Reduction of caudal traction force using dural sac opening rather than spinal cord detethering for tethered cord syndrome caused by lipomyelomeningocele: a case report

Background context

A few reports have addressed tethered cord syndrome. Detethering surgery has been performed in these cases because abnormal tension on the spinal cord causes neurologic and urologic symptoms.

Purpose

To discuss the surgical treatment of tethered cord syndrome with the belief that the tension on the cord can be decreased by shifting tethered cord to the dorsal side.

Study design

A patient with tethered cord syndrome was surgically treated by shifting the tethered cord to the dorsal side by harnessing the lumbar lordosis instead of detethering.

Methods

We performed surgery to shift the tethered cord to the dorsal side by harnessing the lumbar lordosis to decrease the tension on the spinal cord.

Results

The tethered cord that was pressed to the ventral side because of a lipoma was shifted dorsally by laminectomy and opening of the dural sac. Pain and numbness were alleviated immediately after surgery.

Conclusions

The method used in the present case, that is, shifting the tethered cord and lipoma to the dorsal side by harnessing the lumbar lordosis instead of detethering, is a viable treatment option for tethered cord syndrome.     

Finite element investigation of the effect of a bifid arch on loading of the vertebral isthmus

BackgroundThe biomechanical effect of a bifid arch as seen in spina bifida occulta and following a midline laminectomy is poorly understood.PurposeTo test the hypothesis that fatigue failure limits will be exceeded in the case of a bifid arch, but not in the intact case, when the segment is subjected to complex loading corresponding to normal sporting activities.Study designFinite element analysis.MethodsFinite element model of an intact L4-S1 human lumbar motion segment including ligaments was used. A section of the L5 vertebral arch and spinous process was removed to create the model with a midline defect. The models were loaded axially to 1 kN and then combined with axial rotation of 3°. Bilateral stresses, alternating stresses, and shear fatigue failure on both models were assessed and compared.ResultsUnder 1 kN axial load, the von Mises stresses observed in midline defect case and in the intact case were very similar (differences <5 MPa) having a maximum at the ventral end of the isthmus that decreases monotonically to the dorsal end. However, under 1 kN axial load and rotation, the maximum von Mises stresses observed in the ipsilateral L5 isthmus in the midline defect case (31 MPa) was much higher than the intact case (24.2 MPa), indicating a lack of load sharing across the vertebral arch in the midline defect case. When assessing the equivalent alternating shear stress amplitude, this was found to be 22.6 MPa for the midline defect case and 13.6 MPa for the intact case. From this, it is estimated that shear fatigue failure will occur in less than 70,000 cycles, under repetitive axial load and rotation conditions in the midline defect case, whereas for the intact case, fatigue failure will occur only after more than 10 million cycles.ConclusionsA bifid arch predisposes the isthmus to early fatigue fracture by generating increased stresses across the inferior isthmus of the inferior articular process, specifically in combined axial rotation and anteroposterior shear.     

前路选择性椎间隙减压组合椎体次全切除术治疗多节段脊髓型颈椎病的疗效观察

目的观察前路选择性椎间隙减压组合椎体次全切除术治疗多节段脊髓型颈椎病（CSM）的疗效。方法选择20例累及3个节段行前路选择性椎间隙减压组合椎体次全切除术的CSM患者为研究对象即观察组,选择同期收治的20例行两椎体次全切除长节段植骨融合内固定术治疗多节段CSM患者为对照即对照组,观察比较两组手术时间、术中出血量、住院时间,术后影像学评估内固定稳定性、颈椎生理曲度改变以及植骨融合率,参照日本骨科协会（JOA）评分标准评估两组患者神经功能改善情况,评价其治疗效果。结果观察组手术时间、术中出血量以及住院时间优于对照组（t=12．724、28．657、9．573,均P〈0．01）,两组患者术后临床症状均有不同程度改善,JOA评分和Odom优良率观察组（95％和90％）明显优于对照组（70％和70％）（X^2=5．45、9．02,均P〈0．05）。两组患者在术后及随访期间x线片复查均未见钛板、钛网松动和移位,骨性融合率为100％,生理曲度恢复正常,颈椎稳定性良好。两组患者在术后2d和9个月融合节段Cobb角和术前比较明显改善（t=7．364、11．259,均P〈0．01）,术后9个月角度丢失率观察组明显小于对照组（t=13．579,P〈0．01）。结论临床上治疗多节段CSM采用前路选择性椎间隙减压组合椎体次全切除术疗效显著,能兼顾减压以及保留颈椎结构,是减少并发症的一种安全且有效的手术方法,值得在临床上广泛推广和应用。     

Less invasive approaches for the treatment of cervical schwannomas: our experience

Purpose  

The purpose of our paper is to illustrate our experience with minimally invasive approaches for the treatment of cervical schwannomas. Moreover, a brief review of the literature was conducted.     

