Influence of Acute Shortening on the Spinal Cord: An Experimental Study

Kawahara, Norio; Tomita, Katsuro; Kobayashi, Toshiji; Abdel-Wanis, Mohamed E.; Murakami, Hideki; Akamaru, Tomoyuki

doi:10.1097/01.brs.0000155407.87439.a2

Cited by 151 publications

(95 citation statements)

References 40 publications

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“…Meanwhile, excessive displacement and overlapping of the dural sac could be observed and prompt adjustment could be performed during the whole procedure. The clinical observation and animal experiences by Kawahara et al [13] also confirmed that the spine shortened within one-third of the height of the vertebral would not lead to the functional change of the spinal cord. In our opinion, an observed wrinkle or kink of the dura sac no greater than 2-3 cm was admissible and would not lead to positive neurological impact.…”

Section: Discussionmentioning

confidence: 48%

One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?

et al. 2011

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Priority of neurological decompression was regarded as necessary for scoliosis patients associated with Chiari I malformation in order to decrease the risk of spinal cord injury from scoliosis surgery. We report a retrospective series of scoliosis associated with Chiari I malformation in 13 adolescent patients and explore the effectiveness and safety of posterior scoliosis correction without suboccipital decompression. One-stage posterior approach total vertebral column resection was performed in seven patients with scoliosis or kyphosis curve [90°(average 100.1°s coliotic and 97.1°kyphotic curves) or presented with apparent neurological deficits, whereas the other six patients underwent posterior pedicle screw instrumentation for correction of spinal deformity alone (average 77.3°s coliotic and 44.0°kyphotic curves). The apex of the scoliosis curve was located at T7-T12. Mean operating time and intraoperative hemorrhage was 463 min and 5,190 ml in patients undergoing total vertebral column resection, with average correction rate of scoliosis and kyphosis being 63.3 and 71.1%, respectively. Mean operating time and intraoperative hemorrhage in patients undergoing instrumentation alone was 246 min and 1,450 ml, with the average correction rate of scoliosis and kyphosis being 60.8 and 53.4%, respectively. The mean follow-up duration was 32.2 months. No iatrogenic neurological deterioration had been encountered during the operation procedure and follow-up. After vertebral column resection, neurological dysfunctions such as relaxation of anal sphincter or hypermyotonia that occurred in three patients preoperatively improved gradually. In summary, suboccipital decompression prior to correction of spine deformity may not always be necessary for adolescent patients with scoliosis associated with Chiari I malformation. Particularly in patients with a severe and rigid curve or with significant neurological deficits, posterior approach total vertebral column resection is likely a good option, which could not only result in satisfactory correction of deformity, but also decrease the risk of neurological injury secondary to surgical intervention by shortening spine and reducing the tension of spinal cord.

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Section: Discussionmentioning

confidence: 48%

One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?

et al. 2011

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“…A PSO can apply to patients with sharp, angular kyphosis and anterior column fusion [3]. Nevertheless, the excessive shortening of the area variable for the cord can be dangerous with a PSO and authors have recommended limiting the correction to 30-40° [7]. Therefore, neither the SPO nor a PSO would be suitable to correct a severe kyphotic deformity with a Konstam's angle beyond 90°.…”

Section: Discussionmentioning

confidence: 99%

Posterior-only multilevel modified vertebral column resection for extremely severe Pott’s kyphotic deformity

et al. 2009

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Extremely severe Pott's kyphotic deformity cannot be completely corrected by conventional techniques, including vertebral body resection, Smith-Peterson, pedicle subtraction osteotomy or even vertebral column resection (VCR). The authors developed a new technique combining transpedicular eggshell osteotomies and VCR as multilevel modified vertebral column resection (MVCR) through a single posterior approach for surgical treatment of Pott's kyphosis with Konstam's angle beyond 90°. A total of 9 patients (6 males, 3 females) in our institution with severe Pott's kyphosis who underwent single-stage posterior-only multilevel MVCR were retrospectively reviewed. The candidates for multilevel MVCR were those with a sharp, angular kyphosis in the lower thoracic or upper lumbar spine with a Konstam's angle beyond 90°.

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“…Therefore, most authors hold that one-stage neural decompression, such as enlargement of the foramen magnum, drainage of syringomyelia and resection of filum terminale, is necessary. But recent studies [20][21][22][23][24] have demonstrated that shortening of the spine can improve the morphology and tension of the spinal cord, thus improving its function. Xie et al [25] believed that, for adolescents with a main curve [90°or associated with significant neurologic deficits before surgery, PVCR was appropriate and effective alternative because it could appropriate shortening of the spinal cord improves the blood supply, decrease the tension of spinal cord and, subsequently, the function of the spinal cord.…”

Section: Clinical Factorsmentioning

confidence: 99%

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

et al. 2013

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Purpose To determine the risk factors of neurologic deficits during PVCR correction, so as to help improve safety during and after surgery. Methods A consecutive series of 76 patients with severe and rigid spinal deformities who were treated with PVCR at a single institution between October 2004 and July 2011 were included in our study. Of the 76 patients, 37 were male and 39 female, with an average age of 17.5 years (range 10-48 years). There were 52 adolescent patients (with an age \18 years) and 24 adult patients (with an age C18 years). Preoperatively, postoperatively and 6 months after surgery, we performed systemically neurologic function evaluations of each patients through meticulous physical examination. Any new abnormality or deterioration in evaluation of neurologic function than preoperative is reckoned postoperative neurologic deficits. Ten variables that might affect the safety of neurologic deficits during PVCR procedures, including imaging factors, clinical factors and operational factors, were analyzed using univariate analysis. Then the variables with statistical difference were analyzed by using multi-factor unconditional logistic regression analysis. Results No patient in this series had permanent paraplegia and nerve root injury due to operation. Change of neurologic status was found in six patients after surgery. Results of single-factor comparison demonstrated that the following seven variables were statistically different (P \ 0.05): location of apex at main curve (X 3 ), Cobb angle at the main curve at the coronal plane (X 4 ), scoliosis associated with thoracic hyperkyphosis (X 5 ), level of vertebral column resected (X 6 ), number of segmental vessels ligated (X 7 ), preexisting neurologic dysfunction (X 8 ), and associated with intraspinal and brain stem anomalies (X 9 ). The multi-factor unconditional logistic regression analysis revealed that X 8 (OR = 49.322), X 9 (OR = 18.423), X 5 (OR = 11.883), and X 6 (OR = 8.769) were independent and positively correlated with the neurologic deficit. Conclusions Preexisting neurologic dysfunction, associated with intraspinal and brain stem anomalies, scoliosis associated with thoracic hyperkyphosis and level of vertebral column resected are independent risk factors for neurologic deficits during PVCR procedure.

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Influence of Acute Shortening on the Spinal Cord: An Experimental Study

Cited by 151 publications

References 40 publications

One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?

One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?

Posterior-only multilevel modified vertebral column resection for extremely severe Pott’s kyphotic deformity

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

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