The Relevance of the Occult Cervical Spine Controversy and Mechanism of Injury to Prehospital Protocols: A Review of the Issues and Literature

1996 ◽  
Vol 11 (3) ◽  
pp. 228-233 ◽  
Author(s):  
Alexander M. Butman ◽  
Daniel T. Schelble ◽  
Richard W. Vomacka
Keyword(s):  
Spinal Cord ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Neurological Deficits ◽  
Spine Injury ◽  
Mechanism Of Injury ◽  
Spine Trauma ◽  
Spinal Cord Damage ◽  
Spinal Immobilization ◽  
Spine Injuries

Prehospital guidelines that define the clinical indications for spine trauma also serve as the criteria for selective spinal immobilization in the field. Therefore, these criteria are important for avoiding further spinal cord damage. Because some spine injuries may occur without neurological deficits or other clinical signs, the recommended field guidelines extend beyond the signs and symptoms and include mechanisms of injury or other injuries commonly associated with a high risk of spine injury.

scholarly journals The induced dose of experimental autoimmune encephalomyelitis was not determinant and proportional to histopathological findings

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Maiara Carolina Perussolo ◽  
Bassam Felipe Mogharbel ◽  
Lucia de Noronha ◽  
Katherine Athayde Teixeira de Carvalho
Keyword(s):  
Spinal Cord ◽  
Experimental Autoimmune Encephalomyelitis ◽  
Demyelinating Disease ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Control Group ◽  
Autoimmune Encephalomyelitis ◽  
Histopathological Findings ◽  
The Brain ◽  
Experimental Autoimmune

Abstract Background Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, characterized as an inflammatory demyelinating disease. It presents a diversity of neurologic signs and symptoms as well the incapacities. Since the need for advances in MS treatment, many studies are for new therapeutic technologies, mainly through using preclinical models as experimental autoimmune encephalomyelitis (EAE). This study aimed to observe and analyze the development in Lewis rats-induced model of EAE. Methods It was used 23 females of Rattus norvegicus, from 6 to 8 weeks, weighing around 170 g. Of 23 rats, 19 underwent EAE induction distributed in six groups to establish the evolution of clinical signs. B. pertussis toxin (PTX) doses were 200, 250, 300, 350–400 ng, and four animals as the control group. The animals had weight and scores analyzed daily, starting seven and ending 24 days after induction. Then, all animals were euthanized, and the brain and spinal cord were collected for histopathological analyses. Results The results showed that the dose of 250 ng of PTX induced de higher score and weight reduction. All groups who received the PTX demonstrated histopathological findings. Those characterized as leukocyte infiltration, activation of microglia and astrocytes, and demyelinated plaques in the brain. In the spinal cord, the loosening of the myelinated fibers was observed by increasing the axonal space in all tested doses of PTX. Conclusions EAE was not dose-dependent. Histopathological findings do not proportionally related to clinical signs, as in human patients with MS.

scholarly journals Thoracolumbar Chance fracture during a professional female soccer game: case report

2016 ◽  
Vol 14 (1) ◽  
pp. 67-70 ◽  
Author(s):  
Alberto Ofenhejm Gotfryd ◽  
Fernando José Franzin ◽  
Roger Hartl
Keyword(s):  
Spinal Cord ◽  
Rare Case ◽  
Posterior Instrumentation ◽  
Soccer Game ◽  
Spinal Cord Damage ◽  
Chance Fracture ◽  
Professional Soccer ◽  
Initial Care ◽  
Spine Injuries ◽  
Neurological Injuries

ABSTRACT We report a rare case of an unstable flexion-distraction spine fracture with ligament involvement that occurred during a professional female soccer game. There were no neurological déficit. The patient had a painful midline gap which suggested ligamentar injury that was not immediately recognized. Despite that, proper immobilization and referral to hospital for further evaluation avoided additional spinal cord damage. The patient underwent a monosegmental posterior instrumentation spine fusion and after 6 months returned to professional soccer activities. This paper alerts to the possibility of occurrence of severe and unstable spine injuries during soccer practice and the importance of an adequate initial care at the game field in order to avoid iatrogenic neurological injuries.

