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【Objective】 To evaluate the curative effect of posterior atlantoaxial joint release and internal fixation in treating unstable craniocervical junction malformation （UCVJM）. 【Methods】 This study retrospectively enrolled 31 patients with UCVJM， who received posterior atlantoaxial joint release and internal fixation between January 2015 and December 2018. The pre- and postoperative changes of the Japanese Orthopaedic Association （JOA） scores， the cervicomedullary angle （CMA）， the atlantodental interval （ADI） and the height above the Chamberlain line of the odontoid （H） were traced to evaluate whether clinical symptoms， compression of spinal cord， horizontal and vertical dislocation of atlantoaxial were improved postoperatively. 【Results】 The average operation duration， bleeding during operation and the average days of hospitalization were （168.38±38.21）min， （147.09±59.84）mL， and （9.54±2.81） days， respectively. None of the patients had vertebral artery or spinal cord injury during operation. JOA score， ADI， H， and CMA were （11.94±1.37） points， （2.72±1.08）mm， （3.03±0.78）mm， and （145.35±8.00）° respectively on the 6th days after operation compared with the preoperative （9.94±1.26） points， （4.96±1.60）mm， （6.89±1.36） mm and （122.16±9.58）°， with statistical differences， which indicated all indexes were improved （all P<0.001）. During 6-25 months’ follow-up， there was no internal fixation looseness or displacement and JOA score was increased to （13.16±1.19） for all the patients in the last follow-up （all P<0.001）. 【Conclusion】 The posterior atlantoaxial joint release combined with internal fixation is safe and effective for patients with UCVJM.
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【Objective】 To explore the application of multi-mode electrophysiological monitoring technology in cervical spine surgery. 【Methods】 We retrospectively collected data of patients who received cervical spine surgery in Department of Neurosurgery of our hospital in January 2018 to December 2019. All patients were guided by the bispectral index (BIS) to control the depth of anesthesia. High cervical spine lesions were treated with somatosensory evoked potentials (SEP), motor evoked potentials (MEP), brainstem auditory evoked potentials(BAEP)and electromyography (EMG) monitoring. We selected SEP, MEP and EMG combined monitoring for low cervical nerve and spinal cord injury, recorded and summarized the abnormalities of intraoperative electrophysiological monitoring, surgical efficacy and complications at the time of discharge and 6 months after surgery. 【Results】 The intraoperative BIS parameters of 112 patients were 45-60, the MEP amplitude decreased in 9 cases (8.0%), the SEP amplitude decreased in 4 cases (3.6%), the EMG amplitude was abnormal in 5 cases (4.5%), and the BAEP amplitude decreased in 4 cases (3.6%); no operation was terminated due to significant abnormalities in monitoring. Compared with 44 cases (39.3%) before operation, 112 patients had little change in SEP and MEP amplitudes, 35 cases (31.3%) had a slight increase in SEP amplitude, 2 cases (1.8%) had a slight decrease, 24 cases (21.4%) had slightly increased MEP amplitude, while 7 cases (6.3%) had slightly decreased one. There were no new neurological disorders at the time of postoperative discharge and 6 months after surgery. 【Conclusion】 Multi-mode electrophysiological monitoring shows the recovery of damaged nerve electrophysiological activity immediately after the operation, which provides an objective basis for the recovery of nerve function, and can effectively prevent and reduce iatrogenic spinal cord and nerve function damage, and improve the efficacy of surgery.
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【Objective】 To compare the application of modified selective posterior rhiotomy of spinal nerve with traditional rhiotomy in the treatment of spastic cerebral palsy and to evaluate the efficacy and complications of the two surgical methods. 【Methods】 The clinical data of 52 patients with spastic cerebral palsy were analyzed retrospectively. Among them 23 cases were treated with traditional selective posterior rhiotomy and the remaining 29 cases with modified selective posterior rhiotomy. Operation time, amount of blood loss, proportion of root after spinal nerve amputation, postoperative complications, spasm index, ankle clonus, and Holden walking ability at 1 year after operation were compared between the two groups. 【Results】 The operation time of modified selective posterior rhiotomy was longer than that of conventional surgery (P0.05). The proportion of root was smaller in the modified group than in the traditional group (P<0.05). The improved group was superior to the traditional group in the disappearance of ankle clonus (P<0.05). 【Conclusion】 Modified selective posterior rhiotomy has more advantages in eliminating ankle clonus. It is a safe and effective surgical improvement method to evaluate the changes of muscle tension and ankle clonus to quantitatively cut the posterior root of spinal nerve during the operation. This can reduce the proportion of the posterior root of spinal nerve during the operation, and keep the anatomical and functional basis for reducing the occurrence of surgical complications.
