Syringomyelia associated with cervical spondylosis: A rare condition

Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division and treated by our institute. It is the case of a 66-yearold woman. At our observation she was affected by moderate-severe spastic tetraparesis. T2-weighted magnetic resonance imaging(MRI) showed an hyperintense signal within spinal cord from C3 to T1 with a more sharply defined process in the inferior cervical spinal cord. At the same level bulging discs, facets and ligamenta flava hypertrophy determined a compression towards subarachnoid space and spinal cord. Spinal cord compression was more evident in hyperextension rather than flexion. A 4-level laminectomy and subsequent posterior stabilization with intra-articular screws was executed. At 3-mo follow up there was a regression of tetraparesis but motor deficits of the lower limbs residuated. At the same follow up postoperative MRI was executed. It suggested enlargement of the syrinx. Perhaps hyperintensity within spinal cord appeared "bounded" from C3 to C7 with clearer margins. At the level of surgical decompression, subarachnoid space and spinal cord enlargement were also evident. A review of the literature was executed using Pub Med database. The objective of the research was to find an etiopathological theory able to relate syringomyelia with cervical spondylosis. Only 6 articles have been found. At the origin of syringomyelia the mechanisms of compression and instability are proposed. Perhaps other studies assert the importance of subarachnoid space regard cerebrospinal fluid(CSF) dynamic. We postulate that cervical spine instability may be the cause of multiple microtrauma towards spinal cord and consequently may damage spinal cord parenchyma generating myelomalacia and consequently syrinx. Otherwise the hemorrhage within spinal cord central canal can cause an obstruction of CSF outflow, finally generating the syrinx. On the other hand in cervical spondylosis the stenotic elements can affect subarachnoid space. These elements rubbing towards spinal cord during movements of the neck can generate arachnoiditis, subarachnoid hemorrhages and arachnoid adhesions. Analyzing the literature these "complications" of cervical spondylosis are described at the origin of syringomyelia. So surgical decompression, enlarging medullary canal prevents rubbings and contacts between the bone-ligament structures of the spine towards spinal cord and subarachnoid space therefore syringomyelia. Perhaps stabilization is also necessary to prevent instability of the cervical spine at the base of central cord syndrome or syringomyelia. Finally although patients affected by central cord syndrome are usually managed conservatively we advocate, also for them, surgical treatment in cases affected by advanced state of the symptoms and MRI.

Cervical spondylotic myelopathy with syringomyelia presenting as hip Charcot neuroarthropathy:A case report and review of literature

BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for only 5%of CN cases;the shoulder and elbow are most often involved,and the hip joint is rarely affected.As a rare factor,cervical spondylotic myelopathy(CSM)can be associated with syringomyelia,which is scarcely reported in the literature.Here,we present the first case report to date of CN of the hip caused by syringomyelia secondary to CSM.CASE SUMMARY We describe a 76-year-old male patient who was diagnosed with CSM due to neck pain and weakness of limbs 16 years ago.Four years ago,he noticed recurrent swelling of the right hip with pain and was diagnosed with degenerative arthritis.Recently,however,his symptoms gradually worsened,and because of progressive pain,destabilization and weakness of the right hip,he was admitted to our hospital.Through systematic physical,radiographic and laboratory examinations,we finally reached a diagnosis:CN of the right hip associated with syringomyelia secondary to CSM.After comprehensive evaluation of the patient's condition,we performed right total hip arthroplasty.During the follow-up,the patient felt well clinically and could walk independently with a knee brace.CONCLUSION We suggest a possible etiological association between CSM and syringomyelia,which may reflect a potential pathogenesis of CN.We encourage clinicians to actively carry out a detailed medical history and comprehensive physical and imaging examinations in patients with joint lesions,especially chronic shoulder neck pain,to rule out the possibility of this association,which plays a crucial role in the early diagnosis of CN.Arthroplasty may no longer be an absolute contraindication to surgical treatment of CN.Reasonable selection of the surgical strategy can markedly improve the clinical symptoms and quality of life of patients.

