title: What is the optimal sequence of decompression for multilevel noncontinuous spinal cord compression injuries in rabbits?
abstract: BACKGROUND
  In recent years, multilevel spinal cord injuries (SCIs) have gained a substantial amount of attention from clinicians and researchers. Multilevel noncontinuous SCI patients cannot undergo the multiple steps of a one-stage operation because of a poor general condition or a lack of proper surgical approaches. The surgeon subsequently faces the decision of whether to initially relieve the rostral or caudal compression. In this study, we established a spinal cord compression model involving two noncontinuous segments in rabbits to evaluate the effects of differences in decompression order on the functional recovery of the spinal cord.
  
  
  METHODS
  A Fogarty catheter was inserted into the epidural space through a hole in T6-7 and advanced 3 cm rostrally or caudally. Following successful model establishment, which was demonstrated by an evaluation of evoked potentials, balloons of different volumes (40 μl or 50 μl) were inflated in the experimental groups, whereas no balloons were inflated in the control group. The experimental groups underwent the first decompression in the rostral or caudal area at 1 week post-injury; the second decompression was performed at 2 weeks post-injury. For 6 weeks post-injury, the animals were tested to determine behavioral scores, somatosensory evoked potentials (SEPs) and radiographic imaging changes; histological and apoptosis assay results were subsequently analyzed.
  
  
  RESULTS
  The behavioral test results and onset latency of the SEPs indicated that there were significant differences between priority rostral decompression (PRD) and priority caudal decompression (PCD) in the 50-μl compression group at 6 weeks post-injury; however, there were no significant differences between the two procedures in the 40-μl group at the same time point. Moreover, there were no significant peak-to-peak amplitude differences between the two procedures in the 50-μl compression group.
  
  
  CONCLUSIONS
  The findings of this study suggested that preferential rostral decompression was more beneficial than priority caudal decompression with respect to facilitating spinal cord functional recovery in rabbits with severe paraplegia and may provide clinicians with a reference for the clinical treatment of multiple-segment spinal cord compression injuries.
authors.affiliation: Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China.
authors.forename: Chaohua
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China.
authors.forename: Baoqing
authors.initials: B
authors.lastname: Yu
authors.affiliation: Department of Pharmacy, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, China.
authors.forename: Fenfen
authors.initials: F
authors.lastname: Ma
authors.affiliation: Department of Pharmacy, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, China.
authors.forename: Huiping
authors.initials: H
authors.lastname: Lu
authors.affiliation: Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Pathology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China.
authors.forename: Qinghua
authors.initials: Q
authors.lastname: You
authors.affiliation: Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Yu
authors.affiliation: Department of Radiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China.
authors.forename: Jianlan
authors.initials: J
authors.lastname: Qiao
authors.affiliation: Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China. fjjfjj369@sohu.com.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Feng
mesh_terms: D000818:Animals; D017209:Apoptosis; D019299:Decompression, Surgical / Q000379:methods*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D008297:Male; D011817:Rabbits; D011859:Radiography; D020127:Recovery of Function / Q000502:physiology; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology / Q000502:physiology; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*
keywords: Balloon compression; Decompression surgery; Multilevel spine injuries; Somatosensory evoked potentials