BACKGROUND This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst(IEAC)at the posterior cranial f...BACKGROUND This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst(IEAC)at the posterior cranial fossa.CASE SUMMARY The clinical information of a patient with an IEAC was reported,and the related literature was reviewed.A female patient with nausea presented to our hospital.Computed tomography demonstrated an IEAC located at the posterior cranial fossa,which was large and required surgical intervention.After operation,postoperative intraparenchymal hemorrhage was detected.She had a good recovery with conservative treatment 1 mo later.CONCLUSION Though postoperative intraparenchymal hemorrhage is rare after surgical decompression of an IEAC,more attention should be paid to such a complication.展开更多
<strong>Objectives:</strong> Central cord syndrome has been reported to occur with particular frequency among older persons with cervical spondylosis who sustain hyperextension neck injury. This study aims...<strong>Objectives:</strong> Central cord syndrome has been reported to occur with particular frequency among older persons with cervical spondylosis who sustain hyperextension neck injury. This study aims to determine the efficacy of early surgical decompression (within 24 hours) of traumatic central cord syndrome patients in comparison with conservative management for central cord syndrome to determine a line of management to these cases. <strong>Methods: </strong>60 patients suffering from acute traumatic central cord syndrome with various neurological deficits were divided into 2 groups, group A (conservatively managed) and group B (surgically managed). Patients in group B were operated upon within 24 hr. of trauma by posterior decompression. Clinical assessment of each patient on admission, discharge and 3 months follow-ups was done using the ASIA Impairment Scale, FIM, Ashworth scale, bladder function, and neuropathic pain symptoms. <strong>Results:</strong> Data collected from both groups showed, group A (the conservative group) consisted of 22 male (73.3%) and 8 female subjects (26.6%) with a mean age of 57.5 years while in group B (surgical group) the sample consisted of 20 male (66.6%) and 10 female subjects (33.3%) with a mean age of 58.6 years. There was an improvement in our study—according to ASIA and FIM scales—in 8 patients of 30 (26.6%) in the conservative group. In the surgical group, improvement in 16 patients (53.3%). <strong>Conclusions:</strong> Early surgical decompression with laminectomy and duroplasty can be considered a reliable modality in the management of traumatic CCS and can effectively reduce the secondary injury of the spinal cord and consequent deterioration with less hospital stay.展开更多
The goal for treatment in acute spinal cord injury （SCI） is to reduce the extent of secondary damage and facilitate neurologic regeneration and functional recovery. Although multiple studies have investigated potent...The goal for treatment in acute spinal cord injury （SCI） is to reduce the extent of secondary damage and facilitate neurologic regeneration and functional recovery. Although multiple studies have investigated potential new therapies for the treatment of acute SCI, outcomes and management protocols aimed at ameliorating neurologic injury in patients remain ineffective. More recent clinical and basic science research have shown surgical interventions to be a potentially valuable modality for treatment; however, the role and timing of surgical decompression, in addition to the optimal surgical intervention, remain one of the most controversial topics pertaining to surgical treatment of acute SCI. As an increasing number of potential treatment modalities emerge, animal models are pivotal for investigating its clinical application and translation into human trials. This review critically appraises the available literature for both clinical and basic science studies to highlight the extent of investigation that has occurred, specific therapies considered, and potential areas for future research.展开更多
Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compl...Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.展开更多
