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OBJECTIVE@#To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly.@*METHODS@#The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred.@*CONCLUSION@#The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.
Subject(s)
Male , Female , Humans , Aged , Infant , Constriction, Pathologic/surgery , Spinal Stenosis/surgery , Decompression, Surgical/methods , Retrospective Studies , Lumbar Vertebrae/surgery , Endoscopy/methods , Treatment OutcomeABSTRACT
OBJECTIVE@#To compare the clinical efficacy of full endoscopic lamina fenestration discectomy (Endo-LOVE) with full endoscopic transforaminal approach discectomy in the treatment of degenerative lumbar lateral recess stenosis.@*METHODS@#A retrospective analysis of 48 patients with degenerative lumbar lateral recess stenosis between March 2018 and March 2019 was performed. There were 32 males and 16 females, aged from 60 to 83 years old with an average of (72.9±6.5) years, course of disease ranged from 5 to 16 years with an average of (8.0±2.8) years. The patients were divided into observation group and control group according to surgical approaches. There were 28 cases in observation group, underwent Endo-LOVE surgery;and 20 cases in control group, underwent full endoscopic foraminal approach discectomy. The operation time, intraoperative blood loss, hospitalization day and complications were observed between two groups. Visual analgue scale (VAS), Japanese Orthopaedic Association(JOA), Oswestry Disability Index(ODI), lateral crypt angle were compared between two groups. And clinical effects were evaluated by modified Macnab standard.@*RESULTS@#There was no significant difference in follow-up and operation time between two groups (P>0.05). Intraoperative blood loss was from 5 to 15 ml with an average of (8.4±3.6) ml in observation group and 5 to 25 ml with an average of (11.5±5.4) ml in control group. The hospitalization day was from 5 to 8 days with an average of (6.0±1.0) days in observation group and 6 to 9 days with an average (7.2±1.1) days in control group. Intraoperative blood loss and hospitalization day were significantly lower in observation group(P<0.05). There were no serious complications in both groups. The VAS, JOA scores, and ODI at 3-month and final follow-up were significantly improved in both groups (P<0.05), and observation group was significantly better than control group (P<0.05). The skeletal lateral crypt angle and soft lateral crypt angle were significantly greater than the preoperative angle at 3 days postoperatively(P<0.05), and observation group was significantly better than control group(P<0.05). At the final follow-up, the modified Macnab criteria was used to assess clinical efficacy, in observation group, 22 patients obtained excellent results, 5 good and 1 fair;while 11 excellent, 4 good and 5 fair in control group;the clinical efficacy of observation group was significantly better than that of control group(P<0.05).@*CONCLUSION@#Both surgical methods are performed under direct vision, with high safety and good clinical efficacy. However, Endo-LOVE enlarged the lateral crypt more fully.
Subject(s)
Male , Female , Humans , Child, Preschool , Child , Adolescent , Retrospective Studies , Blood Loss, Surgical , Constriction, Pathologic/surgery , Lumbar Vertebrae/surgery , Endoscopy/methods , Diskectomy/methods , Treatment Outcome , Spinal Stenosis/surgery , Intervertebral Disc Displacement/surgery , Diskectomy, Percutaneous/methodsABSTRACT
【Objective】 To compare the clinical efficacy of percutaneous transforaminal endoscopic decompression （PEID） and percutaneous interlaminar endoscopic decompression （PETD） in the treatment of L5-S1 lateral recess stenosis. 【Methods】 We selected the patients in our center diagnosed with L5-S1 lateral recess stenosis from March 2018 to October 2019 and divided them into Group A and Group B according to the principle of prospective， single-blind， and randomized control （A： PETD； B： PEID）. The operation was performed by the same senior surgeon with mature spinal endoscopy technology. We recorded the basic information， operation duration， usage count of C-arm， hospital stay， VAS score and ODI index of lower back and lower limbs before operation and 3 days， 1 month， 1 year and the last follow-up after the operation， and the operative excellent and good rates （the last follow-up）. The angle of bony lateral recess was measured during pre- and postoperative CT. 【Results】 A total of 95 patients （A： n=48； B： n=47） successfully completed the operation and were followed up for at least 1 year. The two groups did not significantly differ in age， gender， hospital stay， or complication by lumbar intervertebral disc herniation， but PEID group had significantly shorter operation duration and fewer usage counts of C-arm （P<0.001）. VAS score of lower back and lower limbs， and ODI index were significantly reduced at 3 days，1 month， 1 year and the last follow-up after the operation， with no significant difference between the two groups at the same time； no statistical difference was found between the two groups in operative excellent and good rates at the last follow-up （P>0.05）. The postoperative bony side recess angle was significantly improved （P<0.05）， while there was no significant difference in either pre- or postoperative bony side recess angle between the two groups （P>0.05）. 【Conclusion】 Both PEID and PETD are effective strategies in the treatment of L5-S1 lateral recess stenosis and can achieve good clinical outcomes.
