Association Between Constipation and a Reduction in Lower Limb Muscle Strength in Preoperative Patients with Thoracic Spinal Tumors / 中国医学科学杂志(英文版)

Objective To investigate the clinical symptoms experienced by patients with thoracic spinal tumors and verify the associated symptoms that are predictive of a decline in muscle strength in the lower limbs. Methods A single-center, retrospective cross-sectional study was conducted on in-patients diagnosed with epidural thoracic spinal tumors between January 2011 and May 2021. The study involved a review of electronic medical records and radiographs and the collection of clinical data. The differences in clinical manifestations between patients with constipation and those without constipation were analyzed. Binary logistic regression analyses were performed to identify risk factors associated with a decline in muscle strength in the lower limbs.Results A total of 227 patients were enrolled, including 131 patients with constipation and 96 without constipation. The constipation group had a significantly higher proportion of patients who experienced difficulty walking or paralysis compared to those without constipation prior to surgery (83.2% vs. 17.7%, χ2 = 99.035,P < 0.001). Constipation (OR = 9.522, 95%CI: 4.150-21.849, P < 0.001) and urinary retention (OR = 14.490, 95%CI: 4.543-46.213, P < 0.001) were independent risk factors for muscle strength decline in the lower limbs. Conclusions The study observed that patients with thoracic spinal tumors who experienced constipation symptoms had a higher incidence of lower limb weakness. Moreover, the analysis revealed that constipation and urinary retention were independent risk factors associated with a preoperative decline in muscle strength of lower limbs.

Comparison of thoracic vs lumbar spinal anaesthesia fo orthopaedic surgeries

Background: Thoracic spinal anaesthesia has emerged as one of the most promising anaesthetic techniques in the recent times. On the other hand, lumbar approach has been the conventional choice  for orthopaedic surgeries since the advent of spinal anaesthesia. This study aimed at determining which approach is better suited for orthopaedic surgeries.Methods: Total 60 patients scheduled for orthopaedic surgeries were divided into two groups : group T and group L. Group T patients were given thoracic  spinal anaesthesia at the T9-T10 / T10-T11 interspace using  1.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25µg (0.5 ml) of fentanyl.  Group L patients received  2.5 ml of  hyperbaric bupivacaine 0.5% (5 mg/ml) + 25 µg (0.5 ml) of fentanyl at LI-L2/L2-L3 interspace. Authors evaluated the degree of analgesia  and  motor block,  haemodynamics  and neurological complications.Results: Onset of analgesia was faster in thoracic group - 2min. The duration of sensory  and motor block was shorter in thoracic group. There were no significant differences in haemodynamic variables and respiratory parameters between the two groups  and no neurological complication in any patient.Conclusions: Thoracic spinal anaesthesia is preferable to lumbar spinal anaesthesia for orthopaedic surgeries.

Thoracic Spinal Cord Infarction Presenting as Isolated Monoplegia

No abstract available.

The MRI findings of cavernous hemangioma in the thoracic spinal epidural space / 实用放射学杂志

Objective To explore the MRI features of cavernous hemangioma in the thoracic spinal epidural space,to improve the recognition of the disease.Methods The clinical,pathological and MRI data of 7 cases with cavernous hemangioma in the thoracic spinal epidural space confirmed by surgery and pathology were analyzed retrospectively.Results 7 cases of cavernous hemangioma in the thoracic spinal epidural space were included in our study,all cases underwent MRI contrast enhancement examination and 6 of them underwent conventional MRI examination.On T1WI,4 cases showed hypointensity,2 cases showed slightly hypointensity and 1 case showed mixed slightly hypointensity.On T2WI,5 cases showed slightly hyperintensity,1 case showed slightly hypointensity. On fat suppression sequence,5 cases showed hyperintensity,1 case showed heterogeneous hyperintensity.On diffusion-weighted imaging (DWI),7 cases showed obviously hyperintensity.On contrast-enhanced images,the lesions enhanced homogeneously in 5,enhanced heterogeneously in 2.Conclusion MRI can display the location,appearance and enhancement pattern of thoracic spinal epidural cavernous hemangioma distinctly,while definite diagnosis of which still depends on pathology.

