脂肪瘤型脊髓栓系综合征的显微手术治疗

目的探讨脂肪瘤型脊髓栓系综合征的显微手术治疗. 方法 32例脂肪瘤型脊髓栓系综合征在显微镜下切除脂肪瘤、松解脊髓、切除硬膜内外的牵拉成分. 结果术后脑脊液皮下漏3例,经脱水、俯卧位等对症治疗后痊愈.术后随访3～12个月,平均6个月,治愈5例,好转21例,无变化6例. 结论显微手术治疗脂肪瘤型脊髓栓系综合征术后并发症少,神经损害情况改善较好.     

脊髓栓系综合征致上尿路积水的手术疗效观察

目的　探讨脊髓栓系综合征 (TCS)引起上尿路积水去栓手术的疗效。　方法　对 2 0例TCS伴有上尿路积水患者进行去栓手术 ,观察比较手术前后膀胱剩余尿、肾和输尿管积水、肾皮质厚度及肾功能的变化。　结果　膀胱剩余尿恢复正常 5例 ,减少 10例 ,总有效率 83%。肾积水明显减少 6例 ,轻度减少 7例 ,无改变 7例 ,总有效率 6 5 %。输尿管积水明显减少 7例 ,好转 4例 ,无变化7例 ,总有效率 6 1%。肾皮质厚度明显增加 5例 ,轻度增加 2例 ,无改变 13例 ,总有效率 35 %。肾功能中度尿毒症转为轻度 2例 ,轻度转为正常 4例 ,14例同术前正常。　结论　去栓手术治疗TCS伴发上尿路积水和尿毒症有效。     

脊柱截骨术治疗合并脊髓纵裂伴脊髓拴系综合征的先天性脊柱侧凸

目的:探讨脊柱截骨术治疗合并脊髓纵裂伴脊髓拴系综合征的先天性脊柱侧凸的安全性和有效性。方法:回顾性分析2007年6月~2013年6月在我院采用脊柱截骨手术治疗的23例合并脊髓纵裂伴脊髓拴系综合征的先天性脊柱侧凸患者。其中男6例,女17例;手术时年龄16.9±3.4岁(10~23岁)。腰骶部疼痛8例,其中5例仅表现为腰骶部疼痛,神经功能损害18例。术前冠状位Cobb角95.4°±25.2°(65°~156°)。Ⅰ型脊髓纵裂9例,Ⅱ型脊髓纵裂14例。脊髓圆锥位置均在L3水平以下。对合并Ⅰ型脊髓纵裂伴脊髓拴系的患者,采用骨性纵隔切除、一期脊柱截骨矫形;合并Ⅱ型脊髓纵裂伴脊髓拴系的患者单纯行一期脊柱截骨矫形(未处理纤维纵隔)。其中行全脊椎截骨13例,经椎弓根截骨10例。术前、术后3个月和末次随访时分别测量患者侧凸Cobb角,并按脊柱裂神经功能评分(SBNS)分级评估神经功能恢复情况。结果:手术时间571.1±136.5min(310~835min);术中失血量4888.3±2482.3ml(500~9600ml)。随访38.9±18.3个月(24~79个月)。术后冠状面Cobb角33.7°±15.9°(3°~73°),较术前明显改善(P0.05),矫正率平均为(62.3±14.1)%;末次随访时冠状面Cobb角37.4°±17.2°(5°~82°),矫正率平均为(58.1±14.7)%,较术后平均丢失4.2°±2.3°,与术后比较无明显矫形丢失(P0.05),但与术前相比有明显改善(P0.05)。末次随访时,18例患者神经损害症状获得不同程度改善,其中13例术前SBNS神经功能分级为Ⅱ级者术后恢复至Ⅰ级;2例Ⅲ级恢复至Ⅱ级;另外3例神经损害评分提高,SBNS分级维持不变,脊柱侧凸畸形及局部疼痛明显好转。围手术期出现并发症5例,其中2例术后出现单侧下肢肌力下降,1例术后2周下肢肌力恢复至4级,另1例于术后3个月恢复至术前水平,术后2年随访肌力基本恢复正常;术中发现胸膜破裂1例,术后脑脊液漏1例、泌尿系感染1例。所有病例术后无伤口感染、假关节形成、内固定松动/断裂及永久性神经损害并发症。结论:脊柱截骨术治疗合并脊髓纵裂伴脊髓拴系综合征的先天性脊柱侧凸患者安全有效,且对神经功能恢复有促进作用。     

