Effect of decompression range on decompression limit of cervical laminoplasty / 中华医学杂志(英文版)

BACKGROUNDS@#Cervical posterior decompression surgery is used to relieve ventral compression indirectly by incorporating a backward shift of the spinal cord, and this indirect decompression is bound to be limited. This study aimed to determine the decompression limit of posterior surgery and the effect of the decompression range.@*METHODS@#We retrospectively reviewed the data of 129 patients who underwent cervical open-door laminoplasty through 2008 to 2012 and were grouped as follows: C4-C7 (n = 11), C3-C6 (n = 61), C3-C7 (n = 32), and C2-C7 (n = 25). According to the relative location of spinal levels within a decompression range, the type of decompression at a given level was categorized as external decompression (ED; achieved at the levels located immediately external to the decompression range margin), internal decompression (ID; achieved at the levels located immediately internal to the decompression range margin), and central decompression (CD; achieved at the levels located in the center, far from the decompression range margin). The vertebral-cord distance (VCD) was used to evaluate the decompression limit. The C2-C7 angle and VCD on post-operative magnetic resonance images were analyzed and compared between groups. The relationship between VCD and decompression type was analyzed. Moreover, the relationship between the magnitude of the ventral compressive factor and the probability of post-operative residual compression at each level for different decompression ranges was studied.@*RESULTS@#There was no significant kyphosis in cervical curvature (> -5°), and there was no significant difference among the groups (F = 2.091, P = 0.105). The VCD of a specific level depended on the decompression type of the level and followed this pattern: ED < ID < CD (P < 0.05). The decompression type of a level was sometimes affected by the decompression range. For a given magnitude of the ventral compressive factor, the probability of residual compression was lower for the group with the larger VCD at this level.@*CONCLUSIONS@#Our study suggests that the decompression range affected the decompression limit by changing the decompression type of a particular level. For a given cervical spinal level, the decompression limit significantly varied with decompression type as follows: ED < ID < CD. CD provided maximal decompression limit for a given level. A reasonable range of decompression could be determined based on the relationship between the magnitude of the ventral compressive factor and the decompression limits achieved by different decompression ranges.

Etiological analysis, preventional and therapeutical strategies for the unsatisfied cervical posterior decompression surgery / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the causes of unsatisfied cervical posterior decompression surgery and describe the overhauling strategies and precaution.</p><p><b>METHODS</b>The clinical data of 14 patients required revision surgery were retrospectively analyzed, and these patients with unsatisfied effects were due to cervical posterior decompression surgery from January 2012 to December 2014. Overhauling reasons were analyzed and then different revision procedures were performed. The functions of cervical cord and ambulation were evaluated respectively by modified Japanese Orthopedic Association(mJOA) score and Nurick grade according to the course order:preoperative for the first time, pre-revision and at final follow-up. Improvement rate of nerves function were calculated before and after operation for the first time, before and after revision. Above data were statistically analyzed by SPSS16.0 software.</p><p><b>RESULTS</b>Reoperation reasons including 2 patients with the insufficiency width of laminectomy, 2 patients with the inadequate length of decompression, 2 patients with nerve root and spinal cord compression caused by fractured collapse, 4 patients with closed the door of vertebral lamina, 1 patient with less open-door angle, 2 patiens with ossification of posterior longitudinal ligament (1 case complicated with close the door), 2 patients with cervical spine kyphotic deformity aggravating (1 case complicated with close the door), 1 patient with nerve root canal stenosis caused by uncovertebral joint hyperplasia. Preoperative for the first time, pre-revision and at final follow-up, mJOA scores were 11.89±1.67, 13.11±1.09, 15.61±0.59, and Nurick grades were 4.21±0.58, 3.57±0.51, 1.71±0.47, respectively. There was significant difference between final follow-up and preoperative for the first time, pre-revision(<0.05). Improvement rate of nerve function was (22.33±9.49)% with bad before and after operation for the first time, and (64.60±9.88)% with good before and after revision, with statistical significance(<0.05).</p><p><b>CONCLUSIONS</b>Individualized revision surgery based on different causes for unsatisfied cervical posterior decompression can improve the function of spinal cord. Preoperative carefully analyzing the etiological factors, thoroughly decompression can reduce the revision rate.</p>

