Segmental spinal instrumentation for neuromuscular spinal deformity

Seventy-six consecutive surgical cases of paralytic neuromuscular spinal deformity were retrospectively analyzed. Posterior arthrodesis with segmental spinal stabilization with Luque L-rods, sometimes preceded by anterior release, was done in all cases. The infection rate of 14.5% was observed to be markedly higher in patients with myelodysplasia. Deep placement of the rods lateral to the spine and well beneath full-thickness skin is recommended to reduce the incidence of this complication.     

Intra-operative spinal sonography in spinal intramedullary tumor

Recently, operative results of intramedullary spinal cord tumors have been greatly improved since the introduction of microsurgery. It is very important to know the precise size and location of the tumor prior to the operation so that we can approach the tumor with a minimum of damage to the spinal cord. However, it is not always possible to demonstrate the precise localization of the tumor preoperatively. In this report, we emphasize that intraoperative spinal sonography is very useful in determining the extent of the tumor and differentiating solid component from cystic component of the tumor. Methods and Materials We performed intraoperative spinal sonography on ten patients with intramedullary spinal cord tumor. This series included three cases of hemangioblastoma, three cases of astrocytoma, two cases of ependymoma, one case of subependymoma, and one case of mixed glioma. Eight out of ten cases were associated with cysts. The intraoperative spinal sonographic examinations were performed after laminectomy. The linear scanning probe of 5 or 7.5 MHz transducer was used. Results 1) Solid components The acoustic pattern of the solid tumor was either hyperechoic or iso-echoic. Six cases (three hemangioblastomas, two ependymomas, and one astrocytoma) were hyperechoic. Other four cases (two astrocytomas, one subependymoma, and one mixed glioma) were iso-echoic. 2) Cystic components The cysts associated with the tumor were anechoic in six out of eight cases, which were confirmed at surgery, and multiple cysts were identified.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rationale for spinal fusion in lumbar spinal stenosis

In order to define the indications for spinal fusion in patients undergoing decompression for lumbar spinal stenosis, 114 patients surgically treated were reviewed. Follow-up was 24 to 108 months. Patients were grouped into four categories: 15 with lateral recess stenosis, 45 with central-mixed stenosis, 43 with stenosis following prior lumbar surgery(s), and 11 with scoliosis and spinal stenosis. Only two patients with lateral recess stenosis underwent fusion with fair results. Approximately one-third of those with central-mixed stenosis required a fusion. Results were good in 70%. In those with stenosis following prior lumbar surgeries, although not statistically significant, those who had concomitant decompression and arthrodesis had a better outcome than those in whom decompression only was done. Patients with scoliosis and stenosis had decompression for significant motor and reflex deficits and fusion over the length of their major curves. Patients having decompression for lumbar stenosis with degenerative spondylolisthesis, isolated disc resorption with degenerative facet joints, intervertebral disc disease with instability, and those with scoliosis with multidirectional instabilities benefit from concomitant spinal fusion.     

Lumbosacral spinal fibrosis (spinal arachnoiditis). Its diagnosis and treatment by spinal cord stimulation

From 1973 to 1981, 94 patients suffering from low-back pain, with or without spread into the lower extremities, were candidates for therapeutic spinal cord stimulation. The etiology of pain in all cases was lumbosacral spinal fibrosis due to multiple myelographies and surgical interventions on the lumbar spine. The long-term results, based on a four-year follow-up, reveal a 60% subjective improvement of pain, a 40% substantial reduction of medication, and a 26% increase in working capacity. The concept of spinal arachnoiditis is reviewed and the term lumbosacral spinal fibrosis proposed. The treatment of this chronic painful and disabling disease is discussed.     

Teaching model for intraoperative spinal sonography in spinal fractures

To improve the technique of intraoperative sonography of the spinal canal, a teaching model of the thoracolumbar spine was developed. It allows to simulate the typical spinal stenosis of a vertebral fracture and the sonographic procedure to detect and measure such a lesion. Moreover, partial laminectomy and modification of a fixateur interne set-up, which are preconditions for successful sonography, can be simulated. Independent of the surgical qualification, a high precision in sonographic localisation and measurement of the spinal canal stenosis was achieved by the training. The results could be validated in the cadaveric model. Thus, sonographic expertise acquired with the teaching model proved to be reliable in the clinical situation. Received: 14 April 1999     

跳跃性脊柱骨折并脊髓损伤的治疗

目的：探讨跳跃性脊柱骨折的诊断和治疗方法。方法 22例手术治疗12例,保守治疗10例,结果 漏诊率达22．7％,按Frankel功能分级,手术治疗和保守治疗脊髓功能均有恢复但差异不明显。结论 对该类损伤要明确受伤机制,仔细检查,以防漏诊。适当放宽手术指征,警惕其他脏器合并伤。     

Primary spinal extradural hydatid cyst causing spinal cord compression

Primary spinal hydatid disease is rare and represents an uncommon but significant manifestation of hydatid disease. We report a case of primary intraspinal extradural hydatid cyst of the thoracic region causing spinal cord compression. The presenting symptoms were mostly atypical and the diagnosis was established preoperatively on the basis of magnetic resonance imaging. The patient underwent surgery resulting in complete recovery and is recurrence-free after 24 months follow-up.     

Histologic studies of the spinal cord following spinal anesthesia

Spinal anesthesia induced in autumn frogs produces histologic changes in the large multipolar cells particularly in the dorsal region of the spinal cord. These changes consist of hydropic swelling, loss of distinct outline, bluish staining of the reticulum, dissolution of the Nissl granules, and disappearance of nuclear structure.These changes are transitory, beginning to regress in six hours after the induction of the anesthesia and disappearing entirely within twenty-four hours. No histologic deviation from the normal is observed twenty-four or more hours after the induction of spinal anesthesia in the autumn frog.Human cords examined twenty-two, thirty-six, ninety-six, 144, 192, and 816 hours after spinal anesthesia show no histologic change from the normal.     

Immediate effects of spinal cord stimulation in spinal spasticity

Six patients with intractable spasms after spinal cord injury underwent implantation of an epidural spinal cord stimulation system. All the patients experienced good relief postoperatively. In three patients spinal cord stimulation consistently produced immediate inhibition of the spasms. This was evident within less than 1 minute of stimulation. Conversely, the spasms reappeared within less than 1 minute after cessation of the stimulation. The clinical observations were confirmed by polygraphic electromyographic recordings.