Unilateral neuropathic arthropathy of the shoulder secondary to syringomyelia: Diagnostic challenges

Neuropathic arthropathy of the shoulder is a rare disorder characterized by joint degeneration, and is associated with loss of sensory innervation. Syringomyelia is a disease in which fluid-containing cavities(syrinxes) form within the spinal cord. Here, we report a case of neuropathic arthropathy of the shoulder secondary to syringomyelia in a 40-year-old woman. X-rays of the left shoulder revealed damage to bone and joint architecture. Blood tests indicated vitamin D deficiency and secondary hyperparathyroidism. Magnetic resonance imaging of the cervical spine showed a large syrinx from the second cervical spine to the second dorsal spine. Although neuropathic arthropathy is uncommon, it should be considered in cases of unexplained pain, discomfort, or limited range of motion of the affected joint. Symptoms related to the affected joint may precede or overshadow neurological deficits. Appropriate radiological examinations and diagnoses are imperative to prevent misdiagnosis or undetected bone and joint disorders.

Syringomyelia after operation:diagnosis and its formational mechanism

Objective： To describe the MRI findings and discuss the pathogenesis formation mechanism of syringomyelia in the patients after spine surgical operation. Methods： Totally 13 patients were been enrolled in the study. Before operation, none of our patients presented with spinal cord syringomyelia. The mean follow-up duration was 6 years （range 2-10 months） by MRI. Four of the 13 patients after spinal cord tumor removed operation, 3 patients after spinal trauma operation, 2 cases had scoliosis before, 2 cases were cervical spondylotic myelopathy and 2 cases had tethered cord syndrome before operation. MR features of pre- and post-operation on all patients were been studied in contrast with surgical results and clinical symptoms. The radiology diagnostic was made by 3 different radiologists respectively. The characteristics of length, width, signals, shape of cavity and spinal cord position as well as subarachnoid shape were focused on. Results： All the patients had no syringomyelia on MRI before operation. The spinal cord of 7 patients showed persist compression and 2 patients had tethered cord before operation. MRI features of syringomyelia after operation in our cases showed longitudinal cavity with syrinx fluid had T1 and T2 relation characteristics of cerebrospinal fluid （CSF）. The mean length was 5.5 spinal segment, 4 cord of 13 patients presented cord compressed from anterior materials, 4 occurred postoperative adhesion to the back of lumbar spinal canal and spinal cord of 1 cases clung to the front wall of cervical spinal canal. Conclusion： The mechanism of syringomyelia in the patients after spinal surgical intervention may be the persisting compression or intention of the spinal cord in the period of pre- or post-operation. The edema, cyst, malacia of spinal cord are the most important lesions and risk factors resulted in the syringomyelia.

Adult Medulloblastoma Associated with Syringomyelia:A Case Report

The association between cerebellar medulloblastoma and syringomyelia is uncommon and only found in pediatric patients.To date,adult medulloblastoma associated with syringomyelia has not been reported in the literature.Paroxysmal bradycardia is an uncommon clinical manifestation in posterior fossa tumors and likely to be vagally mediated via brainstem preganglionic cardiac motor neurons.This report introduces the diagnosis and treatment of a case of adult medulloblastoma associated with syringomyelia, which presented with paroxysmal bradycardia.

Lumboperitoneal Shunt for Syringomyelia

A simple method of treatment for syringomyelia was investigated in this study. Fourteen patients with syringomyelia were treated by percutaneous lumboperitoneal (LP) shunt. After the surgical shunt, obvious shrinkage of the syrinx was observed in nine patients, no change of the syrinx in two patients, and noticeable postoperative expansion of the syrinx in three patients. The results suggest that cerebrospinal fluid (CSF) moves under intraspinal pressure into the spinal cord, contributing to the formation and maintenance of the syrinx in most of our patients, and that LP shunting can effectively shrink of the syrinx.

Treatment of syringomyelia using uncultured umbilical cord mesenchymal stem cells: A case report and review of literature

BACKGROUND Syringomyelia is a disease caused by the formation of a cavity inside the spinal cord and is accompanied by such symptoms as pain,paresthesia,and urination and defecation disorders,and in severe cases causes various paralyses.Currently,there are only surgical methods for the treatment of syringomyelia,but these methods carry the possibility of failure,recurrence,and side effects.CASE SUMMARY The patient was a 59-year-old woman who suffered from pain due to syringomyelia.For treatment,the patient received transplant of uncultured umbilical cord-derived mesenchymal stem cells.As intended,the patient's pain was relieved after treatment.Interestingly,an additional benefit was found in that the size of the cavity also decreased.After 2 years from the last treatment,the patient's cavity had almost completely disappeared and her syringomyelia was deemed cured.CONCLUSION Using uncultured umbilical cord-derived mesenchymal stem cells may be a new treatment alternative for syringomyelia.

