Prevention effect of medical self-crosslinking sodium hyaluronate gel on epidural scar adhesion after laminectomy

Objective:To analyze the effect and medical sclf-crosslinking sodium hyaluronate gel on epidural scar adhesion after laminectomy.Methods:A total of 24 New Zealand L5 laminectomy rabbits were randomly divided into four groups,group A as the control group without any treatment:group B covered by sodium hyaluronate gel;group C and group D covered by 0.5 and1.0 mL medical self-crosslinking sodium hyaluronate gel.All rabbits were scored at various time points after 2.4,6,8,12 weeks,then the formation of scar was observed.Results:In Groups B,C,D loose scar tissue occurred after 2 weeks of the operation,scar tissues were significantly less than that in group A,with mild inflammatory reaction.After 8 weeks,the scar tissues of group B were significantly more than that of groups C,D.After two weeks,group B,C were back to the preoperative level;After 4 weeks,group D was back to the preoperative level;After four weeks,the CSEP of group A was increased significantly,which was significantly higher than that in groups B,C,D.The motor function score of group A,group B and group C were the same as preoperative,but that in group D it was decreased significantly,and then it gradually recovered.After 4 weeks it kept a stable level.The motor function score of group A was decreased gradually after the operation,which kept a stable level after 4 weeks,the motor function score was significantly lower man that in groups B,C,D.Conclusions:Determination of somatosensory evoked potentials is sensitive indicator of spinal cord injury;Application of medical selfcrosslinking sodium hyaluronate gel is effective on epidural scar adhesion after laminectomy.

Effect of Straight-leg-raising Movement on Epidural Fibrosis in Early Stage after Laminectomy in a Rabbit Model

To determine the effect of straight-leg-raising （SLR） movement on epidural fibrosis after laminectomy, 40 adult New Zealand rabbits were selected as laminectomy models in the study. They were divided into 2 groups： a SLR group （group S） and a control group （group C） randomly, with each group having 20 animals. All rabbits were subjected to total laminectomy in the site of S1. Every 5 rabbits in each group selected randomly were killed at the 1st, 2nd, 4th, and 8th week after the surgery. Segments of spines from L,7 to S2 were removed en bloc. After gross evaluation, specimens were sliced up. The slices were stained by HE and Masson＇s trichrome methods respectively for histological examination. Our results showed that formation process of scar in group S was retarded as compared with that of group C at the time of the 2nd-week, but there was no statistical difference between groups in the adhesion degree （P≥0.05）. At the 4th and 8th week, the epidural fibrosis of group S was more serious than that of group C. Since the 2nd-week, the area of scar in group S was larger than that of group C. The number of fibroblasts and inflammatory cells in group S were larger than those of group C at early stage. But in later stage, there was no statistical significance between the two groups. It is concluded that SLR movement after laminectomy may promote the formation of epidural fibrosis and retard the maturity of scar. SLR movement can also aggravate scar adhesion.

Ultrasound Guidance Is Helpful for Paravertebral Block Performance and Catheter Placement in Patients with Laminectomy after Thoracotomy or Lumbotomy: A Case Series Imaging Study

Today, the ultrasound guidance (USG) in regional anesthesia is gold standard more and more often used for medial or paramedian approaches around to the spine, such as the paravertebral (PV) block. Local anatomical changes may greatly handicap the performance of this type of block. We present clinical, sonographic, and radiological data on successful PV block and catheter placement in four patients with vertebral diseases, targeting thoracotomy or lumbotomy postoperative pain after stabilization of the involved vertebral body and preliminary arthrodesis with laminectomy by the posterior approach. We emphasize the importance of USG in this special context involving local anatomical disturbance.

Clinical Outcome after Laminectomy without Fusion for Cervical Spondylotic Myelopathy

Dorsal decompression in patients, presenting with cervical spondylotic myelopathy with no signs of instability, is a standard surgical option. Laminectomy or laminoplasty is applied to reduce the pressure on the myelon. The aim of this study was to evaluate the clinical outcome in a consecutive series of patients. This retrospective study included a total of 65 patients who underwent laminectomy or laminoplasty at a single or more levels, without fusion for cervical spondylotic myelopathy, during an 8-year period (2000-2007). The clinical data evaluation included pre- and postoperative patient history and neurological and surgical variables. The radiological assessment included MRI, CT, and plain anterior-posterior, lateral, and lateral flexion-extension X-rays. The mean follow-up time was 15 months. Improvement of gait disturbance was documented in 74% of the patients concerned. Radicular pain in the upper limbs (UL) and lower limbs (LL) improved in 87% and 50% of the patients, respectively. Sensory deficits improved in the UL and LL in 76% and 54%, respectively. Motor deficits improved in the UL and LL in 70% and 56% of the patients, respectively. Clinical deterioration after surgery was documented in one patient. Based on our results, laminectomy without fusion can be advocated as a safe and effective surgical strategy to treat cervical spondylotic myelopathy in patients without preoperative instability. In these patients, the occurrence of post-procedural clinical deterioration and instability was low, and overall improvement of neurological deficits and amelioration of radicular pain can be expected in a significant number of patients.