应用游离骶囊术治疗小儿脊髓栓系综合征疗效评价

[目的]应用尿动力学评估游离骶囊术治疗小儿脊髓脊膜膨出并TCS的手术效果。[方法]选取骶尾部脊髓脊膜膨出合并TCS患儿20例,于术前及术后3个月行尿动力学评估。[结果]所有患儿均无术后负损伤。术后残余尿量和膀胱逼尿肌漏尿点压显著低于术前,膀胱顺应性和最大膀胱压测定容量显著高于术前。[结论]应用游离骶囊术治疗小儿骶尾部脊髓脊膜膨出并栓系综合征疗效可靠,并可有效改善难以纠正的泌尿系统症状,降低继发性上尿路损伤的风险。     

Laminarthrectomy as a surgical approach for decompressing the spinal canal: assessment of preoperative versus postoperative dural sac cross-sectional areal (DSCSA)

Introduction

Surgery for lumbar spinal stenosis (LSS) is today the most frequently performed procedure in the adult lumbar spine. Long-term benefit of surgery for LSS is well documented both in randomized and in non-randomized trials. In this paper, we present the results from laminarthrectomy as an alternative surgical approach, which have theoretical advantages over other approaches. In this study, we wanted to study the clinical and radiological results of laminarthrectomy. Dural sac cross-sectional areal (DSCSA) is an objective method to quantify the degree of central stenosis in the spinal canal, and was used to measure whether we were able to achieve an adequate decompression of the spinal canal with laminarthrectomy as a surgical approach.

Materials and methods

All patients operated on with this approach consecutively in the period 1 January 2008 to 31 March 2009 were included in the study. All perioperative complications were noted. Clinical results were measured by means of a questionnaire. The patients that agreed to attend the study had an MRI taken of the operated level. DSCSA before and after surgery of the actual level were measured by three observers. We then performed a correlation test between increase of area and clinical results. We also tested for inter- and intra-observer reability.

Results

Fifty-six laminarthrectomy were performed. There were 17 % complications, none of them were life-threatening or disabling. 46 patients attended the study and answered the questionnaire. Thirty-four patients (83 %) reported clinical improvement, whereas six (13 %) patients reported no improvement, and two (4 %) patients reported that they were worse. Mean ODI was 23.0. Mean EQ-5D was 0.77. Mean VAS-score for back-pain was 3.1 and mean VAS-score for leg-pain was 2.8. Mean DSCSA were measured to 80 mm² before surgery and 161 mm² after surgery. That gave an increase of DSCSA of 81 mm² (101 %). We found a significant positive correlation between increase of area and clinical results. We also found consistent inter- and intra-observer reability.

Discussion

In this study, the clinical results of laminarthrectomy were good, and comparable with other reports for LSS. The rates of complications are also comparable with other reports in spinal surgery. A significant increase in the spinal canal diameter was achieved. Within the limitations a retrospective study gives, we conclude that laminarthrectomy seems to be a safe and effective surgical approach for significant decompressing the adult central spinal canal, and measurement of DSCSA, before and after surgery seems to be a good way to quantify the degree of decompression.     

Intramedullary spinal cord gangliocytoma: case report and a review of the literature

We present a case of intramedullary spinal gangliocytoma in a 19-year-old woman who presented with a long history of hyperhidrosis of the face and neck areas and intermittent pain of the hands. The tumor involved the cervico-thoracic region of the spinal cord from C7-T3. The patient underwent debulking of the lesion and remains neurologically stable at two years follow-up. A discussion of this case is followed by a review of the literature surrounding this rare clinicopathological entity.     

