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Purpose Treatment options for adult spinal cord injury without radiographic abnormality (ASCIWORA) varied. Compression of ASCIWORA may more likely result from spinal cord lesions such as edema and hemorrhage or contusion. This study aimed to explore the clinical effect of early durotomy with duroplasty decompression in the treatment of severe ASCIWORA. Methods Data of 16 patients with ASCIWORA who underwent early (< 72 h) posterior laminectomy followed by durotomy with duroplasty decompression from June 2015 to January 2017 were retrospectively analyzed. Patients' prognosis was analyzed by American Spinal Injury Association Impairment Scale (AIS) grades and scores. In 3 patients, intraspinal pressure (ISP) was continuously monitored for 1 week. Results Cervical magnetic resonance imaging (MRI) revealed spinal cord edema in 9 patients and suspected hemorrhage or contusion in 7 cases. Pathological manifestations of spinal cord injury found during the operation were consistent with preoperative MRI findings. Of the 16 cases, AIS grade was improved by 1 grade in 3 cases, 2 grades in 11 cases, and 3 grades in 1 case. The AIS scores at the last follow-up were significantly higher than preoperative scores. There was a high level of ISP after laminectomy, whereas ISP continued to decrease steadily after durotomy. Conclusions Durotomy helps thoroughly decompress the spinal cord and improve cerebrospinal fluid circulation in severe ASCI-WORA cases. Cervical MRI and pathological investigation of the spinal cord can be used to evaluate and predict the prognosis of ASCIWORA patients. ISP monitoring is an effective method for evaluating intramedullary pressure and decompression.

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Objective This study aimed to determine the accuracy and safety of the “blunt end” Kirschner wire (KW) technique for the minimally invasive treatment of unstable pelvic fractures with the assistance of a 3D printed external template. Methods Clinical data of 28 patients with unstable pelvic fractures between January 2016 and January 2018 were retrospectively analyzed. There were 6 cases of B1, 10 of B2, 8 of C1, and 4 of C2 fractures, all of which received surgical treatment. The “blunt end” KW technique with a 3D template was adopted for the minimally invasive placement of the iliosacral (IS) or superior ramus screws. The number of intraoperative fluoroscopies, surgical time, and complications were recorded. Postoperative reduction was assessed using the Matta criteria, and the Majeed score system was used to evaluate postoperative functional recovery. Results The average number of fluoroscopies was 35 per patient, and the average surgical time was 85.2 min. A total of 19 S1 and 28 S2 IS screws were inserted. Eleven antegrade superior ramus screws and 4 retrograde screws were placed in 11 patients, and anterior subcutaneous internal fixation (INFIX) was used to fix the anterior pelvic ring in 17 patients. All patients were followed up for an average of 18 months. Postoperative reduction was evaluated by Matta's criteria: excellent in 16 cases, good in 9 cases, and fair in 3 cases. The Majeed score was used in the last follow-up to evaluate functional recovery: excellent in 13 cases, good in 10 cases, fair in 4 cases, and poor in 1 case. There were no cases of operative vascular injury. Conclusion The “blunt end” KW technique with a 3D printed external template is a safe and effective method for the placement of IS and superior ramus screws in unstable pelvic fractures with minimized surgical duration and radiation exposure.