effect of timing of decompression on neurologic recovery and histopathologic findings after spinal cord compression in a rat model

Prior animal models have shown that rats sustaining 3-second immediate spinal cord compression had significantly better functional recovery and smaller lesion volumes than rats subjected to compression times of 1 hour, 6 hours, 3 weeks, and 10 weeks after spinal cord injury. We compare locomotor rating scales and spinal cord histopathology after 3 seconds and 10 minute compression times. Ten rats were assigned into two early [3-second] and late [10-minute] compressive surgery groups. Compressive injury was produced using an aneurysmal clip method. Rats were followed-up for 11 weeks, and behavioral assessment was done by inclined plane test and tail-flick reflex. At the end of the study, the rats were sacrificed, and spinal cord specimens were studied in light and EM. Basso, Beattie and Bresnahan [BBB] locomotor rating scales were significantly better in the early compression group after the 4th week of evaluation [P<0.05] and persisted throughout the remainder of the study. Histopathology demonstrated decreased normal tissue, more severe gliosis and cystic formation in the late group compared to the early group [P<0.05]. In EM study, injuries in the late group including injury to the myelin and axon were more severe than the early compression group, and there was more cytoplasmic edema in the late compression group. Spinal cord injury secondary to 3-second compression improves functional motor recovery, spares more functional tissue, and is associated with less intracellular edema, less myelin and axon damage and more myelin regeneration in rats compared to those with 10 minutes of compression. Inclined plane test and tail-flick reflex had no significant difference

single posterior approach for vertebral column resection in adults with severe rigid kyphosis

Correction of severe kyphosis is a challenging operation in spinal surgery. A two stage operation has been commonly used: anterior release and decompression followed by posterior correction and fusion. We describe the posterior vertebral osteotomy technique for eorrecticfn of severe and rigid kyphosis through posterior-only approach. Twelve patients [six male and six female] with severe and rigid kyphotic deformity of the thoracic spine were treated by posterior vertebral column resection using a single posterior approach. The apex level of kyphosis was at the upper thoracic in five patients, the lower thoracic in four patients and mid thoracic in three patients. There was old fracture in one patient, congenital deformity in six, tumor in three and neurofibromatosis in two patients. After posterior vertebral column resection, segmental posterior instrumentation was used for correction of the kyphotic deformity. Complications and radiographic findings were analyzed to evaluate clinical outcomes and radiologic changes of posterior vertebral column resection in patients with angulated kyphotic deformity. The major curve correction was averaged 31.66 ° [SD=15.69] [45%]. The resection was performed at the involve level in every patient. Posterior segmental fusion was achieved in average 8.9 [SD=1.7] segments. Anterior reconstruction was with titanium mesh cage in two and with cancellous chip packing in other patients. There were no neurologic complications after six month. Bony fusion achieved in all patients, and there was no correction loss. Satisfactory correction is safely performed by posterior vertebral column resection with a direct visualization of the circumferentially decompressed spinal cord. Although the performance is technically laborious, it offers good correction without jeopardizing the integrity of the spinal cord

Percutaneous Vertebroplasty and Facet Joint Block

It is surprising that about 24% of patients with benign osteoporotic vertebral fracture die within a year from respiratory infection and urinary tract infection because of coughing and voiding difficulties, depending on the sites of compression fractures. We reviewed 500 patients on whom percutaneous vertebroplasty (PVP) was performed, at 612 levels in terms of patient selection, operation technique, medication, and clinical outcomes during the follow-up course for 2 yr study period. To confirm the most painful level among the multiple fracture sites, physical examination after facet joint block under the fluoroscope was the most reliable method. The mean total lumbar spine fracture threshold of bone mineral density was 0.81+/-0.05 g/cm2. The mean changes of numeric rating scale scores, Oswestry Disability Index except sex life, and Karnofsky performance status were -72.00, -83.50 and +60.62% in the osteoporosis group and -51.89, -45.02, and 69.03% in the tumor group. Complications related to the procedure were lateral spinal cord damage, transient paresthesia and transient hypotension. PVP with facet joint block is a profitable method for the vertebral compression fracture because of low risk and short duration of procedure with a high chance to result in pain relief and early mobilization.

Aplicación de la técnica de manejo de la arteria vertebral en la exéresis de un neurinoma espinal C2-C3 de difícil resolución quirúrgica / Transforaminal exceresis of a C2-C3 anterolateral extending spinal neurinoma exposing the vertebral artery

Se presenta el caso de un paciente con un neurinoma espinal C2-C3 de ubicación anterolateral, intra y extracanalicular, con gran compresión medular, que no pudo ser resuelto por la vía tradicional posterior por su alta vascuralización y adherencia a los planos adyacentes, debiendo utilizarse en él un abordamiento anterolateral con exposición y manejo de la arteria vertebral y la exéresis transforaminal del neurinoma con excelentes resultados quirúrgicos y clínicos en el paciente, el cual fue reincorporado a su vida normal a los dos meses de su intervención

Sintomatología, diagnóstico y resultados del tratamiento de los síndromes agudos de compresión medular / Symptomatology, diagnosis and results of treatment in acute spinal cord compression syndromes

Los síndromes agudos de compresión medular en la gran mayoría de los casos (88 por ciento) se deben a tumores espinales, de los cuales dos tercios corresponden a metástasis. El 76 por ciento de los casos presentan un período prodrómico previo a la aparición de déficit neurológicos, caracterizados por dolores, mientras que sólo pocos casos inician su sintomatología con trastornos de la función motora o sensitiva. Aparte de las radiografías simples de columna y la mielografía, la tomografía computarizada y la resonancia magnética ocupan hoy en día una posición destacada en el diagnóstico de esta enfermedad. Independientemente del hecho si se trata de un tumor primario o una metástasis los resultados operatorios son más favorables en aquellos casos que presentan los menores déficit preoperatorios, lo cual subraya la importancia de una interpretación cuidadosa de los síntomas iniciales

Effect of compression of spinal cord on brain rhythms.

Electroencephalographic changes were studied in anaesthetised rats, subjecting them to the mechanical compression of spinal cord. The EEG waves that were studied-Alpha, Theta, and Delta. The changes in these waves and shift from one pattern to another after the compression of the spinal cord at the Lumbar level. These waves were subjected Fourier analysis. The results show remarkable changes in wave patterns and a shift in the dominating wave pattern. With 50% compression the EEG showed a slight increase in the amplitude in all three wave forms-- with Delta wave pattern being more dominant. At 100% compression there is a marked decrease in the Delta amplitude compared to normal. We tried to observe the changes in activity of the brain--the effects of spinal lesion and its relationship with tonic activity changes in EEG.