BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for ...BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for only 5%of CN cases;the shoulder and elbow are most often involved,and the hip joint is rarely affected.As a rare factor,cervical spondylotic myelopathy(CSM)can be associated with syringomyelia,which is scarcely reported in the literature.Here,we present the first case report to date of CN of the hip caused by syringomyelia secondary to CSM.CASE SUMMARY We describe a 76-year-old male patient who was diagnosed with CSM due to neck pain and weakness of limbs 16 years ago.Four years ago,he noticed recurrent swelling of the right hip with pain and was diagnosed with degenerative arthritis.Recently,however,his symptoms gradually worsened,and because of progressive pain,destabilization and weakness of the right hip,he was admitted to our hospital.Through systematic physical,radiographic and laboratory examinations,we finally reached a diagnosis:CN of the right hip associated with syringomyelia secondary to CSM.After comprehensive evaluation of the patient's condition,we performed right total hip arthroplasty.During the follow-up,the patient felt well clinically and could walk independently with a knee brace.CONCLUSION We suggest a possible etiological association between CSM and syringomyelia,which may reflect a potential pathogenesis of CN.We encourage clinicians to actively carry out a detailed medical history and comprehensive physical and imaging examinations in patients with joint lesions,especially chronic shoulder neck pain,to rule out the possibility of this association,which plays a crucial role in the early diagnosis of CN.Arthroplasty may no longer be an absolute contraindication to surgical treatment of CN.Reasonable selection of the surgical strategy can markedly improve the clinical symptoms and quality of life of patients.展开更多
BACKGROUND: The recordings of evoked spinal cord potentials following epidural spinal cord stimulation are thought to be generated by volleys traversing the dorsal column pathway, and it may not directly reflect condu...BACKGROUND: The recordings of evoked spinal cord potentials following epidural spinal cord stimulation are thought to be generated by volleys traversing the dorsal column pathway, and it may not directly reflect conduction defects in corticospinal tracts of cervical spinal cord. To our knowledge there has been few report using several evoked spinal cord potentials in function evaluation of the cervical spinal cord in elderly patients with cervical spondylotic myelopathy (CSM). OBJECTIVE: To investigate the function states of the cervical spinal cord in elderly patients with CSM and explore its pathophysiologic mechanism. DESIGN: Case observation. SETTING: Department of Orthopedics for the aged, Shenzhen Pingle Hospital of Orthopedics. Department of Orthopedic Surgery, Yamaguchi University School of Medicine. PARTICIPANTS: A total of 23 elderly patients with CSM who received treatment in the Department of Orthopedic Surgery, Yamaguchi University School of Medicine of Japan from January 2003 to February 2004 were enrolled in this study. Inclusive criteria: ① Multiple intervertebral levels of cervical spinal cord compression confirmed by MRI, e.g. 3 or more than 3 levels of compressin. ② Age ≥70 years old. ③ Numbness and sensory disturbance in the upper limbs and showed hyperreflexia in the lower limbs. Exclusive criteria: Patients with abnormal motor and sensory nerve conduction velocities in both upper and lower limbs were excluded. METHODS: Evoked spinal cord potentials (ESCPs) following transcranial electric stimulation (TCE-ESCPs), epidural spinal cord stimulation (Spinal-ESCPs) and median nerve stimulation (MN-ESCPs) were recorded in 23 patients from posterior epidural space intraoperatively. The abnormalities of TCE-ESCPs were defined as attenuation of amplitude of the D wave. The most cranial intervertebral level showing abnormal TCE-ESCPs with a marked reduction in size of the negative peak (reduction of over 50%) was considered as the upper level of the spinal cord lesion with respect to the corticospinal tract in white matter. The abnormalities of Spinal-ESCPs were defined as marked reduction in the size of negative peak (reduction of over 50%). The most caudal intervertebral level showing abnormal Spinal-ESCPs was considered as the lower level of the spinal cord lesion with respect to the dorsal column pathway in white matter. The abnormalities of MN-ESCPs were defined as attenuation of the N13 amplitude,which was considered as the lesion level of the spinal cord with respect to the dorsal horn in gray matter. Radiological investigation: Lateral view of plain X-ray films was obtained in flexion and extension of the cervical spine. Instability of the cervical