Efficacy analysis of selective posterior rhizotomy at medullary conus for treatment of double lower extremities spastic cerebral palsy / 中华实用儿科临床杂志

Objective To investigate the clinical efficacy of L1 -S1 selective posterior rhizotomy (SPR)at the medullary conus level for the treatment of double lower extremities spastic cerebral palsy(CP).Methods A total of 1 09 double lower extremities spastic CP children underwent SPR at the level of medullary consul were selected in the Second Affiliated Hospital of Xinjiang Medical University from October 201 0 to May 201 4.The 4 groups were analyzed in terms of muscle tension and gross motor function of the lower limbs 6 months before and after operation,retrospective-ly.The SPSS 1 7.0 software was used for statistical analysis.Results Patients had different degrees of improvement in gross motor function and reduction of spasticity in all muscle groups of lower limbs after operation.Six months after the operation,the muscular tension of hip flexor,hip adductor,knee flexor and plantar flexors (modified Ashworth spastic scale score)were all improved compared with preoperation (t =1 6.635,27.41 1 ,31 .362,38.81 9,all P <0.01 ).Gross motor function of lower limbs (Gross Motor Function Measure)at 6 months after the operation was significantly im-proved compared with preoperation (51 .97 ±1 2.92 vs 41 .01 ±1 1 .46),and the difference was significant(t =26.67, P <0.01 ).The postoperative complications:intracranial hypotension headache (5 cases,4.59%),postoperative high fever (2 cases,1 .83%),incision fat liquefaction (2 cases,1 .83%),sensory barriers of lower limbs (1 case, 0.92%),and urine obstacles (1 case,0.92%).Conclusions SPR at the level of medullary conus has the advantages of minimal injury,rapid recovery and little influence on the stability of the spine.In addition,the procedure can relieve the spasticity of lower limbs of the CP patients effectively.

Anatomia do cone medular aplicada à via epidural de administração de fármacos em macacos-prego (Sapajus libidinosus) / Anatomy of the medullary conus applied to the epidural route of administration of drugs in capuchin monkeys (Sapajus libidinosus)

Com este estudo objetivou-se descrever a topografia do cone medular do macaco-prego (Sapajus libidinosus) a fim de fornecer suporte para que a realização de procedimentos anestésicos, bem como exames de mielografia e coleta de líquor, dentre outros procedimentos que utilizam a via epidural. Para tanto foram dissecados oito animais, sendo seis machos e duas fêmeas, de diferentes faixas etárias. Rebateu-se a pele para retirada da musculatura da região dorsal, exposição de toda a coluna vertebral e identificação das vértebras lombares e sacrais. Para estabelecer o final da medula espinhal e medir o comprimento do cone medular, foi aberto todo o canal vertebral lombossacro, seccionando-se lateralmente os arcos vertebrais. Em seguida a duramáter foi seccionada para visualização do cone medular e observação da relação topográfica deste com as vértebras. Todos os animais apresentaram cinco vértebras lombares e três vértebras sacrais. As vértebras se apresentaram, de forma geral, muito próximas e com os processos espinhosos bem desenvolvidos e direcionados em sentido cranial. O cone medular dos macacos-prego situou-se entre as vértebras L2 e L5, com a base localizando-se com maior frequência na altura da vértebra L3, enquanto o ápice em L4. O comprimento corporal (espaço interarcual occiptoatlântico até o espaço interarcual sacrocaudal) variou de 22,9 a 31,8cm, com média de 27,44 ±3,1cm enquanto que comprimento do cone medular variou de 1,70 a 3,51cm, com média de 2,47 ±0,57cm. Não houve correlação entre o tamanho do corpo e o comprimento do cone medular (r = 0,212). Conclui-se que apesar das variações do comprimento e posicionamento do cone medular, o seu ápice não ultrapassa a articulação lombossacral, tornando seguro o acesso ao espaço epidural por esta via.(AU)

This study aimed to describe the topography of the conus of capuchin monkey (Sapajus libidinosus) to provide support for anesthetic procedures, as well as examinations of myelography and CSF collection, among other procedures using the epidural route. Eight animals were dissected, six males and two females, of different ages. The skin was countered for removal of the dorsal musculature for exposure of the entire spine and identification of the lumbar and sacral vertebrae. To establish the end of the spinal cord and to measure the length of the conus medullaris, we opened the lumbosacral spinal canal through side section of the vertebral arches. The dura mater was sectioned to visualize the conus and to observe the topographical relation with the vertebrae. All animals showed five lumbar vertebrae and three sacral vertebrae. The vertebrae were in general very closed with the spinous processes well developed and directed cranially. The conus of capuchin monkeys was located between the L2 and L5 vertebrae, with the base mostly in the L3 vertebra, and the peak in L4. The body length (interarcual space occiptoatlântico until sacrocaudal interarcual space) ranged from 22.9 to 31.8cm, with a mean of 27.44±3.1cm while the medullary cone length ranged from 1.70 to 3.51cm, with a mean of 2.47±0.57cm. There was no correlation between body size and length of the medullary cone (r=0.212). It is concluded that despite the variations in length and positioning of the medullary cone, its height does not exceed the lumbosacral joint, making safe access to the epidural space in this way.(AU)