Decompression Surgery Research Articles

The Rare Presentation of Traumatic Intracranial Hypotension: A Case Report

AbstractCerebrospinal fluid (CSF) provides buoyant support to the brain and spinal cord. According to the Monroe-Kellie doctrine, confined space in the cranium causes any change in CSF volume contributing to significant intracranial pressure changes, which cause a variety of pathologies and symptoms. We, hereby, present a case of a 33-year-old gentleman who after a motorcycle road traffic accident came to us complaining of persistent headache and neck pain with subdural hematoma (SDH) like presentation, clinically and radiologically, but was reevaluated and diagnosed as traumatic intracranial hypotension and successfully managed surgically after that. Hygromas are believed to be compensatory enlargement of the subdural space due to the loss of CSF volume. The true mechanism of the development of SDH or hygroma due to intracranial hypotension is yet to be hypothesized but provisionally described by a rupture of the bridging veins by being pulled away from the dura because of the low intracranial pressure (ICP) and brain descent. Many prior cases in the literature are shown to have treated the patient with immediate burr hole and decompression of SDH, but this paradoxically worsens the patient due to further lowering of ICP. The causes of prolonged postconcussion headaches are often unidentified, of which intracranial hypotension caused by a CSF leak is potentially under-recognized. In such cases, bilateral SDH with mass effect must be ruled out of any CSF leak before attempting the lifesaving decompressive surgery, as it may paradoxically lead to further morbidity and mortality of the patient.

Reoperation Strategy for Failure of Cervical Disc Arthroplasty at Index and Adjacent Levels

Cervical disc arthroplasty (CDA) is a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF) for cervical degenerative disease, reducing adjacent segment degenerative disease (ASD). Despite its benefits, some patients experience CDA failure due to prosthesis-related complications, heterotopic ossification, segmental kyphosis, ASD, or facet joint degeneration, necessitating revision surgery. Reoperation strategies depend on the failure mechanism, instability, sagittal malalignment, and neural compression. Anterior revision is suited for prosthesis failure, recurrent disc herniation, or ASD, enabling prosthesis removal, decompression, and fusion. In select cases, reimplantation may restore motion. Posterior approaches are preferred for facet degeneration, multilevel stenosis, or posterior hypertrophy, with options including foraminotomy, laminoplasty, or laminectomy and fusion. Complex cases may require combined anterior and posterior surgery for optimal decompression and stability. This narrative review outlines revision strategies, emphasizing biomechanical assessment, radiographic evaluation, and patient-specific considerations. Despite surgical challenges, meticulous planning and execution can optimize outcomes.

Imaging anatomy study on utilizing uncinate process "inflection point" as a landmark for anterior cervical spine decompression surgery

To explore the anatomical parameters of the cervical uncinate process "inflection point" through cervical CT angiography (CTA) and MRI measurements, offering a reliable and safe anatomical landmark for anterior cervical decompression surgery. A retrospective analysis was conducted on the cervical CTA and MRI imaging data of normal adults who met the selection criteria between January 2020 and January 2024. The CTA dataset included 326 cases, with 200 males and 126 females, aged 22-55 years (mean, 46.7 years). The MRI dataset included 300 cases, with 200 males and 100 females, aged 18-55 years (mean, 43.7 years). Based on the CTA data, three-dimensional models of C 3-C 7 were constructed, and the following measurements were obtained from the superior view: uncinate process "inflection point" to vertebral artery distance (UIVD), uncinate process tip to vertebral artery distance (UTVD), uncinate process "inflection point" to "inflection point" distance (UID), uncinate process long-axis to sagittal angle (ULSA), and uncinate process "inflection point" to transverse foramen-sagittal angle (UITSA). From the anterior view, the anterior uncinate process to sagittal angle (AUSA) was measured. From the posterior view, the posterior uncinate process to sagittal angle (PUSA) was measured. Based on the MRI data, uncinate process "inflection point" to dural sac distance (UIDD) and dural sac width (DSW) were measured. The trends in measurement parameters of C 3-C 7 were observed, and the differences in measurement parameters between genders and between the left and right sides of the same segment were compared, as well as the difference in UID and DSW within the same segment was compared. The measurement parameters from C 3 to C 7 in the CTA data showed a general increasing trend, with no significant difference between the left and right sides within the same segment ( P>0.05). The UIVD, UTVD, and UID were greater in males than in females, with significant differences observed in the UIVD and UTVD at C 3 and C 6 and UID at C 3, C 6, and C 7 ( P<0.05). The MRI measured DSW showed a general increasing trend from C 3 to C 7, and the DSW at C 6 was greater in females than in males, with a significant difference ( P<0.05). The UIDD showed a gradual decreasing trend, with the smallest value at C 6. There was no significant difference between males and females or between the left and right sides within the same segment ( P>0.05). The UID was greater than the DSW at C 3-C 7, and the differences were significant ( P<0.05). The uncinate process "inflection point" is a constant anatomical structure located at the anteromedial aspect of the uncinate process tip and laterally to the dural sac. It maintains a certain safe distance from the vertebral artery. As a decompression landmark in anterior cervical spine surgery, it not only ensures surgical safety but also guarantees complete decompression.

