目的:观察综合康复治疗对创伤性颈脊髓中央损伤综合征(traumatic central cord syndrome,TCCS)患者神经功能和生活质量的改善情况,并进行多维度疗效评价.方法:回顾性分析2016年1月～2021年12月我院收治的90例TCCS患者,其中男74例,女16例,年龄27～85岁(56.6±10.7岁),根据综合康复治疗前是否接受了颈椎手术分为术后康复组(82例)和单纯康复组(8例).两组患者在年龄、性别、脊髓损伤程度等方面均无统计学差异(P＞0.05).所有患者均接受1～3个月的物理治疗、作业治疗、膀胱管理等综合康复治疗.收集患者入院和出院时的美国脊髓损伤协会(American Spinal Injury Assosication,ASIA)残损分级(ASIA impairment scale,AIS)和运动评分(motor score,MS)、国际功能分类康复组合(ICF-RS)评分,并进行组间比较;统计患者膀胱功能变化和并发症情况,全面评估TCCS患者的神经功能恢复情况,多维度评价康复措施的疗效.结果:综合康复治疗前AIS分级C级48例,D级42例,治疗后27例患者C级改善为D级(术后康复组23例,单纯康复组4例),余63例AIS分级无变化,但治疗后下肢和上肢的MS较治疗前显著提高(P＜0.05).组间MS评分无统计学差异(P＞0.05).患者ICF-RS所有条目中,"b280痛觉"、"d240控制应激和其他心理需求"评分变化治疗前后无统计学差异(P＞0.05);余条目评分均较治疗前有提高,且有统计学差异(P＜0.05),组间比较无统计学差异(P＞0.05).33例患者由导尿恢复至自主排尿.脊髓损伤并发症占比前2名的是痉挛(54.4％)和神经痛(23.3％),痉挛与MS恢复程度无显著相关性(P=-0.06).结论:综合康复治疗对TCCS患者神经功能恢复有明显促进作用,无论是术后康复还是单纯康复的TCCS患者其综合功能均获得了明显改善.ICF-RS条目细致,适于TCCS这一特殊类型脊髓损伤患者的评估.

OBJECTIVE To investigate the clinical characteristics of children with traumatic spinal cord injury (SCI) admitted to a research rehabilitation center between 2011 and 2020, with a view to generate crucial data for understanding and prevention of pediatric traumatic SCI. DESIGN Retrospective cohort study. SETTING The National Rehabilitation Research Center of China, Beijing, China. PARTICIPANTS Medical records and imaging data of children with traumatic SCI admitted to the rehabilitation research center from 2011 to 2020. INTERVENTIONS Not applicable. OUTCOME MEASURES Data on age, sex, cause of injury, neurological level of injury, impairment scale of SCI and details of spine fracture or dislocation were all collected and analyzed. RESULTS A total of 351 patients were included in the study, including 133 males (37.9%) and 218 females (62.1%). There were 231 cases (65.8%) without spine fracture or dislocation. SCI without fracture or dislocation (SCIWORA) was the most common in children between the age of 5 and 14 years (77.9%), and injuries caused by sports were the most common in girls (90.8%). Among sports injuries, those due to a special dance movement called "Xia-Yao" in Chinese, which involves hyperextension of the trunk, constituted the majority, with the neurological level of injuries located predominantly in the middle (34.6%) and lower (44.2%) thoracic levels. CONCLUSION Girls between the ages of 5 and 14 years constituted the majority of SCIWORA injuries at the thoracic levels, which were caused mainly by "Xia-Yao". Overall, careful attention should be paid to prevent this kind of injury in children.

眩晕是临床中最常见的症状性疾病之一,一项问卷调查显示14岁以上的普通居民中20％～30％有过头晕、不稳或视物旋转的经历[1].由于眩晕和头晕定义模糊,通过病因来鉴别两种症状性疾病存在困难,所以临床和科研中容易将两者混淆.2009年Barany协会提出的前庭症状分类[2]中将眩晕定义为没有自身运动时所感到的自身运动错觉或正常头部运动时感到的扭曲的自身运动错觉;而头晕是指空间定向能力受损或障碍的感觉,并没有运动的虚假或扭曲的错觉.眩晕和头晕均是一种症状学的定义,用于描述不同特点的前庭症状,两者是有本质区别的[3].

