1995 Fiscal Year Final Research Report Summary
Anatomical and experimental investigntion on postoperative ralimlopattiy after postenior decompresion of the cervical spinal cord
| Project/Area Number |
05807135
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| Research Category |
Grant-in-Aid for General Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Research Field |
Orthopaedic surgery
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| Research Institution | Saitama Medical School |
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Principal Investigator |
TSUZUKI Nobuyuki Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical School, Professor, 医学部, 教授 (10049794)
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| Project Period (FY) |
1993 – 1995
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| Keywords | cervical mycloputhy / posterior decompression of cervical spinal cord / postoperative palsy of arm / mechanism of occurrence |
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| Research Abstract |
Based on anatomical and clinical studies on the cervical spinal cord and root using 20 Japanese adults and 118 patients, the following facts were elucidated. 1) There were two possible sites for the occurrence of post-decompressive tethering effects on cervical roots, i.e., intradural and extraural. 2) Extradural tethering effect could be induced by exertion of dural traction force on extradural roots which were anchored to the intervertebral foramina by perineural adhesion, resulting in traction injury of extradural roots. 3) Anatomical characteristics of intra-and extradural portions of a root indicated that the extradural tethering effect might be the most probable cause of post-operative palsy and it was verified by a clinical study. 4) As methods of prevention for each of these tethering effects, a longitudinal durotomy was effectivi in reducing extradural tehthering effect and a suppression of posterior enlargement of dural tube to that degree that allowed intradural rootlets remain relaxd was thought to be effective for prevention of intradural tethering effect. In another series of posterior decompression consisting with 43 patients, dural pressures just posterior to C5 root-sleeve were measured using a 2-9 nylon thread with a diameter of 0.3mm. of nine patients with a dural perssure higher than 40 g-weight/mm^2,4patients developed post-operative C5 palsy. Of twenty nine patients with a dural pressure lower than 40 g-weight/mm^2, one patient developed post-operative C5 palsy. There was a difference of statistical significance (X^2=4.35, p<0.05) between those two groups. This result showed that measurement of dural pressure during surgery might be useful to detect a possibility of post-operative palsy. Further studies are required to develop a more accurate method for predicting post-operative palsy and a simpler method of prevention of it than a longitudinal durotomy.
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