In the conventional posterior approach to the lumbar spine for transforaminal lumbar interbody fusion (TLIF), the paravertebral muscles are stripped from the spinous process. The authors developed a novel surgical procedure in which TLIF was performed via a modified spinous process–splitting (SPS) approach that enabled the preservation of the attachment of the paravertebral muscles to the spinous process. The SPS TLIF group comprised 52 patients with lumbar degenerative or isthmic spondylolisthesis who underwent surgery using a modified SPS TLIF technique, whereas the control group comprised 54 patients who underwent conventional TLIF. Compared with the control group, the SPS TLIF group had a significantly shorter operation time, smaller intra- and postoperative blood loss volumes, and shorter hospital stay and time to ambulation (p < 0.05). The SPS TLIF group had a lower mean visual analog scale score for back pain than the control group on both postoperative day 3 and at 2 years postoperatively (p < 0.05). Follow-up MRI showed changes in the paravertebral muscles in 46 of 54 patients (85%) in the control group and 5 of 52 patients (10%) in the SPS TLIF group (p < 0.001). This novel technique may be a useful alternative to the conventional posterior approach for TLIF.
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Guanyi Liu, Lihua Hu, Feng Shen, Yong Hu, and Weihu Ma
Xuan Ye, Yun-Dong Shen, Jun-Tao Feng, and Wen-Dong Xu
OBJECTIVE
Spinal accessory nerve (SAN) injury results in a series of shoulder dysfunctions and continuous pain. However, current treatments are limited by the lack of donor nerves as well as by undesirable nerve regeneration. Here, the authors report a modified nerve transfer technique in which they employ a nerve fascicle from the posterior division (PD) of the ipsilateral C-7 nerve to repair SAN injury. The technique, first performed in cadavers, was then undertaken in 2 patients.
开云体育世界杯赔率
Six fresh cadavers (12 sides of the SAN and ipsilateral C-7) were studied to observe the anatomical relationship between the SAN and C-7 nerve. The length from artificial bifurcation of the middle trunk to the point of the posterior cord formation in the PD (namely, donor nerve fascicle) and the linear distance from the cut end of the donor fascicle to both sites of the jugular foramen and medial border of the trapezius muscle (d-SCM and d-Traps, respectively) were measured. Meanwhile, an optimal route for nerve fascicle transfer (NFT) was designed. The authors then performed successful NFT operations in 2 patients, one with an injury at the proximal SAN and another with an injury at the distal SAN.
RESULTS
The mean lengths of the cadaver donor nerve fascicle, d-SCM, and d-Traps were 4.2, 5.2, and 2.5 cm, respectively. In one patient who underwent proximal SAN excision necessitated by a partial thyroidectomy, early signs of reinnervation were seen on electrophysiological testing at 6 months after surgery, and an impaired left trapezius muscle, which was completely atrophic preoperatively, had visible signs of improvement (from grade M0 to grade M3 strength). In the other patient in whom a distal SAN injury was the result of a neck cyst resection, reinnervation and complex repetitive discharges were seen 1 year after surgery. Additionally, the patient’s denervated trapezius muscle was completely resolved (from grade M2 to grade M4 strength), and her shoulder pain had disappeared by the time of final assessment.
CONCLUSIONS
NFT using a partial C-7 nerve is a feasible and efficacious method to repair an injured SAN, which provides an alternative option for treatment of SAN injury.
Feng Shen, Bin Zhou, Quan Li, Ming Li, Zhiwei Wang, Qiang Li, and Bo Ran
OBJECT
The object of this study was to review the effectiveness in treating severe and rigid scoliosis with posterioronly spinal release combined with derotation, translation, segmental correction, and an in situ rod-contouring technique.
开云体育世界杯赔率
Twenty-eight patients with severe and rigid scoliosis (Cobb angle > 70° and flexibility < 30%) were retrospectively enrolled between June 2008 and June 2010. The average age of the patients was 17.1 years old (range 12–22 years old), 18 were female, and 10 were male. Etiological diagnoses were idiopathic in 24 patients, neuromuscular in 2 patients, and Marfan syndrome in 2 patients. All patients underwent posterior spinal release, derotation, translation, segmental correction, and an in situ rod-contouring technique. The scoliosis Cobb angle in the coronal plane, kyphosis Cobb angle, apex vertebral translation, and trunk shift were evaluated preoperatively and postoperatively.
