[Safety and efficacy of different doses of tranexamic acid in posterior cervical laminectomy with lateral mass screw fixation and bone graft fusion].

Objective: To investigate the safety and efficacy of different doses of tranexamic acid (TXA) in posterior cervical laminectomy with lateral mass screw fixation and bone graft fusion by a prospective clinical study. Methods: The middle-aged and elderly patients with cervical spondylotic myelopathy, who were admitted between January 2020 and January 2022 and scheduled to undergo posterior cervical laminectomy with lateral mass screw fixation and bone graft fusion, were studied as the research subjects. Among them, 165 patients met the selection criteria and were included in the study. The patients were allocated into 3 groups ( n=55) by random double-blind lottery. Groups A and B were given intravenous infusion of TXA at 30 minutes before operation according to the standards of 15 and 30 mg/kg, respectively; and group C was given normal saline in the same way. There was no significant difference in gender, age, body mass index, and preoperative D-dimer, hemoglobin (Hb), and hematocrit (HCT) between groups ( P>0.05). The intraoperative bleeding, intraoperative blood transfusion, postoperative drainage volume, drainage days, and postoperative hospital stay were recorded. The Hb, HCT, and D-dimer were compared before operation and at 3 days after operation. Venous ultrasonography of the lower extremities was taken after operation to assess thrombosis; and the postoperative hematoma and epilepsy were also observed. Results: All operations were successfully completed, and the incisions healed by first intention. The differences in intraoperative bleeding volume, postoperative drainage volume, drainage days, and postoperative hospital stay between groups were significant ( P<0.05). The above indexes were significantly less in group B than in groups A and C. During operation, 14 patients in group A and 23 patients in group C were transfused, and no patient in group B had blood transfusions. Compared with groups A and C, the blood transfusion volume in group B significantly decreased ( P<0.05), and the difference between groups A and C was not significant ( P>0.05). There was no significant difference in the differences of D-dimer, Hb, and HCT before and after operation between groups ( P>0.05). At 5 days after operation, the venous ultrasonography of the lower extremities showed that the 2 cases of intermuscular venous thrombosis occurred in groups A, B, and C, respectively. No hematoma or epilepsy occurred after operation. Conclusion: The application of 15 and 30 mg/kg TXA in posterior cervical laminectomy with lateral mass screw fixation and bone graft fusion can reduce intraoperative bleeding and postoperative drainage volume, postoperative drainage days, and postoperative hospital stay. And application of 30 mg/kg TXA can reduce intraoperative blood transfusion, without increasing the risk of lower extremity venous thrombosis, hematoma, and epilepsy.

Clinical Outcomes of Atlantoaxial Dislocation Combined with Osteoporosis Using Posterior Atlantoaxial Rod, Screw Fixation, and Posterior Interfacet Fusion: A Retrospective Study of 21 Cases.

BACKGROUND Surgical procedures on atlantoaxial dislocation combined with osteoporosis remain controversial. This study was established to assess the mid-term clinical outcomes of atlantoaxial dislocation combined with osteoporosis using posterior atlantoaxial rod, screw fixation and posterior interfacet fusion. MATERIAL AND METHODS From January 2017 to January 2020, 21 patients (4 males and 17 females) with coexisting atlantoaxial dislocation and osteoporosis who underwent posterior atlantoaxial rod and screw fixation were included in our study with an average age of 64±8.1 years (range, 57-74 years). The subjective and objective symptoms, together with the neurological function of the patients were measured. Radiography and magnetic resonance imaging (MRI) were performed, Japanese Orthopaedic Association (JOA) score for spinal cord function and VAS score for pain recovery was assessed. RESULTS JOA and visual analog scale (VAS) score were significantly improved at 14±5.9 month follow-up compared with pretreatment values. Complete or almost complete anatomical reduction was observed in all 21 patients. All patients had good bony fusion at the final follow-up. No screw-loosening or atlantoaxial redislocation occurred in 21 cases. The only complication was mild numbness in the C2 innervation area of the posterior occipital region in 6 cases, which had no effect on life. CONCLUSIONS The results suggested that posterior atlantoaxial rod, screw fixation system, and posterior interfacet fusion could achieve satisfactory initial results for the treatment of atlantoaxial dislocation combined with osteoporosis.