当患者在站立位脊柱全长X线上测量的Cobb角＞10°,并且出现轴向旋转时,即可诊断为脊柱侧凸.特发性脊柱侧凸(idiopathic scoliosis,IS)是指病因不明的三维结构性脊柱弯曲[1],其中青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)超过80％.AIS的患病率约为2％～2.5％[2].由于AIS在青春期时最容易出现加重,因此该时期对于AIS的预防和治疗更为关键.

Objective:To seek better treatments for abnormal pelvic floor muscle tension and pelvic floor dysfunction after spinal cord injury.Methods:The morphology of pelvic floor muscle fibers of rats with spinal cord injury at different levels was observed under the electron microscope. Thirty female adult Sprague-Dawley rats were randomly divided into a suprasacral (SS) cord injury group, a group with spinal cord injury at or below the sacral level (SC) and a normal group (NG), each of 10. The relevant spinal cord injury models were established in the SS and SC groups through spinal cord disconnection. Four weeks later, the pixel area of ATPase-positive fibers was used to quantify the content of type I fibers in the pubococcygeus muscle of each rat through observation under the electron microscope after hematoxylin and eosin staining.Results:The average content of type I muscle fibers in both the SS and SC group was significantly lower than in the normal group. The SC group′s average level was significantly lower than that of the SS group. Under the microscope the stained myofibers were tortuous, deformed in appearance and with proliferated nuclei. Capillary dilation could be seen locally in the SS group 4 weeks after the injury. In the SC group at 4 weeks after the injury the pubococcal fibers were seriously "dissolved" , or disordered, with spherical nuclei and mild hyperplasia. Under the electron microscope, the sarcomeres of the SC group were obviously dissolved, atrophied and broken, though the basic structure persisted, with mild mitochondrial proliferation. The sarcomeres of the SC group were extremely dissolved and broken, completely losing basic structure, with abundant connective tissue proliferation but without obvious mitochondrial proliferation.Conclusions:After suprasacral cord injury, the content of type I muscle fibers in the pubococcygeus muscle of the pelvic floor decreases somewhat, with the basic structure of the muscle fibers remaining intact. However, after spinal cord injury at or below the sacral level, type I muscle fibers decrease significantly in the pubococcygeus muscle of the pelvic floor, and the basic structure is seriously damaged.

OBJECTIVE:To identify a diagnostic indicator of lumbar spondylolysis visible in plain X-ray films. METHODS:One hundred and seventy-two patients with low back pain who received X-ray and computerized tomography (CT) examinations were identified and studied. They were divided into three groups: the spondylosis without spondylolisthesis (SWS) group, comprising 67 patients with bilateral pars interarticularis defects at L5 and without spondylolisthesis, the isthmic spondylolisthesis (IS) group, comprising 74 patients with L5/S1 spondylolisthesis and bilateral L5 pars interarticularis defects, and the control group, comprising 31 patients with low back pain but without spondylolysis. The sagittal diameters of the vertebral arch (SDVAs) of L4 and L5 were measured in lateral X-ray image, and the differences in SDVA between L4 and L5 (DSL4-5) in each case were calculated and analyzed. RESULTS:There were no significant differences in demographic characteristics among the three groups. In the SWS and IS groups, the SDVA of L5 was significantly longer than the SDVA of L4 (p < 0.001), whereas no significant difference found in the control group (p > 0.05). DSL4-5, in which the SDVA of L4 was subtracted from the SDVA of L5, significantly differed among the three groups (p < 0.001), and the normal threshold was provisionally determined to be 1.55 mm. CONCLUSIONS:In bilateral L5 spondylolysis, the SDVA of L5 is wider than the SDVA of L4, and this difference is greater in isthmic spondylolisthesis. This sign in lateral X-rays may provide a simple and convenient aid for the diagnosis of spondylolysis.

