Traditional Chinese medicine manipulative reduction combined with percutaneous vertebroplasty for treating type III Kummell's disease: A case report.

BACKGROUND: A patient with type III Kummell's disease had a ruptured posterior cortex of the fractured vertebral body, which caused spinal cord compression. An open surgery was considered the best choice of operation. However, the patient and her family refused open surgery and instead demanded a minimally invasive surgical treatment such as percutaneous vertebroplasty (PVP). After preoperative discussion, we finally adopted the novel therapy of traditional Chinese medicine manipulative reduction (TCMMR) combined with PVP. CASE SUMMARY: A patient with type III Kummell's disease exhibiting bone block-induced spinal cord compression was admitted to our hospital. She suffered from a variety of medical disorders but refused open surgery, and instead asked for PVP surgery. TCMMR, in parallel with PVP, was used to restore the height of the compressed vertebral body and reduce the symptoms of spinal cord compression by the bone block in order to strengthen the vertebral body and prevent further collapse. The surgery was very successful. The height of the compressed vertebra was restored, and the symptom of spinal cord compression by bone block was reduced successfully via TCMMR. The fractured vertebra was solidified by the PVP. The pain visual analog score declined from preoperative 7 scores to postoperative 2 scores, and the Frankel spinal cord scale increased from preoperative D degree to postoperative E degree. CONCLUSION: The new method has advantages in treating patients with type III Kummell's disease who cannot be treated with open surgery.

Delayed arterial symptomatic epidural hematoma on the 14th day after posterior lumbar interbody fusion: A case report.

BACKGROUND: Delayed arterial symptomatic epidural hematoma (SEH) on the 14th day after posterior lumbar interbody fusion (PLIF) is rare but it may lead to severe complications if not identified and treated in a timely manner. After diagnosis of the current case, early surgical removal of the hematoma and strict hemostasis treatment was accomplished. This case report highlights the importance of swift diagnosis and treatment in SEH patients. CASE SUMMARY: A 41-year-old male patient with a single-segment lumbar disc herniation underwent left-side PLIF. On the 14th post-operative day, the patient complained of lumbar incision pain with sudden onset accompanied by left limb radiation pain and aggravated cauda equina symptoms. Magnetic resonance imaging examination and a puncture blood draw at the incision site confirmed a delayed arterial SEH. Emergency surgical removal of the hematoma and hemostasis was performed. About 70 mL of hematoma was found in the left incision. Continuous bleeding was found in the anterior branch of the transverse process of the 4th lumbar artery in the muscle area about 2 cm below the transverse process of the 4th lumbar vertebra. A blood jet of about 10 cm in height was observed and bipolar electrocoagulation was used to stop the bleeding. Post-operative lumbar incision pain and left lower limb pain were relieved immediately and gradually disappeared. There was no recurrence during the 12-mo follow-up. CONCLUSION: For delayed arterial SEH on the 14th day after PLIF, preventive measures including pre-, intra- and post-operative prevention should be implemented.

Reduced capacity of dendritic cells from trauma-hemorrhage mice in initiating delayed-type hypersensitivity to fluorescein isothiocyanate.

OBJECTIVE: To study the role of dendritic cells (DCs) in initiating delayed-type hypersensitivity (DTH) to fluorescein isothiocyanate (FITC) after trauma-hemorrhage in mice. METHODS: Inbred BALB/c mice (6-8 weeks old, male) were epicutaneously sensitized with FITC 12 hours, 1 day, 2 days, 4 days and 7 days after closed bilateral femur fractures combined with hemorrhage. And 5 days after sensitization, DTH was evaluated by ear swelling after a challenge of FITC. Draining lymph node cells were examined for the percentages of FITC-positive cells, cluster of differentiation (CD)11c-positive cells and major histocompatibility complex II (MHC II)-positive cells by means of flow cytometry. In vitro proliferative responses of syngeneic lymphocytes and in vivo passive transfer of DTH to naive recipients induced by isolated DCs from the draining lymph nodes were determined. RESULTS: The time of DTH to FITC decreased more significantly in the mice with trauma-hemorrhage (12 hours to 4 days) than in the mice with sham injury. After sensitization, the relative percentages of FITC+ cells, FITC+/CD11c+ cells and FITC+/CD11c+/MHC II+ cells from the draining lymph nodes were all significantly reduced following injury. And the capacity of DCs from the draining lymph nodes in stimulating proliferative responses of lymphocytes and transferring DTH to naive recipients were also inhibited after injury. CONCLUSIONS: Trauma-hemorrhage induces repressive DTH in mice, which may be attributed, at least partially, to the reduced trafficking of DCs into the draining lymph nodes and insufficient maturation during DC migration.

[Clinical application of the reconstruction of prevertebral fascia in cervical vertebrae anterior approach].

OBJECTIVE: To evaluate the preventive effect of the reconstruction of prevertebral fascia on the complication of cervical vertebrae anterior approach. METHODS: One hundred and seventy-six patients with cervical vertebrae anterior approach were divided into two groups by throwing coins, coins for the positive, patients entered the group A, coins for the negative, patients entered the group B. Eighty-seven cases of group B were treated with cervical vertebrae anterior decompression, bone grafting and internal fixation with plate and screws. In other 89 cases of group A, prevertebral fascia were covered on the surface of the plate and screws as experiment group. The patients were followed up after three weeks, three months and 12 months. The incidence of the dysphagia was as observation indicator and was statistically analyzed. RESULTS: The followed-up period was 3 weeks, 3 months and 12 months after operation. The incidence of the dysphagia of group A was respectively 25.8%, 9.0%, 5.6%; the incidence of the dysphagia of group B was respectively 25.3%, 20.6%, 14.9%. The dysphagia in the experiment group was lower than that in contrast group, 3 months and 12 months after operation (3 months P = 0.030, 12 months P = 0.049 < 0.05). CONCLUSION: The reconstruction of prevertebral fascia is an effective method to avoid the dysphagia of cervical vertebrae anterior approach.