intervertebral level was determined as horizontal displacement of the vertebral body of over 3 mm. MAIN OUTCOME MEASURES: The results of examination of TCE-ESCPs, Spinal-ESCPs and MN-ESCPs in elderly patients with CSM. RESULTS: The 23 elderly patients with CSM were participated in the result analysis. ①TCE-ESCPs: The impairment of the corticospinal tract in white matter at single intervertebral level was revealed in 18 of 23 patients by recordings of TCE-ESCPs (sensitivity 78%). In the 18 patients, the lesion level was shown at the upper cervical segment in 14 patients (C3-4 n=10 and C4-5 n=4), and at the lower cervical segment in 4 patients (C5-6 n=4). ②Spinal-ESCPs: The impairment of the dorsal column pathway of white matter at single intervertebral level was revealed in 17 of 23 patients, by recordings of Spinal-ESCPs (sensitivity 74%). In the 17 patients, the lesion level was presented at the upper cervical segment in 14 patients (C3-4 n=10 and C4-5 n=4), and at the lower cervical segment in 3 patients (C5-6 n=3). ③MN-ESCPs: All patients revealed abnormal MN-ESCPs at one or more intervertebral levels (sensitivity 100%). The impairment at single intervertebral level was demonstrated in 17 patients, and the impairment at multiple intervertebral levels was shown in 4 patients (3 patients at the C3-4, C4-5, and C5-6, and one patient at the C4-5, C5-6, and C6-7). ④Radiological findings: The Instability of the intervertebral level at the C3-4 or C4-5 motion segment was seen in 15 patients, with a total of 20 levels, and where 10 were at the C3-4 intervertebral level and 5 were at the C3-4, C4-5 intervertebral level. CONCLUSION: The results suggest that in most elderly patients with CSM who have multiple intervertebral level compressions of the cervical spinal cord on MRI, white matter is impaired at the single cervical intervertebral level, and not only the dorsal column pathway, but also the corticospinal tract can be affected. Combined the findings of radiography, the excessive motion and instability of the C3-4 or C4-5 intervertebral level plays an important role in inducing the long tract lesion in elderly patients with CSM.展开更多
A 30 yrs male,was admitted with complains ofneck pain,weakness in both upper and lower limbs forfour months and mild intermittent paresthesia along hisupper limbs.Physical examination showed mild senso-ry deficit
Objective:To compare the therapeutic effects of acupotomy trinity lysis and traditional acupotomy on cervical spondylotic myelopathy.Methods:A total of 205 patients with cervical spondylotic myelopathy of liver and ki...Objective:To compare the therapeutic effects of acupotomy trinity lysis and traditional acupotomy on cervical spondylotic myelopathy.Methods:A total of 205 patients with cervical spondylotic myelopathy of liver and kidney deficiency syndrome were randomly divided into the experimental group(105 cases)and the control group(100 cases).The experimental group was relaxed with acupotomy in three positions:Heaven(tian),Human(ren)and Earth(di).Traditional acupotomy was used to relax Ashi acupoints of the affected vertebra in the control group.One treatment was conducted in one week,and the duration of one course of treatment was three weeks.The VAS,JOA score and NDI index were observed after treatment.Results:Before and after treatment,the total treatment efficiency of the treatment group was 95.23%,and that of the control group was 80.00%,there was significant difference between the two groups,P<0.05;Before operation,there was no significant difference in JOA score,NDI index score,and VAS score between the treatment group and the control group(P>0.05);there was no significant difference after 1 week(P>0.05),but there were significant differences between the two groups 2 weeks and 3 weeks after operation(P<0.05).Conclusion:Acupotomy trinity lysis is a safe,effective and economical treatment for cervical spondylotic myelopathy.展开更多
Objective To investigate the difference between different surgical methods for thoracic ossification of ligamentum flavum(OLF) combined with cervical spondylotic myelopathy(CSM) . Methods From January 1991 to January ...Objective To investigate the difference between different surgical methods for thoracic ossification of ligamentum flavum(OLF) combined with cervical spondylotic myelopathy(CSM) . Methods From January 1991 to January 2003,56 cases展开更多
