Role of Intraoperative Disc Contrast Injection in Determining the Segment Responsible for Cervical Spinal Cord Injury without Radiographic Abnormalities

Zhang, Jidong; Xiang, Qun

doi:10.1111/os.12197

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…A hyperextension injury, which is accompanied by anterior longitudinal ligament rupture, intervertebral disc destruction, or cervical fracture-dislocation, induces cervical instability and raises the risk of cervical spinal cord injury (SCI) due to pre-existing CSCS [3]. Anterior longitudinal ligament and intervertebral disc rupture are common findings on magnetic resonance imaging (MRI) in patients with a hyperextension cervical injury without fracture or dislocation [1,4,5]. The risk of cervical instability demands surgical stabilization to prevent additional harm.…”

Section: Introductionmentioning

confidence: 99%

Comparison of laminoplasty and posterior segment fusion with laminoplasty and anterior segment fusion for treating acute extensional cervical spinal cord injury in pre-existing canal stenosis: a multicenter retrospective study

Lv,

Zou,

Xiong

et al. 2024

JCTR

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Background: Patients with pre-existing cervical spinal canal stenosis (CSCS) are more likely to suffer from an extensional spinal cord injury (SCI). However, the appropriate surgical alternatives for extended cervical SCIs in individuals with pre-existing CSCS remain unknown. The purpose of this study was to evaluate the clinical efficacies of laminoplasty and posterior short-segment fusion (PSF) with laminoplasty and anterior short-segment fusion (ASF) in the treatment of these patients. Methods: The clinical data of 258 patients from six spine centers were included in this retrospective study. Patients were divided into two different groups based on the surgical approach: laminoplasty and PSF (PSF group) and laminoplasty and ASF (ASF group). ASIA grades and JOA scores were obtained before and after surgery to assess neurological function. Results: There were 116 patients in the PSF group and 142 patients in the ASF group. The average operation time, intraoperative blood loss, and hospital stay were 188 min, 298 ml, and 7.6 days, respectively, in PSF group, compared to 245 min, 366 ml, and 10.4 days in PSF group, respectively. Complete decompression was achieved in all patients, and fusion was achieved 6 months after surgery. A post-operative computed tomography scan revealed that 39/464 (8.4%) screws had perforated, but no neurovascular complications occurred. Both surgical strategies improved the ASIA grade and there was no significant difference between the two groups (P = 0.926). The JOA score improved from 6.21 ± 1.85 to 10.90 ± 3.56 in the PSF group and from 6.45 ± 2.17 to 11.48 ± 3.62 in the ASF group, but at the final follow-up, there was no significant difference between the two groups (P = 0.134). The incidence of post-operative complications in the ASF group (24/142, 16.9%) (P = 0.043) was higher than that in the PSF group (6/116, 5.17%). Conclusions: Cervical laminoplasty combined with short-segment transpedicular screw fixation is a reliable option to treat extensional cervical SCIs in patients with CSCS. This surgical strategy is beneficial for achieving sufficient cervical spinal cord decompression, preserving cervical spine stability, and avoiding extra anterior cervical decompression and fusion, thereby reducing surgery time, intraoperative blood loss volume, post-operative complication rate, and length of hospital stay. Relevance for Patients: Cervical laminoplasty combined with posterior segmental fusion (PSF) reduces operative time, bleeding, and complications and achieves adequate spinal cord decompression in the treatment of extension cervical SCI in patients with CSCS.

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Section: Introductionmentioning

confidence: 99%

Comparison of laminoplasty and posterior segment fusion with laminoplasty and anterior segment fusion for treating acute extensional cervical spinal cord injury in pre-existing canal stenosis: a multicenter retrospective study

Lv,

Zou,

Xiong

et al. 2024

JCTR

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“…which exposes the cervical cord into much higher risk of injury based on the pathological stenosis. Several research demonstrated anterior longitudinal ligament discontinuity, avulsed disc annulus were observed commonly by MRI evaluation in SCIWORA [13][14][15]. Meanwhile,significant intersegmental displacements may occur when injured cervical spine was subjected to flexion, extension, or distraction forces [16].…”