Study design Retrospective analysis. Setting China Rehabilitation Research Center, Beijing, China. Objective To explore possible mechanisms underlying spinal cord injury (SCI) in children caused by hyperextension of the spine while dancing. Methods The clinical records of 88 children with SCI (mean age, 5.97 years; age range, 4–10 years) admitted to our hospital from January 1989 to October 2019 were retrospectively reviewed. Computed tomography and magnetic resonance imaging were performed on the day of injury. The time from injury to development of paralysis, as well as post-injury activities were surveyed, while abnormal patterns on images, the range of the involved vertebrae, and the extents of edema and atrophy were assessed. Results Among the 88 patients, 6 (6.8%) were unable to move immediately after SCI, while paralysis occurred in 42, 23, and 17 patients at <30, 30–60, and >60 min after SCI, respectively. The neurological level of injury of 84 patients was between T4 and T12. On sagittal T2-weighted images (T2WIs), the longitudinal range of spinal cord edema was more than one vertebral body in 65 patients, while spinal cord atrophy below T8 was found in 40 patients. On axial T2WIs, although three patients had none, long T2 signals were found in the central gray matter of seven patients. Meanwhile, necrosis of the central area combined with the peripheral white matter was observed in 57 patients, while three patients had total involvement on a cross section. Conclusion Ischemia-related damage, rather than direct trauma to the spinal cord, may play an important role in SCI due to spinal hyperextension during dancing.

目的 探讨完全性脊髓损伤患者脑运动控制功能的变化情况.方法 2017年1月至2019年1月,病程3～6个月完全性脊髓损伤患者11例与健康人12例,在试图/实际运动、意象运动(MI)任务下行功能磁共振成像(fMRI)扫描,观察不同运动任务引发激活效应的空间分布和信号强度.结果 患者试图运动时的脑激活区域显著多于健康人实际运动时的激活区域,包括双侧初级感觉/运动皮质(S1/M1)、辅助运动区(SMA)、外侧苍白球(PA)、小脑、左侧丘脑和壳核等.健康人意象运动的比较,患者激活簇主要存在于右M1、SMA、背侧运动前区(PMd)、左SMA、岛叶和基底核.患者试图运动比意象运动在左M1、双SMA、扣带回运动区和右小脑诱发更多的兴奋.结论 亚急性期完全性脊髓损伤患者执行运动任务时,M1、SMA的兴奋模式基本正常,顶叶和小脑等感觉运动整合区域激活增加,提示发生适应性重组.

Objective:To explore the curative effect of anterior cervical surgery for lower cervical dislocation combined with spinal cord injury.Methods:A retrospective case series study was carried out to analyze the clinical data of 72 patients with lower cervical dislocation and spinal cord injury admitted in Beijing Boai Hospital, China Rehabilitation Research Center from January 2011 to August 2018, including 55 males and 17 females, with an average age of 35.8 years (range, 18-63 years). The segments of injury were at C 3 in 2 patients, at C 4 in 16, at C 6 in 24 and at C 7 in 30. Bases on American Spinal Injury Association (ASIA) grade, there included grade A in 43 patients, grade B in 22, grade C in 6 and grade D in 1. All patients were treated with anterior decompression and fusion. Operation time, intraoperative hemorrhage, decompression and fusion, complications and ASIA grade were observed. Results:All patients were followed up for 3-72 months (average 24.2 months). Operation time was 90-180 months [(118±58)minutes] and intraoperative bleeding volume was 50-180 ml [(104±30)ml]. Spinal cord was decompressed in all patients. The reduction was excellent in 58 patients (81%) and fair in 14 patients (19%). Fusion was confirmed in 48 patients (67%). The complications were improved after timely treatment, including cervical edema in 1 patient, laryngeal edema in 1, cerebrospinal fluid leakage in 4 and axial pain in 2. ASIA grade change of spinal cord injury: grade A were recovered to grade B in 2 patients, grade A to grade C in 1, grade B to grade C in 1, grade C to grade D in 2 ( P>0.05). Conclusion:For dislocation of lower cervical spine combined with spinal cord injury, anterior surgery can obtain good decompression, reduction and fusion effect, but it has limited help for improvement of neurological function.