Cervical spondylotic myelopathy(CSM)is the main cause of adult spinal cord dysfunction,mostly appearing in middle-aged and elderly patients.Currently,the diagnosis of this condition depends mainly on the available ima...Cervical spondylotic myelopathy(CSM)is the main cause of adult spinal cord dysfunction,mostly appearing in middle-aged and elderly patients.Currently,the diagnosis of this condition depends mainly on the available imaging tools such as X-ray,computed tomography and magnetic resonance imaging(MRI),of which MRI is the gold standard for clinical diagnosis.However,MRI data cannot clearly demonstrate the dynamic characteristics of CSM,and the overall process is far from costefficient.Therefore,this study proposes a new method using multiple gait parameters and shallow classifiers to dynamically detect the occurrence of CSM.In the present study,45 patients with CSM and 45 age-matched asymptomatic healthy controls(HCs)were recruited,and a three-dimensional(3D)motion capture system was utilized to capture the locomotion data.Furthermore,63 spatiotemporal,kinematic,and nonlinear parameters were extracted,including lower limb joint angles in the sagittal,coronal,and transverse planes.Then,the Shapley Additive exPlanations(SHAP)value was utilized for feature selection and reduction of the dimensionality of features,and five traditional shallow classifiers,including support vector machine(SVM),logistic regression(LR),k-nearest neighbor(KNN),decision tree(DT),and random forest(RF),were used to classify gait patterns between CSM patients and HCs.On the basis of the 10-fold cross-validation method,the highest average accuracy was achieved by SVM(95.56%).Our results demonstrated that the proposed method could effectively detect CSM and thus serve as an automated auxiliary tool for the clinical diagnosis of CSM.展开更多
Background:The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial.The purpose of this study was to compare clinical and radiological outcomes and complications between the a...Background:The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial.The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.Methods:A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study.Perioperative information,intraoperative blood loss,clinical and radiological outcomes,and complications were recorded.Japanese Orthopedic Association(JOA)score,36-item short form survey(SF-36)score and cervical alignment were assessed.Results:There were no significant differences in JOA scores between the anterior and posterior group preoperatively(11.6±1.6 vs.12.1±1.5),immediately postoperatively(14.4±1.1 vs.13.8±1.3),or at the last follow-up(14.6±1.0 vs.14.2±1.1)(P>0.05).The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values.The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up.The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value(69.4 vs.61.7).Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively(-2.0°±7.3°vs.-1.4°±7.5°).The Cobb angle significantly improved immediately postoperatively(12.3°±4.2°vs.9.2°±3.6°)and at the last follow-up(12.4°±3.5°vs.9.0°±2.6°)in both groups compared with their preoperative values(P=0.00).Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.Conclusions:Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features.However,the JOA score recovery rate and SF-36 score in the anterior group were significantly higher.Persistent axial pain could be a major concern when undertaking the posterior approach.展开更多
Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,t...Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,the microvascular network is compressed and destroyed,resulting in ischemia and hypoxia.The main pathological changes are inflammation,damage to the blood spinal cord barriers,and cell apoptosis at the site of compression.Studies have confirmed that vascular regeneration and remodeling contribute to neural repair by promoting blood flow and the reconstruction of effective circulation to meet the nutrient and oxygen requirements for nerve repair.Surgical decompression is the most effective clinical treatment for this condition;however,in some patients,residual neurological dysfunction remains after decompression.Facilitating revascularization during compression and after decompression is therefore complementary to surgical treatment.In this review,we summarize the progress in research on chronic compressive spinal cord injury,covering both physiological and pathological changes after compression and decompression,and the regulatory mechanisms of vascular injury and repair.展开更多
