BACKGROUND:Propagation phase contrast tomography can greatly improve the spatial resolution of chondrocytes and microvessels depending on the high colimation and high coherence performance of hard X-ray. OBJECTIVE: To detect the alteration of angioarchitecture after spinal cord injury in rats using propagation phase contrast tomography. METHODS: Eight male Sprague-Dawley rats were divided into two groups: in experimental group, an acute spinal cord injury model was induced in rats by the modified Alen’s method; in sham control group, rats were subjected to laminectomy. At 1 day after operation, normal and injured spinal cord segments were taken and treated with formaldehyde-methyl salicylate sequentialy for 48 hours. The segments were scanned by propagation phase contrast tomography in BL13W1 beamline experimental station of Shanghai Synchrotron Radiation Facility, China. Harvested data were analyzed by VGStudio Max 2.1 software for three-dimensional reconstruction and microvasculature quantitative analysis. RESULTS AND CONCLUSION:The propagation phase contrast tomography successfuly simulated the morphology of angioarchitecture folowing spinal cord injury. After acute spinal cord contusion, the destruction of nerve tissues was accompanied by severe microvasculature damage. Intramedulary tissue damage and loss of blood supply was spread from the central zone to the ends. Three-dimensional microvascular quantitative data showed that after spinal cord contusion, the number of microvessels and vascular perfusion volume drasticaly reduced (P < 0.01). These findings indicate that the propagation phase contrast tomography without angiography has potential as a new ultra high-resolution visualization technique for three-dimensional microvessel imaging and quantitative analysis.

Objective:To evaluate the significance of the lumbar bowstring ratio (LBR) and sagittal spine-pelvis parameters in predicting postoperative neurogenic pain in adult patients with high-grade lumbar isthmic spondylolisthesis following spinal fusion surgery.Methods:A retrospective analysis was conducted on the clinical and imaging data of 95 adult patients with high-grade lumbar isthmic spondylolisthesis treated by spinal surgery at Xiangya Hospital of Central South University from August 2012 to January 2023. Each patient was followed for a minimum of six months. Participants were categorized into pain and non-pain groups based on the presence of persistent radicular pain (≥8 weeks) and a visual analogue scale (VAS) score of ≥3 postoperatively. The pain group comprised 15 patients (5 males, 10 females; mean age 55.47±6.42 years, range 46-71 years), while the non-pain group included 80 patients (20 males, 60 females; mean age 60.98±11.50 years, range 40-85 years). Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and VAS scores. LBR was defined as the ratio of the vertical distance from the anterior convexity of the L 1-L 5 anterior longitudinal ligament to a line connecting the posterior superior margin of the L1 vertebra and the posterior margin of the S1 vertebra, to the distance between these two points. Spinal-pelvic parameters measured included pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), PT/SS ratio, and changes in LBR before and after surgery (ΔLBR). Statistical comparisons of demographic and imaging parameters were performed between the two groups, and variables showing significant differences were subjected to binary logistic regression analysis to identify independent risk factors for postoperative neurogenic pain. Results:All 95 patients achieved complete anatomical reduction of the dislocation without reported wound infections. Follow-up was completed at 7.68±2.98 months (range 6-12 months) postoperatively. Among the patients, 15 developed iatrogenic radicular pain. Postoperative complications included pulmonary infection (4 cases: 1 in the pain group, 3 in the non-pain group), cerebrospinal fluid leakage (8 cases: 2 in the pain group, 6 in the non-pain group), and delirium (5 cases: 2 in the pain group, 3 in the non-pain group). No significant differences were observed in demographic data between the groups ( P>0.05). Both groups demonstrated significant improvements in ODI (pain group Z=-3.413, P=0.001; non-pain group Z=-7.772, P<0.001) and VAS scores (pain group Z=-3.426, P=0.001; non-pain group Z=-7.838, P<0.001) at the 6-month follow-up compared to preoperative values. Significant differences were found between the pain and non-pain groups in PI ( t=3.315, P=0.004), PT ( t=5.087, P<0.001), SS ( t=7.431, P<0.001), LL ( t=3.764, P<0.001), PT/SS ( t=7.267, P<0.001), LBR ( t=6.455, P<0.001), and ΔLBR ( Z=5.362, P<0.001) before and after surgery. Binary logistic regression analysis identified smaller preoperative PT/SS [ OR=0.760, 95% CI(0.601, 0.961), P=0.022] and larger preoperative LBR [ OR=5.721, 95% CI (1.068, 30.634), P=0.042] as independent risk factors for postoperative neurogenic pain. Conclusion:High LBR and reduced PT/SS are significant risk factors for neurogenic pain following complete discectomy and fusion in adult patients with high-grade lumbar isthmic spondylolisthesis. For such patients, careful consideration is warranted regarding anatomical complete reduction during surgical intervention.

OBJECTIVETo investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi.

METHODSFrom January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotomy. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups.

RESULTSPostoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P > 0.05), and no reoperations were necessary. After surgery, the average time and volume of transfusion was 4.9 days and 9.1 liters in group A, versus 7.3 days and 12.8 liters in group B (P < 0.01). The patients in group B had a longer postoperative hospital stay than the those in group A (average 17.6:10.0 days, P < 0.01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B, and 3 patients required repeated surgery.

