Degree Of Neurological Recovery Research Articles

Incidence of traumatic sciatic nerve injury in patients with acetabular fractures and factors affecting recovery: a retrospective study

BackgroundReports on traumatic sciatic nerve injury associated with acetabular fracture are rare. In this study, we investigated the demographics of these injuries, their clinical characteristics, management, and factors potentially influencing neurological recovery.MethodsWe retrospectively reviewed all patients diagnosed to have acetabular fracture at our trauma center between January 2014 and June 2021. Data on patient demographics, characteristics of sciatic nerve injury, neurological recovery, factors potentially influencing neurological recovery were analyzed.ResultsEighteen patients (bilateral in one case) met the diagnostic criteria. All these injuries involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Four of the 19 sides with traumatic sciatic nerve injury involved the common peroneal nerve division and 15 involved both the common peroneal and tibial nerve divisions. Seventeen patients (18 sides) underwent intraoperative nerve exploration, which revealed abnormalities in 7 sides and no obvious abnormality in 11 sides. At the last follow-up, 10 sides (52.6%) had complete recovery and 9 (47.4%) had partial recovery; the difference was statistically significant between those with or without abnormal nerve damage during exploration (P = 0.046). Linear regression analysis showed that a nerve abnormality detected intraoperatively was a predictor of nerve recovery (P = 0.009). The mean recovery time was significantly longer for partial recovery than for complete recovery (13.78 months vs. 6.70 months; P = 0.001).ConclusionsAll the injuries in this series involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Damage to the common peroneal nerve division was more severe than that to the tibial nerve division preoperatively. However, the degree of recovery of the common peroneal division was not worse than that of the tibial division. There was a relationship between the degree of neurological recovery and whether there was an abnormality at the time of intraoperative nerve exploration. Patients with partial recovery took longer to recover.

Continuation of Hemodialysis in a Patient With Global Hypoxic Brain Injury: Ethical Considerations and Factors That May Influence Decision Making.

Survivors of an out-of-hospital cardiac arrest are at a high risk of mortality and morbidity especially when there is resultant global hypoxic brain injury. In these situations, the patient's degree of neurologic recovery may be uncertain and family decision making is often difficult. Decision making may also be complicated by the age of the patient and one's underlying cultural and spiritual beliefs stressing the importance of patient- and family-centered care. In this article, this clinical case demonstrates the challenges in decision making and highlights the importance of communication among the health care team and the family to align the patient's goals, values, and preferences in light of a poor neurological prognosis.

Image Features of Magnetic Resonance Angiography under Deep Learning in Exploring the Effect of Comprehensive Rehabilitation Nursing on the Neurological Function Recovery of Patients with Acute Stroke.

This study was to explore the effects of imaging characteristics of magnetic resonance angiography (MRA) based on deep learning on the comprehensive rehabilitation nursing on the neurological recovery of patients with acute stroke. In this study, 84 patients with acute stroke who were treated in hospital were selected as the research objects, and they were rolled into a control group (routine care) and an experimental group (comprehensive rehabilitation care). The dense dilated block-convolution neural network (DD-CNN) algorithm under deep learning for cerebrovascular was adopted to assess the effect of comprehensive rehabilitation care on the neurological recovery of patients with acute stroke. The results showed that the Berg scale scores, Fugl-Meyer scores, and Functional Independence Measure (FIM) scores of the experimental group of patients after 6 weeks and 12 weeks of comprehensive rehabilitation nursing were greatly different from those before treatment, showing statistical differences (P < 0.05). Compared with conventional magnetic resonance imaging (MRI) images, MRA images based on CNN algorithm, Dense Net algorithm, and DD-CNN algorithm can more clearly show the patient's cerebral artery occlusion. The average dice similarity coefficient (DSC) values of CNN algorithm, Dense Net algorithm, and DD-CNN algorithm were determined to be 84.3%, 95.7%, and 97.8%, respectively; the average sensitivity (Sen) values of the three algorithms were 76.1%, 95.4%, and 96.8%, respectively; and the average accuracy (Acc) values were 87.9%, 96.3%, and 97.9%, respectively. Thus, there were statistically obvious differences among the three algorithms in terms of average values of DSC, Sen, and Acc (P < 0.05). The MRA images processed by the DD-CNN algorithm showed that the degree of neurological recovery of the experimental group was observably greater than that of the control group, and the difference was statistically obvious (P < 0.05). In short, the image features of MRA based on the deep learning DD-CNN algorithm showed good application value in studying the effect of comprehensive rehabilitation nursing on the neurological recovery of patients with acute stroke, and it was worthy of promotion.

Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?

Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to identify patients likely to benefit most from surgery. Thirty-six consecutive patients were prospectively analyzed using the modified Japanese Orthopedic Association (mJOA) score, MEPs/SSEPs and advance and conventional MRI parameters, at baseline, and 3- and 12-month postoperatively. Patients were subdivided into “normal” and “best” responders (<50%, ≥50% improvement in mJOA), and correlation between Diffusion Tensor Imaging (DTI) parameters, mJOA, and MEP/SSEP latencies were examined. Twenty patients were “best” responders and 16 were “normal responders”, but there were no statistical differences in age, T2 hyperintensity, and midsagittal diameter between them. There was a significant inverse correlation between the MEPs central conduction time and mJOA in the preoperative period (p = 0.0004), and a positive correlation between fractional anisotropy (FA) and mJOA during all the phases of the study, and statistically significant at 1-year (r = 0.66, p = 0.0005). FA was significantly higher amongst “best responders” compared to “normal responders” preoperatively and at 1-year (p = 0.02 and p = 0.009). A preoperative FA > 0.55 was predictor of a better postoperative outcome. Overall, these results support the concept of a multidisciplinary approach in the assessment and management of DCM.

Neurological recovery after traumatic spinal cord injury: what is meaningful? A patients' and physicians' perspective.

Cross-sectional survey. Most studies on neurological recovery after traumatic spinal cord injury (tSCI) assess treatment effects using the American Spinal Injury Association Impairment Scale (AIS grade) or motor points recovery. To what extent neurological recovery is considered clinically meaningful is unknown. This study investigated the perceived clinical benefit of various degrees of neurological recovery one year after C5 AIS-A tSCI. The Netherlands. By means of a web-based survey SCI patients and physicians evaluated the benefit of various scenarios of neurological recovery on a scale from 0 to 100% (0% no benefit to 100% major benefit). Recovery to AIS-C and D, was split into C/C+ and D/D+, which was defined by the lower and upper limit of recovery for each grade. A total of 79 patients and 77 physicians participated in the survey. Each AIS grade improvement from AIS-A was considered significant benefit (all p < 0.05), ranging from 47.8% (SD 26.1) for AIS-B to 86.8% (SD 24.3) for AIS-D+. Motor level lowering was also considered significant benefit (p < 0.05), ranging from 66.1% (SD 22.3) for C6 to 81.7% (SD 26.0) for C8. Meaningful recovery can be achieved without improving in AIS grade, since the recovery of functional motor levels appears to be as important as improving in AIS grade by both patients and physicians. Moreover, minor neurological improvements within AIS-C and D are also considered clinically meaningful. Future studies should incorporate more detailed neurological outcomes to prevent potential underestimation of neurological recovery by only using the AIS grade.

Unilateral moyamoya disease mimicking intracranial hemorrhage in a pediatric patient: Surgical treatment with encephalo-duro-myo-synangiosis in a progressive disease

Abstract Background Moyamoya disease (MMD) is characterized by progressive bilateral internal carotid artery stenosis and its distal branches. When angiographic findings are unilateral, the diagnosis is considered to be probable MMD. Surgery is recommended treatment of patients with deterioration caused by progressive cerebral ischemic events. Different techniques have been described, and the encephalo-duro-myo-synangiosis (EDMS) procedure is highly recommended for patients with rapid deterioration. A case of unilateral MMD mimicking intracranial hemorrhage in a pediatric patient is reported. Case description A 14-year-old girl was referred to our center due to a decreased level of consciousness. Physical examination revealed right-sided hemiparesis; however, a brain CT scan showed multiple hyperdense masses mimicking a hemorrhagic lesion. A brain MRI showed a large hypointensity in the temporoparietal, suggesting a vascular lesion. In all children that exhibit encephalitis, vascular events such as MMD should be considered. An emergency surgical EDMS procedure was performed, and the patient regained consciousness and exhibited no TIAs during the follow-up period. A postoperative brain MRI showed an improvement in brain vascularity. Conclusion After EDMS, a considerable degree of neurological recovery was observed in our patient with rare unilateral MMD mimicking intracranial hemorrhage. We found that the progression of clinical improvement after indirect revascularization in our case was due to EDMS. Surgical treatment with EDMS is reasonable for MMD because it allows for flexible revascularization that adequately addresses the requirement for new blood supply in the ischemic lesion. The EDMS procedure is followed by an observation period to preclude the possibility of the patient developing definite MMD.

