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Journal of Neurorestoratology  2018, Vol. 6 Issue (1): 158-164    doi: 10.26599/JNR.2018.9040017
Research Article     
Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation
Dionne Telemacque1, Fengzhao Zhu1, Kaifang Chen1, Lin Chen2, Zhengwei Ren1, Sheng Yao1, Yanzheng Qu1, Tingfang Sun1, Xiaodong Guo1,(✉)
1 Sino-Canada Spine and SCICenter, Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China
2 Department of Neurorestoratology, Neurosurgery Center, Tsinghua University Yuquan Hospital, Beijng, China
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Abstract  Introduction:

We developed the method of cervical spinal cord decompression through durotomy followed by duroplasty and analyzed its efficacy.

Purpose:

To develop a tactic of decompression durotomy and duroplasty for the treatment of severe spinal cord injury(SCI) with extensive edema of the spinal cord and without intramedullary hematoma, and to demonstrate the effectiveness of this method.

Methods:

From October 2016 to January 2018, 17 decompression operations were performed in the cervical spine in patients with SCI. Decompression laminectomy was done without durotomy in the first group of patients. In the second group, duroplasty of the spinal cord was performed after decompression durotomy. A total of 17 patients, 16 males (94%) and 1 female (6%), were operated on (ages from 32 to 66 years). The patients were divided into two groups: a control group and an experimental group. We used the ASIA scale for assessing the patients. The mean follow up time is 12 months (8−24 months).

Results:

The first group, i.e., the control group consisted of 10 patients who underwent decompression laminectomy without durotomy. The second group, i.e., the experimental group consisted of 7 patients who underwent durotomy followed by duroplasty. In this group, the positive dynamics were observed in 6 patients. Out of 2 patients with ASIA grade “A”, one showed improvement to ASIA grade “C”, and one improved to ASIA “D”. Two patients with ASIA grade “B” showed recovery to ASIA “D”. Two patients with ASIA grade “C” improved to grade “D” while one patient showed no change from ASIA “C”. Durotomy and duroplasty was effective in the experimental group.

Conclusion:

The performance of durotomy and duroplasty is an efficient method for the full-scale decompression of the spinal cord and the prevention of edema. This method aims at decreasing intraspinal pressure, as well as preventing ischemia and apoptosis, which is possible for the prevention and treatment of the spinal cord compartment syndrome or spinal cord intramedullary hypertension.



Key wordsspinal cord injury      spinal cord compartment syndrome      decompression      durotomy      spinal cord intramedullary hypertension     
Received: 11 October 2018      Published: 30 December 2018
Corresponding Authors: Xiaodong Guo   
About author:

§ These authors contributed equally to this work.

Cite this article:

Dionne Telemacque, Fengzhao Zhu, Kaifang Chen, Lin Chen, Zhengwei Ren, Sheng Yao, Yanzheng Qu, Tingfang Sun, Xiaodong Guo. Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation. Journal of Neurorestoratology, 2018, 6: 158-164.

URL:

http://jnr.tsinghuajournals.com/10.26599/JNR.2018.9040017     OR     http://jnr.tsinghuajournals.com/Y2018/V6/I1/158

Fig. 1The spinal cord can be observed after incision of the dura.
Fig. 2The dural patch sutured with the dura after duroplasty.
Method of decompressionASIA grade before operationASIA grade after operationImprovement of ASIA grade
LaminectomyBD2
BC1
CC0
CD1
CC0
AB1
BC1
BB0
CD1
CC0
DurotomyAC2
AD3
BD2
BD2
CD1
CD1
CC0
Table 1Changes of ASIA grade after surgery (A-A, B-B, C-C, D-D─0; A-B, B-C, C-D─1; A-C, B-D─2; A-D, B-E─3).
Fig. 3One case of duroplasty: A and B show the preoperative cervical CT and MRI; C, D and E show the intra-operative imaging; F, G and H show the postoperative imaging of this patient.
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