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【Objective】 To investigate the effect of decompression technique with bone-chisel under percutaneous spinal endoscopy through transforaminal approach in elderly patients with unilateral lateral recess stenosis （ULLRS）. 【Methods】 We enrolled 46 old patients with ULLRS who underwent percutaneous spinal endoscopy through transforaminal approach assisted with bone-chisel technique from March 2017 to July 2019. The visual analogue scale （VAS） score of low back pain and leg pain， the Oswestry dysfunction index （ODI）， and the modified MacNab score before and after operation were obtained. We also recorded preoperative and postoperative sagittal diameter measured by computer tomography （CT） to evaluate decompression of the lateral recess. All the patients were followed up for at least 1 year for complications. 【Results】 All the 46 patients were followed up for 17 to 42 months. Dural tear occurred in one case， transient nerve root irritation in two cases， and there were no other complications. The low back pain VAS score， lower limb pain VAS score， and ODI index of all the patients were significantly improved in the last follow-up （P<0.05）. The results of the modified MacNab efficacy evaluation at the last follow-up revealed that the excellent and good rate was 91.3% （excellent in 38， good in 4， and fair in 4）. The sagittal diameter （mm） of the bony lateral recess 1 year after surgery increased by an average of 55.8%， which was significantly better than that before surgery （t=6.354， 4.22±1.25 vs. 2.71±0.57， P<0.001）. 【Conclusion】 Percutaneous spinal endoscopy through transforaminal foramen approach combined with bone-chisel technique is effective in treating ULLRS in elderly patients.
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A partir de la introducción de las técnicas modernas en diagnóstico por Resonancia Magnética por Imágenes (RMI), revolucionó la comprensión de las malformaciones cavernosas, permitiendo su diagnóstico preciso. En paralelo, el avance de las técnicas microquirúrgicas y el conocimiento de las zonas seguras de acceso al tronco cerebral han definido los accesos para su resección segura. Se presenta un caso de paciente varón de 25 años de edad, sin antecedentes patológicos, consulta por cefalea de un año de evolución. En RM donde se observa lesión nodular en relación con el receso lateral derecho. Se realiza abordaje suboccipital medial, con acceso telovelar hacia el receso lateral con la exéresis completa de la lesión. Un adecuado conocimiento sobre la anatomía del IV ventrículo, seleccionando el abordaje microquirúrgico más apropiado, con técnica quirúrgica meticulosa es prioritario en la resección de cavernomas en esta localización. El devastador resultado neurológico que puede ocurrir en un paciente con una malformación cavernosa del tronco encefálico cuando estos sangran, plantean a la resección microquirúrgica como la mejor opción en aquellas lesiones accesibles a través de zonas seguras.