A variety of inlfammatory cytokines are involved in spinal cord injury and inlfuence the recov-ery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The ce...A variety of inlfammatory cytokines are involved in spinal cord injury and inlfuence the recov-ery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The cerclage suture was released 8 or 72 hours later, to simulate decompres-sion surgery. Neurological function was evaluated behaviorally for 3 weeks after surgery, and tumor necrosis factorα immunoreactivity and apoptosis were quantiifed in the region of injury. Rats that underwent decompression surgery had significantly weaker immunoreactivity of tumor necrosis factorα and signiifcantly fewer apoptotic cells, and showed faster improvement of locomotor function than animals in which decompression surgery was not performed. De-compression at 8 hours resulted in signiifcantly faster recovery than that at 72 hours. These data indicate that early decompression may improve neurological function after spinal cord injury by inhibiting the expression of tumor necrosis factorα.展开更多
Background:Although decompression surgery is the optimal treatment for patients with severe degenerative cervical myelopathy(DCM),some individuals experience no improvement or even a decline in neurological function a...Background:Although decompression surgery is the optimal treatment for patients with severe degenerative cervical myelopathy(DCM),some individuals experience no improvement or even a decline in neurological function after surgery,with spinal cord ischemia–reperfusion injury(SCII)identified as the primary cause.Spinal cord compression results in local ischemia and blood perfusion following decompression is fundamental to SCII.However,owing to inadequate perioperative blood flow monitoring,direct evidence regarding the occurrence of SCII after decompression is lacking.The objective of this study was to establish a suitable animal model for investigating the underlying mechanism of spinal cord ischemia–reperfusion injury following decom-pression surgery for degenerative cervical myelopathy(DCM)and to elucidate alterations in neurological function and local blood flow within the spinal cord before and after decompression.Methods:Twenty-four Sprague–Dawley rats were allocated to three groups:the DCM group(cervical compression group,with implanted compression material in the spinal canal,n=8),the DCM-D group(cervical decompression group,with removal of compression material from the spinal canal 4 weeks after implantation,n=8),and the SHAM group(sham operation,n=8).Von Frey test,forepaw grip strength,and gait were assessed within 4 weeks post-implantation.Spinal cord compression was evaluated using magnetic resonance imaging.Local blood flow in the spinal cord was monitored during the perioperative decompression.The rats were sacrificed 1 week after decompression to observe morphological changes in the compressed or decompressed segments of the spinal cord.Additionally,NeuN expression and the oxidative damage marker 8-oxoG DNA were analyzed.Results:Following spinal cord compression,abnormal mechanical pain worsened,and a decrease in forepaw grip strength was observed within 1–4 weeks.Upon decompression,the abnormal mechanical pain subsided,and forepaw grip strength was restored;however,neither reached the level of the sham operation group.Decompression leads to an increase in the local blood flow,indicating improved perfusion of the spinal cord.The number of NeuN-positive cells in the spinal cord of rats in the DCM-D group exceeded that in the DCM group but remained lower than that in the SHAM group.Notably,a higher level of 8-oxoG DNA expression was observed,suggesting oxidative stress following spinal cord decompression.Conclusion:This model is deemed suitable for analyzing the underlying mechanism of SCII following decompressive cervical laminectomy,as we posit that the obtained results are comparable to the clinical progression of degenerative cervical myelopathy(DCM)post-decompression and exhibit analogous neurological alterations.Notably,this model revealed ischemic reperfusion in the spinal cord after decompression,concomitant with oxidative damage,which plausibly underlies the neurological deterioration observed after decompression.展开更多
Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,t...Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,the microvascular network is compressed and destroyed,resulting in ischemia and hypoxia.The main pathological changes are inflammation,damage to the blood spinal cord barriers,and cell apoptosis at the site of compression.Studies have confirmed that vascular regeneration and remodeling contribute to neural repair by promoting blood flow and the reconstruction of effective circulation to meet the nutrient and oxygen requirements for nerve repair.Surgical decompression is the most effective clinical treatment for this condition;however,in some patients,residual neurological dysfunction remains after decompression.Facilitating revascularization during compression and after decompression is therefore complementary to surgical treatment.In this review,we summarize the progress in research on chronic compressive spinal cord injury,covering both physiological and pathological changes after compression and decompression,and the regulatory mechanisms of vascular injury and repair.展开更多
