Transient Spinal Cord Injury Research Articles

Percutaneous endoscopic lumbar discectomy via the medial foraminal and interlaminar approaches: A comparative study with 2-year follow-up.

The purpose of this study was to analyze the clinical effect of percutaneous endoscopic medial foraminal discectomy (PEMFD) in the treatment of lumbar disc herniation (LDH). We retrospectively examined and compared clinical data from 39 single-level LDH patients who underwent PEID and 47 who underwent PEMFD. All the patients were diagnosed with single-level LDH and were treated in Xuzhou Central Hospital for single-segmental lumbar disc herniation between June 2017 and December 2019. Collect and count surgical-related indicators, intraoperative bleeding volume and 24-hour postoperative drainage volume, lower extremity numbness Visual Analogue Scale (VAS), the pain VAS and lumbar Oswestry Disability Index (ODI) scores. Intraoperative bleeding volume and 24-hour postoperative drainage volume were significantly lower in the PEMFD group (p < 0.05). Operation time and length of hospital stay did not significantly differ between the groups. Transient spinal cord injury and surgical site infection did not occur. Recurrence occurred in two patients in each group. Repeat surgery in these patients demonstrated remarkable epidural scarring in the PEID group patients; no scarring was evident in the PEMFD group patients. The numbness VAS score 72 h after surgery and the pain VAS and ODI scores 1 month after surgery significantly differed between groups; however, pain VAS and ODI scores 6, 12, and 24 months after surgery did not. At last follow-up, the modified MacNab criteria outcome did not significantly differ between the groups. PEMFD and PEID have similar short- and medium-term outcomes. However, PEMFD has several advantages: simplicity, lower bleeding volume, and preservation of the LF.

In-hospital thromboembolic complications after frozen elephant trunk aortic arch repair

ObjectiveThis study evaluated the frequency and clinical impact of thromboembolic complications after frozen elephant trunk aortic arch repair using the Thoraflex device (Terumo Aortic). MethodsA total of 128 consecutive patients (mean age 67.9 ± 13.7 years, 31.0% female) underwent frozen elephant trunk aortic arch repair using the Thoraflex device between September 2014 and May 2021 in 4 Canadian centers. Patient baseline characteristics, intraoperative details, and frozen elephant trunk thromboembolic complications were collected retrospectively and analyzed. ResultsFifteen patients (11.7%) had thrombus visualized within the frozen elephant trunk stent graft on imaging (n = 8; 53.3%) or had a thromboembolic event (n = 9; 60.0%) before hospital discharge. Sites of embolism were mesenteric (n = 8; 88.9%), renal (n = 4; 44.4%), and iliofemoral (n = 1; 11.1%). Patients who experienced thromboembolic complications were more likely to have a history of autoimmune disease (n = 3; 20.0% vs n = 2; 1.8%; P = .01) and implantation of a longer frozen elephant trunk stent graft (150 mm vs 100 mm) (n = 13; 86.7% vs n = 45; 39.8%; P < .001). All patients with thromboembolic complications received therapeutic anticoagulation, and a smaller proportion required an open surgical (n = 5; 33.3%) or an endovascular (n = 2; 13.3%) intervention. Radiographic resolution of thromboembolic complications was observed in 86.7% of patients (n = 13). In-hospital mortality occurred in 1 patient, stroke occurred in 1 patient, and transient spinal cord injury occurred in 1 patient. ConclusionsThromboembolic complications occur more often than previously recognized after frozen elephant trunk aortic arch repair using the Thoraflex device and are associated with increased rates of surgical and endovascular reintervention. Prevention and management of these complications require further study.

First-in-Human Use of the Cook Hybrid Frozen Elephant Trunk Graft: The Canadian Experience

Advancements in technology have changed the treatment of aortic arch pathologies. Specifically, the introduction of the frozen elephant trunk technique has allowed one-stage treatment of pathologies that would have otherwise required a two-stage procedure. We present the early outcomes of a novel frozen elephant hybrid stent graft. Between August 2015 and July 2019, 39 patients (56% male; mean age 67 ± 11years) underwent an arch reconstruction with a novel hybrid stent graft in four different Canadian centers. The most common indication for surgery was arch aneurysm (31%) followed by acute dissection (28%). All patients were prospectively followed with clinical and imaging assessments. The device was successfully implanted in all patients. There were 3 perioperative deaths (8%). Transient spinal cord injury occurred in 5 patients (13%); all had complete neurologic recovery before discharge. Seven patients had a perioperative stroke/transient ischemic attack; 3 of them initially presented with cerebral malperfusion caused by acute dissection. One patient died during the study follow-up. Survival at 30 days and at 1 and 3 years was 92% ± 5%, 89% ± 5%, and 89% ± 5%, respectively. At a median follow-up of 16 months, 3 patients required a reintervention to address a type I distal endoleak and 1 patient was treated for a type II endoleak. There was no arch anastomosis complications. The Cook hybrid stent graft device provides encouraging midterm results in a high-risk cohort. This novel graft is simple to deploy, may be customized to patients' anatomy in elective cases, eases arch reconstruction, and allows versatility in the choice of arch grafts.