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【Objective】 To discuss and summarize the choice of the operation plan and evaluation of curative effect of spasmodic cerebral palsy. 【Methods】 Clinical data of 80 patients with spastic cerebral palsy treated by neurosurgery in The First Affiliated Hospital of Xi’an Jiaotong University were collected retrospectively and analyzed statistically. Eighty patients were followed up for 12 to 52 months, with an average follow-up of 21.3 months. The muscle tension grading, spasm index, range of motion, Holden walking ability and postoperative complications were compared one year after surgery. 【Results】 Totally 64 cases received selective posterior rhizotomy (SPR) combined muscle strength muscle tension adjustment method (MMA) and 16 cases selective peripheral neurotomy combined muscle strength muscle tension adjustment method. The grade and spasm index of muscle tension decreased significantly one year after operation (P<0.001). The range of joint motion and Holden walking ability were significantly improved (P<0.001). Transient urination disorder occurred in two cases (2.5%), and limb sensation disorder in two cases (2.5%), all of which were improved within three months. Weakness of dorsiflexion of foot in one case (1.25%). 【Conclusion】 Selective partial neurotomy and muscle tension adjustment is a safe and effective surgical method to treat spasmodic cerebral palsy. Real-time evaluation of muscle tension and ankle clonus changes during the operation is an important factor to ensure the postoperative efficacy.
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【Objective】 To explore the application of multi-mode electrophysiological monitoring technology in highly selective posterior rhizotomy (SPR) of patients with spastic cerebral palsy. 【Methods】 We retrospectively collected data on patients with systolic cerebral palsy who underwent SPR in our hospital from January 2019 to December 2019. Bispectral index (BIS), somatosensory evoked potentials (SEP) and electromyography during surgery of all the patients were measured. We used EMG to monitor the depth of the anus, spinal cord function, and the stimulation response of multiple muscle groups, and recorded and summarized abnormal intraoperative electrophysiological monitoring, surgical treatment and complications during displacement and discharge, and relief and exercise functional recovery six months after the surgery. 【Results】 The intraoperative BIS parameters of 18 patients were 60-75, the EMG amplitude was abnormal in 1 case (5.6%), and the SEP amplitude decreased in 1 case (5.6%). The preoperative muscle tension of both lower extremities was 3.6 on average, and the postoperative muscle tension was 1.4, with a decrease by 2.2 grades. There were 16 cases (88.9%) in long-term follow-up, among which 12 cases (75%) had complete relief of spasm, 4 cases (25%) had significant improvement, gait function improvement rate was 100%, and no complications occurred. 【Conclusion】 Multi-mode electrophysiological monitoring technology is an effective method for SPR to increase the success rate of surgery. It can increase the accuracy of the ratio of posterior root resection of spinal nerves, reduce the risk of spinal cord damage, and improve the poor prognosis.
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【Objective】 To quantitatively analyze the surgical freedom of odontioectomy via endoscopic endonasal approach. 【Methods】 Seven adult head specimens were dissected by the endoscopic transnasal approach to the sellar region and craniocervical junction. The center of sellar floor (CenSF), opticocarotid recess (LOCR), foramen magnum, atlas, atlas-occipital joint and tip of odontoid process (TOP) were exposed. The surgical freedom of TOP was calculated by using the spatial coordinate positioning system of neuronavigation, and compared with that of LOCR and CenSF. 【Results】 CenSF and LOCR were common landmarks in the endonasal endoscopic approach. When the surgical freedom between TOP and CenSF and LOCR was compared, it indicated that ① The angle of attack on axial plane (AAAP):There was a significant difference among TOP, LOCR and CenSF (5.7 ° vs. 6.9 ° vs. 8.5 °, P=0.004). The comparison between the two groups showed that TOP was less than CenSF (P=0.003). ② The angle of attack on sagittal plane (AASP): There was a significant difference among TOP, LOCR and CenSF (6.3° vs. 7.0° vs. 9.5°, P=0.009). The TOP was less than CenSF (P=0.008). ③ There was no statistical significance between TOP and LOCR in surgical freedom (P=0.604, P=0.688). 【Conclusion】 Endoscopic transnasal approach can provide sufficient surgical freedom for odontoidectomy.