Neuropathic arthropathy of the shoulder: Two cases of syringomyelia with cocaine use

Neuropathic arthropathy (NA) is a progressive, degenerative disorder associated with decreased sensory innervation of the involved joints. The shoulder joint is an uncommon presentation for NA, although syringomyelia is the most common cause for this joint. Two cases are presented of NA of the shoulder, with both patients having a history of syringomyelia and cocaine use. In both cases a work up for malignancy was negative, but imaging was consistent with NA. Although syringomyelia has been linked with this presentation in prior publications, the role of cocaine use may not be incidental, with complex biochemical interactions in bone metabolism. Cocaine has been shown to involve the Leptin, Neuromedin U (NmU), cocaine and amphetamine-regulated transcript (CART), and Receptor activator of nuclear factor kappa-B ligand (RANKL) pathways of bone remodeling. Treatment can be challenging, involving concurrent use of pharmacotherapy, surgical correction, and protective bracing.

Theco-thecal bypass technique elucidating a novel procedure and perspective on treatment of post-arachnoiditis syringomyelia:A case report

BACKGROUND Post-arachnoiditis syringomyelia is a condition in which there is an intraspinal cerebrospinal fluid(CSF)blockade due to arachnoidal adhesions and bands.Although many of the techniques currently in use,namely,the theco-peritoneal,syringo-pleural,syringo-peritoneal,and syringo-subarachnoid shunts,are effective,the results are often variable.CASE SUMMARY A 36-year-old man with a past history of pulmonary tuberculosis,presented with progressive paraesthesia in the feet and progressive paraparesis along with constipation,difficulty in micturition,and decreased libido.He was bedridden a month before presentation.Magnetic resonance imaging revealed a dorsal multiloculated syrinx from D3-D10 vertebral levels.He underwent a D1-2 to D11 theco-thecal shunt bilaterally to abolish the CSF gradient across the level of the syrinx.There was no direct surgical handling of the spinal cord involved.At the 15-mo follow up,the patient had significant improvement in his symptoms and function.CONCLUSION We present a novel technique aimed at correcting the primary cause of a postarachnoiditis syrinx,the subarachnoid cerebrospinal flow obstruction or block,which we believe is simple and effective,involves minimal handling of the normal neural structures,and attempts to restore the physiology of CSF flow across the obstruction,with favorable clinical results.

Clinical Efficacy of Minimally Invasive Subpial Tonsillectomy(MIST)for Treatment of Chiari Malformation(TypeⅠ)with Syringomyelia

Background To investigate the clinical efficacy of minimally invasive subpial tonsillectomy(MIST)in the treatment of Chiari malformation(type I)with syringomyelia.Methods A total of 209 Chiari malformation(type I)patients with syringomyelia were studied.The patients were grouped based on the syrinx diameter changes:complete disappearance group(48 patients),obvious shrinkage group(147 patients),and non-obvious shrinkage group(14 patients).The Chicago Chiari Outcome Scale(CCOS)was used to compare clinical data of the three groups of patients before treatment.The correlations between disease duration and syrinx diameter changes as well as post-treatment clinical symptoms were analyzed.The related factors of efficacy were analyzed.Results Age and disease duration were the oldest/longest in the non-obvious shrinkage group,and the youngest/shortest in the complete disappearance group(P<0.05).The maximum diameter reduction of syrinx was the greatest in the complete disappearance group,and the smallest in the non-obvious shrinkage group(P<0.05).The proportions of patients with hypoesthesia,limb weakness,and muscle atrophy were the largest in the non-obvious shrinkage group,and the smallest in the complete disappearance group(P<0.05).The CCOS score were the highest in the complete disappearance group,and the lowest in the non-obvious shrinkage group(P<0.05).There were statistically significant(P<0.05)negative correlations between disease duration and maximum diameter reduction of syrinx,CCOS pain score,CCOS non-pain score,CCOS functionality score,and CCOS complication score,disease duration and hypoesthesia,limb weakness,muscle atrophy,and sleep apnea.Result of multivariate stepwise regression analysis indicated that age,disease duration,and preoperative syrinx diameter were the risk factors for efficacy(P<0.05).Conclusion For patients with Chiari malformation complicated by syringomyelia,the longer the disease duration,the more difficult it is to achieve syrinx reduction and improve the clinical symptoms.“Minimally invasive subpial tonsillectomy(MIST)and cisterna magna reconstruction”is an improved surgical approach to treat Chiari malformation(cerebellar tonsil herniation).It has the advantages of small incision,less postoperative reaction,and fewer complications,and it emphasizes the reshaping and repair of cerebellar tonsils,reconstruction of cisterna magna,and restoration of cerebrospinal fluid circulation.

