Clinical characteristics analysis of lumbar disc herniation with symptom aggravated caused by spinal manipulative therapy / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the characteristics of lumbar disc herniation (LDH) with symptom aggravated caused by spinal manipulative therapy (SMT).</p><p><b>METHODS</b>Detailed clinical profiles of a total number of 10 LDH patients with symptoms aggravated after SMT were reviewed including 5 males and 5 females with age from 46 to 68 years old, 7 patients of them were more than 50 years old. The clinical data of 10 patients were analyzed involving age, gender, clinical symptoms, signs, imaging findings, surgical treatment and prognosis. Laminectomy and discectomy were performed, and follow-up was carried out in all patients.</p><p><b>RESULTS</b>The duration of symptoms in all the patients before SMT was 4 to 15 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24 hours. MRI showed intervertebral disc herniation, 7 patients were observed in L4-L5. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications occurred. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; Eight patients reported a complete resolution of presentation and the rest two patients were significantly improved.</p><p><b>CONCLUSIONS</b>SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors.</p>

Surgical methods and techniques of lipomyelomeningocele in children / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the methods and techniques of surgical treatment of lipomyelomeningocele in children.</p><p><b>METHODS</b>From January 2004 to March 2007, twenty-five children aged from 2 months to 6 years with lipomyelomeningocele were operated on. Magnetic resonance imaging and electromyogram had been conducted to all the patients. The operation was composed of subtotal excision of lipomas, suture of spinal pia mater and resection of terminal filum. The results of treatment were evaluated by Hoffman's functional grading scheme for lipomyelomeningocele.</p><p><b>RESULTS</b>After operation, all the patients recovered and were released from hospital. No complications, including cerebrospinal fluid leakage and infection occurred. During the follow-up of 1 - 4 years, 18 asymptomatic patients' neurological function were normal and there was no deterioration, 7 symptomatic patients improved. Among the 7 patients, 4 patients had higher function grades compared with their preoperative assessments, and the other stayed in the same grades but with symptoms improved. Magnetic resonance imaging showed no tethered cord in all the patients postoperatively.</p><p><b>CONCLUSIONS</b>For lipomyelomeningocele, early operation should be performed to prevent the development of neurological defect. It is safe and effective to adopt subtotal excision of lipomas, suture of spinal pia mater, and resection of terminal filum.</p>

Avascular necrosis of a vertebral body / 中华创伤杂志(英文版)

Avascular necrosis of a vertebral body, a relatively uncommon entity, is caused by malignancy, infection, radiation, systemic steroid treatment, trauma, and the like.1 Vertebral osteonecrosis induced by trauma is called Kvmell's disease, because it was initially described by Hermann Kvmell of Germany in 1891.2 This paper reported a young female with posttraumatic vertebral osteonecrosis and analyzed the causes. She was treated by thoracoscopic surgery successfully.