I. Causes and prevention of spinal cord neurological dysfunction after chronic compression and decompression of the spinal cord.
Spinal cord function nerve dysfunction after chronic compression and decompression of the spinal cord is becoming more and more common in clinical practice and once troubled spine surgeons. Through years of retrospective case summaries, we analyzed the causes of spinal cord dysfunction after chronic compression and decompression of the cervical spinal cord and successfully identified the main causes of spinal cord neurological dysfunction after decompression surgery. At the same time, prospective studies were conducted to prevent spinal cord neurological dysfunction after chronic compression decompression of the spinal cord. Preliminary prevention and treatment methods have been explored, and significant clinical results have been achieved.
Second, clinical research on the causes of spinal surgery failure and countermeasures.
The analysis of the causes of spinal surgery failure, and the corresponding countermeasure research has been a difficult problem in spinal surgery. Over the years, we have collected cases of surgical failure, retrospectively analyzed the imaging data, fixation and fusion methods, surgical techniques, pathological factors and reoperation results, and successfully searched for the main causes of surgical failure. In most cases, “revision” surgery was performed, including decompression, internal fixation, replacement of other endosseous, addition of other endosseous, and re-fusion with bone graft, etc., and good clinical results were achieved.
Clinical study of anterior spinal artery syndrome caused by cervical spondylosis
This project was funded by the research fund of Shanghai Jiaotong University School of Medicine. The significance of this project lies in the discovery of another clinical manifestation of cervical spondylosis in addition to spinal cord type, nerve root type, sympathetic type and other cervical spondylosis. This project analyzes the clinical manifestations of anterior spinal artery syndrome caused by cervical spondylosis, and discusses its mechanism and imaging manifestation characteristics and treatment. It was found that central disc herniation in cervical spondylosis without obvious causative factors can cause anterior spinal artery syndrome. The diagnosis of this disease is based on “superficial and sensory separation” and is confirmed by the combination of history, clinical symptoms and other signs, as well as imaging examinations. Timely decompression can achieve better results.
High cervical spine trauma and high cervical spine deformity surgical treatment.
Surgical treatment of high cervical spine trauma and deformity was previously a “no-go” area for spine surgery. Successful surgical treatment is one of the signs of the level of spinal surgery, and also a sign of the comprehensive technical strength of the department and the hospital, and the success of the operation requires great assistance from nursing, anesthesia, ICU and radiology. In recent years, we have successfully performed anterior internal fixation of odontoid fracture and posterior decompression implantation; posterior decompression implantation of atlantoaxial fracture; anterior internal fixation of cardinal fracture and combined anterior/posterior decompression implantation. High cervical deformity orthopedics carries out post-traumatic deformity orthopedics, as well as orthopedics for congenital and degenerative deformities and other surgical treatments.
[Contents]
I. Causes and countermeasures of spinal cord dysfunction after chronic compression and decompression of the spinal cord
Cervical spondylosis, cervical posterior longitudinal ligament ossification disease and other chronic compression diseases of the cervical spinal cord, the current method of surgery used anterior cervical decompression or posterior decompression, and achieve better results. With the development of decompression techniques and the gradual promotion of clinical applications, postoperative complications such as spinal cord and neurological dysfunction have received more and more attention from scholars. However, there are few reports about the causes and countermeasures related to spinal cord dysfunction after decompression of chronic spinal cord compression. After years of case summary and analysis, the authors found that the causes of spinal cord dysfunction after chronic compression and decompression of the cervical spinal cord are: postoperative spinal cord “reperfusion injury”; spinal cord nerve injury due to surgical error; postoperative epidural hematoma compression; posterior total laminectomy “decompression disease “; compression of the decompression junction resulting in spinal cord compression injury. And to explore the corresponding various methods of prevention and treatment. Has achieved good clinical results. In particular, the cause of postoperative spinal cord “reperfusion injury” has been studied in depth, and the method of prevention and treatment is proposed: preoperative 0.5-1 hours methylprednisolone 500mg, gastric mucosal protector push or drip; intraoperative ice saline infusion; postoperative methylprednisolone, gastric mucosal protector, dehydrating agent and improve microcirculation drug treatment for 5-7 days. This approach has been accepted by most scholars.
(a) Studies have found different rates of postoperative “reperfusion injury” in chronic spinal cord compression diseases with different degrees of cervical spinal stenosis: the incidence is as high as 25% for spinal stenosis of 70% or more.
(Preoperative) posterior longitudinal ligamentous ossification of the cervical spine with 90% cervical spinal stenosis
(Postoperative) posterior total laminectomy, posterior internal fixation postoperative
(b) The rate of postoperative spinal cord “reperfusion injury” is different for different chronic spinal cord compression diseases: the incidence of bony tissue compression, such as posterior longitudinal ligament ossification, cervical spinal deformity and chronic spinal cord compression, is significantly higher than that of cervical spondylosis. A stenosis rate of 50% or more is associated with a higher incidence.
Preoperative diagnosis: dentate deformity, C1/2 dislocation, spinal cord compression Posterior cervical decompression, occipitocervical bone graft fusion and internal fixation Postoperative
(c) Rate of spinal cord “reperfusion injury” after cervical spondylosis: there is a high incidence of stenosis rate of 70% or more.
