Jyi-Feng Chen

In situ local autograft for instrumented lower lumbar or lumbosacral posterolateral fusion

This study evaluated the effectiveness of local in situ autografts in instrumented posterolateral fusion of the lower lumbar or lumbosacral spine for treating degenerative spondylolisthesis. The subjects were 182 degenerative spondylolisthesis patients with spinal canal stenosis who, in one operation, underwent lumbar laminectomy with two-level (L3-4, L4-5 or L5-S1) transpedicle screw/rod system instrumentation and posterolateral fusion using autogenous spinous processes and laminae as the only source of bone grafts. The surgical results were assessed clinically and radiologically. All patients received follow-up for at least eighteen months. At the end of follow-up, bilateral fusion mass was radiographically confirmed in 113 (62%) patients, unilateral fusion mass was observed in fifty-seven (31%) patients, and twelve (7%) patients exhibited no fusion mass at the arthrodesis level. The clinical outcome was rated excellent/good in 138 (76%) patients, fair in thirty-five (19%) and poor in nine (5%). Use of in situ local autografts yields satisfactory clinical results in instrumented posterolateral spinal fusion. No significant correlation was noted between the level of arthrodesis and the radiological outcome, nor between the level of arthrodesis and the clinical outcome. Radiographic evaluation of bony fusion mass was not predictive of the clinical findings.

Classification of symptomatic osteoporotic compression fractures of the thoracic and lumbar spine

The pathophysiology of osteoporotic compression fractures is different from those occurring secondary to traumatic spinal injury, and currently, there is no classification suitable for symptomatic osteoporotic compression fractures treated by percutaneous vertebroplasty. We propose a new classification based on the radiological appearance in the subacute or chronic stage of the clinical presentation of these fractures. They are classified by the authors based on observations and measurements from preoperative and postoperative dynamic lateral radiographs. Compression fractures are divided into two types. Type I is a compression fracture involving the anterior column only. Type II is a fracture involving both the anterior and middle column. Each type is divided into two groups: fractures with union and those with non-union. Type II compression fractures have a higher incidence of non-union than type I (p<0.05). In both type I and II non-union groups, fractures achieve greater increase in vertebral body height after vertebroplasty than both type I and type II union group fractures (p<0.05). In both non-union groups, fractures achieved a greater reduction of kyphotic angle post-vertebroplasty than type I and II union group fractures (p<0.05). Further clinical follow-up of these patients will confirm and extend this classification.

Continuous regional cerebral blood flow monitoring in the neurosurgical intensive care unit.

The aim of this study was to examine the intracranial pressure (ICP) and regional cerebral blood flow (rCoBF) changes during the acute stage of severe head injury and to improve outcome by modifying treatment modalities using real-time ICP and rCoBF data. Twenty patients with moderate or severe head injury that were monitored in our neurosurgical intensive care unit were included in this study. The changes in ICP, rCoBF and the relationship of ICP/rCoBF were observed. In patients with high ICP and low rCoBF, mannitol improves the rCoBF and decreases the ICP of these patients. When low rCoBF exists, hyperventilation may lead to a rapid further decline of rCoBF, however, some hyperemic brains respond well to hyperventilation treatment. Triple-H therapy is suitable for those with low rCoBF without significantly high ICP, which is an abnormal condition considered to be caused by vasospasm.

Repeated Percutaneous Balloon Compression for Recurrent Trigeminal Neuralgia: A Long-Term Study

BACKGROUND Percutaneous balloon compression (PBC) is an alternative surgical treatment for trigeminal neuralgia refractory to carbamazepine. PBC is the preferred procedure for some patients. However, to our knowledge, the clinical results of repeat PBC have not been reported thus far. OBJECTIVE The aim of this study was to evaluate the outcomes of and the complication rates associated with repeat PBC performed for recurrent trigeminal neuralgia, over an 8-year study period. METHODS Until July 2004, we performed PBC in 272 consecutive patients with typical symptoms of unilateral trigeminal neuralgia at our hospital. PBC was successful in 43 patients, and they did not experience any pain for at least 3 months; however, symptoms recurred later. Among these 43 patients, 32 underwent a repeat (second) PBC whereas 11 received pharmacologic treatment. The repeat PBC was performed between March 2001 and December 2004, and the patients were followed up till June 2010. RESULTS Thirty-two patients with recurrent trigeminal neuralgia participated in this study. The follow-up period ranged from 5.08 to 8.75 years (mean, 6.43 years). After the repeat PBC, 30 patients (93.8%) experienced immediate relief from neuralgia. None of the patients developed transient diplopia or anesthesia dolorosa. Although 2 patients (6.2%) experienced severe hypoesthesia, they could tolerate it. Six patients (18.8%) showed limited mandibular activity. No major surgical or anesthetic complication was observed, and death did not occur. Pain did not recur in any patient for 3 months after the surgery. The symptoms recurred in 5 patients (16.7%) within 2 years, in 7 patients (23.3%) within 3 years, and in 12 patients (40%) within 5 years after the surgery. Over the 8-year study period, symptoms recurred in 13 patients (43.3%). CONCLUSIONS Repeated PBC is recommended for patients with recurrent trigeminal neuralgia after the first PBC or other unsuccessful treatments. Although the recurrence rate associated with the repeat PBC was slightly higher than that associated with the first, repeated PBC was safe, less complicated, and associated with a low incidence of dysesthesia and had a high success rate.