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【Objective】 To investigate the clinical efficacy of modified posterior fossa decompression in treating Chiari type I malformation under the neuroendoscope. 【Methods】 We made a retrospective analysis of the clinical data of 63 patients with Chiari type I malformation treated at the Neurosurgery Department of The First Affiliated Hospital of Xi’an Jiaotong University from January 2015 to December 2019. Of the patients, 28 ones underwent modified posterior fossa decompression assisted with neuroendoscopy (observation group) while 35 received posterior fossa decompression with duraplasty (control group). Tator grading, syringomyelia improvement and complications were compared between the two groups to evaluate the postoperative efficacy. 【Results】 The operations were successful in all the 63 patients and no death or severe neurological dysfunction was observed. The efficacy rate was 78.6% in the observation group and 54.3% in the control group, with significant difference (P0.05). 【Conclusion】 Modified posterior fossa decompression assisted with neuroendoscope is a safe and effective treatment for Chiari type Ⅰ malformation. Intraoperative dural watertight suture and dural-muscle suspension can help reduce the occurrence of subcutaneous effusion.
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Chiari malformation, also known as cerebellar tonsillar hernia, is a congenital developmental anomaly in which the cerebellar tonsils extend downward and protrude into the cervical spinal canal through the foramen magnum. It is a common craniocervical junction malformation. Its pathogenesis is complex and clinical manifestations are diverse. Also Chiari malformation is accompanied by many complications. Its pathogenesis remains not clear; therefore, its treatment is controversial. In recent years, new understanding and great progress have been made in the pathogenesis, diagnosis and treatment of Chiari malformation. In this paper, we discuss the classification, pathogenesis and diagnosis of Chiari malformation. In addition, we summarize the operation of Chiari with the hope to provide some help for further basic and clinical research.
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ABSTRACT:Objective To compare the clinical effects of Zero-P and traditional titanium plate with cage in treating single level cervical spondylosis.Methods We retrospectively analyzed the clinical data of 28 patients with single level cervical spondylosis who underwent anterior cervical discectomy and fusion (ACDF)by traditional titanium plate with cage (group A,n=16)or Zero-P implant (group B,n=16)in our department between January 2012 and January 2014.The intraoperative blood loss,operation time,postoperative JOA scores,JOA recovery rate,NDI scores,and dysphagia incidence in both groups were measured and compared.The changes of the midpoint interbody height (IBH),the cervical Cobb angle of the surgical segment and the cervical Cobb angle of C2 and C7 vertebral body were measured on the standing lateral cervical spine X-ray.Results The operation time was significantly longer in group A than in group B (P 0 .0 5 ).The incidence of dysphagia was lower in group B than in group A.The two groups did not significantly differ in JOA score or JOA improvement rate during the same period after operation (P>0.05).The NDI score in group B was significantly lower than that in group A (P0 .0 5 ).The midpoint interbody height in group B was significantly greater than that in group A (P0.05).Conclusion Zero-p and traditional titanium plate with cage have similar effects in treating single level cervical spondylotic myelopathy,and Zero-P system has the advantages of lower incidence of dysphagia after operation,shorter operation time and better recovery of postoperative cervical physiological structure.
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Objective To investigate the indications,surgical principles and advantages and disadvantages of microsurgery of intra-spinal tumor via the quadrant pathway.Methods We made a retrospective analysis of the clinical data of patients with spinal canal tumors treated via the quadrant pathway from October 2014 to July 201 5. Results Totally 1 6 patients were included.Their tumors were fully removed by microscopic resection,in which there were three epidural cases,twelve subdural extra-medullar cases,and one intra-medullar case.In terms of stage,there were three cases of cervical segment (C3 - C7 ),four cases of thoracic (T1 - T10 ),nine cases of thoracic and lumbar ones (T1 1 - S2 ). In pathology, there were nine cases of neurilemmoma, two cases of neurofibroma,four cases of meningeal tumor and one case of neuroepithelial cyst.The postoperative symptoms and signs of the patients were significantly improved,and no recurrence or complications occurred in the follow-up 2-10 months.Conclusion Quadrant pathway can be used in removing spinal epidural and subdural tumor,which is shorter than two vertebral segments in length,and the cross-sectional area is less than 2/3 of the spinal cord. However,surgery with extensive adhesion and intra-medullary lesions should be performed carefully,and the surgical techniques are more demanding and a longer learning curve is needed.