PAGET＇S disease, also called osteitis deformans, is a metabolic bone disorder. It is characterized by increased bone resorption and the compensatory formation of new bones. The increased bone conversion and remodelin...PAGET＇S disease, also called osteitis deformans, is a metabolic bone disorder. It is characterized by increased bone resorption and the compensatory formation of new bones. The increased bone conversion and remodeling lead to the incrustation of woven bones and lamellar bones and finally result in the expansion, loosening, and excessive vascularization of the affected bones, rendering them susceptible to deformity and fracture. Paget＇s disease occurs much more commonly in Anglo-Saxons than in Asians and Africans.展开更多
BACKGROUND Acute carpal tunnel syndrome(ACTS)is commonly caused by repetitive strain,trauma,or inflammatory conditions.However,ACTS due to tophaceous gout is a clinical event that remains poorly understood and underre...BACKGROUND Acute carpal tunnel syndrome(ACTS)is commonly caused by repetitive strain,trauma,or inflammatory conditions.However,ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported.This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications.CASE SUMMARY A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout.Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo,the patient underwent emergency decompression surgery for both wrists at different time points.Postoperatively,he exhibited complete recovery of sensory and motor functions,with no recurrence at long-term follow-up.Favorable outcomes were achieved through immediate decompression surgery,anti-inflammatory medications,postoperative active and passive range-of-motion exercises,and intermittent wrist splinting.Prompt diagnosis and surgical intervention,when necessary,are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS.An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes.CONCLUSION Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.展开更多
Objective： To evaluate the surgical procedure of endo- scopic transforminal discectomy, bone grafting and Dynalok pedicle screw fixation under X-Tube operation system in the treatment of lumbar disc herniation combin...Objective： To evaluate the surgical procedure of endo- scopic transforminal discectomy, bone grafting and Dynalok pedicle screw fixation under X-Tube operation system in the treatment of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis. Methods： From June 2004 to May 2006, 42 patients with classic features of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis underwent endoscopic transforminal lumbar interbody fu- sion （TLIF）. Under the guidance of fluoroscopy, a 2.8 to 3.0 cm incision with 4.5 to 5.0 cm apart from the posterior middle line was made on the symptomatic side and the working portal （X-Tube） was docked unilaterally on the facet joint. A total facetectomy was then performed to expose neural fo- ramina and nerve root. Discectomy and endplate prepara- tion were completed through the tube. A Telamon cage was placed obliquely into the intervertebral space after interbody grafting, and then the Dynalok pedicle screw fixation system was performed. This procedure was accomplished on the lateral side when it is necessary. Results： Clinical outcomes were determined using the Oswestry Disability Index （ODI） which revealed that 62.2% of patients got excellent results, 29.2% good and 8.6% fair. The average hospital stay was 12.5 days （5-25 days）. Op- eration time averaged 240 min （110-320 min）, blood loss averaged 140 ml （80-420 ml） and incision length averaged 3 cm （2.8-3.2 cm）. Five patients had complications including wound infection in 1 case, incision dehiscence and focal skin necrosis in 1, progressive radicular pain of contralat- eral leg in 1 and residual radicular numbness after transient radicular pain in 2. Conclusions： This surgical procedure of endoscopic transforminal diskectomy, bone grafting, cage placement and pedicle screw fixation can be effectively accomplished under X-Tube operation system with predominant benefits such as small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery.展开更多