Ⅰ型Chiari畸形合并脊髓空洞的手术治疗策略

目的探讨有限后颅窝减压联合硬膜扩大修补术治疗Ⅰ型Chiari畸形合并脊髓空洞的临床疗效和手术经验。方法回顾性分析我院经有限后颅窝减压联合硬膜扩大修补术治疗的47例Ⅰ型Chiari畸形合并脊髓空洞患者的临床资料。术后复查MRI评估后颅窝容积变化、小脑扁桃体形态以及脊髓空洞形态变化等。采用日本骨科协会(JOA)评分评估患者神经功能改善情况,并记录并发症发生情况。结果47例患者均顺利完成有限后颅窝减压联合硬膜扩大修补术。术后并发症主要为单侧肢体麻木、切口疼痛、发热、皮下积液等,均经保守对症治疗后痊愈。随访期间患者临床症状和神经功能均有不同程度地改善和好转,无神经功能恶化或死亡病例。患者术后3个月的JOA评分为(15.83±1.31)分,高于术前的(14.66±2.06)分,差异有统计学意义(P<0.05)。术后6个月MRI显示,47例患者均可见脊髓空洞范围缩小或消失。结论有限后颅窝减压联合硬膜扩大修补术治疗Ⅰ型Chiari畸形合并脊髓空洞在保证减压效果的同时,还可以增加对后颅窝内容物的支撑,有效预防术后局部粘连,并恢复枕大池区脑脊液正常生理循环,是Ⅰ型Chiari畸形合并脊髓空洞的有效治疗方式。

术前牵引一期后路截骨矫形术治疗重度脊柱侧凸伴脊髓空洞的疗效分析

目的:分析重度脊柱侧凸(severe scoliosis,SS)伴脊髓空洞(syringomyelia,SM)患者术前牵引和手术截骨矫形的效果,探讨术前牵引一期后路截骨矫形手术治疗SS伴SM(SS-SM)患者的安全性和有效性。方法:回顾2007年1月~2023年10月我院行术前牵引一期后路截骨矫形手术的40例SS-SM病例,男19例,女21例,年龄11~41岁(18.28±6.66岁)。所有患者既往无神经外科手术治疗史,术前均行全脊柱X线片、CT及MRI检查,测量冠状面主弯角度、矢状面后凸角度、SM的大小[最大脊髓空洞/脊髓比值(maximal syrinx/cord ratio,S/C)]和长度,观察是否合并Chiari畸形,计算畸形角度比(deformity angular ratio,DAR),牵引过程中及术后均适时复查全脊柱X线片,评估患者脊柱畸形矫正情况。根据SM是否合并ChiariⅠ型畸形(ChiariⅠmalformation,CMⅠ)分为合并CMI SM组(CMⅠ-related SM,CS组)与特发性SM组(idiopathic SM,IS组);根据SM的大小分为大空洞组(big syrinx,S/C>0.6,BS组)与小空洞组(little syrinx,S/C≤0.6,LS组),统计分析不同组患者术前牵引与手术对矫形的贡献率并进行比较(CS组vs IS组、BS组vs LS组)。结果:40例患者SM的S/C为0.59±0.18,长度为9.43±5.50个节段。36例术前行颅-股骨牵引(skull-femoral traction,SFT),4例行颅重力牵引(halo-gravity traction,HGT),牵引过程中5例出现暂时性局部麻木,2例出现暂时性局部肌力减退,5例发生牵引钉道感染。29例(72.5%)行低级别截骨,11例(27.5%)行高级别截骨脊柱短缩融合术,脊柱融合节段数平均为13.48±1.34节段。术后躯干局部麻木2例,肺部感染4例,浅部术口感染3例,均未发生运动功能障碍。术前冠状面主弯角度、矢状面后凸角度、术前总畸形角度比(total DAR,T-DAR)分别为104.80°±18.58°、66.57°±31.21°、25.73°±8.30°/节段,牵引后分别为65.55°±19.00°、44.95°±23.32°、16.73°±7.24°/节段,矫形术后侧凸和后凸角分别为37.78°±14.91°、29.95°±14.14°,主弯柔韧性为(20.79±11.02)%。术后冠状面侧凸和矢状面后凸的总矫形率分别为(64.44±9.44)%和(51.74±18.40)%,牵引和手术对冠状面侧凸、矢状面后凸矫形的平均贡献率分别为(59.90±17.67)%和(40.10±17.67)%、(59.21±27.51)%和(40.79±27.51)%。CS组与IS组、BS组与LS组组间侧凸及后凸总矫形率、牵引与手术对侧凸及后凸矫形的贡献率之间无显著性差异,术前牵引均改善34%以上的DAR,实现50%以上的矫形贡献率。CS组男性比例较高,IS组中女性比例较高(P=0.027);两组患者年龄、术前主弯Cobb角和柔韧性、脊柱后凸角、DAR值、S/C和SM长度、牵引改善效果和术后总矫形率、融合节段、截骨等级、手术失血和手术时间、牵引与手术对脊柱矫形的贡献均无统计学差异(P>0.05)。BS组平均S/C比值明显高于LS组(0.74 vs 0.45,P<0.001),融合节段数少于LS组(13.00 vs 13.90,P=0.031),高级别截骨比例高于LS组(8/19 vs 3/21,P=0.049);两组患者年龄、术前主弯Cobb角及柔韧性、脊柱后凸角、DAR值、SM长度、牵引改善效果和术后总矫形率、手术失血和手术时间、牵引与手术对脊柱矫形的贡献率均无统计学差异(P>0.05)。结论:术前牵引可在一定程度上改善脊柱畸形,减小术中矫形难度及神经损伤风险;对于SS-SM患者,无论其否合并CMⅠ、SM大小如何,术前牵引均能为冠状面侧凸矫形及矢状面后凸矫形贡献一半以上的畸形矫正率;术前牵引一期后路截骨矫形手术治疗未行预防性神经外科干预的SS-SM是一种安全有效的治疗策略。

