Rara presentación de un linfoma espinal: informe de caso y diagnóstico mediante resonancia magnética / Rare presentation of a spinal lymphoma: case report and diagnosis by magnetic resonance imaging

El linfoma primario del sistema nervioso central es una forma de enfermedad extraganglionar originada en el cerebro, la leptomeninges, la médula espinal o los ojos. Los tumores espinales son neoplasias de baja prevalencia y pueden causar una morbimortalidad neurológica considerable. El linfoma aislado que surge dentro del conducto dural es la forma menos común de linfoma primario del sistema nervioso central: representa aproximadamente el 1% de los casos y se observa más a menudo en el contexto de diseminación secundaria que como el sitio primario de origen. Los síntomas son inespecíficos y dependen del nivel espinal involucrado. La presentación es insidiosa e incluye dorsalgia, debilidad y dificultad progresiva para la deambulación. La resonancia magnética es la modalidad de elección para búsqueda de lesiones dentro del conducto espinal/raquídeo, en pacientes que presentan síntomas neurológicos. El tratamiento quirúrgico no resulta útil, y el objetivo principal de la cirugía es conocer el diagnóstico histológico. (AU)

A primary central nervous system lymphoma is a form of extranodal disease originating in the brain, leptomeninges, spinal cord, or eyes. Spinal tumors are low-prevalence neoplasms and can cause considerable neurological morbidity and mortality. An isolated lymphoma emerging within the dural canal is the rarest form of primary central nervous system lymphoma: it accounts for approximately 1% of cases occurring more often in the context of secondary dissemination than as the primary site of origin. Symptoms are nonspecific and depend on the spinal level involved. The presentation is insidious and includes dorsalgia, weakness, and progressive difficulty in ambulatory function. MRI is the modality of choice to search for lesions within the spinal/rachial canal in patients presenting with neurological symptoms. Surgical treatment is not helpful, and the main objective of surgery is to know the histological diagnosis. (AU)

Solitary Dorsal Intramedullary Schwanomma ­ A Rare Lesion

Intramedullary schwanommas are rare, and most cases are reported in cervical region. Less than 20 dorsal intramedullary schwanommas have been reported till date in literature. This is due to their cell of origin, the Schwann cell, which is not normally found within the parenchyma of the brain and spinal cord; therefore it is not surprising that these lesions are rare. We report a rare solitary dorsal intramedullary schwanomma in a young adult patient who presented with paraplegia.

A case-control study:the clinical efficacy of total laminectomy with lateral mass screw fixation and single open-door laminoplasty for cervical spinal cord injury without fracture and dislocation / 中国骨伤

OBJECTIVE@#To compare the clinical effects of total laminectomy with lateral mass screw fixation and single open-door laminoplasty in the treatment of cervical spinal cord injury without fracture and dislocation.@*METHODS@#The clinical data of 75 patients with cervical spinal cord injury without fracture and dislocation treated from December 2014 to April 2020 were retrospectively analyzed, including 65 males and 10 females, aged from 33 to 83 years old with an average of (60.1±11.4) years. According to surgical method, the patients were divided into observation group (36 cases) and control group (39 cases). The observation group was treated with C3-C6 single open-door laminoplasty. In the control group, the C3-C6 whole lamina was opened by "uncovering", and the lateral mass screw was fixed and fused. The general conditions including operation time, intraoperative blood loss, hospital stay and complications such as axial pain, cerebrospinal fluid leakage, postoperative C5 nerve palsy were recorded. Visual analogue scale(VAS), Nurick pain scale, Japanese Orthopaedic Association(JOA) scores and American Spinal Injury Association(AISA) injury scale were used to evaluate the improvement of clinical symptoms and related functional recovery 12 months after operation.@*RESULTS@#There were no statistically significant differences in operation time, intraoperative blood loss and hospital stay between two groups(P>0.05). There were statistically significant differences in JOA, VAS, ASIA and Nurick scores of the all patients between 12 months after surgery and before surgery (P<0.05), and there was no significant difference between groups. There was significant difference in the incidence of C5 nerve root palsy and axial pain between two groups(P<0.05), but there was no significant difference in the complications of cerebrospinal fluid leakage between two groups (P>0.05).@*CONCLUSION@#Total laminectomy with lateral mass screw fixation and single open-door laminoplasty in treating cervical spinal cord injury without fracture and dislocation can obtain satisfactory results in restoring nerve function, alleviating pain and improving daily behavior, but single open-door laminoplasty has the advantages of less trauma and low incidence of complications.

Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report

Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion. Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5- C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed. Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed ⅘ muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk. Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, whichmay be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.

Candida Tropicalis Spondylodiscits in an Immunocompetent Host: A Case Report and Literature Review

Background Fungal spondylodiscitis is not common but should be suspected in some cases. Candida tropicalis infections are being more frequently diagnosed due to some factors related to the microorganism. Case Description A C. tropicalis spondylodiscitis is described in a 72-year-old man who was treated with a combination of echinocandin (micafungin) and surgery. Conclusion The presence of some risk factors should promptly raise the suspicion of fungal spondylodiscitis. Treatment should be instituted as early as possible for the best outcome for the patient.

Reporte de caso: Quiste neuroentérico intradural/extramedular en paciente joven / Case report: Intradural/extramedullary neurenteric cyst in a young patient

Introducción: Los quistes neuroentéricos son lesiones congénitas, benignas, solitarias e infrecuentes del eje espinal, compuestas de tejido endodérmico heterotópico, productos del cierre incompleto del tubo neural. Se presentan, principalmente, en hombres durante la primera y segunda década de vida. Se localizan mayoritariamente en el espacio intradural/extramedular, ventralmente a la médula espinal, a nivel cervical bajo o torácico superior. La sintomatología neurológica depende de la localización del quiste. El diagnóstico presuntivo se realiza con una resonancia magnética, y el definitivo con un estudio histopatológico, llevado a cabo posterior a la exéresis completa o parcial de la muestra, con abordaje posterior, en la mayoría de los casos. Caso: Se describe el caso de una paciente de 35 años, quien tiene antecedente de haber presentado a los 14 años un quiste neuroentérico intradural/extramedular, a nivel cervial bajo. Había debutado con cervicalgia irradiada a miembros superiores e inferiores, radiculopatía, pérdida de la fuerza muscular, e hiperreflexia. Se realizó en ese momento una resonancia magnética, evidenciando una lesión ocupante de espacio en C5 y C6, la cual fue intervenida quirúrgicamente a través de una laminectomía en C5-C6 con abordaje posterior. Se realizó exéresis completa de la misma. El estudio anatomopatológico reportó quiste neuroentérico intradural/extramedular, sin atipias celulares. La evolución posoperatoria de la paciente resultó satisfactoria. Conclusión: Se describe este caso clínico, resaltando su importancia, al tratarse de lesiones sumamente infrecuentes en la literatura médica, con sintomatología poco específica, pudiendo confundirse con otras patologías, y recidivar, incluso después de haberse extraído completamente

Introduction: Neuroenteric cysts are congenital, benign, solitary, and infrequent lesions of the spinal axis, composed of heterotopic endodermic tissue, resulting from an incomplete closure of the neural tube. They mainly occur in men, during the first or second decade of life. Most of these cysts are located in the intradural/extramedullary compartment, ventrally to the spinal cord, especially at the lower cervical or upper thoracic spine. The neurological symptomatology varies depending on the location of the cyst. The presumptive diagnosis is made with magnetic resonance imaging, and the definitive diagnosis is made with a histopathological assessment, which is done after a complete or partial resection of the mass, generally with a posterior approach. Case presentation: We describe the case of a 35-year-old female patient, with the medical history of presenting an intradural/extramedullary neuroenteric cyst, located at the lower cervical level, at the age of 14. She presented cervical pain irradiated to upper and lower limbs, radicular pain, loss of muscular strength, and hyperreflexia. A magnetic resonance imaging was indicated, showing a space-occupying lesion at the C5 and C6 levels, which was surgically intervened through a posterior cervical (C5-C6) laminectomy. A complete resection of this mass was performed. The histopathological assessment reported an intradural/extramedullary neuroenteric cyst, with no cellular atypia. The patient's postoperative progress and development were satisfactory. Conclusion: The objective is to describe this case, highlighting its importance, since these lesions are extremely infrequent in the medical literature, with a non-specific symptomatology, which is why they can be confused with other pathologies, and recur, even after their complete resection.