Atorvastatin attenuates spinal cord injury by chronic fluorosis in rats.

The aim of the study was to explore the effect of atorvastatin on improvement of the function of the spinal cord in rats with chronic fluorosis. Sixty 3-month-old Wistar rats were separated randomly into three groups: normal group (N group), control group (C group) and atorvastatin group (A group). The Basso Beattie and Bresnahan scale and oblique board test showed that the rats in A group got higher score and better hind-limb motor function than C group. Immunohistochemistry and western blotting revealed that compared with N group, matrix metalloproteinase 9 (MMP-9) and p53 were highly expressed and myelin basic protein (MBP) was low expressed in spinal cord of C group. Meanwhile, MMP-9 and p53 expression were decreased and MBP was upregulated by atorvastatin compared with C group. In conclusion, the improvement of the function of the spinal cord in rats can be found when they were treated with atorvastatin.

The Prognostic Value of Serum Neuron Specific Enolase (NSE) and S100B Level in Patients of Acute Spinal Cord Injury.

BACKGROUND The correlation between serum concentration of neuron specific enolase (NSE), S100B, and the prognosis of patients with acute spinal cord injury (ASCI) remains controversial. MATERIAL AND METHODS Sixty patients with confirmed diagnosis of ASCI were recruited for this study from February 2015 to January 2017. The serum level of NSE and S100B were dynamically measured: on the day of injury and for 2 weeks. The 60 cases were divided into Group A (1 or more than 1 ASIA grade improved at 6 months after the injury) and Group B (ASIA grades changed <1 at 6 months after the injury). The serum level of the 2 groups were compared at different time points. And the prognostic value of serum NSE and S100B as biomarkers in patients with ASCI were calculated by Bayes theorem. RESULTS The serum levels of NSE in Groups A and B on the 2nd day of injury reached a peak at 66.80±13.76 g/L and 98.87±20.12 µg/L, respectively, and then declined gradually. On the 14th day of injury, the serum levels of NSE in both groups were 21.23±8.45 and 39.32±16.31 µg/L, respectively, which were much lower than those on the 2nd day (P<0.05). The serum levels of S100B in Groups A and B rose after the injury and reached a peak on the 4th day of injury. Then, the levels declined gradually to 1.14±0.64 and 1.97±0.98 µg/L, respectively, 2 weeks after the injury. Serum levels of NSE and S100B were good biomarkers for predicting the prognosis of ASCI patients with the sensitivity of 74.35% and 71.79%, the specificity of 71.43% and 66.67%. The cutoff value for serum NSE and S100B were 29.07 µg/L and 1.67 µg/L respectively. The AUCs were 0.78 (95% CI: 0.66-0.89) and 0.76 (95% CI: 0.63-0.89) respectively for serum NSE and S100B. CONCLUSIONS Serum levels of NSE and S100B protein can reflect the degree of spinal cord injury and could be potential biomarkers for the prognosis of acute spinal cord injury.

[White matter injury of spinal cord in rats with chronic fluorosis and recovery after defluoridation].