From the introduction of modern imaging techniques with Magnetic Resonance Imaging, it revolutionized the understanding of cavernous malformations, allowing for accurate diagnosis. In parallel, the advancement of microsurgical techniques and the knowledge of safe areas of access to the brain stem have defined access for safe resection. We present a case of male patient of 25 years of age, without pathological history, consultation for headache of one year of evolution. In MRI where nodular lesion is observed in relation to the right lateral recess. A medial suboccipital approach was performed, with telovelar access to the lateral recess with complete excision of the lesion. An adequate knowledge about the anatomy of the IV ventricle, selecting the most appropriate microsurgical approach, with meticulous surgical technique is a priority in the resection of cavernous in this location. The devastating neurological outcome that can occur in a patient with a cavernous malformation of the brainstem when they bleed, posed to microsurgical resection as the best option in those lesions accessible through safe areas.
Subject(s)
Humans , Male , Congenital Abnormalities , Brain Stem , Magnetic Resonance Imaging , HeadacheABSTRACT
Introduction: The lumbosacral spine is the region of transition from the appendicular to the axial skeleton.Accidents, degenerative conditions, congenital defects and neoplastic metastases often affect the lumbar region.Low back pain resulting from lumbar canal stenosis is one of the major complaints in young to adult population.Apart from that lumbar vertebrae morphometry is required in many surgical as well as anaesthetic procedures.Aims and objectives: The present study was undertaken to determine the morphometry of human cadavericlumbar vertebrae and to compare findings with other authors and forming a baseline data in relation to variouslumbar canal pathologies that can be of help to the medical and surgical experts.Materials and methods: Dried lumbar vertebrae were obtained from the Department of Anatomy of RegionalInstitute of Medical Sciences, Imphal, India. Vertebrae belonging to same set and without any external deformitywere chosen and separated into typical and atypical ones. Measurement of Midsaggital diameter, Interpediculardistance, and Anteroposterior diameter of lateral recess was done using digital vernier calliper.Observations and Results: The study showed increase in all the diameters from L1 to L5 with a narrowing in allcases at L3 level. Therefore, L3 remains the transition point in all the measurements and thus one of the possiblesites for nerve root compression due to canal stenosis, which is one of the major causes of low back pain.Conclusion: The present data forms a baseline of adult lumbar vertebral morphology and is useful source ofinformation to surgeons, physicians and anatomists. It is also helpful for the screw and implant manufacturers.Further study with sex and ethnic consideration can generate forensic and anthropological data.KEY WORDS: Lumbar vertebrae, Lumbar canal stenosis, Morphometry, Midsaggital diameter, Interpediculardistance, Lateral recess diameter.
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STUDY DESIGN: Prospective clinical study. PURPOSE: To investigate the effect of percutaneous transforaminal endoscopic surgery (PTES) for lateral recess stenosis (LRS)(LRS) in elderly patients and to assess patients’ health-related quality of life (HRQoL). OVERVIEW OF LITERATURE: PTES is an increasingly used surgical approach, primarily employed for lumbar disc herniation treatment. However, indications for PTES have been increasing in recent years. PTES has been recommended as a beneficial alternative to open decompression surgery in specific LRS cases; PTES is termed as percutaneous endoscopic ventral facetectomy (PEVF) in such cases. METHODS: In total, 65 elderly patients with LRS were prospectively studied. Patients presented severe comorbidities (coronary insufficiency, heart failure, diabetes mellitus, and respiratory failure); thus, general anesthesia administration would potentially cause considerable hazards. All the patients underwent successful PEVF in 2015–2016. The patients were assessed preoperatively and at 6 weeks; 3, 6, and 12 months; and 2 years postoperatively. Patients’ objective assessment was conducted according to specific clinical scales; the Visual Analog Scale (VAS) was separately used for leg and low-back pain (VAS-LP and VAS-BP, respectively), whereas the Short Form 36 Health Survey Questionnaire was used for the HRQoL evaluation. RESULTS: All studied parameters presented maximal improvement at 6 weeks postoperatively, with less enhancement at 3 and 6 months with subsequent stabilization. Statistical significance was found in all follow-up intervals for all parameters (p<0.05). Parameters with maximal absolute amelioration were VAS-LP, bodily pain, and role limitations due to physical health problems. In contrast, VAS-BP, general health, and mental health were comparatively less enhanced. CONCLUSIONS: PEVF was associated with remarkably enhanced HRQoL 2 years postoperatively. PEVF is thus a safe and effective alternative for LRS surgical management in elderly patients with severe comorbidities.
