Current management for spinal cord injury aims to reduce secondary damage and recover sensation and movement.Acute spinal cord injury is often accompanied by spinal cord compartment syndrome.Decompression by durotomy ...Current management for spinal cord injury aims to reduce secondary damage and recover sensation and movement.Acute spinal cord injury is often accompanied by spinal cord compartment syndrome.Decompression by durotomy and/or myelotomy attempts to relieve secondary damage by completelyrelieving the compression of the spinal cord,removing the necrotic tissue,decreasing edema,reducing hemorrhage,and improving blood circulation in the spinal cord.However,it is controversial whether durotomy and/or myelotomy after spinal cord injury are beneficial to neurological recovery.This review compares the clinical effects of durotomy with those of myelotomy in the treatment of spinal cord injury.We found that durotomy has been performed more than myelotomy in the clinic,and that durotomy may be safer and more effective than myelotomy.Durotomy performed in humans had positive effects on neurological function in 92.3% of studies in this review,while durotomy in animals had positive effects on neurological function in 83.3% of studies.Myelotomy procedures were effective in 80% of animal studies,but only one clinical study of myelotomy has reported positive results,of motor and sensory improvement,in humans.However,a number of new animal studies have reported that durotomy and myelotomy are ineffective for spinal cord injury.More clinical data,in the form of a randomized controlled study,are needed to understand the effectiveness of durotomy and myelotomy.展开更多
Introduction:We developed the method of cervical spinal cord decompression through durotomy followed by duroplasty and analyzed its efficacy.Purpose:To develop a tactic of decompression durotomy and duroplasty for the...Introduction:We developed the method of cervical spinal cord decompression through durotomy followed by duroplasty and analyzed its efficacy.Purpose:To develop a tactic of decompression durotomy and duroplasty for the treatment of severe spinal cord injury(SCI)with extensive edema of the spinal cord and without intramedullary hematoma,and to demonstrate the effectiveness of this method.Methods:From October 2016 to January 2018,17 decompression operations were performed in the cervical spine in patients with SCI.Decompression laminectomy was done without durotomy in the first group of patients.In the second group,duroplasty of the spinal cord was performed after decompression durotomy.A total of 17 patients,16 males(94%)and 1 female(6%),were operated on(ages from 32 to 66 years).The patients were divided into two groups:a control group and an experimental group.We used the ASIA scale for assessing the patients.The mean follow up time is 12 months(8−24 months).Results:The first group,i.e.,the control group consisted of 10 patients who underwent decompression laminectomy without durotomy.The second group,i.e.,the experimental group consisted of 7 patients who underwent durotomy followed by duroplasty.In this group,the positive dynamics were observed in 6 patients.Out of 2 patients with ASIA grade“A”,one showed improvement to ASIA grade“C”,and one improved to ASIA“D”.Two patients with ASIA grade“B”showed recovery to ASIA“D”.Two patients with ASIA grade“C”improved to grade“D”while one patient showed no change from ASIA“C”.Durotomy and duroplasty was effective in the experimental group.Conclusion:The performance of durotomy and duroplasty is an efficient method for the full-scale decompression of the spinal cord and the prevention of edema.This method aims at decreasing intraspinal pressure,as well as preventing ischemia and apoptosis,which is possible for the prevention and treatment of the spinal cord com-partment syndrome or spinal cord intramedullary hypertension.展开更多
The currently recommended management for acute traumatic spinal cord injury aims to reduce the incidence of secondary injury and promote functional recovery.Elevated intraspinal pressure(ISP)likely plays an important ...The currently recommended management for acute traumatic spinal cord injury aims to reduce the incidence of secondary injury and promote functional recovery.Elevated intraspinal pressure(ISP)likely plays an important role in the processes involved in secondary spinal cord injury,and should not be overlooked.However,the factors and detailed time course contributing to elevated ISP and its impact on pathophysiology after traumatic spinal cord injury have not been reviewed in the literature.Here,we review the etiology and progression of elevated ISP,as well as potential therapeutic measures that target elevated ISP.Elevated ISP is a time-dependent process that is mainly caused by hemorrhage,edema,and blood-spinal cord barrier destruction and peaks at 3 days after traumatic spinal cord injury.Duraplasty and hypertonic saline may be promising treatments for reducing ISP within this time window.Other potential treatments such as decompression,spinal cord incision,hemostasis,and methylprednisolone treatment require further validation.展开更多
