ABSTRACT
Objective To assess the adequacy of decompression immediately in anterior cervical surgical procedures with epidurography, and to prevent from leaving compressive materials. Methods After completing primary decompression of anterior cervical intervertebral space by discectomy or corpectomy, posterior longitudinal ligaments were incised or resected, 5-10 ml Omnipaque 300 contrast medium was injected into upper and lower segments of decompressed area through a soft 18# injection needle. Distribution of the contrast medium in front of dura mater was observed by fluoroscopy so as to identify whether the spinal cords were decompressed completely. 64 patients suffered from cervical spondylotic myelopathy, and spinal cords were compressed respectively by giant intervertebral disc prolapse, osteophyte or short segmental OPLL. Intraoperative epidurography was performed after primary anterior decompression. If contrast medium in front of dura mater was discontinued by fluoroscopy, incomplete decompression was judged. 39 of 64 patients were followed up after operation, and in 18 patients of them MRI were taken within 1-12 weeks after operation. Neurological function was compared between preoperation, immediate postoperation and final follow-up by means of JOA scores. Results After completing primary decompression, epidurographs showed that the contrast medium were continuous in front of dura mater in 49 cases(77%), 11 patients of them were examined by MRI during follow-up and the images indicated that cervical cords were free of compression. In 15 cases (23%), the contrast medium was not continuous in front of dura mater, then decompression was performed further until the contrast medium no any interruption. 7 patients of them were confirmed by MRI that cervical cords were no more compressed. 39 patients were followed up postoperatively with a mean follow-up of 13 months. Neurological function was recovered immediately after operation by 52% and 61% at final follow-up. No neurological deficit progressed in all of them. Conclusion Intraoperative epidurography is effective and safe for assessment of decompression during anterior cervical surgical procedures.
ABSTRACT
Objective The theory of chemical radiculitis was put forward about 30 years ago, but it has not been proved by clinical study so for. The current study was initiated to assess whether the annular tear in painful disc was the cause of radiating leg pain (radiculopathy) in patients with discogenic low back pain. Methods Forty-two patients with chronic low back pain in single level and shooting leg pain in unilateral or bilateral lower limbs without lumbar disc herniation on CT and MR imaging were treated (age range, 19-52 years; mean age, 34.9 years; 27 males, 15 females). All patients showed annular disruption and pain reproduction on injection of the contrast during discography at single disc level (not including patients who had two or three levels disc disease). CT scan was performed to identify the location of annular tears after discography. The examinations of electromyography(EMG) and motor nerve conduction velocity (MCV) were performed in all patients, which were used to analyze the degree of nerve root injury and the relation with radiating leg pain. Results The patients with posterolateral annular disruption in single side mainly presented single lower limb radiation pain, in contrast, the patients with posterolateral annular disruption in two sides or posterior midline annular disruption mainly presented dual lower limb radiation pain. There was a significant positive correlation between the site of annular tear and the side of radiation pain. The examinations of EMG in all 42 cases found that there were abnormal insertional activities such as fibrillation potentials and positive sharp waves in 32 cases(76%). Of the 23 patients with unilateral lower limb radiation, nerve root lesions were found on the symptomatic side in 17 cases(74%). Of the 19 cases with bilateral lower limb radiation pain, root lesions were suggested in 15 patients(79%). The conduction velocities of common peroneal nerve and tibial nerve decreased with a statistically significant difference in symptomatic side compared with normal side. Conclusion Inflammatory chemical mediators and cytokines produced in painful disc leaking into epidural space through annular tear could lead to the injury to adjacent nerve roots, which might be primary pathophysiologic mechanism for the production of chemical radiculitis.