Acute Traumatic Cervical Central Cord Syndrome—Is Early Intervention Justified?

2018 ◽  
Vol 15 (02/03) ◽  
pp. 094-099
Author(s):  
Rahul Saha ◽  
Sandip Chatterjee
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Cervical Spinal Cord ◽  
Randomized Study ◽  
Japanese Orthopaedic Association ◽  
Fracture Dislocation ◽  
Spine Injury ◽  
Disc Prolapse ◽  
Central Cord Syndrome ◽  
Early Surgical Intervention

AbstractThe clinical features suggestive of traumatic central cord syndrome (TCCS) were presented by Thorburn in his publication in 1887. Later in 1954, Schneider first mentioned the involvement of central cervical spinal cord after an acute cervical spine injury and described it as TCCS. This is generally caused due to an extreme hyperextension injury without vertebral damage and secondary to anteroposterior pinching or squeezing of the spinal cord. There exists a lot of controversy whether early surgical intervention is justified in these patients. It is to assess our own results that we decided to review 40 such cases treated by the senior author in the past 8 years. Twenty-four of these were managed with early surgical intervention (which we defined as within 48 hours), and 16 were treated conservatively. In all cases, the existence of fracture-dislocation, disc prolapse, as well as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and exact motor and sensory deficit were recorded. The numbers are too few, but there was definite evidence that patients with disc prolapse and fracture dislocation did better with surgery than with conservative treatment. Those with grade 0 power in the upper limbs however did significantly better with surgical treatment. Those with advanced pre-existing cervical spondylotic changes did better than those without these premorbid changes. However, the numbers are too small for meaningful statistical analysis. This is a retrospective study conducted as a pilot study to plan for a future randomized study, which is very necessary in our clinical practice. Currently, we still quote the pros and cons of surgical intervention to the relatives and go by their choice.

scholarly journals Early surgical intervention may facilitate recovery of cervical spinal cord injury in DISH

2019 ◽  
Vol 27 (1) ◽  
pp. 230949901983478 ◽  
Author(s):  
Osahiko Tsuji ◽  
Kota Suda ◽  
Masahiko Takahata ◽  
Satoko Matsumoto-Harmon ◽  
Miki Komatsu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Intervention ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury ◽  
Early Surgical Intervention

A critical reappraisal of corticospinal tract somatotopy and its role in traumatic cervical spinal cord syndromes

2021 ◽  
pp. 1-7
Author(s):  
Allan D. Levi ◽  
Jan M. Schwab
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Upper Extremity ◽  
Corticospinal Tract ◽  
Cervical Spinal Cord ◽  
Hand Function ◽  
Cervical Spinal Cord Injury ◽  
Pathophysiological Mechanism ◽  
Cord Injury ◽  
Central Cord Syndrome

The corticospinal tract (CST) is the preeminent voluntary motor pathway that controls human movements. Consequently, long-standing interest has focused on CST location and function in order to understand both loss and recovery of neurological function after incomplete cervical spinal cord injury, such as traumatic central cord syndrome. The hallmark clinical finding is paresis of the hands and upper-extremity function with retention of lower-extremity movements, which has been attributed to injury and the sparing of specific CST fibers. In contrast to historical concepts that proposed somatotopic (laminar) CST organization, the current narrative summarizes the accumulated evidence that 1) there is no somatotopic organization of the corticospinal tract within the spinal cord in humans and 2) the CST is critically important for hand function. The evidence includes data from 1) tract-tracing studies of the central nervous system and in vivo MRI studies of both humans and nonhuman primates, 2) selective ablative studies of the CST in primates, 3) evolutionary assessments of the CST in mammals, and 4) neuropathological examinations of patients after incomplete cervical spinal cord injury involving the CST and prominent arm and hand dysfunction. Acute traumatic central cord syndrome is characterized by prominent upper-extremity dysfunction, which has been falsely predicated on pinpoint injury to an assumed CST layer that specifically innervates the hand muscles. Given the evidence surveyed herein, the pathophysiological mechanism is most likely related to diffuse injury to the CST that plays a critically important role in hand function.