INFLUENCE OF ARTERIAL HYPERTENSION WITH DIFFERENT DURATION ON NEUROLOGICAL AND FUNCTIONAL OUTCOME OF ISCHEMIC STROKE

Relevance. The outcome of acute ischemic stroke depends on the complex interaction of many factors, such as those that are not controllable, and those that can be affected. An important prognostic value of blood pressure level during the first day after a stroke has been proven. At the same time, the relationship between the primary ischemic stroke outcome and various characteristics of arterial hypertension (duration, severity of pre-existing arterial hypertension, its course) continues to be studied.&#x0D; Objective: to study the relationship between the degree of neurological recovery and functional dependence in patients after ischemic stroke within 1 year, depending on the duration of arterial hypertension in the pre-stroke period.&#x0D; Materials and methods. The study included 156 patients, 6 patients were excluded because of the loss of communication with them and refusal to participate in the study. 150 patients, 74 (49,3 %) women and 76 (50,7 %) men aged 43 to 80 years (mean age 67.4±0,71 years) with a history of ischemic stroke and the presence of arterial hypertension were examined during the year, on 1, 21 days, after 6 and 12 months. The stroke severity was evaluated by NIHSS, functional dependence – by the Barthel Index. The diagnosis of arterial hypertension, its severity, duration was based on data from clinical, instrumental examination and medical documentation.&#x0D; Results. The severity of ischemic stroke by NIHSS at the time of admission was 9,5±0,35 points; the average degree of neurological disorders severity was determined in 57,4 % of patients. The arterial hypertension duration in the history of examined patients varied from 2 to 45 years, the average 12,3±0,64 years. The most commonly reported was the arterial hypertension with its duration 6-10 years (46 %). In the case of arterial hypertension duration up to 5 years, the ischemic stroke has developed in 18,7 % of patients. The duration of arterial hypertension in anamnesis significantly correlated with the severity of the neurological deficiency at the time of admission and at the end of the acute period (r=0,65; r=0,66, respectively). The degree of functional dependence in patients with arterial hypertension duration over 10 years was worse comparatively with patients that had arterial hypertension duration up to 5 years and even with patients with a duration from 6 to 10 years after 6 and 12 months period (61,7±2,1; 90,9±1.1; 82,8±1,4 and 64,9±2,7; 93,2±0,9; 85,7±1,3, correspondingly, all p &lt;0,05).&#x0D; Conclusions. The reliable direct relationship between the arterial hypertension duration and the degree of neurological disorders in the acute period of ischemic stroke and the reverse relationship between the duration of arterial hypertension and the degree of functional recovery in all periods of the study were found. The most patients with moderate and severe functional dependence in a year have arterial hypertension duration more than 10 years.

Clinical Presentation, Diagnosis, and Surgical Treatment of Spontaneous Cervical Intradural Disc Herniations: A Review of the Literature.