RESULTS
The average operative time was 241.8 ± 32.1 minutes and estimated blood loss was 780.5 ± 132.6 ml. The average scoliosis Cobb angle in the coronal plane was corrected from 85.7° (range 77°–94°) preoperatively to 33.1° (range 21°–52°) postoperatively, with a correction ratio of 61.3%. The average kyphosis Cobb angle was 64.5° (range 59°–83°) preoperatively, which was decreased to 42.6° (range 34°–58°) postoperatively, with a correction ratio of 33.9%. After an average of 24 months of follow-up (range 13–30 months), no major complications were observed in these patients, except screw pullout of the upper thoracic vertebrae in 2 patients and screw penetration into the apical vertebrae in 1 patient.
CONCLUSIONS
Posterior spinal release combined with derotation, translation, segmental correction, and an in situ rod-contouring technique has proved to be a promising new technique for rigid scoliosis, significantly correcting the scoliosis and accompanied by fewer complications.
Yao Li, Zhonghai Shen, Xiangyang Wang, Yongli Wang, Hongming Xu, Feng Zhou, Shaoyu Zhu, and Huazi Xu
OBJECT
The authors' goal in this paper was to quantify reference data on the dimensions and relationships of the maximum posterior screw angle and the thoracic spinal canal in different pediatric age groups.
开云体育世界杯赔率
一百一十二年儿科患者分裂into 4 age groups, and their thoracic vertebrae were studied on CT scans. The width, depth, and maximum posterior screw angles with different screw entrance points were measured on a Philips Brilliance 16 CT. The statistical analysis was performed using the Student t-test and Pearson's correlation analysis.
RESULTS
The width and depth of the thoracic vertebrae increased from T-5 to T-12. The width ranged from 18.5 to 37.1 mm, while the depth ranged from 16.1 to 28.2 mm. The maximum posterior screw angle decreased from T-5 to T-12 in all groups. The ranges and mean angles at the entrance points were as follows: initial entrance point, 6.9° to 12.3° with a mean angle of 9.1°; second entrance point, 20.6° to 27.0° with a mean angle of 24.2°; and third entrance point, 29.2° to 37.5° with a mean angle of 33.7°. There were no significant age-related differences noted for the maximum posterior screw angles.
CONCLUSIONS
The angle decreased from T-5 to T-12. No significant age-related differences were noted in the maximum posterior screw angles. Screws should be placed between the initial and second points and parallel to the coronal section or at a slight anterior orientation.
Shang-Hang Shen, Aij-Lie Kwan, Bo-Liang Wang, Jian-Feng Guo, Guo-Wei Tan, Si-Fang Chen, Xi-Yao Liu, Feng Liu, Ming Cai, and Zhan-Xiang Wang
Object
The occurrence of hydrocephalic macrocephaly is uncommon. When the condition does occur, it is usually seen in infants and young children. Patients with this disorder have an excessively enlarged head and weak physical conditions. Various surgical techniques of reduction cranioplasty for the treatment of these patients have been reported. In this study, a revised surgical procedure with the aid of simulated computer imaging for the treatment of hydrocephalic macrocephaly is presented.
开云体育世界杯赔率
Five cases of hydrocephalic macrocephaly in children ranging in age from 16 to 97 months were reviewed. These patients underwent surgical treatment at The First Affiliated Hospital of Xiamen University over a period of 4 years from January 2007 to January 2011. After physical examination, a 3D computer imaging system to simulate the patient's postoperative head appearance and bone reconstruction was established. Afterward, for each case an appropriate surgical plan was designed to select the best remodeling method and cranial shape. Then, prior to performing reduction remodeling surgery in the patient according to the computer-simulated procedures, the surgeon practiced the bone reconstruction technique on a plaster head model made in proportion to the patient's head. In addition, a sagittal bandeau was used to achieve stability and bilateral symmetry of the remodeled cranial vault. Each patient underwent follow-up for 6–32 months.