scholarly journals Lacrosse Equipment and Cervical Spinal Cord Space During Immobilization: Preliminary Analysis

2010 ◽  
Vol 45 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Michael Higgins ◽  
Ryan T. Tierney ◽  
Jeffrey B. Driban ◽  
Steven Edell ◽  
Randall Watkins
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Repeated Measures ◽  
Cervical Spinal Cord ◽  
Spine Injury ◽  
Imaging Center ◽  
Mri Scans ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Cervical Spine Alignment

Abstract Context: Removal of the lacrosse helmet to achieve airway access has been discouraged based only on research in which cervical alignment was examined. No researchers have examined the effect of lacrosse equipment on the cervical space available for the spinal cord (SAC). Objective: To determine the effect of lacrosse equipment on the cervical SAC and cervical-thoracic angle (CTA) in the immobilized athlete. Design: Observational study. Setting: Outpatient imaging center. Patients or Other Participants: Ten volunteer lacrosse athletes (age  =  20.7 ± 1.87 years, height  =  180.3 ± 8.3 cm, mass  =  91 ± 12.8 kg) with no history of cervical spine injury or disease and no contraindications to magnetic resonance imaging (MRI). Intervention(s): The lacrosse players were positioned supine on a spine board for all test conditions. An MRI scan was completed for each condition. Main Outcome Measure(s): The independent variables were condition (no equipment, shoulder pads only [SP], and full gear that included helmet and shoulder pads [FG]), and cervical spine level (C3–C7). The dependent variables were the SAC and CTA. The MRI scans were evaluated midsagittally. The average of 3 measures was used as the criterion variable. The SAC data were analyzed using a 3 × 5 analysis of variance (ANOVA) with repeated measures. The CTA data were analyzed with a 1-way repeated-measures ANOVA. Results: We found no equipment × level interaction effect (F3.7,72  =  1.34, P  =  .279) or equipment main effect (F2,18  =  1.20, P  =  .325) for the SAC (no equipment  =  5.04 ± 1.44 mm, SP  =  4.69 ± 1.36 mm, FG  =  4.62 ± 1.38 mm). The CTA was greater (ie, more extension; critical P  =  .0167) during the SP (32.64° ± 3.9°) condition than during the no-equipment (25.34° ± 2.3°; t9  =  7.67, P  =  .001) or FG (26.81° ± 5.1°; t9  =  4.80, P  =  .001) condition. Conclusions: Immobilizing healthy lacrosse athletes with shoulder pads and no helmets affected cervical spine alignment but did not affect SAC. Further research is needed to determine and identify appropriate care of the lacrosse athlete with a spine injury.

Lipomyelomeningocele: pathology, treatment, and outcomes

2012 ◽  
Vol 33 (4) ◽  
pp. E3 ◽  
Author(s):  
Christina E. Sarris ◽  
Krystal L. Tomei ◽  
Peter W. Carmel ◽  
Chirag D. Gandhi
Keyword(s):  
Spinal Cord ◽  
Neurological Disorder ◽  
Surgical Intervention ◽  
Neurological Deterioration ◽  
Neurological Dysfunction ◽  
Tethered Spinal Cord ◽  
Urodynamic Studies ◽  
Early Surgical Intervention

Lipomyelomeningocele represents a rare but complex neurological disorder that may present with neurological deterioration secondary to an inherent tethered spinal cord. Radiological testing is beneficial in determining the morphology of the malformation. Specialized testing such as urodynamic studies and neurophysiological testing may be beneficial in assessing for neurological dysfunction secondary to the lipomyelomeningocele. Early surgical intervention may be beneficial in preventing further neurological decline.

scholarly journals Mucopolysaccharidoses and Orthopedic Management (Focused also on Craniocervical Junction)

