Pedicle screw fixation combined with posterior decompression and bone grafting for thoracolumbar spinal fractures can enhance curative effect and spinal cord function.

OBJECTIVE: To explore the efficacy of pedicle screw fixation (PSF) combined with posterior decompression and bone grafting for thoracolumbar spinal fractures (TLSFs) and its influence on spinal cord function. METHODS: In this retrospective study, 94 patients with TLSFs treated in the China-Japan Friendship Hospital rom June 2015 and September 2020 were selected, including 53 cases in the joint group treated with PSF combined with posterior decompression and bone grafting, and 41 cases in the control group with PSF alone. The two groups were compared in terms of operation time, intra-operational blood loss, length of hospital stay and wound healing as well as the pre- and post-treatment spinal cord function, and patients' clinical outcomes. Pre- and post-operatively, the pain severity was evaluated by the Visual Analogue Scale (VAS), the spinal dysfunction was assessed by Oswestry Disability Index (ODI), and the injured vertebral height and Cobb angles of the thoracolumbar spine (TLS) were compared. The clinical efficacy and postoperative complication rates of the two groups were observed and compared. RESULTS: Less operative time, intraoperative bleeding, hospitalization time and wound healing time were determined in the joint group compared with the control group (all P<0.05). The postoperative sensory function and motor function were also better in the joint group (all P<0.05). Postoperatively, the joint group showed lower VAS and ODI scores than in the control group, with lower upper and lower TLS Cobb angles, and higher height of the anterior and posterior margins of the fractured vertebra (all P<0.05). The total effective rate was higher, and the incidence of postoperative complications was significantly lower in the joint group compared with the control group. CONCLUSION: PSF combined with posterior decompression and bone grafting is effective in the treatment of TLSFs, which can not only significantly improve the spinal cord function and alleviate spinal dysfunction, but also help to relieve pain and reduce postoperative complications.

Predictive Value of Spinal Cord Function Classification and Sagittal Deformity Angular Ratio for Neurologic Risk Stratification in Patients with Severe and Stiff Kyphoscoliosis.

BACKGROUND: Three-column osteotomies were developed to treat severe spinal deformities but result in high neurologic complications and require further risk stratification. The present study investigated whether the combination of spinal cord function classification (SCFC) and deformity angular ratio (DAR) could further stratify the neurologic risks in the surgical correction of severe and stiff kyphoscoliosis. METHODS: The patients with kyphoscoliosis who had undergone posterior 3-column osteotomies at the spinal cord level were reviewed. Using our SCFC system, the preoperative neurologic function (type A, B, or C) was classified. The sagittal DAR (S-DAR), coronal, and total DARs were calculated. Intraoperative monitoring events and new neurologic deficits (NNDs) postoperatively were documented and analyzed using the SCFC and DAR or both combined. RESULTS: The NND rates increased significantly from type A to C (P = 0.000) and increased exponentially with an increase in S-DAR in types B and C but not type A. They also increased exponentially with aggravation of the SCFC in the medium and high but not low S-DAR group. All NNDs had recovered at 3 months for type A and most had recovered at 6 months for type B or C. CONCLUSIONS: The NNDs in type A SCFC usually experienced better recovery even with high S-DARs. Type B SCFC with an S-DAR >20° and type C SCFC with any S-DAR resulted in significantly greater intra- and postoperative neurologic risks. The combination of SCFC and S-DAR can further stratify the intra- and postoperative neurologic risks with these procedures.

Multipulse transcranial electrical stimulation (TES): normative data for motor evoked potentials in healthy horses.

