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Journal of Neurorestoratology  2018, Vol. 6 Issue (1): 152-157    doi: 10.26599/JNR.2018.9040014
Research Article     
Early intradural microsurgery improves neurological recovery of acute spinal cord injury: A study of 87 cases
Jiaxin Xie, Xunding Deng, Yu Feng, Ning Cao, Xin Zhang, Fang Fang, Shemin Zhang, Yaping Feng(✉)
People’s Liberation Army Clinical Center for Spinal Cord Injury, Department of Neurosurgery, The 920th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, China
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Abstract  Objective:

To introduce a novel intradural microsurgery method for acute spinal cord injury, while evaluating the safety and effect.

Methods:

87 patients with complete spinal cord injury were enrolled and treated with the novel intradural microsurgery within 48 h, in addition to traditional surgical interventions (internal fixation, laminectomy).

Results:

Complications including massive hemorrhage, infection and impairment aggravation did not occur during and after surgery. There were 16 cases of B grade, 13 cases of C grade, 6 cases of D grade base on the ASIA impairment scale 3 months after surgery, and average 18.51 increase in motor score, 16.64 increase in light touch score, 17.12 increase in pin prick score were achieved.

Conclusions:

Early intradural microsurgery is safe, causing no neurological function lost and no major adverse event, and it is associated with neurologic improvement in patients with severe spinal cord injury.



Key wordsspinal cord injury      decompression      microsurgery     
Received: 12 October 2018      Published: 30 December 2018
Corresponding Authors: Yaping Feng   
Cite this article:

Jiaxin Xie, Xunding Deng, Yu Feng, Ning Cao, Xin Zhang, Fang Fang, Shemin Zhang, Yaping Feng. Early intradural microsurgery improves neurological recovery of acute spinal cord injury: A study of 87 cases. Journal of Neurorestoratology, 2018, 6: 152-157.

URL:

http://jnr.tsinghuajournals.com/10.26599/JNR.2018.9040014     OR     http://jnr.tsinghuajournals.com/Y2018/V6/I1/152

Intraoperative FindingsSurgical Procedures
(a) The spinal arachnoid was intact. The spinal cord appeared pale, swollen, lack of pulsation, but no softening.Opened the spinal arachnoid by a longitudinal incision. Explored and removed adhesion of the spinal arachnoid to restore the pulsation of the cord and CSF flow.
(b) The spinal arachnoid was intact. The spinal cord appeared pale, swollen, lack of pulsation, and softening region of the spinal cord was found.Opened the spinal arachnoid by a longitudinal incision. Explored and removed adhesion of the spinal arachnoid to restore the pulsation of the cord and CSF flow. Moreover, a 0.3−0.5 cm longitudinal incision was made over the tissue softening region to remove intraspinal softening necrotic tissue. The lesion cavity was rinsed with physiological saline gently.
(c) The spinal arachnoid was lacerated. The spinal cord tissue was severely damaged partly liquefied.Explored the injury site. Open the dura longitudinally to allow the gush out of degenerated tissue. Washed the region gently with physiological.
Table 1Intraoperative findings and corresponding surgical procedures.
Fig. 1Imaging examinations before surgery.
Fig. 2Morphology of injured spinal cord during surgery: (A) The spinal cord was hyperemic and swelling; (B) the necrotic tissue poured out during surgery.
ASIA Impairment ScaleABCDE
Time 1870000
Time 259131140
Time 352161360
Table 2Distribution of ASIA Impairment Scale Grade (cases) (n=87).
Spinal Cord FunctionTime 1Time 2Time 3Final improvement
Motor score40.3253.47 a58.83 a18.51
Light touch score65.6278.35 a82.26 a16.64
Pin prick score66.4779.52 a83.59 a17.12
Table 3Average ASIA score of the patients before and after surgery (n=87).
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