The spinal cord is composed of gray matter and white matter.It is well known that the properties of these two tissues differ considerably.Spinal diseases often present with symptoms that are caused by spinal cord comp...The spinal cord is composed of gray matter and white matter.It is well known that the properties of these two tissues differ considerably.Spinal diseases often present with symptoms that are caused by spinal cord compression.Understanding the mechanical properties of gray and white matter would allow us to gain a deep understanding of the injuries caused to the spinal cord and provide information on the pathological changes to these distinct tissues in several disorders.Previous studies have reported on the physical properties of gray and white matter,however,these were focused on longitudinal tension tests.Little is known about the differences between gray and white matter in terms of their response to compression.We therefore performed mechanical compression test of the gray and white matter of spinal cords harvested from cows and analyzed the differences between them in response to compression.We conducted compression testing of gray matter and white matter to detect possible differences in the collapse rate.We found that increased compression(especially more than 50%compression)resulted in more severe injuries to both the gray and white matter.The present results on the mechanical differences between gray and white matter in response to compression will be useful when interpreting findings from medical imaging in patients with spinal conditions.展开更多
文摘BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for only 5%of CN cases;the shoulder and elbow are most often involved,and the hip joint is rarely affected.As a rare factor,cervical spondylotic myelopathy(CSM)can be associated with syringomyelia,which is scarcely reported in the literature.Here,we present the first case report to date of CN of the hip caused by syringomyelia secondary to CSM.CASE SUMMARY We describe a 76-year-old male patient who was diagnosed with CSM due to neck pain and weakness of limbs 16 years ago.Four years ago,he noticed recurrent swelling of the right hip with pain and was diagnosed with degenerative arthritis.Recently,however,his symptoms gradually worsened,and because of progressive pain,destabilization and weakness of the right hip,he was admitted to our hospital.Through systematic physical,radiographic and laboratory examinations,we finally reached a diagnosis:CN of the right hip associated with syringomyelia secondary to CSM.After comprehensive evaluation of the patient's condition,we performed right total hip arthroplasty.During the follow-up,the patient felt well clinically and could walk independently with a knee brace.CONCLUSION We suggest a possible etiological association between CSM and syringomyelia,which may reflect a potential pathogenesis of CN.We encourage clinicians to actively carry out a detailed medical history and comprehensive physical and imaging examinations in patients with joint lesions,especially chronic shoulder neck pain,to rule out the possibility of this association,which plays a crucial role in the early diagnosis of CN.Arthroplasty may no longer be an absolute contraindication to surgical treatment of CN.Reasonable selection of the surgical strategy can markedly improve the clinical symptoms and quality of life of patients.
文摘BACKGROUND: The recordings of evoked spinal cord potentials following epidural spinal cord stimulation are thought to be generated by volleys traversing the dorsal column pathway, and it may not directly reflect conduction defects in corticospinal tracts of cervical spinal cord. To our knowledge there has been few report using several evoked spinal cord potentials in function evaluation of the cervical spinal cord in elderly patients with cervical spondylotic myelopathy (CSM). OBJECTIVE: To investigate the function states of the cervical spinal cord in elderly patients with CSM and explore its pathophysiologic mechanism. DESIGN: Case observation. SETTING: Department of Orthopedics for the aged, Shenzhen Pingle Hospital of Orthopedics. Department of Orthopedic Surgery, Yamaguchi University School of Medicine. PARTICIPANTS: A total of 23 elderly patients with CSM who received treatment in the Department of Orthopedic Surgery, Yamaguchi University School of Medicine of Japan from January 2003 to February 2004 were enrolled in this study. Inclusive criteria: ① Multiple intervertebral levels of cervical spinal cord compression confirmed by MRI, e.g. 3 or more than 3 levels of compressin. ② Age ≥70 years old. ③ Numbness and sensory disturbance in the upper limbs and showed hyperreflexia in the lower limbs. Exclusive criteria: Patients with abnormal motor and sensory nerve conduction velocities in both upper and lower limbs were excluded. METHODS: Evoked spinal cord potentials (ESCPs) following transcranial electric stimulation (TCE-ESCPs), epidural spinal cord stimulation (Spinal-ESCPs) and median nerve stimulation (MN-ESCPs) were recorded in 23 patients from posterior epidural space intraoperatively. The abnormalities of TCE-ESCPs were defined as attenuation of amplitude of the D wave. The most cranial intervertebral level showing abnormal TCE-ESCPs with a marked reduction in size of the negative peak (reduction of over 50%) was considered as the upper level of the spinal cord lesion with respect