scholarly journals Full-Endoscopic Decompression with the Application of an Endoscopic-Matched Ultrasonic Osteotome for Removal of Ossification of the Thoracic Ligamentum Flavum

2021 ◽  
pp. 275-281
Author(s):  
Yuan-Ting Zhao
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Surgery ◽  
Ligamentum Flavum ◽  
Japanese Orthopaedic Association ◽  
Thoracic Myelopathy ◽  
Improvement Rate ◽  
Cord Injury ◽  
Endoscopic Spinal Surgery

Background: Resection of the ossification of the thoracic ligamentum flavum (OTLF) with a high-speed burr may cause a high rate of perioperative complications, such as dural laceration and/or iatrogenic spinal cord injury. Objectives: The aim of this study was to investigate the safety and feasibility of the endoscopicmatched ultrasonic osteotome in full-endoscopic spinal surgery for direct removal of OTLF. Study Design: Retrospective study. Setting: All data were from Honghui Hospital in Xi’an. Methods: This study conducted between December 2017 and December 2018, included 27 consecutive patients who met the study criteria, had single-level OTLF, and underwent fullendoscopic decompression under local anesthesia. The postoperative follow-up was scheduled at 1, 3, 6, and 12 months postoperatively. Outcomes evaluations included the Visual Analog Scale (VAS) score for lower extremity pain and the modified Japanese Orthopaedic Association (mJOA) score and improvement rate for the assessment of thoracic myelopathy. Removal of OTLF was measured by comparing the pre- and postoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans. Results: The operation was completed in all patients without conversion to open surgery. The operation time ranged from 65 to 125 minutes (average, 83.7 ± 12.3 minutes). All patients were followed up for 12 to 18 months, with an average follow-up of 14.3 ± 1.3 months. Satisfactory neurologic decompression was confirmed by postoperative CT and MRI, and no revision surgery was required. The VAS and mJOA scores showed statistically higher improvement at the 1-month follow-up and the last follow-up compared with the preoperative assessment (P < 0.05). According to the improvement rate at the final follow-up, 20 cases were classified as good, 6 cases were fair, and 1 case remained unchanged. Limitations: A single-center, noncontrol study. Conclusions: The endoscopic-matched ultrasonic osteotome can be considered quite safe and feasible for direct removal of OTLF during full-endoscopic spinal surgery in strictly selected patients, as this allows for effective direct decompression of OTLF while minimizing trauma and instability. In addition, because of the design characteristics of the ultrasonic osteotome, surgical complications, especially dural tears and spinal cord injury, can also be effectively controlled. Key words: Percutaneous endoscopic spinal surgery, ultrasonic osteotome, ossification of thoracic ligamentum flavum, microsurgery, thoracic myelopathy, minimally invasive procedures

Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele

2011 ◽  
Vol 15 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Shoichi Kokubun ◽  
Hiroshi Ozawa ◽  
Toshimi Aizawa ◽  
Ngo Minh Ly ◽  
Yasuhisa Tanaka
Keyword(s):  
Spinal Cord ◽  
Japanese Orthopaedic Association ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Neurological Deficits ◽  
Thoracic Myelopathy ◽  
Shortening Osteotomy ◽  
Cord Injury ◽  
Rod System

Object Tethered cord syndrome (TCS) is a disorder involving an abnormal stretching of the tethered spinal cord caused by several pathological conditions and presents with a variety of neurological symptoms. Untethering (tethered cord release) is the gold standard treatment for TCS. However, untethering carries risks of spinal cord injury and postoperative retethering. To avoid these potential risks, the authors applied spine-shortening osteotomy to adult patients with TCS, and report on the surgical procedure and treatment outcomes. Methods Eight patients with TCS caused by a lipomyelomeningocele were surgically treated by the authors' original procedure of spine-shortening osteotomy. Six patients were male and 2 were females; average age at the time of surgery was 31 years old. Spine-shortening osteotomy was performed at the level of L-1 in all but 2 patients, in whom it was performed at T-12, with spinal fusion between T-12 and L-2 or T-11 and L-1 using a pedicle screw–rod system. The average follow-up period was 6.2 years and the patients' pre- and postoperative conditions were evaluated clinically and radiologically. Results Preoperatively, all patients displayed severe neurological deficits such as motor disturbance, muscle atrophy, and bladder dysfunction. Several months before surgery, all showed progressive symptoms. Those symptoms showed initial improvement in 6 patients and stabilized in 2 postoperatively, but the improved symptoms worsened again in 4 of the 6 patients. The osteotomized vertebrae were shortened by 21 mm on average, and all spines showed complete bone union without loss of correction. At the final follow-up evaluations, 6 patients showed stabilization as per the modified Japanese Orthopaedic Association score for thoracic myelopathy. Conclusions Spine-shortening osteotomy successfully helps reduce the spinal cord tension without causing direct neural damage. At minimum, it stabilized the patients' symptoms and/or helped delay neurological deterioration for a period of time. Spine-shortening osteotomy might be a feasible mode of treatment for adult TCS caused by a spinal lipoma.