Spinal cord injury following aortic arch replacement.

Postoperative spinal cord injury is a devastating complication after aortic arch replacement. The purpose of this study was to determine the predictors of this complication. A group of 254 consecutive patients undergoing aortic arch replacement via median sternotomy, with (n = 78) or without (n = 176) extended replacement of the upper descending aorta, were included in a risk analysis. The frozen elephant trunk technique was used in 46 patients. The patients' atherothrombotic lesions (extensive intimal thickening of > 4mm) were identified from computed tomography images. Complete paraplegia (n = 7) and incomplete paraparesis (n = 4) occurred immediately after the operation (permanent spinal cord injury rate, 1.97%; transient spinal cord injury rate, 2.36%). A multivariable logistic regression analysis identified the use of the frozen elephant trunk technique (odds ratio 36.3), previous repair of thoracoabdominal aorta or descending aorta (odds ratio 29.4), proximal atherothrombotic aorta (odds ratio 9.6), chronic obstructive lung disease (odds ratio 7.1) and old age (odds ratio 1.1) as predictors of spinal cord injury (p < 0.0001, area under curve 0.93). Spinal cord injury occurs with a non-negligible incidence following aortic arch replacement. The full objective assessment of the morphology of the whole aorta and the recognition of the risk factors are mandatory.

Open surgery for descending thoracic aorta in an endovascular era

BackgroundThoracic endovascular aortic repair has become the preferred treatment for a variety of descending thoracic aortic pathologies. However, there are unresolved issues such as morphologic appearance of chronic dissection, persistent false lumen perfusion, and adequacy of landing zone. Enthusiasm for improving the technique of open aortic repair and perioperative management is fading. In this study, we would like to demonstrate how we improve our surgical outcomes by establishing a dedicated aortic multidisciplinary team at the Kawasaki Aortic Center. MethodWe performed a single-center retrospective study from January 2015 to December 2016. All patients with open descending thoracic aortic replacement were recruited. Preoperative patient demographic data, bypass strategies, operative details, and postoperative outcomes were reviewed. ResultFrom January 2015 to December 2016, we treated 168 cases of descending thoracic aortic repair using a left thoracotomy. Median age was 69.0 ± 21.8 years old, and 63.1% were aortic dissection (acute, 4.8%; chronic, 58.3%); 81.3% patients underwent elective operations. Left heart bypass, deep hypothermic circulatory arrest, and partial cardiopulmonary bypass were performed in 88.6%, 9.0%, and 2.4% of patients, respectively. Mean operative time was 312 ± 94 minutes. In-hospital mortality in total was 0.6%. The rate of transient spinal cord injury was 4.7%. ConclusionsUnder a dedicated aortic multidisciplinary team, we demonstrated that open descending thoracic aorta replacement can be performed with excellent early outcomes with low reintervention rates, regardless of the nature of the aortic pathologies.

Posterior corrective surgery for moderate to severe focal kyphosis in the thoracolumbar spine: 57 cases with minimum 3years follow-up.

