Journal of neurosurgery. Spine
-
The surgical treatment of severe and rigid spinal deformities poses difficulties and dangers. In this article, the authors summarize their surgical techniques and evaluate patient outcomes after performing posterior vertebral column resection (PVCR) for the correction of spinal deformities with curves greater than 100°, and investigate the crucial points to ensure neurological safety during this challenging procedure. ⋯ Posterior vertebral column resection was effective in correcting severe rigid spinal deformity, although the procedure was technically demanding, exhaustingly lengthy, and was associated with a variety of complications. The PVCR technique created a space for spinal correction and spinal cord tension adjustment and the correction could be performed under direct inspection and by palpation of the tension in the spinal cord through the space. Therefore, in terms of the spinal cord, the deformity correction process involved in the PVCR procedure is relatively safe.
-
Case Reports
Novel surgical technique for ossification of posterior longitudinal ligament in the thoracic spine.
Several surgical procedures have been developed to treat thoracic ossification of the posterior longitudinal ligament (OPLL). However, favorable surgical results are not always achieved, and consistent protocols and procedures for surgical treatment of thoracic OPLL have not been established. This technical note describes a novel technique to achieve anterior decompression via a single posterior approach. ⋯ In every step of the anterior decompression, the space created in the bilateral sides of the dural sac allowed the surgeons to see the OPLL and anterolateral aspect of the dural sac directly and easily. After removal of the ossified PLL, posterior instrumented fusion was performed. This surgical procedure allows the surgeon to perform, safely and effectively, anterior decompression via a posterior approach for thoracic OPLL.
-
Noncommunicating canalicular syringomyelia occurs in up to 65% of patients with Chiari malformation Type I. The pathogenesis of this type of syringomyelia is poorly understood and treatment is not always effective. Although it is generally thought that syringomyelia is simply an accumulation of CSF from the subarachnoid space, the pathogenesis is likely to be more complex and may involve cellular and molecular processes. Aquaporin-4 (AQP4) has been implicated in numerous CNS pathological conditions involving fluid accumulation, including spinal cord edema. There is evidence that AQP4 facilitates the removal of extracellular water following vasogenic edema. The aim of this study was to investigate AQP4 expression and the structural and functional integrity of the blood-spinal cord barrier (BSCB) in a model of noncommunicating canalicular syringomyelia. ⋯ This study demonstrated a prolonged disruption of the BSCB directly surrounding the central canal in the experimental model of noncommunicating canalicular syringomyelia. The disruption was widespread at 12 weeks, when central canal dilation was most marked. Loss of integrity of the barrier with fluid entering the interstitial space of the spinal parenchyma may contribute to enlargement of the canal and progression of syringomyelia. Significant changes in AQP4 expression were not observed in this model of canalicular syringomyelia. Further investigation is needed to elucidate whether subtle changes in AQP4 expression occur in canalicular syringomyelia.