BACKGROUND Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis.On the other hand,the reported rate of revision surgery after indirect decompression highl...BACKGROUND Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis.On the other hand,the reported rate of revision surgery after indirect decompression highlights the necessity of working out prediction models for the radiographic results of indirect decompression with assessing their clinical relevance.AIM To assess factors that influence radiographic and clinical results of the indirect decompression in patients with stenosis of the lumbar spine.METHODS This study is a single-center cross-sectional evaluation of 80 consecutive patients(17 males and 63 females)with lumbar spinal stenosis combined with the instability of the lumbar spinal segment.Patients underwent single level or bisegmental spinal instrumentation employing oblique lumbar interbody fusion(OLIF)with percutaneous pedicle screw fixation.Radiographic results of the indirect decompression were assessed using computerized tomography,while MacNab scale was used to assess clinical results.RESULTS After indirect decompression employing anterior reconstruction using OLIF,the statistically significant increase in the disc space height,vertebral canal square,right and left lateral canal depth were detected(Р<0.0001).The median(M)relative vertebral canal square increase came toМ=24.5%with 25%-75%quartile border(16.3%;33.3%)if indirect decompression was achieved by restoration of the segment height.In patients with the reduction of the upper vertebrae slip,the median of the relative increase in vertebral canal square accounted for 49.5%with 25%-75%quartile border(2.35;99.75).Six out of 80 patients(7.5%)presented with unsatisfactory results because of residual nerve root compression.The critical values for lateral recess depth and vertebral canal square that were associated with indirect decompression failure were 3 mm and 80 mm2 respectively.CONCLUSION Indirect decompression employing anterior reconstruction is achieved by the increase in disc height along the posterior boarder and reduction of the slipped vertebrae in patients with degenerative spondylolisthesis.Vertebral canal square below 80 mm2 and lateral recess depth less than 3 mm are associated with indirect decompression failures that require direct microsurgical decompression.展开更多
A variety of inlfammatory cytokines are involved in spinal cord injury and inlfuence the recov-ery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The ce...A variety of inlfammatory cytokines are involved in spinal cord injury and inlfuence the recov-ery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The cerclage suture was released 8 or 72 hours later, to simulate decompres-sion surgery. Neurological function was evaluated behaviorally for 3 weeks after surgery, and tumor necrosis factorα immunoreactivity and apoptosis were quantiifed in the region of injury. Rats that underwent decompression surgery had significantly weaker immunoreactivity of tumor necrosis factorα and signiifcantly fewer apoptotic cells, and showed faster improvement of locomotor function than animals in which decompression surgery was not performed. De-compression at 8 hours resulted in signiifcantly faster recovery than that at 72 hours. These data indicate that early decompression may improve neurological function after spinal cord injury by inhibiting the expression of tumor necrosis factorα.展开更多
Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatme...Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatment of spinal cord injury is inhibiting or reversing secondary injury.Governor Vessel electroacupuncture can improve symptoms of spinal cord injury by inhibiting cell apoptosis and improving the microenvironment of the injured spinal cord.In this study,Governor Vessel electroacupuncture combined with decompression at different time points was used to treat acute spinal cord injury.The rat models were established by inserting a balloon catheter into the atlanto-occipital space.The upper cervical spinal cord was compressed for 12 or 48 hours prior to decompression.Electroacupuncture was conducted at the acupoints Dazhui（GV14） and Baihui（GV 20）（2 Hz,15 minutes） once a day for 14 consecutive days.Compared with decompression alone,hind limb motor function recovery was superior after decompression for 12 and 48 hours combined with electroacupuncture.However,the recovery of motor function was not significantly different at 14 days after treatment in rats receiving decompression for 12 hours.Platelet-activating factor levels and caspase-9 protein expression were significantly reduced in rats receiving electroacupuncture compared with decompression alone.These findings indicate that compared with decompression alone,Governor Vessel electroacupuncture combined with delayed decompression（48 hours） is more effective in the treatment of upper cervical spinal cord injury.Governor Vessel electroacupuncture combined with early decompression（12 hours） can accelerate the recovery of nerve movement in rats with upper cervical spinal cord injury.Nevertheless,further studies are necessary to confirm whether it is possible to obtain additional benefit compared with early decompression alone.展开更多