To evaluate the radiological and clinical outcomes of the corrective surgery for patients with moderate to severe focal kyphosis in thoracolumbar spine. Fifty-seven patients with moderate to severe focal kyphosis of the thoracolumbar spine underwent apical segmental resection osteotomy with dual axial rotation correction at our hospital. There were 30 male and 27 female patients. The mean age was 34.3years. The kyphosis level radiographs were obtained from each patient before surgery, immediately after surgery and at follow-up. Local kyphosis and scoliosis Cobb angles were measured. Full-spine standing radiographs were obtained before surgery and at follow-up, and the spine sagittal and coronal balance were evaluated. The height of patients, the Frankel grading system for neurological functions, the Oswestry disability index for life quality, the visual analogue score for back pain and the patient satisfactory index for satisfaction to surgery were applied before surgery and at follow-up. The radiological and clinical outcomes were further analyzed in different sub-groups of patients according to etiology, severity of kyphosis, age, level of kyphosis apex, Frankel grade before surgery, and complications. The average follow-up time of patients was 46.1months. The average kyphosis angle reduced from 94.6° before surgery to 31.0° immediately after surgery, and remained at 34.4° at follow-up. The sagittal balance of the spine, height of patients, Frankel grading, Oswestry disability index and visual analogue score were improved. The patient satisfactory index (PSI) showed a satisfied rate of 91.2%. The correction rate was significantly higher in patients with kyphosis angle less than 95° and age less than 35years. The clinical improvement rate was significantly higher in patient with kyphosis apex at lower thoracic spine or thoracolumbar segment, Frankel grade E before surgery and no complication group. The incidence of intra-operative and early stage complications was 38.6%, and the incidence of instrumentation failure was 10.5%. The most severe complication was transient spinal cord injury, and the incidence was 7.0%. All complications got good relief after appropriate intervention. Apical segmental resection osteotomy with dual axial rotation correction is an effective procedure to treat moderate to severe focal kyphosis, the prevention of serious neurological complications is fundamental to achieve the ideal clinical results.

IF13. Outcomes of the Candy-Plug Technique to Achieve Thrombosis of Thoracic False-Lumen Postdissection Aneurysms

False lumen (FL) perfusion and aneurysmal degeneration of the thoracic aorta limits the response to endovascular treatment in patients with chronic aortic dissection by retrograde flow arising from distal entry tears. Aim of the study is to evaluate the “candy-plug” FL embolization technique to prevent back-flow in chronic aortic dissection aneurysms. The “candy-plug” stent graft is a custom-made endograft at the shape of a candy with proximal and distal diameters of up to 50 mm that taper down at the middle of the graft to 16 mm (Fig 1). With the adjunct of a regular plug, complete FL occlusion can be achieved. Between 2013 and 2015, 12 patients (11 males; mean age, 65 ± 11years; American Society of Anesthesiologists 3/4) with chronic type B dissection (CTBD) received candy-plug endografts for residual type A aortic dissection (n = 6) or CTBD aneurysms (n = 6) in conjunction with extension of aortic stent grafting of the true lumen (TL) to the celiac trunk. Eleven procedures were elective and one acute. All procedures were technically successful in occluding FL perfusion, and only one patient required additional embolization techniques at the level of the candy-plug (Fig 2). There was no 30-day mortality, but one patient with transient spinal cord injury recovered. At a mean follow-up of 12 ± 6 months (range, 1-26), there were two reinterventions due to persisting retrograde FL perfusion. On later follow-up, one patient underwent visceral debranching and thoracoabdominal stenting. Two further patients required fenestrated endografts of the abdominal aorta for expansion of the abdominal chronic aortic dissection aneurysm. There was only one late death in the patient with conversion to hybrid procedure. FL embolization of chronic dissection aneurysms with a candy-plug endograft presents a useful tool that expands the material options for FL embolization. Application of this technique achieves complete FL thrombosis in most patients, who would otherwise require open surgery or complex endovascular procedures with fenestrated/branched abdominal endografts.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Surgical Pitfalls of an Ultrasonic Bone Curette (Sonopet) in Spinal Surgery

We report our experience with the SONOPET ultrasonic bone curette. Between September 2001 and July 2005, 546 patients underwent microscopic spinal surgeries using a high-speed drill and the SONOPET instrument. We encountered operative complications thought to be attributable to the use of the SONOPET in six patients (1.1%). There were five instances of dural puncture and one spinal cord injury. All dural tears occurred when the dura mater was aspirated into the tip of the SONOPET. None of the affected patients developed postoperative clinical complications because cerebrospinal fluid leakage was avoided by appropriate closure. We think that the transient spinal cord injury occurred because the vibration emanating from the SONOPET was transmitted directly to the spinal cord. Some patients experienced damage to the epidural venous plexus for reasons similar to those described above. SONOPET facilitates the removal of bone in a narrow field, such as that encountered during keyhole surgery. It aids in the removal of the lateral edge of bone and is especially useful for expanding the foramen intervertebrale or opening the lateral recess. However, its use is not without risk. To prevent dural tears and venous plexus injury, we recommend that cotton be placed between the SONOPET and important structures. To avoid spinal cord injury, we suggest that the SONOPET be inserted horizontal with the dura mater to avoid the direct transmission of vibrations emanating from the instrument to the spinal cord. SONOPET is suitable for decompression on the lateral side, but not for decompression above the spinal cord.

