Cauda Equina Syndrome Associated with Dural Ectasia in Chronic Anlylosing Spondylitis

Cauda equina syndrome (CES) associated with dural ectasia is a rare neurologic complication in patients with longstanding ankylosing spondylitis (AS). We report a 68-year-old male with a 30-year history of AS who presented a typical symptom and signs of progressive CES, urinary incontinence and neuropathic pain of the lumbosacral radiculopathy. Computed tomography (CT) and magnetic resonance imaging (MRI) findings showed the unique appearances of dural ectasia, multiple dural diverticula, erosion of posterior element of the lumbar spine, tethering of the conus medullaris and adhesion of the lumbosacral nerve roots to the posterior aspect of the dural ectasia. Considering the progressive worsening of the clinical signs, detethering of the conus medullaris through resection of the filum terminale was performed through a limited laminectomy. However, the urinary incontinence did not improve and there was a partial relief of the neuropathic leg pain only. The possible pathogenetic mechanism of CES-AS and the dural ectasia in this patient with longstanding AS are discussed with a literature review.     

Surgical Experience of Neglected Lower Cervical Spine Fracture in Patient with Ankylosing Spondylitis

The management of lower cervical fractures in patients with ankylosing spondylitis (AS) differs from normal cervical fractures. Patients with AS are highly susceptible to extensive neurologic injuries and spinal deformities after cervical fractures from even minor traumatic forces. These injuries are uniquely complex, require careful imaging assessment, and aggressive surgical management to optimize spinal stability and functional outcomes.     

Spinal Cord Stimulation for Pain Management in Ankylosing Spondylitis: A Case Report

Introduction. The classic presentation of ankylosing spondylitis not only impairs spinal mobility but also imposes functional limitations, and fatigue is common. Methods. We report here the outcomes of spinal cord stimulation (SCS) in the case of a 47‐year‐old man with low back and hip/thigh pain due to ankylosing spondylitis, with failed responses to conservative therapies aimed at treating this pain. Results. Spinal cord stimulation induced axial low back and bilateral hip paresthesia resulting in complete subjective pain relief, cessation of analgesic medications, reduced fatigue, and improved sleep patterns. SCS also resulted in improved socioeconomic outcomes with a return to work. Conclusions. With further research in patients with broader presentations of the disease, SCS may prove efficacious in suppressing intractable pain symptoms due to ankylosing spondylitis, thus improving quality of life measures.     

The contribution of pre-existing spinal pseudarthrosis to the surgical correction for thoracolumbar kyphosis secondary to ankylosing spondylitis

The correction of global kyphosis (GK) for ankylosing spondylitis (AS) patients with pre-existing pseudarthrosis were frequently over 45°. Mismatch between kyphosis correction of GK and pedicle subtraction osteotomy (PSO) may be ascribed to contribution of pseudarthrosis. The aim of the present study was to evaluate surgical outcomes of PSO away from the level of pseudarthrosis and to elucidate the contribution of pre-existing spinal pseudarthrosis in surgical correction of thoracolumbar kyphosis caused by AS. Eighteen AS patients with pre-existing pseudarthrosis were included. PSO outside the level of pseudarthrosis were performed for all the patients. The average follow-up period were 29 months. Radiographs were analyzed for correction and complications. Significant improvement in all sagittal parameters were found postoperatively without obvious correction loss at the final follow-up. Local kyphosis (LK) improved from 23.88° preoperatively to 12.67° postoperatively with a mean correction of 11.47°. Average correction of per PSO segment, GK and sum of disc wedging within fused region (SDW) were 33.53°, 49.27° and 4.00°, respectively. PSO away from the level of pseudarthrosis, but with posterior instrumentation crossing it was a feasible method and was able to maintain sustained surgical outcomes. Regarding GK correction, PSO accounted for 68.1% while pre-existing pseudarthrosis provided 23.3%, which resulted from anterior column opening postoperatively. Thus, extra kyphosis correction attributed to pre-existing pseudarthrosis should be considered for surgical-decision making to prevent overcorrection.     