Surgery in adult onset tethered cord syndrome (ATCS): review of literature on occasion of an exceptional case

Tethered cord syndrome, usually discovered in childhood, is a developmental abnormality impairing the longitudinal movement of the spinal cord that can be combined with various forms of spinal dysraphism. Adult onset tethered cord syndrome (ATCS) seems not as rare as once thought, however, low susceptibility in adulthood commonly leads to a delay in diagnosis and therapy. We conducted a meticulous literature research to evaluate the clinical presentation, associated malformations, prognostic factors, as well as the benefits and risks of surgical treatment in ATCS patients. The age of patients at onset of symptoms ranged from 18 to 76 years with a mean of 36.5 years, including 184 males and 202 females. In contrast to the pediatric clientele, pain is the predominant symptom in adults, and elicitating mechanisms like trauma, excessive physical training, or degenerative spinal canal stenosis are reported more often. Surgical untethering aims the restoration of craniocaudal mobility of the spinal cord in order to prevent the further progression of symptoms, to restore neurological function, and to improve pain. In our evaluation of literature, pain was the most responsive symptom after surgical untethering (307 of 368 patients). Sensory and motor symptoms also seem to benefit from the surgery, especially if less than 6 months standing and mild. Improvement could be achieved in 43% (144 of 335 patients) for sensory deficits and 58.6% (191 of 326 patients) for motor deficits. Sphincter troubles are less responsive; they show an improvement in 45.6% (141 of 309 patients). Factors reported to be associated with the postoperative deterioration and/or bad outcome are the split cord malformation, lipomyelomeningocele, previous surgery, rapid motor function worsening experienced shortly before the operation, and long delay in diagnosis. The rate of secondary decline and retethering could not be established in our literature research. We report on an additional case of ATCS with the late onset of symptoms at the age of 49; she underwent surgical untethering with neuronavigational guidance. Performing neuronavigational guidance on the basis of multimodal images (computed tomography and magnetic resonance imaging fused with the intraoperative biplanar X-ray) in our patient showed substantial benefit in the surgical orientation within a complex skeletal and neuronal anomaly.     

Dorsal thoracic spinal cord herniation: report of an unusual case and review of the literature

Background context

Spinal cord herniation is a rare but well-documented condition that has been associated with tethering through the dural defect. Both spinal cord herniation and cord tethering result in progressive myelopathy that can be improved or stabilized with surgical intervention. Most cases of herniation are caused by dural defects in the ventral or ventrolateral thoracic spine, rarely occurring through the dorsal dura. This is the first reported case of a spontaneous dorsal herniation.

Purpose

To describe a unique case of thoracic tethered cord resulting from a dorsal dural defect through which there is spinal cord herniation.

Study design

A case report and review of the literature.

Methods

A 55-year-old man presented with progressive low back pain, paresthesias, and weakness in his left lower extremity that was exacerbated by walking. Imaging revealed a dorsal dural defect with tethering and herniation of the spinal cord at T7.

Results

The patient underwent a T6–T7 laminoplasty to release the tethered cord and repair the dural defect. At 1-year follow-up, the patient noted improvement in strength and back spasticity.

Conclusions

Spinal cord herniation through a dural defect is an uncommon but important cause of symptomatic tethered cord in adults. Surgical intervention can significantly alter the course and prevent further disability.     

Thoracic spinal cord compression caused by hypopbosphataemic rickets: a case report and review of the world literature

Vitamin D resistant hypophosphataemic rickets is a rare cause of spinal cord compression. The compression is caused by a combination of thickening of the laminae and calcification of the ligamentum flavum. Modern imaging techniques including CT and MRI provide excellent detail of both the level and degree of compression. MRI is particularly useful for examining the rest of the spinal cord for areas of impending compression and for postoperative follow-up. With careful surgical decompression a full neurological recovery can be achieved.     

经皮椎间孔镜罕见并发症类脊髓高压综合征一例报道

目的 报道并分析经皮椎间孔镜手术中"类脊髓高压综合征"1例,以期对今后手术中出现此并发症能早诊断早处理.方法 回顾分析2019年12月武汉市第一医院收治的1例腰椎间盘突出症病人术中出现"类脊髓高压综合征"的临床资料,并查阅文献进行分析总结.结果"类脊髓高压综合征"主要临床表现为头颈部突发的较为严重的疼痛、胸口憋闷感、耳...     