The efficacy of C1/2 arthrodesis with C2 root resection at symptomatic side for occipital neuralgia from atlantoaxial osteoarthritis

This article aimed to assess the efficacy of surgical treatments, particularly arthrodesis with C2 nerve transection, in patients with atlantoaxial osteoarthritis (AAOA). Data of patients with AAOA who underwent surgical treatment between January 2020 and November 2023 were retrospectively collected. Of 11 patients with AAOA, nine underwent fusion surgery, and two underwent decompression surgery. C2 root transection on the symptomatic side was performed in all fusion cases. C2 root transection was not performed during decompression. All patients experienced immediate and persistent pain relief after surgery. Four patients who underwent fusion surgery reported a complete disappearance of pain. Four patients who underwent fusion surgery reported some numbness of the scalp, but it did not affect the quality of daily activities or cause significant discomfort. One patient who underwent decompression surgery reported residual tingling sensation and hyperesthesia of the scalp. We concluded that C1-2 fusion surgery is an excellent surgical treatment option and should be primarily considered for patients with refractory AAOA. C2 root transection on the symptomatic side can completely alleviate pain at the expense of minor scalp anesthesia. Decompressive-only surgery is not recommended but can be considered in strictly selected patients.

Nationwide orbital decompression volume, surgical approach, and subspecialty distribution patterns within the center for medicare and medicaid services population in the era of teprotumumab

ABSTRACT Purpose To evaluate nationwide practice patterns in orbital decompression surgery for thyroid eye disease (TED) after approval of teprotumumab in January 2020. Methods This retrospective study analyzed the Centers for Medicare and Medicaid Services (CMS) database before (2016–2019) and after teprotumumab approval (2020–2023). External (CPT codes 67414 and 67445) and endoscopic (CPT 31292 and 31293) approaches were included. Controls were cataract surgery (CPT 66984) and upper blepharoplasty (CPT 15822 and 15823). Main outcomes were orbital decompression volume, surgical approach, and subspecialty distribution. Results In total 4,534 orbital decompressions were billed to CMS from 2016 to 2023. Nationwide orbital decompression volume significantly declined (−37%, p < 0.001) in the post-teprotumumab period, even when controlling relative to cataract surgery (p < 0.001) or upper blepharoplasty (p = 0.010). This was attributed to decreased external orbital decompressions (−41%, p < 0.001), while endoscopic approach was less impacted (−28%, p = 0.007). Specialty distribution trended away from oculofacial plastic surgeons (−10%) toward otolaryngologists (+18%) (p < 0.001). The proportion of endoscopic approach significantly grew (+13%, p < 0.001). Conclusions A nationwide evolution in surgical patterns for TED was observed after teprotumumab approval. Notable trends included decreased orbital decompressions, otolaryngologists performing proportionately more decompressions, and increased endoscopic approaches.

Combined Rigid-Flexible Multibody Analysis Reveals Reduced Pedicle Screw Loads in Short-Segment Fixation for Decompressed Lumbar Spine Stabilization.