Surgical pitfalls of an ultrasonic bone curette (SONOPET) in spinal surgery. Commentary

OBJECTIVE: We report our experience with the SONOPET ultrasonic bone curette. METHODS: Between September 2001 and July 2005, 546 patients underwent microscopic spinal surgeries using a high-speed drill and the SONOPET instrument. RESULTS: We encountered operative complications thought to be attributable to the use of the SONOPET in six patients (1.1%). There were five instances of dural puncture and one spinal cord injury. All dural tears occurred when the dura mater was aspirated into the tip of the SONOPET. None of the affected patients developed postoperative clinical complications because cerebrospinal fluid leakage was avoided by appropriate closure. We think that the transient spinal cord injury occurred because the vibration emanating from the SONOPET was transmitted directly to the spinal cord. Some patients experienced damage to the epidural venous plexus for reasons similar to those described above. CONCLUSION: SONOPET facilitates the removal of bone in a narrow field, such as that encountered during keyhole surgery. It aids in the removal of the lateral edge of bone and is especially useful for expanding the foramen intervertebrale or opening the lateral recess. However, its use is not without risk. To prevent dural tears and venous plexus injury, we recommend that cotton be placed between the SONOPET and important structures. To avoid spinal cord injury, we suggest that the SONOPET be inserted horizontal with the dura mater to avoid the direct transmission of vibrations emanating from the instrument to the spinal cord. SONOPET is suitable for decompression on the lateral side, but not for decompression above the spinal cord.

Experience with cervical stenosis and temporary paralysis in athletes

Transient spinal cord injury (TSCI) in athletes presents one of the most challenging clinical scenarios. Management difficulties in and subsequent return-to-play decisions are especially important in those with cervical canal stenosis. Ten athletes (nine male and one female patients) were evaluated for TSCI. The diagnostic survey included physical and neurological examinations, plain radiographs with flexion-extension dynamic studies, computerized tomography, and magnetic resonance (MR) imaging. Clinical courses were followed and, in those who returned to contact sports activities, subsequent experience was noted. Symptoms consisted of paralysis, weakness, or numbness in all four extremities, their duration ranging from 15 minutes to 48 hours. Radiography revealed no evidence of fracture/dislocation or ligamentous instability. Spinal stenosis of 8 to 13 mm in length at three or more levels was evident in all cases. Four patients returned to competition without recurrent TSCI (mean follow-up duration 40 months); six individuals retired. The occurrence of TSCI is not uncommon in athletes involved in contact sports. The diagnostic workup focuses on excluding fracture/dislocation, cord contusion, ligamentous infolding or instability, herniated nucleus pulposus, syrinx, or other surgically correctable lesions. There appear to be two groups of athletes who sustain TSCI: those who experience TSCI yet in whom radiographic studies are normal, and those with cervical stenosis, the most difficult management group. It does not appear that a single episode of TSCI in an athlete with spinal stenosis will substantially increase the risk of subsequent catastrophic spinal cord injury in those in whom MR imaging demonstrates preservation of cerebrospinal fluid signal.

800 Experience with Transient Spinal Cord Injury in Athletes

800 Experience with Transient Spinal Cord Injury in Athletes

800 Experience with Transient Spinal Cord Injury in Athletes

800 Experience with Transient Spinal Cord Injury in Athletes

Cervical Spine Injury in a Boxer

Cervical spine fracture is a rare, yet potentially catastrophic complication associated with boxing. Neurologic deficits, ocular injuries, or other traumatic musculoskeletal injuries have been commonly reported. Symptoms of cervical spine injury may be minimal or absent. Cervical spine fracture may be undiagnosed and unreported in boxers with presumed soft-tissue injury to the head and neck. We describe a young athlete who sustained a transient spinal cord injury while boxing, which required a cervical spine fusion and postoperative immobilization in a halo vest. This athlete also had an os odontoideum, which placed him at significant risk for such an injury. Pre- and postparticipation screening of the cervical spine should be considered in all boxers.

Chemoembolization through Intercostal Arteries in Hepatocellular Carcinoma' Report of A Case of Transient Spinal Cord Injury

Chemoembolization through Intercostal Arteries in Hepatocellular Carcinoma' Report of A Case of Transient Spinal Cord Injury