BACKGROUND: There are indications that transcranial electrical stimulation (TES) assesses the motor function of the spinal cord in horses in a more sensitive and reproducible fashion than transcranial magnetic stimulation (TMS). However, no normative data of TES evoked motor potentials (MEP) is available. RESULTS: In this prospective study normative data of TES induced MEP wave characteristics (motor latency times (MLT); amplitude and waveform) was obtained from the extensor carpi radialis (ECR) and tibial cranialis (TC) muscles in a group of healthy horses to create a reference frame for functional diagnostic purposes. For the 12 horses involved in the study 95% confidence intervals for MLTs were 16.1-22.6 ms and 31.9-41.1 ms for ECR and TC muscles respectively. Intra-individual coefficients of variation (CV) and mean of MLTs were: ECR: 2.2-8,2% and 4.5% and TC: 1.4-6.3% and 3.5% respectively. Inter-individual CVs for MLTs were higher, though below 10% on all occasions. The mean ± sd of MEP amplitudes was respectively 3.61 ± 2.55 mV (ECR muscle left) and 4.53 ± 3.1 mV (right) and 2.66 ± 2.22 mV (TC muscle left) and 2.55 ± 1.85 mV (right). MLTs showed no significant left versus right differences. All MLTs showed significant (p < 0.05) voltage dependent decreases with slope coefficients of linear regression for ECR: - 0.049; - 0.061 ms/V and TC: - 0.082; - 0.089 ms/V (left; right). There was a positive correlation found between height at withers and MLTs in all 4 muscle groups. Finally, reliable assessment of MEP characteristics was for all muscle groups restricted to a transcranial time window of approximately 15-19 ms. CONCLUSIONS: TES is a novel and sensitive technique to assess spinal motor function in horses. It is easy applicable and highly reproducible. This study provides normative data in healthy horses on TES induced MEPs in the extensor carpi radialis and tibialis cranialis muscles bilaterally. No significant differences between MLTs of the left and right side could be demonstrated. A significant effect of stimulation voltage on MLTs was found. No significant effect of height at the withers could be found based upon the results of the current study. A study in which both TMS and TES are applied on the same group of horses is needed.

A preliminary study of 3.0-T magnetic resonance diffusion tensor imaging in cervical spondylotic myelopathy.

PURPOSE: To compare diffusion tensor imaging (DTI) parameters of the spinal cord between patients with cervical spondylotic myelopathy (CSM) and normal subjects, and investigate their significance in the clinical diagnosis, surgical planning and post-operative evaluation of CSM. METHODS: Routine sequence magnetic resonance imaging (MRI) and DTI scans were performed in 50 normal subjects and 60 cases of CSM with 3.0-T MR. DTI images, apparent diffusion coefficient (ADC) and fractional anisotropy (FA) colormaps corresponding to spinal cord cross-sections were obtained. The spinal cord function of CSM patients was measured using modified Japanese Orthopaedic Association (mJOA) scoring and Nurick grade at different times. The changes in DTI parameters and their correlation with spinal cord function scores were analysed by SPSS 19. RESULTS: There were significant differences in DTI parameters of the spinal cord between normal subjects and patients with CSM (ADC: 1.119 ± 0.087 vs. 1.395 ± 0.091, P < 0.01; FA: 0.661 ± 0.057 vs. 0.420 ± 0.080, P < 0.01). The FA values at the maximal compression level of the spinal cord in the patients with CSM were significantly associated with the mJOA score pre-operatively, 1 week, and 1, 3 and 6 months post-operatively, with Pearson's correlation coefficients of 0.58 (P < 0.01), 0.53 (P < 0.05), and 0.51 (P < 0.05), 0.54 (P < 0.05) and 0.55 (P < 0.05), respectively. However, the FA values were significantly negatively associated with the Nurick grade, with Pearson's correlation coefficients of - 0.40 (P < 0.05), - 0.39 (P < 0.05), and -0.41 (P < 0.05), - 0.45 (P < 0.05) and - 0.44 (P < 0.05), respectively. CONCLUSIONS: DTI may play a significant role in diagnosing and predicting the development of CSM. These slides can be retrieved under Electronic Supplementary Material.

Spinal cord function in patients with ossification of cervical posterior longitudinal ligament after at least two years nonoperative treatment:a regression of the outcomes in 63 cases / 中国矫形外科杂志

12)is good after nonoperative treatment above 2 years.