RESUMEN
PURPOSE: Posterior decompression with instrumented fusion (PDF) is a suitable surgical treatment for K-line (-)-type cervical ossification of the posterior longitudinal ligament (OPLL). However, the adequate indications of PDF have not been clarified yet. The purpose of this study was to investigate the surgical results of PDF and perioperative factors that influence the surgical outcome, and to clarify the adequate indications of PDF. METHODS: Twenty-seven patients (21 men and 6 women, mean age: 61.4â¯years) who were diagnosed with a K-line (-)-type OPLL that was treated with PDF were included in this study. We evaluated these patients clinically and radiologically to investigate the outcomes of PDF and perioperative factors that influence improvements in the Japanese Orthopedic Association (JOA) score. RESULTS: The mean recovery rate of JOA score at the final follow-up examination was 53.3%. In the statistical analysis, the preoperative C2-C7 angle and the C2-C7 angle immediately postoperatively significantly predicted the surgical outcome. The C2-C7 angle immediately postoperatively was the only most important predictor. Using a receiver operating characteristic curve analysis, we found that the cutoff value of the C2-C7 angle immediately postoperatively for good outcomes (recovery rate of JOA score ≥50%) was -2.0°. CONCLUSIONS: PDF for K-line (-)-type OPLL patients with preoperative lordotic alignment can be expected to have favorable outcomes, which is the adequate indication for PDF. Since the C2-C7 angle immediately postoperatively was the most important predictor, the physician should pay attention to maintain the cervical lordotic alignment to enhance the surgical outcomes in surgical planning.
Asunto(s)
Descompresión Quirúrgica/métodos , Osificación del Ligamento Longitudinal Posterior/cirugía , Fusión Vertebral/métodos , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Perioperatorio , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
In animal models of degenerative lumbar disease, inducible nitric oxide synthase (iNOS) is expressed in macrophages and Schwann cells following compression of the cauda equina. We previously reported that NO metabolites (nitrite plus nitrate: [NOx]) in the cerebrospinal fluid (CSF) correlate with postoperative pain relief in patients with degenerative lumbar disease and with neurologic recovery rate postoperatively or after conservative treatment in patients with spinal cord injury. The objective of the present study was to examine the relationship between [NOx] and neurologic severity, and recovery in degenerative cervical and lumbar diseases. Two hundred fifty-seven cases, including 85 patients with cervical compression myelopathy (CCM), 25 with cervical disc herniation (CDH), 70 with lumbar canal stenosis (LCS), and 77 with lumbar disc herniation (LDH), were examined. The CSF [NOx] was measured using the Griess method. Severity of neurologic impairment and clinical recovery was assessed using the Japanese Orthopedic Association score and Hirabayashi's method. [NOx] in CCM and LCS, but not CDH and LDH groups, was significantly higher than that in controls, and correlated with postoperative recovery rates, but not with preoperative neurologic severity. [NOx] significantly correlated with neurologic recovery following surgery for CCM and LCS.
Asunto(s)
Vértebras Cervicales , Degeneración del Disco Intervertebral/líquido cefalorraquídeo , Degeneración del Disco Intervertebral/fisiopatología , Vértebras Lumbares , Óxido Nítrico/líquido cefalorraquídeo , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/líquido cefalorraquídeo , Desplazamiento del Disco Intervertebral/fisiopatología , Desplazamiento del Disco Intervertebral/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos , Dolor Postoperatorio/epidemiología , Prevalencia , Compresión de la Médula Espinal/líquido cefalorraquídeo , Compresión de la Médula Espinal/fisiopatología , Compresión de la Médula Espinal/cirugía , Estenosis Espinal/líquido cefalorraquídeo , Estenosis Espinal/fisiopatología , Estenosis Espinal/cirugía , Adulto JovenRESUMEN
STUDY DESIGN: Multiple center study to evaluate cerebrospinal fluid (CSF) concentrations of nitric oxide metabolites [NOx] in relation to neurologic severity and prognosis in spinal cord injury (SCI). OBJECTIVE: To examine whether CSF [NOx] correlates with neurologic severity and recovery in SCI. SUMMARY OF BACKGROUND DATA: Inducible nitric oxide synthase is expressed in rat spinal cord immediately after SCI. Excessive nitric oxide production is cytotoxic, causing neuronal apoptosis with subsequent neurodysfunction in the spinal cord. We previously reported a significant correlation between initial [NOx] after incomplete cervical cord injury (CCI) and neurologic recovery at the final follow-up in 25 cases. METHODS: Ninety-six cases (SCI group), including 76 patients with CCI and 20 patients with thoracic cord injury were examined. Mean follow-up period was 11 months. The control group comprised 40 cases (3 healthy volunteers and 37 patients with neither pain nor neurologic disorders). CSF [NOx] were measured using the Griess method. Severity of neurologic impairment was assessed using Frankel's classification and the American Spinal Injury Association motor score (ASIA MS). Degree of neurologic recovery was assessed using Frankel's classification and the ASIA motor recovery percentage. RESULTS: CSF [NOx] did not differ significantly among the control, CCI, and thoracic cord injury groups at the initial examination. In the CCI group, [NOx] in the Frankel A and B classes were significantly higher than [NOx] in the control group at 5 to 14 days, in the Frankel A and B classes at 0 to 4 days, and in the Frankel C and D classes at 5 to 14 days. Also, in the CCI group at 5 to 14 days, [NOx] correlated significantly with ASIA MS and motor recovery percentage. CONCLUSION: There was a significant correlation between CSF [NOx] at the pathologic early subacute stage (approximately 5-14 days) and neurologic severity and recovery in SCI.