Successful use of ultrasound‐guided caudal catheter in a child with a very low termination of dural sac and Opitz–GBBB syndrome: a case report

We report a 2‐year‐old patient with Opitz–GBBB syndrome scheduled for a posterior sagittal anorectoplasty (PSARP). The ultrasound scan revealed the inferior end of dural sac just below sacrococcygeal membrane, although the patient had previously two successful caudal epidural blocks. Consequently, the epidural catheter was inserted under a real‐time ultrasound guidance without dural puncture. Our patient had excellent pain relief without any side effects.     

Complex regional pain syndrome: the case for spinal cord stimulation (a brief review)

Complex regional pain syndrome is a disabling disorder with an unknown mechanism which is extremely resistant to conventional pharmaceutical and therapeutic therapies. In this paper we present the underlying theories of this disorder. We present spinal cord stimulation as an alternative to conventional interventions in the management of this disabling condition spinal cord stimulation significantly improves pain, reduces narcotic intake and improves activity levels and overall quality of life. There is now a significant body of evidence to support the utilization of spinal cord stimulation in the management of complex regional pain syndrome.     

肘骨性关节炎合并囊肿致肘管综合征1例

<正>患者,男,51岁,左肘间断疼痛10年,左手环、小指麻木、无力半年。病史:患者10年来因双肘部高强度劳动,出现间断疼痛,以劳累后明显,症状逐年加重,并伴有功能障碍,近半年来因左肘部外伤出现左手环、小指感觉麻木、无力,并呈进行性加重,行保守治疗无效,于2009年3月4日前来就诊。查体:体型偏胖,肘关节伸屈活动-10°～120°,左手呈轻度     

Long-term outcome of patients treated with spinal cord stimulation for therapeutically refractory failed back surgery syndrome: a retrospective study

Background and purpose

Long-term efficiency (> 5 years) of spinal cord stimulation for failed back surgery syndrome is poorly described in literature. The aims of our study were to evaluate the long-term efficiency and the quality of life of our series of patients with spinal cord stimulation for failed back surgery syndrome.

Methods

The data of 55 patients implanted successively in our institution between 1995 and 2005 for failed back surgery syndrome were collected retrospectively. We contacted them for a telephone survey focused on efficiency, quality of life and treatment satisfaction.

Results

An internal pulse generator was placed in 42 patients. Thirty-two of them were contacted to answer our survey with a mean follow-up of 8.3 years. Seventy-five percent of our population reported a pain decrease of greater or equal to 50%. The efficiency of percutaneous leads was reported as 50% for the quadripolars and 83% for the octopolars. The surgical leads evaluations were positive in 70% for 4 × 1 as well as for 4 × 2 leads. We observed a default of low back pain relief in 84% of patients with an incomplete pain relief (59%). The ability to sit, get out of the bed, and climb stairs increased in 75%. The walk was better in 82%. Decrease in drug consumption of greater or equal to 50% was observed in 66%.

Conclusions

Our retrospective study demonstrates a satisfaction of 75% of the patients after 8.3-years follow-up. Spinal cord stimulation is an effective treatment for refractory failed back surgery syndrome.     

Repair of cervical esophageal perforation using longus colli muscle flap: a case report of a patient with cervical spinal cord injury

BACKGROUND CONTEXT: Perforation of the esophagus after anterior cervical spine surgery is a rare, but well-recognized complication. The management of esophageal perforation is controversial, and either nonoperative or operative treatment can be selected. PURPOSE: Several reports have described the use of a sternocleidomastoid muscle flap for esophageal repair. In this case report, we describe a longus colli muscle flap as a substitute for a sternocleidomastoid flap in a patient with an esophageal perforation. STUDY DESIGN: Case report. PATIENT SAMPLE: A 20-year-old man sustained cervical spinal cord injury, on diving and hitting his head against the bottom of a pool. A C6 burst fracture was observed with posterior displacement of a bone fragment into the spinal canal. The patient exhibited complete paralysis below the C8 spinal segment level. METHODS: The patient underwent subtotal corpectomy of the sixth cervical vertebra with the iliac bone graft and augmented posterior spinal fixation (C5-7) with pedicle screws. After the primary operation, the patient showed signs of infection such as throat pain, a high fever, and osteolytic change of the grafted bone by cervical radiograph. A second operation was performed to replace the graft bone using fibula. On the day after the operation, food residue was confirmed in the suction drainage tube, suggesting esophagus perforation. A third operation was immediately performed to confirm and treat esophagus perforation, although apparent esophageal perforation could not be detected at the second operation. Because the erosion around the perforation of the esophageal posterior wall was extensive, a longus colli muscle flap transposition was accordingly performed into the interspace between the esophageal posterior wall and the grafted bone in addition to simple suturing of the perforation. RESULTS: Neither high fever nor pharyngeal pain has recurred at latest follow-up, 5 years after surgery. CONCLUSIONS: To the best of our knowledge, this is the first report concerning the use of a longus colli muscle flap for esophageal perforation after anterior cervical spine surgery.     