Reliability of Early Ambulation after Intradural Spine Surgery : Risk Factors and a Preventive Method for Cerebrospinal Fluid Leak Related Complications

ObjectiveCerebrospinal fluid leakage related complications (CLC) occasionally occur after intradural spinal surgery. We sought to investigate the effectiveness of early ambulation after intradural spinal surgery and analyze the risk factors for CLC. MethodsFor this retrospective cohort study, we enrolled 314 patients who underwent intradural spinal surgery at a single institution. The early group contained 79 patients who started ambulation after 1 day of bedrest without position restrictions, while the late group consisted of 235 patients who started ambulation after at least 3 days of bed rest and were limited to the prone position after surgery. In the early group, Prolene 6–0 was used as the dura suture material, while black silk 5–0 was used as the dura suture material in the late group. ResultsThe overall incidence rate of CLC was 10.8%. Significant differences between the early and late groups were identified in the rate of CLC (2.5% vs. 13.6%), surgical repair required (1.3% vs. 7.7%), and length of hospital stay (2.99 vs. 9.29 days) (p<0.05). Logistic regression analysis revealed that CLC was associated with practices specific to the late group (p=0.011) and the revision surgery (p=0.022). ConclusionUsing Prolene 6–0 as a dura suture material for intradural spinal surgery resulted in lower CLC rates compared to black silk 5–0 sutures despite a shorter bed rest period. Our findings revealed that suture - needle ratio related to dura defect was the most critical factor for CLC. One-day ambulation after primary dura closure using Prolene 6–0 sutures appears to be a cost-effective and safe strategy for intradural spinal surgery.     

经皮内镜椎间孔入路腰椎间盘切除术并发硬脊膜撕裂的综合处理及疗效分析

目的 探讨经皮内镜椎间孔入路腰椎间盘切除术（PETD）治疗腰椎间盘突出症并发硬脊膜撕裂的处理方法及预后。方法 回顾性分析2016年3月至2017年1月采用PETD治疗的236例腰椎间盘突出症的病例资料。结果 236例中,3例发生硬脊膜撕裂,发生率为1.3%(3/236)。2例术中诊断,其中1例术中转为显微镜下修补硬脊膜,1例术中未做处理;1例术后诊断,在显微镜下完成硬脊膜修补。3例随访12个月,末次随访时视觉模拟量表评分从术前8.0分降至1.7分,Oswestry功能障碍指数从82.1%降至17.8%,均无神经功能障碍等后遗症;改良MacNab评分2例为优,1例为良。结论 硬脊膜撕裂是PETD较为少见的并发症,应根据术中和术后情况,采取综合治疗措施,总体预后良好     

重型颅脑损伤患者血清和脑脊液髓鞘碱性蛋白变化及意义

探讨颅脑损伤患者血清和脑脊液（CSF）中髓鞘碱性蛋白（MBP）含量变化。方法采用酶联免疫吸附法测定了60例重型颅脑损伤患者的血清和CSF中MBP含量。结果患者血清和CSF中MBP含量均增高,其上升水平与脑损伤类型及程度有关。结论同步检测血清和CSF中MBP含量变化,对判断颅脑损伤的程度及类型有一定实用价值。     

协同刺激分子在格林-巴利综合征患者 脑脊液、血及周围神经中的表达

目的　探讨协同刺激分子在格林 巴利综合征 (GBS)患者脑脊液、血和周围神经组织中的表达及其作用。方法　用RT PCR法及原位杂交法观察GBS患者外周血、脑脊液和周围神经组织中协同刺激分子B7 1、B7 2、CD2 8、CTLA 4的表达。结果　GBS患者外周血、CSF和周围神经组织中协同刺激分子CD2 8、B7 1、B7 2在炎性细胞上的表达明显高于对照组 ;GBS患者CSF中CD2 8、B7 1、B7 2mRNA的表达明显高于外周血。结论　在GBS发病过程中协同刺激分子的表达对T细胞的活化 ,进而导致体液免疫和细胞免疫反应起重要作用。     