Spinal cord compression in patients with vertebral metastases often requires surgical decompression with spinal fixation. Recent studies reported increased implant failures due to mechanical complications, raising concerns about current clinical practices. Long-segment fixation (Lf) is commonly employed to enhance mechanical stability and reduce the severity of pedicle screw failure. The study investigates how the number of vertebral levels involved in fixation affects the loads on pedicle screw anchorages in a fatigue-related displacement domain. Using a rigid-flexible multibody approach, a non-linear T12-S1 model was employed to simulate two fixation types following L3 posterior decompression surgery: Lf spanning two levels above and below the decompression site (L1, L2, L4, and L5) and a short-segment fixation (Sf) involving only adjacent vertebrae. Internal reactions at the rod-pedicle screw anchorages were estimated in terms of pullout, shear forces, and bending moments. The range of motion analysed (flexion: 22°, extension: 8°, lateral bending: 12°, axial rotation: 5°) was confined to the "Cone of Economy", representing a small-displacement volume where loads are assumed cyclically exchanged. Lf exhibited up to fivefold higher reactions than Sf, with a heterogeneous shear force distribution: middle screws appeared shielded, while extremity screws were overloaded (~400 N, comparable to experimental fatigue strength). Pullout forces remained within safe limits (< 150 N). The rigid-flexible multibody approach effectively estimated internal loads in the implant-spine constructs under dynamic conditions. The findings highlight the long-term implications of Lf, demonstrating that involving more vertebral levels triggers adverse loads on pedicle screws, potentially compromising implant durability.

Nomogram for predicting the postoperative outcomes in cervical spondylotic myelopathy based on apparent diffusion coefficient.

To development a nomogram based on clinical features and apparent diffusion coefficient (ADC) of the cervical spinal cord in surgical prognosis in patients with cervical spondylotic myelopathy (CSM). Patients with CSM who underwent decompression surgery between March and September 2023 were enrolled. Patients underwent conventional cervical spine MRI and sagittal position ZOOM-DWI before surgery. Recovery rate of neurological function was calculated based on the mJOA before and 6 months after surgery. According to recovery rate, patients were divided into good-recovery group (> 50%) and poor-recovery group (< 50%). Clinical- MRI factors model (Model 1) and Clinical-MRI-ADC factors model (Model2) were bulid by multivariate logistic regression to predict. Receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA) were utilized to compare the predictive performance of the two models. A nomogram based on model 2 was constructed to predict poor recovery rate. 100 CSM patients were included in this study, including 60 patients in the good-recover group and 40 patients in the poor-recover group. Compared with model 1, the nomogram based on model 2 had a better AUC (0.933vs0.864). The calibration curve of model 2 is closer to the reference line, which indicates that model 2 has better resolution and accuracy. The DCA curve analysis of model 2 also showed better clinical utility. The nomogram based on model 2 performs well in predicting poor recovery rates. The nomogram based on ADC values can effectively predict the outcome of postoperative neurological recovery in CSM patients.

Perioperative Safety of Lumbar Decompression Surgery Performed Under Continuous Low-Dose Aspirin Administration.

Retrospective clinical analysis. To investigate the changes in perioperative bleeding and overall safety associated with the use of low-dose aspirin (LDA) in spinal surgery. There is no consensus on whether to continue the use of LDA in patients requiring spinal surgery. Furthermore, previous studies have shown inconsistent results regarding the impact of LDA on the risk of intraoperative and postoperative bleeding. A retrospective cohort study was conducted at a single institution from 2014 to 2023, involving 375 patients diagnosed with lumbar spinal stenosis. Of these, 98 were on LDA therapy and 207 were not. After excluding those on other antiplatelet or anticoagulant therapies, propensity score matching was applied, resulting in two groups of 89 patients each. The study assessed variables such as operative time, intraoperative blood loss, postoperative drain volume, and hemoglobin level changes up to one week post-surgery. The LDA treated group (L group) experienced significantly higher intraoperative blood loss (70.3ml) compared to the non-LDA treated group (N group) (46.4ml, P =0.003). Postoperative drain volumes did not differ significantly, but postoperatively, hemoglobin levels decreased by 2.2g/dL in the L group and by 1.9g/dL in the N group after one week ( P =0.04). There were no significant differences in the rate of postoperative transfusions or serious bleeding complications between the groups. Although LDA use was associated with increased intraoperative blood loss and a significant drop in postoperative hemoglobin levels, it did not lead to serious bleeding complications. These findings suggest that with careful management, LDA can be safely continued in patients undergoing lumbar decompression surgery. However, the generalizability of these results is limited by the observational nature of the study and its single-center design. 3.