合并Chiari畸形Ⅰ型和脊髓空洞症的脊柱侧凸与特发性脊柱侧凸影像学特征和矫形效果比较

目的 比较合并Chiari畸形Ⅰ型和脊髓空洞症的脊柱侧凸与特发性脊柱侧凸(IS)患者的影像学特征和矫形效果。方法 回顾性分析2007年1月—2015年6月在昆明医科大学第二附属医院接受一期后路脊柱融合术治疗的合并Chiari畸形Ⅰ型和脊髓空洞症的22例脊柱侧凸患者资料(研究组),并与年龄、性别、主弯位置、侧凸数量、冠状面影像学参数1∶1配对的22例IS患者(IS组)进行比较。记录所有患者手术时间、预估出血量、融合节段数、螺钉密度等。在手术前后站立位脊柱全长正侧位X线片上测量并计算冠状面影像学参数(主弯Cobb角、侧曲角、柔韧性、顶椎位置、冠状面平衡)、矢状面后凸角、胸椎后凸角(TK)、腰椎前凸角(LL)、矢状位垂直轴(SVA)、畸形角度比(DAR)、矫形率及矫形丢失率。结果 所有手术顺利完成,研究组随访(6.2±1.2)年,IS组随访(6.2±1.1)年。2组患者手术时间、预估出血量、融合节段数、螺钉密度差异均无统计学意义(P> 0.05)。2组患者手术前后影像学参数差异均无统计学意义(P> 0.05)。所有患者均未发生螺钉松动、断裂、术后神经功能损伤等并发症。结论 术前年龄、性别、主弯位置、侧凸数量、冠状面影像学参数相匹配的情况下,伴发Chiari畸形Ⅰ型和脊髓空洞症的脊柱侧凸患者与IS患者具有相似的矢状面影像学参数和主弯柔韧性,且在一期后路脊柱融合术治疗后可获得相似的矫形效果。

Cerebrospinal fluid dynamics in Chiari malformation associated with syringomyelia