Gangliocytic Paraganglioma of the Filum Terminale. A Rare Entity

Paragangliomas are rare, benign and slow-growing neuroendocrine tumors that can arise from the adrenal medulla (85­90%) or from the extra-adrenal paraganglia. In the central nervous system (CNS), they can be found at several sites, but more often at the cauda equina and filum terminale region, where they account for between 2.5 and 3.8% of total tumor cases of that region. There are only 8 cases described in the literature that mention the presence of the gangliocytic variant of this entity at the filum terminale. We present the case of a 41-year-old man with chronic lumbar pain refractory to medical treatment, without any associated neurological deficits. Magnetic resonance imaging (MRI) revealed an intradural, extramedullar oval lesion with regular contours and homogeneous caption of contrast at L1 level. He was submitted to surgical treatment, with complete resection of the lesion. The histological analysis revealed a gangliocytic paraganglioma of the filum terminale. At 5 years of follow-up, he remains asymptomatic and without any signs of relapse. These are lesions with an overall good prognosis with gross total resection. Although the recurrence rate is extremely low, prolonged observation is recommended due to the slow-growing nature of the tumor, being estimated that between 1 and 4% can recur even after gross total removal.

Intradural Spinal Arachnoid Cyst in a Pediatric Patient: A Case Report

The present case reports a 13-year-old patient with an intradural arachnoid cyst, which manifested itself with a sudden loss of strength and sensitivity in the lower and upper limbs and a severe pain in the cervical and thoracic region. On examination, a lesion displayed as an intradural hematoma; however, a laminotomy was performed and it was realized that the lesion was an arachnoid spinal cyst of the cervical-dorsal spine.

Minimally invasive treatment of cervical1-2 epidural neurilemmoma / 北京大学学报(医学版)

OBJECTIVE@#To explore the minimally invasive surgical method for cervical1-2 epidural neurilemmoma.@*METHODS@#The clinical features, imaging characteristics and surgical methods of 63 cases of cervical1-2 epidural neurilemmoma from July 2010 to December 2018 were reviewed and analyzed. Pain and numbness in occipitocervical region were the common clinical symptoms. There were 58 cases with pain, 30 cases with numbness, 3 cases with limb weakness and 2 cases with asymptomatic mass. Magnetic resonance imaging (MRI) showed that the tumors located in the cervical1-2 epidural space with diameter of 1-3 cm. The equal or slightly lower T1 and equal or slightly higher T2 signals were found on MRI. The tumors had obvious enhancement. Individualized laminotomy was performed according to the location and size of the tumors, and axis spinous processes were preserved as far as possible. Resection of tumor was performed strictly within the capsule.@*RESULTS@#Total and subtotal resection of tumor were achieved in 60 and 3 cases respectively, and no vertebral artery injury was found. The operation time ranged from 60 to 180 minutes, with an average of 92.83 minutes. The hospitalization time ranged from 3 to 9 days, with an average of 5.97 days. All tumors were confirmed as neurilemmoma by pathology. There was no postoperative infection or cerebrospinal fluid leakage. There was no new-onset dysfunction except 9 cases of numbness in the nerve innervation area. The period of follow-up ranged from 6 months to 8 years (median: 3 years). All the new-onset dysfunction recovered completely. Pain disappeared in all of the 58 patients with pain. Numbness recovered completely in 27 patients while slight numbness remained in another 3 patients. Three patients with muscle weakness recovered completely. The spinal function of all the patients restored to McCormick grade Ⅰ. No recurrence was found on MRI. No cervical spine instability or deformity was found on X-rays.@*CONCLUSION@#It is feasible to resect cervical1-2 epidural neurilemmoma by full use of the anatomical space between atlas and axis and individual laminotomy. It is helpful to prevent cervical instability or deformity by minimizing the destruction of cervical2 bone and preserving normal muscle attachment to cervical2 spinous process. Strict intracapsular resection can effectively prevent vertebral artery injury.