Comparison on clinical effect between one-stage anterior debridement bone graft fusion and anter-posterior combination in the treament of multiple-level thoracic spinal tuberculosis / 重庆医学

Objective To compare the curative effects between one‐stage anterior debridement bone graft fusion and posteri‐or fixation fusion combined with anterior debridement bone graft fusion in the treatment of multiple lower thoracic spinal tuberculo‐sis .Methods A total of 62 patients with multiple lower thoracic spinal tuberculosis in our hospital from March 2002 to March 2010 were treated by the anterior debridement bone graft fusion ,including 32 cases of anterior internal fixation by one screw‐rod system (group A) and 30 cases of posterior internal fixation by two nail‐stick systems(group B) .The cure rate ,operation time ,bleeding volume ,the Cobb′s angle and recovery situation of spinal cord injury were compared between the two groups .Results All patients were followed up for 24-36 months (average 28 months) and showed successful bone graft fusion .In the Frankel classification e‐valuation at postoperative 12 months ,the improvement rate of spinal cord injury was 76 .92% (10/13) in the group A and 81 .82%(9/11) in the group B ,showing no statistically significant difference (χ2 =0 .087 ,P>0 .05) .The total cure rate was 84 .38% (27/32) in the group A and 85 .48% (26/30) in the group B ,showing no statistically significant difference (χ2 =0 .066 ,P>0 .05) .The Cobb′s angles before operation ,immediately after operation and at the last follow‐up were (28 .16 ± 4 .16)° ,(5 .03 ± 3 .24)° and (8 .81 ± 2 .44)° in the group A and (26 .83 ± 5 .41)° ,(5 .50 ± 3 .03)° and(8 .06 ± 2 .45)° in the group B ,showing no statistically sig‐nificant difference (t=1 .038 ,t=0 .588 ,t=1 .200 ,all P>0 .05) .The operation time was (171 .31 ± 12 .84)min in the group A and (219 .23 ± 21 .44)min in the group B ,showing statistically significant difference (t=10 .754 ,P<0 .05) .The bleeding volume was (341 .25 ± 76 .10)mL in the group A and (440 .67 ± 67 .16)mL in the group B ,showing statistically significant difference (t=5 .439 ,P<0 .05) .Conclusion One‐stage anterior debridement ,and anterior or posterior internal fixation for treating multiple lower thoracic spinal tuberculosis can obtain the better curative effect ,but selecting case is very important .

Neurologic and Histological Study of Clip Compression Model for Rat Thoracic Spinal Cord Injuries

OBJECTIVE: The purpose of this study was to assess the time-response of clip compression model for the relationship between the duration of the injury on the rat thoracic spinal cord, and histological and functional outcome measures. METHODS: After laminectomy at T9 in Sprague-Dawley rats, a modified aneurysm clip with a closing force of 30-gram was applied extradurally around the spinal cord at T9, and then rapidly released with cord compression persisting for 1, 5, and 10 minutes, respectively. The locomotor function, according to the Basso-Beattie-Bresnahan (BBB) scale, was assessed weekly for 4 weeks after the injury. The injured spinal cord was then examined histologically including quantification of cavitation. RESULTS: Spinal cord injury by clip compression resulted in worsened BBB scale scores. However, there was spontaneous functional improvement in times for all 3 injury severities, with the greatest improvement in the 1-minute compression group. From 1 week after the injury, BBB scores in the 1-minute group were significantly higher than in the 5 or 10-minutes groups until the end of the follow-up period (p<0.05). For histological analysis, the cavitation area and cavity volume at 4 weeks was directly proportional to the severity of the injury. CONCLUSION: The results of this study show that the rat thoracic cord clip compression model is a reliable and reproducible spinal cord injury model. The duration of clip compression injury in the rat thoracic cord has been correlated with both functional and histologic outcome measures.

Effects of Hot Spring Hydrotherapy on Spasticity of Patients with Incomplete Thoracic Spinal Cord Injury / 中国康复理论与实践

@#Objective To observe the effect of hot spring hydrotherapy and routine rehabilitation on spasticity of patients with incomplete thoracic spinal cord injury (SCI). Methods 25 patients with incomplete thoracic SCI were divided into hydrotherapy group (n=15) and control group (n=10). The hydrotherapy group received both routine rehabilitation and hydrotherapy，and the control group only underwent routine rehabilitation．They were evaluated with Modified Ashworth Scale (MAS) before and after treatment. Results There was a significant reduction on MAS in both the groups after treatment (P<0.01), and it was more in the hydrotherapy group (P<0.05). Conclusion The hot spring hydrotherapy can facilitate the release of spasticity after incomplete thoracic SCI.

