagnosed in the Department of Hematology.Magnetic resonance imaging revealed that multiple segmental space-occupying lesions were causing severe spinal cord compression in the thoracic spinal canal.As a result,the patient received routine chemotherapy before surgery.Interestingly,the intraspinal space-occupying lesions completely diminished on magnetic resonance imaging after a course of chemotherapy,and the sensation and strength in his lower limbs markedly recovered.CONCLUSION An intraspinal space-occupying lesion could be the first symptom of acute myeloid leukemia,causing spinal nerve compression without any other symptoms.Following standard chemotherapy,spinal canal compression can be quickly relieved,and the spinal cord and nerve function restored,avoiding emergency surgery.
文摘To the Editor: The incidence of community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection and reports of CA-MRSA infection have been increasing yearly. But community-acquired intraspinal methicillin-resistant Staphylococcus aureus (MRSA) infection has never been reported. We describe a case of intraspinal abscess due to CA-MRSA infection.