Background About 50%--70% of patients with Chiad malformation I （CMI） presented with syringomyelia （SM）, which is supposed to be related to abnormal cerebrospinal fluid （CSF） flow around the foramen magnum. The aim of this study was to investigate the cerebrospinal fluid dynamics at levels of the aqueduct and upper cervical spine in patients with CMI associated with SM, and to discuss the possible mechanism of formation of SM. Methods From January to Apdl 2004, we examined 10 adult patients with symptomatic CMI associated with SM and 10 healthy volunteers by phase-contrast MRI. CSF flow patterns were evaluated at seven regions of interest （ROI）： the aqueduct and ventral and dorsal subarachnoid spaces of the spine at levels of the cerebellar tonsil, C2-3, and C5-6. The CSF flow waveforms were analyzed by measuring CSF circulation time, durations and maximum velocities of cranial- and caudal-directed flows, and the ratio between the two maximum velocities. Data were analyzed by ttest using SPSS 11.5. Results We found no definite communication between the fourth ventricle and syringomyelia by MRI in the 10 patients. In both the groups, we observed cranial-directed flow of CSF in the early cardiac systolic phase, which changed the direction from cranial to caudal from the middle systolic phase to the early diastolic phase, and then turned back in cranial direction in the late diastolic phase. The CSF flow disappeared at the dorsal ROI at the level of C2-3 in 3 patients and 1 volunteer, and at the level of C5-6 in 6 patients and 3 volunteers. The durations of CSF circulation at all the ROIs were significantly shorter in the patients than those in the healthy volunteers （P=-0.014 at the midbrain aqueduct, P=-0.019 at the inferior margin of the cerebellar tonsil, P=-0.014 at the level of C2-3, and P=-0.022 at the level of C5-6）. No significant difference existed between the two groups in the initial point and duration of the caudal-directed CSF flow during a cardiac cycle at all the ROIs. The maximum velocities of both cranial- and caudal-directed CSF flows were significantly higher in the patients than those in the volunteers at the aqueduct （P=-0.018 and P=-0.007） and ventral ROI at the inferior margin of the cerebellar tonsil （P〈0.001 and P=-0.002）, as so did the maximum velocities of the caudal-directed flow in the ventral and dorsal ROIs at the level of C2-3 （P=-0.004; P=-0.007）. Conclusions The direction of CSF flow changes in accordance with cardiac cycle. The syringomyelia in patients with CMI may be due to the decreased circulation time and abnormal dynamics of the CSF in the upper cervical segment. The decompression of the foramen magnum with dural plasty is an alternative for patients with CMI associated with SM.

Chiari畸形合并脊髓空洞(CM-SM)手术前后的MR影像表现

目的探究Chiari畸形合并脊髓空洞(CMSM)手术前后的MR影像表现,分析其病因。方法选择本院收治的33例CM-SM患者为研究对象,对其临床资料和术前、术后M R影像资料进行回顾性分析。结果术后经MRI检查提示,脊髓空洞明显缩小的有26例,脊髓空洞轻微变小的偶6例,无明显变化的1例。手术后患者枕大池成形较好,小脑下疝堵塞有所改善,脑室出口通畅,术后蛛网膜下腔脑脊液明显多于术前。术前患者的中脑导水管脑脊液RF、MF、SV均明显少于术后6个月,V_(dmax)与V_(umax)高于术后6个月,对比差异显著(P<0.08);术前患者的桥延池脑脊液MF、SV明显少于术后6个月,V_(dmax)与V_(umax)高于术后6个月,对比差异显著(P<0.05)。术前与术后6个月的RF对比,无显著差异(P>0.05);术前患者的C2-3椎间盘脑脊液MF、SV均明显少于术后6个月,V_(dmax)与V_(umax)高于术后6个月,对比差异显著(P<0.05)。术前与术后6个月的RF对比,无显著差异(P>0.05)。结论MRI用于CN-SM患者手术前后检查,可以确定枕大孔区不全梗阻引起的脑脊液循环异常可形成脊髓空洞,经手术治疗后,枕大孔区梗阻解除,恢复脑脊液流动。

Charcot Elbow Joint as the Initial Symptom in Chiari Malformation with Syringomyelia

Charcot joint （CJ）, also known as neurotrophic arthropathy, is secondary to diabetes, syringomyelia, spinal tuberculosis, etc. The clinical manifestations are varied. The main performance includes pain, slightly restricted joint movement and very obvious swelling and damage of joint. It is easy to be misdiagnosed when the joint is the first symptom. We report a case of Charcot elbow joint as the initial symptom in Chiari malformation with syringomyelia.

