scholarly journals Spontaneous Recovery of Penetrating Cervical Spinal Cord Injury with Physiotherapeutic Treatment: Case Report and Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Yao Christian Hugues Dokponou ◽  
Mamoune El Mostarchid ◽  
Housni Abderrahmane ◽  
Niamien Patrice Koffi ◽  
Miloudi Gazzaz ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spontaneous Recovery ◽  
Sports Injuries ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Neck Region ◽  
Road Accidents ◽  
Unique Case ◽  
Neurological Improvement ◽  
Cord Injury

Stab wounds to the cervical spine are less common than injuries from road accidents, sports injuries, and falls. The presence of vital, vascular, neural, respiratory, and digestive structures in the neck region mean that this kind of spinal injury is generally critical, and its management is a challenge. We report a unique case of a previously healthy 17-year-old adolescent admitted for quadriplegia secondary to a stab wound to the cervical spine at the C4C5 level. There was no surgical indication. The patient underwent physiotherapy. He showed spontaneous neurological improvement two weeks later and was able to sit on his own and to walk about three months of physical rehabilitation.

scholarly journals Outcome of Late Anterior Surgery and Arthrodesis of Lower Cervical Spinal Cord Injury

1970 ◽  
Vol 18 (1) ◽  
pp. 47-53
Author(s):  
SMNK Chowdhury ◽  
SU Ahmed ◽  
SA Ara ◽  
SMMA Chowdhury ◽  
SS Hossain ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
Neurological Deficit ◽  
Neurological Outcome ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Anterior Surgery ◽  
Cord Injury

Objective: To evaluate the efficacy and outcome of late anterior surgery and arthrodesis of lower cervical spinal cord injury. Study design: Prospective Analysis. Setting: Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka; Bangladesh. Subjects and Methods: 32 consecutive patients with sub axial cervical spinal cord injury managed surgically from January 2000 to July 2005 by late anterior surgery and autologous bone graft stabilization considered as study unit. The indications of surgery were persistent cervical spinal cord compression and / or instability of cervical spine. Most cases were admitted late and operations were carried out as late 1 week to 27 weeks after injury. All the patients were investigated by radiograph and MRI of cervical spine accordingly. Post operative patient were followed up for twice, just before discharge from hospital and there-after minimum 3 months to 3 years. Quantification of deficit and neurological outcome were rated by American Spinal Injury Association (ASIA) classification system. Results: Males were found predominant with 93.75% over the female 6.25%; with ratio is 15: 1. Minimum age of the patient is 16 years and maximum age is 55 years. Most frequently (37.50%) encountered group were between the age of 31 to 40 years. Mean age is 32.29±10.09 years. Falling due to slip while carrying heavy load on head and / or neck (37.50%) was the most common cause of sub axial cervical spinal injury followed by road traffic accidents (31.25%), which may not be reported elsewhere till to-date. 31.25% suffered a single vertebral level, 62.50% patients suffered two vertebral levels and 6.25% patients suffered three level vertebral levels. The commonest skeletal level was C5/6 (46.87%) followed by C5 (25.00%) but C5 (46.87%) was commonest neurological level followed by C4 (18.75%). 81.25% of patients sustained a neurological injury. Of these, 75.00% had incomplete neurological deficit. After the operative procedure these incomplete neurological deficit patients have shown very attractive neurological recoveries. 6.25% of total population, who had complete neurological deficit, was graded as ASIA grade - A did not show any neurological recovery. In the current series none of the patients had worsening of neurological deficit due surgical intervention. Conclusion: This study offer significant potential for repairing some of the damage caused by cervical spinal cord injury. Further more, though controversy exists as to the ideal approach and timing (early versus late surgery) we have seen that benefits derived from late anterior surgery in our patients. Key words: Spinal Cord Injury; ASIA impairment scale; Neurological outcome. DOI: 10.3329/jdmc.v18i1.6306 J Dhaka Med Coll. 2009; 18(1) : 47-53

scholarly journals Outcome of Cervical Spine Trauma Patients Admitted to the Intensive Care Unit at a Tertiary Government Referral Trauma Center in Nepal