Late-onset recurrence of neurological deficits after surgery for spinal arachnoid diverticula

2017 ◽  
Vol 182 (13) ◽  
pp. 380-380 ◽  
Author(s):  
Emili Alcoverro ◽  
James Fraser McConnell ◽  
Daniel Sanchez-Masian ◽  
Luisa De Risio ◽  
Steven De Decker ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Medical Treatment ◽  
Medical Records ◽  
Late Onset ◽  
Clinical Signs ◽  
Neurological Deficits ◽  
Laminectomy Membrane ◽  
Spinal Cord Dysfunction ◽  
Time To Relapse

Spinal cord dysfunction secondary to spinal arachnoid diverticula (SAD) has been widely reported in the veterinary literature and there is some suggestion that surgical treatment may provide better outcomes than medical treatment. Despite this, previous reports have mentioned cases with recurrence of clinical signs following surgical treatment but the cause for this has not been further investigated. The medical records of seven dogs and one cat which presented for investigation of recurrence of neurological deficits at least six months after surgery for SAD were retrospectively reviewed. Median time to relapse of the neurological deficits was 20.5 months after surgery. On repeated imaging, 3/8 cases showed clear regrowth of diverticulum, 2/8 cases showed dorsal compression at the previous laminectomy site (presumed to be the laminectomy membrane), and 3/8 cases showed herniation of the spinal cord through the laminectomy defect associated with a stellate appearance to the spinal cord with small multiloculated areas of dilation of the subarachnoid space. Repeat surgical intervention was most successful in the cases where SAD recurrence was identified while medical treatment resulted in either subtle improvement or stabilisation on the clinical signs, sometimes followed by slow deterioration.

Cervical Spine Trauma Management

2018 ◽  
Vol 1 (2) ◽  
pp. 14
Author(s):  
Rully Hanafi Dahlan ◽  
Sevline Estethia Ompusunggu ◽  
Farid Yudoyono
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Early Mobilization ◽  
Cord Compression ◽  
Spinal Injuries ◽  
Spine Injury ◽  
Spine Trauma ◽  
Neurological Improvement ◽  
Operative Care ◽  
Cord Injury

The incidence of spine injury following accidents are still very high in developing countries. Many problems occur after the accident including primary intervention on the scene, transportation to the public primary hospital, the referral system, and finally, the management at the central hospital.Cervical spinal cord injuries represent 20-33% of total spinal injuries with the prevalence of the subaxial levels. In patients with a preoperative neurological deficit due to spine trauma, in case of spinal cord compression or instability, surgery is often the treatment of choice to grant a chance of neurological recovery, early mobilization, and faster return to usual daily activities compared to the conservative treatment. In the past, many authors suggested a delayed surgical treatment to reduce postoperative complications rate, but recent studies have shown that an early decompression (<72 h) may facilitate a postoperative neurological improvement probably due to the prevention of the secondary mechanisms of damage in acute SCI.In the context of the advanced management of spinal injuries, the main points of the focused assessment, the important waypoints of a full classification of the skeletal and spinal cord injury, the principles of early prioritization and decision making, the outline of the surgical strategy including indications, timing, approaches, technique and post-operative care, and the outline principles of rehabilitation. The authors in this paper try to summarize and create a guideline of management, based on experience in a regional centre.

scholarly journals Traumatic spine injuries in children. Experience on 434 cases and therapeutic perspectives

2015 ◽  
Vol 29 (2) ◽  
pp. 135-140
Author(s):  
A. Tascu ◽  
Fl. Exergian ◽  
S. Daniel ◽  
A. Iliescu ◽  
C. Pascal ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Spinal Injury ◽  
Adult Population ◽  
Spine Injury ◽  
Pediatric Spine ◽  
Good Recovery ◽  
Spine Trauma ◽  
Spine Injuries ◽  
Low Incidence ◽  
Sport Events

Abstract Traumatic spine injuries in pediatric patients have a low incidence, mainly due to a more flexible spine and is a specific matter in comparison to spinal injury in adults. Pediatric spine fractures constitute 1 to 3% of all pediatric fractures. Between 20 % and 60% of the fractures occur in the lumbar and thoracic spine. These spine injury appeared most frequently in sport events, followed by traffic events and accidental falling. The vast majority of the children with spinal trauma had grade D and E lesions on Frankel scale and had a good recovery in 1 to 3 months after the event. Prognosis and outcome is better in children with spine trauma, reducing toward adolescence and in young adults and the death rate was extremely low compared to the adult population

Spinal injury patterns among skiers and snowboarders

2011 ◽  
Vol 31 (5) ◽  
pp. E8 ◽  
Author(s):  
Molly E. Hubbard ◽  
Ryan P. Jewell ◽  
Travis M. Dumont ◽  
Anand I. Rughani
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Head Injury ◽  
Spinal Cord Injuries ◽  
Skull Fracture ◽  
Closed Head Injury ◽  
Spine Injury ◽  
Cervical Spine Trauma ◽  
Spine Trauma ◽  
Injury Patterns