to the corticospinal tract in white matter. The abnormalities of Spinal-ESCPs were defined as marked reduction in the size of negative peak (reduction of over 50%). The most caudal intervertebral level showing abnormal Spinal-ESCPs was considered as the lower level of the spinal cord lesion with respect to the dorsal column pathway in white matter. The abnormalities of MN-ESCPs were defined as attenuation of the N13 amplitude,which was considered as the lesion level of the spinal cord with respect to the dorsal horn in gray matter. Radiological investigation: Lateral view of plain X-ray films was obtained in flexion and extension of the cervical spine. Instability of the cervical intervertebral level was determined as horizontal displacement of the vertebral body of over 3 mm. MAIN OUTCOME MEASURES: The results of examination of TCE-ESCPs, Spinal-ESCPs and MN-ESCPs in elderly patients with CSM. RESULTS: The 23 elderly patients with CSM were participated in the result analysis. ①TCE-ESCPs: The impairment of the corticospinal tract in white matter at single intervertebral level was revealed in 18 of 23 patients by recordings of TCE-ESCPs (sensitivity 78%). In the 18 patients, the lesion level was shown at the upper cervical segment in 14 patients (C3-4 n=10 and C4-5 n=4), and at the lower cervical segment in 4 patients (C5-6 n=4). ②Spinal-ESCPs: The impairment of the dorsal column pathway of white matter at single intervertebral level was revealed in 17 of 23 patients, by recordings of Spinal-ESCPs (sensitivity 74%). In the 17 patients, the lesion level was presented at the upper cervical segment in 14 patients (C3-4 n=10 and C4-5 n=4), and at the lower cervical segment in 3 patients (C5-6 n=3). ③MN-ESCPs: All patients revealed abnormal MN-ESCPs at one or more intervertebral levels (sensitivity 100%). The impairment at single intervertebral level was demonstrated in 17 patients, and the impairment at multiple intervertebral levels was shown in 4 patients (3 patients at the C3-4, C4-5, and C5-6, and one patient at the C4-5, C5-6, and C6-7). ④Radiological findings: The Instability of the intervertebral level at the C3-4 or C4-5 motion segment was seen in 15 patients, with a total of 20 levels, and where 10 were at the C3-4 intervertebral level and 5 were at the C3-4, C4-5 intervertebral level. CONCLUSION: The results suggest that in most elderly patients with CSM who have multiple intervertebral level compressions of the cervical spinal cord on MRI, white matter is impaired at the single cervical intervertebral level, and not only the dorsal column pathway, but also the corticospinal tract can be affected. Combined the findings of radiography, the excessive motion and instability of the C3-4 or C4-5 intervertebral level plays an important role in inducing the long tract lesion in elderly patients with CSM.
文摘A 30 yrs male,was admitted with complains ofneck pain,weakness in both upper and lower limbs forfour months and mild intermittent paresthesia along hisupper limbs.Physical examination showed mild senso-ry deficit
基金Scientific Research Project of Shandong Colleges of Traditional Chinese Medicine(2016FY06)。
文摘Objective:To compare the therapeutic effects of acupotomy trinity lysis and traditional acupotomy on cervical spondylotic myelopathy.Methods:A total of 205 patients with cervical spondylotic myelopathy of liver and kidney deficiency syndrome were randomly divided into the experimental group(105 cases)and the control group(100 cases).The experimental group was relaxed with acupotomy in three positions:Heaven(tian),Human(ren)and Earth(di).Traditional acupotomy was used to relax Ashi acupoints of the affected vertebra in the control group.One treatment was conducted in one week,and the duration of one course of treatment was three weeks.The VAS,JOA score and NDI index were observed after treatment.Results:Before and after treatment,the total treatment efficiency of the treatment group was 95.23%,and that of the control group was 80.00%,there was significant difference between the two groups,P<0.05;Before operation,there was no significant difference in JOA score,NDI index score,and VAS score between the treatment group and the control group(P>0.05);there was no significant difference after 1 week(P>0.05),but there were significant differences between the two groups 2 weeks and 3 weeks after operation(P<0.05).Conclusion:Acupotomy trinity lysis is a safe,effective and economical treatment for cervical spondylotic myelopathy.
文摘Objective To investigate the difference between different surgical methods for thoracic ossification of ligamentum flavum(OLF) combined with cervical spondylotic myelopathy(CSM) . Methods From January 1991 to January 2003,56 cases
基金supported by the National Natural Science Foundation of China(62173212).