距骨骨折术后异位骨化致踝管综合征1例

患者,男,41岁,车祸致左踝关节肿痛2h入院,行左距骨内踝粉碎性骨折切开复位钢板内固定（图1a-1f）,手术顺利,术后预防感染消肿补液治疗,术后2周创口拆线,愈合良好。术后摄片提示：左距骨左内踝骨折对位对线良好,内固定物位置正确（图1e-1f）。     

Thoracic disc herniation leads to anterior spinal artery syndrome demonstrated by diffusion-weighted magnetic resonance imaging (DWI): a case report and literature review

BackgroundThoracic disc herniation rarely causes acute ischemic events involving the spinal cord. Few reports have suggested this as a mechanism leading to anterior spinal artery syndrome, and none with illustration through diffusion-weighted magnetic resonance imaging (DWI).PurposeThe purpose of this study was to report a case of anterior spinal artery syndrome secondary to thoracic disc herniation and demonstrate the first use of DWI to aid in diagnosis of this rare myelopathy.Study designCase report.MethodsA 36-year-old woman developed sudden onset of back pain followed by evolving paraparesis and sensory loss consistent with anterior spinal artery distribution ischemia. T2-weighted magnetic resonance imaging (MRI) demonstrated an acute herniated nucleus pulposus at the T7–T8 disc, which produced a focal indentation of the adjacent anterior spinal cord without cord displacement or canal stenosis. T2-weighted hyperintensities were seen at T4–T7 levels with corresponding brightness on DWI and reduction of the apparent diffusion coefficient, consistent with cord ischemia.ResultsRemarkably, within just a few days and following conservative treatment, including heparin and steroids, this patient's neurologic status began to show improvement. Within 3 weeks, she was ambulating with assisted devices, and at the 10-month follow-up, the patient had nearly complete neurological improvement. A follow-up MRI at 10 months showed normal T2-weighted imaging except for a 1×2-mm area of anterior-left lateral cord myelomalacia at T4–T5.ConclusionsAcute thoracic disc herniation with cord contact but without canal stenosis is able to disrupt blood flow to the cord leading to anterior spinal artery distribution ischemia. This case represents the first demonstrated use of DWI in diagnosing this rare cause of anterior spinal artery ischemia.     

Incomplete Brown-SÉquard syndrome caused by cervical kyphosis secondary to neurofibromatosis: report of a case

The case of a 17-year-old boy who suffered from incomplete Brown-SÉquard syndrome caused by dystrophic cervical kyphosis secondary to neurofibromatosis is presented. He became aware of weakness of his left upper and lower extremities and was unable to walk within 1 month of his first feeling numbness in the right upper and lower extremities. Thereafter his condition deteriorated rapidly. On radiological investigation the entire dural sac was shifted anteriorly and the spinal cord was flattened anteroposteriorly and asymmetrically at the angular kyphosis level, as in Hirayama's disease. Despite morphological similarities to Hirayama's disease, this patient presented with quite different clinical features: incomplete Brown-SÉquard syndrome and rapidly progressive symptoms. It is suspected that the myelopathy in this case can be attributed to compression of the spinal cord between the vertebral body and the posterior dural wall on only one side. He was successfully treated with posterior interspinous wiring combined with anterior decompression and fusion. The neurological deficit fully disappeared, and complete bony union was obtained 1 year after the operation.