Background: Tuberculosis of the spine is common in Nigeria. It commonly causes neurological deficit especially when the lesions are higher up in the spine. Objective: To report a case of a young man who had C4 quadrip...Background: Tuberculosis of the spine is common in Nigeria. It commonly causes neurological deficit especially when the lesions are higher up in the spine. Objective: To report a case of a young man who had C4 quadriplegia from tuberculous destruction of C3 to C5 vertebral bodies and their intervening discs, aretropharyngeal prevertebral abscess and associated segmental kyphosis. He had received prior antituberculous therapy with no improvement. Results: He recovered completely neurologically when he had adequate decompression and 360°;instrumented fusiondone in a 3-stage surgery that involved drainage and debridement of the retropharyngeal prevertebral abscess, anterior corpectomy of C3 and C4 with fusion using a titanium mesh cage, and posterior fusion of C3 to C6 using titanium rods and lateral mass screws. Surgical treatment was supported with skull traction and antituberculous therapy. Conclusion: This case shows that complete neurologic recovery is feasible in spinal quadriplegia that fails to respond to antituber-culous therapy when adequate decompression and fusion are done.展开更多
We report a series of patients operated for one or multilevel lumbar spinal stenosis (with and without spondylolisthesis) using the minimal invasive bilateral interlaminar decompression. We discuss our results, compar...We report a series of patients operated for one or multilevel lumbar spinal stenosis (with and without spondylolisthesis) using the minimal invasive bilateral interlaminar decompression. We discuss our results, comparing this procedure (from a technical point of view) with the muscle-preserving interlaminar decompression (MILD) and the unilateral approach for bilateral decompression (ULBD). Clinical and outcome data of 62 consecutive patients were reviewed, using the Visual Analogue Scale for both low back pain (LBP) and legs pain and the Oswestry Disability Index (ODI) for the degree of disability. Mean age was 68.88 ± 9.54 years and mean follow-up (FU) was 16.38 ± 11.12 months. A statistically significant improvement of LBP, legs pain and ODI was globally observed. At latest FU, patients with multilevel lumbar spinal stenosis significantly improved all scores and patients with spondylolisthesis significantly decreased their disability. No major complications occurred. Two cerebrospinal fluid (CSF) collections were treated conservatively. No wound infection occurred. No progression of spondylolisthesis was observed. No reoperation was needed. Although efficacious in patients with lumbar spinal stenosis, MILD and ULBD can have both some limitations. MILD has been found to decrease lumbar function in multilevel decompression (increasing sagittal translation and lumbar lordosis probably due to the removal of half of the spinous processes) and ULBD shows some disadvantages due to the difficulty of manipulating instruments through a small portal and the inadequate decompression due to a minimal exposure. The minimal invasive bilateral interlaminar decompression (in this technique, the access is bilateral but the supraspinous and interspinous ligaments and the spinous processes are preserved) allows wide access (bilateral exposure) with minimal invasiveness and very low morbidity in patients with lumbar spinal stenosis at one or more levels.展开更多
Objective To study the efficiacy and safety of transfacet approach decompression to treat thoracic spinal stenosis caused by anterior compression. Methods Thirty-three patients with thoracic spinal stenosis caused by ...Objective To study the efficiacy and safety of transfacet approach decompression to treat thoracic spinal stenosis caused by anterior compression. Methods Thirty-three patients with thoracic spinal stenosis caused by anterior展开更多
Objective To investigate the surgical techniqueand efficiency of the "Cave-in" 360° circumferential decompression for thoracic spinal stenosis(TSS)with ossification of posterior longitudinal ligament(OP...Objective To investigate the surgical techniqueand efficiency of the "Cave-in" 360° circumferential decompression for thoracic spinal stenosis(TSS)with ossification of posterior longitudinal ligament(OPLL).Methods From October 2005 to展开更多
BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spi...BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spinal metastases.Percutaneous vertebroplasty(PVP)has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms.She couldn't straighten her legs because of severe pain.Computed tomography(CT)showed a mass lesion in the lung and bone destruction in the L4 vertebrae.The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma.PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time.Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation.The incision was scaled up with the TESSY technology.The pain was obviously relieved following the operation and no serious complications occurred.Postoperative CT showed that the decompression around the nerve root was successful,polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed.During the 1-year follow-up period,the patient was in a stable condition.CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms.Because of the small sample size and short followup time,the long-term clinical efficacy of this method needs to be further confirmed.展开更多
Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,t...Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,the microvascular network is compressed and destroyed,resulting in ischemia and hypoxia.The main pathological changes are inflammation,damage to the blood spinal cord barriers,and cell apoptosis at the site of compression.Studies have confirmed that vascular regeneration and remodeling contribute to neural repair by promoting blood flow and the reconstruction of effective circulation to meet the nutrient and oxygen requirements for nerve repair.Surgical decompression is the most effective clinical treatment for this condition;however,in some patients,residual neurological dysfunction remains after decompression.Facilitating revascularization during compression and after decompression is therefore complementary to surgical treatment.In this review,we summarize the progress in research on chronic compressive spinal cord injury,covering both physiological and pathological changes after compression and decompression,and the regulatory mechanisms of vascular injury and repair.展开更多