Analysis of clinical efficacy of C expanded half lamina excision combined with unilateral open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of C expanded half lamina excision combined with unilateral open door laminoplasty for multiple segmental cervical spinal cord compression syndrome.@*METHODS@#The clinical data of 58 patients with multiple segmental cervical spinal cord compression syndrome underwent surgical treatment between September 2014 and May 2018 were retrospectively analyzed. There were 34 males and 24 females with a mean age of 64.4 years old (ranged from 46 to 78 years old). Among them, 28 cases received the surgery of C expanded half lamina excision combined with C-C unilateral open-door laminoplasty (improvedgroup), and 30 cases received a single C-C unilateral open-door laminoplasty (traditional group). Operation time, intraoperative blood loss, complications including C nerve root palsy and axial symptoms were compared between two groups. To evaluate the situation of the imaging indicators by measuring the space available for the spinal cord through cross sectional MRI of cervical spine at the narrowest segment of C (including intervertebral disc levels of C). Pre- and post-operative Japanese Orthopedic Association(JOA) score, Neck Disability Index(NDI) score, and improvement rate of neurological function, were recorded and analyzed between the two groups.@*RESULTS@#All the patients were followed up for 12 to 18 months with an average of(14.5±1.8) months for improved group and (14.5±1.9) months for traditional group, and no significant difference was found between the two groups (>0.05). There was no significant difference in intraoperative blood loss and C nerve root palsy between the two groups (>0.05). The operation time (119±10) min vs (126±12) min and axial symptoms 7.1%(2/28) vs 26.6%(8/30) was significant difference between the two groups (0.05).@*CONCLUSION@#C expanded half lamina excision combined with unilateral open-door laminoplasty is an effective method to treat multiple segmental cervical spinal cord compression syndrome, for it can not only fully relieved spinal cord compression, but also achievedgood effect in preventing complications such as axial symptoms by reducing stripping of muscles from C2 spinous process.

Preliminary results of vertebral canal decompression by spinous process splitting / Resultados preliminares da descompressão do canal vertebral por separação do processo espinhoso / Resultados preliminares de la descompresión del canal vertebral por separación del proceso espinoso

ABSTRACT Objective Considering that the technique of spinous process splitting has been advocated as a less invasive treatment of lumbar stenosis, the objective of this study was to evaluate the preliminary results of this technique in the surgical treatment of lumbar canal stenosis. Methods Twenty patients with lumbar spinal canal stenosis who underwent surgical treatment for lumbar canal decompression with the spinous process splitting technique were assessed in the preoperative period and on postoperative days 1, 7 and 30 for VAS for lower back and lower limbs pain and radiographic evaluation of the operated segment. Results The mean visual analogue scale score for lumbar pain in the preoperative assessment was 4.2 ± 3.37 and 0.85 ± 0.88, 1.05 ± 1.19 and 1.15 ± 1.04 after 1, 7 and 30 postoperative days, respectively. The mean VAS score for lower limb pain was 8 ± 1.72 preoperatively, and 0.7 ± 1.13, 0.85 ± 1.04, and 1.05 ± 1 after 1, 7, and 30 postoperative days, respectively. There were no radiographic signs of instability of the vertebral segment operated in the radiographic evaluation. Conclusions Decompression of the lumbar canal through the spinous process splitting technique in patients with lumbar canal stenosis had good immediate and short-term results in relation to low back and lower limbs pain. Level of evidence IV; Therapeutic Study.