Subject(s)
Aged , Humans , Anesthesia, General , Clinical Study , Comorbidity , Constriction, Pathologic , Decompression , Diabetes Mellitus , Follow-Up Studies , Health Surveys , Heart Failure , Leg , Mental Health , Prospective Studies , Quality of Life , Visual Analog Scale , Weights and MeasuresABSTRACT
<p><b>OBJECTIVE</b>To explore the safety and effectiveness of percutaneous transforaminal endoscopic BEIS technology for lumbar lateral recess stenosis in the elderly.</p><p><b>METHODS</b>From February 2014 to May 2016, 21 patients with lumbar lateral recess stenosis in elderly were treated with percutaneous endoscopic BEIS. There were 13 males and 8 females, aged from 70 to 85 years old with an average of 74.3 years. Preoperative, 1 and 12 months postoperative visual analogue scale(VAS) scores and Oswestry Disability Index(ODI) were statistically analyzed. MacNab was used to assess the clinical effects.</p><p><b>RESULTS</b>All the operations were successful. The time ranged from 90 to 130 min with an average of 110 min. All the patients were followed up for 12 to 38 months with an average of 18 months. Preoperative, 1 and 12 months postoperative VAS scores were 8.47±1.23, 1.78±0.72, 0.68±0.32, and ODI scores were 32.48±10.03, 19.53±3.55, and 5.15±1.02, respectively. Postoperative scores of VAS and ODI were obviously improved(<0.05). According to modified MacNab standard to evaluate the clinical effects, 14 cases obtained excellent results, 5 good, 2 fair. Lower limb paresthesia occurred in 1 case, and the condition was restored at 3 months postoperatively with conservative treatment. One patient was complicated with emphysema before operation secondary to pulmonary infection, and was effectively controlled with regulate antibiotic therapy. No infection of vertebral body or intervertebral space, no injuries of blood vessels or nerve root, no tear of dura, or the leakage of cerebrospinal fluid were found.</p><p><b>CONCLUSIONS</b>Percutaneous transforaminal endoscopic BEIS is a safe and effective method for lumbar lateral recess stenosis in the elderly.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Diskectomy, Percutaneous , Endoscopy , Lumbar Vertebrae , Lumbosacral Region , Pathology , Spinal Stenosis , General Surgery , Treatment OutcomeABSTRACT
OBJECTIVE To discuss the clinical features of primary lateral recess cysts of the sphenoid sinus,and to study the therapeutic effect of the endoscopic surgery.METHODS Nine patients with primary lateral recess cysts of the sphenoid sinus received endoscopic surgery from 2007 to 2015.Clinical data of the disease was analyzed retrospectively.Seven cases complained of cheek numbness as the chief complaint and 2 cases with progressive vision loss as the chief complaint.There were no obvious positive signs in head and facial regions.All cases were underwent marsupialization of the cysts via sphenoid sinus with nasal endoscope under general anesthesia.RESULTS All the cases had no intraoperative and postoperative complications,and the symptoms were disappeared after operation.No recurrence was found during follow-up of 6 to 24 months.The cavity of the cysts had permanent drainage to sphenoid sinus after operation in all the patients.CONCLUSION 1.Primary lateral recess cysts of the sphenoid sinus had unique symptoms and imaging characteristics.2.The marsupialization of the cysts via sphenoid sinus with nasal endoscope under general anesthesia was a safe,effective and minimally invasive method to management of the primary lateral recess cysts of the sphenoid sinus.
