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Do Multiple Isolated Vertebral Thoracolumbar Transverse Process Fractures Increase the Risk of Ligamentous Injury and Surgical Intervention in the Setting of Trauma?

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Open Journal of Modern Neurosurgery 2018年第1期8卷 77-83页

作者： Nickalus Khan Jonathan Reding Matthew Gilbert Michael S. Muhlbauer L. Madison Michael Department of Neurosurgery University of Tennessee Health Science Center Memphis USA College of Medicine University of Tennessee Health Science Center Memphis USA semmes-murphey neurologic & spine institute Memphis USA

Background: Isolated thoracolumbar vertebral transverse process fractures (TPF) are often considered a stable injury. However, the use of advanced imaging such as magnetic resonance imaging and spine specialist consultation are often ordered as part of the routine workup of these fractures. The routine ordering of advanced imaging, spine specialist consultation, and delayed mobilization causes unnecessary economic and clinical burdens to patients and the overall healthcare system. Purpose: To determine if a higher number of isolated TPFs (iTPFs) lead to an increase in ligamentous injury to the spine, and whether ligamentous injury—if present—requires surgical intervention. Methods: The retrospective review was performed from 2009 to 2015, using a surgical trauma database to identify patients with greater than 3 isolated TPF (iTPF) to determine if iTPF leads to an increase in ligamentous injury to the spine and if this increase leads to increased surgical intervention. Results: A total of 102 patients were identified with complete follow up at 6 - 8 weeks post injury. The majority of the included patients suffered from blunt trauma. There was a small rate of ligamentous injury (n = 7, 7%) that did not require additional treatment. None of the fractures included were considered unstable. None of the patients included required surgical intervention during their hospital visit or in follow up visits. Conclusion: iTPFs are a stable injury to the thoracolumbar spine. There is a small rate of associated ligamentous injury that does not change the management or require further interventions. Thoracolumbar iTPFs do not automatically need spine specialist consultation and advanced imaging techniques.

关键词： Transverse Process Fracture Ligamentous Injury Imaging spine Service Consultation

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Advances in the treatment of cervical rheumatoid: Less surgery and less morbidity

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World Journal of Orthopedics 2014年第3期5卷 292-303页

作者： Grant W Mallory Sasha R Halasz Michelle J Clarke Department of neurologic Surgery Mayo ClinicRochesterMN 55905United States

Rheumatoid arthritis is a chronic systemic inflammatory disease that often affects the cervical *** it was initially thought that cervical involvement was innocuous,natural history studies have substantiated the progressive nature of untreated *** the past 50 years,there has been further elucidation in the pathophysiology of the disease,as well as significant advancements in medical and surgical *** introduction of disease modifying drugs and biologic agents has reduced the amount of patients with advanced stages of the disease needing *** in instrumentation techniques has improved patient outcomes and fusion *** introduction of endoscopic approaches for ventral decompression may further lower surgical *** this review,we give a brief overview of the pertinent positives of the disease.A discussion of historical techniques and the evolution of surgical therapy into the modern era is *** improved medical therapies and lessinvasive approaches,we will likely continue to see less advanced cases of disease and less surgical ***,a thorough understanding of the disease is crucial,as its systemic involvement and need for continued medical therapy have tremendous impact on overall complications and outcomes even in patients being seen for standard degenerative disease with comorbid rheumatoid.

关键词： Atlantoaxial instability Cranial settling Subaxial subluxation Cervical Surgery Morbidity Rheumatoid arthritis

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Surgical staged treatment for moderate to severe adolescent cervical kyphosis

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Chinese Medical Journal 2011年第23期124卷 3864-3867页

作者： LIANG Lei ZHOU Xu-hui LIU Yang GAO Rui CHEN Hua-jiang YANG Li-li SHI Sheng YUAN Wen Department of spine Surgery Changzheng Orthopaedics Hospital the Second Military Medical University Shanghai 200003 China