MRI underestimates lumbar spinal canal cross-sectional area compared to CT in patients with lumbar spinal stenosis

ObjectivesLumbar spinal stenosis (LSS) is a common condition characterized by the narrowing of the spinal canal, often leading to neural compression. Accurate imaging is crucial for diagnosis and surgical planning, with MRI and CT being the primary modalities. While MRI excels in soft tissue visualization, CT is superior for assessing bony structures. This study compares lumbar spinal canal cross-sectional area measurements on MRI and CT in patients undergoing surgery for LSS.MethodsTwenty patients with LSS who underwent lumbar decompression surgery after failed conservative treatment were included. Axial MRI and CT images from L1 to S1 levels were obtained and analyzed using Radiant DICOM Viewer. The spinal canal area was measured and compared between modalities. Statistical analyses assessed the measurement discrepancies, including paired t-tests and Pearson correlations.ResultsThe mean difference in cross-sectional area between MRI and CT across all levels was 26.5 mm2, with MRI consistently underestimating the canal area by 15.3%. The correlation between MRI and CT measurements was high (0.775–0.950), yet significant differences were found (p < 0.001). MRI underestimation was more pronounced in smaller spinal canals, though this trend was not statistically significant. Agreement between MRI-only evaluations and surgical findings was moderate (Cohen's Kappa = 44%, p = 0.035).ConclusionsMRI's underestimation of spinal canal size compared to CT has implications for surgical planning, particularly in severe stenosis. A multimodal MRI and CT approach may improve diagnostic accuracy and surgical outcomes. Future research should involve larger cohorts to elucidate these findings further.

Characterizing a new rat model of chronic pain after spine surgery

Chronic pain after spine surgery (CPSS) is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40% of patients undergoing lumbar spine surgery. We aimed to develop a rat model that mimics clinical CPSS conditions by taking two sequential surgical procedures. Step 1: A plastic rod was inserted into the left L5 intervertebral foramen to produce a steady compression on the dorsal root ganglion (DRG) and the spinal nerve, a common cause of low back pain (LBP). Step 2: The rod was removed after 7 days when rats exhibited mechanical and heat hypersensitivity in the ipsilateral hindpaw, followed by a full L5 laminectomy to mimic spine decompression surgery in LBP patients. The retention of the rod induced a prolonged LBP-like behavior but was quickly resolved after rod removal without laminectomy. However, rats that received laminectomy after rod removal developed heightened mechanical and heat sensitivity in the hindpaw, impaired gait, and reduced spontaneous exploration activity, indicating CPSS. Patch clamp recording revealed a significant augmentation in the intrinsic excitability of small-diameter DRG neurons in CPSS rats. Administration of Dermorphin [D-Arg2, Lys4] (1–4) amide (DALDA, 5 mg /kg, i.p.), a peripherally acting mu-opioid receptor (MOR)-preferred agonist, attenuated pain hypersensitivity, capsaicin-induced [Ca2+]i rising and the increased intrinsic excitability of DRG neurons from CPSS rats. Our findings suggest that this new model, which mirrors the nature of CPSS developed in patients, may be useful for future studies of the underlying mechanisms.

Bilateral Endoscopic Endonasal Optic Nerve Decompression in an Infant with Osteopetrosis: A Case Report

Background: Osteopetrosis is a rare genetic disorder characterized by abnormal bone density and structure, often leading to vision loss due to optic canal stenosis and consequent nerve compression. Early intervention is critical to prevent irreversible damage. This case report discusses the management of bilateral optic nerve compression in an infant with osteopetrosis. Case Description: A 7-month-old male with a family history of osteopetrosis presented with hepatosplenomegaly. The infant was diagnosed with osteopetrosis based on radiological findings and genetic testing. Ophthalmologic examination and MRI showed evidence of bilateral optic nerve compression. Endoscopic transcaruncular optic nerve decompression was not attainable The patient underwent a bilateral expanded endoscopic endonasal medial orbital wall and optic canal decompression. Conclusion: This is one of the few reported cases of endoscopic endonasal optic nerve decompression surgery on an infant. Endoscopic endonasal optic nerve decompression surgery is a viable and effective treatment option for optic nerve compression in infants with osteopetrosis, especially in cases where cost of surgery is a limiting factor for patients. This approach provides direct access to the optic canal with minimal morbidity, offering significant potential for visual recovery, and an improved quality of life. Our patient represents the youngest reported infant in the literature, demonstrating the potential for undergoing this surgical approach at the earliest possible age to aid with his prognosis.