Object Skiing and snowboarding injuries have increased with the popularity of these sports. Spinal cord injuries (SCIs) are a rare but serious event, and a major cause of morbidity and mortality for skiers and snowboarders. The purpose of this study is to characterize the patterns of SCI in skiers and snowboarders. Methods The authors queried the Nationwide Inpatient Sample for the years 2000–2008 for all patients admitted with skiing or snowboarding as the mechanism of injury, yielding a total of 8634 patients. The injury patterns were characterized by the ICD-9 diagnostic and procedure codes. The codes were searched for those pertaining to vertebral and skull fracture; spinal cord, chest, abdominal, pelvic, and vessel injuries; and fractures and dislocations of the upper and lower extremity. Statistical analysis was performed with ANOVA and Student t-test. Results Patients were predominantly male (71%) skiers (61%), with the average age of the skiers being older than that of snowboarders (39.5 vs 23.5 years). The average length of stay for patients suffering from spine trauma was 3.8 days and was increased to 8.9 days in those with SCI. Among hospitalized patients, SCI was seen in 0.98% of individuals and was equally likely to occur in snowboarders and skiers (1.07% vs 0.93%, p < 0.509). Cervical spine trauma was associated with the highest likelihood of SCI (19.6% vs. 10.9% of thoracic and 6% of lumbar injuries, p < 0.0001). Patients who were injured skiing were more likely to sustain a cervical spine injury, whereas those injured snowboarding had higher frequencies of injury to the lumbar spine. The most common injury seen in tandem with spine injury was closed head injury, and it was seen in 13.4% of patients. Conversely, a spine injury was seen in 12.9% of patients with a head injury. Isolated spine fractures were seen in 4.6% of patients. Conclusions Skiers and snowboarders evaluated at the hospital are equally likely to sustain spine injuries. Additionally, participants in both sports have an increased incidence of SCI with cervical spine trauma.

Evaluation of cervical spine injury and predicting neurological deficit by magnetic resonance imaging

2021 ◽  
Vol 12 (2) ◽  
pp. 92-97
Author(s):  
Sushant H Bhadane ◽  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
Mr Imaging ◽  
Neurological Deficit ◽  
Spine Injury ◽  
Cervical Spine Injuries ◽  
Cord Injury ◽  
Spine Injuries ◽  
Posterior Element

Background: The consequences of cervical spine injuries range from simple neck pain, to quadriplegia, or even death. MR imaging has become part of the diagnostic and prognostic tools for spinal cord injury. Aim: To prospectively evaluate cervical spine injuries by MR imaging and to find out association of MR imaging findings with degree of neurological deficit. Material and Methods: Descriptive longitudinal hospital based study was conducted on 30 patients with known or suspected cervical spine trauma who presented to the emergency department. Results: Mean age of the cases was about 42 years, with female to male ratio of 1:6.5. C6-C7 spinal level was most commonly involved. Proportions complete spinal cord injury (CSCI), incomplete spinal cord injury (ISCI) and neurologically normal (NN) were 23.33%, 60% and 16.67% respectively. Out of 12 MRI findings, cord haemorrhage, contusion, posterior element fracture, disc injury, prevertebral hematoma, subluxation and soft tissue injury was statistically associated with degree of neurological deficit. Cord contusion, cord haemorrhage and posterior element fracture were potential predictors of neurological status at admission. Cord contusion, cord haemorrhage and subluxation were potential predictors at 3 months. Conclusion: MRI proved a pivotal role in the diagnosis of SCIs, deciding prompt management and predicting neurological deficit and prognosis of neurological recovery. So, MRI is an excellent diagnostic modality for the evaluation of spinal trauma and predicting the degree of neurological deficit and recovery.

scholarly journals Traumatic spine injuries in the geriatric population

2008 ◽  
Vol 25 (5) ◽  
pp. E16 ◽  
Author(s):  
Pascal Jabbour ◽  
Michael Fehlings ◽  
Alexander R. Vaccaro ◽  
James S. Harrop
Keyword(s):  
Spinal Cord ◽  
Elderly Population ◽  
Clinical Presentation ◽  
Management Strategies ◽  
The Elderly ◽  
Spine Trauma ◽  
Geriatric Population ◽  
Treatment Algorithms ◽  
Cord Injury ◽  
Spine Injuries

