METHODS: The patients were evaluated clinically and FNP was graded using the House Brackmann (HB) scale. High resolution computerized tomography (HRCT) of the temporal bone was used to evaluate temporal bone fractures. Transmastoid facial nerve decompression was performed and the facial nerve function was re-evaluated in subsequent follow ups.
RESULTS: There were five cases with immediate onset and four with delayed onset of FNP. Only three cases had pure temporal bone fractures, the others were associated with other life threatening injuries. The sensitivity and specificity of HRCT temporal bone to detect the obvious facial canal fracture line were 50% and 40% respectively. 75% of patients with immediate onset of HB grade VI FN palsy who were operated within a month recovered completely. Surgeries for the delayed onset FNP were performed at a mean of 70 days (range 51-94). All recovered to HB grade II-III from severe FNP.
CONCLUSIONS: Our study demonstrated that transmastoid FN decompression surgery was beneficial to traumatic nerve injury. Early intervention resulted in better outcomes. However, FN function could still be salvaged even in delayed FN decompression.
RESULTS: There were 27 patients with 30 segments of surgery. They were 12 males and 15 females with an average age of 58.81±8.1. There was significant improvement in VAS for lower back pain from 7.11±1.31 to 3.67±1.3, VAS for leg pain from 6.81±2.19 to 1.59±1.89, ODI from 26.41±8.95 to 13.69±8.34, and JOA score from 7.63±2.87 to 13.5±1.73. A-P diameter increased 134%, lateral diameter increased 120%, lateral recess depth increased 166%, disc height increased 126%, foraminal height increased 124%, spinal canal area increased 30%. The p-values were all <0.001. The average hospital stay was 6.79±3.01 days. Complications included 1 pedicle screw malformation, 1 ALL avulsion fracture, 1 abdominal herniation, 1 venous damage, 1 failure.
CONCLUSION: XLIF surgery presents a favorable option for patients with lumbar spinal stenosis. This is a minimally invasive surgical method that reduces pain, reduces bleeding, and is effective in indirectly decompressing the spinal canal both clinal and imaging.
Case Description: A patient with cervical stenosis secondary to metastatic tumor in the intradural and extradural compartments presented with lower limb paraparesis. She underwent an uneventful tumor excision accompanied by posterior cervical decompression and fusion. Postoperatively, she was quadriplegic and required ventilator support. The emergent postoperative MR scan revealed focal hyperintensity on the T2-weighted image consistent with spinal cord edema extending into the lower brain stem.
Conclusion: Very few cases of reperfusion injury of the cervical spinal cord or "white cord syndrome" are described in the literature. Here we present a patient who, following cervical laminectomy and fusion for excision of metastatic tumor, developed quadriplegia. Notably, postoperative MR showed only findings of upper cervical cord and lower brain stem edema consistent with a "white cord syndrome" without other compressive pathology.