2021 ◽  
pp. 219256822098070
Author(s):  
Gyanendra Shah ◽  
Gaurav Raj Dhakal ◽  
Anil Gupta ◽  
Pawan Kumar Hamal ◽  
Siddhartha Dhungana ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cervical Spine ◽  
Cervical Spinal Cord ◽  
Limited Resource ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Resource Setting ◽  
Cord Injury ◽  
Huge Impact

Study Design: Retrospective study. Objectives: Cervical spinal cord injury (SCI) is a devastating event for patient and family. It has a huge impact on society because of intensive resources required to manage the patient in both acute and rehabilitation phases. With the limited resource setting in underdeveloped countries like Nepal, questions are often raised regarding whether the outcome justifies the expenses of their care. The objective was to assess the outcomes of cervical SCI patients admitted to intensive care unit (ICU). Methods: All cervical SCI admitted in ICU during May 2017 to August 2018 were included in this study. Demographic details, mode, morphology, and neurological level of injury, intervention performed and outcomes of ICU stay were analyzed. Results: Out of 48 patients, 36 (75%) were male and 12 female with mean age 43.9 ± 15.9 years. Fall injury was the commonest mode of injury (83.3%). Most patients presented within 1 to 3 days of injury and C5-C6 (33.3%) was the most common involved level and 75% presented with ASIA A neurology. Mechanical ventilation was required in 95.8% of the patients and 22 patients were operated upon. The average stay in ICU was 15 days and 13 patients died in the ICU. Conclusions: Majority of cervical SCI with complete motor paraplegia required ICU care. Inspite of the intensive care, a subset of these patients succumbed to the complications of the injury. Therefore, it is essential to establish trauma ICU care with specific protocols on managing cervical spine injuries.

Numerical Investigation of Spinal Cord Injury After Flexion-Distraction Injuries At the Cervical Spine

2021 ◽  
Author(s):  
Marie-Helene Beausejour ◽  
Eric Wagnac ◽  
Pierre-Jean Arnoux ◽  
Jean-Marc Mac-Thiong ◽  
Yvan Petit
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
White Matter ◽  
Cervical Spinal Cord ◽  
Element Model ◽  
Von Mises Stress ◽  
Study Objective ◽  
Cord Injury ◽  
Post Traumatic

Abstract Flexion-distraction injuries frequently cause traumatic cervical spinal cord injury (SCI). Post-traumatic instability can cause aggravation of the secondary SCI during patient's care. However, there is little information on how the pattern of disco-ligamentous injury affects the SCI severity and mechanism. This study objective was to analyze how different flexion-distraction disco-ligamentous injuries affect the SCI mechanisms during post-traumatic flexion and extension. A cervical spine finite element model including the spinal cord was used and different combinations of partial or complete intervertebral disc (IVD) rupture and disruption of various posterior ligaments were modeled at C4-C5, C5-C6 or C6-C7. In flexion, complete IVD rupture combined with posterior ligamentous complex rupture was the most severe injury leading to the most extreme von Mises stress (47 to 66 kPa), principal strains p1 (0.32 to 0.41 in white matter) and p3 (-0.78 to -0.96 in white matter) in the spinal cord and to the most important spinal cord compression (35 to 48 %). The main post-trauma SCI mechanism was identified as compression of the anterior white matter at the injured level combined with distraction of the posterior spinal cord during flexion. There was also a concentration of the maximum stresses in the gray matter after injury. Finally, in extension, the injuries tested had little impact on the spinal cord. The capsular ligament was the most important structure in protecting the spinal cord. Its status should be carefully examined during patient's management.

scholarly journals Impact of cervical spinal cord contusion on the breathing pattern across the sleep-wake cycle in the rat

2019 ◽  
Vol 126 (1) ◽  
pp. 111-123 ◽  
Author(s):  
Kun-Ze Lee
Keyword(s):  
Spinal Cord ◽  
Tidal Volume ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Minute Ventilation ◽  
Respiratory Frequency ◽  
Breathing Patterns ◽  
Cord Injury ◽  
Spinal Contusion ◽  
Cervical Spinal Injury