Adolescent cervical kyphosis refers to manifestation characterized by loss of physiological cervical lordosis with involvement of multiple cervical vertebrae. There is no standard treatment strategy for this disease, especially in those patients who need surgical intervention. The aim of this study was to evaluate the surgical staged treatment for moderate to severe adolescents cervical kyphosis. Methods A total of 26 adolescent with cervical kyphosis were retrospectively assigned into following two groups according to the magnitude of kyphosis： moderate group （n=17）, the Cobb angle was 46.6°±4.8°. The surgical procedure was that skull traction was first carried out for 5-7 days and then the anterior fusion and instrumentation were performed. Severe group （n=-9）, the Cobb angle was 61.6°±4.8°. The treatment strategy was that the anterior release were first performed, followed by skull traction for 7-10 days, and then anterior fusion were performed. Radiographic evaluation was performed postoperatively. Results Three days after surgery, the X-ray examination showed that the Cobb angle was -8.9°±6.8° in the moderate group and -6.0°±6.3° in the severe group. The deformed appearance was obviously corrected, with neck pain and neurologic function improved significantly. Further magnetic resonance imaging （MRI） indicated the physiology curvature of the cervical spine had been reconstructed. Conclusion Surgical staged treatment may be an ideal therapeutic intervention for cervical kyphosis patients with a Cobb angle exceeding 35° in adolescents.

关键词： cervical vertebrae kyphosis staged treatment adolescent

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Surgical decompression in acute spinal cord injury： A review of clinical evidence, animal model studies, and potential future directions of investigation

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Frontiers in Biology 2014年第2期9卷 127-136页

作者： Yiping LI Chandler L. WALKER Yi Ping ZHANG Christopher B. SHIELDS Xiao-Ming XU Spinal Cord and Brain Injury Research Group Stark Neurosciences Research Institute Department of Neurological Surgery and Goodmanand Campbell Brain and Spine Indiana University School of Medicine Indianapolis IN 46202 USA Norton Neuroscience institute Norton Healthcare Louisville KY 40202 USA

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.

关键词： acute spinal cord injury surgical decompression durotomy animal models

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New strategies for the repair of spinal cord injury

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Chinese Science Bulletin 2014年第31期59卷 4041-4049页

作者： Zhourui Wu Ziru Zhao Yan Yu Xiao Hu Wei Xu Zhili Zeng Yi Eve Sun Liming Cheng Department of spine Surgery Shanghai Tongji HospitalTongji University School of Medicine Translational Stem Cell Center Shanghai Tongji HospitalTongji University School of Medicine

Spinal cord injury(SCI)leads to several neurologic damages to patients with sensory and motor function *** some inspiring results were reported in animal,even in non-human primate models,the clinical translation of these research achievements barely move forward for the SCI *** review mainly focused on the pathogenesis of the primary and secondary injury,the clinical therapies and the new technologies in spinal cord ***,the key scientific issues on this field were discussed in the ***,some suggestions were proposed for the scientific and clinical researches.

关键词：脊髓损伤修复临床治疗动物模型科学问题运动功能研究成果发病机制

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The translational importance of establishing biomarkers of human spinal cord injury

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Neural Regeneration Research 2017年第3期12卷 385-388页

作者： Sanam Salimi Elizei Brian K.Kwon International Collaboration on Repair Discoveries(ICORD) University of British ColumbiaBCCanada Vancouver spine Surgery institute Department of OrthopaedicsUniversity of British ColumbiaBCCanada

The evaluation of such novel therapies for acute spinal cord injury in clinical trials is extremely *** current dependence upon the clinical assessment of neurologic impairment renders many acute SCI patients ineligible for trials because they are not ***,the difficulty in predicting neurologic recovery based on the early clinical assessment forces investigators to recruit large cohorts to have sufficient *** that objectively classify injury severity and better predict neurologic outcome would be valuable tools for translational *** such,the objective of the present review was to describe some of the translational challenges in acute spinal cord injury research and examine the potential utility of neurochemical biomarkers found within cerebrospinal fluid and *** focus on published efforts to establish biological markers for accurately classifying injury severity and precisely predict neurological outcome.