多发性硬化患者血清和脑脊液中白细胞介素-6的变化及其意义

本研究应用生物学方法检测27例多发性硬化（MS）患者血清和脑脊液（CSF）白细胞介素-6（IL－6）水平，以探讨IL－6在MS发病中的作用。结果显示MS患者血清IL-6水平显著高于其他非炎症性神经病（NIND）组及正常对照（NC）组，其CSFIL－6水平亦显著高于NIND组；但MS患者血清与CSFIL-6水平不呈线性相关，血清IL-6水平随病情稳定而下降。本研究结果提示IL－6可能参与MS的免疫病理过程。     

小脑幕缘切开术中引流环池脑脊液对颅脑损伤合并小脑幕切迹疝患者颅内压的影响

目的研究小脑幕缘切开术中引流环池脑脊液对降低颅脑损伤合并小脑幕切迹疝患者颅内压的作用。方法将40例颅脑损伤合并小脑幕切迹疝患者按随机数字表法分为两组。观察组（20例）在术中对环池脑脊液充分引流并计量,对照组（20例）术中对环池脑脊液不进行引流,两组术后监测颅内压5d,比较引流前后颅内压及侧脑室内压力的变化。结果观察组术后不同时间颅内压均值均低下对照组（P〈0．05）。观察组小脑幕缘切开前至环池脑脊液引流结束时侧脑室内压力下降均值较对照组下降均值高（P〈0.05）：结论小脑幕缘切开术中对环池脑脊液充分引流能恢复脑脊液循环通路,降低颅内压,提高减压效果。     

巨噬细胞和粒细胞集落刺激因子在细菌性脑膜炎患者脑脊液中呈增高趋势

检测了24例细菌性脑膜炎(BM)，20例多发性硬化症(MS)和20例肌紧张性头痛(TH)患者的脑脊液(CSF)巨噬细胞集落刺激因子(M-CSF)及粒细胞集落刺激因子(G-CSF)。24例BM患者中19例检出M-CSF，含量为60～5600／ml；16例检出G-CSF，含量为40～1200／ml。20例MS组和20例TH组均未检出。BM患者CSF中M-CSF和G-CSF呈增高趋势。鉴于这两种细胞集落刺激因子可促使活性单拔细胞、纤堆细胞和内皮细胞产生某些细胞因子，从而增强机休抵抗细菌感染的能力，提示M-CSF和G-CSF在中枢神经系统感染性疾病中可能起到重要的免疫调节作用。     

The validity of the PAM-RL device for evaluating periodic limb movements in sleep and an investigation on night-to-night variability of periodic limb movements during sleep in patients with restless legs syndrome or periodic limb movement disorder using this system

BackgroundThe status of night-to-night variability for periodic limb movements in sleep (PLMS) has not been clarified. With this in mind, we investigated the validity of PLMS measurement by actigraphy with the PAM-RL device in Japanese patients with suspected restless legs syndrome (RLS) or periodic limb movement disorder (PLMD) and the night-to-night variability of PLMS among the subjects.MethodsForty-one subjects (mean age, 52.1 ± 16.1 years) underwent polysomnography (PSG) and PAM-RL measurement simultaneously. Thereafter, subjects used the PAM-RL at home on four more consecutive nights.ResultsThe correlation between PLMS index on PSG (PLMSI-PSG) and PLM index on PAM-RL (PLMI-PAM) was 0.781 (P < .001). When the PLMSI cutoff value on PSG was set at 15 episodes per hour, the cutoff value for predicting this PLMSI level was 16.0 episodes per hour. When the condition was set to the level in which the mean interclass correlation coefficient reached ⩾0.9, the number of required nights for repeated measurements was 26 nights for subjects with PLMI of <15 episodes per hour and three nights for those with PLMI ⩾15 episodes per hour on PAM-RL.ConclusionsPAM-RL is thought to be valuable for assessing PLMS even in Japanese subjects. Recording of PAM-RL for three or more consecutive nights may be required to ensure the screening reliability of a patient with suspected pathologically frequent PLMS.