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Objective:To explore the curative effect of anterior cervical surgery for lower cervical dislocation combined with spinal cord injury.Methods:A retrospective case series study was carried out to analyze the clinical data of 72 patients with lower cervical dislocation and spinal cord injury admitted in Beijing Boai Hospital, China Rehabilitation Research Center from January 2011 to August 2018, including 55 males and 17 females, with an average age of 35.8 years (range, 18-63 years). The segments of injury were at C 3 in 2 patients, at C 4 in 16, at C 6 in 24 and at C 7 in 30. Bases on American Spinal Injury Association (ASIA) grade, there included grade A in 43 patients, grade B in 22, grade C in 6 and grade D in 1. All patients were treated with anterior decompression and fusion. Operation time, intraoperative hemorrhage, decompression and fusion, complications and ASIA grade were observed. Results:All patients were followed up for 3-72 months (average 24.2 months). Operation time was 90-180 months [(118±58)minutes] and intraoperative bleeding volume was 50-180 ml [(104±30)ml]. Spinal cord was decompressed in all patients. The reduction was excellent in 58 patients (81%) and fair in 14 patients (19%). Fusion was confirmed in 48 patients (67%). The complications were improved after timely treatment, including cervical edema in 1 patient, laryngeal edema in 1, cerebrospinal fluid leakage in 4 and axial pain in 2. ASIA grade change of spinal cord injury: grade A were recovered to grade B in 2 patients, grade A to grade C in 1, grade B to grade C in 1, grade C to grade D in 2 ( P>0.05). Conclusion:For dislocation of lower cervical spine combined with spinal cord injury, anterior surgery can obtain good decompression, reduction and fusion effect, but it has limited help for improvement of neurological function.
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@#Respiratory dysfunction is the primary cause of death early after cervical spinal cord injury, and it can be restored by electrical stimulation, magnetic stimulation, nerve transfer surgery, and cell transplantation. This paper reviewed the anatomy, clinical manifestations,and associated restoration techniques of respiratory muscle dysfunction after cervical spinal cord injury.
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@#Objective To explore the factors related with bladder function after surgical intervention in patients with first lumbar burst fractures uniting isolated conus medullaris syndrome (CMS). Methods 25 patients complicated CMS in 618 patients with Ｌ1 burst fracture were analyzed retrospectively. Results The recovery rate of patients with saddle sensation weakness was higher than the patients with saddle sensation disappeared (P<0.05). There was no difference in bladder function between patients accepted surgery within 2 weeks and more than 2 weeks (P>0.05). Conclusion Saddle sensation before surgery related with the recovery of bladder function.
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BACKGROUND: Glucocorticoid-induced osteoporosis has relationship with the down-regulation of osteoprotegedn expression. Osteoprotegerin could inhibit bone resorption in the animal experiment and clinical application for treating oestrogenic hormone deficiency osteoporosis. OBJECTIVE: To investigate the effects of exogenous recombinant osteoprotegerin fusion protein on glucocorticoid-induced osteoporosis in rats. DESIGN, TIME AND SETTING: Randomized grouping, controlled animal expenment was performed in the Institute of Orthopedics, Chinese PLA General Hospital between January 2006 and June 2008. MATERIALS: Sixty healthy male Wistar rats of clean grade; Dexamethasone was produced by Tianjin Jinyao Amino Acid Co., Ltd (Licenca No. H12020515). METHODS: Sixty rats were divided into 3 groups randomly with 20 rats in each. Control group: the rats were administrated with 0.9％ sodium chloride. Dexamethasone group: the rats were administrated with dexamethasone intramuscularly. Osteoprotegedn group: the rats were administrated with dexamethasone and recombinant osteoprotegerin intramuscularly. MAIN OUTCOME MEASURES: All rats were sacrificed at 12 weeks after administration. The urine calcium, phosphor, creatinine, bone mineral density, biomechanics tests of femur and vertebral body, were measured. Immunohistochemistry staining were performed to observe osteoprotegerin expression.RESULTS: Sixty rats were all involved in the final analysis. ①Compared with control group, udne calcium increased in the Dexamethasone group (P < 0.05); the bone mineral density of lumbar vertebra and femur decreased significantly (P < 0.05), especially lumbar vertebra (P < 0.01); biomechanics tests of femur and vertebral body (maximum load, maximum stress, elasticity load, elasticity stress, elastic modulus) decreased significantly (P < 0.05); immunohistochemistry staining showed that endogenous osteoprotegerin expressions were reduced significantly in bone marrow of Dexamethasone group (P < 0.01). ②Compared with Dexamethasone group, urine calcium decreased in the osteoprotegerin group (P < 0.01 ); the bone mineral density of lumbar vertebra and femur increased (P < 0.05); the parameters of biomechanics testa of femur and vertebral body increased (P < 0.05); the osteoprotegerin expression was not changed between Dexamethasone group and osteoprotegerin group.CONCLUSION: Glucocorticoid could inhibit osteoprotegerin expression in the bone followed by progressive bone loss and induce osteoporosis. Recombinant osteoprotegerin works effectively in inhibiting bone resorption after administrated with glucocorticoid, reduce bone resorption index, increase bone mineral index and bone strength, thus improving the osteoporosis which is induced by glucocorticoid.