运用经络辨证论治脊髓空洞症的临证经验

脊髓空洞症是当下诊断容易却难以治愈的慢性进行性疾病,其主要累及脊髓。西医治疗目前以手术治疗为主,对症治疗为辅,但疗效并不明显。针灸治疗对脊髓空洞症的症状改善以及延缓疾病的进展有着一定的疗效。运用升阳通督针法与盘龙刺法调节督脉气血,以调动全身阳气;从经络辨证体系诊疗本病并指导临床选穴与治疗,以疾病的辨位归经、辨候归经、辨经虚实三个方面,从经脉到病候临证论治;以及从神经、肌肉的解剖等结构针灸学方向考虑本病的病因病位,确立诊疗方案。

Clinical manifestations and significance of post-traumatic thoracolumbar syringomyelia

Objective: To analyze the pathogenic mechanism and the clinical significance of post traumatic thoracolumbar syringomyelia through reviewing the clinical manifestations. Methods: The data of 15 patients (14 males and 1 female, aged from 28 to 56 years, with an average of 36 years) with post traumatic syringomyelia treated in our hospital from December 1997 to February 2002 were studied retrospectively. Two patients suffered from T 11 fractures, 7 from T 12 fractures and 6 from L 1 fractures. There were 12 patients with burst fractures and 3 with fracture dislocations. Anterior decompression, bone graft, bone fusion and internal fixation were made on 6 patients, posterior decompression, bone graft, bone fusion and internal fixation on 1 patient, and non surgical treatment on 8 patients. Results: Syringomyelia of the patients was diagnosed accurately with magnetic resonance imaging at 0.5 4 years after the original thoracolumbar fracture. The cavern was round in 6 cases, elliptic in 6 cases, and irregular in 3 cases. The patients also suffered from pain (80%), myodynamia attenuation in lower extremities ( 66.7 %), aggravated spasm ( 46.7 %), sensation loss or hypesthesia ( 46.7 %), decreased coordinate function of lower extremities (20%) and autonomic nerve symptom ( 6.7 %). Conclusions: Post traumatic thoracolumbar syringomyelia should be suspected if the patient has new neurological symptoms, such as myodynamia attenuation in lower extremities, after the neural function becomes stable for certain time.

通道辅助微创后颅窝减压手术治疗ChiariⅠ型

目的评估应用通道辅助进行微创后颅窝减压手术治疗ChiariⅠ型畸形(CM-1)的临床效果.方法在2020年3月至2021年2月期间,北部战区总医院神经外科对20例CM-1成人患者进行了通道辅助下的后颅窝减压手术.其中13例采用显微镜技术,7例采用神经内镜技术.本研究通过回顾性分析,评估了手术前后神经功能、影像学检查结果、术后并发症以及术后12个月的颈椎日本骨科协会评分(JOA).结果20例患者在术后均有不同程度的症状改善,颈椎JOA评分平均恢复率为65.3%.术后MRI检查显示,3例患者的脊髓空洞完全消失,16例缩小,1例无变化.术后出现3例硬膜外积液和1例轻度感染,但无患者需要二次手术.结论通道辅助的微创后颅窝减压手术能够缓解脊髓压迫,有效减小脊髓空洞,并改善临床症状.该技术具有肌肉损伤小、恢复快的优点,是一种安全有效的治疗CM-1的手术方式.

基于日常生活活动评分的个性化护理模式对脊髓空洞症手术患者生活质量及恢复进程的影响

目的:回顾性分析基于日常生活活动评分(activity of daily living, ADL)的个性化护理模式在脊髓空洞症手术中的应用效果。方法:收集2021年10月至2023年10月郑州市中心医院140例脊髓空洞症手术患者,1:1匹配设计,按护理方法不同分为个性化组(n=70)、常规组(n=70),常规组行常规护理,个性化组在此基础上行基于日常生活活动评分的个性化护理模式。比较两组恢复进程、并发症发生情况、疼痛程度[视觉模拟评分法(visual analogue scale, VAS)]、负性情绪[心理状态症状自评量表(symptom check list-90,SCL-90)]、生活能力(ADL量表)。结果:个性化组下床活动时间、住院时间均短于常规组(P<0.05);个性化组脊髓损伤出血、感染、分流管堵塞、脑脊液漏等并发症发生率0.00%低于常规组8.57%(P<0.05);干预后,个性化组VAS评分较干预前降低,且个性化组低于常规组(P<0.05);干预后个性化组SCL-90评分低于常规组(P<0.05);干预后个性化组ADL评分低于常规组(P<0.05)。结论:脊髓空洞症手术患者实施基于ADL评分的个性化护理模式,能降低并发症发生率、减轻疼痛程度、加快恢复进程、改善负性情绪、提高生活能力。