Abstract
Bowstring disease (BSD) is a new classification of spine disease caused by axial stretched lesion on nerve roots and the spinal cord, which is differentiated from disc herniation and canal stenosis in that it is caused by nerve compression lesions. BSD could be caused by mismatched growth rates between the spine and nerve roots (the juvenile type), or by imbalanced degenerative rates between the spine column and nerve roots (degenerative type). Here, we propose that there are several self‐adjust mechanisms to relieve axial nerve tension: (i) nerve growth; (ii) posture adjustment and low back pain; (iii) autogenous degeneration of intervertebral disc; and (iv) idiopathic and degenerative scoliosis. Iatrogenic lesions could also result in BSD, which could be presented as adjacent segment degeneration, leading to adding‐on effects and other neurological symptoms. The diagnosis criteria are proposed based on symptoms, physical examination, and radiological presentations. To remove axial tension on nerve roots, lumbar surgery should aim to restore the coordination of spine and cord units. Capsule surgery, shortening the spine column, could decompress cord and nerve roots 3‐dimensionally.
Highlights
Radiographic changes in the cervical spine following anterior arthrodesis: a longterm analysis of 166 patients
We interviewed over 600 TCS patients from seven cities of mainland China and found that bladder dysfunction appeared at 4.9 years of age and deteriorated at 11.8 years of age
Onset and aggravation of neurological lesions was closely correlated with growth peak
Summary
Jian-gang Shi, MD†, Xi-ming Xu, MD†, Jing-chuan Sun, MD, Yuan Wang, MD, Qing-jie Kong, MD, Guo-dong Shi, MD. Some spine surgeons come to notice the dilemma despite modern techniques and advanced theories: (i) many patients complain of back or leg pain without obvious nerve compression (these individuals are commonly left undiagnosed or untreated); and (ii) some patients suffer neurological deterioration or even foot-drop and tethered cord syndrome (TCS) after routine back surgery (typically, there are no obvious postoperative radiographic findings). These issues are quite common and challenging for spine surgeons. The theory of BSD addresses common concerns regarding nerve root and spinal cord axial stretch lesions, which could revolutionize surgery philosophy
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