Asunto(s)
Óxido Nítrico/líquido cefalorraquídeo , Traumatismos de la Médula Espinal/líquido cefalorraquídeo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/patología , Enfermedades del Sistema Nervioso/fisiopatología , Recuperación de la Función , Índice de Severidad de la Enfermedad , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/fisiopatología , Factores de Tiempo , Adulto JovenRESUMEN
In animal models of spinal cord injury (SCI), inducible NO (nitric oxide) synthase is expressed in the spinal cord immediately after sustaining SCI. Excessive NO production has cytotoxic effects and induces neuronal apoptosis, causing neural degeneration and neurodysfunction in the spinal cord. Little is known, however, about the relationship between NO(x) (NO metabolites: nitrite and nitrate) levels in the cerebrospinal fluid (CSF) and neurologic severity or recovery in clinical cases. The objective of the present study was to examine the correlation between CSF NO(x) levels and neurologic severity or recovery in SCI. Twenty-five patients with incomplete cervical cord injury (CCI) were examined. Eight cases were treated conservatively (non-operated group). Seventeen cases underwent surgical intervention (operated group). NO(x) levels in the CSF were measured using the Griess method. The severity of the neurologic impairment was assessed using Frankel's classification and the American Spinal Injury Association motor score (ASIA MS). The degree of neurologic recovery was assessed using Frankel's classification and the ASIA motor recovery percentage (MRP). There was no significant difference in the NO(x) levels between the CCI group (NO(x) levels: 5.9 +/- 0.7 microM) and the 36 control subjects (1 volunteer and 35 patients without neurologic disorders, NO(x) levels: 4.9 +/- 0.3 microM). There was no significant difference in NO(x) levels and MRP between the non-operated group and the operated group. The NO(x) levels in total SCI group were significantly correlated with the ASIA MS and MRP. There was a significant correlation between CSF NO(x) levels and neurologic severity or recovery in incomplete CCI.
Asunto(s)
Vértebras Cervicales/lesiones , Óxido Nítrico/líquido cefalorraquídeo , Traumatismos de la Médula Espinal/líquido cefalorraquídeo , Traumatismos de la Médula Espinal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/líquido cefalorraquídeo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Recuperación de la Función/fisiología , Traumatismos de la Médula Espinal/fisiopatología , Índices de Gravedad del TraumaRESUMEN
We investigated the time course of changes in nitric oxide metabolite (NO2- plus NO3-: NOx) levels in the cerebrospinal fluid and the expression of local inducible nitric oxide synthase following cauda equina compression in rats. Cerebrospinal fluid NOx levels were significantly increased from 12 h to 3 days after compression, and decreased thereafter. Histologically, inducible nitric oxide synthase immunoreactivity was observed in macrophages that infiltrated the dura mater on days 1 and 3 after compression, but not in foamy macrophages in the parenchyma of the cauda equina observed afterwards. The pattern of NOx levels coincided with the appearance of inducible nitric oxide synthase labeled macrophages, indicating a critical role of these cells as the main synthesizers of NOx in the acute stage of cauda equina compression.
Asunto(s)
Cauda Equina/enzimología , Síndromes de Compresión Nerviosa/líquido cefalorraquídeo , Óxido Nítrico Sintasa de Tipo II/metabolismo , Óxido Nítrico/líquido cefalorraquídeo , Animales , Cauda Equina/patología , Modelos Animales de Enfermedad , Ectodisplasinas/metabolismo , Inmunohistoquímica/métodos , Masculino , Síndromes de Compresión Nerviosa/patología , Ratas , Ratas Wistar , Proteínas S100/metabolismo , Factores de TiempoRESUMEN
Halo application is a standard method for cervical immobilization. However, complications may occur in children because of their thin skull and immature bone. The authors report two cases of odontoid fracture in preschool children treated with a Minerva cast. Two 4-year-old children sustained displaced odontoid fractures in motor vehicle accidents. The fractures were immediately reduced and immobilized using a Minerva cast, followed by the application of a soft collar. By the 1-year follow-up, uneventful bone union had occurred, and the children were able to attend preschool with minimal or no neurologic deficits. The Minerva cast is a classic, inexpensive method of cervical immobilization and is still useful for this kind of fracture. Immediate reduction and immobilization with a Minerva cast is a viable option for displaced odontoid fractures in preschool children.