Postoperative assessment of cervical muscle morphology, strength, and functional outcomes in patients with degenerative cervical myelopathy

IntroductionDecompressive surgery is considered a practical option for patients with progressive degenerative cervical myelopathy (DCM), nearly 40% of patients with moderate and severe DCM report partial recovery post-surgery (e.g., &amp;lt;50% improvement).Research questionTo examine the impact of decompression surgery on cervical muscle morphology and strength in DCM patients and the relationship between preoperative muscle conditions and postoperative outcomes.Material and methodsA total of 10 DCM patients underwent surgery and were followed for 2 years. Among 10 patients, 7 underwent posterior fusion surgery, and 3 underwent anterior cervical discectomy and fusion (ACDF). Cervical muscle strength and MRI measurements were taken before and after surgery. Metrics included cross-sectional area (CSA), functional CSA (FCSA), fatty infiltration, and asymmetry of multifidus and semispinalis cervicis (MF + Scer) muscles. Functional outcomes were assessed using the modified Japanese Orthopedic Association, Neck Disability Index, and SF−12 health survey post-surgery.ResultsNo significant differences in isometric cervical muscle strength were found between the ACDF and posterior fusion groups at the two-year follow-up. Posterior fusion resulted in decreased MF + Scer muscle CSA (p = 0.01), FCSA (p = 0.027), and increased asymmetry (p = 0.003). The entire cervical extensor muscle CSA also decreased (p &amp;lt; 0.03) with posterior fusion. ACDF led to decreased CSA (p = 0.001) and FCSA (p &amp;lt; 0.001) of all cervical muscles. No significant correlations were observed between pre-surgery muscle measures and functional score changes in posterior fusion.ConclusionContrary to our hypothesis, cervical muscle strength did not improve two years post-surgery in either surgical group. Additionally, no significant correlations were observed between pre-surgical muscle strength or fat infiltration and postoperative functional outcomes. Posterior fusion surgery had a more pronounced effect on cervical musculature compared to ACDF, with greater reductions in muscle CSA and increases in asymmetry.

Severe brainstem dysfunction in a neonate following intrauterine myelomeningocele repair: illustrative case.

Caudal brainstem dysfunction associated with Chiari malformation type II (CM-II) is an important source of morbidity and mortality in neonates with myelomeningocele (MMC). Prenatal MMC repair has been shown to improve or even completely reverse the extent of hindbrain herniation (HH) associated with CM-II as well as reduce the incidence of hydrocephalus requiring CSF diversion, possibly leading to a reduction in CM-II-related symptoms in these children. Urgent CSF diversion and potential CM-II decompression surgery are typically the preferred treatments for infants demonstrating caudal brainstem dysfunction, although contemporary reports have described a decreased need for both CSF diversionary surgery and CM-II decompression following prenatal MMC repair. The authors present a unique case of a newborn demonstrating a rapid onset of severe caudal brainstem dysfunction despite imaging evidence of complete HH reversal following intrauterine MMC repair, highlighting the need for continued close monitoring of these infants despite satisfactory improvement in HH following fetal surgery. https://thejns.org/doi/10.3171/CASE24815.

Diagnostic efficacy of nerve root sedimentation sign in post-lumbar interbody fusion patients: an imaging evaluation and modification

BackgroundThe sedimentation sign offers an efficient method for evaluating lumbar spinal stenosis. However, limited research exists regarding its applicability to post-operative MRI scans. This study aims to assess the viability of utilizing the nerve root sedimentation sign (NRSS) and Schizas classification (SC) in the evaluation of post-operative lumbar stenosis.MethodsPatients were classified into seven groups using SC: A1, A2, A3, A4, B, C and D. The dural sac cross-sectional area (DSCA), anterior-posterior dural sac diameter (AP), and the Oswestry disability index (ODI) of each group were compared. The difference in DSCA between direct and indirect decompression surgery was also compared to confirm whether the deformation of the spinal canal will affect the results.Results232 postoperative patients were evaluated. The variance of analysis showed that DCSA, AP and ODI had significant differences among the SC groups and NRSS groups postoperatively (P < 0.01). Comparison of DSCA results between direct and indirect decompression postoperative patients showed significant differences between groups A1 and A2, A2 and A3. AP comparison results showed significant differences between groups A1 and A2. ODI comparison results showed significant differences between groups A2 and A3. Among OLIF patients, groups A1 and A2 had mean DSCA values greater than 100mm2, while in the T/PLIF group, groups A1-4 had mean DSCA values greater than 100mm2.ConclusionBoth sedimentation signs are applicable for the evaluation of postoperative lumbar spinal stenosis. We recommend updating the definition of negative nerve root sedimentation sign to nerve root sedimentation on the dorsal side of the dural sac, with an occupying area less than half, and greater than half considered positive sign. Sedimentation sign is mainly formed by the interaction of gravity, extradural pressure, and nerve root tension.