Objective： To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods...Objective： To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods： This study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 2006. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association （JOA） score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments. Results： There was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group. Conclusions： The median approach endoscopic decompression is an ideal method for bilateral radiculopathy resulting from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine. The initial clinical outcome is exllent. Preservation of adjacent level disease can be assessed only in long-term follow-up.展开更多
Upper cervical schwannoma is rare,and belongs to benign tumors that is usually asymptomatic.It accounted for only ten percent of schwannomas cases and mostly occurs in 40-50 years old patients.Aggressive and total res...Upper cervical schwannoma is rare,and belongs to benign tumors that is usually asymptomatic.It accounted for only ten percent of schwannomas cases and mostly occurs in 40-50 years old patients.Aggressive and total resection is the treatment of choice for this tumor.Preoperative diagnosis is difficult,relying on clinical suspicion,and confirmed by surgical pathology.We report a 54-year-old male patient with chief complain of progressive weakness and numbness of his right arm for four months.He had a history of lymph node tumor in 2007 and excised in 2011.Neurological decrease was found on the right arm.The radiographic examination showed lytic lesion on the second,third,and fourth cervical spine.Computed tomography scan showed destruction extending to the first cervical vertebra.Capsulated extradural and extramedullary mass and compression to the spinal cord was found from the magnetic resonance imaging.Two-stage operation was performed.The first stage was posterior decompression with occipitocervical fusion and instrumentation,while the second was anterior decompression and iliac strut graft.Both operations performed using the surgical ultrasonic dissector.During three months'follow-up,it showed neurological improving.Neurological deficit appears when there is compression on the spinal cord.Total resection is the treatment of choice for these tumors.Preoperative imaging should be performed to exclude malignant tumor and found tumor extension.展开更多
Objective： To elucidate the therapeutic effect of subtemporal decompressive craniotomy with large flap resection on serious craniocerebral injury associated with cerebral infarction. Methods： Forty-eight cases of s...Objective： To elucidate the therapeutic effect of subtemporal decompressive craniotomy with large flap resection on serious craniocerebral injury associated with cerebral infarction. Methods： Forty-eight cases of serious head injury accompanied by cerebral infarction were classified into two groups with each having 24 cases： treatment group, in which large bone-flap decompressive craniotomy was performed; control group, in which routine craniotomy and hematoma evacuation were adopted. The status of cerebral infarction pre- and post-operation, as well as the curative effect 3 months after operation were comparatively analysed be- tween the two groups. Results： There was no significant difference regard- ing the status of cerebral infarction on the first day after operation; while one week after operation, the size of cere- bral infarction was significantly smaller in treatment group than control one （P〈0.05）. Postoperative 3 months, the mor- tality rate was 20.8% in treatment group, being evidently superior to that of control group （33.3%, P〈0.05）. The mo- derate disability （good and fair） rate was 41.7% in treatment group, significantly higher than that in control group （25.0%,P〈0.05）. Conclusion： Large bone-flap decompressive cran- iotomy is confirmed effective and hence it offers us a prefer- able alternative of treatment by which to reduce disability and fatality rates for patients with serious head injury ac- companied by cerebral infarction.展开更多
基金The Science and Technology Program of Nantong Health Committee,No.MA2019003 and No.KEY03.
文摘BACKGROUND This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst(IEAC)at the posterior cranial fossa.CASE SUMMARY The clinical information of a patient with an IEAC was reported,and the related literature was reviewed.A female patient with nausea presented to our hospital.Computed tomography demonstrated an IEAC located at the posterior cranial fossa,which was large and required surgical intervention.After operation,postoperative intraparenchymal hemorrhage was detected.She had a good recovery with conservative treatment 1 mo later.CONCLUSION Though postoperative intraparenchymal hemorrhage is rare after surgical decompression of an IEAC,more attention should be paid to such a complication.
