中下段颈椎的应力松弛特性及前、后路手术对其的影响

目的 研究中下段颈椎的应力松弛特性，并评估椎间盘切除植骨术与椎板切开术对其影响。方法 6例新鲜尸体完整颈椎及手术后颈椎，在模拟生理状态下进行屈曲及伸展位的应力松弛实验。结果 在恒应变条件下，绘制术前及不同术式后的中下段颈椎的应力松弛函数及曲线；术后的中下段颈椎的应力和初始化应力比值G(t)比术前明显增大，前路椎间盘切除植骨术后的G(t)值比椎板切开术大，两者均有统计学意义。结论 在恒应变条件下，颈椎具有快速应力松弛敏感性，屈曲位比伸展位大。椎板成形术及颈椎前路椎间盘切除植骨术都使颈椎的应力松弛能力减弱，前路椎间盘切除植骨术的影响更大。     

Spontaneous Spinal Epidural Hematoma in an Infant : A Case Report and Review of the Literature

Spontaneous spinal epidural hematoma (SSEH) is rare in children, especially in infants, in whom only 12 cases have been reported. Because of the nonspecificity of presenting symptoms in children, the diagnosis may be delayed. We report herein a case of SSEH in a 20-month-old girl who initially presented with neck pain, and developed lower extremity motor weakness and symptoms of neurogenic bladder 2 weeks prior to admission. The magnetic resonance imaging showed an epidural mass lesion extending from C7 to T4, and the spinal cord was severely compressed by the mass. After emergency decompressive surgery the neurologic function was improved immediately. Two months after surgery, the neurological status was normal with achievement of spontaneous voiding. We suggest that surgical intervention can provide excellent prognosis in case of SSEH in infants, even if surgery delayed.     

Laminotomy in adults: technique and results

The objective of this study was to describe step by step our surgical technique of laminotomy and analyze our series with regard to spinal deformities (risk and predisposing factors), postoperative pain and rate of postoperative contusions. Data regarding patients who underwent our technique of laminotomy (N = 40, mean follow-up: 52 ms) (N = 40) between 2002 and 2006 were retrospectively evaluated. The technique used is illustrated in depth. Chronic pain was present in 30% with a mean score of 3/10 cm (Graphic Rating Scale). Postoperative kyphoses occurred in three patients, all below 35 years of age and with laminotomies which involved C2 and/or C7. None of these deformities required further surgical treatment because they were self-limiting or asymptomatic at a mean follow-up of 52 months. Based on the results, our technique proved to be safe and effective in terms of late deformities, blood loss, early and chronic postoperative pain and protection from postoperative accidents over the surgical site.     

A rare case of cervical facet joint and synovial cyst at C5/C6

Lumbar synovial cysts are uncommon, and particularly rare at cervical levels. We report a 40-year-old woman who presented with pain distribution in the typical C6 dermatome. MRI revealed a right-sided large extradural cystic lesion adjacent to the C5/C6 facet joint that was hyperintense on T2-weighted MRI and hypointense on T1-weighted MRI. The patient underwent posterior cervical surgery at the C5/C6 level which involved posterior decompressive unilateral laminotomy and excision of the C5/C6 facet joint cyst. Following complete facetectomy of the right C5/C6 facet joint and exposure of the C6 nerve throughout its foraminal course, instrumented fusion was performed. Following the procedure, the patient had an uneventful recovery with relief of her radicular symptoms at follow-up clinical review.     

Interspinous Implant with Unilateral Laminotomy for Bilateral Decompression of Degenerative Lumbar Spinal Stenosis in Elderly Patients

Objective

This study assessed the safety and efficacy of one level unilateral laminotomy bilateral decompression (ULBD) with the placement of a device for intervertebral assisted motion (DIAM) compared with one level ULBD only in elderly patients with degenerative lumbar spinal stenosis (DLSS).

Methods

A non randomized prospective analysis was performed on 16 patients who underwent one level ULBD with DIAM (Group A) and 20 patients with one level ULBD only (Group B) between February 2007 and March 2008. Radiographic imaging, visual analog scale (VAS) and MacNab outcome scale were obtained before and after surgery at a mean interval of 21 months (range 17-27 months).