Enlarged laminectomy for ossification of posterior longitudinal ligament in cervical spine

Objective To introduce surgical strategy of enlarged laminectomy (with partial facet joint dissection to expose nerve root) ,and to discuss its benefit for cervicalossification of posterior longitudinal ligament (OPLL)

An experimental study on preventive effect of continuous irrigation from peridural adhesion after laminectomy

Objective To observe the preventive effect of continuous irrigation with sodium hyaluronate injection from peridural adhesionaminectomy.Methods Larninectomies were performed in L1,L4,L7 of 25 New Zealand rabbits respectively with 3

An Injectable Hydrogel with or without Drugs for Prevention of Epidural Scar Adhesion after Laminectomy in Rats

Epidural scarring occurs inevitably in the defect after spinal laminectomy, and thus how to prevent or reduce it becomes a challenging topic. In the present study, an injectable hydrogel and its dexamethasone （DEX）-loaded hydrogel systems were adopted to prevent epidural scarring in a postlaminectomy rat model. The hydrogel system composed of poly（D,L-lactic acid-co-glycolic acid）-poly（ethylene glycol）-poly（D,L-lactic acid-co-glycolic acid） （PLGA-PEG-PLGA） triblock copolymers was a free-flowing sol at room temperature, and spontaneously turned into a semi-solid gel at body temperature. A lumbar 3 total laminectomy was performed on Sprague Dawley （SD） rats, and the efficacy of the injectable hydrogel with or without drugs in preventing epidural scar formation was evaluated via the gross anatomical observation and histological examination at one month post-surgery. The results demonstrate that the use of hydrogel alone reduced epidural scarring significantly, whereas the efficacy of the DEX-loaded hydrogels presented an irregular dose-dependency of drug and even the inappropriate drug doses resulted in the negative results. Therefore, the present study confirms that the PLGA-PEG- PLGA hydrogel holds potential as a barrier device to decrease peridural scarring, and reveals that the sustained delivery of the steroid hormone DEX to prevent surgery-related adhesions in the laminectomy defect is complex. Moreover, our in vivo studies also remind the researchers to pay attention to the irregular dose-dependency of the hormone drugs.

Ossified pseudomeningocele after laminectomy

Spinal pseudomeningoceles are rare extradural collections of cerebrospinal fluid （CSF） that result from unintended durotomy during lumbar spine surgery. Most pseudomeningoceles are asymptomatic, but some patients may present with recurrence of preoperative symptoms. In rare cases, delayed myelopathy can also be observed. Among spinal pseudomeningoceles, ossified pseudomeningoceles are even rarer, and to the best of our knowledge,

Substance P promotes epidural fibrosis via induction of type 2 macrophages

In response to spinal surgery,neurons secrete a large amount of substance P into the epidural area.Substance P is involved in macrophage differentiation and fibrotic disease.However,the specific roles and mechanisms of substance P in epidural fibrosis remain unclear.In this study,we established a mouse model of L1–L3 laminectomy and found that dorsal root ganglion neurons and the macrophages infiltrating into the wound area released sphingolipids.In vitro experiments revealed that type 1 macrophages secreted substance P,which promoted differentiation of type 1 macrophages towards a type 2 phenotype.High-throughput mRNA-seq analysis revealed that the sphingolipid metabolic pathway may be involved in the regulation of type 2 macrophages by substance P.Specifically,sphingomyelin synthase 2,a component of the sphingolipid metabolic pathway,promoted M2 differentiation in substance P-treated macrophages,while treating the macrophages with LY93,a sphingomyelin synthase 2 inhibitor,suppressed M2 differentiation.In addition,substance P promoted the formation of neutrophil extracellular traps,which further boosted M2 differentiation.Blocking substance P with the neurokinin receptor 1 inhibitor RP67580 decreased the number of M2 macrophages in the wound area after spinal surgery and alleviated epidural fibrosis,as evidenced by decreased fibronectin,α-smooth muscle actin,and collagen I in the scar tissue.These results demonstrated that substance P promotes M2 macrophage differentiation in epidural fibrosis via sphingomyelin synthase 2 and neutrophil extracellular traps.These findings provide a novel strategy for the treatment of epidural fibrosis.