Rosai-Dorfman Disease Occurred in Epidural Space of the Thoracic Spinal Canal / 대한척추외과학회지

Rosai-Dorfman disease is a rare, non-neoplastic lymphoproliferative disorder that is characterized by its specific histological features. However, it is uncommon for it to involve the thoracic spinal cord as a site of extranodal disease. A 36 year-old man developed progressive paraparesis 2 weeks prior to admission. On an MRI study, the spinal cord was compressed at the T4 and T5 levels posteriorly by an epidural mass. A decompressive laminectomy and removal of the mass were performed and Rosai-Dorfman disease was confirmed histologically. After the operation, additional high-dose radiotherapy was performed. The motor weakness and hypesthesia in the lower extremities resolved completely and there was no evidence of recurrence at the final follow-up examination.

Inconsistence between the changing pattern of somatosensory-envoked potentials and post-operative neurological function in surgery for thoracic spinal stenosis / 中国矫形外科杂志

[Objective]To investigate the value of intra-operative somatosensory-evoked potential monitoring in surgery for thoracic spinal stenosis.[Method]Twenty-two patients with thoracic spinal stenosis underwent decompressive laminectomy surgery.The preoperative and intraoperative SPEs were recorded.The SEPs were analyzed with three indices:(1)SEPs wave pattern;(2)P40 latency;(3)P40-N50 amplitude.More than 50% decrease in SEPs amplitudes or more than 10% increase in latency was considered to be the warning threshold.[Result]Cases were classified into four groups according to preoperative SPEs wave pattern.Type Ⅰ inclued 2 cases whose SEPs monitoring had least meaning,and the spinal cord function remained unchanged postoperatively.4 cases with Type Ⅱ and the SEPs wave pattern were too unreliable to make analysis.Eleven cases in Type Ⅲ showed significant changes on SEPs,and most patients felt relief of symptom a week later.Type IV with 5 cases showed normal SEPs and all of them got well restored neurological function.[Conclusion]SEPs has good correlation with clinical outcomes.Its sensitivity,instant response and quantitative analysis make SEPs with great effectiveness in intraoperative monitoring on surgery of thoracic spinal stenosis.

Perioperative application of methylprednisolone for thoracic spinal stenosis / 中国矫形外科杂志

[Objective]To study the prophylactic effects of high dose methylprednisolone(MP) for perioperative surgical treatment of thoracic spinal stenosis.[Method]From July 2003 to December 2007,a retrospective study of 40 patients who underwent simply posterior thoracic vertebral canal decompression was made.The patients were divided into 2 groups according to the application of MP or none-MP at perioperation.Twenty-one patients in MP group were treated with MP stoss(30 mg/kg,iv 15 min) 30 min prior to the decompression and then 45 min later MP(5.4 mg/kg/h) was continuted for 23 hours.Nineteen patients in the control group were treated with dexamethasone(DX) 15 mg 30 min prior to the decompression and then DX(10 mg/d,iv) was given for 3 days after operation.Neurological function improvement rates were evaluated according to the JOA scores(postoperative JOA scores-preoperative JOA scores /17﹣preoperative JOA scores)?100% at 3d,7d,3d and 12 months after operation.Complication were observed.[Result]Neurological function recovery rates were 33.54?10.01% in MP group and 28.29?8.73% in the control group at 3 days after operation.The difference was found to be significant(P0.05).Neurological deficit was found in 5 in control group,while no one in the MP group.[Conclusion]High dose of MP used perioperatively for thoracic stenosis can protect spinal cord and improve operative security,while it does not increase serious adverse complications.

Clinical characteristics and operative treatment of the ossification of ligamentum flavum thoracic spinal stenosis / 中国矫形外科杂志

[Objective]To evaluate the clinical characteristics and effect of operative treatment for the ossification of ligamentum flavum thoracic spinal stenosis (OLF-TSS). [Methods]From October 1998 to February 2007,38 patients with OLF-TSS were treated with en bloc hemi-articular process laminectomy. In this group,25 cases were male,and 13 cases were female. The average age was 48 years (range,29～71 years). Totally 81.6% of the lesion was between T10～L1 intervertebral disc space.The average history was 10 months. There were 5.3 percent with protrusion of intervertebral disc of thoracio spine.[Results]Thirty-eight cases were followed-up for 1～8 years,with an average of 3 years and 6 months. Dural injury occurred in 4 cases of 38,3 cases appeared postoperative cerebrospinal fluid leakage. All cases were cured conservatively mainly with bed rest in the prostrate position. According to WANG's evaluation,25 had excellent results,11 had good results,2 had no change and none was poor,The excellent to good rate was 94.7% in this group. There were no patients with the wrong level. No patient neurological functions were deteriorated.[Conclusion]The chinical features of OLF-TSS are very complex. The common symptoms of the disease are progressive onset of numbness,weakness,low back pain,intermittent claudication of the lower extremities,constriction on trunk or lower limbs and sphincter dysfunction. The clinical presentation and neurological examination associated with X-ray film,MRI and CT were the important means of the diagnosis of the disease. Removal of the posterior wall of the thoracic spinal canal via the technique of en bloc hemi-articular process laminectomy is safe and effective to treat OLF-TSS. The strategy for diminishing fault and complications is to discriminate pathogenic segment (locating-diagnosis) and follow the principles of surgical procedure.