Section: Introductionmentioning

confidence: 99%

A comparative study of laminoplasty with short segment transpedicular screw fixation versus laminoplasty with anterior fusion in treating extensional cervical spinal cord injury without radio graphic abnormality in adults

Zhang

Zhou

et al. 2019

Preprint

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Background: Cervical spinal cord injury(CSCI) without major fracture or dislocation is often described as cervical SCI without radiographic abnormality (SCIWORA). Majority of this injury could be without radiographic abnormality but with disrupted anterior longitudinal ligament or intervertebral disc unless examined by MRI. The optimal surgical management of this cervical spinal cord injury remains controversial. This study is to evaluate the clinical advantages of laminoplasty combined with short-segment transpedicular screw fixation for managing this issue. Methods: SCIWORA patients were collected into two groups according to different surgical methods. Patients in group A received laminoplasty combined with transpedicular screw fixation, and patients in group B received anterior cervical fusion combined with laminoplasty. All cervical spine were assessed by X-ray, CT, MRI preoperatively and postoperatively to evaluate the decompression range, bonegraft fusion and instruments location. ASIA grade and JOA score were recorded to assess the neurological function recovery. Complications, surgery time, intraoperative blood loss and hospital stay were compared between two groups. Mean follow-up was at least 2 years. Results: In this study, Forty eight patients were in group A and 54 ones were in group B. All cases were decompressed fully and obtained fusion 6-month postoperatively. The ASIA grade was improved postoperatively, but no significantly different between two groups (p=0.907). The JOA was 6.12±1.76 preoperatively and improved to 11.98±2.98 postoperatively with the 53.13% neurofunction recovery rate in group A, with no significantly different compared with group B(vs 6.63±2.45, p=0.235; vs 12.62±3.59, p=0.303; vs 57.76%, p=0.590)respectively. Total 18 complications occurred but the occurrence was significant lower in group A(p=0.020). The average surgery time was 2.2±0.32 hours, intraoperative blood loss was 304±56ml and hospital stay was 8.2±3.1 days, significantly decreased compared with group B(vs 3.1±0.29, p=0.000; vs 388±61ml, p=0.000; vs 12±2.8days, p=0.000)respectively. Conclusions: Cervical laminoplasty combined with short-segment transpedicular screw fixation is a reliable option to treat SCIWORA patients with CSS. The advantages include achieving sufficient cervical decompression, maintaining cervical stability and avoiding extra anterior cervical fusion which increases surgery time, intraoperative blood loss, postoperative complications and hospital stay.

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“…There are several common generic self‐report measures, including the Medical Outcomes Survey Short‐Form 36 (SF‐36), the Oswestry Disability Index (ODI), the Visual Analogue Scale (VAS), and the Japanese Orthopaedic Association (JOA) scoring systems. Among these self‐report measures, the JOA scoring systems, which were released by the Clinical Outcome Committee of the JOA, are among the most common and widely used evaluation systems in Asia. The JOA scoring systems are meant to capture data related to function, perceived disability, and symptoms, including gait disturbance of patients with spinal degeneration.…”

Section: Introductionmentioning

confidence: 99%

Correlations of Japanese Orthopaedic Association Scoring Systems with Gait Parameters in Patients with Degenerative Spinal Diseases

Zheng

Liu

et al. 2016

Orthopaedic Surgery

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Role of Intraoperative Disc Contrast Injection in Determining the Segment Responsible for Cervical Spinal Cord Injury without Radiographic Abnormalities

Abstract: IODCI helps to determine the segment responsible for cervical SCIWORA.

Cited by 5 publications

References 11 publications

Comparison of laminoplasty and posterior segment fusion with laminoplasty and anterior segment fusion for treating acute extensional cervical spinal cord injury in pre-existing canal stenosis: a multicenter retrospective study

Comparison of laminoplasty and posterior segment fusion with laminoplasty and anterior segment fusion for treating acute extensional cervical spinal cord injury in pre-existing canal stenosis: a multicenter retrospective study

A comparative study of laminoplasty with short segment transpedicular screw fixation versus laminoplasty with anterior fusion in treating extensional cervical spinal cord injury without radio graphic abnormality in adults

Correlations of Japanese Orthopaedic Association Scoring Systems with Gait Parameters in Patients with Degenerative Spinal Diseases

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