OBJECTIVE: To explore the injury mechanism for white matter of spinal cord and the improvement of function after defluoridation. METHODS: A total of 120 Wistar rats were separated randomly into 4 groups (n = 30 each). High flouriod group received high concentration NaF water (200 mg/L) to establish fluorosis model; control group distilled water; defluoridation group high concentration NaF water (200 mg/L) for 12 weeks and then distilled water for 12 weeks; defluoridation control group. The urinary contents of fluoride were detected at Weeks 4, 8 and 12. The first two groups were sacrificed at Week 12 while the other two groups at Week 24. The spinal cord functions were detected by BBB scale and incline plate test. Their cervical spinal cord tissues were collected and observed under electron microscope. The expression of myelin basic protein (MBP) in thoracic cord was detected by immunohistochemistry and Western blot. The comparison of measurement data was performed with F test and correlation analysis. Cytological changes of white matter in spinal cord were detected after chronic fluorosis. RESULTS: The spinal functions of high flouriod and defluoridation groups were inferior to those of the control groups. But no difference existed among the groups. Pathological manifestations of chronic white matter injury of spinal cord could be found in high flouriod and defluoridation groups. The MBP expression in spinal cord of fluorosis and defluoridation groups decreased in comparison with those in control groups. But no difference existed among them. CONCLUSION: White matter injury of spinal cord is present in chronic fluorosis rats. Defluoridation for a short time offers no recovery.

[Etiology and treatment of postoperative spinal cord injury for patients undergoing laminectomy for fluorosis thoracic canal stenosis].

OBJECTIVE: To elucidate the etiology of postoperative spinal cord injury (PSCI) for patients undergoing laminectomy for fluorosis thoracic canal stenosis (FTCS) and summarize the methods of diagnosis and treatment. METHODS: From 2006 to 2009, a total of 192 FTCS cases underwent laminectomy. Among them, 16 cases with gradual postoperative neural deterioration were finally diagnosed as PSCI on MRI.One case of intraoperative spinal cord injury was excluded so that only 15 cases were included. RESULTS: All cases were treated immediately with incision cite puncture and dehydration.Neural function recovered after secondary operation as JOA score improved from 3.00 ± 1.14 to 7.72 ± 1.41 at 12 months follow-up.Statistical analysis demonstrated a linear correlation between the diagnosis time and the improvement of JOA score. CONCLUSION: Hematoma and fluid leakage are the common reasons of PSCI for FTCS patients. Meticulous hemostasis, usage of artificial dura matter and partial negative pressure drainage are valuable preventive measures.

[Damage of blood brain barrier of spinal cord in rats with chronic fluorosis].

OBJECTIVE: To explore the impairment mechanisms of blood brain barrier in spinal cord and observe the changes of matrix metalloproteinase-9 (MMP-9) and functional improvement in rats with chronic fluorosis. METHODS: A total of 120 Wistar rats were divided randomly into 4 groups, high fluoride (fed by water with a high concentration of sodium fluoride at 200 mg/L), high fluoride control (fed by distilled water), defluorination (fed by water with a high concentration of sodium fluoride at 200 mg/L for 12 weeks and then distilled water for 12 weeks) and defluorination control (n = 30 each). The urinary contents of fluoride were detect for 4 groups at Weeks 4, 8 and 12. The high fluoride and control groups were sacrificed at Week 12 while the defluorination and defluorination control groups at Week 24. Their cervical spinal cords were collected for electron microscope examinations. The expression of MMP-9 protein in thoracic cord was detected by immunohistochemistry and Western blot. Quantitative analysis of function of blood brain cord barrier was performed by the technique of Evans blue. The comparison of measurement data was performed with F test and correlation analysis. The cytological changes of neurons in thoracic spinal cord were detected after chronic fluorosis. RESULTS: Under electron microscope, the pathological manifestations of chronic damage in blood brain barrier could be found. As compared with the high fluoride control group, the content of Evans blue increased markedly in spinal cord of the high fluoride group (29.2 ± 0.1 vs 0.7 ± 0.1 mg/L, P < 0.01). It was higher in the defluorination group than that in the defluorination control group. But there was no significant difference with the high fluoride group (29.2 ± 0.1 vs 28.9 ± 0.2 mg/L, P > 0.01). And the expression of MMP-9 increased in spinal cord of the fluorosis and defluorination groups in comparison with those in the control group. But no difference existed among them. CONCLUSION: The damage of blood brain barrier of spinal cord occurs probably as a result of a higher expression of MMP-9 in rats with chronic fluorosis. Defluorination for a short time may not recover.

Influence of hinge position on the effectiveness of expansive open-door laminoplasty for cervical spondylotic myelopathy.