Spontaneous cervical intradural disc herniation (IDH) is a rare occurrence with limited and disparate information available regarding its presentation, diagnosis, and treatment. However, its accurate detection is vital for planning surgical treatment. In this review of the literature, we collected data from all cervical IDHs described to date. Particular attention was paid to diagnostic findings, surgical approach, and causation for cervical IDH, especially at the cervicothoracic junction. A review for cases of cervical IDH was performed via the following search criteria: ("neck"[MeSH Terms] OR "neck"[All Fields] OR "cervical"[All Fields]) AND intradural[All Fields] AND disc[All Fields]. Thirty-seven cases of cervical disc herniation were identified. Demographic variables identified included age, sex, cervical level of herniation, history of associated cervical trauma, presence of Brown-Séquard syndrome, Horner syndrome, and other neurologic findings, radiographic findings, direction of surgical approach, and postoperative outcomes. A total of 37 cases of cervical IDH were identified. Most of the cases occurred at the lower levels of the cervical spine, with 35.1% at the C5-C6 level, followed by 24.3% at C6-C7, and lower still at other levels. Of the patients reviewed, 44.4% had a previous history of trauma before manifestation of symptom, with the majority being spontaneous IDH with no previous history of trauma or spine surgery. Brown-Séquard syndrome was present in 43.2% of the patients, whereas 10.8% of patients experienced Horner syndrome. The most common presentations of IDH included quadriplegia, finger/gait ataxia, radiculopathy, and nuchal pain. The degree of neurologic recovery was not associated with patient age. Most of the cervical IDHs in the literature were treated surgically via an anterior approach, but a larger portion of patients who underwent a posterior approach had improved recovery. Cervical IDH is a rare event, with this review of the literature outlining the clinical and radiographic parameters of its presentation as well as comparing common surgical strategies for treatment. We outline theories underlying the development of cervical IDH and argue for a posterior surgical approach in which the disc herniation is sequestrated with migration.

Outcomes of Surgical Treatment for Thoracic Myelopathy: A Single-institutional Study of 73 Patients.

Retrospective study. The aim was to investigate the clinical outcomes in patients with thoracic myelopathy in a single institution and to identify prognostic factors for poor outcomes. Because of the rarity of thoracic myelopathy, a few studies have analyzed a large number of clinical results for patients with thoracic myelopathy treated in a single institution. Seventy-one patients who underwent surgical treatment for thoracic myelopathy between 2000 and 2011 in a single institution were included in this analysis. We investigated the patients' characteristics, surgical outcomes, and prognostic factors for poor outcomes. Of the 73 patients, eight patients had disc herniation (DH) or spinal stenosis (SS), 10 patients had ossification of the posterior longitudinal ligament (OPLL), 40 patients had ossification of the ligamentum flavum (OLF), and 15 patients had OPLL + OLF. The mean patient age at the time of surgery was 61.9 years. Thoracic myelopathy was caused by OPLL and/or OLF in 65 patients (89%). Fifty-eight patients underwent laminectomy, eight patients underwent laminectomy and posterior fusion, four patients underwent OPLL extirpation and posterior fusion, and three patients underwent OPLL extirpation. The mean Japanese Orthopedic Association Scoring System scores before surgery and at the final follow-up examination were 6.0 ± 1.8 and 7.7 ± 2.0 points, respectively, yielding a mean recovery rate of 30% ± 43%. The JOA score improved significantly postoperatively (P < 0.05). Risk factors for poor outcomes were longer preoperative symptom duration, preoperative JOA score < 7, and OPLL and/or OLF. Large blood loss volume was significantly associated with a worse postoperative JOA score. A considerable degree of neurological recovery was observed after surgical treatment in patients with thoracic myelopathy. Prognostic factors for poor outcomes were longer preoperative duration of symptoms, worse preoperative symptoms, OPLL and/or OLF, and large volume of intraoperative bleeding. 4.

Higher Mean Arterial Pressure Values Correlate with Neurologic Improvement in Patients with Initially Complete Spinal Cord Injuries

Traumatic spinal cord injury (SCI) guidelines recommend to maintain mean arterial pressures (MAPs) above 85 mm Hg for 7 days following SCI to minimize spinal cord ischemia. Some physicians doubt that patients with initially complete injuries benefit. To assess the relationship between MAP augmentation and neurologic improvement in SCI patients stratified by initial American Spinal Injury Association Impairment Scale (AIS) score. High-frequency MAP values of acute SCI patients admitted over a 6-year period were recorded, and values were correlated with degree of neurologic recovery in an analysis stratified by postresuscitation AIS score. Sixty-two patients with SCI were analyzed. Thirty-three patients were determined to have complete injuries, and of those 11 improved at least 1 AIS grade by discharge. The average MAP of initially AIS A patients who improved versus those who did not was significantly higher (96.6 ± 0.07 mm Hg vs. 94.4 ± 0.06 mm Hg, respectively; P < 0.001), and the proportion of MAP values <85 mm Hg was significantly lower (13.5% vs. 25.6%, respectively; P < 0.001). A positive correlation between MAP values and outcome was also observed in AIS B and C patients but was not observed in patients who were initially AIS D. A positive correlation was observed between MAP values and neurologic recovery in AIS A, B, and C patients but not AIS D patients. These data raise the possibility that patients with an initially complete SCI may derive greater benefit from MAP augmentation than patients with initial AIS D injuries.