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STUDY DESIGN: A single-center, retrospective patient review of clinical and radiological outcomes of microsurgical posterior lumbar interbody fusion and decompression, without posterior instrumentation, for the treatment of lateral recess stenosis. PURPOSE: This study documented the clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression of the lateral recess using interbody cages without posterior instrumentation for the treatment of lateral recess stenosis. OVERVIEW OF LITERATURE: Although microsurgery has some advantages, various complications have been reported following microsurgical decompression, including cage migration, pseudoarthrosis, neurologic deficits, and persistent pain. METHODS: A total of 34 patients (13 men, 21 women), with a mean age of 56.65+/-9.1 years (range, 40-77 years) confirmed spinal stability, and preoperative radiological findings of lateral recess stenosis, were included in the study. Interbody polyetheretherketone cages and auto grafts were used in all patients. Posterior instrumentation was not used because of limited resection of the posterior lumbar structures. Preoperative and postoperative radiographs, computed tomography scans, and magnetic resonance imaging were assessed and compared to images taken at the final follow-up. Functional recovery was also evaluated according to the Macnab criteria at the final follow-up. RESULTS: The average follow-up time was 35.05+/-8.65 months (range, 24-46 months). The clinical results, operative time, intraoperative blood loss, and duration of hospital stay were similar to previously published results; the fusion rate (85.2%) was decreased and the migration rate (5.8%) was increased, compared with prior reports. CONCLUSIONS: Although microsurgery has some advantages, migration and pseudoarthrosis remain challenges to achieving adequate lumbar interbody fusion.
Subject(s)
Humans , Male , Constriction, Pathologic , Decompression , Follow-Up Studies , Length of Stay , Magnetic Resonance Imaging , Microsurgery , Neurologic Manifestations , Operative Time , Pseudarthrosis , Retrospective Studies , TransplantsABSTRACT
STUDY DESIGN: A prospective radiological assessment was conducted. OBJECTIVES: To analyze the changes in the heights of the intervertebral disc and neural foramen, and the diameters and areas of the dural sac and lateral recess following anterior lumbar interbody fusion and posterior fixation in lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: Anterior lumbar interbody fusion distracts from the height of the intervertebral disc and neural foramen and increase the area of the spinal canal. MATERIALS AND METHODS: A mini-open anterior lumbar interbody fusion and posterior fixation was performed on 40 cases between January 1999 and March 2002. The measured factors included the height of the intervertebral disc and neural foramen, the midsagittal and lateral diameters of the dural sac, the area of the dural sac and the diameter of the lateral recess. These were measured with calipers in 1mm reconstructive computed tomography images before and 6 months after the anterior lumbar interbody fusion. The measured factors were independently taken by three different orthopaedic surgeons. RESULTS: The heights of the intervertebral disc and neural foramen were increased by means of 39.1 and 18.7% respectively. The midsagittal diameter of the dural sac was increased by a mean of 11.6% and that of the lateral dural sac decreased by a mean of 3.7%. The area of the dural sac was increased by a mean of 8.1% and the diameter of lateral recess by a mean of 26.3%. There were statistically significant increases in all the measured factors, with the exception of the lateral diameter of the dural sac. CONCLUSIONS: Anterior lumbar interbody fusion significantly increases the heights of the intervertebral disc and neural foramen, the midsagittal diameter of the dural sac, the area of the dural sac and the diameter of the lateral recess, but not the lateral diameter of the dural sac.
Subject(s)
Intervertebral Disc , Prospective Studies , Spinal Canal , SpineABSTRACT
Objective To review the preliminary experience on managing the patients suffering from lumbar disc herniation with lateral recess stenosis by microedoscopic discectomy.Methods A total of 79 patients affected with lumbar disc herniation with lateral recess stenosis were treated by MEDⅡ in our hospital from Jan 2002 to Sep 2004.Results All patients were discharged within 7 d postoperatively and no complications occurred.The average duration of follow-up was 12.3 months and the successful clinical outcome was 99%.Conclusion Microendoscopic discectomy is a minimum invasive procedure.The successful clinical outcome could be achieved in properly selected patients.The microendoscopic discectomy is an effective procedure in managing lumbar intervertebral disc herniation with lateral recess stenosis.