Effects of Thoracic Spinal Exercise Program in VDT Workers: Pain Relief and Increased Flexibility / 대한산업의학회지

OBJECTIVES: The purpose of this study of the Thoracic Spinal Exercise Program was to evaluate its effects on VDT workers. These effects were found to include a decrease thoracic kyphosis, increase thoracic spine mobility and decrease in the VAS (visual analog scale). These measures provide a means of assessing the muscle endurance and muscle strength of the subjects. METHODS: This study was conducted during the period from July 1 to August 31, 2003, and involved 58 VDT workers belonging to a company located in Seoul who were working seated in front of a computer for most of the day. After applying the thoracic exercise program, we examined the changes in the of thoracic kyphosis angle, spinal length (C7-S3), TFED (thoracic flexibility in the extension direction), MEBH (maximal elevation with both hands in the overhead direction) and CE (chest expansion). RESULTS: Obtained f om this study are as follows. 1. A significant reduction in the VAS was observed in the exercise group (pre-exercise 5.90 +/- 0.88 points, post-exercise 4.23+/- 0.82 points), as compared with the control group (pre-exercise 6.00+/-0.90 points, post-exercise 5.93+/-0.81 points). 2. A significant reduction in thoracic kyphosis (pre-exercise 36.97+/-7.49, post-exercise 31.83 +/-5.90) and a significant increase in thoracic flexibility in the extension direction (pre-exercise 7 . 4 7+/-2.30, post-exercise 11.77+/-3.65) were observed in the exercise group. The thoracic kyphosis angle showed a significant reduction in the exercise group, as compared to the control group. The thoracic flexibility in the extension direction showed a significant increase in the exercise group, as compared to the control group. 3. There was a significant increase in the spinal length in the exercise group (pre-exercise 494 +/-27.66 mm, post-exercise 518.60+/-27.95 mm). CONCLUSIONS: The Thoracic Spinal Exercise Program results in an increase in thoracic spine mobility and a decrease in pain. In practical terms, the effects of the exercise program are good health and posture.

Posterolateral Approach in Ventral or Ventrolateral Thoracic Tumor

There were many surgical approaches for the ventral or ventrolateral thoracic spinal cord tumor. Six ventrally or ventrolaterally located thoracic spinal tumors were successfully resected through the posterolateral approach. This approach allows direct visualization of the ventral and dorsal boundaries of the tumor with minimal manipulation of the spinal cord. Compared to the traditional laminectomy, visualization of the tumor and spinal cord can be shown to markedly improved. Also, when compared to the transthoracic approach, this approach has be associated with fewer potential complications, such as violation of pleural space and mediastinum, and eliminates the necessity of vertebrectomy. Neurological improvement was obtained in all six patients. It is believed that this approach offers significant advantages for the treatment of ventrally or ventrolaterally located thoracic tumors, and should be considered an to alternative the transthoracic approach.

Appearance of the Tracer Substance in the Spinal Cord following injection into or around the Coeliac Plexus / 대한마취과학회지