[目的]探讨侧路椎间孔镜腰椎间盘切除术后6年以上中期疗效.[方法]回顾性分析2012年1月～2013年6月通过侧路椎间孔镜腰椎间盘切除术后随访6年以上的42例患者.男24例,女18例,平均年龄(48.56±6.34)岁,腰椎间盘突出症37例,腰椎管狭窄症5例.均行俯卧位单节段椎间孔镜下腰椎间盘切除手术治疗.观察术前、术后6个月和末次随访直腿抬高试验角度、腰痛VAS评分、腿痛VAS评分、JOA评分、Oswestry功能障碍指数(ODI)和McNab优良率;影像观察手术节段椎间隙高度和节段稳定性.[结果]本组病例均顺利手术,术中无硬膜撕裂、神经根损伤发生,术后无感染发生.随访75～93个月,平均(82.75±5.52)个月.2例患者(4.76％)接受了翻修术,均在术后3个月内;1例YESS患者因腿痛缓解不满意,行同节段椎间孔镜TESSYS翻修;另1例患者因复发并腰痛行手术节段及下位节段腰椎融合术.与术前相比,术后6个月和末次随访时,42例患者直腿抬高试验角度显著增加(P＜0.05),腰痛和腿痛VAS评分均显著减少(P＜0.05),腰椎JOA评分显著提高(P＜0.05),ODI评分显著减少(P＜0.05).按McNab标准,临床优良率术后6个月为83.33％,末次随访时为85.71％.影像方面,末次随访时手术节段椎间隙高度为术前的(84.52±5.66)％,动力位影像未见腰椎不稳征象.[结论]侧路椎间孔镜腰椎间盘切除术后不仅术后6个月时的近期疗效良好,6年以上随访的中期疗效亦保持良好.术后6年以上虽有椎间隙高度轻度下降,但无手术节段失稳征象.

目的 分析胸腰段创伤性后凸畸形(PTK)的临床特点,探讨采用闭合-张开楔形截骨(COWO)治疗胸腰段PTK的临床疗效.方法 从2006年-2015年共连续性收治胸腰段PTK患者12例.其中男性8例,女性4例,年龄20～59岁,平均35.7岁.除2例患者外,其余10例患者伤后早期均于外院接受过手术治疗,本次手术距初始受伤时间为6个月～14年,平均31.2个月.所有患者均表现为局部后凸畸形及中重度腰背部疼痛.8例患者合并神经损伤,ASIA残损分级包括A级4例,B级1例,C级2例,D级1例.所有患者均采取COWO的截骨方式.具体评价指标包括手术时间、手术出血量、围手术期并发症情况、术前和随访时VAS疼痛评分、神经功能情况以及影像学相关指标.结果 所有患者均顺利完成手术,平均随访时间37.8个月(24～52个月).平均手术时间389 min(320～420 min).术中平均出血量3045 ml(2200～4000 ml).除1例患者术后出现一过性神经损害加重外,无持续性神经损害病例.有3例患者术后出现脑脊液漏,但均未影响伤口愈合.腰痛VAS评分由术前平均6.7分改善至2.3分(P<0.05).术前平均后凸角度62.3°(36～96°),术后即刻矫正至8.5°(-12～50°),最终随访时有4.1°矫正丢失.最终随访时所有患者均获得骨性融合,无内固定失败发生.结论 早期处理不当是胸腰段PTK的主要原因.相对于其他原因引起的后凸畸形,胸腰段PTK具有其特殊的临床特点,在选择手术截骨方式应充分考虑这些因素.COWO是矫正PTK合理有效的治疗手段.

STUDY DESIGN:Retrospective analysis.SETTING:China Rehabilitation Research Center, Beijing, China.OBJECTIVE:A retrospective study that documents the modalities and clarifies the heterogeneity among spinal cord injuries (SCIs) caused by trauma to the thoracolumbar vertebral junction.METHODS:X-ray and MRI imaging, neurological records, and the urodynamics results of 190 patients were reviewed and used to categorize different SCI modalities. First, injuries were divided into complete and incomplete injuries using the International Standard for Neurological Classification of Spinal Cord Injury. Next, the complete injuries were further grouped using the neurological level of injury and Long T2 signal from mid-sagittal MRI images, whereas the bulboconvernosus reflexes were also used as a reference to detect injury to the sacral cord.RESULTS:The SCI modalities were classified into five categories: pure complete epiconus lesion with caudal cord intact (G1), complete epiconus injury with conus medullaris (CM) totally involved in the lesion (G2), CM syndrome, cauda equine syndrome without sacral sparing (G3 and G4), and incomplete injury (G5).CONCLUSIONS:The heterogeneity of SCIs at the thoracolumbar junction was documented, a criterion we propose to be of great significance when selecting patients for clinical trials. In particular, the G2 group, which comprises nearly one third of the patients with epiconus lesions, is sometimes mistaken as G1, an observation that has thus far received insufficient attention.

