Effect of decompression range on decompression limit of cervical laminoplasty / 中华医学杂志(英文版)

BACKGROUNDS@#Cervical posterior decompression surgery is used to relieve ventral compression indirectly by incorporating a backward shift of the spinal cord, and this indirect decompression is bound to be limited. This study aimed to determine the decompression limit of posterior surgery and the effect of the decompression range.@*METHODS@#We retrospectively reviewed the data of 129 patients who underwent cervical open-door laminoplasty through 2008 to 2012 and were grouped as follows: C4-C7 (n = 11), C3-C6 (n = 61), C3-C7 (n = 32), and C2-C7 (n = 25). According to the relative location of spinal levels within a decompression range, the type of decompression at a given level was categorized as external decompression (ED; achieved at the levels located immediately external to the decompression range margin), internal decompression (ID; achieved at the levels located immediately internal to the decompression range margin), and central decompression (CD; achieved at the levels located in the center, far from the decompression range margin). The vertebral-cord distance (VCD) was used to evaluate the decompression limit. The C2-C7 angle and VCD on post-operative magnetic resonance images were analyzed and compared between groups. The relationship between VCD and decompression type was analyzed. Moreover, the relationship between the magnitude of the ventral compressive factor and the probability of post-operative residual compression at each level for different decompression ranges was studied.@*RESULTS@#There was no significant kyphosis in cervical curvature (> -5°), and there was no significant difference among the groups (F = 2.091, P = 0.105). The VCD of a specific level depended on the decompression type of the level and followed this pattern: ED < ID < CD (P < 0.05). The decompression type of a level was sometimes affected by the decompression range. For a given magnitude of the ventral compressive factor, the probability of residual compression was lower for the group with the larger VCD at this level.@*CONCLUSIONS@#Our study suggests that the decompression range affected the decompression limit by changing the decompression type of a particular level. For a given cervical spinal level, the decompression limit significantly varied with decompression type as follows: ED < ID < CD. CD provided maximal decompression limit for a given level. A reasonable range of decompression could be determined based on the relationship between the magnitude of the ventral compressive factor and the decompression limits achieved by different decompression ranges.

Reoperation to the ossification of the posterior longitudinal ligament / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss surgical approaches of ossification of the posterior longitudinal ligament (OPLL) of cervical spine.</p><p><b>METHODS</b>Between June 2005 to July 2010, 36 patients with OPLL of cervical spine were reoperated. There were 23 male, 13 female, age from 39 to 72 years (mean 57 years). The time of the first operation to the reoperation were 4 months to 24 years, an average of 3.9 years. Among 20 patients underwent anterior corpectomy and fusion (ACD) at first operation, 14 cases combined stenosis of cervical spinal canal, 10 cases were insufficient decompression of OPLL, 5 cases injured of cervical spinal cord during the first operation, 1 case was adjacent disc herniation. Among 14 cases underwent expensive open-door laminoplasty (ELAP) at first operation, 6 cases were insufficient decompression of OPLL, 4 cases were inadequate decompressed segment, 2 cases were cervical segmental kyphosis, 2 cases were progression of OPLL combined with disc herniation. Among 2 cases underwent combined approach at first operation, 1 case was insufficient decompression of OPLL, the other was adjacent disc herniation. Their pre- and post-operative X-ray, CT and MRI were analyzed. The complications of reoperation were recorded.</p><p><b>RESULT</b>There were 30 patients followed-up, with a period of 1.5 - 4.0 years, average 1.8 years. With 36 patients, none had deterioration, 2 patients had no recovery post-reoperation, 34 patients had 31.2% Japanese Orthopedic Association score improve rate. Among 22 cases underwent ELAP at second operation, 3 cases had postoperative segmental palsy. Among 14 cases underwent ACD at second operation, 3 cases had intraoperative dural defects.</p><p><b>CONCLUSION</b>Surgical strategy for OPLL of cervical spine should consider the type of OPLL and stenosis of cervical spinal canal.</p>

Urinary level of tissue factor and its procoagulant activity in patients with type 2 diabetes / 南方医科大学学报

<p><b>OBJECTIVE</b>To examine the urinary level of tissue factor (uTF) and its procoagulant activity (PCA) in patients with diabetes mellitus, and explore the relationship between uTF and renal damage in diabetes mellitus.</p><p><b>METHODS</b>Eighty-six patients with type 2 diabetes mellitus were divided into 3 groups according to urine albumin excretion (UACR), namely normal albuminuria group, microalbuminuria group and macroalbuminuria group. The levels of uTF, PCA, blood urea nitrogen (BUN), serum creatinine (CRE), serum cystatin C (CYSC), glycohemoglobin A1c (HbA1c), and high-sensitivity C-reactive protein (hs-CRP) were measured in all the patients and 21 healthy controls.</p><p><b>RESULTS</b>Compared with normal control, the diabetic patients showed significantly increased levels of uTF and PCA. The urinary TF-PCA was positively correlated to BUN, CYSC, CRE, UACR, fasting glucose and hs-CRP, but not to uTF; only hs-CRP, UACR were positively correlated to uTF.</p><p><b>CONCLUSION</b>uTF is probably implicated in the development and progression of diabetic nephropathy.</p>

A prospective randomized comparison between with or without instrumentation in short-level anterior discectomy and autograft bone fusion / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate anterior cervical plating in short-level anterior discectomy and autograft bone fusion.</p><p><b>METHODS</b>Eighty-one patients who underwent one- and two-level anterior cervical discectomy and fusion were randomized to 2 groups, with or without instrumentation. Among them, 55 patients were followed up. The mean follow-up time was (22 +/- 7) months. Fusion rate, disc height and cervical lordotic alignment were assessed by radiographs.</p><p><b>RESULTS</b>The improving rates were 68% in non-instrumented group and 58% in instrumented group, respectively (P > 0.05). The fusion rate was 93% in the non-instrumented group and 100% in the later one. The disc height was decreased (0.7 +/- 1.0) mm in the former group and increased (1.2 +/- 0.6) mm in the later one (P < 0.01). Although the postoperative cervical lordotic alignment was maintained better in instrumented group, the difference was not significant.</p><p><b>CONCLUSION</b>Anterior cervical plating can make good influence on the result of anterior cervical discectomy and fusion in some degree.</p>

Diagnosis and treatment of esophageal fistula in anterior cervical spine surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the causes, diagnosis, treatment and prevention of esophagocutaneous fistula in anterior cervical spine surgery.</p><p><b>METHODS</b>Thirteen cases with esophagocutaneous fistula in anterior cervical spine surgery were studied.</p><p><b>RESULTS</b>The causes includes: (1) During the operation, esophagus was oppressed by a clasp for so long time that made a pressure necrosis of the esophagus; (2) Esophagus was injured by loose plates and screws; (3) Loose bone grafts oppressed esophagus; (4) Esophagus was injured by operative appliance in the operation; (5) Esophagus was oppressed by the plate.</p><p><b>DIAGNOSIS</b>After anterior cervical spine surgery if patients had a high fever, sore throat, swelling incision, and food sediment was found in the incision, esophagocutaneous fistula should be considered. The final diagnosis could be done by esophageal radiography.</p><p><b>TREATMENT</b>Fasting cure, nasogastric tube and wound drainage should be used; When the inflammation ended, patients should undergo operation of closure of the esophageal fistula.</p><p><b>CONCLUSIONS</b>The esophagocutaneous fistula in anterior cervical spine surgery has several causes mentioned above. We should take precautionary measures to avoid the complication, and use appropriate treatment to cure when it happens.</p>