Long-Term Follow-Up After Spinal Cord Injury in Canada

2006 ◽  
Author(s):  
Mark I. Tonack ◽  
Sander L. Hitzig ◽  
B. Catharine Craven ◽  
Kent A. Campbell ◽  
Kathryn A. Boschen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cord Injury ◽  
Long Term Follow Up

OPEN HAEMORRHOIDS SURGERY IN SPINAL CORD INJURY PATIENTS

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Khaled Hassan
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Anal Fissure ◽  
Open Surgery ◽  
Anal Fissures ◽  
Cord Injury ◽  
Long Term Follow Up ◽  
Grade Iii

This Pilot retrospective research conducted on the results of open surgery in patients with Grade III and IV haemorrhoids With SCI. No major complications had arisen at 6 weeks post-operative and all wounds had healed, but 1 patient Anal fissure recurrence. 75% of patients reported a substantial increase in anorectal anorexia during long-term follow-up. With symptoms. Five patients reported recurrences: three haemorrhoids (18 percent) and two anal fissures (25 percent).   Keywords: Haemorrhoids, Pilot retrospective research, Anorectal Anorexia.

Postoperative changes in spinal cord signal intensity in patients with spinal cord injury without major bone injury: comparison between preoperative and postoperative magnetic resonance images

2020 ◽  
pp. 1-8
Author(s):  
Masaaki Machino ◽  
Kei Ando ◽  
Kazuyoshi Kobayashi ◽  
Hiroaki Nakashima ◽  
Shunsuke Kanbara ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Symptom Severity ◽  
Surgical Outcomes ◽  
Signal Intensity ◽  
Japanese Orthopaedic Association ◽  
Magnetic Resonance Images ◽  
Postoperative Symptom ◽  
Bone Injury ◽  
Cord Injury

OBJECTIVEAlthough increased signal intensity (ISI) on MRI is observed in patients with cervical spinal cord injury (SCI) without major bone injury, alterations in ISI have not been evaluated. The association between postoperative ISI and surgical outcomes remains unclear. This study elucidated whether or not the postoperative classification and alterations in MRI-based ISI of the spinal cord reflected the postoperative symptom severity and surgical outcomes in patients with SCI without major bone injury.METHODSOne hundred consecutive patients with SCI without major bone injury (79 male and 21 female) with a mean age of 55 years (range 20–87 years) were included. All patients were treated with laminoplasty and underwent MRI pre- and postoperatively (mean 12.5 ± 0.8 months). ISI was classified into three groups on the basis of sagittal T2-weighted MRI: grade 0, none; grade 1, light (obscure); and grade 2, intense (bright). The neurological statuses were evaluated according to the Japanese Orthopaedic Association (JOA) scoring system and the American Spinal Injury Association Impairment Scale (AIS).RESULTSPreoperatively, 8 patients had grade 0 ISI, 49 had grade 1, and 43 had grade 2; and postoperatively, 20 patients had grade 0, 24 had grade 1, and 56 had grade 2. The postoperative JOA scores and recovery rate (RR) decreased significantly with increasing postoperative ISI grade. The postoperative ISI grade tended to increase with the postoperative AIS grade. Postoperative grade 2 ISI was observed in severely paralyzed patients. The postoperative ISI grade improved in 23 patients (23%), worsened in 25 (25%), and remained unchanged in 52 (52%). Patients with an improved ISI grade had a better RR than those with a worsened ISI grade.CONCLUSIONSPostoperative ISI reflected postoperative symptom severity and surgical outcomes. Alterations in ISI were seen postoperatively in 48 patients (48%) and were associated with surgical outcomes.

scholarly journals A multicentre follow-up of clinical aspects of traumatic spinal cord injury

Spinal Cord ◽  
2006 ◽  
Vol 45 (6) ◽  
pp. 404-410 ◽  
Author(s):  
M C Pagliacci ◽  
◽  
M Franceschini ◽  
B Di Clemente ◽  
M Agosti ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Aspects ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury
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