Reoperation to the ossification of the posterior longitudinal ligament / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss surgical approaches of ossification of the posterior longitudinal ligament (OPLL) of cervical spine.</p><p><b>METHODS</b>Between June 2005 to July 2010, 36 patients with OPLL of cervical spine were reoperated. There were 23 male, 13 female, age from 39 to 72 years (mean 57 years). The time of the first operation to the reoperation were 4 months to 24 years, an average of 3.9 years. Among 20 patients underwent anterior corpectomy and fusion (ACD) at first operation, 14 cases combined stenosis of cervical spinal canal, 10 cases were insufficient decompression of OPLL, 5 cases injured of cervical spinal cord during the first operation, 1 case was adjacent disc herniation. Among 14 cases underwent expensive open-door laminoplasty (ELAP) at first operation, 6 cases were insufficient decompression of OPLL, 4 cases were inadequate decompressed segment, 2 cases were cervical segmental kyphosis, 2 cases were progression of OPLL combined with disc herniation. Among 2 cases underwent combined approach at first operation, 1 case was insufficient decompression of OPLL, the other was adjacent disc herniation. Their pre- and post-operative X-ray, CT and MRI were analyzed. The complications of reoperation were recorded.</p><p><b>RESULT</b>There were 30 patients followed-up, with a period of 1.5 - 4.0 years, average 1.8 years. With 36 patients, none had deterioration, 2 patients had no recovery post-reoperation, 34 patients had 31.2% Japanese Orthopedic Association score improve rate. Among 22 cases underwent ELAP at second operation, 3 cases had postoperative segmental palsy. Among 14 cases underwent ACD at second operation, 3 cases had intraoperative dural defects.</p><p><b>CONCLUSION</b>Surgical strategy for OPLL of cervical spine should consider the type of OPLL and stenosis of cervical spinal canal.</p>

A prospective randomized comparison between with or without instrumentation in short-level anterior discectomy and autograft bone fusion / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate anterior cervical plating in short-level anterior discectomy and autograft bone fusion.</p><p><b>METHODS</b>Eighty-one patients who underwent one- and two-level anterior cervical discectomy and fusion were randomized to 2 groups, with or without instrumentation. Among them, 55 patients were followed up. The mean follow-up time was (22 +/- 7) months. Fusion rate, disc height and cervical lordotic alignment were assessed by radiographs.</p><p><b>RESULTS</b>The improving rates were 68% in non-instrumented group and 58% in instrumented group, respectively (P > 0.05). The fusion rate was 93% in the non-instrumented group and 100% in the later one. The disc height was decreased (0.7 +/- 1.0) mm in the former group and increased (1.2 +/- 0.6) mm in the later one (P < 0.01). Although the postoperative cervical lordotic alignment was maintained better in instrumented group, the difference was not significant.</p><p><b>CONCLUSION</b>Anterior cervical plating can make good influence on the result of anterior cervical discectomy and fusion in some degree.</p>

Surgical treatment of the cervical spine fractures combined with ankylosing spondylitis / 中华创伤骨科杂志

Objective To study effects and other related problems of surgery for patients with cervical spine fracture and ankylosing spondylitis.Methods Twelve patients with cervical spine fracture and ankylosing spondylitis were treated with surgery from April 1986 to April 2004.All eases were studied retrospectively.They were followed up for an average of 67.5 months and their complete clinical data were kept.The neurological function was evaluated by ASIA (American Spinal Injury Association) impairment scale,and the image analyzing software (Image-Pro Plus 5.1) was used to measure the angles of superior and inferior vertebral bodies of the fusion segment at flexion and extension positions.The difference between flexion and extension angles,?,served as the parameter of interspinal movement.According to the definition of spinal fusion by FDA (Food and Drug Administration),the?≥4?was considered as nonfusion.Other related problems were discussed by descriptive study.Results The average improvement in the nine patients with neurological injury was 1.3 ASIA grades.The injured segments in 10 cases were treated with fusion,of whom nine were fused by internal fixation.The fusion rate was 100%.Three cases were scheduled to have laminoplasty,but two had to receive laminectomy instead because of intraoperative complete fracture at the hinged side.Ten patients were complicated by insufficient function of major organs preop- eratively,and endotracheal intubation was difficult to perform in eight cases.Postoperative complications occurred in three cases,but fortunately healed completely.There were no deaths or fatal complications.Conclusions The neurological function can be improved by surgery for patients with cervical spine fracture and ankylosing spondylitis. Although the cervical spine is instable for most of the patients,fusion with internal fixation is indicated and can be successful.Those who had preoperative systemic diseases are likely to suffer from postoperative complications.The difficult endotracheal intubation is a common intraoperative problem.

The role of Clq receptor and anti-Clq antibody in the pathogenesis of systemic lupus erythematosus / 中华风湿病学杂志

Objective To investigate the expression of Clq complement receptor(ClqRp and gClqR)in the peripheral blood mononuclear cells(PBMC)of systemic lupus erythematosus(SLE), and the corre|ation between serum levels of complement lq(Clq)and anti-Clq autoantibodies(ClqAb)with ClqRp and gClqR is analyzed. The probable mechanism of ClqRp and gClqR in the development of SLE is explored. Methods The peripherial blood monouclear cells of 58 SLE patients and 30 healthy subjects were collected for the detection of the expression of ClqRp and gClqR by flow cytometry. The serum levels of Clq and ClqAb were detected by single radial immunodiffusion and enzyme-linked immunosorbent assay(ELISA)re- spectively. The correlation between ClqRp and gClqR and other disease activity parameters, such as Clq, ClqAb, SLEDAI score, anti-dsDNA antibody, C3, C4 levels were analyzed. Results The expression of ClqRp on mononuclear and neutrophiles of SLE was(7.2?2.3)% and(3.4?2.1)%, lower than that in healthy individuals [(10.6?2.1)% and(9.0?8.7)% ], P