Abstract
BackgroundIn recent years, multilevel spinal cord injuries (SCIs) have gained a substantial amount of attention from clinicians and researchers. Multilevel noncontinuous SCI patients cannot undergo the multiple steps of a one-stage operation because of a poor general condition or a lack of proper surgical approaches. The surgeon subsequently faces the decision of whether to initially relieve the rostral or caudal compression. In this study, we established a spinal cord compression model involving two noncontinuous segments in rabbits to evaluate the effects of differences in decompression order on the functional recovery of the spinal cord.MethodsA Fogarty catheter was inserted into the epidural space through a hole in T6-7 and advanced 3 cm rostrally or caudally. Following successful model establishment, which was demonstrated by an evaluation of evoked potentials, balloons of different volumes (40 μl or 50 μl) were inflated in the experimental groups, whereas no balloons were inflated in the control group. The experimental groups underwent the first decompression in the rostral or caudal area at 1 week post-injury; the second decompression was performed at 2 weeks post-injury. For 6 weeks post-injury, the animals were tested to determine behavioral scores, somatosensory evoked potentials (SEPs) and radiographic imaging changes; histological and apoptosis assay results were subsequently analyzed.ResultsThe behavioral test results and onset latency of the SEPs indicated that there were significant differences between priority rostral decompression (PRD) and priority caudal decompression (PCD) in the 50-μl compression group at 6 weeks post-injury; however, there were no significant differences between the two procedures in the 40-μl group at the same time point. Moreover, there were no significant peak-to-peak amplitude differences between the two procedures in the 50-μl compression group.ConclusionsThe findings of this study suggested that preferential rostral decompression was more beneficial than priority caudal decompression with respect to facilitating spinal cord functional recovery in rabbits with severe paraplegia and may provide clinicians with a reference for the clinical treatment of multiple-segment spinal cord compression injuries.
Highlights
In recent years, multilevel spinal cord injuries (SCIs) have gained a substantial amount of attention from clinicians and researchers
Overall recovery of the animals after spinal cord compression In the 50-μl compression group, 1 of 14 injured rabbits died after a mean survival time of 5 days post-injury because of the severity of its Spinal cord injury (SCI), whereas all the control group and 40-μl compression group animals survived
None of the control group rabbits presented with bladder dysfunction after surgery
Summary
Multilevel spinal cord injuries (SCIs) have gained a substantial amount of attention from clinicians and researchers. Up to 26.2% of pediatric patients with SCIs exhibit multiple levels of damage [3]. Most patients with SCIs exhibit a critical area of injury that significantly impacts spinal cord function. In these cases, the key lesion site is the location of surgical treatment. A small number of patients may present with SCIs at multiple levels, resulting in neurological dysfunction in several segments. In these cases, it is typically difficult to determine the critical site of damage. The operative site is often determined based on the degree of compression and the experience of the surgeon
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