Management of pain syndrome in patients with adjacent level pathology – long-term outcomes after minimally invasive technologies

Long-term outcomes (3–5 years) in 71 patient with the adjacent level lesion syndrome (ALDS) were analyzed. All patients underwent minimally invasive surgical interventions (puncture laser decompression of intervertebral discs and radiofrequency denervation of the facet joints) in the neurosurgical department of Irkutsk Scientific Center for Surgery and Traumatology. The applied technology was chosen after analyzing clinical examination findings, introscopy findings, degeneration coefficient and intervertebral disc height.In the study, there were 37 males, 34 females. Average age 54.1 ± 2.3 years. The time interval between the initial decompression and stabilization surgery and the subsequent minimally invasive surgical intervention was 48 ± 3.8 months.The effectiveness of minimally invasive surgical treatment was assessed after analyzing clinical and neurological findings, radiological findings (MRI, MSCT, overview and functional spondylography) as well as by the visual analog pain scale and MacNab questionnaire.

Outcomes of lateral femoral cutaneous nerve decompression surgery in meralgia paraesthetica: assessment of pain, sensory deficits, and quality of life.

Meralgia paraesthetica (MP) is a rare neuropathy of the lateral femoral cutaneous nerve (LFCN), characterized by thigh pain, paraesthesia, or sensory loss. When conservative treatments fail, surgical interventions such as neurolysis or neurectomy are considered. This study aims to evaluate the effectiveness of surgical decompression of the LFCN in alleviating pain, addressing sensory deficits, and improving quality of life. A prospective study was conducted on 26 patients who underwent LFCN decompression surgery between 2015 and 2023, with a minimum follow-up period of one year. Outcomes were assessed using pre- and postoperative questionnaires, including the Brief Pain Inventory (BPI) and the Pain Disability Index (PDI). The cohort consisted of 15 males and 11 females, with 81% reporting symptom onset following prior surgeries or trauma. Postoperatively, 95.8% of patients experienced pain relief, with 76.9% achieving complete pain resolution (NRS 0). There was a significant reduction in average perceived pain (from 6.6 ± 1.9 to 0.7 ± 1.1; p < 0.001) and maximum perceived pain (8.0 ± 1.54 to 1.0 ± 1.67; p < 0.001). Full sensory function was restored in 61.2% of patients, and quality of life scores improved markedly, with an average increase of 8.4 out of 10 points (± 1.9; p < 0.001). These results demonstrate that neurolysis of the LFCN is highly effective in the treatment of refractory MP, offering substantial pain relief, sensory restoration, and improved quality of life. Furthermore, patients with previous injuries or surgeries benefited most from NL, suggesting that these factors serve as positive prognostic indicators.

Measurement of CSF flow and brain motion in Chiari malformation type I subjects undergoing posterior fossa decompression surgery.