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@#Objective To explore the effects of rehabilitation for adult cervical spinal cord injury without radiological abnormality. Methods 80 patients were studied retrospectively. Results The increase of motor score of anterior, posterior and conservative group were around 5, 2 and 2, whereas that of FIM were 11, 17 and 15, respectively. The changes of sensory score were uncertain.Conclusion The effect of surgical or conservative treatment is limited on neurological recovery, while rehabilitation can bring more functional independence to patients with cervical spinal cord injury without radiological abnormality.
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@# Objective To summarize clinical characteristics and treatment methods of cervical vertebrae injury in the elderly.MethodsThe data of 59 elderly patients with cervical vertebrae injury from 2002 to 2006 years were retrospectively reviewed.ResultsThe most common type of injuries was hyperextension injuries of cervical spine and cervial central cord syndrome.Traffic accident and falling injury were the most common reasons.Early operation and early rehabilitation could improve the ASIA 1 or 2 grade,and avoid complications of cord injury effectively.ConclusionThe key treatment point of cervical vertebrae injury in the elderly is how to get them leave bed in order to reduce the complications of cord injury,early operation and rehabilitation are good method to decrease the mortality and increase quality of life.
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@#Objective To summarize clinical characteristics and treatment methods of cervical vertebrae injury in the elderly.MethodsThe data of 59 elderly patients with cervical vertebrae injury from 2002 to 2006 years were retrospectively reviewed.ResultsThe most common type of injuries was hyperextension injuries of cervical spine and cervial central cord syndrome.Traffic accident and falling injury were the most common reasons.Early operation and early rehabilitation could improve the ASIA 1 or 2 grade,and avoid complications of cord injury effectively.ConclusionThe key treatment point of cervical vertebrae injury in the elderly is how to get them leave bed in order to reduce the complications of cord injury,early operation and rehabilitation are good method to decrease the mortality and increase quality of life.
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[Objective]To examine the relationship of thoracic kyphosis with gender,age,shape of thoracic vertebral bodies and intervertebral discs.[Method]The gender,age data and MR films of Thoracic spines of 61 cases were collected in a retrospective study.The MR films were scanned into computer.Vertebral and disc morphology,as represented by antero-posterior height ratios,were quantified in computer.Kyphosis was indicated by the Cobb angle.Pearsons correlation analysis and stepwise regression were applied to examine relationship between them.[Result]Vertebral morphology was highly related with thoracic curvature,while a poorer association was noted to disc morphology.The combined infuence of both morphology of vertebral body and intervertebral disc accounted for the variability in kyphosis in 81% female,and 72% in male.[Conclusion]The normal kyphosis of the thoracic spine is determined by the morphological state of both the vertebral bodies and intervertebral discs,especially in female.
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[Objective]To compare the neurological improvement of the patients with spinal cord injury without radiographic abnormality (SCIWORA)after primary treatment including operation via anterior/posterior approach and conservative management,and to discuss about evaluating standard for this kind of patients.[Method]Eighty adult cervical SCIWORA patients,72 males and 8 females with an average age of 52.7 years(34 to 74 years)and a follow up period of 53 weeks (48 to 60 weeks),were retrospectively studied. They were divided into the anterior operated,posterior operated and conservative treated groups. The motor and sensory scores and impairment scale of each patient were obtained at least three times by international standard for the neurological classification of spinal cord injury (ASIA standard),and those of their first and final visits to the hospital were retrieved and analyzed. Mann-Whitney U Test and Wilcoxon Rank Sum Test were used in statistic study.[Result]All the patients achieved an average increase of 2 to 5 points of motor scores (P
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[Objective]To analyze the clinical characteristics and treatment methods of upper-middle thoracic fractures with spinal cord injury.[Method]Forty patients with upper-middle thoracic fracture were retrospectively reviewed.Hanley-Eskay classification was used:compression fractures in 4,burst fractures in 11,fracture-dislocations in 23,and burst dislocation in 2 cases.Neurologicall function(according to the ASIA classification):A in 29,B in 3,C in 4,D in 0,and E for 4 cases.Four cases without spinal cord injury received conservative treatment.Thity-six cases with spinal cord injury underwent laminectomy and reduction followed by posterior fusion with bone graft and pedicular screw instrumentation.All 36 cases received early rehabilitation.[Result]All 40 cases were evaluated clinically,radiographically,and functionally during the follow-up(mean,32 months).Conservative group:one case developed delayed kyphosis deformity with neurological deficit and underwent anterior-posterior surgical treatment 16 months tater.Surgical group:the correction in 3 patients was not complete on radiographs after operation.No loose screw or breakage was found,and the grafted bone was completely fused.Among the patients with spinal cord injury,one case in ASIA A improved to ASIA B,one case in ASIA B improved to ASIA C,two cases in ASIA C improved to ASIA D.All of the 4 cases with hemorrhage less than 4 mm(MIRI) increased 1 grade of ASIA.Activities of daily living(ADL)scores were increased (average,22.53?6.25)at early rehabilitation in all cases.[Conclusion]The upper-middle thoracic fractures are involved in multipla spine vertebral levels,high dislocation incidence,serious spinal cord injury(most cases were complete injury),poor prognosis.Presence of hemorrhage less than 4 mm (MRI) was associated with good prognosis.Posterior approach decompression and reduction followed by fusion with bone grafting and pedicle screws instrumentation are ideal surgical methods for patients with fresh fractures.Early rehabilitation may improve daily life ability and prevent complications.