Could extended laminectomy effectively prevent spinal cord injury due to spinal shortening after 3-column osteotomy?
Tóm tắt
To explore whether the laminectomy extension can effectively prevent spinal cord injury (SCI) due to spinal shortening after 3-column osteotomy in goat models.
A total of twenty healthy goats were included and done with 3-column osteotomy of T13 and L1 under the somatosensory evoked potential (SSEP) monitoring. The samples were divided into two groups. The first group underwent regular laminectomy while the second group underwent an extended laminectomy with an extra 10 mm-lamina cranial to L2. The SSEP measured after 3-column osteotomy was set as the baseline, and the SSEP decreased by 50% from the baseline amplitude and/or delayed by 10% relative to the baseline peak latency was set as positive results, which indicated spinal cord injury. The vertebral column was gradually shortened until the SSEP monitoring just did not show a positive result. The height of the initial osteotomy gap (the distance from the lower endplate of T12 to the upper endplate of L2), the shortened distance (△H), the number of spinal cord angulated and the changed angle of the spinal cord (△α) were measured and recorded in each group. Neurological function was evaluated by the Tarlov scores on day 2 postoperatively.
All the goats except one of the first group due to changes in the SSEP during the osteotomy were included and analyzed. In the first group, the height of the initial osteotomy segment and the safe shortening distances were 61.6 ± 2.6 mm and 35.2 ± 2.6 mm, respectively; the spinal cord of 5 goats was angulated (46.4 ± 6.6°), the other four goats were kinked and not angulated. In the second group, the height of the initial osteotomy segment and the safe shortening distances were 59.8 ± 1.5 mm and 43.3 ± 1.2 mm, respectively, and the spinal cord of ten goats were angulated (97.6 ± 7.2°). There was no significant difference in the height of the initial osteotomy segment between the two groups by using Independent-Samples T-Test, P = 0.095 (P > 0.05); there were significant difference in the safe shortening distance and the changed angle of the spinal cord between the two groups by using Independent-Samples T-Test (both
An additional resection of 10 mm-lamina cranial to L2 showed the satisfactory effect in alleviating SCI after 3-column osteotomy. Timely and appropriate extend laminectomy could be a promising therapeutic strategy for SCI attributable to facilitating spinal cord angulation rather than spinal cord kinking and increasing the safe shortening distance.
Từ khóa
Tài liệu tham khảo
Lu QA, Wang YS, Xie JM, et al. Effect of spinal shortening for Protection of spinal cord function in canines with spinal cord angulation. Med Sci Monit. 2019;25:9192–9.
Sui WY, Huang ZF, Deng YL, et al. The Safety and Efficiency of PVCR without Anterior Support Applied in Treatment of Yang Type a severe thoracic kyphoscoliosis. World Neurosurg. 2017;104:723–8.
Huang JH, Yang WZ, Shen C, et al. Surgical Treatment of congenital scoliosis Associated with tethered cord by thoracic spine-shortening Osteotomy without Cord Detethering. Spine. 2015;40:E1103–9.
Yang HZ, Wang BB, Zou XB, et al. Relationship between the laminectomy extension and spinal cord injury caused by acute spinal shortening: goat in vivo experiment. Eur Spine J. 2020;29:1167–74.
Alemdaroğlu KB, Atlihan D, Cimen O, et al. Morphometric effects of acute shortening of the spine: the kinking and the sliding of the cord, response of the spinal nerves. Eur Spine J. 2007;16:1451–7.
Singh PM, Reid K, Gaddam R, et al. Effect of choline chloride premedication on xylazine-induced hypoxaemia in sheep. Vet Anaesth Analg. 2017;44:1149–55.
Morris SH, El-Hawary R, Howard JJ, et al. Validity of somatosensory evoked potentials as early indicators of neural compromise in rat model of spinal cord compression. Clin Neurophysiol. 2013;124:1031–6.
Vialle R, Loureiro MC, Ilharreborde B, et al. The feasibility of detecting motor and sensory potentials in a sheep model. Lab Anim. 2006;40:469–73.
Teng WN, Tsou MY, Chen PT, et al. A desflurane and fentanyl dosing regimen for wake-up testing during scoliosis surgery: implications for the time-course of emergence from anesthesia. J Formos Med Assoc. 2017;116:606–12.
Gürer B, Kertmen H, Kasim E, et al. Neuroprotective effects of testosterone on ischemia/reperfusion injury of the rabbit spinal cord. Injury. 2015;46:240–8.
Camlar M, Turk Ç, Buhur A, et al. Does Decompressive Duraplasty have a neuroprotective effect on spinal trauma?: an experimental study. World Neurosurg. 2019;126:e288–94.
Maier SP, Smith JS, Schwab FJ, et al. Revision surgery after 3-Column osteotomy in 335 patients with adult spinal deformity: Intercenter variability and risk factors. Spine. 2014;39:881–5.
Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res. 2010;468:687–99.
Raman T, Passias PG, Kebaish KM. Asymmetric three-column osteotomy for coronal malalignment in adult patients with prior thoracic Fusion for adolescent idiopathic scoliosis: three-year follow-up. World Neurosurg. 2019;131:e441–6.
Dalle OCL, Ames CP, Deviren V, et al. Outcomes following single-stage posterior vertebral column resection for severe thoracic kyphosis. World Neurosurg. 2018;119:e551–9.
Qiu F, Yang JC, Ma XY et al. Relationship between spinal cord volume and spinal cord Injury due to spinal shortening. Plos One. 2015;10(5):e0127624.
Kawahara N, Tomita K, Kobayashi T et al. Influence of acute shortening on the spinal cord: an experimental study. Spine. 2005:30(6):613–20.
Ji L, Wang S, Lan B, Lv M, Li J, Huang Y, Huang S, Liu S. Protective effect of Extended Laminectomy on spinal cord Injury Induced by spinal shortening. J Neurotrauma. 2022;39(15–16):1039–49.
Wang BY, Wu TK, Liu H, et al. Biomechanical analysis of bilateral Facet Joint stabilization using Bioderived Tendon for posterior cervical spine motion reservation in goats. World Neurosurg. 2017;107:268–75.
Yang HZ, Wang BB, Zou XB, et al. Safe limit of shortening of the spinal cord in Thoracolumbar Bivertebral Column Resections: an experimental study in goats. World Neurosurg. 2020;134:e589–95.
Chen J, Yang JF, Deng YL, et al. A retrospective study of Surgical correction for spinal deformity with and without osteotomy to compare Outcome using intraoperative neurophysiological monitoring with evoked potentials. Med Sci Monit. 2020;26:e925371.
Hilibrand AS, Schwartz DM, Sethuraman V, et al. Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical spine surgery. J Bone Joint Surg Am. 2004;86:1248–53.
Jorge A, Zhou J, Dixon EC, et al. Area under the curve of Somatosensory Evoked Potentials detects spinal cord Injury. J Clin Neurophysiol. 2019;36:155–60.