文摘<strong>Objectives:</strong> Central cord syndrome has been reported to occur with particular frequency among older persons with cervical spondylosis who sustain hyperextension neck injury. This study aims to determine the efficacy of early surgical decompression (within 24 hours) of traumatic central cord syndrome patients in comparison with conservative management for central cord syndrome to determine a line of management to these cases. <strong>Methods: </strong>60 patients suffering from acute traumatic central cord syndrome with various neurological deficits were divided into 2 groups, group A (conservatively managed) and group B (surgically managed). Patients in group B were operated upon within 24 hr. of trauma by posterior decompression. Clinical assessment of each patient on admission, discharge and 3 months follow-ups was done using the ASIA Impairment Scale, FIM, Ashworth scale, bladder function, and neuropathic pain symptoms. <strong>Results:</strong> Data collected from both groups showed, group A (the conservative group) consisted of 22 male (73.3%) and 8 female subjects (26.6%) with a mean age of 57.5 years while in group B (surgical group) the sample consisted of 20 male (66.6%) and 10 female subjects (33.3%) with a mean age of 58.6 years. There was an improvement in our study—according to ASIA and FIM scales—in 8 patients of 30 (26.6%) in the conservative group. In the surgical group, improvement in 16 patients (53.3%). <strong>Conclusions:</strong> Early surgical decompression with laminectomy and duroplasty can be considered a reliable modality in the management of traumatic CCS and can effectively reduce the secondary injury of the spinal cord and consequent deterioration with less hospital stay.
文摘The goal for treatment in acute spinal cord injury （SCI） is to reduce the extent of secondary damage and facilitate neurologic regeneration and functional recovery. Although multiple studies have investigated potential new therapies for the treatment of acute SCI, outcomes and management protocols aimed at ameliorating neurologic injury in patients remain ineffective. More recent clinical and basic science research have shown surgical interventions to be a potentially valuable modality for treatment; however, the role and timing of surgical decompression, in addition to the optimal surgical intervention, remain one of the most controversial topics pertaining to surgical treatment of acute SCI. As an increasing number of potential treatment modalities emerge, animal models are pivotal for investigating its clinical application and translation into human trials. This review critically appraises the available literature for both clinical and basic science studies to highlight the extent of investigation that has occurred, specific therapies considered, and potential areas for future research.
文摘Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.
基金supported by a grant from the Anhui Provincial Health Department-Funded Medical Research Project in 2009 in China,No.09C33a grant from the Key Scientific Research Project of Cultivating Fund of Wannan Medical College in China,No.WK2014ZF14
文摘A variety of inlfammatory cytokines are involved in spinal cord injury and inlfuence the recov-ery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The cerclage suture was released 8 or 72 hours later, to simulate decompres-sion surgery. Neurological function was evaluated behaviorally for 3 weeks after surgery, and tumor necrosis factorα immunoreactivity and apoptosis were quantiifed in the region of injury. Rats that underwent decompression surgery had significantly weaker immunoreactivity of tumor necrosis factorα and signiifcantly fewer apoptotic cells, and showed faster improvement of locomotor function than animals in which decompression surgery was not performed. De-compression at 8 hours resulted in signiifcantly faster recovery than that at 72 hours. These data indicate that early decompression may improve neurological function after spinal cord injury by inhibiting the expression of tumor necrosis factorα.
基金Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences,Grant/Award Number:WJYY-YJKT-2022-13。