Radiologically, Chiari malformation type I (CM-I) is characterized by cerebellar tonsil herniation of at least 5 mm through the foramen magnum. In symptomatic cases, posterior fossa decompression (PFD) surgery is often performed and improves symptoms in approximately 75% of patients. However, the surgery involves risks, and identifying which candidates will benefit from surgery is important. It has previously been shown that the amount of tonsillar descent does not correlate with symptom severity or surgical outcomes. The authors hypothesized that using advanced neuroimaging methods to directly measure CSF flow and brain motion will give insights regarding which patients have the greatest likelihood of cerebral dynamic improvements from surgery. Here, the authors evaluated 108 CM-I patients (age 19-70 years), 61 of whom underwent PFD surgery. The authors used phase-contrast MRI to measure CSF flow/stroke volume and cine displacement encoding with stimulated echoes (DENSE) imaging to measure brain motion, with a goal to predict postsurgical cerebral dynamic improvements from presurgical images. The authors found that CSF stroke volume increased after PFD surgery by 28.9% (p = 0.014), brainstem motion decreased after surgery by 17.3% (p = 0.002), and cerebellum motion decreased 45.2% (p < 0.001). Notably, the amount of CSF flow increase after surgery had no relationship to tonsillar descent (R = 0.059, p = 0.767) but did relate to the amount of presurgical CSF flow (R = -0.518, p = 0.005). Likewise, improvements to brain motion were better predicted by the amount of presurgical motion (brainstem, R = -0.638, p < 0.001; cerebellum, R = -0.878, p < 0.001) than by tonsillar descent (brainstem, R = -0.312, p = 0.093; cerebellum, R = -0.620, p < 0.001). Here, the authors found that presurgical measures of cerebral dynamics were more descriptive of improvements to CSF flow and brain motion after PFD surgery than the conventional measure of presurgical tonsillar descent. These expanded quantitative assessments to determine which patients may benefit from surgery could improve the overall quality of patient care.

Early Clinical and Radiologic Evaluation of Endoscopic Unilateral Laminectomy for Bilateral Decompression in Degenerative Lumbar Spinal Stenosis: A Retrospective Study.

Early Clinical and Radiologic Evaluation of Endoscopic Unilateral Laminectomy for Bilateral Decompression in Degenerative Lumbar Spinal Stenosis: A Retrospective Study.

Clinical Observation on the Effectiveness of Combined Anterior and Posterior Cervical Surgery for Cervical Spinal Stenosis with Cervical Injury

Objective: To explore and analyze the clinical effectiveness of combined anterior and posterior cervical surgery for the treatment of cervical spinal stenosis with cervical injury. Methods: From March 2023 to June 2024, 40 patients who received treatment for cervical spinal stenosis with cervical injury in our hospital were selected as the study subjects. They were randomly divided into the experimental group and the control group, with 20 patients in each group. The experimental group underwent combined anterior and posterior cervical surgery, while the control group underwent simple anterior cervical decompression surgery. The changes in clinical indicators and improvement in cervical function before and after surgery were compared and analyzed between the two groups. Results: Following surgical treatment, the clinical indicators in the experimental group improved more significantly than those in the control group. Additionally, the postoperative cervical function improvement in the experimental group was superior to that in the control group. The differences between the two groups were statistically significant (P &lt; 0.05). Conclusion: For patients with cervical spinal stenosis and cervical injury, the combined anterior and posterior cervical surgery approach can effectively improve cervical function, demonstrating significant therapeutic effects. This surgical method is worthy of clinical promotion.

Percutaneous enzymatic chemonucleolysis of intervertebral disks appears safe and effective in treatment of acute-onset paraparesis and paraplegia in small dogs.

To investigate the safety and effectiveness of intradiscal chondroitinase injection as a pragmatic treatment for nonambulatory paraparesis and paraplegia in small dogs. In this phase 1 clinical trial, dogs presented to 2 university neurology clinics between January 2023 and June 2024 with acute-onset nonambulatory paraparesis or paraplegia occurring within 48 hours before presentation. Included animals weighed < 15 kg and were between 2 and 10 years old, with caregivers who were unable to afford decompressive surgery. Under fluoroscopic guidance, each dog received 1.25 U of chondroitinase ABC into each of 4 consecutive intervertebral disks in the clinically identified lesion location. Recovery was defined as the ability to walk 50 steps without assistance by 4 months after the injection. 54 dogs were included, with 4 lost to sufficient follow-up. In those with appropriate follow-up, 38 of 40 dogs (proportion, 0.95; 95% CI, 0.83 to 1.00) with intact pain sensation to the hindquarters recovered by a median of 11 days after the intervention, and 4 of 10 dogs (0.4; 95% CI, 0.17 to 0.69) without pain sensation recovered. No adverse effects related to the injection procedure were detected. In dogs with intact pain perception, this nonsurgical intervention is associated with similar proportion and time to recover as decompressive surgery. Because of the small case number, uncertainty remains regarding the effectiveness of this intervention in dogs in which hindquarter pain perception has been lost. Nonsurgical treatment for presumed disc-associated paresis and paraplegia appears promising. Randomized controlled trials are required for assessment of effectiveness versus decompressive surgery.