RESUMO Objetivo A técnica da separação do processo espinhoso tem sido preconizada como técnica menos invasiva para o tratamento da estenose lombar. Objetivo é avaliar os resultados preliminares dessa técnica no tratamento cirúrgico da estenose do canal lombar. Métodos Vinte pacientes portadores de estenose do canal vertebral lombar e submetidos ao tratamento cirúrgico para descompressão do canal lombar, por meio da técnica da separação do processo espinhoso, foram avaliados no período pré-operatório, um, sete e trinta dias de pós-operatório, por meio da escala visual de avaliação da dor lombar e dor nos membros inferiores e avaliação radiográfica do segmento operado. Resultados O escore médio da escala visual analógica da dor lombar na avaliação pré-operatória foi 4,2 ± 3,37 e, respectivamente, 0,85 ± 0,88; 1,05 ± 1,19 e 1,15 ± 1,04 após um, sete e trinta dias de pós-operatório. O escore médio da escala visual analógica da dor nos membros inferiores foi 8 ± 1,72 no pré-operatório e, respectivamente, 0,7 ± 1,13; 0,85 ± 1,04 e 1,05 ± ١ após um, sete e trinta dias de pós-operatório. Não foram observados sinais radiográficos de instabilidade do segmento vertebral operado na avaliação radiográfica. Conclusão A descompressão do canal lombar por meio da técnica da separação do processo espinhoso nos pacientes com estenose do canal lombar apresentou bons resultados imediatos e a curto prazo, em relação à dor lombar e dor nos membros inferiores . Nível de evidência IV; Estudo Terapêutico.

RESUMEN Objetivo Teniendo en cuenta que la técnica de separación del proceso espinoso ha sido recomendada para el tratamiento menos invasivo de la estenosis lumbar, el objetivo de este estudio fue evaluar los resultados preliminares de esta técnica en el tratamiento quirúrgico de la estenosis del canal lumbar. Métodos Veinte pacientes con estenosis del canal espinal lumbar que se sometieron a tratamiento quirúrgico para descompresión del canal lumbar con la técnica de separación del proceso espinoso se evaluaron en el período preoperatorio y en los días 1, 7 y 30 postoperatorios mediante EVA para del dolor lumbar y de los miembros inferiores y evaluación radiográfica del segmento operado. Resultados La puntuación promedio de la escala visual analógica del dolor lumbar en la evaluación preoperatoria fue de 4,2 ± 3,37 y 0,85 ± 0,88; 1,05 ± 1,19 y 1,15 ± 1,04 después de 1, 7 y 30 días postoperatorios. La puntuación promedio de la EVA para el dolor de las extremidades inferiores fue 8 ± 1,72 en el preoperatorio y de 0,7 ± 1,13; 0,85 ± 1,04 y 1,05 ± 1 después de 1, 7 y 30 días postoperatorios, respectivamente. No se observaron signos radiográficos de inestabilidad del segmento vertebral operado en la evaluación radiográfica. Conclusiones La descompresión del canal lumbar por medio de la técnica de separación del proceso espinoso en pacientes con estenosis del canal lumbar tuvo buenos resultados inmediatos y a corto plazo con relación al dolor lumbar y las extremidades inferiores. Nivel de evidencia IV; Estudio Terapéutico.