The present study was designed to investigate breathing patterns across the sleep-wake state following a high cervical spinal injury in rats. The breathing patterns (e.g., respiratory frequency, tidal volume, and minute ventilation), neck electromyogram, and electroencephalography of unanesthetized adult male rats were measured at the acute (i.e., 1 day), subchronic (i.e., 2 wk), and/or chronic (i.e., 6 wk) injured stages after unilateral contusion of the second cervical spinal cord. Cervical spinal cord injury caused a long-term reduction in the tidal volume but did not influence the sleep-wake cycle duration. The minute ventilation during sleep was usually lower than that during the wake period in uninjured animals due to a decrease in respiratory frequency. However, this sleep-induced reduction in respiratory frequency was not observed in contused animals at the acute injured stage. By contrast, the tidal volume was significantly lower during sleep in contused animals but not uninjured animals from the acute to the chronic injured stage. Moreover, the frequency of sigh and postsigh apnea was elevated in acutely contused animals. These results indicated that high cervical spinal contusion is associated with exacerbated sleep-induced attenuation of the tidal volume and higher occurrence of sleep apnea, which may be detrimental to respiratory functional recovery after cervical spinal cord injury. NEW & NOTEWORTHY Cervical spinal injury is usually associated with sleep-disordered breathing. The present study investigated breathing patterns across sleep-wake state following cervical spinal injury in the rat. Unilateral cervical spinal contusion significantly impacted sleep-induced alteration of breathing patterns, showing a blunted frequency response and exacerbated attenuated tidal volume and occurrence of sleep apnea. The result enables us to investigate effects of cervical spinal injury on the pathogenesis of sleep-disordered breathing and evaluate potential therapies to improve respiration.

scholarly journals Spinal Cord Injury With Tetraplegia in Young Persons After Diving Into Shallow Water: What Has Changed in the Past 10 to 15 Years?

2020 ◽  
pp. 219256822094412
Author(s):  
Christopher Ull ◽  
Emre Yilmaz ◽  
Oliver Jansen ◽  
Sebastian Lotzien ◽  
Thomas A. Schildhauer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Shallow Water ◽  
Spinal Injury ◽  
Care Center ◽  
Risk Groups ◽  
Young Person ◽  
Health Care Center ◽  
Neurological Improvement ◽  
Cord Injury

Study Design: Retrospective, monocentric, observational study in a tertiary health care center. Objectives: To analyze prehospital and clinical findings, complications, neurological improvement and follow-up in a young person cohort with spinal cord injury (SCI) and tetraplegia according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) A to D after diving into shallow water. Methods: Included were all persons younger than 50 years with SCI after head-first diving into shallow water between June 2001 and June 2019. All persons with SCI were divided into complete tetraplegia (AIS A) and incomplete tetraplegia (AIS B, C, and D) to test differences. Results: A total of 59 males (98.7%) and 1 female with a mean age of 27.7 years suffered an SCI. Alcohol use was documented in 25 cases (41.7%). At the time of admission, 33 people (55%) showed a complete tetraplegia (AIS A) and 27 showed an incomplete tetraplegia with 8 AIS B (13.3%), 15 AIS C (25%), and 4 AIS D (6.7%). At the time of discharge, people with initially complete tetraplegia showed a significant improvement from admission to discharge ( P ≤ .004). Persons with incomplete tetraplegia were more likely to improve their neurological status compared with complete tetraplegia patients ( P ≤ .001). Especially persons with complete tetraplegia suffered from typical SCI-related problems and complications. Conclusions: People with SCI and tetraplegia at the time admission show neurological improvement in 50% of the cases with an overall better outcome in persons with incomplete tetraplegia. The surgical treatment of SCI within 24 hours seems to be associated with a better neurological outcome and a lower level of tetraplegia. The incidence of SCI caused by diving into shallow water remains stable without a significant change, especially in high-risk groups. More education and prevention programs are necessary to avoid these injuries.

