In order to improve the accuracy and reliability of the electrodes implant location when using spinal functional electrical stimulation to rebuild hindlimb motor function, we measured the distributions of function core regions in rat spinal cord associated with hindlimb movements. In this study, we utilized three-dimensional scanning intraspinal microstimulation technology to stimulate the rat spinal cord to generate hip, knee and ankle joint movements, and acquired the coordinates of the sites in spinal cord which evoked these movements. In this article, 12 SD rats were used to overcome the individual differences in the functional region of the spinal cord. After normalized and overlaid the messages, we obtained the function core regions in spinal cord associated with ankle dorsiflexion movement, hip flexion movement, hip extension movement and hip adduction movement. It provides a reference for rebuilding the hindlimb movement function with micro-electronic neural bridge.
【摘要】 目的 探讨椎管内囊肿的手术治疗疗效。 方法 2006年5月-2009年12月对30例患者的临床表现、影像学和治疗情况进行回顾性分析。 结果 30例均行手术治疗，3例为椎管内单侧硬膜下髓外囊肿，3例为脑脊膜囊肿，12例为髓外硬脊膜下囊肿，9例为神经根袖套部囊肿（Tarlov囊肿），3例为脊管内肠源性囊肿。术后21例症状消失；9例好转，其中3例术后发生脑脊液漏，伤口二次缝合未成功，后经内引流后切口愈合。 结论 椎管内囊肿的临床表现及体征复杂，不典型，与椎管内肿瘤及椎间盘突出症的临床表现和体征相似；对症状及体征明显者宜施行手术治疗，手术治疗效果较满意。【Abstract】 Objective To evaluate the therapeutic effect of the surgery on intraspinal cyst. Methods A total of 30 patients from May 2006 to December 2009 were collected, and the clinical manifestations, results of examinations and therapeutic effects were retrospectively analyzed. Results All the patients underwent the surgery, inluding 3 with unilateral intraspinal subdural extramedullary cyst, 3 with meningeal cyst, 12 with subdural extramedullary cyst, 3 with nerve-root oversleeve cyst (Tarlov cyst), and 3 with intra-spinal-canal enterogenous cyst. Afterh the surgery, the symptoms disappeared in 21 patients, alleviated in 9 including 3 with postoperative cerebrospinal-fluid leakage whose wound was not sutured successfully for the second time and healed up after drainage. Conclusions The clinical manifestations of intraspinal cyst are complicated and untypical, which is similar to that of intraspinal tumor and slipped disc. The surgeries should be performed on the patients with obvious symptoms and the therapeutic effect is good.
ObjectiveTo apply H-shaped allogeneic bone graft combined with spinous process replantation for posterior spinal canal reconstruction after removal of intraspinal tumors,and observe its effectiveness. MethodsA total of 48 cases of thoracic and lumbar intraspinal tumors were recruited between February 2006 and May 2012,including 35 males and 13 females with a mean age of 29.5 years (range,17-48 years).The disease duration was 3-16 months (mean,10.5 months).Intraspinal tumors located at T5,6 in 3 cases,at T10 in 7 cases,at T12,L1 in 13 cases,at L3 in 10 cases,and at L4-S1 in 15 cases.There were 18 cases of epidural meningioma,2 cases of epidural lipoma,3 cases of extramedullary neurological tumors,10 cases of extramedullary meningioma,6 cases of extramedullary schwannoma,6 cases of intramedullary ependymoma,and 3 cases of intramedullary astrocytoma.All patients underwent H-shaped allogeneic bone graft combined with spinous process replantation for posterior spinal canal reconstruction after removal of intraspinal tumor by posterior laminectomy.The Oswestry disability index (ODI) was used to assess postoperative symptom improvement,and the Frankel grade of spinal cord injury to evaluate the extent of nerve damage and recovery. ResultsAfter operation,8 cases had cerebrospinal fluid leakage,and 4 cases had yellowish exudate,and they were all cured after appropriate treatment; primary healing of wound was obtained in the other cases,without postoperative complication.Forty-eight patients were followed up 18-72 months (mean,38 months).CT showed all the graft bones healed and posterior spinal canal was well reconstructed without iatrogenic spinal stenosis formation.X-ray film showed no vertebral instability or spondylolisthesis,and no shifting of reconstructed vertebrae.MRI showed no recurrence except 1 case.The symptoms were improved significantly after operation; the ODI score at last follow-up (16.69±2.53) was significantly lower (t=0.89,P=0.00) than that at preoperation (47.83±7.25).The results of symptom improvement were excellent in 36 cases,good in 10 cases,fair in 1 case,and poor in 1 case; the excellent and good rate was 95.83%.At last follow-up,Frankel grade was improved significantly (Z=13.32,P=0.00) when compared with preoperative grade except 1 recurrent patient. ConclusionThe application of the H-shaped allogeneic bone graft combined with spinous process replantation can well reconstruct the posterior spinal canal,and also can effectively avoid iatrogenic spinal stenosis,so it is worthy of promoting in the clinical treatment of intraspinal tumor surgery.
