Intradural Lysis and Peripheral Nerve Implantation for Traumatic Obsolete Incomplete Paralysis
Shao-Cheng Zhang, M.D.
Professor & Chief Surgeon
Department of Orthopedics
Changhai Hospital
Shanghai, China
Yu-hai Ma, M.D.
Assistant Professor
Department of Orthopedics
Changhai Hospital
Shanghai, China
Hui-ren Liu, M.D.
Assistant Professor
Department of Orthopedics
The Second Hospital of Tangshan
Hebei Province, China
Xue-song Zhang, M.D.
Assistant Professor
Department of Orthopedics
Changhai Hospital
Shanghai, China
Yong-tai Pan, M.D.
Assistant Professor
Department of Orthopedics
The 180th Hospital of PLA
Fujian Province, China
Xu-dong Zheng, M.D.
Assistant Professor
Department of Orthopedics
Aviation Industry Central Hospital
Beijing,China
Twenty-eight patients who suffered traumatic obsolete incomplete paralysis were treated with intradural lysis and peripheral nerve implantation by a microsurgery technique. The endorachis was opened and the fibrous bands adhering to the spinal cord from the arachnoid, pia mater spinalis, ligamenta denticulatum, and the initial part of the nerve root were completely relieved. The abnormal spinal cord was then opened by three to six incisions, which were each 0.1 mm to 0.2 mm deep and longer than the abnormal portion. A cyst found in the back or side of the spinal cord was opened and the liquid in it was drained. After that, the denuded spineurium and perineurium of the autogenous sural nerve were grafted, which makes the character and aspect of the nerve like the cauda equine. The nerve was longitudinally implanted into the incised spinal cord, and the cyst was waded with grafted nerve and at least one of them is ectropion sutured with the pia mater with 9-0 scatheless wire as a drain. Finally, the endorachis was covered by sacrospinal muscle flap. These patients were followed for 2 years to 8 years (average 3.5 years), and the sensibility and motion of each increased at least one grade. The strength of the main muscle was increased two grades and reached four grades in 11 patients, and the capability to walk was recovered. Relieving of the adhesion in the endorhachis, carving the cicatricial spinal cord, and implanting the autogenous peripheral nerve yields good results by initial clinical observation for traumatic obsolete and incomplete paralysis.