目的 通过与传统诊断方法的对比分析,探讨髂耻足三联试验在骶髂关节功能障碍诊断中的效果及临床意义.方法 选择2018年6月至2019年3月门诊骶髂关节功能障碍患者(病例组)30例和正常对照组30例,分别采用髂耻足三联试验和传统诊断方法进行骶髂关节功能障碍相关检查,最后以骶髂关节注射术来确定诊断.对比两种诊断方法对骶髂关节功能障碍诊断的敏感度、特异度、受试者工作特征曲线(receiver operating characteristic,ROC)曲线下面积以及敏感度差异.结果 病例组患者和对照组受试者比较,性别(x2=0.287,P=0.592)、年龄(t=0.400,P=0.691)差异无统计学意义.传统方法诊断骶髂关节功能障碍的敏感度为33.3％,特异度96.7％,ROC曲线下面积为0.650(P=0.046);髂耻足三联试验诊断骶髂关节功能障碍的敏感性为76.7％,特异性为96.7％,ROC曲线下面积为0.867(P ＜0.001).两种诊断方法的诊断敏感度差异有统计学意义(x2=11.38,P=0.001).结论 骶髂关节功能障碍的髂耻足三联试验,具有更高的诊断敏感性,对于怀疑骶髂关节功能障碍的腰腿痛患者应进行全面的专科体格检查,早期诊断,避免漏诊,降低腰椎术后失败综合征的发生风险.

Background:Denis typing and Magerl typing have been used for the classification of thoracolumbar injuries.In 2013,AOSpine published a new version of the AO classification of thoracolumbar fractures.Objective:To investigate the evolution of thoracolumbar injury classification and to analyze the characteristics of the latest AO (AO2013) thoracolumbar injury classification and its relationship with spinal cord injury and treatment plans.Methods:①Denis,Magerl and AO2013 classifications of thoracolumbar injury were compared with each other to analyze their differences and common ground.Then the characteristics of the AO2013 were summarized.②Clinical data of 183 patients with thoracolumbar injury were retrospectively reviewed.There were 101 males and 82 females with a mean age of 47.4 years (range,15-90years).ASIA Impairment Scale (AIS) sheets,operation notes,preoperative and postoperative radiographic images including X-rays,CT scans and MRI,were reviewed.The segments with pedicle screw inserted (pedicle screw levels,PSL) were documented.All the patients' thoracolumbar injuries were classified according to the three classifications mentioned above by well experienced doctors.The three classifications' relationships with AIS and the PSL were analyzed.And the distribution of all the cases reviewed in the AO2013 subtypes were also laid out.Results:When compared with the Magerl classification,the AO2013 owns the following modifications:①A0 and A4 are added to type A.A0 means the fracture of the spinous process and/or transverse process without interruption of the stability of the spine.A4 designates complete burst fractures with involvement of both endplates,which were typed as A3 in the Magerl classification.②The Maged type B with dislocation is now classified as type C,while all subtypes for Magerl type C have been abandoned.③Neurologic status assessment and case-specific modifiers are added.Denis classification related hardly to the AIS and PSL,while Magerl classification showed lost relationships.However,AO2013 was strongly related to both the AIS and PSL.The SCI percentages of A0,A1,A2,A3,A4,B 1,B2 and C subtypes of AO2013 were as follows:0、5.6％、66.7％、50％、100％、100％、88.8％ and 100％,respectively.Conclusions:Thoracolumbar injury classification,such as Denis classification,is developed simply according to the morphological appearance at first,then the injury mechanisms are considered,as to the Magerl classification.Now needs for guidance for treatment is more emphasized and AO2013 is launched.It refines the classic assessment of injury morphology,and incorporates all the radiologic images to evaluate the stability of the spine.It also shows strong relationship with the AIS and PSL,which may lead to a good prospect of universal application.