Dural defects are common in spinal and cranial neurosurgery.A series of complications,such as cerebrospinal fluid leakage,occur after rupture of the dura.Therefore,treatment strategies are necessary to reduce or avoid...Dural defects are common in spinal and cranial neurosurgery.A series of complications,such as cerebrospinal fluid leakage,occur after rupture of the dura.Therefore,treatment strategies are necessary to reduce or avoid complications.This review comprehensively summarizes the common causes,risk factors,clinical complications,and repair methods of dural defects.The latest research progress on dural repair methods and materials is summarized,including direct sutures,grafts,biomaterials,non-biomaterial materials,and composites formed by different materials.The characteristics and efficacy of these dural substitutes are reviewed,and these materials and methods are systematically evaluated.Finally,the best methods for dural repair and the challenges and future prospects of new dural repair materials are discussed.展开更多
Objective:To explore the effect of expansive duraplasty on spinal cord injury in rat model.Methods:The 42 adult SD rats were randomly divided into contusion injury group(control group),durotomy group and expansive dur...Objective:To explore the effect of expansive duraplasty on spinal cord injury in rat model.Methods:The 42 adult SD rats were randomly divided into contusion injury group(control group),durotomy group and expansive duraplasty group,each group included 12 rats and the remaining 6 rats were used to create dural allograft.The function of the hind limbs of the animals was evaluated by BBB score.Hematoxylin-eosin(HE)staining was employed for lesion volume measurements,Luxol Fast Blue(LFB)staining were used for white matter sparing and Immunohistochemistry(IHC)analysis was performed to detect the glial fibrillary acidic protein(GFAP)expression.Results:The BBB scores of rats in expansive duraplasty group were higher in comparison with contusion injury group on day 7 and 21 after surgery,the differences were statistically significant(P<0.05),the BBB scores of rats in expansive duraplasty group were higher in comparison with durotomy group on day 14 and 28 after surgery,the differences were statistically significant(P<0.05);lesion volume measurements showed a decrease in expansive duraplasty group relative to contusion injury group,and the differences were statistically significant(P<0.05),analysis of Integrated Optical Density(IOD)values showed that white matter sparing was higher in expansive duraplasty group compared with contusion injury group and durotomy group,and the differences were statistically significant(P<0.01),the average number of GFAP positive(+)cells in expansive duraplasty group was reduced when compared with the other two groups,and the differences were statistically significant(P<0.05).Conclusion:Our findings suggest that expansive duraplasty following spinal cord injury may improve motor functions of the rats,reduce lesion volume,inhibit demyelination and reduce connective tissue scar formation.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
基金financially supported by the National Key Research and Development Program of China,No.2016YFC1100100(to XDG)
文摘Current management for spinal cord injury aims to reduce secondary damage and recover sensation and movement.Acute spinal cord injury is often accompanied by spinal cord compartment syndrome.Decompression by durotomy and/or myelotomy attempts to relieve secondary damage by completelyrelieving the compression of the spinal cord,removing the necrotic tissue,decreasing edema,reducing hemorrhage,and improving blood circulation in the spinal cord.However,it is controversial whether durotomy and/or myelotomy after spinal cord injury are beneficial to neurological recovery.This review compares the clinical effects of durotomy with those of myelotomy in the treatment of spinal cord injury.We found that durotomy has been performed more than myelotomy in the clinic,and that durotomy may be safer and more effective than myelotomy.Durotomy performed in humans had positive effects on neurological function in 92.3% of studies in this review,while durotomy in animals had positive effects on neurological function in 83.3% of studies.Myelotomy procedures were effective in 80% of animal studies,but only one clinical study of myelotomy has reported positive results,of motor and sensory improvement,in humans.However,a number of new animal studies have reported that durotomy and myelotomy are ineffective for spinal cord injury.More clinical data,in the form of a randomized controlled study,are needed to understand the effectiveness of durotomy and myelotomy.
基金supported by the National Natural Science Foundation of China(grant Nos.81672158 and 81371939)International Science&Technology Cooperation Program of China(No.2013DFG32690)National Key R&D Program of China(No.2016YFC1100100).