Traumatic Cervical Epidural Hematoma without Osseous Fracture Presenting as Hemiparesis / 대한신경손상학회지

Traumatic cervical epidural hematoma (EDH) with no osseous fracture or underlying hematological abnormalities is a rare disorder that sometimes requires emergent surgical decompressive therapy. A 47-year-old woman was admitted to our emergency room due to severe neck pain and rapid onset hemiparesis after a car accident. Plain cervical radiographs and computed tomography scan did not reveal any abnormality. However, magnetic resonance imaging (MRI) revealed a large posterior EDH compressing the spinal cord extensively from C3 to C5. Emergent hematoma removal was performed following laminectomy, and subsequently the patient showed substantial clinical improvement. Complete removal of the hematoma was confirmed by MRI at 10 days after surgery. Here, the authors present a discussion of the etiology, pathogenesis, and prognosis of this rare pathologic entity.

Cervical Cerebrospinal Fluid Leakage Concomitant with a Thoracic Spinal Intradural Arachnoid Cyst / 대한신경손상학회지

We encountered a very rare case of spontaneous spinal cerebrospinal fluid (CSF) leakage and a spinal intradural arachnoid cyst (AC) that were diagnosed at different sites in the same patient. These two lesions were thought to have interfered with the disease onset and deterioration. A 30-year-old man presented with sudden neck pain and orthostatic headache. Diplopia, ophthalmic pain, and headache deteriorated. CSF leakage was confirmed in C2 by radioisotope cisternography, and an epidural blood patch was performed. While his symptoms improved gradually, paraparesis suddenly progressed. Thoracolumbar magnetic resonance imaging (MRI) revealed an upper thoracic spinal intradural AC, which was compressing the spinal cord. We removed the outer membrane of the AC and performed fenestration of the inner membrane after T3-4 laminectomy. Postoperative MRI showed complete removal of the AC and normalized lumbar subarachnoid space. All neurological deficits including motor weakness, sensory impairment, and voiding function improved to normal. We present a case of spontaneous spinal CSF leakage and consecutive intracranial hypotension in a patient with a spinal AC. Our report suggests that if spinal CSF leakage and a spinal AC are diagnosed in one patient, even if they are located at different sites, they may affect disease progression and aggravation.

Modified dual-injection lumbar erector spine plane (ESP) block for opioid-free anesthesia in multi-level lumbar laminectomy / 대한마취과학회지

No abstract available.

Primary Peripheral Gamma Delta T-Cell Lymphoma of the Central Nervous System: Report of a Case Involving the Intramedullary Spinal Cord and Presenting with Myelopathy

Primary central nervous system lymphoma of T-cell origin (T-PCNSL) is rare, and its clinicopathological features remain unclear. Peripheral T-cell lymphoma of γδ T-cell origin is an aggressive lymphoma mainly involving extranodal sites. Here, we report a case of γδ T-PCNSL involving the intramedullary spinal cord and presenting with paraplegia. A 75-year-old Korean woman visited the hospital complaining of back pain and lower extremity weakness. Magnetic resonance imaging revealed multifocal enhancing intramedullary nodular lesions in the thoracic and lumbar spinal cord. An enhancing nodular lesion was observed in the periventricular white matter of the lateral ventricle in the brain. There were no other abnormalities in systemic organs or skin. Laminectomy and tumor removal were performed. The tumor consisted of monomorphic, medium-to-large atypical lymphocytes with pale-to-eosinophilic cytoplasm. Immunohistochemically, the tumor cells were CD3(+), TCRβF1(-), TCRγ(+), CD30(-), CD4(-), CD8(-), CD56(+), TIA1(+), granzyme B(+), and CD103(+). Epstein-Barr virus in situ was negative. This case represents a unique T-PCNSL of γδ T-cell origin involving the spinal cord.

Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process

BACKGROUND: In lumbar spinal stenosis, spinous process-splitting decompression has demonstrated good clinical outcomes with preservation of the posterior ligamentous complex and paraspinal muscles in comparison to conventional laminectomy, but the radiological consequence and clinical impact of the split spinous processes have not been fully understood. METHODS: Seventy-three patients who underwent spinous process-splitting decompression were included. The bone union rate and pattern were evaluated by computed tomography performed 6–18 months after surgery and compared among subgroups divided according to the number of levels decompressed and the extent of spinous process splitting. The bone union pattern was classified into three categories: complete union, partial union, and nonunion. The visual analog scale (VAS) score, Oswestry disability index (ODI), and walking distance assessed both before and 24–36 months after surgery were compared among subgroups divided according to the union pattern of the split spinous process. RESULTS: Overall, the rates of complete union, partial union, and nonunion were 51.7%, 43.2%, and 5.1%, respectively. In the subgroup with partial splitting of the spinous process, the rates were 85.7%, 14.3%, and 0%, respectively; those of the subgroup with total splitting of the spinous process were 32.9%, 59.2%, and 7.9%, respectively. With single-level decompression, a higher rate of union was observed compared with multilevel decompression. The VAS, ODI, and walking distance were significantly improved after surgery and did not differ according to the degree of union of the split spinous process. CONCLUSIONS: We found that the single-level operation and partial splitting of the spinous process were favourable factors for obtaining complete restoration of the posterior bony structure of the lumbar spine in spinous process-splitting decompression.

Biomechanical changes of sheep cervical spine after unilateral hemilaminectomy and different degrees of facetectomy / 北京大学学报(医学版)

OBJECTIVE@#To establish animal models and investigate the impact of unilateral hemilaminectomy (ULHL) and different degrees of facetectomy (FT) on the cervical spinal biomechanics.@*METHODS@#Twenty sheep were randomly and evenly divided into 4 groups. No operation was performed for group A, right C4-C6 ULHL was performed for group B, right C4-C6 ULHL and 50% ipsilateral C4-C5 FT was performed for group C, right C4-C6 ULHL and 100% ipsilateral C4-C5 FT was performed for group D. Animals of group A, B, C and D were sacrificed 24 weeks after operating and fresh cervical spine specimens were acquired, biomechanically tested and these data were compared to determine whether ULHL and different degrees of FT led to long-term differences in range of motion.@*RESULTS@#(1) Changes of the total range of motion of cervical spine 24 weeks after surgery: the total range of motion of group D (60.2°±8.6°) was significantly greater than group A (40.7°±6.4°) and group B (41.2°±13.1°) under flexion-extension station, the total range of motion of group D (81.5°±15.7°) was significantly greater than that of group A (56.7°±12.2°) and group B (57.7°±12.8°) under lateral bending station, and the total range of motion of group D (38.5°±17.5°) had no obvious increase compared with group A (26.4°±9.9°) and group B (27.1°±10.9°) under axial rotation station. The total range of motion of group C had no obvious increase compared with group A and group B under flexion-extension station (44.1°±11.7°), lateral bending station (73.6°±11.4°) and axial rotation station (31.3°±11.5°). (2) Changes of the intersegmental motion 24 weeks after surgery: the intersegmental motion of group D (20.3°±4.6°) at C4-C5 was significantly greater than that of group A (11.7°±3.4°) and group B (11.9°±2.1°) under flexion-extension station, the intersegmental motion of group D (26.8°±3.5°) at C4-C5 was significantly greater than that of group A (15.2°±3.1°) and group B (16.2°±3.2°) under lateral bending station, the intersegmental motion of group D (15.2°±3.5°) at C4-C5 was significantly greater than that of group A (6.6°±2.3°) and group B (7.1°±1.9°) under axial rotation station. The intersegmental motion of group C (21.2°±4.1°) at C4-C5 was significantly greater than that of group A and group B under lateral bending station, the intersegmental motion of group C at C4-C5 had no obvious increase compared with group A and group B under flexion-extension station (15.7°±3.7°) and axial rotation station (10.3°±3.1°).@*CONCLUSION@#ULHL does not affect cervical stability, ULHL and 50% ipsilateral FT does not affect the long-term cervical stability, ULHL and 100% ipsilateral FT can lead to long-term instability under lateral bending and flexion-extension station.

