Efficacy of intramedullary and extramedullary decompression and lavage therapy under microscope for treatment of chronic cervical spinal cord injury

J South Med Univ, 2018 · DOI: 10.3969/j.issn.1673-4254.2018.02.09 · Published: February 1, 2018

Simple Explanation

This study investigates the effectiveness of different surgical approaches for treating chronic cervical spinal cord injury, specifically comparing standard decompression with a more extensive decompression and irrigation technique. The researchers analyzed the outcomes of patients who underwent either standard decompression (Group A) or a more involved procedure including spinal cord incision, adhesion release, and irrigation (Group B). The study found that the more extensive surgical approach (Group B) led to better clinical outcomes and a shorter recovery time compared to the standard decompression (Group A).

Study Duration

7 Years (2008-01 to 2015-01)

Participants

57 patients with chronic cervical spinal cord injury

Evidence Level

Not specified

Key Findings

1
Patients undergoing intramedullary and extramedullary decompression (Group B) showed significantly higher JOA scores and improvement rates compared to those undergoing extramedullary decompression alone (Group A).
2
Inflammatory factors (IFN-γ, IL-17F, IL-6, sCD40L) were significantly elevated in the cerebrospinal fluid of patients with chronic cervical spinal cord injury.
3
The group undergoing the more extensive procedure had a shorter recovery time, reaching a plateau in 3 months, suggesting a quicker return to stability.

Research Summary

This study compared the clinical efficacy of intramedullary and extramedullary decompression with lavage therapy versus extramedullary decompression alone for chronic cervical spinal cord injury. The results indicated that intramedullary and extramedullary decompression achieved better outcomes, potentially due to relieving adhesions, secondary compression, and reducing local inflammatory factors. The study suggests that altering the local microenvironment can promote nerve function recovery and shorten the time to reach a plateau, leading to improved functional outcomes.

Practical Implications

Surgical Approach

Intramedullary and extramedullary decompression should be considered for chronic cervical spinal cord injury to potentially achieve better outcomes compared to extramedullary decompression alone.

Inflammation Management

Addressing local inflammation during surgery may improve nerve function recovery in chronic cervical spinal cord injury.

Recovery Time

Intramedullary and extramedullary decompression may lead to a shorter recovery time for patients with chronic cervical spinal cord injury.

Study Limitations

1
The study only conducted a recent efficacy follow-up contrast of 12 months after surgery, and the neural functional improvement of the two groups of patients over 1 year after surgery could not be continuously evaluated.
2
The study only tested four common inflammatory factors in the intramedullary decompression group.
3
The study did not perform invasive cerebrospinal fluid sampling and testing in the extramedullary decompression group to avoid increasing iatrogenic spinal cord injury during surgery.

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