A hollow cylindrical PMMA strut for cervical spine reconstruction after cervical multilevel corpectomy.

Study Design: Between January 2002 and December 2005, a prospective study was performed with 14 patients. The patients had cervical diseases and received more than 1 segment anterior cervical corpectomies. Objectives: We investigated the effectiveness of the hollow cylindrical polymethyl methacrylate (PMMA) strut with the autograft for fusion and reconstruction of the cervical spine after multiplelevel cervical corpectomy. Summary of Background Data: We usually used the titanium mesh cage to reconstruct the cervical spine after cervical corpectomy. A significant number of poor outcomes were noted. Because the mesh cage is very hard, it sinks into the vertebral body without the cortex. It is also difficulty to assess the fusion status. Methods: A total of 14 patients (age range: 31 to 76 y) underwent anterior cervical corpectomy after fusion and reconstruction with cylindrical PMMA struts. Each patient was reinforced with anterior cervical plate fixation. Follow-up radiographic evaluation was comprised of plain lateral dynamic radiographs and computerized tomography (CT) scans. We evaluated the patients for cervical lordosis and vertebral body height on the basis of plain radiographs. The fusion status was evaluated with CT scans. Neurologic status was assessed preoperative and postoperatively using the Nuricks grading system. Results: The mean follow-up was 48.2 months (range: 28 to 70 mo). All patients showed spinal stability at 6 months follow-up on the basis of plain lateral dynamic radiograph results. Thirteen patients showed neurologic improvement with complete bony fusion in the 24-month reconstructed CT scans. There were no complications related to the hollow cylindrical PMMA strut. One patient had loosened screws and required a second operation. Conclusions: The cylindrical PMMA strut provides solid fusion and increased cervical lordosis and vertebral body height. There are few complications associated with the use of this strut, and neurologic recovery is satisfactory. The hollow cylindrical PMMA strut, combined with an anterior cervical plate, is a very successful surgical construct in these patients after long-segmental cervical corpectomy.

Long-Term Follow-up of Patients Treated with Percutaneous Balloon Compression for Trigeminal Neuralgia in Taiwan

OBJECTIVE This study aimed to evaluate the outcomes and complication rates associated with percutaneous balloon compression (PBC) for trigeminal neuralgia for a 10-year follow-up period. METHODS A total of 185 patients with trigeminal neuralgia were treated with an initial PBC between July 2000 and December 2001 and were followed up until July 2010. PBC was performed under general anesthesia with endotracheal intubation. Meckels cave was cannulated with a No. 4 Fogarty catheter, and the balloon was inflated for 70-90 seconds. RESULTS Treatment and long-term follow-up was completed for 130 of the 185 patients. The mean length of the follow-up period was 8.9 years. Sixty-two patients (47.7%) were 65 years of age or older. Seventy-eight patients (60%) had pain involving the ophthalmic or multiple trigeminal divisions. One hundred twenty-two patients (93.8%) experienced immediate relief from neuralgia after the procedure. No pain recurred within 3 months. Seventeen patients (14%) had recurrent symptoms within 2 years. Twenty-three patients (18.9%) had recurrent symptoms within 3 years. Thirty-six patients (29.5%) had recurrent symptoms within 5 years. A total of 46 patients (37.7%) had recurrent symptoms during the entire study period. CONCLUSIONS PBC is a technically simple, less painful procedure carried out under brief general anesthesia and is well tolerated by patients. The operation success rate is high, and the recurrence rate is similar to that of other reports. We also found that longer compression time resulted in longer symptom-free periods.

Cerebrospinal fluid galactorrhea: A rare complication of ventriculoperitoneal shunting

In this report we describe a 26-year-old woman who had an intra-abdominal pseudocyst located at the peritoneal catheter tip following ventriculo-peritoneal (VP) shunt implantation. Retrograde cerebrospinal fluid (CSF) flowed outside the catheter and communicated with the right breast lactiferous ductal system and leaked from the nipple orifice. CSF galactorrhea only occurs when the lactiferous duct is injured during VP shunt implantation, in combination with the formation of an intra-abdominal CSF pseudocyst prior to lactiferous duct healing. Leakage of CSF from the nipple orifice can be successfully treated by simply guiding the peritoneal catheter tip into the peritoneal cavity through a new laparotomy; that is, shunt revision is not always required.

Clinical experience with rigid occipitocervical fusion in the management of traumatic upper cervical spinal instability.

Traumatic injuries of the craniovertebral junction or the upper cervical spine may result in occipitocervical (OC) or upper cervical spinal instability. Internal fixation can provide immediate stability to this region. Over a 6-year period, 16 patients with traumatic upper cervical spinal instability underwent a posterior approach OC fusion, using a plate and screw system, at the neurosurgical department of our institution. One patient died. The postoperative course of all the other patients was uncomplicated. At the most recent follow-up examination, all patients had satisfactory fusion. OC fusion with a plate and screw system is a safe and effective method for the treatment of traumatic craniovertebral and high cervical spine instability. Accurate imaging diagnosis and strict patient selection are the keys to a successful outcome.