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Journal of Neurorestoratology 2018, 6(1): 158-164 https://doi.org/10.26599/JNR.2018.9040017
Research Article | Open Access | Issue | Published: 30 December 2018

Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation

Show Author's Information Dionne Telemacque1,§,  Fengzhao Zhu1,§,  Kaifang Chen1,§,  Lin Chen2,  Zhengwei Ren1,  Sheng Yao1,  Yanzheng Qu1,  Tingfang Sun1,  Xiaodong Guo1
Sino-Canada Spine and SCICenter, Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China
Department of Neurorestoratology, Neurosurgery Center, Tsinghua University Yuquan Hospital, Beijng, China

§ These authors contributed equally to this work.

Keywords:
spinal cord injury, decompression, spinal cord compartment syndrome, durotomy, spinal cord intramedullary hypertension
Cite this article:
Telemacque D, Zhu F, Chen K, et al. Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation. Journal of Neurorestoratology, 2018, 6(1): 158-164. https://doi.org/10.26599/JNR.2018.9040017
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Abstract Full text About this article
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.


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Abstract
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About this article

Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation

Show Author's information Dionne Telemacque1,§, Fengzhao Zhu1,§, Kaifang Chen1,§, Lin Chen2, Zhengwei Ren1, Sheng Yao1, Yanzheng Qu1, Tingfang Sun1, Xiaodong Guo1
Sino-Canada Spine and SCICenter, Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China
Department of Neurorestoratology, Neurosurgery Center, Tsinghua University Yuquan Hospital, Beijng, China

§ These authors contributed equally to this work.

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.

Keywords: spinal cord injury, decompression, spinal cord compartment syndrome, durotomy, spinal cord intramedullary hypertension

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Publication history
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Publication history

Received: 11 October 2018
Accepted: 24 December 2018
Published: 30 December 2018
Issue date: December 2018

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© The author(s) 2018

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© The authors 2018. This article is published with open access at http://jnr.tsinghuajournals.com

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