Case report: Thoracolumbar spinal stenosis associated with alkaptonuria.

Background: Alkaptonuria is a rare autosomal genetic disorder with an incidence of about 1 in 1 million per year. Spinal involvement often manifests in the later stages of the disease. However, this is the first report of the presentation of thoracolumbar spinal stenosis. Case presentation: We report the case of a 61-year-old female patient with significant thoracolumbar stenosis symptoms. The patient had obvious kyphosis with preoperative lower extremity muscle strength grade 2/5. Symptoms and imaging signs initially suggested ankylosing spondylitis. This patient was classified into motor incomplete injury (ASIA C). However, the patient was found to have melanin deposits on the sclera and skin, and the urine was darkened at rest. CT and MRI both suggested no bone bridge connection between vertebrae, which was the key difference between ankylosing spondylitis and alkaptonuria in imaging. Most importantly, urine specimen testing and intraoperative pathology demonstrated alkaptonuria. The patient underwent spinal decompression and vertebral body fixation. Postoperative recovery was good: the patient had significantly relieved pain and could stand and walk. Conclusion: This case is the first report of thoracolumbar spinal stenosis associated with alkaptonuria involving the spine.

Sequential sagittal alignment changes in the cervical spine after occipitocervical fusion.

BACKGROUND: There are few studies regarding sequential changes in the sagittal alignment of the upper and lower cervical regions of the spine after occipitocervical fusion (OCF). In addition, no comparisons of cervical sagittal alignment (CSA) between patients with craniocervical junction disorders (CJDs) and normal populations have been reported. AIM: To compare the CSA of patients with CJDs with that of normal controls and investigate the sequential changes in the CSA of the upper and lower cervical spine after OCF. METHODS: Eighty-four patients who underwent OCF (OCF group) and 42 asymptomatic volunteers (control group) were included. Radiographic parameters, including the occipital to C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2-7 angle (C2-7a), and pharyngeal inlet angle (PIA), were measured and compared pre- and postoperatively. The correlations among the parameters were analyzed using Pearson's correlation test. RESULTS: The O-C2a and PIA of the OCF group were smaller than those of the control group, while their O-EAa and C2-7a values were larger than those of the normal controls. There were no significant differences in O-C2a, C2-7a, or PIA in the OCF group at baseline, 1 mo, or the final follow-up after surgery. The Pearson's correlation results showed that there were significant correlations between the O-C2a and C2Ta, C2-7a, C2-7 sagittal vertical axis (SVA), and PIA at 1 mo after OCF surgery and between O-C2a and O-EAa, C2Ta, C2-7a, C2-7 SVA, and PIA at the final follow-up. CONCLUSION: Patients with CJDs have a more kyphotic upper CSA and a more lordotic lower CSA than normal controls. The effectiveness of OCF surgery in restoring CSA may be limited by the realignment of the craniocervical junction being neglected. The reduction in O-C2a after OCF surgery may increase C2-7a and decrease PIA.

[Restraining degeneration of punctured intervertebral discs by transplantation of rabbit nucleus pulposus cells and marrow stroma cells].

OBJECTIVE: To assess the ability of transplanted nucleus pulposus cells (NPC) and marrow stroma cells (MSC) in restraining the degeneration of punctured intervertebral discs in rabbits. METHODS: The passage 3 NPC and MSC were harvested for transplantation. Fifteen New Zealand white rabbits were divided into three groups: saline group (3), MSC group (6) and NPC group (6). The L3/4, L4/5, and L5/6 discs of the rabbits were stabbed and punctured using a 18G needle. The rabbits were then treated with saline, MSC, or NPC in their respective groups. The untreated L2/3, L6/7, and L7/S1 discs served as self controls. The lateral projection of lumbar vertebrae X rays and sagittal Nuclear Magnetic Resonance Images of the lumbar verteral T2 weighed signals were collected before and 4, 6 and 8 weeks after the operations. The %DHI and standardized T2WI (ST2WI) were measured using Image-pro plus 6.0 and Merge eFilm Workstation. RESULTS: All animals survived above 8 weeks after been transplanted. The transplantation effectively restrained the degeneration of the punctured discs. The NPC group had higher %DHI in week 8 (79.29 +/- 2.53)% than in week 6 (74.31 +/- 42.59)% (P<0.05). However, no difference of %DHI appeared between the NPC and MSC group in week 8. The NPC group had stronger T2 weighed signals in week 8 than the MSC group. CONCLUSION: Both NPC and MSC restrain the degeneration of punctured discs. NPC have shown stronger potential of extracellular matrix synthesis, and height and water content recovery of discs.

[Prevention of postoperative cerebrospinal fluid leakage with absorbable hemostatic fluid gelatin].

OBJECTIVE: To explore the effectiveness of absorbable hemostatic fluid gelatin in preventing postoperative cerebrospinal fluid leakage. METHODS: The clinical data of 17 patients with dura mater tear were retrospectively analyzed from March to September in 2003. There were 16 males and 1 female, aged from 16 to 67 years old with an average of (39.6 ± 15.4) years. The injury site was at cervical vertebrae in 1 case, thoracic vertebrae in 9 cases, thoracolumbar junction in 4 cases, lumbar vertebrae in 3 cases. There were burst fracture in 4 cases and fracture-dislocation in 13 cases. According to ASIA grade, 12 cases were grade A, 2 cases were grade B, 2 cases were grade D, 1 case were grade E. Two cases caused by traffic accident, 10 by high falling, 4 by heavy parts crash, 1 by stairs fell during the earthquake. Absorbable hemostatic fluid gelatins were used to plug the dura mater tear,in order to prevent postoperative cerebrospinal fluid leakage. Postoperative drainage were recorded every day. RESULTS: Of 17 patients, 15 cases did not develop with cerebrospinal fluid leakage. Two cases develop with cerebrospinal fluid leakage after operation and their drainage were removed at 6 to 7 days after operation. In all cases, no complications related with cerebrospinal fluid leakage occurred, such as headache, dizzy, fever,neck resistance, rash, incision disunion, incision infection, hematoma, neurologic symptoms aggravation. No abnormal phenomena was found on incision surrounding at follow-up of 9 months. CONCLUSION: Using absorbable hemostatic fluid gelatin to plug the dura mater tear during operation is an effective method in preventing postoperative cerebrospinal fluid leakage.

[Comparison of screw' inserting angle through the 11th and 12th rib anterior approaches for L1 burst fracture].

OBJECTIVE: To compare screw's inserting angle through the 11th and 12th rib in treating L1 burst fracture, explore effects on inserting screw and postoperative angle. METHODS: From October 2007 to October 2010, 108 patients with L1 brust fracture treated through anterior approach were analyzed,including 68 males and 40 females, aged from 21 to 64 years (mean 38.22 years). All patients were divided into the 11th (A, 51 cases) and 12th (B, 57 cases) approach. The data of operation time,blood loss, duration of incision pain, JOA score, Oswestry score, VAS score, quality of life (SF-36), recovery of nervous function, coronal Cobb angle, included angle between screw and plate were observed. RESULTS: All patients were followed up for 9 to 37 months, mean 23 months. The operation time, blood loss, duration of incision pain, in group A were lower than group B (P<0.05), JOA score, Oswestry score, VAS score, SF-36, recovery of nervous function had no significant differences (P>0.05). There were no differences in Cobb angle before operation, but had significance after operation (P=0.000). There were statistically significance between two group in angle between screw and plate (P=0.000, P=0.003). CONCLUSION: The 11th rib approach for the treatment of L1 burst fracture has less effects on screw, less trauma and less angle between screw and plate.