关键词： spinal cord injury, biomarkers, cerebrospinal fluid, injury severity neurological recovery

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Clinical and radiographic results of cervical artificial disc arthroplasty： over three years follow-up cohort study

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Chinese Medical Journal 2010年第21期123卷 2969-2973页

作者： TIAN Wei HAN Xiao LIU Bo LI Qin HU Lin LI Zhi-yu YUAN Qiang HE Da XING Yong-gang Department of spine Surgery Beijing Jishuitan Hospital Fourth Clinical Medical College of Peking University Beijing 100035 China

Background Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. The clinical and radiographic effects of cervical disc arthroplasty in short term have been ascertained. The aim of this study is to research the data of mid-term *** In this prospective cohort study, 50 patients who underwent cervical disc arthroplasty from December 2003 to January 2006 were enrolled. There were 39 patients who received 1-level disc arthroplasty, and 11 patients received 2-level disc arthroplasty, with an average age of 50.9 years （range from 29 to 73）. The median follow-up was 41.85months （range from 36.00-55.63 months）. Patients were followed prospectively with respect to their symptoms,neurologic signs, and radiographic *** The median value of Japanese Orthopaedic Association （JOA） score was 14.0 before surgery, and 16.5 at the most recent follow-up （P 〈0.01）. The median value of the recovery rate of the JOA score was 92.2%. The preoperative range of motion （ROM） at the indexed level was （10.40±4.97）°, which has significantly correlated with the most recent follow-up ROM which was （8.56±4.76）° （P 〈0.05, r=0.33）. The ROM at the operative level at the most recent follow-upwas greater than the value at the 3-month follow-up of （7.52±3.37）° （P 〈0.05）. The preoperative functional spinal unit （FSU） angulation was （-0.96±6.52）°, which was not significantly correlated with that of the most recent follow-up value of （-2.65±7.95）° （P 〈0.01, r=0.53）. The preoperative endplate angulation was （2.61±4.85）°, which had no significant correlation with that of the most recent follow-up value of （0.71±6.41）° （p 〉0.05）.Conclusions The clinical and radiographic results of cervical disc arthroplasty are good in mid-term follow-up. The normal range of motion of the operated level and the biomechanics in the cervical spine are well preserved.

关键词： cervical disc arthroplasty cervical spondylosis cervical disc herniation

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Accuracy and complications of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy-based navigation

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Chinese Medical Journal 2014年第14期127卷 2654-2658页

作者： Tao Xiaohui Tian Wei Liu Bo Li Qin Zhang Guilin Peking Univ Dept Spine Surg Beijing Jishuitan Hosp Fourth Clin Med Coll Beijing 100035 Peoples R China

Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The aim of this research was to evaluate the accuracy of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy- based navigation （ITFN） and assess the perioperative complication rate related to screw placement. Methods A retrospective review identified patients who underwent operative management with C2 instruments using ITFN at our hospital between January 2006 and December 2012. Clinical data were obtained from medical records and final screw positions were graded according to a modified classification of Gertzbein and Robbins. Grade A and B screws were considered well positioned. Results The study included 99 patients （53 males and 46 females） who underwent posterior C2 screw fixation using ITFN. The mean Japan Orthopedic Association score improved from （6.7±1.9） points before surgery to （12.5±2.7） points at 6-month follow-up （z= ＋8.628, P 〈0.01）. The mean visual analogue scale improved from （4.1±1.2） points before surgery to （0.7±0.9） points at 6-month follow-up, with an improvement of 83.7% （z= 8.638, P 〈 0.01）. Of the 196 screws analyzed using computed tomography and chart review, 126 transarticular, 64 pedicle, and 6 pars screws were placed with 82.5% （104/126）, 89.1% （57/64）, and 100% （6/6） accuracy （grade A）, respectively; 98.5% （193/196） of screws were grade A or B （grade C, 1.5% （3/196））, and no neurologic injuries occurred. In normal C2 cases, 93 transarticulars and 47 pedicles were placed with high accuracy rates of 90.3% （84/93） and 93.6% （44/47）（grade A）, respectively. However, in cases with C2 deformity, 33 transarticular, 17 pedicle, and 6 pars screws were placed with only 60.6% （20/33）, 76.5% （13/17）, and 100% （6/6） accuracy （grade A）, respectively. Conclusion ITFN is a safe, accurate, and effective tool for poster