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Objective To explore the normal number of lumbar lateral recess and the relationship between the CT pathology and clinical manifestation in the patients who suffered from lumbar lateral recess stenosis. Methods Lumbar specimen of 15 normal adult corpse and 20 healthy volunteers were observed, and the anterior and posterior(AP) sagittal diameters of normal lumber lateral recess were measured. The CT pathology and clinical manifestation of 174 patients who suffered from lumbar lateral recess stenosis were analysed. Results At the levels of L1 and L2, the lateral recess was found in about 34% normal persons.At the levels of L3 to S1, the lateral recess was found in all healthy persons.All patients who suffered from lumbar lateral recess stenosis had narrow AP sagittal diameters of lumbar lateral recess (
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The distance between the medial border of the two articular processes was measured by CT and MRI. At the level of C5-6-7 it was 23-25 mm(24mm on average). If the distance is 24 mm at C5-6 a tuohy needle is inserted 10 mm(24?2-2) lateral to the midline. When the needle touches vertebral lamina, withdraw the needle 2mm and redirect it cephalad at 45-60, Resistance is encountered when the needle touches ligament flavum. When the resistance disappears, the tip of the needle has entered the lateral recess via tuohy needle. This approach was used in 45 patients with satisfactory results. In ten patients the position of the cathter was confirmed with contrast medium by CT and MRI.
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The new approaches were designed to have anti-inflammatory analgetics act concentratively on the surrounding of pathological nerve roots or to inject collagenase directly to the protruding lumbar intervertebral disc for more simple and effective treatment of the low back pain. Method: The approaches to epidural lateral recess via incisura margo lateralis of lamina arcus vertebrae or margo medialis of joint processus artieularis were supposed and applied in clinic after study of anatomy and analysis of lumbar vertebra X-ray and CT photographes. The safety and feasibility of the approaches were evaluated according to the test of block region, measurement of therapeutic effect and monitoring of CT during the whole procedures in some cases. Result: A total of 170 cases via the incisura margo lateralis of lamina areus vertebrae were tested, 168 cases turned out to be successful and 2 cases failing. Another 15 cases via margo medialis of joint proeessus articularis, all punctures were successful. Conclusion: The approaches can lead to epidural lateral recess precisely to obtain a better treatment. When the technique is applied to discolysis, no X-ray machine will be needed and therefore no injury of X-ray occurs to both doctors and patients.
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The intense radicular pain of sciatica caused by a herniated disc is familiar. That similar symptoms may result from nerve root entrapment in a stenotic lateral vertebral recess without discal herniation is less well known and its possibility should be considered in the patients with root pain. We recently experienced a case of superior facet syndrome in a 57 years old female with intense sciatic pain. On operation, the right L-5 root was found to be entrapped in a stenotic lateral recess beneath the superior articular facet of the L-5 vertebra. There was no evidence of a herniated disc. The result was clinically excellent with surgical unroofing of the lateral recess with removal of the overhanging horizontal portion of the superior facet, L-5 vertebra of right.
Subject(s)
Female , Humans , Middle Aged , Intervertebral Disc Displacement , Sciatica , SpineABSTRACT
Objective To investigate the effects of sterigmatocystin(ST) on the ependymal cells,neurons and endothelial cells of blood vessel of the lateral recess of the fourth ventricle in BALB/c mice in vivo after single oral administration. Methods BALB/c mice were treated intragastrically by gavage with ST 3000??m/kg.The mice were killed 1 hour,2 hours,4 hours,8 hours,16 hours after oral administration respectively for observing ependymal cells,neurons and endothelial cells of blood vessel of the lateral recess with transmission electron microscopy(TEM).Results After oral administration of ST pinocytosis vesicles began to increase in endothelial cells of blood vessel in 1 hour,apocrine of ependymal cells began to increase and myelin sheath degeneration appeared in 2 hours,extensive myelin sheath degeneration and mitochondrion degeneration and incisure and vacuoles in nucleus of neuron were found in 4 and 8 hours.Lipofuscin was found in cytoplasm of neuron 16 hour.Conclusion Oral ST exposure in mice could cause myelin sheath degeneration and damaged changes of neurons.