Objective To evaluate the effects of prophylactic ondansetron for preventing intrathecal opioid induced pruritus. Methods According to the Cochrane Handbook, such databases as The Cochrane Library, OVID, EMbase, PubMed, CNKI and CBM were searched to collect the randomized controlled trials (RCTs) about ondansetron for preventing intrathecal opioid induced pruritus. According to the predefined inclusion and exclusion criteria, the literatures were screened, and meta-analysis was conducted by using RevMan 5.0 software. Results Eight RCTs involving 577 patients were included. The quality evaluation showed the bias of all studies was unclear. Meta-analysis showed that because the heterogeneity of the included studies was so large (P=0.0001, I2=80%), subgroup analyses were performed. The subgroup analyses on surgery methods showed no statistical heterogeneity among all subgroups. a) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in arthroscopic knee or urologic surgery (RR=0.49, 95%CI 0.35 to 0.67); b) There was no significant difference in incidence rate of pruritus between the ondansetron group and the control group in obstetric surgery (RR=0.98, 95%CI 0.86 to 1.12); c) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in gynecologic surgery (RR=0.51, 95%CI 0.34 to 0.76); and d) There was no significant difference in the incidence rate of pruritus between the ondansetron group and the control group in outpatient surgery (RR=0.49, 95%CI 0.35 to 0.67). Conclusion The subgroup analyses performed because of the large heterogeneity of the included studies indicate that ondansetron can prevent the intrathecal opioid induced pruritus in arthroscopic knee, urologic and gynecological surgeries rather than obstetric and outpatient surgeries. Due to the small scale, large heterogeneity and unclear quality evaluation of the included studies, more high quality RCTs are required to provide reliable evidence.
ObjectiveTo investigate the feasibility and effectiveness of modified replanting posterior ligament complex (PLC) applying piezoelectric osteotomy in the treatment of primary benign tumors in thoracic spinal canal.MethodsThe clinical data of 38 patients with primary benign tumors in thoracic spinal canal between March 2014 and March 2016 were retrospectively analyzed. There were 16 males and 22 females, aged from 21 to 72 years (mean, 47.1 years). The disease duration ranged from 6 to 57 months (mean, 32.6 months). Pathological examination showed 24 cases of schwannoma, 6 cases of meningioma, 4 cases of ependymoma, 2 cases of lipoma, and 2 cases of dermoid cyst. The lesions located in 18 cases of single segment, 15 cases of double segments, and 5 cases of three segments. The length of the tumors ranged from 0.7 to 6.5 cm. There were boundaries between the tumors and the spinal cord, cauda equina, and nerve roots. The preoperative Japanese Orthopaedic Association (JOA) score was 12.2±2.3 and the thoracic Cobb angle was (11.7±2.7)°. Modified PLC replantation and microsurgical resection were performed with piezoelectric osteotomy. Continuity of uniside supraspinal and interspinous ligaments were preserved during the operation. The PLC was exposed laterally. After removing the tumors under the microscope, the pedicled PLC was replanted in situ and fixed with bilateral micro-reconstruction titanium plate. X-ray film, CT, and MRI examinations were performed to observe spinal stability, spinal canal plasty, and tumor resection after operation. The effectiveness was evaluated by JOA score.ResultsThe operation time was 56-142 minutes (mean, 77.1 minutes). The intraoperative blood loss was 110-370 mL (mean, 217.2 mL). The tumors were removed completely and the incisions healed well. Three cases complicated with cerebrospinal fluid leakage, and there was no complications such as spinal cord injury and infection. All the 38 patients were followed up 24-28 months (mean, 27.2 months). There was no internal fixation loosening, malposition, or other related complications. At last follow-up, X-ray films showed no sign of kyphosis and instability. CT showed no displacement of vertebral lamina and reduction of secondary spinal canal volume, and vertebral lamina healed well. MRI showed no recurrence of tumors. At last follow-up, the thoracic Cobb angle was (12.3±4.1)°, showing no significant difference when compared with preoperative value (t=0.753, P=0.456). JOA score increased to 23.7±3.8, showing significant difference when compared with preoperative value (t=15.960, P=0.000). Among them, 14 cases were excellent, 18 were good, 6 were fair, and the excellent and good rate was 84.2%.ConclusionModified replanting PLC applying piezoelectric osteotomy and micro-reconstruction with titanium plate for the primary benign tumors in thoracic spinal canal can reconstruct the anatomy of the spinal canal, enable patients to recover daily activities quickly. It is an effective and safe treatment.
Objective To evaluate the efficacy of intravertebral analgesia for external cephalic version. Methods We electronically searched The Cochrane Library (Issue 4, 2009), PubMed (1980 to 2009), Ovid MEDLINE (1950 to 2009), Ovid EBM Database (1991 to 2009), EMbase (1980 to 2009), CBM (1978 to 2009) and CNKI (1979 to 2009) to collect literature about intravertebral analgesia for external cephalic version. We screened randomized controlled trials (RCTs) according to the predefined inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies, and then performed meta-analyses by using RevMan 5.0.13 software. Results Seven RCTs involving 620 women met the inclusion criteria. Five trials were of relatively high quality, and 1 of low quality and 2 not clear. The result of meta-analyses showed that intravertebral analgesia was superior in external cephalic version with a RR 1.53 and 95%CI 1.24 to 1.88. Conclusion Intravertebral analgesia can increase the successful rate of external cephalic version in the treatment of breech presentation compared with intravenous medicine for systematic use or no analgesia.