All levels miniplate fixation and a modified hybrid fixation method in expansive open-door cervical laminoplasty: a retrospective comparative study / 北京大学学报(医学版)

OBJECTIVE@#To retrospectively compare the effect of alternate levels miniplate and anchor fixation with the effect of all levels miniplate fixation in expansive open-door cervical laminoplasty (EOLP).@*METHODS@#Patients with cervical spondylosis underwent EOLP between July 2015 and June 2016 were included in the study. There were 33 patients in the alternate group (alternate levels miniplate and anchor fixation group) and 34 patients in the miniplate group (all levels miniplate fixation group). Neurological function was evaluated with the Japanese Orthopedic Association (JOA) score and degree of pain was assessed with the visual analogue scale (VAS) score. Basic clinical and surgical data, complication rates and medical costs of the two groups were compared. In addition, radiological examinations were performed pre- and post-operatively and at the final follow-up. Relative imaging data such as anteroposterior diameter (APD), cervical curvature index (CCI) and open angle were collected and compared.@*RESULTS@#(1) The mean follow-up time was 18.6 months in the alternate group and 18.9 months in the miniplate group. There were no significant differences in operation time, intraoperative blood loss, perioperative complication rates, post-operative hospital stays, VAS scores and neurological recovery rates preoperatively and at the final follow-up between the two groups. (2) Additionally, no obvious differences were observed about CCIs and APDs at the three follow-up time points between the two groups. Post-operative open angles at C4 and C6 in the alternate group were significantly smaller than those in the miniplate group. However, there were no significant differences in C3, C5 and C7 open angles between the two groups post-operatively. Notably, no significant differences were detected about the open angles at all levels between the two groups at the final follow-up. (3) When comparing radiologic data at different time points in each group, CCIs and open angles at each level had no significant differences, but APDs after surgery and at the final follow-up were significantly larger than pre-operative APDs. (4) Total costs in the alternate group were significantly lower than those in the miniplate group.@*CONCLUSION@#The two surgical methods showed almost the same neurological recovery rates and complication rates. However, use of alternate levels miniplate and anchor fixation in EOLP can reduce medical expenses.

Analysis of Preoperative Factors Affecting Postoperative Spinal Canal Expansion after Posterior Decompression for the Treatment of Multilevel Cervical Myelopathy / 대한척추외과학회지

STUDY DESIGN: Retrospective analysis OBJECTIVES: To evaluate preoperative factors related with spinal canal expansion after posterior decompression for the treatment of multilevel cervical myelopathy. SUMMARY OF LITERATURE REVIEW: Data about preoperative factors related with spinal canal expansion after posterior cervical decompression surgery are inconsistent. MATERIALS AND METHODS: We reviewed 67 patients with cervical myelopathy who underwent posterior laminectomy or laminoplasty. Radiologically, we evaluated the C2-7 Cobb angle and range of motion using X-rays from the preoperative assessment and final follow-up. Expansion of the spinal canal at 6 weeks postoperatively was evaluated using magnetic resonance imaging and compared with the preoperative values. The preoperative factors of age, sex, number of operated levels, operation method, and radiological parameters were investigated as factors potentially related to postoperative spinal canal expansion using multivariate regression and correlation analyses. The clinical outcome was analyzed by the Neck Disability Index (NDI) and Japanese Orthopaedic Association (JOA) scores. RESULTS: The postoperative spinal canal expansion was 4.76 mm in sagittal images and 4.31 mm in axial images, with higher values observed in males and cases of severe preoperative cord compression. A lordotic preoperative Cobb angle was related to postoperative spinal canal expansion and JOA score improvement, but without statistical significance. The clinical outcomes of NDI (18.3→14.8) and JOA scores (10.81→14.6) showed improvement, but were not significantly related with any preoperative factors. CONCLUSIONS: The amount of preoperative spinal canal stenosis was associated with postoperative spinal canal expansion after posterior decompression in multilevel cervical myelopathy. The preoperative Cobb angle was not related to postoperative spinal canal expansion or clinical improvement.