To investigate the prognostic values of clinical factors 72 h within traumatic cervical spinal cord injury (TCSCI). Data were extracted from the medical materials of 57 TCSCI cases. AIS was used as the outcome measure and divided into dichotomous variables by two methods, i.e. “complete(AIS = A)/incomplete(AIS ≠ A) SCI” and “motor complete(AIS = A or B)/incomplete(AIS ≠ A and B) SCI”. Relationships between evaluated factors and outcomes were investigated by univariate and multivariate methods. MRI Cord transection (MCT) cases, most significantly related to complete SCIs by univariate analysis (P = 0.006), all showed complete SCIs when discharged, which makes it unsuitable for logistic regression. With MCT cases removed, univariate analysis was conducted again, then logistic regression. At last, only C5 spine injury (P = 0.024, OR = 0.241) was related to complete SCI. Cases with compression flexion injury mechanism (CFIM), most significantly related to motor complete SCIs by univariate analysis (P = 0.001), was also unsuitable for logistic regression for the same reason. At last, C3 spine injury (P = 0.033, OR = 0.068) and high energy injury (P = 0.033, OR = 14.763) were related to motor complete SCIs with CFIM cases removed. The results show that MCT and C5 spine injury are good predictors for complete/incomplete SCIs. CFIM, C3 spine injury and high energy injury are good predictors for motor complete/incomplete SCIs.

Objective To explore the effect of co-disciplinary teaching on clinical ability of postgraduates in the practice of intraopera-tive neurophysiologic monitoring (IONM). Methods From January, 2010 to March, 2016, 36 postgraduates of rehabilitation therapy were randomly assigned into group S (n=18) and group SA (n=18), who were taught IONM by a doctor of Department of Spine and Spinal Cord or the same doctor and another anesthesiologist. The IONM ability of the postgraduates in both groups in the spine and spinal cord surgery was evaluated. Results The IONM ability of postgraduates was significantly stronger in group SA than in group S (t=4.704, P<0.001), espe-cially in the prevention and settlement of the disturbance. Conclusion The co-disciplinary teaching is effective on the clinical ability of post-graduates.

目的 通过总结多种电学方法在脊髓损伤领域中的临床疗效,讨论电学技术从基础研究转化为临床技术的研究进展,为今后临床工作的开展提供转化医学的新思路.方法 分析电学治疗方法的起源及发展过程,讨论并分析4种电学技术转化为脊髓损伤领域治疗技术的临床疗效,这些技术包括:脊髓损伤部位的电刺激技术,瘫痪肢体的功能性电刺激技术,呼吸功能障碍的膈肌起搏技术和排尿功能障碍的神经电调节技术.结果 1)直流电场能够促进未完全断裂的脊髓轴突再生,振荡电场能够双向修复脊髓损伤近端和远端的神经轴突.2)功能性电刺激用于重建瘫痪肢体的运动功能,通过刺激肢体周围神经引起肌肉按照一定顺序收缩产生动作,可以预防多种合并症.3)膈肌起搏技术能够诱发膈肌收缩,保证脊髓损伤膈肌功能障碍患者呼吸时产生自然的负压状态,重建呼吸功能.4)频率为5 ～ 20 Hz,脉宽为1～5 ms的电流能够既抑制逼尿肌的过度活动,又改善诸多盆底功能.结论 电流作为一种治疗技术,既有作为生物电的共性,又在不同条件下具备不同的电学特性和临床疗效.今后的脊髓损伤研究中,应加强电学治疗技术与临床技术的结合,来解决更多的临床问题.