文摘Cervical spondylotic myelopathy(CSM)is the main cause of adult spinal cord dysfunction,mostly appearing in middle-aged and elderly patients.Currently,the diagnosis of this condition depends mainly on the available imaging tools such as X-ray,computed tomography and magnetic resonance imaging(MRI),of which MRI is the gold standard for clinical diagnosis.However,MRI data cannot clearly demonstrate the dynamic characteristics of CSM,and the overall process is far from costefficient.Therefore,this study proposes a new method using multiple gait parameters and shallow classifiers to dynamically detect the occurrence of CSM.In the present study,45 patients with CSM and 45 age-matched asymptomatic healthy controls(HCs)were recruited,and a three-dimensional(3D)motion capture system was utilized to capture the locomotion data.Furthermore,63 spatiotemporal,kinematic,and nonlinear parameters were extracted,including lower limb joint angles in the sagittal,coronal,and transverse planes.Then,the Shapley Additive exPlanations(SHAP)value was utilized for feature selection and reduction of the dimensionality of features,and five traditional shallow classifiers,including support vector machine(SVM),logistic regression(LR),k-nearest neighbor(KNN),decision tree(DT),and random forest(RF),were used to classify gait patterns between CSM patients and HCs.On the basis of the 10-fold cross-validation method,the highest average accuracy was achieved by SVM(95.56%).Our results demonstrated that the proposed method could effectively detect CSM and thus serve as an automated auxiliary tool for the clinical diagnosis of CSM.
文摘Background:The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial.The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.Methods:A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study.Perioperative information,intraoperative blood loss,clinical and radiological outcomes,and complications were recorded.Japanese Orthopedic Association(JOA)score,36-item short form survey(SF-36)score and cervical alignment were assessed.Results:There were no significant differences in JOA scores between the anterior and posterior group preoperatively(11.6±1.6 vs.12.1±1.5),immediately postoperatively(14.4±1.1 vs.13.8±1.3),or at the last follow-up(14.6±1.0 vs.14.2±1.1)(P>0.05).The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values.The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up.The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value(69.4 vs.61.7).Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively(-2.0°±7.3°vs.-1.4°±7.5°).The Cobb angle significantly improved immediately postoperatively(12.3°±4.2°vs.9.2°±3.6°)and at the last follow-up(12.4°±3.5°vs.9.0°±2.6°)in both groups compared with their preoperative values(P=0.00).Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.Conclusions:Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features.However,the JOA score recovery rate and SF-36 score in the anterior group were significantly higher.Persistent axial pain could be a major concern when undertaking the posterior approach.
基金supported by the National Natural Science Foundation of China,No.81450020(to HQL)。
文摘Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,the microvascular network is compressed and destroyed,resulting in ischemia and hypoxia.The main pathological changes are inflammation,damage to the blood spinal cord barriers,and cell apoptosis at the site of compression.Studies have confirmed that vascular regeneration and remodeling contribute to neural repair by promoting blood flow and the reconstruction of effective circulation to meet the nutrient and oxygen requirements for nerve repair.Surgical decompression is the most effective clinical treatment for this condition;however,in some patients,residual neurological dysfunction remains after decompression.Facilitating revascularization during compression and after decompression is therefore complementary to surgical treatment.In this review,we summarize the progress in research on chronic compressive spinal cord injury,covering both physiological and pathological changes after compression and decompression,and the regulatory mechanisms of vascular injury and repair.
基金supported by JSPS KAKENHI(No.JP 15K20002)Yamaguchi University School of Medicine Affiliated Hospital:Translational Promotion Grant and President of Yamaguchi University Strategic Expenses:Young Researcher Support Project(all to NN)
文摘The spinal cord is composed of gray matter and white matter.It is well known that the properties of these two tissues differ considerably.Spinal diseases often present with symptoms that are caused by spinal cord compression.Understanding the mechanical properties of gray and white matter would allow us to gain a deep understanding of the injuries caused to the spinal cord and provide information on the pathological changes to these distinct tissues in several disorders.Previous studies have reported on the physical properties of gray and white matter,however,these were focused on longitudinal tension tests.Little is known about the differences between gray and white matter in terms of their response to compression.We therefore performed mechanical compression test of the gray and white matter of spinal cords harvested from cows and analyzed the differences between them in response to compression.We conducted compression testing of gray matter and white matter to detect possible differences in the collapse rate.We found that increased compression(especially more than 50%compression)resulted in more severe injuries to both the gray and white matter.The present results on the mechanical differences between gray and white matter in response to compression will be useful when interpreting findings from medical imaging in patients with spinal conditions.