In this paper the authors review spine trauma and spinal cord injury (SCI) in the geriatric population. The information in this study was compiled through a literature review of clinical presentation and management of SCI in the elderly population. This was done to define, identify, and specify treatment algorithms and management strategies in this unique patient population.

scholarly journals Lumbar Spine Injuries in National Collegiate Athletic Association Athletes: A 5-Season Epidemiological Study

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711882004 ◽  
Author(s):  
Jeffrey D. Hassebrock ◽  
Karan A. Patel ◽  
Justin L. Makovicka ◽  
Andrew S. Chung ◽  
Sailesh V. Tummala ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
National Collegiate Athletic Association ◽  
Spine Injury ◽  
Common Mechanism ◽  
Mechanism Of Injury ◽  
Convenience Sample ◽  
Injury Rates ◽  
Spine Injuries ◽  
Ncaa Athletes ◽  
Injury Recurrence

Background: Lumbar spine injuries in National Collegiate Athletic Association (NCAA) athletes have not been well studied. Purpose: To describe the epidemiology of lumbar spine injuries in NCAA athletes during the 2009/2010 through 2013/2014 academic years utilizing the NCAA Injury Surveillance Program (ISP). Study Design: Descriptive epidemiology study. Methods: A voluntary convenience sample of NCAA varsity teams from 25 sports was examined. Mechanism of injury, injury recurrence, and time lost from sport were recorded. Injury rates were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in 1 NCAA-sanctioned practice or competition. Injury rate ratios and injury proportion ratios were calculated to compare the rates within and between sports by event type, season, patient sex, mechanism, injury recurrence, and time lost from sport. Comparisons between sexes were made utilizing data that had both male and female samples. Results: An estimated 50,834 lumbar spine injuries were identified. The overall rate of injuries was 2.88 per 10,000 AEs. The rate of injuries was 2.60 per 10,000 AEs in men compared with 2.89 per 10,000 AEs in women for sex-comparable sports. Women were 1.11 times more likely than men to suffer a lumbar spine injury. Women's gymnastics (8.02 injuries per 10,000 AEs) and women's tennis (5.73 injuries per 10,000 AEs) had the highest rates of lumbar spine injuries. Athletes were 1.6 and 2.4 times more likely to sustain a lumbar spine injury during the preseason than the regular season or postseason, respectively. Noncontact was the most common mechanism of injury (45%). Injury recurrence was most common in men’s outdoor track (43%). Most injuries resulted in less than 24 hours of time loss from event participation (64%). Conclusion: The rate of lumbar spine injuries was high in NCAA athletes, and injuries commonly recurred (20.73%). In general, women were more likely to sustain a lumbar spine injury compared with men. Higher injury rates occurred during competition and via a noncontact mechanism of injury. In addition to prevention programs, reconditioning programs should be considered to prevent these injuries.

scholarly journals MR imaging of penetrating spinal trauma

2003 ◽  
Vol 7 (3) ◽  
pp. 25-29
Author(s):  
Peter Corr ◽  
Hoosen Lakhi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mr Imaging ◽  
Clinical Signs ◽  
Artery Occlusion ◽  
Spinal Trauma ◽  
Mr Studies ◽  
Neurological Deficits ◽  
Cord Injury ◽  
Shot Wounds

Objective: To determine the utility of MR imaging in the assessment of spinal cord injury following penetrating spinal trauma.Methods: We retrospectively reviewed the case notes and MR studies of patients referred to our MR facility over a 2-year period with neurological deficits following penetrating spinal injuries. All MR studies were performed on the same MR scanner with identical protocols. We reviewed the MR studies blinded to the clinical data and MR reports. We recorded the presence of: spinal cord transection, cord contusion, haematomyelia, extramedullary haematoma and vascula injury.Results: 20 patients (17 males, 3 females) with a mean age of 28 years were studied. Causes of injury were knife wounds in 17 patients and gun shot wounds in 3 patients. Site of injury was: cervical in 14, thoracic 4, lumbar in 2. Neurological deficits were: Brown-Séquard syndrome in 8, paraparesis in 7, quadraparesis in 2, hemiplegia 2, unconscious 1. MR findings were: partial cord transection in 9 patients, cord oedema/contusion in 5, haematomyelia in 2, myelomalacia in 2, and disk herniation in 1. One patient with cord transection sustained verterbral artery occlusion. Only 4 patients with Brown-Séquardsyndrome had partial cord transection, the other 5 had cord contusions.Conclusions: MR accurately demonstrates spinal cord injury in patients with penetrating spinal trauma, however the clinical signs detected do not always correlate with the MR findings.

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