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Objective To investigate the appropriate surgical approach in the management of cervical cord injury following ossification of the posterior longitudinal ligament. Methods The clinical data of 25 patients with cervical cord injury following ossification of the posterior longitudinal ligament who received surgical treatment were retrospectively analyzed. According to Frankel grades, two patients were at grade A, three at grade B, 14 at grade C and six at grade D. The surgical procedures consisted of anterior decompression (12 patients), posterior decompression (8 patients) and combined posteroanterior decompression (5 patients). Results No iatrogenic injury of great vessels, trachea, esophagus or spinal cord occurred. All the patients were followed up for 15-86 months (mean 38.3 months). All segments with anterior fixation attained solid fusion, without implants loosening or breakage. No reelosed open-door was found in patients who received posterior laminoplasty. The spinal function got improved in 21 patients, and a relief of pain or numb of the upper limb was attained in four patients whose spinal cord injury was not cured. Conclusions The surgical outcome of cervical cord injury following ossification of the posterior longitudinal ligament is satisfactory. It is important to select a suitable surgical approach according to the imaging manifestations associated with the general conditions of the patients.
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Objective To evaluate the effectiveness of rehabilitative treatment for severe cervical spondylotic myeiopathy after combined posterior-anterior surgery. Methods Fifty-four patients (mean age, 59.5) who had undergone combined posterlor-anterior surgery of the cervical spine due to severe cervical spondylotic myelopathy were studied with an average follow-up of 38.7 months. All the patients were allocated into either a rehabilitation treatment group (28 patients) or a control group (26 patients). Neurological function in the two groups was assessed using the Japanese Orthopedic Association (JOA) grading system. In addition, the status of axial symptoms, wound healing and post-operative complications were also evaluated. Results The bone grafts completely fused in both groups. All of the wounds in the rehabilitation treatment group healed without any infection. Three wounds were infected in the control group, but were cured by prompt treatment. Two patients in the rehabilitation group and 9 in the control group suffered laryngeal edema. There was no significant difference between the two groups before the operation with regard to their JOA scores, which significantly increased postoperation in both groups. In the rehabilitation treatment group, the postoperation JOA scores were significantly higher than in the control group. At the same time, there were significantly fewer patients with neck axial symptoms in the rehabilitation treatment group than that in the control group (25.0% versus 69.2% , P < 0.01 ). Conclusions Systematic rehabilitation treatment pro-and post-operation of patients with severe cervical spondylotie myelopathy can accelerate neurological recovery and help prevent postoperative complications and neck axial symptoms.
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BACKGROUND: After acute spinal cord injury (SCI), edema of spinal cord is an important factor for inducing and deteriorating pathological changes of spinal cord tissue. After injury, noradrenaline (NE) instantly causes microvascular contraction, endothelial injury, increase of arterial permeability and participation in edema. Recently, many researches suggest that excitatory amino acids (EAA) are related to cellular edema.OBJECTIVE: To study the effect and mechanism of selective phenol aminergic neuron, 6-hydroxy dopamine (6-OHNA)and aspartic acid (ASP) on edema after acute SCI.DESIGN: Randomized controlled study.SETTING: Department of Spine Surgery, the Third Hospital of Hebei Medical University.MATERIALS: The experiment was carried out at the Experimental Animal Center of the Third Hospital of Hebei Medical University from March to September 2003. A total of 160 Wistar rats weighing 300-350 g of both genders were randomly divided into three groups: 6-OHNA group (n =60), MK-801 group (n =50) and control group (n =50).METHODS: Acute SCI was induced at the level of T13 vertebral body with the static lcad technique. Rats in 6-OHNA group were injected with 6-OHNA into subarachnoid space; rats in MK-801 group were injected with MK-801 into caudal vein; rats in control group did not receive any treatment. The extent of edema was compared in the three groups by means of neurological scoring, water content measurement, light microscopy and electron microscopy.MAIN OUTCOME MEASURES: Neurological scores and water content.RESULTS: All 160 rats were involved in the final analysis. ① After SCl, content of NE in 6-OHNA group was decreased from (217.45±4.26) ng/g to (29.37±2.61) ng/g, and the difference was significant (P＜ 0.01). Edema in spinal cord tissue was effectively inhibited for 24 hours. At 12 hours after SCl, function recovered remarkably and vascular-derived edema was the mildest. ② In MK-801 group, there was no significant suppression of the edema until 24 hours after injury. Early recovery of neurological function was not significantly different from that in control group (P ＞ 0.05), but functional recovery was obvious until 24 hours after injury (P＜0.05). The degree of cytotoxic edema was the lightest.CONCLUSTON: NE can inhibit vascular-derived edema at early phase of SCI, and EAA can inhibit cytotoxic edemas,which develops at a relatively later stage.
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[Objective]To evaluate the effectiveness of posterior lumbar interbody fusion(PLIF) in the treatment of upper lumbar disc herniation.[Method]Twenty six patients of upper lumbar disc herniation underwent posterior lumbar interbody fusion,lumbago VAS and the pain in waist and lower extremities grades were tested before operation,all patients had an average follow-up period of 20.8 months,then lumbago VAS and the pain in waist and lower extremities grades were tested at last follow-up,lumbago VAS and the pain in waist and lower extremities grades were compared through paired t-test.[Result]All 26 patients had a followed-up.Postoperative VAS had significant lower than preoperative,statistical analysis has remarkable significance(P
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0.05);the better result was obtained including low back pain,Taillard index and relative disc height at the end of follow-up in POLA.[Conclusion]Posterior oblique lumbar arthrodeses is better ideal method in the treatment of degenerative spondylolisthesis.
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[Objective]To verify whether or not the modified open-door laminoplasy preserving semispinalis cervicis insert into axis is effective in preventing postoperative axial symptom and maintaining postoperative cervical sagittal alignment.[Method]Since March 2002 to December 2003,forty-eight patients underwent modified open-door laminoplasy preserving semispinalis cervicis insert into Axis,among them,thirty-two patients who were followed up for more than 2 years were included in this study.Preoperative and postoperative JOA score,degree of axial symptom,ranges of neck motion,cervical curvature index were recorded and compared.[Result]Preoperative and postoperative JOA score was(9.04?2.9)and(12.5?3.1)respectively,with recovery rate as(44.9?26.9).There was significant difference between preoperative evident axil symptom rate(46.8%)and postoperative evident axil symptom rate(18.7%),while no significant difference between preoperative and postoperative ranges of neck motion,cervical curvature index was seen.[Conclusion]Modified open-door laminoplasy is less invasive to the posterior extensor mechanism especially the semispinalis cervicis than conventional open-door laminoplasy.This new procedure is effective in preventing postoperative morbidities often seen after conventional laminoplasy with adequate decompression of the spinal cord.