后路椎板切除入路手术治疗椎管内神经鞘瘤的疗效

目的:探讨后路椎板切除入路手术治疗椎管内神经鞘瘤的临床疗效。方法:我院2005年1月~2011年1月收治71例椎管内神经鞘瘤,男39例,女32例,年龄25~99岁,平均51.6岁;颈段22例,胸段24例,腰、骶段25例,3例肿瘤位于髓内,66例位于髓外硬膜下,2例位于硬膜外。均行后路椎板切除入路手术治疗,术中57例采用半椎板切除,6例行全椎板切除,2例行多节段半椎板切除,6例行半椎板联合患侧关节突关节切除以完全暴露肿瘤组织,切除肿瘤;其中载瘤神经根与肿瘤无法分离而一并切除者9例;14例行全椎板切除或多节段半椎板切除或半椎板联合患侧关节突切除者采用脊柱内固定及植骨融合术。术后随访8~70个月,观察临床疗效,复查X线片观察脊柱稳定性及植骨融合情况,复查MRI观察肿瘤有无复发。结果:手术时间2~6h,平均3.5h;术中出血量300~800ml,平均450ml。71例患者肿瘤均获完全切除,术后均经病理检查证实为神经鞘瘤。术中无脊髓神经损伤。术后12例患者出现不同程度脑脊液漏,4例患者出现脊髓缺血再灌注损伤,给予对症治疗后康复。随访期内(8~70个月)全部患者临床症状及神经功能均有明显改善,复查MRI未见肿瘤残留或复发。14例采用脊柱内固定及植骨融合术患者植骨融合,内固定稳定。随访期间所有患者未见椎体滑脱、失稳现象。结论:后路椎板切除入路能充分暴露肿瘤,有利于完全切除肿瘤,采用此入路手术治疗椎管内神经鞘瘤临床疗效满意。     

小切口椎板间插装融合技术治疗腰椎管狭窄症的近期疗效

目的探讨经小切口局部椎板减压,椎板间插装融合(interlaminar lumbar instrumented fusion,ILIF)技术治疗腰椎管狭窄症的近期疗效。方法 2009年11月-2011年1月,采用经小切口椎板减压、ILIF治疗16例腰椎管狭窄症患者。男7例,女9例;年龄49～67岁,平均52.8岁。病程2年～9年4个月,平均4年7个月。16例均为退变性狭窄,4例合并双侧侧隐窝狭窄,3例合并腰椎间盘突出。病变节段:L3、42例,L4、54例,L5、S14例,L3、4和L4、5双节段2例,L4、5和L5、S1双节段4例。手术前后采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)进行临床疗效评定;CT扫描并测量椎管横截面面积。结果手术时间35～80 min,平均47 min;术中出血量120～350 mL,平均145 mL;住院时间4～15 d,平均7.8 d。除1例发生脑脊液漏,其余切口均Ⅰ期愈合。16例均获随访,随访时间12～22个月,平均14.8个月。术后CT扫描固定节段,示14例棘突间融合,2例可能融合;融合时间3～10个月,平均4.6个月。术后VAS评分、ODI及椎管横截面面积均较术前显著改善,差异有统计学意义(P<0.05)。结论 ILIF可兼顾椎板减压和重建后柱稳定性,同时保护脊髓,具有创伤小及操作简便的优点。     

胸椎黄韧带骨化症手术治疗方法的选择

目的 探讨胸椎黄韧带骨化症的发病机制及手术方法.方法 回顾性分析经手术治疗的56例胸椎黄韧带骨化症患者的影像学与临床资料.所有患者采用全椎板切除加后外侧融合术,全椎板切除方法包括整块全椎板切除术与椎板分解切除术;手术疗效采用日本骨科协会(JOA)评分法进行评价.结果 56例患者共累及237个节段,以下胸段最为多见,占57.4％(136/237).术后随访18 ～70(25.00±11.56)个月.根据最后一次随访结果,56例患者中优25例,良20例,无变化6例,差5例,优良率80.4％(45/56).根据骨化巢形态,各型手术优良率分别为外侧型83.3％(5/6)、弥漫型82.4％(14/17)、厚结节型78.8％( 26/33).应用整块全椎板切除术24例,其中4例厚结节型中有2例术后脊髓损伤加重;应用椎板分解切除术32例,其中29例厚结节型中仅2例术后脊髓损伤加重.结论 局部应力因素是胸椎黄韧带骨化形成的主要原因之一;全椎板切除加后外侧融合术是治疗本病的理想手术方法,其中外侧型、弥漫型可采用整块全椎板切除术,而厚结节型采用椎板分解切除术更为安全.     

Effect of posterior instrumented fusion on three-dimensional volumetric growth of cervical ossification of the posterior longitudinal ligament: a multiple regression analysis

Background Context

Despite the fact that ossification of posterior longitudinal ligament (OPLL) is a three-dimensional disease, conventional studies have focused mainly on a two-dimensional measurement, and it is difficult to accurately determine the volume of OPLL growth and analyze the factors affecting OPLL growth after posterior decompression (laminoplasty or laminectomy and fusion).

In-hospital complication rate following microendoscopic versus open lumbar laminectomy: a propensity score-matched analysis

Background Context

The incidence of postoperative complications after microendoscopic laminectomy (MEL) has not been compared with that after open laminectomy in a large study, so it is not clear whether MEL is a safer procedure.

应用人工硬脊膜预防瘢痕粘连早期临床观察

目的：介绍一种新的预防脊柱外科手术后瘢痕组织形成，硬膜粘连的一种方法，提高对椎板切除术后硬膜粘连的认识。方法：对17例腰椎间盘突出症椎板间开窗、间盘摘除的病人，术中应用美国戈尔公司生产的人造硬脊膜，术后3—6个月行核磁共振检查瘢痕组织的生成与硬膜粘连的情况。结果：17例应用人造硬脊膜的病人，3—6个月核磁共振示人造硬脊膜与脊髓之间无粘连，无瘢痕组织长入硬脊膜外空间，而同期手术的14例病人末应用此人工材料，其核磁共振影像均可见不同程度的瘢痕组织增生，脊髓与瘢痕组织粘连，神经根周围亦有瘢痕组织包裹、环绕。结论：人造硬脊膜有效降低了椎板切除术后瘢痕组织的产生程度，使病人减少了椎板切除术后瘢痕组织生成导致的疼痛，亦为二次手术创造了有利的条件。人造硬脊膜是一种比较理想的隔离物。