Spinal Canal Decompression and Neurological Outcome in Thoracolumbar Burst Fractures; A Review of Evidence- Based Data

BackgroundThe association between neurologic recovery and initial compromise of spinal canal has not been frequently documented and the controversy persists regarding the management of bone fragments within the spinal canal after thoracolumbar burst fractures. Although, the surgical clearance of the spinal canal, either by direct removal of bone fragments or by ligamentotaxis, is generally accepted as the treatment of choice for burst fractures, debate persists as to whether surgical decompression is necessary to treat burst fractures. ObjectiveTo better understand whether the degree of neurologic recovery from thoracolumbar burst fractures is affected and predicted by initial compromise of spinal canal and to which extent the decompression is helpful, via reviewing the evidence-based data of the literature. MethodsUp-to-date, the experimental and clinical literature concerning the role of, and the biological rationale for, surgical decompression after acute Spinal Cord Injury (SCI) were reviewed. Evidence from clinical trials was categorized as Class I (well-conducted randomized prospective trials), Class II (well-designed comparative clinical studies), or Class III (retrospective studies). ConclusionAlthough, there is a biological evidence from experimental studies in animals that decompressive surgery may improve neurological recovery after SCI, the role of surgical decompression in patients with SCI is only supported by Class III and limited Class II evidence. Accordingly, decompressive surgery for thoracolumbar burst fractures can only be considered a practice option.

Surgical treatment of spinal tuberculous granuloma

Objective To study the clinical, imaging characteristics, surgical treatments and results of spinal tuberculous granuloma. Methods A total of 15 cases of spinal tuberculous granuloma were retrospectively studied. Laminectomy with partial excision of tuberculous granuloma, open spinal dura mater with communication inside and outside the blood supply, and postoperative continued application of anti-TB drugs≥1 year were performed. Results The surgery area covered 1-7 segment, up to the neck pillow, and down to the lumbar segments. The granuloma length was 3-16 cm. The lesions located mainly in extramedullary of subarachnoid cavity, most commonly seen in the lower point of the physiological curvature of the thoracic subarachnoid cavity. The granuloma could be entirely separated from the dura. From the appearance of neurological damage to the surgery, the shortest time was 3 days, the longest time was 1 month. The prognosis of patients with short duration was better than that of those with a long time. Two weeks after surgery, the muscle strength of 2 cases was increased from grade Ⅰ to grade Ⅳ and the Frankel classification changed from C to D-E. The muscle strength of 13 cases was increased from grade Ⅱ to grade Ⅳ, and the Frankel classification changed from C to D. The follow-up duration was from 1 month to 3 years. Varying degrees of neurological recovery were observed in all the patients. After two months, the MRI of 11 cases showed disappearance of granulomas around the surgical area. After six months, the MRI of 9 cases showed that the granulomas of surgical and non-surgical areas were completely disappeared. Conclusion Surgical decompression could improve the prognosis of spinal tuberculous granuloma. After neurological damage occurred, the sooner the surgery performed, the better the prognosis. Key words: Tuberculosis, central nervous system; Granuloma; Spinal canal

Regulations in the United States for cell transplantation clinical trials in neurological diseases

