Radiographic changes induced after cervical facet radiofrequency denervation

BACKGROUND CONTEXT: Paraspinal infections after zygapophyseal (facet) radiofrequency denervation (RFD) are a serious but rare complication of this procedure. We are aware of only one case report of an epidural abscess after facet joint injection. PURPOSE: To report post-procedure inflammatory changes after cervical facet RFD. STUDY DESIGN: Case report. PATIENT SAMPLE: A 35-year-old Caucasian female. METHODS: Retrospective case review. RESULTS: The patient underwent cervical RFD and was admitted to the hospital 7 days after her procedure with severe neck pain. Magnetic resonance imaging (MRI) with contrast revealed what appeared to be evidence of a paraspinal muscle abscess although blood tests were negative. She was treated with antibiotic therapy, yet she never developed systemic signs of infection. A follow-up MRI without contrast revealed no evidence of infection, and she was discharged home on hospital day 6. At her first follow-up visit, she was still experiencing scalp pain and paraspinal muscle spasm. During subsequent follow-up visits, she has continued to improve clinically without experiencing signs of infection. Another follow-up MRI 6 weeks after her discharge home revealed persistent minimal left paraspinal enhancement at C2-3, possibly representing post-procedure granulation tissue with no evidence of abscess. CONCLUSIONS: Post-procedural MRI findings after radiofrequency lesioning can resemble radiographic findings associated with a paraspinal abscess. Patients with radiographic findings consistent with abscess should only be treated if clinical signs or symptoms of systemic infection are present.     

微血管减压术治疗舌咽神经痛16例临床分析

目的　研究舌咽神经痛 (glossopharyngealneuralgia,GPN)手术治疗的最佳术式 ,评估微血管减压手术(microvasculardecompression ,MVD)的效果、并发症和随访结果 ,探讨可能的治疗机制。方法　 2 0 0 0年 12月到2 0 0 3年 10月间 ,16例GPN患者接受了MVD ,无一例行神经根切断术。患者全部进行了电话或信件随访。结果　15例患者术后疼痛消失 ,1例患者为不典型GPN ,术后疼痛减轻。 1例患者术后出现轻度声音嘶哑和吞咽困难 ,1例患者出现偶发干咳。本组患者平均随访时间为 14 .1± 6 .3月 ,随访期间无一例复发。结论　MVD是治疗舌咽神经痛的一种安全、有效的手术方式 ,尤其适用于典型的GPN患者。     

Functional posterior rhizotomy: the Tokyo experience

Purpose The author describes the history of functional posterior rhizotomy (FPR), the surgical procedure currently used, and the results together with its future perspective in Japan. The modern form of FPR was introduced to Japan in 1995, and the first surgery was carried out in 1996. Despite initial resistance from orthopedic surgeons, the procedure has eventually gained wide recognition in the country. Materials and Methods The author has operated on 98 patients (60 boys and 38 girls, aged from 2 to 19 years old) by the end of 2006. Most patients were mild to severely disabled children with spastic hypertonia because of cerebral palsy and other diseases. The surgical procedure used is based on the Peacock’s procedure with some modification for the mildly disabled children whose spasticity was predominantly the muscles of the ankle joint. Intraoperative neurophysiology was an indispensable tool for preserving urogenital function and for judging which root/rootlet to be cut. Results Seventeen to 83% of the root/rootlets were found to be abnormal and were cut, clearly correlating with the degree of disability. However, there was a wide difference in the cutting rate, even in children with the same degree of disability. The result of surgery in this group of patients was the same as in previously published data. Twenty out of 51 patients (39%) followed for more than a year at the current institute showed improved locomotion after FPR. Thirty patients (59%) demonstrated suprasegmental effects after FPR. Conclusion The role of FPR will grow in importance as a treatment for spasticity in Japan in the future.     

Surgical management of spasticity

Intractable and severe spasticity in childhood has the ability to impact on the quality of life, function and care of the child. Where medical and physical measures have proved insufficient, a surgical approach may be pursued. Irrespective of the underlying pathology, intrathecal baclofen will reduce spasticity in a controllable and reversible fashion, whereas selective dorsal rhizotomy is reserved for the management of bilateral cerebral palsy due to early birth. Owing to the potential for complications of intrathecal baclofen and the permanence of selective dorsal rhizotomy, careful selection and preparation are required to produce satisfactory results.     

Swallowing in torticollis before and after rhizotomy

To determine risk factors for dysphagia after ventral rhizotomy, videofluoroscopic barium swallowing examinations were done on 41 spasmodic torticollis patients before and after surgery. Radiologic abnormalities were present in 68.3% of the patients before surgery, but these were only mildly abnormal in the majority. After surgery 95.1% showed radiologic abnormalities which were moderate or severe in one-third of the patients. Swallowing abnormalities correlated significantly with duration of torticollis and subjective complaints of swallowing difficulty both before and after surgery, but not with age, sex, or type of torticollis. The major acute postoperative finding was aggravation of preexisting pharyngeal dysfunction. Follow-up from about half of our original sample showed that gradual improvement occurred from 4 to 24 weeks after surgery by subjective report. We review the innervation of intrinsic and extrinsic pharyngeal musculature, and suggest that C1–3 rhizotomies and selective sectioning of the spinal accessory nerve are responsible for aggravation of pharyngeal swallowing dysfunction in the acute postsurgical period.     