Effects of durotomy versus myelotomy in the repair of spinal cord injury

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.

Midline synovial and ganglion cysts causing neurogenic claudication

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.

Potential risk of mitomycin C at high concentrations on peripheral nerve structure

Although the local application of mitomycin C may prevent epidural adhesion after laminectomy, mitomycin C can induce neurotoxicity in optic and acoustic nerves at high concentrations. To determine the safe concentration range for mitomycin C, cotton pads soaked with mitomycin C at different concentrations （0.1, 0.3, 0.5, and 0.7 mg/mL） were immediately applied for 5 minutes to the operation area of rats that had undergone laminectomy at L1. Rat sciatic nerves, instead of dorsal nerves, were used in this study. The results showed that mitomycin C at 0.1-0.5 mg/mL did not damage the structure and function of the sciatic nerve, while at 0.7 mg/mL, mitomycin C signiifcantly reduced the thickness of the sciatic nerve myelin sheath compared with lower concen-trations, though no functional change was found. These experimental ifndings indicate that the local application of mitomycin C at low concentrations is safe to prevent scar adhesion following laminectomy, but that mitomycin C at high concentrations （＆gt;0.7 mg/mL） has potential safety risks to peripheral nerve structures.

Acute spontaneous thoracic epidural hematoma associated with intraspinal lymphangioma: A case report

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.

Ligamentum flavum hematoma following a traffic accident:A case report

BACKGROUND Ligamentum flavum hematoma(LFH)can cause compression of the spinal cord or nerve root,which results in neurological symptoms.We report a case of lumbar radicular pain due to LFH following a traffic accident.CASE SUMMARY A 59-year-old man complained of left buttock and lateral thigh pain that was dull in nature after a traffic accident 18 d prior to presentation.Magnetic resonance imaging(MRI),taken 17 d after the traffic accident,revealed a mass lesion at the L4-5 Level.These MRI findings suggested subacute LFH.The patient’s pain was not alleviated with conservative treatment,including oral medication and epidural steroid injection.After a partial-hemilaminectomy and removal of LFH,the patient’s pain completely disappeared.CONCLUSION Because early operation for decompression is important for a good outcome,clinicians should be able to determine LFH from MRI results and be aware of the possibility of LFH,especially in patients with a history of trauma.

Atypical osteochondroma of the lumbar spine associated with suprasellar pineal germinoma:A case report

BACKGROUND Osteochondromas are the most common benign bone tumor,accounting for 36%of benign bone tumors.Often found within the appendicular skeleton,osteochondromas of the spine are rare,comprising 4%to 7%of primary benign spinal tumors.CASE SUMMARY We report a case of a solitary lumbar osteochondroma in an 18-year-old male with a history of a suprasellar pineal germinoma treated with combined chemotherapy and radiation.He underwent mass excision and partial laminectomy with the ultrasonic bone scalpel(Misonix,Farmingdale,NY,United States)at the L5 Level without the use of adjuvants.The patient returned to work and full activities without back pain at 3 mo postoperatively.CONCLUSION Osteochondromas are common tumors of the appendicular skeleton but rarely occur within the spine.This case discussion supplements current osteochondroma literature by describing an unusual presentation of this tumor.

Paraparesis induced by extramedullary haematopoiesis

We describe a case of worsening paraparesis induced by spinal cord compression at T6-T7 levels associated with compensatory extramedullary haematopoiesis from a compound heterozygote for haemoglobin E and for β-thalassemia.An emergency T3-T9 laminectomy was performed with excision of the masses and complete rehabilitation of the patient.

Spinal canal decompression for hypertrophic neuropathy of the cauda equina with chronic inflammatory demyelinating polyradiculoneuropathy:A case report

BACKGROUND Hypertrophic neuropathy of the cauda equina(HNCE)is a rare disease,especially in children.It can be caused by different etiological agents such as inflammation,tumor or hereditary factors.Currently,there is no uniform standard for clinical treatment of HNCE.Furthermore,it is unclear whether spinal canal decompression is beneficial for patients with HNCE.CASE SUMMARY We report the case of a 13-year-old boy with enlargement of the cauda equina.The onset of the disease began at the age of 6 years and was initially marked by radiating pain in the buttocks and thighs after leaning over and weakness in the lower limbs when climbing a ladder.The child did not receive any medical treatment.As the disease slowly progressed,the child needed the help of others to walk,and he had a trendelenburg gait.He underwent spinal canal decompression and a nerve biopsy during his hospital stay.A diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy was made based on electrophysiological findings and pathological examination results.Immunoglobulin or hormone therapy was recommended during hospitalization,but his mother refused.After discharge,the boy’s mother helped him carry out postoperative rehabilitation training at home.His lower-limb muscle strength gradually increased,and he could stand upright and take steps.Six mo after surgery,the child was readmitted and began immunoglobulin therapy.Long-term oral steroid treatment was initiated after discharge.The movement and sensation of the lower limbs were further improved,and the boy could walk normally 1 year after surgery.CONCLUSION Spinal canal decompression can improve the clinical symptoms of HNCE caused by inflammation,even in children.When combined with specific etiological interventions,spinal cord decompression can lead to optimal outcomes.