Results
Medium-pressure ventriculoperitoneal shunt surgery or shunt revision procedures were performed in each patient for treating hydrocephalus, and all patients underwent total cranial vault remodeling to reduce the cranial cavity space. Three of the 5 patients underwent a single-stage surgery, while the other 2 patients underwent total cranial vault remodeling in the first stage and the ventriculoperitoneal shunt operation 2 weeks later because of unrecovered hydrocephalus. All patients had good outcome with regard to hydrocephalus and macrocephaly.
Conclusions
There are still no standard surgical strategies for the treatment of hydrocephalic macrocephaly. Based on their experience, the authors suggest using a computer imaging system to simulate a patient's postoperative head appearance and bone reconstruction together with total cranial vault remodeling with shunt surgery in a single-stage or 2-stage procedure for the successful treatment of hydrocephalic macrocephaly.
Lin-Feng Wang, Ying-Ze Zhang, Yong Shen, Yan-Ling Su, Jia-Xin Xu, Wen-Yuan Ding, and Ying-Hua Zhang
Object
The aim of this study was to investigate the clinical significance of both the signal intensity ratio obtained from MR imaging and clinical manifestations on the prognosis of patients with cervical ossification of the posterior longitudinal ligament.
开云体育世界杯赔率
The authors retrospectively reviewed the records of 58 patients with cervical ossification of the posterior longitudinal ligament who underwent cervical laminoplasty from February 1999 to July 2007. Magnetic resonance imaging (1.5-T) was performed in all patients before surgery. Sagittal T2-weighted images of the cervical spinal cord compressed by the ossified posterior longitudinal ligament showed increased intramedullary signal intensity, whereas the sagittal images obtained at the C7–T1 disc levels were of normal intensity. The signal intensity ratio between regions of intramedullary increased signal intensity and the normal C7–T1 disc level was calculated based on the signal intensity values generated from the MR imaging workstation. Patients were divided into 3 groups according to their signal intensity ratio (high, intermediate, and low signal intensity groups).
Results
There were significant differences between the 3 groups regarding recovery rate (p < 0.001), age (p = 0.022), duration of disease (p = 0.001), Babinski sign (p < 0.001), ankle clonus (p < 0.001), and both pre- and postoperative Japanese Orthopaedic Association score (p < 0.001). There was no significant difference in sex among the 3 groups (p = 0.391).
Conclusions
Patients with low signal intensity ratios that changed on T2-weighted imaging experienced a good surgical outcome. Low increased signal intensity might reflect mild neuropathological alteration in the spinal cord and greater recuperative potential. An increased signal intensity ratio with positive pyramidal signs indicates less recuperative potential of the spinal cord and a poor surgical outcome.
Chih-Lung Lin, Huei-Chuan Shih, Aaron S. Dumont, Neal F. Kassell, Ann-Shung Lieu, Yu-Feng Su, Shen-Long Hwong, and Chin Hsu
Object
Sex differences in the outcome of aneurysmal subarachnoid hemorrhage (SAH) are controversial, and the potential influence of estradiol on vasodilation is unclear. In the present study the authors evaluate the effect and possible mechanism of 17β-estradiol (E2) on SAH-induced vasospasm in a two-hemorrhage rodent model of SAH.
开云体育世界杯赔率
A 30-mm Silastic tube filled with E2 in corn oil (0.3 mg/ml) was subcutaneously implanted in male rats. Serum levels of E2 were measured on Days 0, 1, 2, 3, 4, and 7 postimplantation. The degree of vasospasm was determined by averaging the cross-sectional areas of the basilar artery (BA) 7 days after the first SAH. Expressions of endothelial nitric oxide synthase (eNOS) and inducible NOS (iNOS) in the BA were also evaluated.