ARTICLE INFO Objective: This study aimed to use a systematic approach to evaluate the current utilization, safety, and effectiveness of cell therapies for neurological diseases in human. And review the present regulations, considering United States (US) as a representative country, for cell transplantation in neurological disease and discuss the challenges facing the field of neurology in the coming decades. Methods: A detailed search was performed in systematic literature reviews of cellular- based therapies in neurological diseases, using PubMed, web of science, and clinical trials. Regulations of cell therapy products used for clinical trials were searched from the Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Results: Seven most common types of cell therapies for neurological diseases have been reported to be relatively safe with varying degrees of neurological recovery. And a series of regulations in US for cellular therapy was summarized including preclinical evaluations, sourcing material, stem cell manufacturing and characterization, cell therapy product, and clinical trials. Conclusions: Stem cell-based therapy holds great promise for a cure of such diseases and will value a growing population of patients. However, regulatory permitting activity of the US in the sphere of stem cells, technologies of regenerative medicine and substitutive cell therapy are selective, theoretical and does not fit the existing norm and rules. Compiled well-defined regulations to guide the application of stem cell products for clinical trials should be formulated.

Transplantation of autologous bone marrow stem cells in patients with chronic spinal cord injury

Stem cells are being investigated by their potential use in regenerative medicine. There is currently a lack of effective clinical therapy for a number conditions, such as severe spinal cord injury (SCI). SCI can lead to chronic paraplegia, considered an irreversible condition. The administration of stem cells has been tested as a potential therapy for SCI. In the present study we evaluated the feasibility, safety and potential efficacy of autologous mesenchymal stem cells (MSC) transplantation in patients with chronic complete SCI. We conducted a phase I/II, non-controlled study in 14 patients of both genders aging between 18-65 years, with ASIA A classified chronic traumatic SCI. Baseline somatosensory evoked potentials (SSEP), spinal magnetic resonance imaging (MRI) and urodynamics were assessed before and after treatment. Pain rating was performed using the McGill Pain Questionnaire and a visual analogue score scale. Bone marrow-derived MSC were cultured and characterized by flow cytometry, cell differentiation assays and G-band karyotyping, showing morphological and phenotypic characteristics of MSC, as well as genetic stability. MSC were injected directly into the lesion following laminectomy and durotomy. Transplantation of bone marrow derived MSC was an overall safe procedure. All of the patients were discharged within 48 hours after surgery. Only one patient developed a post-operatory complication, evolving a liquoric fistula that was treated by an additional surgical procedure. Nine patients had improvements in urologic function. All patients displayed variable improvements in sensitivity and 8 patients developed lower limbs motor functional gains, principally in the hip flexors. All patients had variable improvements in ASIA global scores. Additionally, 6 patients had changes in the AIS score to grade B and one to grade C. A direct correlation between motor gain and lesion level and an inverse correlation between light touch gain and lesion volume were found 6 months after transplantation. One patient presented changes in SSEP 3 and 6 months after MSC transplantation. Although there is an abundance of studies describing the natural history of neurologic functional gains during the first year post-SCI, there is a lack of data regarding the degree of neurological recovery that may naturally occur during prolonged follow up investigation. In the present study, we enrolled only patients with chronic and complete spinal cord injury (ASIA A) whom had previously been subjected to decompressive surgery and lengthy rehabilitation protocols without acquiring significant motor or sensory gains. Although this was not a controlled study, based on the patient profiles and the expected spontaneous gains, our study showed potential benefits of MSC transplantation treatment, in variable degrees of motor and sensory improvements, clinical pain measures and urodynamics parameters. The use of MSC presents several advantages, such as isolation from bone marrow aspirates and large-scale expansion in cell culture procedures, which are feasible to be performed in autologous transplantations. We conclude that intralesional transplantation of autologous MSC in spinal cord injury patients is safe and feasible, and may provide some progressive benefits. We are currently beginning new clinical trials based on MSC therapy for SCI.