Iatrogenic giant pseudomeningocele of the cervical spine:A case report

BACKGROUND Only a few cases of giant pseudomeningoceles have been reported in the literature.Herein,we report a giant pseudomeningocele of the cervical spine that was found after cervical laminectomy for an epidural hematoma following epidural blockade.CASE SUMMARY A 47-year-old man presented with recurrent neck pain and posterior neck swelling after spinal surgery.Magnetic resonance imaging of the cervical spine revealed fluid collection(5.6 cm×6.6 cm×11.2 cm)at the C3-6 level;this proved to be a pseudomeningocele.Symptoms related to the pseudomeningocele resolved following dural repair and fat graft transplantation.CONCLUSION Although rare,pseudomeningocele is a possibility in patients with recurrent back pain,radicular pain,or a persistent headache following spinal surgery.Continuous attention should be paid throughout the spinal procedure,whether conservative or non-conservative.

Effects of percutaneous intervertebral foraminal BEIS technique on patients with lumbar disc herniation

Objective:To compare the application effects of percutaneous percutanuous intervertebral foraminal BEIS(Broad Easy Immediate Surgery)technique on patients with lumbar disc herniation.Methods:Eighty-six patients with lumbar disc herniation treated in the Seventh People’s Hospital of Zibo City from Mary 2016 to May 2019 were selected and divided into control group and study group according to the simple randomization of random number table method,with 43 cases in each group.Patients in control group were treated with lamina fenestration while patients in study group were treated with percutanuous intervertebral foraminal BEIS technique.The surgical status and hospital stay,complications,pain[Visual Analogue Scale(VAS)score],Oswestry Disability Index(ODI)score and quality of life[MOS 36-item Short From Health Survey(SF-36)]were compared between the two groups.Results:The surgical time in study group was longer than that in control group,and the incision length was shorter than that in control group,and the fluoroscopy frequency was more than that in control group,and the intraoperative blood loss was less than that in control group,and the hospital stay was shorter than that in control group(P<0.05).There were no significant differences in the incidence rates of postoperative complications between the two groups(P>0.05).There were statistically significant differences in the between-group effects,timepoint effects and interaction effects of VAS pain score(P<0.05),and the VAS pain score in study group at 24 h and 1 w after surgery was significantly lower than that in control group(P<0.05).There were no statistically significant differences in the group-between effects and interaction effects of ODI score(P>0.05),and there were statistically significant differences in the time-point effects(P<0.05).There were statistically significant differences in the betweengroup effects,time-point effects and interaction effects of SF-36 score(P<0.05).The ODI score at 3 months after surgery in study group was lower than that in control group while the SF-36 score was higher than that in control group(P<0.05).Conclusion:Compared with traditional lamina fenestration,percutanuous intervertebral foraminal BEIS technique has the advantages of less trauma and quicker postoperative recovery in the treatment of lumbar disc herniation.Self-made simple locator can reduce the fluoroscopy frequency,improve the accuracy of positioning,further reduce surgical trauma and promote recovery of patients.

Spontaneous Spinal Epidural Hematoma Causing Paraplegia: A Case Report

A spontaneous spinal epidural hematoma without any identified etiology is a very rare entity. We report here a 44 years old woman admitted within our department for 04 days of severe back pain complicated rapidly of bilateral lower-limbs weakness and urinary retention. Neurological examination found a complete paraplegia (0/5 stergh), with incomplete sensory deficit below the T-10 level, bowel and bladder dysfunction, decreased deep and superficial reflex. MRI with different sequences showed a large epidural mass lesion with slightly high signal intensity on T1-weighted images and heterogeneous low signal intensity on T2-weighted images from T11 to L1 suggesting an epidural hematoma. She underwent an urgent total laminectomy from T11 to L1 following by a complete removal of a large dark and compact epidural hematoma compressing the spinal cord. Operatively, there’s no sign suggesting an AVM. Postoperative course was uneventful and she was discharged ten days after surgery with complete recovery.