STUDY DESIGN: A prospective study. OBJECTIVE: To assess the influence of different hinge positions on the clinical results of expansive open-door laminoplasty (EOLP) for cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: EOLP is currently the most widely adopted surgical treatment for CSM, although many long-term clinical follow-up studies have reported that most patients recover satisfactorily after EOLP, there have been numerous reports regarding postoperative complications, such as stubborn axial symptoms and segmental motor paralysis. The hinge position in EOLP plays a decisive role in determining the openness of the door so that affect clinical outcomes, whereas no thorough studies on the hinge positions have been published. METHODS: A total of 102 consecutive CSM patients who underwent EOLP from February 2006 to February 2007 were enrolled in this randomized controlled trial and assigned alternatively to 1 of 2 treatment groups. Using a random digits table, 57 patients with the hinge located at the inner margin of the lateral mass were classified as wide-open group, whereas 45 patients with the hinge positioned at the lamina margin served as narrow-open group. All patients were followed up over 24 months, clinical results including operation duration, intraoperative bleeding volume, Japanese Orthopaedic Association scores, axial symptoms assessment, and C5 palsy, and radiologic examinations like C2-C7 angle, cervical curvature index, and range of motion were analyzed statistically. RESULTS: In this study, there were no significant differences in terms of operation duration, intraoperative bleeding volume, neural function recovery rate, curvature index, and range of motion. The neural functions were satisfactorily improved after EOLP in both groups (Japanese Orthopaedic Association score developed from 7.2 ± 1.1 to 14.3 ± 1.2 and 8.1 ± 0.9 to 15.1 ± 1.6 with P = 0.01 and 0.02, respectively), whereas the severity of axial symptoms was significantly lower in narrow-open group than in wide-open group (P<0.01). The incidence of C5 palsy in wide-open group was higher than that in narrow-open group (5.3% vs. 0%), even though the difference did not reach statistical significance (1-tailed Fisher exact test, P = 0.17). CONCLUSIONS: Our results indicate that proper inward shift of the hinge can ensure effectiveness of surgical decompression, avoid an excessive backward shift of the spinal cord, reduce the incidence of C5 palsy, and alleviate the severity of axial symptoms. In addition, an inward shift should be cautious and contraindicated in patients with fluorosis cervical stenosis, ossification of posterior longitudinal ligament, and ossification of ligament flavum.

Influence of hinge position on the effectiveness of open-door expansive laminoplasty for cervical spondylotic myelopathy.

OBJECTIVE: To assess the influence of different hinge positions on clinical results of expansive open-door laminoplasty (EOLP) for cervical spondylotic myelopathy (CSM). METHODS: A total of 102 CSM patients who underwent EOLP from February 2006 to February 2007 were enrolled in this randomized controlled trial. Using a random digits table, 57 patients with the hinge located at the inner margin of the lateral mass were classified as wide-open group, while 45 patients with the hinge positioned at the lamina margin served as narrow-open group. All patients were observed over 24 months, and the clinical and radiological results were analyzed statistically. RESULTS: There were no significant differences in operation duration, intraoperative bleeding volume, Japanese Orthopaedic Association (JOA) scores, cervical curvature index, range of motion and neural function recovery rate. The neural functions were satisfactorily improved after surgery in both groups, while the severity of axial symptoms was significantly lower in the narrow-open group than in the wide-open group (P equal to 0.003). The incidence of C(5) palsy in the wide-open group was higher than that in the narrow-open group (5.3% vs 0), even though the difference did not reach statistical significance (one tailed Fisher's exact test, P equal to 0.17). CONCLUSIONS: Proper inward shift of the hinge can ensure effectiveness of surgical decompression, avoid an excessive backward shift of the spinal cord, decrease the incidence of C(5) palsy and alleviate the severity of axial symptoms.

[Relationship between expression of MMP-9 and presyrinx state of experimental syringomyelia of rabbits].