Management of thoracic myelopathy caused by ossification of the posterior longitudinal ligament combined with ossification of the ligamentum flavum—a retrospective study

Ossification of the posterior longitudinal ligament (OPLL) or ossification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy and is relatively common in the Japanese population and literature. However, no series of OPLL combined with OLF has been previously published. Many different surgical procedures have been used for the treatment of thoracic OPLL or OLF. However, the possibility of postoperative paraplegia remains a major risk, and consistent protocols and procedures for surgical treatment of thoracic OPLL combined with OLF have also not been established. To compare the effect of thoracic myelopathy treatment and safety of posterior decompression with or without instrumented fusion and circumferential spinal cord decompression via a posterior approach in Chinese patients of OPLL combined with OLF at a single institution. This retrospective clinical study of 31 cases was conducted to investigate the clinical outcomes of three kinds of surgical procedures for thoracic myelopathy caused by OPLL combined with OLF in Chinese population. Procedure was performed in 31 patients. Neurologic status was evaluated using the Japanese Orthopaedic Association (JOA) score and Hirabayashi recovery rate before and after surgery. A total of 31 patients who underwent surgery for thoracic OPLL combined with OLF were classified into three groups: posterior decompression group (13 patients); circumferential decompression group (seven patients), which included four who underwent extirpation and the other three underwent the floating procedure; and posterior decompression and fusion group (11patients), all of whom underwent laminectomy with posterior instrumented fusion. In each group, JOA score was used to evaluate thoracic myelopathy, and Hirabayashi recovery rate was calculated 1year after surgery and at final examination. Mean recovery rate at the final follow-up was 46.5% in the posterior decompression group, 65.1% in the circumferential decompression group, and 62.7% in the posterior decompression and fusion group. Postoperative paralysis occurred in three patients in the posterior decompression group, one in the circumferential decompression group, and one in the posterior decompression and fusion group. In the circumferential decompression group, leakage of cerebrospinal fluid occurred in four patients. Urinary tract infection occurred in two patients, and superficial wound disruption occurred in one patient. Late neurologic deterioration occurred in four patients in the posterior decompression group. There were no cases of postoperative paralysis or late neurologic deterioration in the posterior decompression and fusion group. Thoracic OPLL combined with OLF is an uncommon cause of myelopathy in the Chinese population. It can present acutely after minor trauma. A considerable degree of neurologic recovery was obtained by posterior decompression with instrumented fusion, despite the anterior impingement of the spinal cord by the remaining OPLL. In addition, the rate of postoperative complications was low with this procedure. We consider that one-stage posterior decompression and instrumented fusion be selected for patients in whom the spinal cord is severely damaged before surgery and/or when circumferential decompression is associated with an increased risk.

Prevention of Nerve Injury After Periacetabular Osteotomy

The Bernese periacetabular osteotomy (PAO) is the preferred pelvic osteotomy in many centers treating symptomatic acetabular dysplasia in the young adult. Major nerve injury has been reported as a complication that can occur with this complex procedure, but the incidence and circumstances associated with such injury are not well known. We asked: (1) What is the incidence of sciatic and femoral nerve injury after PAO; (2) what are the risk factors associated with such injury; and (3) what are the consequences of such injury including the degree of neurologic recovery? We identified 1760 PAOs that were performed between 1991 and 2008 at five institutions. A major nerve injury was defined as a postoperative motor nerve palsy or sensory deficit present after surgery in the distribution of the femoral or sciatic nerves. Risk factors associated with nerve injury and the treatment and degree of neurologic recovery were reviewed from medical records. Thirty-six of the 1760 patients (2.1%) had a major nerve deficit of the sciatic or femoral nerve develop. We identified no patient or surgical risk factor associated with the occurrence of nerve injury. Seventeen of the 36 patients had complete recovery. The median time to recovery or plateau was 5.5 months (range, 2 days to 24 months). The incidence of sciatic and femoral nerve injury during PAO is less than previously reported. Full recovery can be expected in only ½ of the patients and more commonly with injuries of the femoral nerve. If direct nerve injury is suspected, we believe exploration may be warranted. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Change in platelet monoamine oxidase activity in the acutest period of ischemic stroke is associated with the degree of neurological recovery

We studied monoamine oxidase activity (MAO) in platelets of patients in the acute period of ischemic stroke. Neurological deficit was evaluated by the data of clinical examinations and scales. In 80% patients MAO activity was considerably increased on 3-5 day after stroke. We found a correlation between increased MAO activity on 3-5 day after ischemic stroke and regression of neurological deficit on day 21 after ischemic stroke. The increase in MAO activity during the acute period of ischemic stroke is presumably a compensatory response aimed at stabilization of tissue homeostasis.

Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level

OBJECT The object of this study was to evaluate the efficacy and safety of posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) at the same level. METHODS Between January 2003 and December 2005, 11 patients (8 men and 3 women) with thoracic myelopathy due to OLF and OPLL at the same level underwent posterior decompressive laminectomy and excision of OLF. Posterior instrumentation was also performed for stabilization of the spine and reducing the thoracic kyphosis angle by approximately 5-15 degrees (kyphosis correction), and spinal fusion was performed in all cases. The follow-up period ranged from 2 to 4 years (mean 2.8 years). The outcomes were evaluated using a recovery scale based on the Japanese Orthopaedic Association classification. The score of each patient was calculated before surgery, 1 year after surgery, and at the final follow-up visit. RESULTS After surgery, the thoracic kyphosis in the stabilization area was reduced from 30.0 +/- 4.02 degrees to 20.8 +/- 2.14 degrees on average. The mean score on the Japanese Orthopaedic Association scale improved from 3.5 +/- 1.69 preoperatively to 8.5 +/- 1.63 at the final follow-up, with a recovery rate of 68.0%. The results were good in 9 patients and fair in 2 patients. Postoperative MR imaging showed that the spinal cord was shifted posteriorly and decompressed completely in all cases. Myelopathy was not aggravated in any case after surgery. CONCLUSIONS A considerable degree of neurological recovery was observed after posterior decompression and kyphosis correction. The procedure is easy to perform with a low risk of postoperative paralysis. The authors therefore suggest that the procedure is useful for patients whose spinal cords are severely impinged by OLF and OPLL at the same level.

Updates of ossification of posterior longitudinal ligament. Clinical results and complication of surgery for thoracic myelopathy due to ossification of posterior longitudinal ligament

We performed 3 types of surgical procedures for thoracic myelopathy due to OPLL : posterior decompression, OPLL-extirpation, and posterior decompression with instrumented fusion (PDF) . A considerable degree of neurological recovery was obtained in all patients who underwent PDF, despite the anterior impingement of the spinal cord by OPLL remaining. In addition, the rate of post-operative complications was extremely low with PDF, when compared with posterior decompression and OPLL-extirpation groups. We recommend that one stage posterior decompression with instrumented fusion be selected for cases in whom the spinal cord is severely damaged pre-operatively.

Postoperative factors affecting neurological recovery after laminoplasty for cervical spondylotic myelopathy.

Objective To elucidate possible postoperative factors affecting neurological recovery af-ter cervical expansive open-door laminoplasty in treatment of patients with multilevel cervical spondyiotic myelopathy. Methods This study involved the patients with multilevel cervical spondylotic myeiopathy who underwent expansive open-door laminoplasty between May 2001 and December 2006. They were classified into two groups according to the degree of neurological recovery: an excellent recovery group (group A), the recovery rotes greater than 75%, and a poor recovery group (group B), the recovery rates lower than 25%. Comparisons of various preoperative clinical and imaging parameters such as patient's age, gender, duration between symptom onset and surgery, follow-up time, preoperative JOA score, preoperative range of motion (ROM), preoperative cervical curvature index(CCI), preoperative Pavlov ratio, segments of myelopathy and so on, revealed that the mean age and mean preoperative JOA scores were significantly different. The cases with the age older than 60 years and preoperative JOA scores less than 6 were excluded. Therefore, group A re-mained 24 cases (group A1) and group B 18 cases (group B1). The same analyses were repeated between group A1 and group B1. There was no significant difference between two groups among the above mentioned parameters. Postoperative ROM and its reduction rate, postoperative CCI and its reduction rate, Pavlov ratio and its increasing rate were analyzed by t test, and the relationship between these six parameters and im-proving rate of JOA scores were also analyzed. Results Except postoperative ROM, other five indexes were statistical differences between A1 and B1 groups. Except postoperative ROM in group A1 and postoperative ROM and its reduction rate in group B1, other indexes had statistical correlation with improving rate of post-operative JOA scores. Conclusion Modulating postoperative ROM, maintaining cervical lordosis and achieving sufficient canal diameter may improve neurological recovery in selected patients. Key words: Laminectomy; Cervical spondylosis; Prognosis