ObjectiveTo investigate the surgical outcome of combined posterior and anterior approaches for the resection of thoracolumbar spinal canal huge dumbbell-shaped tumor. MethodsBetween January 2009 and March 2015, 12 patients with thoracolumbar spinal canal huge dumbbell-shaped tumor were treated by posterior approach and anterolateral approach through diaphragmatic crura and thoracoabdominal incision for complete resection. There were 9 males and 3 females, with an average age of 45 years (range, 30-65 years). The disease duration was 8-64 weeks (mean, 12.7 weeks). The tumor was located at T12, L1 in 6 cases, at L1, 2 in 5 cases, and at L2, 3 in 1 case. The tumor size ranged from 4.3 cm×4.0 cm×3.5 cm to 7.5 cm×6.3 cm×6.0 cm. According to tumor outside the spinal involvement scope and site and based on the typing of Eden, 5 cases were rated as type b, 2 cases as type d, 4 cases as type e, and 1 case as type f in the transverse direction; two segments were involved in 8 cases, and more than two segments in 4 cases. The degree of tumor excision, tumor recurrence, and the spine stability were observed during follow-up. The verbal rating scale (VRS) was used to evaluate pain improvement. ResultsThe average surgical time was 170 minutes (range, 150- 230 minutes); the average intraoperative blood loss was 350 mL (range, 270-600 mL). All incisions healed by first intention, and no thoracic cavity infection and other operation related complication occurred. Of 12 cases, 10 were histologically confirmed as schwannoma, and 2 as neurofibroma. The patients were followed up 6 months to 6 years (mean, 31 months). Neurological symptoms were significantly improved in all patients, without lower back soreness. The thoracolumbar X-ray film and MRI showed no tumor residue. No tumor recurrence, internal fixator loosening, scoliosis, and other complications were observed during follow-up. VRS at last follow-up was significantly improved to grade 0 (10 cases) or grade I (2 cases ) from preoperative grade I (2 cases), grade II (8 cases), and grade III (2 cases) (Z= —3.217, P=0.001). ConclusionCombined posterior approach and anterolateral approach through diaphragmatic crura and thoracoabdominal incision for complete resection of thoracolumbar spinal canal huge dumbbell-shaped tumor is feasible and safe, and can protect the stability of thoracolumbar spine and paraspinal muscle function. It can obtain satisfactory clinical result to use this method for treating the complex type of thoracolumbar spinal canal dumbbell-shaped tumor.
Objective To investigate the effectiveness of posterior non-decompression surgery in the treatment of thoracolumbar fractures without neurological symptoms by comparing with the conventional posterior decompression surgery. Methods Between October 2008 and October 2015, a total of 97 patients with thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms were divided into the decompression surgery group (51 cases) and the non-decompression surgery group (46 cases). There was no significant difference in gender, age, cause of injury, injury segment, the thoracolumbar injury severity score (TLICS), combined injury, disease duration, and preoperative relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score between 2 groups (P>0.05). The operation time, intraoperative blood loss volume, postoperative drainage, bed rest time, hospitalization time, and relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, and VAS score, ODI, JOA score at preoperative and postoperative 3 days and 1 year were recorded and compared. Results The operation time, intraoperative blood loss volume, and postoperative drainage in non-decompression surgery group were significantly less than those in decompression surgery group (P<0.05). There was no significant difference in the postoperative bed rest time and hospitalization time between 2 groups (P>0.05). In decompression surgery group, 4 cases had cerebrospinal fluid leakage and healed after conservative treatment. All incisions healed by first intention, and no nerve injury or infection of incision occurred. All patients were followed up 10-18 months (mean, 11.7 months). The recovery of vertebral body height was satisfactory in 2 groups, without secondary kyphosis and secondary nerve symptoms. The imaging indexes and effectiveness scores of 2 groups at 3 days and 1 year after operation were significantly improved when compared with preoperative ones (P<0.05). The intraspinal occupying percentage, VAS score, and ODI at 1 year after operation were significantly lower than those at 3 days after operation in 2 groups (P<0.05), and JOA score at 1 year after operation was significantly higher than that at 3 days after operation (P<0.05). Relative anterior vertebral height at 1 year after operation was significantly higher than that at 3 days after operation in non-decompression surgery group (P<0.05); and there was no significant difference in decompression surgery group (P>0.05). At 3 days, the intraspinal occupying percentage and JOA score in non-decompression surgery group were higher than those in decompression surgery group (P<0.05), and VAS score and ODI at 3 days in non-decompression surgery group were lower than those in decompression surgery group (P<0.05). No significant difference was found in the other indexes between 2 groups at 3 days and 1 year after operation (P>0.05). Conclusion Compared with the posterior decompression surgery, posterior non-decompression surgery has the advantages of less bleeding, less trauma, less postoperative pain, and so on. It is an ideal choice for the treatment of thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms under the condition of strict indication of operation.