Early Decompression in Acute Spinal Cord Injury : Review and Update

Spinal cord injury (SCI) has a significant negative effect on the quality of life due to permanent neurologic damage and economic burden by continuous treatment and rehabilitation. However, determining the correct approach to ensure optimal clinical outcomes can be challenging and remains highly controversial. In particular, with the introduction of the concept of early decompression in brain pathology, the discussion of the timing of decompression in SCI has emerged. In addition to that, the concept of “time is spine” has been added recently, and the mortality and complications caused by SCI have been reduced by providing timely and professional treatment to patients. However, there are many difficulties in establishing international clinical guidelines for the timing of early decompression in SCI because policies for each country and medical institution differ according to the circumstances of medical infrastructure and economic conditions in the surgical treatment of SCI. Therefore, we aim to provide a current review of timing of early decompression in patient with SCI.

Review: Steroid Use in Patients With Acute Spinal Cord Injury and Guideline Update / 대한신경손상학회지

Acute spinal cord injury (SCI) is a devastating condition that causes enormous damage to a patient’s physical, mental, and economic situation and requires a multidisciplinary approach to treatment. Research on SCI has been performed for a long time, and the management of SCI has developed dramatically in recent decades as a mechanism of injury and the pathophysiology of SCI have been revealed from the primitive stage in the past. In the treatment of patients with acute SCI, there is a lot of debate regarding surgical treatment strategies and pharmacological management, such as steroid use. In particular, the efficacy of steroid use, such as methylprednisolone sodium succinate, has been increasing and decreasing and is still intensely debated. The practice guidelines reported so far for this are also at the “suggest” stage with weak recommendations. Therefore, this review aims to summarize the effects of steroid use on SCI. This review provides an overview of current practical guidelines and clinical studies on steroid use in patients with SCI.

Letter to the Editor: Commentary on Spinal Surgery and Subsequent ESR and WBC Changes Pattern: A Single Center Prospective Study (Korean J Neurotrauma 2021;17:136–147) / 대한신경손상학회지

no abstract available.

Letter to the Editor: Commentary on Recurrent Cervical Spontaneous Spinal Epidural Hematoma with Conservative Management: A Case Report (Korean J Neurotrauma 2021;17:186–191) / 대한신경손상학회지

no abstract available.

Freehand Placement of the C1 Pedicle Screw Using Direct Visualization of the Pedicle Anatomy and Serial Dilatation / 대한신경손상학회지

Objective@#We designed a method for inserting C1 pedicle screws using the direct visualization technique of the pedicle and serial dilatation technique to reduce complications and malposition of screw, and assessed the accuracy of this method. @*Methods@#Free-hand C1 pedicle screw insertion using the direct visualization technique of the pedicle and serial dilatation technique was performed on 5 consecutive patients with C1–2 instability at a single institute from March to December 2018. The method involved protecting the vertebral artery (VA) and C1 root using the Penfield No. 1, securing the entry point of the posterior arch screw and the pedicle was visible directly in Trendelenburg position. The hole at the entry point of the C1 posterior arch was serially dilated using a 2.5×3.0 mm drill bit, and the C1 pedicle screw was inserted with the free hand technique. We measured postoperative radiological parameters and recorded intraoperative complications, postoperative neurological deficits and the occurrence of occipital neuralgia. Postoperative computed tomography (CT) was performed to check screw malposition or construction failure. @*Results@#Of the 10 C1 pedicle screws on postoperative CT, 20% of screws (grade A) were in the ideal position while 80% of screws (grade B) occupied a safe position. Overall, 100% of screws were safe (grade A or B). There were no iatrogenic neurological deficits, VA injury. @*Conclusion@#Freehand placement of the C1 pedicle screw through the direct visualization technique of the pedicle and serial dilatation technique is safe and effective without intraoperative fluoroscopy guidance.

The R-line: A New Imaging Index for Decision Making Regarding C2Lamina Decompression in Cervical Ossification of the Posterior Longitudinal Ligament / 대한신경손상학회지

Objective@#The optimal treatment modality for cervical ossification of the posterior longitudinal ligament (OPLL) including the C2 level remains controversial. Cervical laminoplasty is a widely accepted considering of advantages such as development of few postoperative complications, including kyphosis or neck pain. We encountered seven patients with postoperative disabilities resulting from incomplete decompression after undercutting of the C2 lamina. Based on this experience, we developed a new index to determine the degree of decompression in cervical OPLL—the rostral line (R-line). @*Methods@#Total of 79 consecutive patients who underwent posterior decompression of cervical OPLL were included in this study. Mean age at the time of operation, the C2-C7 cervical lordotic angle and OPLL thickness at the most stenotic level of the spinal canal, and preoperative/postoperative Japanese Orthopedic Association score was checked in these group. We compared the correspondence between the degree of C2 lamina decompression using the R-line and actual degree of decompression. @*Results@#In all patients, the R-line touched the upper half of the C2 lamina on preoperative magnetic resonance imaging (MRI). The C2-C3 local segment lordotic angle and maximal degree of spinal cord compression by OPLL were independently correlated to postoperative C2 cord shifting. This result indicates that the R-line is a valid indicator to determine the degree of C2 lamina decompression in OPLL extending to the C2 level. @*Conclusion@#The results showed that undercutting the C2 lamina can result in incomplete spinal cord decompression and poor clinical outcome if the R-line touches the upper half of the C2 lamina on preoperative MRI.

Analysis of Risk Factors and Management of Cerebrospinal Fluid Morbidity in the Treatment of Spinal Dysraphism

OBJECTIVE: Spinal dysraphism defects span wide spectrum. Wound dehiscence is a common postoperative complication, and is a challenge in the current management of cerebrospinal fluid (CSF) leaks and wound healing. The purpose of this study is to evaluate the risks of CSF-related morbidity in the surgical treatment of spinal dysraphism. METHODS: Ten patients with spinal dysraphism were included in this retrospective study. The median age of the cohort was 4.8 months. To assess the risk of CSF morbidity, we measured the skin lesion area and the percentage of the skin lesion area relative to the back surface for each patient. We then analyzed the relationship between morbidity and the measured skin lesion area or related factors. RESULTS: The overall median skin lesion area was 36.2 cm2 (n=10). The percentage of the skin lesion area relative to the back surface ranged from 0.6% to 18.1%. During surgical reconstruction, 4 patients required subsequent operations to repair CSF morbidity. The comparison of the mean area of skin lesions between the CSF morbidity group and the non-CSF morbidity group was statistically significant (average volume skin lesion of 64.4+/-32.5 cm2 versus 27.7+/-27.8 cm2, p<0.05). CSF morbidity tended to occur either when the skin lesion area was up to 44.2 cm2 or there was preexisting fibrosis before revision with an accompanying broad-based dural defect. CONCLUSION: Measuring the lesion area, including the skin, dura, and related surgical parameters, offers useful information for predicting wound challenges and selecting appropriate reconstructive surgery methods.

Erratum: Intraventricular Cavernous Hemangiomas Located at the Foramen of Monro

In the paper by Lee et al., the name of the corresponding author was given incorrectly. The correct name should be Chan-Young Choi as given above.

Intraventricular Cavernous Hemangiomas Located at the Foramen of Monro

Intraventricular cavernous hemangiomas are uncommon. Among them, those occurred at the foramen of Monro in the third ventricle may be of particular interest because of its rarity, development of hydrocephalus, being differentiated from other brain lesions. We present a rare case of intraventricular cavernous hemangioma at foramen of Monro which was resected through microsurgery and also review the relevant literatures.