文摘BACKGROUND Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis.On the other hand,the reported rate of revision surgery after indirect decompression highlights the necessity of working out prediction models for the radiographic results of indirect decompression with assessing their clinical relevance.AIM To assess factors that influence radiographic and clinical results of the indirect decompression in patients with stenosis of the lumbar spine.METHODS This study is a single-center cross-sectional evaluation of 80 consecutive patients(17 males and 63 females)with lumbar spinal stenosis combined with the instability of the lumbar spinal segment.Patients underwent single level or bisegmental spinal instrumentation employing oblique lumbar interbody fusion(OLIF)with percutaneous pedicle screw fixation.Radiographic results of the indirect decompression were assessed using computerized tomography,while MacNab scale was used to assess clinical results.RESULTS After indirect decompression employing anterior reconstruction using OLIF,the statistically significant increase in the disc space height,vertebral canal square,right and left lateral canal depth were detected(Р<0.0001).The median(M)relative vertebral canal square increase came toМ=24.5%with 25%-75%quartile border(16.3%;33.3%)if indirect decompression was achieved by restoration of the segment height.In patients with the reduction of the upper vertebrae slip,the median of the relative increase in vertebral canal square accounted for 49.5%with 25%-75%quartile border(2.35;99.75).Six out of 80 patients(7.5%)presented with unsatisfactory results because of residual nerve root compression.The critical values for lateral recess depth and vertebral canal square that were associated with indirect decompression failure were 3 mm and 80 mm2 respectively.CONCLUSION Indirect decompression employing anterior reconstruction is achieved by the increase in disc height along the posterior boarder and reduction of the slipped vertebrae in patients with degenerative spondylolisthesis.Vertebral canal square below 80 mm2 and lateral recess depth less than 3 mm are associated with indirect decompression failures that require direct microsurgical decompression.
基金supported by a grant from the Anhui Provincial Health Department-Funded Medical Research Project in 2009 in China,No.09C33a grant from the Key Scientific Research Project of Cultivating Fund of Wannan Medical College in China,No.WK2014ZF14
文摘A variety of inlfammatory cytokines are involved in spinal cord injury and inlfuence the recov-ery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The cerclage suture was released 8 or 72 hours later, to simulate decompres-sion surgery. Neurological function was evaluated behaviorally for 3 weeks after surgery, and tumor necrosis factorα immunoreactivity and apoptosis were quantiifed in the region of injury. Rats that underwent decompression surgery had significantly weaker immunoreactivity of tumor necrosis factorα and signiifcantly fewer apoptotic cells, and showed faster improvement of locomotor function than animals in which decompression surgery was not performed. De-compression at 8 hours resulted in signiifcantly faster recovery than that at 72 hours. These data indicate that early decompression may improve neurological function after spinal cord injury by inhibiting the expression of tumor necrosis factorα.
基金supported by the Capital Characteristic Clinical Application Research Projects of Beijing Municipal Science and Technology Plan of China,No.Z16110000516009
文摘Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatment of spinal cord injury is inhibiting or reversing secondary injury.Governor Vessel electroacupuncture can improve symptoms of spinal cord injury by inhibiting cell apoptosis and improving the microenvironment of the injured spinal cord.In this study,Governor Vessel electroacupuncture combined with decompression at different time points was used to treat acute spinal cord injury.The rat models were established by inserting a balloon catheter into the atlanto-occipital space.The upper cervical spinal cord was compressed for 12 or 48 hours prior to decompression.Electroacupuncture was conducted at the acupoints Dazhui（GV14） and Baihui（GV 20）（2 Hz,15 minutes） once a day for 14 consecutive days.Compared with decompression alone,hind limb motor function recovery was superior after decompression for 12 and 48 hours combined with electroacupuncture.However,the recovery of motor function was not significantly different at 14 days after treatment in rats receiving decompression for 12 hours.Platelet-activating factor levels and caspase-9 protein expression were significantly reduced in rats receiving electroacupuncture compared with decompression alone.These findings indicate that compared with decompression alone,Governor Vessel electroacupuncture combined with delayed decompression（48 hours） is more effective in the treatment of upper cervical spinal cord injury.Governor Vessel electroacupuncture combined with early decompression（12 hours） can accelerate the recovery of nerve movement in rats with upper cervical spinal cord injury.Nevertheless,further studies are necessary to confirm whether it is possible to obtain additional benefit compared with early decompression alone.