[Purpose] The objective of the study was to compare the incidence, diagnosis, treatment, and prognosis of patients with spinal cord stab injury to those with the more common spinal cord contusion injury. [Subjects] Of patients hospitalized in China Rehabilitation Research Center from 1994 to 2014, 40 of those having a spinal cord stab injury and 50 with spinal cord contusion were selected. [Methods] The data of all patients were analyzed retrospectively. The cases were evaluated by collecting admission and discharge ASIA (American Spinal Injury Association) and ADL (activity of daily living) scores. [Results] After a comprehensive rehabilitation program, ASIA and ADL scores of patients having both spinal cord stab injury and spinal cord contusion significantly increase. However, the increases were noted to be higher in patients having a spinal cord stab injury than those having spinal cord contusion. [Conclusion] Comprehensive rehabilitation is effective both for patients having spinal cord stab injury and those with spinal cord contusion injury. However, the prognosis of patients having spinal cord stab injury is better than that of patients with spinal cord contusion.

Objective To investigate the clinical characteristics of nontraumatic spinal cord injury, including the demographic character-istics, etiology and neurological function. Methods 44 patients with nontraumatic spinal cord injury in the past 4 years were reviewed. Re-sults There were 27 males (61.3%) and 17 females (38.7%) with mean age of 39.85 years (3.5~78). They were followed up for mean of 13.3 (3~23) months. Myelitis (36%) and spinal tumor (including primary and metastatic tumor, 18.1%) were the most common causes, followed by intraspinal tumor (15.9%), vascular disease (13.6%), nontraumatic acute disc herination (6.8%), spinal cord ischemia after non-spinal sur-gery (4.5%) and hepatic myelopathy (4.5%). Neurological function at the initial admission included tetraplegia in 9 patients, paraplegia in 30 patients, conus medullaris syndrome in 2 patients and cauda equina syndrome in 2 patients. Neurological function of ASIA at the initial admission included A in 14 cases, B in 6, C in 13 and D in 11. 34%patients improved at least one ASIA grade when evaluated at final follow up. Conclusion Nontraumatic etiologies contribute to a significant proportion for spinal cord injury. Patients with nontraumatic spinal cord injury present the clinical characteristics different from traumatic spinal cord injury cases.

Objectives: To evaluate the clinical outcomes of minimally invasive lateral lumbar interbody fu-sion(LLIF) combined with posterior short-segment instrumentation for thoracolumbar fractures. Methods: From Octomber 2009 to September 2012, twelve patients with thoracolumbar fractures who met the inclusion criteria were treated with posterior short-segment pedicle instrumentation combined with delayed minimally invasive LLIF. There were 10 males and 2 females with a mean age of 33±9.4 years (21-47 years). All the patients underwent posterior short-segment pedicle instrumentation as the initial treatment. Minimally invasive LLIF was performed within two weeks after the posterior procedure, under the assistance of self-designed work-ing-tunnel. The levels of LLIF included T11/12 in 4 patients, T12/L1 in 5 and L1/2 in 3. The evaluation in-dex included average operation time, average blood loss and complication associated with the surgery. ASIA impairment scale(2011) and Cobb angle were used to evaluated the neurological function and the loss of cor-rection preoperatively, postoperatively and at final follow-up, respectively. The status of fusion was evaluated according to Suk′s criteria at final follow-up. Results: All the patients tolerated the operation well. The mean operation time and blood loss of the posterior procedure was 125.8±29 minutes and 460±88.1ml, respectively,while 127.1±21.7 minutes and 185.8±62.3ml, respectively for the minimally invasive LLIF procedure. Hemop-neumothorax was noted in 1 case after the minimally invasive LLIF procedure. One patient presented with neurological deficit after LLIF procedure. The mean follow-up period was 12.75±4.6 months. The mean Cobb angle improved from 31°±8.7° preoperatively to 5.1°±3.5° postoperatively. At final follow-up a mean of 4.3°± 2.1° of loss of correction was noted. Solid fusion was achieved in 8 patients(66.7%) and probable fusion was in 4 patients(33.3%). Five patients with incomplete spinal cord injury achieved at least one grade of neurolog-ical function improvement, others had no change. No implant failure was noted. Conclusions: Posterior short-segment pedicle instrumentation combined with minimally invasive LLIF is effective for indicative thora-columbar fractures, if it can be used for an alternative or complementary treatment for conventional wide-open combined anterior and posterior approaches, needs more cases and longer observation.