Dorsal root rupture injury induces extension of astrocytic processes into the peripheral nervous system and expression of GDNF in astrocytes

Preganglionic brachial plexus injuries fall into two categories according to the lesion site, root avulsion injury and root rupture injury. The latter type of injury involves part of the peripheral nervous system (PNS) component at the injured spinal cord surface. Previous investigators have used rhizotomy of experimental animals as a model for dorsal root rupture injury. However, the effect on the central nervous system (CNS)–PNS junction accompanied by the mechanical stress from traction force is hard to estimate in this model. The current study aimed to demonstrate temporal molecular alterations from the CNS–PNS junction to the ruptured dorsal root after traction injury by immunohistochemical procedures. At 28 days after dorsal rupture injury, GFAP-positive structures could be clearly identified showing rather straight lines from the centro–peripheral junction toward the peripheral stump in the ruptured dorsal root. Immunoelectron microscopy for GFAP verified GFAP IR within the astrocytic processes at the injured dorsal root at 28 days after dorsal rupture injury. Glial cell line-derived neurotrophic factor immunoreactivity (GDNF IR) was slightly upregulated within the Schwann cell bodies on the injured dorsal root at 24–48 h after rupture injury. However, GDNF IR had appeared showing a process-like profile on the ruptured dorsal root by 28 days, and it was closely related with GFAP-positive structures. In contrast, a small increase in GFAP IR was only detected on the proximal side on the rhizotomized dorsal root at 28 days after rhizotomy. A marked decrease in NF IR and S-100 IR was observed at the ruptured dorsal root from 7 days. On the other hand, laminin IR was strongly upregulated on the ruptured dorsal root from 48 h to 7 days, and was still evident at 28 days. We therefore conclude that the astrocytes show a unique ability to extend their processes toward the stump. This ability may provide a new medium for the study of axonal regeneration in future clinical experiments.     

桥小脑角肿瘤继发性舌咽神经痛的外科治疗-附3例报告

目的 探讨肿瘤继发性舌咽神经痛的致病机理和外科治疗。方法 回顾性分析1993年1月-2002年6月收治的3例桥小脑角肿瘤继发性舌咽神经痛的临床和病理组织学资料。结果 3例患者均为女性，分别为桥小脑角的舌咽神经鞘膜瘤、微小血管瘤样脑膜瘤和脉络丛乳头状瘤。主要临床表现是咽部和舌根部疼痛或伴有耳深部疼痛。1例行肿瘤切除及舌咽神经切断术，另2例行肿瘤切除、舌咽神经切断及迷走神经1-2支感觉支切断术，3例均取得满意疗效。3例术后出现轻度声嘶。随访平均2．3年，3例肿瘤及疼痛均无复发。结论 桥小脑角肿瘤是引起舌咽神经痛的原因之一。切除肿瘤同时行舌咽神经根及迷走神经1-2支感觉支切断是治疗肿瘤继发性舌咽神经痛的有效方法。     

Selective rhizotomies for spinal root pain and neuralgia of the inguinal region

Summary Our recent experience stimulated a review of selective rhizotomies for the alleviation of localized pain. Three patients with postoperative neuralgia in the inguinal region and two with neoplastic root compression were treated. Results were good and long-lasting in two cases, moderate in two and poor in one case. The relief appeared to be better, the more clearly the pain was localized. In lesions distal to the spinal root it is necessary to undertake selective paravertebral root blocks with local anaesthetics. Experimental data are discussed that help in an understanding of pain recurrence after rhizotomy.     

椎板切开复位选择性脊神经后根切断治疗痉挛性脑瘫

目的:探讨通过显微神经外科和电生理技术,进行椎板切开复位选择性脊神经后根切断术对痉挛性脑性瘫痪的治疗效果.方法:行T11～L1椎板切开复位,显微镜下在脊髓圆锥水平将L1～S2神经后根分离成神经小枝,观察电刺激神经后根小枝所诱发的肌肉收缩和肌电图反应,切断异常反应的神经后根小枝.神经后根小枝切断数目不超过60%.结果:所有病例术后肌痉挛程度立即出现明显下降,随访发现所有患者肢体运动功能均有改善,术后未出鲻现腰椎前凸、畸形及滑脱现象.结论:T11～L1椎板切开复位,脊髓圆锥入路选择性L1～S2神经后根切断,能够有效地控制脑瘫所引起的下肢肌痉挛,改善运动功能并减少术后并发症的发生.     

不同入路选择性脊神经后根切断术对腰椎稳定性的影响

目的了解痉挛性脑瘫患者行腰骶部选择性脊神经后根切断术（SPR）与圆锥部SPR术后腰椎稳定性的改变。方法对行腰骶部SPR治疗的45例、圆锥部SPR治疗的38例痉挛性脑瘫患者,于术前及术后3个月～7年（平均19个月）拍摄腰椎正、侧位与40。双斜位及过伸过屈位x线片,观察术后腰椎失稳畸形和神经症状发生率及手术前后腰骶角、侧位腰椎Cobb角、弓顶距离及前凸指数、Posner指数等指标。结果①行腰骶部SPR患者腰骶角、侧位腰椎Cobb角、弓顶距离、前凸指数及第1～2腰椎（L1～L2）、第4～5腰椎（L4～L5）、第5腰椎～第1骶椎（L5～S1）Posner指数,手术前后比较差异有统计学意义（P〈0．05）,行圆锥部SPR患者只有第12胸椎～L：间Posner指数手术前后差异有统计学意义（P〈0．05）;②腰骶部SPR患者术后发生各种腰椎畸形共6例（13％）,伴腰椎不稳的神经症状者3例;圆锥部SPR患者术后发生腰椎畸形2例（5％）,伴神经症状1例。两组差异有统计学意义（X^2=6．63,P〈0．05）。结论痉挛性脑瘫患者SPR术后中短期腰椎稳定性变化不大,圆锥部SPR影响相对很小。远期影响有待进一步随访。