Objective To investigate the surgical technique and efficiency of the "Cave-in" 360°circumferential decompression for thoracic spinal stenosis(TSS)with ossification of posterior longitudinal ligament(OPLL).Methods From October 2005 to October 2009,26 TSS cases with OPLL were surgically treated,including 17 males and 9 females.Nineteen cases had upper thoracic spinal stenosis(T1-4)with OPLL,while 14 of them also had ossification of ligamentum flavum(OLF).All the other 7 cases had middle and/or lower(T5-12)TSS with both OPLL and OFL.All patients had severe spinal cord compression,and preoperative Frankel Grade was B in 6 cases,C in 13 cases and D in 7 cases.All these cases were surgically treated by 360° circumferential decompression("Cave-in" technique).Firstly,posterior wall was removed to decompress thoracic spinal cord.Secondly,the residual facets and pedicles were removed and posterior 1/3 of vertebral cancellous bones were cut along pedicles at 60° angle inclination to make a "culvert".Finally,the culvert walls were pressed to collapse and the OPLL blocks were removed to achieve ventral decompression.Pedical screw fixations were performed in all patients.Results All cases had immediate postoperative neurological improvement except 2 who experienced transient postoperative neurological deterioration for 13-27 days.At the end of 6-30 months follow-up,all these patients had neurological improvement.At the last follow-up,Frankei Grade was C in 2 cases,D in 15 cases and E in 9 cases.Conclusion This "Cave-in"360° circumferential decompression removes ventral and dorsal spinal compression from the posterior approach in TSS cases.It is a direct decompression procedure,which reduces the rate of postoperative paralysis.

[Summary] Traditional anterior thoracotomy surgery for thoracic idiopathic scoliosis has amount of disadvantages such as large trauma,postoperative pain,and pulmonary function decrease.Video-assisted thoracoscopic surgery (VATS),which is considered as an effective method for the treatment of idiopathic thoracic scoliosis,can avoid those disadvantages as compared with thoracotomy surgery.Common surgical procedures include anterior spinal release with intervertebral fusion and instrumentation through video-assisted thoracoscopic surgery (IVATS).This article reviewed the history,indications,contraindications,advantages,disadvantages and outcomes of VATS in the treatment of idiopathic thoracic scoliosis.

Objective To investigate the effects of carbon monoxide poisoning on the long-term cognition in elderly patients.Methods Totally 53 patients with carbon monoxide poisoning and 51 healthy persons at our Hospital from June 2005 to June 2008 were enrolled.Mini-mental state examination(MMSE) and activities of daily living(ADL) scale were utilized to evaluale the life quality of the elderly patients through a cross-sectional study on July 2011.Results MMSE score showed that the attention calculation score,delayed recall score,and total score were higher in control group (4.9±0.4,2.9±1.0,28.3±2.3,respectively) than in carbon monoxide poisoning group (4.5±0.8,2.6±0.6,25.5±3.5,respectively) (t＝3.138,3.607,4.802,all P＜0.05).ADL score of carbon monoxide poisoning group was 26.7±7.3,and that of the control group was 2.04±7.6 (t＝1.827,P＞0.05).Conclusions Elderly patients with acute carbon monoxide poisoning may cause long-term cognitive impairment with decreasing attention calculation and delayed recall.

To explore the role of cerebro-spinal flu id(CSF)glutamate and nitric oxide (NO) in the pathogenesis of neonatal hypoxic- ischemia encephalopathy (HIE), glutamate and NO in CSF were determined in 24 new born infants with HIE and 8 normal control infants, respectively. The results sh owed that the levels of glutamate and NO in CSF were significantly higher in the neonates with moderate and severe HIE than those in both of the control group an d neonates with mild HIE.There was an obviously positive relationship between le v els of glutamate and NO. It is concluded that glutamate and NO play an important role in the pathogenesis of neonatal HIE.

Objective To discuss the CT and MR imaging appearances and diagnostic value of spinal lymphoma. Methods Sixteen patients with pathologically proved spinal lymphoma (aged 8 to 63 years) were retrospectively reviewed. CT were performed in all 16 patients, and MRwere performed in 12 patients. Results Totally 65 vertebrae (cervical 15, thoracic 22, lumbar and sacrum 28) were involved. Multiple lesions were found in 11 patients. The characters of these lesions were osteolytic, osteogenic or mixed on CT. The signal intensity was hypo or iso on T1WI and iso or slightly hyper on T2WI. The extradural involvements were more extensive than that of the vertebrae both on CT and MR images. Conclusion Lesions of spinal lymphoma usually demonstrate various bone destructions on CT, and hypo or iso intensity on T1WI as well as iso or slightly hyper intensity on T2WI, tending to involve paraspinal or extradural space, and longitudinal involvements are often seen along the vertebral canal. MRI is more sensitive than CT in detecting spinal lymphoma lesions.