文摘Background:Although decompression surgery is the optimal treatment for patients with severe degenerative cervical myelopathy(DCM),some individuals experience no improvement or even a decline in neurological function after surgery,with spinal cord ischemia–reperfusion injury(SCII)identified as the primary cause.Spinal cord compression results in local ischemia and blood perfusion following decompression is fundamental to SCII.However,owing to inadequate perioperative blood flow monitoring,direct evidence regarding the occurrence of SCII after decompression is lacking.The objective of this study was to establish a suitable animal model for investigating the underlying mechanism of spinal cord ischemia–reperfusion injury following decom-pression surgery for degenerative cervical myelopathy(DCM)and to elucidate alterations in neurological function and local blood flow within the spinal cord before and after decompression.Methods:Twenty-four Sprague–Dawley rats were allocated to three groups:the DCM group(cervical compression group,with implanted compression material in the spinal canal,n=8),the DCM-D group(cervical decompression group,with removal of compression material from the spinal canal 4 weeks after implantation,n=8),and the SHAM group(sham operation,n=8).Von Frey test,forepaw grip strength,and gait were assessed within 4 weeks post-implantation.Spinal cord compression was evaluated using magnetic resonance imaging.Local blood flow in the spinal cord was monitored during the perioperative decompression.The rats were sacrificed 1 week after decompression to observe morphological changes in the compressed or decompressed segments of the spinal cord.Additionally,NeuN expression and the oxidative damage marker 8-oxoG DNA were analyzed.Results:Following spinal cord compression,abnormal mechanical pain worsened,and a decrease in forepaw grip strength was observed within 1–4 weeks.Upon decompression,the abnormal mechanical pain subsided,and forepaw grip strength was restored;however,neither reached the level of the sham operation group.Decompression leads to an increase in the local blood flow,indicating improved perfusion of the spinal cord.The number of NeuN-positive cells in the spinal cord of rats in the DCM-D group exceeded that in the DCM group but remained lower than that in the SHAM group.Notably,a higher level of 8-oxoG DNA expression was observed,suggesting oxidative stress following spinal cord decompression.Conclusion:This model is deemed suitable for analyzing the underlying mechanism of SCII following decompressive cervical laminectomy,as we posit that the obtained results are comparable to the clinical progression of degenerative cervical myelopathy(DCM)post-decompression and exhibit analogous neurological alterations.Notably,this model revealed ischemic reperfusion in the spinal cord after decompression,concomitant with oxidative damage,which plausibly underlies the neurological deterioration observed after decompression.
基金supported by the National Natural Science Foundation of China,No.81450020(to HQL)。
文摘Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,the microvascular network is compressed and destroyed,resulting in ischemia and hypoxia.The main pathological changes are inflammation,damage to the blood spinal cord barriers,and cell apoptosis at the site of compression.Studies have confirmed that vascular regeneration and remodeling contribute to neural repair by promoting blood flow and the reconstruction of effective circulation to meet the nutrient and oxygen requirements for nerve repair.Surgical decompression is the most effective clinical treatment for this condition;however,in some patients,residual neurological dysfunction remains after decompression.Facilitating revascularization during compression and after decompression is therefore complementary to surgical treatment.In this review,we summarize the progress in research on chronic compressive spinal cord injury,covering both physiological and pathological changes after compression and decompression,and the regulatory mechanisms of vascular injury and repair.
文摘PAGET＇S disease, also called osteitis deformans, is a metabolic bone disorder. It is characterized by increased bone resorption and the compensatory formation of new bones. The increased bone conversion and remodeling lead to the incrustation of woven bones and lamellar bones and finally result in the expansion, loosening, and excessive vascularization of the affected bones, rendering them susceptible to deformity and fracture. Paget＇s disease occurs much more commonly in Anglo-Saxons than in Asians and Africans.
文摘BACKGROUND Acute carpal tunnel syndrome(ACTS)is commonly caused by repetitive strain,trauma,or inflammatory conditions.However,ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported.This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications.CASE SUMMARY A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout.Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo,the patient underwent emergency decompression surgery for both wrists at different time points.Postoperatively,he exhibited complete recovery of sensory and motor functions,with no recurrence at long-term follow-up.Favorable outcomes were achieved through immediate decompression surgery,anti-inflammatory medications,postoperative active and passive range-of-motion exercises,and intermittent wrist splinting.Prompt diagnosis and surgical intervention,when necessary,are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS.An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes.CONCLUSION Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.