OBJECTIVE: To investigate the relationship between the expression of MMP-9 and the formation of spinal cord edema in presyrinx state of experimental syringomyelia in rabbits and evaluate the inhibitory function of doxycycline in the formation of spinal cord edema in presyrinx state. METHODS: A total of 96 Chinese white rabbits were divided randomly into four groups:kaolin group (n = 24), doxycycline treatment group (n = 24), physiological saline group (n = 24) and control group (n = 24). Under ketamine anesthesia, 0.6 ml of 25% kaolin solution was injected into the cisterna magna in all rabbits of kaolin and doxycycline groups while 0.6 ml of 37°C physiological saline into the cistern in those of saline group; doxycycline (25 mg × kg(-1) × d(-1)) was applied post-operatively for doxycycline group. At Days 1, 3, 7 and 14 after kaolin injection, 6 rabbits of all four groups were selected randomly for sacrificing. Water content of spinal cord could be obtained. The expression of MMP-9 activity was measured by Western blot and immunohistochemistry. RESULTS: At any time point, the water content of spinal cord and the expression of MMP-9 in kaolin group improved obviously more than those of saline and control groups (P < 0.01). At Day 1, there was no marked difference in the water content of spinal cord and the expression of MMP-9 between doxycycline and kaolin groups (P > 0.05). At other time points, the water content of spinal cord and the expression of MMP-9 in doxycycline group markedly decreased than those of kaolin group (P < 0.01). CONCLUSION: In the model of experimental syringomyelia, MMP-9 plays an important role in causing edema in presyrinx state. Thus doxycycline may be used to prevent and treat syringomyelia.

[Clinical validity of hinge position to expansive semi open-door laminoplasty].

OBJECTIVE: To evaluate and compare the efficacy and clinical results of cervical expansive open door laminoplasty (EOLP) with different hinge position. METHODS: From February 2006 to February 2007, a total of 102 cases with cervical spondylotic myelopathy were assessed in this randomized controlled trial. Fifty-seven patients underwent EOLP with the hinge located at the inner margin of the lateral mass classified as wide-open group. Forty-five cases who underwent EOLP with the hinge positioned at the lamina margin served as narrow-open group. The clinical results and radiological examinations of both groups were evaluated 24 months after surgery. RESULTS: There were no significant differences in operation time, bleeding quantity and recovery rate of Japanese Orthopaedic Association (JOA) scores. The incidence of C(5) palsy and severity of axial symptoms in the wide-open group were significantly lower than those in the narrow-open group (P < 0.05). There were no significant differences in cervical curvature index and range of motion between the two groups. CONCLUSIONS: Well-suited and appropriated inwardly shift the hinge could promote clinical outcomes after EOLP, especially decrease the incidence of the C(5) palsy and the severity of axial symptom, but it is contraindication for patients with ossification of posterior longitudinal ligament, ossification of ligament flavum and fluorosis cervical stenosis.

[Treatment of fluorosis cervical canal stenosis by open-door cervical expansive laminoplasty using anchor fixation].