Preoperative diagnosis: cervical spondylosis after anterior decompression graft fusion and internal fixation
Clinical study on the causes of spinal surgery failure and countermeasures
A retrospective analysis of the imaging data, fixation and fusion methods, surgical techniques, pathological factors and reoperation and outcomes of a group of failed spinal surgery cases was conducted to find the causes of surgical failure. The analysis revealed that technical errors accounted for 73.2% of the surgical failures and non-technical causes accounted for 26.8%. Among the reasons for revision surgery, technical reasons were the first. Most of the cases underwent “revision surgery”, including decompression, re-fixation, replacement of other endografts, addition of other endografts, re-fusion of bone graft, etc.
Revision after failed anterior cervical spine surgery (before revision surgery) Revision after failed anterior cervical spine surgery (after revision surgery)
Revision after failed anterior cervical spine surgery (pre-revision surgery) (post-revision surgery)
Surgical treatment of FBSS (pre-revision surgery)
Revision after failed posterior internal fixation of thoracolumbar segment fracture (before revision surgery) (after revision surgery)
III. Prospective study of anterior spinal artery syndrome due to cervical spondylosis
To prospectively study the anterior spinal artery syndrome due to cervical spondylosis, analyze its clinical manifestations, and discuss its mechanism and imaging performance characteristics and treatment. METHODS: There were 25 cases in this group, 16 males and 9 females, with an average age of 53.2 years. On the basis of typical spinal cord type cervical spondylosis without trauma and other non-obvious causative factors, there were 19 cases of acute aggravation of symptoms within a short period of time and 6 cases of gradual aggravation. In addition to the signs of spinal cervical spondylosis, all of them showed the phenomenon of “sensory separation” in which superficial sensation was lost or diminished while deep sensation existed. Spastic paralysis of the lower limbs. X-rays and CT showed different degrees of cervical spine degeneration. The MRI examination revealed central disc herniation and anterior central spinal cord compression in all cases. The spinal cord was mostly atrophied to varying degrees. Most of the cases had slightly low or no significant change in T1 signal and high or slightly high T2 signal in the anterior 2/3 of the spinal cord, but there were 6 cases with no change in both T1 and T2 signals. Among the patients with slow onset disease, there were 3 cases of anterior 2/3 cystic changes in the spinal cord. Anterior decompression was performed in 24 cases and posterior decompression in 1 case, using JOA assessment criteria. Central disc herniation in cervical spondylosis in the absence of an obvious cause can cause anterior spinal cord artery syndrome. The diagnosis of this disease is based on “superficial and sensory separation”, and the diagnosis is confirmed by combining the medical history, clinical symptoms and other signs, as well as imaging examinations. Timely decompression can achieve better results.
MRI T1-weighted sagittal view: C3, 4, C4, 5, and C6, 7 discs protruding into the spinal canal, straightening of the cervical physiological curvature, and mild atrophy of the spinal cord.
MRI T2-weighted sagittal view: the herniated discs and thickened ligamentum flavum of C6 and 7 compress the spinal cord, and the spinal cord shows wasp-like changes, with a focal high signal shadow in the anterior 2/3 of the spinal cord.
IV. Surgical treatment of high cervical spine trauma and deformity
The surgical treatment of high cervical spine trauma includes: anterior odontoid internal fixation for odontoid fracture, posterior decompression and implant fixation for cervical spine, combined anterior/posterior decompression and implant internal fixation, etc. High cervical deformity orthopedic surgery: post-traumatic deformity orthopedic surgery, as well as orthopedic surgery for congenital and degenerative deformities and other surgical treatments are carried out.
Anterior internal fixation of odontoid fracture Posterior internal fixation of odontoid fracture with bone graft fusion
Hangman fracture, cervical 34 dislocation posterior implant internal fixation
Atlantoaxial fracture, occipital cervical implant fusion and internal fixation
Posterior endoprosthesis for cervical 2 free odontoid fracture
[Results]
I. Clinical outcomes.
(A) Causes and countermeasures of spinal cord dysfunction after chronic compression and decompression of the spinal cord
After adopting various methods to prevent and treat postoperative spinal cord dysfunction, more than 1140 patients with chronic spinal cord compression disease were treated surgically. The incidence of postoperative spinal cord “reperfusion injury” was reduced from 25% to less than 8%, and the degree of postoperative spinal cord dysfunction was also significantly reduced. No significant postoperative spinal cord dysfunction has occurred in cervical spinal stenosis rates below 69%.
(B) Clinical research on the causes of spinal surgery failure and countermeasures
More than 590 cases of failed spinal surgical treatment were subjected to “revision surgery”. After follow-up from 4 months to 8 years, the recovery rate of spinal cord function after surgery was 81% for those with original spinal cord dysfunction and 19% for those with general spinal cord dysfunction. For those who had bone discontinuity and pseudo-joint formation, they were given bone graft fusion and internal fixation, and all of them had bone fusion and no pseudo-joint formation after surgery. There was no loosening or displacement of the internal fixation, and excellent results were obtained.
(C) Prospective study of anterior spinal artery syndrome caused by cervical spondylosis
The average follow-up time after surgery was 16 months. The postoperative efficacy was excellent (spinal cord function recovery rate ≥75%) in 11 cases, good (50-74%) in 7 cases, fair (25-49%) in 6 cases and poor (≤24%) in 1 case.
(D) Surgical treatment of high cervical spine trauma and deformity
More than 210 cases were treated by anterior/posterior bone graft fusion and internal fixation. After more than 5 months of follow-up, all of them had bony fusion and no pseudarthrosis formation after surgery. There was no loosening or displacement of internal fixation, and excellent results were obtained.