The present study was undertaken in an attempt to explore the spinal cord after injection of a tracer substanee into the coe1iac plexus. We studied two groups of rabbits weighing 2.0 to 2.3 kg ; a normal control group and the experimental group. The animals were anesthetized with 20 % urethane 7 ml/kg body weight intraperitoneally. To make an injectable mixture of the tracer substance, 0.5 gm of ferric oxide (Iron sesquioxide) was mixed with 2 ml of lactated Ringer's solution just prior to injection. In normal control group (N=3), animals were killed after anesthetization by shedding blood and the segment of vertebrae from the 6th thoracic to 11th thoracic were removed and fixed in 10% formalin solution. The experimental group was subdivided into a subgroup of perineurial injection of the tracer mixture to the bilateral coeliac ganglia (the perineurial injection subgroup, N=5), a subgroup of intraneural injection of tracer mixture to the bilateral coeliac ganglia (the coeliac ganglion subgroup, N=5) and a subgroup of intraneural injection of the tracer mixture to the bilateral superior mesenteric ganglia (the superior mesenteric ganglion subgroup, N=3). In the perineurial injection subgroup, the bilateral coeliac ganglia were exposed under surgical microscope and 1 ml of the tracer mixture was injected bilaterally exterior to the perineurial connective tissue of coeliac ganglion. After the injection, the abdominal wall was closed and animals were then allowed to rest in the lateral position for 2 hours. In the coeliac ganglion subgroup and the superior mesenteric ganglion subgroup 0.6 to 0.7 ml of the tracer mixture was injected bilateraUy into the coeliac ganglia or the superior mesenteric ganglia. After the injection, the aMominal wall of the animals were closed and then allowed to rest in the lateral position for 90 minutes. At the end of experiment, animals of the experimental group were killed by shedding blood and the segment of vertebrae from the 6th thoracic to 11th thoracic were removed and fixed in 10% formalin solution. Following decalcification in 50% formic acid, histological study was performed with hematoxilin-eosin(H-E) stain or iron stain in transverse sections and sagittal plane of specimen which was obtained in one animal of the coeliac ganglion group. The results were as follows ; 1. In the perineurial injection subgroup, moderate density of the tracer substance was diffused into the dura mater. There was minimally infiltrated tracer in the area of lateral side of the formatio reticularis and the perivascular space of the white matter and pia mater. 2. In the coelic ganglion subgroup many tracer were diffused into the perineurial epithelial space of unmyelinated fibers and around the Schwann's sheath of fibers in the ventral and dorsal roots. The white matter was infiltrated uniformly with the tracer substance. there was evidence of diffusion of the tracer substance through the glia limitans of the white matter in the transversely or sagittally sectioned slides. 3. The superior mesenteric ganglion was tightly encased with the connective tissue capsule, thus we experienced moderate resistance to injection of the tracer mixture. There was most extensive diffusion of the tracer substance in the ventral and dorsal roots, dorsal horns of the gray matter, the area of the lateral side of the formatio reticularis and the remaining whole area of the white matter. And the tracer substance was infiltrated around the peripherally situated cells of gray matter. Our observation demonstrate that the tightly encased ganglion like the superior mesenteric ganglion is the candidate for paralysis when a neurolytic agent was injected intraneura1ly. In discussion we indicated the existance of small ganglion on the wall of upper abdominal aorta which is prone to produce paraplegia of the distal extremities in case of neurolytic coeliac plexus block.

Thoracic Spinal Stenosis

A stenotic spinal canal in the cervical or lumbar region is a well-known clinical entity. However, stenosis involving a thoracic vertebra is rarely mentioned in the literature. Improved neuroimaging facilities, especially MRI, let us detect the thoracic canal stenosis not so infrequently as in the past years. The authors are reporting six operative cases of thoracic myelopathy associated with thoracic spinal stenosis. Motor & sensory abnormalities were found in all cases during the clinical course. Magnetic resonance imaging and Metrizamide CT scanning were useful in the diagnosis of thoracic spinal stenosis. Treatment consited of wide posterior decompression resulting in symptomatic improvement in five of six patients.

A Study on Scoliosis Induced by Resection of Thoracic Spinal Nerves / 대한정형외과학회잡지

Msny clinical and experimental studies trying to elucidate the cause of idiopathic scoliosis have been carried out. There, however, is no established theory to explain it. This paper is aimed at approaching one of various causes of idiopathic scoliosis by producing thoracic scoliosis in growing rabbits with unilateral resection of thoracic spinal nerves. All 43 rabbits were divided into four different groups. The first group(11 rabbits) consisted of rsbbits whose primary anterior and posterior divisions of the unilateral thoracic spinal nerves were resected. The second(11 rabbits) and the third(11 rabbits) were groups of rabbits whose primary anterior and posterior devisions were resected respectively. The fourth(10 rabbits) was the control group. The first group of rsbbits showed the most prominent curvature of the spine. The group of resection of primary posterior division showed less severe scoliosis than the first group but more marked scoliosis than the group of resection of primary anterior division. The biopsy of the denervated muscles included in the scoliosis revealed atrophy. It is concluded from the animal experiments with 43 growing rabbits that unilateral paralysis of the thoracic spinal nerves could be one csuse of iniopathic scoliosis and the primary posterior division of the thoracic spinal nerve contributed to the production of scoliosis more than the primary anterior division.