文摘Background: Tuberculosis of the spine is common in Nigeria. It commonly causes neurological deficit especially when the lesions are higher up in the spine. Objective: To report a case of a young man who had C4 quadriplegia from tuberculous destruction of C3 to C5 vertebral bodies and their intervening discs, aretropharyngeal prevertebral abscess and associated segmental kyphosis. He had received prior antituberculous therapy with no improvement. Results: He recovered completely neurologically when he had adequate decompression and 360°;instrumented fusiondone in a 3-stage surgery that involved drainage and debridement of the retropharyngeal prevertebral abscess, anterior corpectomy of C3 and C4 with fusion using a titanium mesh cage, and posterior fusion of C3 to C6 using titanium rods and lateral mass screws. Surgical treatment was supported with skull traction and antituberculous therapy. Conclusion: This case shows that complete neurologic recovery is feasible in spinal quadriplegia that fails to respond to antituber-culous therapy when adequate decompression and fusion are done.
文摘We report a series of patients operated for one or multilevel lumbar spinal stenosis (with and without spondylolisthesis) using the minimal invasive bilateral interlaminar decompression. We discuss our results, comparing this procedure (from a technical point of view) with the muscle-preserving interlaminar decompression (MILD) and the unilateral approach for bilateral decompression (ULBD). Clinical and outcome data of 62 consecutive patients were reviewed, using the Visual Analogue Scale for both low back pain (LBP) and legs pain and the Oswestry Disability Index (ODI) for the degree of disability. Mean age was 68.88 ± 9.54 years and mean follow-up (FU) was 16.38 ± 11.12 months. A statistically significant improvement of LBP, legs pain and ODI was globally observed. At latest FU, patients with multilevel lumbar spinal stenosis significantly improved all scores and patients with spondylolisthesis significantly decreased their disability. No major complications occurred. Two cerebrospinal fluid (CSF) collections were treated conservatively. No wound infection occurred. No progression of spondylolisthesis was observed. No reoperation was needed. Although efficacious in patients with lumbar spinal stenosis, MILD and ULBD can have both some limitations. MILD has been found to decrease lumbar function in multilevel decompression (increasing sagittal translation and lumbar lordosis probably due to the removal of half of the spinous processes) and ULBD shows some disadvantages due to the difficulty of manipulating instruments through a small portal and the inadequate decompression due to a minimal exposure. The minimal invasive bilateral interlaminar decompression (in this technique, the access is bilateral but the supraspinous and interspinous ligaments and the spinous processes are preserved) allows wide access (bilateral exposure) with minimal invasiveness and very low morbidity in patients with lumbar spinal stenosis at one or more levels.
文摘Objective To study the efficiacy and safety of transfacet approach decompression to treat thoracic spinal stenosis caused by anterior compression. Methods Thirty-three patients with thoracic spinal stenosis caused by anterior
文摘Objective To investigate the surgical techniqueand efficiency of the "Cave-in" 360° circumferential decompression for thoracic spinal stenosis(TSS)with ossification of posterior longitudinal ligament(OPLL).Methods From October 2005 to
文摘BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spinal metastases.Percutaneous vertebroplasty(PVP)has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms.She couldn't straighten her legs because of severe pain.Computed tomography(CT)showed a mass lesion in the lung and bone destruction in the L4 vertebrae.The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma.PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time.Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation.The incision was scaled up with the TESSY technology.The pain was obviously relieved following the operation and no serious complications occurred.Postoperative CT showed that the decompression around the nerve root was successful,polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed.During the 1-year follow-up period,the patient was in a stable condition.CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms.Because of the small sample size and short followup time,the long-term clinical efficacy of this method needs to be further confirmed.
基金supported by the National Natural Science Foundation of China,No.81450020(to HQL)。
文摘Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,the microvascular network is compressed and destroyed,resulting in ischemia and hypoxia.The main pathological changes are inflammation,damage to the blood spinal cord barriers,and cell apoptosis at the site of compression.Studies have confirmed that vascular regeneration and remodeling contribute to neural repair by promoting blood flow and the reconstruction of effective circulation to meet the nutrient and oxygen requirements for nerve repair.Surgical decompression is the most effective clinical treatment for this condition;however,in some patients,residual neurological dysfunction remains after decompression.Facilitating revascularization during compression and after decompression is therefore complementary to surgical treatment.In this review,we summarize the progress in research on chronic compressive spinal cord injury,covering both physiological and pathological changes after compression and decompression,and the regulatory mechanisms of vascular injury and repair.