关键词： three-dimensional fluoroscopy screw fixation intraoperative navigation

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Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis

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Chinese Neurosurgical Journal 2019年第3期5卷 151-162页

作者： Eleni Tsianaka Abdullah Al-Shawish Alexander Potapov Kostas Fountas Michael Spyrou Nikolay Konovalov Department of Neurosurgery University Hospital of LarissaViopolis41111LarissaGreece Department of Neurosurgery Ibn Sina HospitalSabahMedical AreaShuwaikhKuwait Department of Neurotraumatology “N.N.Burdenko”Neurosurgery Institute164th Tverskaya–Yamskaya Str.MoscowRussia Department of Neurosurgery Ygeia Private HospitalGolgon333025LimassolCyprus Department of spine Neurosurgery “N.N.Burdenko”Neurosurgery Institute164th Tverskaya–Yamskaya Str.MoscowRussia.

Posterior circulation intracranial aneurysm (IA) treatment remains challenging, due to the anatomy of the area and the high rupture possibility. Endovascular treatment seems to be more suitable for these aneurysms, but studies focused on endovascular treatment demonstrate a high rate of re-intervention needing. A meta-analysis might offer a clearer view, being useful in a more effective treatment planning. Methods: A systematic search was performed, using the PubMed database platform. The final article pool contained 20 articles. Studied parameters were operative mortality, late mortality, permanent neurologic deficit (PND), and the need for re-intervention (Re-int). We divided patients into two subgroups, those with ruptured and those with unruptured aneurysm. Statistical analysis was performed using appropriate software. Results: In the total population (645 patients), there was a superiority of coiling over clipping in terms of PND and of coiling in terms of Re-int. As regards mortality, there was no clear superiority of one method over the other. Conclusions: The current study came to the conclusion that there is a superiority of coiling over clipping in terms of PND. On the other hand, clipping seems to be superior to coiling in terms of the need for re-intervention. As regards mortality (both operative and late), there is no clear superiority of one method over the other. Studying subgroups of patients (ruptured and unruptured posterior circulation IAs), in terms of PND, there is no superiority of one method over the other. The same goes for Op-Mo on ruptured aneurysms.

关键词： Clipping Coiling Intracranial aneurysms Meta-analysis Posterior circulation

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Small bowel entrapment and ureteropelvic junction disruption associated with L3 Chance fracture-dislocation

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World Journal of Clinical Cases 2016年第9期4卷 264-268页

作者： Sebastien Pesenti Benjamin Blondel Alice Faure Emilie Peltier Franck Launay Jean-Luc Jouve Pediatric Orthopaedics Hopital d'Enfants de la TimoneAix Marseille University spine Unit Aix Marseille University Pediatric Surgery H?pital NordAix-Marseille University

Paediatric Chance fracture are rare lesions but often associated with abdominal injuries. We herein present the case of a seven years old patient who sustained an entrapment of small bowel and an ureteropelvic disruption associated with a Chance fracture and spine dislocation following a traffic accident. Initial X-rays and computed tomographic(CT) scan showed a Chance fracture with dislocation of L3 vertebra, with an incarceration of a small bowel loop in the spinal canal and a complete section of the left lumbar ureter. Paraplegia was noticed on the initial neurological examination. A posterior L2-L4 osteosynthesis was performed firstly. In a second time she underwent a sus umbilical laparotomy to release the incarcerated jejunum loop in the spinal canal. An end-toend anastomosis was performed on a JJ probe to suture the left injured ureter. One month after the traumatism, she started to complain of severe headaches related to a leakage of cerebrospinalis fluid. Three months after the traumatism there was a clear regression of the leakage. One year after the trauma, an anterior intervertebral fusion was done. At final follow-up, no neurologic recovery was noticed. In case of Chance fracture, all physicians should think about abdominal injuries even if the patient is asymptomatic. Initial abdominal CT scan and magnetic resonance imaging provide in such case crucial info for management of the spine and the associated lesions.

关键词： Chance fracture Uretero-pelvic disruption Small bowel injuries Seatbelt Dural tear

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