Serum levels of E2 in the E2-treated rats were at physiological levels (56–92 pg/ml) and were significantly higher than those in the control and vehicle-treated groups. Treatment with E2 significantly (p < 0.01) attenuated SAH-induced vasospasm. Induction of iNOS messenger (m)RNA and protein in the BA by SAH was significantly diminished by the E2 treatment but not by vehicle treatment. The SAH-induced suppression of eNOS mRNA and protein was relieved by E2 treatment.
Conclusions
These results suggest that continuous treatment with E2 at physiological levels prevents cerebral vasospasm following SAH. The beneficial effect of E2 may be in part related to the prevention of augmentation of iNOS expression and the preservation of normal eNOS expression after SAH. Treatment with E2 holds therapeutic promise in the treatment of cerebral vasospasm following SAH and merits further investigation.
Shiuh-Lin Hwang, Chih-Lung Lin, Ann-Shung Lieu, Kung-Shing Lee, Tai-Hung Kuo, Yan-Fen Hwang, Yu-Feng Su, and Shen-Long Howng
Object.Cage-assisted anterior cervical discectomy and fusion (ACDF) has proven to be a safe and effective procedure for the treatment of one- and two-level degenerative disc disease (DDD). To the authors' knowledge, clinical results after three- and four-level interbody cage—augmented ACDF have not been reported in the literature. The authors investigated the safety and effectiveness of titanium cages used in such procedures and evaluated the results in cases with or without plate fixation.
Methods.56例患有宫颈DDD回答e divided into two groups. Group 1 included 32 patients who underwent titanium cage—assisted ACDF; Group 2 included 24 patients who underwent the same procedure, supplemented with plate fixation. The cervical DDD was confirmed by radiography and magnetic resonance imaging. The patients underwent radiographic evaluation to assess cervical lordosis, segmental height of cervical spine, the height of the foramina, and spinal stability. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) scores. Neck pain was graded using a 10-point visual analog scale (VAS). The follow-up period ranged from 13 to 28 months (mean 17.2 months).
1和2两组显著增加(p < 0.001) was demonstrated in the JOA scores (preoperatively 10.7 ± 2.4 and 11.1 ± 2, postoperatively 13.9 ± 2.2 and 14.1 ± 2.3, respectively) and VAS pain scores (preoperatively 8.8 ± 0.9 and 8.5 ± 1, postoperatively 3.1 ± 2.1 and 2.8 ± 1.8, respectively); however, there was no significant intergroup difference. A significant increase in the cervical lordosis, foraminal height, and segmental height was observed in both groups. Good stability of cage fusion was obtained in both groups 12 months postoperatively (90.6% in Group 1 and 91.7% in Group 2); however, there were no statistically significant intergroup differences. The complication rate in Group 2 was higher than that in Group 1. The hospital length of stay in Group 1 was significantly lower than in Group 2 (p < 0.001).
Conclusions.这些发现表明,泰坦的分析ium cage—assisted ACDF provided long-term stabilization, increased lordosis, increased segmental height, and increased foraminal height. In both groups good neurological outcomes were achieved and donor site morbidity was avoided. The lower complication rate and shorter hospital stay, however, make the cage-assisted fusion without plate fixation better than with plate fixation.
Chen Wang, Chien-Min Chen, Fang Shen, Xiao-Dong Fang, Guang-Yu Ying, Yu-Cheng Ren, Dan-Feng Yu, Liang-Liang Zhu, Yong-Jian Zhu, and Jian-Min Zhang
Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations, and microsurgical ligation is the treatment modality most frequently used for these lesions. Developments in endoscopic techniques have made endoscopy an even less invasive alternative to routine microsurgical approaches in spine surgery, but endoscopic management of SDAVF or other intradural spinal lesions has not been reported to date.
The authors describe the use of a microscope-assisted endoscopic interlaminar approach for the ligation of the proximal draining vein of an L-1 SDAVF in a 58-year-old man. A complete cure was confirmed by postoperative angiography. The postoperative course was uneventful, and short-term follow-up showed improvements in the patient's neurological function. The authors conclude that the endoscopic interlaminar approach with microscope assistance is a safe, minimally invasive, innovative technique for the surgical management of SDAVFs in selected patients.