OBJECTIVE: To evaluate the therapeutic effect of open-door cervical expansive laminoplasty (ELP) with anchor fixation on fluorosis cervical stenosis (FCS). METHODS: From February 2005 to February 2006, 20 patients with FCS underwent ELP using anchor fixation (group A) and 24 patients with FCS received ELP using conventional silk thread fixation (group B). In group A, there were 11 males and 9 females aged (58.0 +/- 11.2) years old, the course of disease ranged from 6 months to 5 years, and the stenosis involved 3 vertebral levels in 3 cases, 4 levels in 8 cases, and 5 levels in 9 cases, and the sagittal diameter of the cervical spinal canal was (7.30 +/- 5.23) mm. While in group B, there were 11 males and 13 females aged (61.0 +/- 9.1) years old, the course of disease ranged from 5 months to 5 years, the stenosis involved 3 vertebral levels in 5 cases, 4 levels in 10 cases, and 5 levels in 9 cases, and the sagittal diameter of the cervical spinal canal was (7.11 +/- 4.92) mm. No significant differences were evident between two groups in terms of the general information (P > 0.05). Before operation and at 24 months after operation, the nerve function was assessed by JOA score, the axial symptom (AS) was evaluated using Chiba 12-point method, and the changes of cervical lordosis index (CLI) and cervical range of motion (CRM) were detected by imaging examination. RESULTS: All wounds healed by first intention. All patients were followed up for 24 months. JOA score: in group A, it was improved from 7.4 +/- 1.5 before operation to 14.6 +/- 2.1 at 24 months after operation with an improvement rate of 61% +/- 3%; in group B, the score was increased from 7.1 +/- 2.2 to 12.6 +/- 2.5 with an improvement rate of 52% +/- 5%; significant differences were evident in two groups between before and after operation, and between two groups in terms of the improvement rate (P < 0.05). AS score: in group A, it was improved from 6.2 +/- 2.1 before operation to 10.8 +/- 0.3 at 24 months after operation with an improvement rate of 74% +/- 4%; in group B, the score was increased from 6.3 +/- 1.9 to 8.8 +/- 0.5 with an improvement rate of 39% +/- 3%; significant differences were evident in two groups between before and after operation, and between two groups in terms of improvement rate (P < 0.05). X-ray films and CT scan at 24 months after operation displayed that there was no occurrence of "breakage of door spindle" or "re-close of door" in two groups, there was no occurrence of anchor loosing in group A, and the molding of the spinal canal was satisfactory in two groups. Preoperatively, the CLI was 11.9 +/- 1.9 in group A and 11.3 +/- 2.2 in group B and the CRM was (39.5 +/- 2.4) degrees in group A and (40.2 +/- 1.8) degrees in group B. While at 24 months after operation, the CLI was 9.5 +/- 2.2 in group A and 8.2 +/- 2.8 in group B, and the CRM was (30.6 +/- 2.0) degrees in group A and (28.7 +/- 2.4) degrees in group B, suggesting there was a significant decrease when compared with the preoperative value and group A was superior to group B (P < 0.05). The saggital diameter of the cervical spinal canal 24 months after operation was (13.17 +/- 2.12) mm in group A and (12.89 +/- 3.21) mm in group B, indicating there was a significant difference when compared with the preoperative value (P < 0.01). CONCLUSION: Compared with conventional silk thread fixation, ELP using anchor fixation brings more stability to vertebral lamina, less invasion to the posterior muscular-skeletal structure of the cervical spine, slight postoperative neck AS, and satisfactory clinical outcomes.

Radiographic predictors of residual low back pain after laminectomy for lumbar canal stenosis: a minimum of 6-year follow-up.

OBJECTIVE: To identify radiographic predictors of residual low back pain (LBP) after laminectomy for lumbar canal stenosis (LCS). METHODS: Clinical results and radiographic findings in 69 patients who underwent single level laminectomy for LCS were retrospectively reviewed. Patients who had an improvement in LBP scores evaluated by Japanese Orthopaedic Association (JOA) scoring system during the follow-up periods were classified as the recovery group, and others were classified as the non-recovery group. Patients'clinical data and radiographic parameters like lordosis angle, range of motion and intervertebral rotational angle were analyzed using binary logistic regression analysis to detect factors significantly related with the occurrence of residual LBP. RESULTS: The average preoperative JOA score of 14.8+/-5.05 improved to 21.59+/-5.51 at the final follow-up. Binary logistic regression analysis revealed that significant predictors of residual LBP were preoperative lumbar lordosis angle and range of motion. CONCLUSIONS: Our results suggest that patients with flat back and limited lumbar mobility before surgery tend to have poor results in terms of LBP. Therefore, these sagittal radiographic parameters should be taken into account when choosing laminectomy as the surgical option for LCS.

Radiographic predictors of residual low back pain after laminectomy for lumbar spinal canal stenosis: minimum 5-year follow-up.