CONCLUSIONSPrimary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.

Adult ; Aged ; Biliary Tract Surgical Procedures ; methods ; Choledocholithiasis ; surgery ; Common Bile Duct ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective:To investigate the clinical efficacy of manual reduction under general anesthesia combined with anterior cervical discectomy and fusion (ACDF) in the treatment of lower cervical locked facet dislocation.Methods:Retrospectively analyzed were the data of 53 patients with traumatic single segment dislocation of lower cervical spine combined with single/bilateral facet articular lock who had been admitted to Department of Orthopaedic Spine Surgery, Xiangya Hospital, Central South University from January 2019 to December 2020. There were 36 males and 17 females, aged from 18 to 64 years (average, 45.5 years). All the patients were treated with ACDF under neuroelectrophysiological monitoring. Clinical efficacy was assessed by observing complications and comparing American Spinal Injury Association (ASIA) grading, Modified Japanese Orthopaedic Association (mJOA) scores, neck disability index (NDI) and visual analogue scale (VAS) before and after surgery.Results:All patients were followed up for 16 to 30 months (mean, 24 months). All incisions healed by primary intention with no infection after operation. There were 2 cases of delirium, 9 cases of abdominal distension, 4 cases of lower extremity venous thrombosis, and one case of central diabetes insipidus. Postoperative imaging data showed that all patients achieved sequential reduction of the cervical spine, intervertebral bony fusion, and no internal fixation loosening. The last follow-up showed that the overall improvement rate of ASIA grading of spinal cord function was 84.9% (45/53) compared with the preoperation and that the VAS score (2.0±0.5), mJOA score (13.1±3.1) and NDI index (16.6±5.9) were significantly improved compared with the preoperative values (7.5±1.5, 6.9±3.5, and 37.8±7.8) ( P< 0.05). Conclusion:On the premise of fully assessing the patient's injury status, manual reduction under general anesthesia combined with ACDF is a safe and effective treatment of single-level lower cervical fracture combined with facet dislocation.

Spinal infection caused by Parvimonas micra(P.micra)is a rare infection.The characteristic imageology includes spondylodiscitis,spondylitis,paravertebral abscess,and epidural abscess.One case of spondylodiscitis of lumbar complicated with spinal epidural abscess caused by P.micra was admitted to the Department of Spinal Surgery,Xiangya Hospital,Central South University on February,2023.This case is a 60 years old man with lower back pain and left lower limb numbness.MRI showed spondylitis,spondylodiscitis,and epidural abscess.The patient underwent debridement,decompression and fusion surgery.The culture of surgical sample was negative.P.micra was detected by metagenomic next-generation sequencing(mNGS).The postoperative antibiotic treatment included intravenous infusion of linezolid and piperacillin for 1 week,then intravenous infusion of ceftazidime and oral metronidazole for 2 weeks,followed by oral metronidazole and nerofloxacin for 2 weeks.During the follow-up,the lower back pain and left lower limb numbness was complete remission.Spinal infection caused by P.micra is extremely rare,when the culture is negative,mNGS can help the final diagnosis.

Effective methods for visualizing neurovascular morphology are essential for understanding the normal spinal cord and the morphological alterations associated with diseases. However, ideal techniques for simultaneously imaging neurovascular structure in a broad region of a specimen are still lacking. In this study, we combined Golgi staining with angiography and synchrotron radiation micro-computed tomography (SRμCT) to visualize the 3D neurovascular network in the mouse spinal cord. Using our method, the 3D neurons, nerve fibers, and vasculature in a broad region could be visualized in the same image at cellular resolution without destructive sectioning. Besides, we found that the 3D morphology of neurons, nerve fiber tracts, and vasculature visualized by SRμCT were highly consistent with that visualized using the histological method. Moreover, the 3D neurovascular structure could be quantitatively evaluated by the combined methodology. The method shown here will be useful in fundamental neuroscience studies.

Effective methods for visualizing neurovascular morphology are essential for understanding the normal spinal cord and the morphological alterations associated with diseases. However, ideal techniques for simultaneously imaging neurovascular structure in a broad region of a specimen are still lacking. In this study, we combined Golgi staining with angiography and synchrotron radiation micro-computed tomography (SRμCT) to visualize the 3D neurovascular network in the mouse spinal cord. Using our method, the 3D neurons, nerve fibers, and vasculature in a broad region could be visualized in the same image at cellular resolution without destructive sectioning. Besides, we found that the 3D morphology of neurons, nerve fiber tracts, and vasculature visualized by SRμCT were highly consistent with that visualized using the histological method. Moreover, the 3D neurovascular structure could be quantitatively evaluated by the combined methodology. The method shown here will be useful in fundamental neuroscience studies.
Animals ; Imaging, Three-Dimensional ; Mice ; Neural Networks, Computer ; Spinal Cord/diagnostic imaging* ; Synchrotrons ; X-Ray Microtomography