文摘Objective： To evaluate the surgical procedure of endo- scopic transforminal discectomy, bone grafting and Dynalok pedicle screw fixation under X-Tube operation system in the treatment of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis. Methods： From June 2004 to May 2006, 42 patients with classic features of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis underwent endoscopic transforminal lumbar interbody fu- sion （TLIF）. Under the guidance of fluoroscopy, a 2.8 to 3.0 cm incision with 4.5 to 5.0 cm apart from the posterior middle line was made on the symptomatic side and the working portal （X-Tube） was docked unilaterally on the facet joint. A total facetectomy was then performed to expose neural fo- ramina and nerve root. Discectomy and endplate prepara- tion were completed through the tube. A Telamon cage was placed obliquely into the intervertebral space after interbody grafting, and then the Dynalok pedicle screw fixation system was performed. This procedure was accomplished on the lateral side when it is necessary. Results： Clinical outcomes were determined using the Oswestry Disability Index （ODI） which revealed that 62.2% of patients got excellent results, 29.2% good and 8.6% fair. The average hospital stay was 12.5 days （5-25 days）. Op- eration time averaged 240 min （110-320 min）, blood loss averaged 140 ml （80-420 ml） and incision length averaged 3 cm （2.8-3.2 cm）. Five patients had complications including wound infection in 1 case, incision dehiscence and focal skin necrosis in 1, progressive radicular pain of contralat- eral leg in 1 and residual radicular numbness after transient radicular pain in 2. Conclusions： This surgical procedure of endoscopic transforminal diskectomy, bone grafting, cage placement and pedicle screw fixation can be effectively accomplished under X-Tube operation system with predominant benefits such as small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery.
文摘Objective： To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods： This study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 2006. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association （JOA） score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments. Results： There was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group. Conclusions： The median approach endoscopic decompression is an ideal method for bilateral radiculopathy resulting from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine. The initial clinical outcome is exllent. Preservation of adjacent level disease can be assessed only in long-term follow-up.
文摘Upper cervical schwannoma is rare,and belongs to benign tumors that is usually asymptomatic.It accounted for only ten percent of schwannomas cases and mostly occurs in 40-50 years old patients.Aggressive and total resection is the treatment of choice for this tumor.Preoperative diagnosis is difficult,relying on clinical suspicion,and confirmed by surgical pathology.We report a 54-year-old male patient with chief complain of progressive weakness and numbness of his right arm for four months.He had a history of lymph node tumor in 2007 and excised in 2011.Neurological decrease was found on the right arm.The radiographic examination showed lytic lesion on the second,third,and fourth cervical spine.Computed tomography scan showed destruction extending to the first cervical vertebra.Capsulated extradural and extramedullary mass and compression to the spinal cord was found from the magnetic resonance imaging.Two-stage operation was performed.The first stage was posterior decompression with occipitocervical fusion and instrumentation,while the second was anterior decompression and iliac strut graft.Both operations performed using the surgical ultrasonic dissector.During three months'follow-up,it showed neurological improving.Neurological deficit appears when there is compression on the spinal cord.Total resection is the treatment of choice for these tumors.Preoperative imaging should be performed to exclude malignant tumor and found tumor extension.
文摘Objective： To elucidate the therapeutic effect of subtemporal decompressive craniotomy with large flap resection on serious craniocerebral injury associated with cerebral infarction. Methods： Forty-eight cases of serious head injury accompanied by cerebral infarction were classified into two groups with each having 24 cases： treatment group, in which large bone-flap decompressive craniotomy was performed; control group, in which routine craniotomy and hematoma evacuation were adopted. The status of cerebral infarction pre- and post-operation, as well as the curative effect 3 months after operation were comparatively analysed be- tween the two groups. Results： There was no significant difference regard- ing the status of cerebral infarction on the first day after operation; while one week after operation, the size of cere- bral infarction was significantly smaller in treatment group than control one （P〈0.05）. Postoperative 3 months, the mor- tality rate was 20.8% in treatment group, being evidently superior to that of control group （33.3%, P〈0.05）. The mo- derate disability （good and fair） rate was 41.7% in treatment group, significantly higher than that in control group （25.0%,P〈0.05）. Conclusion： Large bone-flap decompressive cran- iotomy is confirmed effective and hence it offers us a prefer- able alternative of treatment by which to reduce disability and fatality rates for patients with serious head injury ac- companied by cerebral infarction.