STUDY DESIGN: Retrospective study of patients who underwent laminectomy for unification. OBJECTIVE: To identify radiographic predictors of residual low back pain (LBP) after laminectomy for lumbar spinal canal stenosis (LCS). SUMMARY OF BACKGROUND DATA: Residual LBP is a common complication of laminectomy and no radiographic predictors of its occurrence have been identified previously. METHODS: Clinical results and radiographic findings in 49 patients (21 males and 28 females, minimum 5-year follow-up) who underwent single level laminectomy for LCS were retrospectively reviewed. Patients who had an improvement in LBP scores in the Japanese Orthopedic Association (JOA) scoring system during the follow-up periods were classified as the recovery group, whereas those without improvements were classified as the nonrecovery group. Patients' clinical data (sex, duration of symptoms, age at surgery, JOA scores) and radiographic parameters (including lumbar lordotic angle, lumbar range of motion (ROM) and the intervertebral rotational angle) were analyzed to detect the factors significantly related with the occurrence of residual LBP. RESULTS: The average preoperative JOA score of 14.8+/-5.1 points improved to 21.6+/-5.5 points at the final follow-up providing an average recovery rate of 48.1+/-36.8%. Thirty-four and 15 patients were classified into the recovery and the nonrecovery groups, respectively. Binary logistic regression analysis revealed that significant predictors of residual LBP were preoperative lumbar lordosis angle and lumbar ROM. The mean preoperative lumbar lordosis and ROM in the nonrecovery group were significantly smaller than those in the recovery group (lordosis: 25.3+/-15.8 degrees vs. 37.8+/-13.6 degrees, P=0.006 and ROM: 22.1+/-10.6 degrees vs. 31.2+/-9.9 degrees, P=0.006). In addition, increase of the postoperative lumbar ROM was significantly larger in the nonrecovery than that in the recovery group (P=0.009). CONCLUSIONS: Our results indicate that preoperative lordosis angle and lumbar ROM were the significant radiographic predictors for residual LBP after laminectomy for LCS. Patient with flatback and limited lumbar mobility before surgery are prone to suffer residual LBP. It is suggested that these sagittal radiographic parameters should be taken into account when choosing laminectomy as the surgical option for LCS.

The validity of intraoperative angiography for the treatment of spinal arteriovenous fistula.

STUDY DESIGN: Retrospective study of patients with spinal arteriovenous fistula (AVF) who underwent surgical treatment. OBJECTIVE: To evaluate the validity of the intraoperative angiography (IA) for the surgical treatment of spinal AVF. SUMMARY OF BACKGROUND DATA: Owing to the development of interventional techniques, endovascular embolization has become the treatment of choice for AVF, but it is not applicable for every spinal AVF owing to anatomic complexity of the spinal cord vessels. To get effective occlusion of the AVF, IA has been routinely used in the management of cerebral vascular diseases, but report of its use for spinal AVF is rare. METHODS: Since 2004, 4 consecutive cases of spinal AVF (3 males and 1 female, 3 thoracic, and 1 thoracolumbar) were involved in this study. The mean age at the time of operation was 62.3 years (range from 48 to 76 y). Types of AVFs and surgical techniques were reviewed retrospectively and the outcomes were assessed using the Japanese Orthopedic Association scoring system. RESULTS: AVFs in 3 patients were diagnosed as the dural type and that in the remaining patient as the perimedullary type; all feeding arteries were derived from the ninth to 10th intercostal arteries. Preoperative angiography demonstrated that the feeding arteries in 2 patients with a dural AVF were the branches of Adamkiewicz artery and in another dural AVF case, the Adamkiewicz artery could not be determined, therefore, endovascular embolization was not feasible. Including a patient with perimedullary AVF, a microsurgical clipping combined with IA was selected as the treatment. Complete occlusion of the fistula was achieved in all cases, the mean preoperative Japanese Orthopedic Association score of 4.5 improved to 6 at the final follow-up, and no perioperative complications were observed during the follow-up period. CONCLUSIONS: The favorable clinical results in our spinal AVF cases confirmed that IA ensures safe and accurate occlusion of the fistula. This technique provides satisfactory surgical results for spinal AVFs.