文摘Introduction:We developed the method of cervical spinal cord decompression through durotomy followed by duroplasty and analyzed its efficacy.Purpose:To develop a tactic of decompression durotomy and duroplasty for the treatment of severe spinal cord injury(SCI)with extensive edema of the spinal cord and without intramedullary hematoma,and to demonstrate the effectiveness of this method.Methods:From October 2016 to January 2018,17 decompression operations were performed in the cervical spine in patients with SCI.Decompression laminectomy was done without durotomy in the first group of patients.In the second group,duroplasty of the spinal cord was performed after decompression durotomy.A total of 17 patients,16 males(94%)and 1 female(6%),were operated on(ages from 32 to 66 years).The patients were divided into two groups:a control group and an experimental group.We used the ASIA scale for assessing the patients.The mean follow up time is 12 months(8−24 months).Results:The first group,i.e.,the control group consisted of 10 patients who underwent decompression laminectomy without durotomy.The second group,i.e.,the experimental group consisted of 7 patients who underwent durotomy followed by duroplasty.In this group,the positive dynamics were observed in 6 patients.Out of 2 patients with ASIA grade“A”,one showed improvement to ASIA grade“C”,and one improved to ASIA“D”.Two patients with ASIA grade“B”showed recovery to ASIA“D”.Two patients with ASIA grade“C”improved to grade“D”while one patient showed no change from ASIA“C”.Durotomy and duroplasty was effective in the experimental group.Conclusion:The performance of durotomy and duroplasty is an efficient method for the full-scale decompression of the spinal cord and the prevention of edema.This method aims at decreasing intraspinal pressure,as well as preventing ischemia and apoptosis,which is possible for the prevention and treatment of the spinal cord com-partment syndrome or spinal cord intramedullary hypertension.
基金supported by a grant from Chongqing Yingcai Plan Project,No.cstc2021ycjh-bgzxm0041(to ZXQ).
文摘The currently recommended management for acute traumatic spinal cord injury aims to reduce the incidence of secondary injury and promote functional recovery.Elevated intraspinal pressure(ISP)likely plays an important role in the processes involved in secondary spinal cord injury,and should not be overlooked.However,the factors and detailed time course contributing to elevated ISP and its impact on pathophysiology after traumatic spinal cord injury have not been reviewed in the literature.Here,we review the etiology and progression of elevated ISP,as well as potential therapeutic measures that target elevated ISP.Elevated ISP is a time-dependent process that is mainly caused by hemorrhage,edema,and blood-spinal cord barrier destruction and peaks at 3 days after traumatic spinal cord injury.Duraplasty and hypertonic saline may be promising treatments for reducing ISP within this time window.Other potential treatments such as decompression,spinal cord incision,hemostasis,and methylprednisolone treatment require further validation.
基金Supported by Jilin Health Science and Technology Capability Improvement Project,No.2022C107.
文摘Dural defects are common in spinal and cranial neurosurgery.A series of complications,such as cerebrospinal fluid leakage,occur after rupture of the dura.Therefore,treatment strategies are necessary to reduce or avoid complications.This review comprehensively summarizes the common causes,risk factors,clinical complications,and repair methods of dural defects.The latest research progress on dural repair methods and materials is summarized,including direct sutures,grafts,biomaterials,non-biomaterial materials,and composites formed by different materials.The characteristics and efficacy of these dural substitutes are reviewed,and these materials and methods are systematically evaluated.Finally,the best methods for dural repair and the challenges and future prospects of new dural repair materials are discussed.
基金Middle-aged Medical Backbone Talent Project of Wuhan of Hubei Province(No.[2019]87)The Key Talent Training Project of Renmin Hospital of Wuhan University(No.[2017]54)。
文摘Objective:To explore the effect of expansive duraplasty on spinal cord injury in rat model.Methods:The 42 adult SD rats were randomly divided into contusion injury group(control group),durotomy group and expansive duraplasty group,each group included 12 rats and the remaining 6 rats were used to create dural allograft.The function of the hind limbs of the animals was evaluated by BBB score.Hematoxylin-eosin(HE)staining was employed for lesion volume measurements,Luxol Fast Blue(LFB)staining were used for white matter sparing and Immunohistochemistry(IHC)analysis was performed to detect the glial fibrillary acidic protein(GFAP)expression.Results:The BBB scores of rats in expansive duraplasty group were higher in comparison with contusion injury group on day 7 and 21 after surgery,the differences were statistically significant(P<0.05),the BBB scores of rats in expansive duraplasty group were higher in comparison with durotomy group on day 14 and 28 after surgery,the differences were statistically significant(P<0.05);lesion volume measurements showed a decrease in expansive duraplasty group relative to contusion injury group,and the differences were statistically significant(P<0.05),analysis of Integrated Optical Density(IOD)values showed that white matter sparing was higher in expansive duraplasty group compared with contusion injury group and durotomy group,and the differences were statistically significant(P<0.01),the average number of GFAP positive(+)cells in expansive duraplasty group was reduced when compared with the other two groups,and the differences were statistically significant(P<0.05).Conclusion:Our findings suggest that expansive duraplasty following spinal cord injury may improve motor functions of the rats,reduce lesion volume,inhibit demyelination and reduce connective tissue scar formation.
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.