2018 ◽  
Vol 08 (01) ◽  
pp. e128-e137
Author(s):  
Christina Lampe ◽  
Christian Lampe
Keyword(s):  
Spinal Cord ◽  
Soft Tissues ◽  
Surgical Intervention ◽  
Cervical Spinal Cord ◽  
Joint Stiffness ◽  
Craniocervical Junction ◽  
Musculoskeletal Symptoms ◽  
Atlantoaxial Instability ◽  
Enzyme Replacement ◽  
Life Threatening

AbstractMucopolysaccharidoses (MPSs) are multisystemic, chronic progressive, heterogeneous, and life-threatening diseases, involving severely the musculoskeletal system, in particular in MPS I, II, IV, VI, VII, and less prevalent in MPS III. Accumulation of glycosaminoglycans (GAGs) in soft tissues, such as ligaments, tendons, and joint capsules, as well as in cartilage, and bone lead to orthopedic complications: joint stiffness, contractures, and skeletal deformities, resulting in hip dysplasia, genua valga, feet deformities, kyphoscoliosis, narrowing of the spinal canal, atlantoaxial instability, carpal tunnel syndrome, trigger finger, and growth retardation. These complications significantly reduce the quality of life due to impaired mobility, loss of independency, and pain. Compression of the cervical spinal cord is also life threatening. According to the progressive nature of MPSs, musculoskeletal symptoms worsen over time and surgical intervention may be inevitable. However, due to the increased anesthesia risk of MPSs, surgical intervention has to be evaluated carefully by a multidisciplinary team. Additionally, due to the rarity of the diseases, not many standards or recommendations are available to determine the indication of a surgical intervention, so each intervention must be decided individually, based on the few data available. In addition, conservative treatment should be taken into consideration. Physiotherapy, pain medication, insoles, orthosis, braces, corsets, and special footwear play a pivotal role. Unfortunately, the skeletal tissues are poorly vascularized and enzyme replacement therapy does not have much effect on them. It is important to detect and observe musculoskeletal complications in the regular follow-up visits, in particular the life-threatening compression of the cervical spinal cord.

scholarly journals Serial plasma DNA levels as predictors of outcome in patients with acute traumatic cervical spinal cord injury

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Hung-Chen Wang ◽  
Yu-Tsai Lin ◽  
Shih-Yuan Hsu ◽  
Nai-Wen Tsai ◽  
Yun-Ru Lai ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Japanese Orthopaedic Association ◽  
Cervical Spinal Cord Injury ◽  
Acute Injury ◽  
Control Group ◽  
Plasma Dna ◽  
Post Injury ◽  
Cord Injury

Abstract Background Acute traumatic cervical spinal cord injury (SCI) is a leading cause of disability in adolescents and young adults worldwide. Evidence from previous studies suggests that circulating cell-free DNA is associated with severity following acute injury. The present study determined whether plasma DNA levels in acute cervical SCI are predictive of outcome. Methods In present study, serial plasma nuclear DNA (nDNA) and mitochondrial DNA (mtDNA) levels were obtained from 44 patients with acute traumatic cervical SCI at five time points from day 1 to day 180 post-injury. Control blood samples were obtained from 66 volunteers. Results Data showed a significant increase in plasma nDNA and mtDNA concentrations at admission in SCI patients compared to the control group. Plasma nDNA levels at admission, but not plasma mtDNA levels, were significantly associated with the Japanese Orthopaedic Association (JOA) score and Injury Severity Score in patients with acute traumatic cervical SCI. In patients with non-excellent outcomes, plasma nDNA increased significantly at days 1, 14 and 30 post-injury. Furthermore, its level at day 14 was independently associated with outcome. Higher plasma nDNA levels at the chosen cutoff point (> 45.6 ng/ml) predicted poorer outcome with a sensitivity of 78.9% and a specificity of 78.4%. Conclusions These results indicate JOA score performance and plasma nDNA levels reflect the severity of spinal cord injury. Therefore, the plasma nDNA assays can be considered as potential neuropathological markers in patients with acute traumatic cervical SCI.

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