Results

The disc height, interpedicular distance, slip distance and segmental lordotic angle were similar between two groups. In the group A, there was no significant difference between the pre- and post-operative imaging in terms of the sagittal balance and disc height. Both groups showed significant improvement in the clinical outcomes. In addition, there was significantly less low-back pain in the group A than in the group B at the last follow up, while the clinical improvement of the leg pain and MacNab outcome scale showed no significant difference in the two groups. There were no major complications or DIAM associated complications.

Conclusion

ULBD with DIAM is a safe and efficacious treatment for selective elderly patients with DLSS, particularly for relieving low back pain comparing to ULBD. ULBD with DIAM did not alter the disc height or sagittal alignment at the mean 21 months follow-up interval.     

Primary epidural burkitt lymphoma in a child: case presentation and literature review

Primary spinal epidural Burkitt lymphoma, presenting with signs of spinal cord compression, is very uncommon in childhood. Previously reported pediatric cases with isolated epidural Burkitt lymphoma had a high mortality, and survivors usually suffered serious neurologic sequelae. The authors present a 13-year-old female with isolated epidural Burkitt lymphoma with favorable outcome, and review the pediatric literature.     

Split laminotomy in pediatric neurosurgery

Technique A novel technique of multilevel opening of the spinal canal is introduced into pediatric neurosurgery. Split laminotomy helps to preserve the spinal column integrity in cases of posterior exposure of the spinal canal. The spinal processes are cut in the midline and the laminae are separated and retracted while the lesion in the spinal canal is explored. At closure the lamina are simply sutured.Results and discussion Excellent postoperative results were obtained in patients from different age groups. Pediatric peculiarities of the new method are discussed.     

Surgical Tips to Preserve the Facet Joint during Microdiscectomy

Lumbar microdiscectomy (MD) is the gold standard for treatment of lumbar disc herniation. Generally, the surgeon attempts to protect the facet joint in hopes of avoiding postoperative pain/instability and secondary degenerative arthropathy. We believe that preserving the facet joint is especially important in young patients, owing to their life expectancy and activity. However, preserving the facet joint is not easy during lumbar MD. We propose several technical tips (superolateral extension of conventional laminotomy, oblique drilling for laminotomy, and additional foraminotomy) for facet joint preservation during lumbar MD.     

Laminotomy with Continuous Irrigation in Patients with Pyogenic Spondylitis in Thoracic and Lumbar Spine

Objective

Pyogenic spondylitis often results in acute neurological deterioration requiring adequate surgical intervention and appropriate antibiotic treatment. The purpose of this study was to conduct an analysis of the clinical effect of continuous irrigation via laminotomy in a series of patients with pyogenic spondylitis in thoracic and lumbar spine.

Methods

The authors conducted a retrospective investigation of 31 consecutive patients with pyogenic thoracic and lumbar spondylitis who underwent continuous irrigation through laminotomy from 2004 to 2008. The study included 22 men and 9 women, ranging in age from 38 to 78 years (mean 58.1 years). The average follow-up duration was 13.4 months (range, 8-34 months). We performed debridement and abscess removal after simple laminotomy, and then washed out epidural and disc space using a continuous irrigation system. Broad spectrum antibiotics were administered empirically and changed according to the subsequent culture result. Clinical outcomes were based on the low back outcome scale (LBOS), visual analogue scale (VAS) score, and Frankel grade at the last follow-up. Radiological assessment involved plain radiographs, including functional views.

Results

Common predisposing factors included local injection for pain therapy, diabetes mellitus, chronic renal failure, and liver cirrhosis. Causative microorganisms were identified in 22 cases (70.9%) : Staphylococcus aureus and Streptococcus spp. were the main organisms. After surgery, LBOS, VAS score, and Frankel grade showed significant improvement in most patients. Spinal stability was maintained during the follow-up period, making secondary reconstructive surgery unnecessary for all patients, except one.

Conclusion

Simple laminotomy with continuous irrigation by insertion of a catheter into intervertebral disc space or epidural space was minimally invasive and effective in the treatment of pyogenic spondylitis. This procedure could be a beneficial treatment option in patients with thoracolumbar spondylitis combined with minimal or moderate destructive change of vertebrae.