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Objective To compare the modified expanding suspended laminoplasty and posterior pedicle screw fixation applied in lumbar intraspinal tumors and evaluate operation,complications,postoperative neurofunctional improvement and lumbar lumbar stability in the two groups.Methods We made a retrospective analysis of the clinical data of 1 14 cases of lumbar intraspinal tumors, including 66 cases of modified expanding suspended laminoplasty and 48 cases of posterior pedicle screw fixation.We compared the operation time,operation bleeding volume,and incidence of postoperative cerebrospinal fluid leakage in the two groups.We also analyzed the lumbar instability and spinal cord injury score standard by the Japanese Orthopedic Association (JOA)between the two groups at 3,6, 12,and 24 months after operation.Results The results of modified expanding suspended laminoplasty group were significantly better than those of posterior pedicle screw fixation group in operation time, operation bleeding volume and incidence of postoperative cerebrospinal fluid leakage (P 0.05).At 3,6 or 12 months after the operation, changes in the increase of JOA score of the two groups had no significant difference (P > 0.05 ).However,24 mouths after the operation,the group of posterior pedicle screw fixation had significantly improved JOA score compared with that in the modified expanding suspended laminoplasty group.Conclusion Both the modified expanding suspended laminoplasty and posterior pedicle screw fixation have a favorable outcome of postoperative lumbar instability and neurofunction.And posterior pedicle screw fixation is superior to modified expanding suspended laminoplasty in improving neurofunction.
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Objective To study intraoperative neural electrophysiological monitoring applied in lumbosacral spinal cord tumor resection.Methods We retrospectively reviewed the clinical data of 212 patients undergoing lumbosacral spinal cord tumor resection with or without intraoperative neural electrophysiological monitoring in our hospital.The patients were divided into two groups:124 patients in the monitored group received intraoperative neural electrophysiological monitoring while 88 ones in the control group did not.The monitoring was performed by recording the cortical somatosensory evoked potential (CSEP),dermatomal somatosensory evoked potential (DSEP) and electromyography (EMG).The patients were followed up for 3-6 months and their postoperative outcome was analyzed.Results There were significant differences in the outcome (P <0.05),but no difference was found in the incidence of complications between the monitored group and the control group.The sensitivity of CSEP +DSEP+EMG was 100%,and the specificity was 55.9% in the former group.Conclusion Combined monitoring with CSEP,DSEP and EMG during lumbosacral spinal cord tumor resection is valuable in protecting the spinal nerve roots and ensuring better operation safety.
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Objective To evaluate the value of pedicled fat and capsule-packed nerve root in operation of sacral canal cysts.Methods We collected the information of 14 cases of sacral canal cysts for operation in our department and analyzed the operation indications and skills as well as the prognosis.Results All the operations were performed with the help of the microscope and the electrophysiological monitor.The capsules were removed in 9 cases and wrapped in 6 cases,with the total resection rate of 64.3%.The clinical symptoms were improved markedly after the operation.Conclusion The operation with pedicled fat and the capsule-packed nerve root is valuable in treating sacral canal cysts because it can protect the nerve root and get lower recurrence rate.
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Spine surgery is a branch of science bridging neurosurgery and orthopedics.In our country,spinal neurosurgery started relatively late and its development is unbalanced regionally despite rapid development in recent years.In this paper, we make an objective evaluation of the development and present situation of spinal neurosurgery in China and its existing problems.We also introduce some theoretical knowledge about stability of the spine as well as some methods commonly used in clinic to protect and reconstruct spinal stability. We urge neurosurgeons to pay more attention to the learning of and research on spinal stability and biomechanics,and perform spinal surgery vigorously and assuredly.
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Objective To compare the clinical efficacy of intraspinal tumor resection under quadrant channel and hemilaminectomy surgery.Methods We retrospectively studied 33 patients with intraspinal tumor with the lesion length of less than 5 cm hospitalized in our hospital from July 2013 to July 201 5.Of the 33 patients,1 6 patients received intraspinal tumor resection under quadrant channel and 1 7 patients received intraspinal tumor resection under hemilaminectomy surgery.We compared various indicators in the two groups,including the length of surgical incision,surgical operation time,bleeding volume during operation,time for the first ground activity after surgery,length of hospital stay (LOS)after surgery,visual pain simulation (VAS)score 1 week after surgery, and JOA score excellent and good rates.Results The patients who received quadrant channel intraspinal tumor resection outperformed those who received hemilaminectomy surgery regarding the length of surgical incision, bleeding volume during operation,time for the first ground activity after surgery,LOS after surgery,and VAS score 1 week after surgery (P <0.05 ).Conclusion Intraspinal tumor resection under quadrant channel is a safe and effective therapy because of small trauma,less bleeding,quick recovery and curative effect.