Objective To explore the repair effect of methylcobalamin treatment of nerve after spinal cord injury.Methods 108 cases of patients with acute spinal cord injury were selected treated in our hospital from 2010 April to 2014 April , including 60 cases of male, female 48 cases, were randomly divided into Mecobalamin group(n=56) and control group(n=52), mecobalamin group was treat with a cobalt amine, control group was given conventional treatment (dexamethasone intravenous drip note).According to American spinal cord injury score (ASIA) to set sensory function, motor function and spinal cord function score criteria, observed and record ed the sensory function, motor function, recovery of neurological function and complications the two groups of patients were treated for 6 weeks and followed up for 6 months.Results Spinal cord injury patients after 6 weeks and 6 months follow-up, the improvement of sensory and motor function of mecobalamin group were significantly better than the control group ( P <0.01 );Mecobalamin group patients after first to 3 weeks of recovery of neurological function was higher than those of the control group (P<0.05);the 2 groups were found urinary tract infections, lung infections, vomiting, reaction of ulcer complications, but the difference was not statistically significant ( P>0.05).Conclusion In patients with acute spinal cord injury treated by mecobalamin treatment can improve the nerve function damage condition, improve the prognosis and quality of life.

Objective To study the CT and MRI features of the chordoma in the mobile spine.Methods The CT and MRI fea-tures were retrospectively analyzed in twenty-four cases of chordoma in the mobile spine.Results In all the twenty-four cases,bone lesions were solitary in eight cases and multiple in sixteen cases,mostly occurred in cervical,occasionally occurred in thoracic or lum-bar vertebra.Both vertebral body and part appendix were involved in all cases.CT imaging showed that all the lesions mainly mani-fested as osteolytic bone destruction,peripheral osteosclerosis and the cortical bone were incomplete.Soft-tissue mass involved para-vertebral and intraspinal.Five lesions appeared vertebrae compression.Eight lesions appeared intervertebral foramen expansion.Le-sions appeared honeycomb or annular enhancement after contrast media injection.Lesions were presented as heterogeneous slightly hypo-isointensity on T1 WI,hyperintensity on T2 WI.Low signal fibrous septa within the tumors were seen.Lesions appeared hon-eycomb enhancement after Gd-DTPA injection.Conclusion CT and MRI findings of chordoma in the mobile spine can be regarded as characteristic,which are helpful for clinical diagnosis.

Objective To discuss the selection of approaches for CT-guided percutaneous biopsy of thoracic and lumbar spine. Methods One hundred and forty-one cases of thoracic (70 cases) or lumbar (71 cases) vertebral undiagnosed lesions underwent CT-guided percutaneous biopsy. Appropriate needle approaches were designed according to different locations of lesions in the vertebra, including 63 cases of paravertebral path, 45 cases of transpedicular path, 11 cases of transcostovertebral path, and 22 cases of other paths. Results Out of the 141 cases, a definite diagnosis was obtained in 128 cases. The diagnostic accuracy of biopsy was 90.8%. No complications occurred. Conclusions The needle approach for CT-guided percutaneous biopsy of the thoracic and lumbar spine should be selected according to different locations of lesions, which should be based on principles of safety, enough specimen, and minimally invasive to patients.

Objective To analyze the selection of puncture needles in CT-guided percutaneous biopsy in musculoskeletal system diseases.Methods Three hundred and sixty-four undiagnosed lesions of musculoskeletal system underwent CT-guided percutaneous biopsy from January 1996 to March 2005.Proper selection of different puncture needles,including biopsy gun,bone biopsy needle,or both,was made according to different locations and characteristics of the lesions.Results Among 255 lytic lesions,the biopsy gun alone was used in 47 cases and both biopsy gun and bone biopsy needle were used in 208 cases.Among 73 mixed lesions,the bone biopsy needle alone was used in 49 cases,biopsy gun alone in 14 cases,and both in 10 cases.The bone biopsy needle was used in all 36 sclerotic lesions.Enough specimens were obtained in all the cases,and no complications occurred.A correct biopsy diagnosis was made in 334 cases,the diagnostic accuracy of biopsy being 91.8%(334/364). Conclusions The puncture needles for CT-guided percutaneous biopsy of the musculoskeletal system lesions should be selected according to different locations and characteristics of lesions.For sclerotic lesions or lesions containing relatively more sclerotic contents,the bone biopsy needle should be used.For lytic lesions,the biopsy gun should be used.And the combined use of both bone needle and biopsy gun should be utilized for mixed lesions.

Early diagnosis and symptomatic therapy of amyotrophic lateral sclerosis(ALS)can profoundly influence care and quality of life of the patient and relatives,and may increase survival time.Medication with riluzole should be initiated as early as possible.PEG is associated with improved nutrition and should be inserted early.Noninvasive positive pressure ventilation improves survival and quality of life.Palliative end-of-life care should be provided to ALS patient.