Failure of Mean Arterial Pressure Goals to Improve Outcomes Following Penetrating Spinal Cord Injury

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. 708-714 ◽  
Author(s):  
William J. Readdy ◽  
Rajiv Saigal ◽  
William D. Whetstone ◽  
Anthony N. Mefford ◽  
Adam R. Ferguson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Patient Population ◽  
Spinal Injury ◽  
Neurological Recovery ◽  
American Spinal Injury Association ◽  
Neurological Improvement ◽  
Cord Injury

Abstract BACKGROUND: Increased spinal cord perfusion and blood pressure goals have been recommended for spinal cord injury (SCI). Penetrating SCI is associated with poor prognosis, but there is a paucity of literature examining the role of vasopressor administration for the maintenance of mean arterial pressure (MAP) goals in this patient population. OBJECTIVE: To elucidate this topic and to determine the efficacy of vasopressor administration in penetrating SCI by examining a case series of consecutive penetrating SCIs. METHODS: We reviewed consecutive patients with complete penetrating SCI who met inclusion and exclusion criteria, including the administration of vasopressors to maintain MAP goals. We identified 14 patients with complete penetrating SCIs with an admission American Spinal Injury Association grade of A from 2005 to 2011. The neurological recovery, complications, interventions, and vasopressor administration strategies were reviewed and compared with those of a cohort with complete blunt SCI. RESULTS: In our patient population, only 1 patient with penetrating SCI (7.1%) experienced neurological recovery, as determined by improvement in the American Spinal Injury Association grade, despite the administration of vasopressors for supraphysiological MAP goals for an average of 101.07 ± 34.96 hours. Furthermore, 71.43% of patients with penetrating SCI treated with vasopressors experienced associated cardiogenic complications. CONCLUSION: Given the decreased likelihood of neurological improvement in penetrating injuries, it may be important to re-examine intervention strategies in this population. Specifically, the use of vasopressors, in particular dopamine, with their associated complications is more likely to cause complications than to result in neurological improvement. Our experience shows that patients with acute penetrating SCI are unlikely to recover, despite aggressive cardiopulmonary management.

scholarly journals Nerve transfers for restoration of finger flexion in patients with tetraplegia

2017 ◽  
Vol 26 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Jayme A. Bertelli ◽  
Marcos F. Ghizoni
Keyword(s):  
Median Nerve ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Manual Muscle Testing ◽  
Upper Limbs ◽  
Muscle Testing ◽  
Finger Flexion ◽  
Cord Injury

OBJECTIVE The purpose of this paper was to report the authors' results with finger flexion restoration by nerve transfer in patients with tetraplegia. METHODS Surgery was performed for restoration of finger flexion in 17 upper limbs of 9 patients (8 male and 1 female) at a mean of 7.6 months (SD 4 months) after cervical spinal cord injury. The patients' mean age at the time of surgery was 28 years (SD 15 years). The motor level according to the ASIA (American Spinal Injury Association) classification was C-5 in 4 upper limbs, C-6 in 10, and C-7 in 3. In 3 upper limbs, the nerve to the brachialis was transferred to the anterior interosseous nerve (AIN), which was separated from the median nerve from the antecubital fossa to the midarm. In 5 upper limbs, the nerve to the brachialis was transferred to median nerve motor fascicles innervating finger flexion muscles in the midarm. In 4 upper limbs, the nerve to the brachioradialis was transferred to the AIN. In the remaining 5 upper limbs, the nerve to the extensor carpi radialis brevis (ECRB) was transferred to the AIN. Patients were followed for an average of 16 months (SD 6 months). At the final evaluation the range of finger flexion and strength were estimated by manual muscle testing according to the British Medical Research Council scale. RESULTS Restoration of finger flexion was observed in 4 of 8 upper limbs in which the nerve to the brachialis was used as a donor. The range of motion was incomplete in all 5 of these limbs, and the strength was M3 in 3 limbs and M4 in 1 limb. Proximal retrograde dissection of the AIN was associated with better outcomes than transfer of the nerve to the brachialis to median nerve motor fascicles in the arm. After the nerve to the brachioradialis was transferred to the AIN, incomplete finger flexion with M4 strength was restored in 1 limb; the remaining 3 limbs did not show any recovery. Full finger flexion with M4 strength was demonstrated in all 5 upper limbs in which the nerve to the ECRB was transferred to the AIN. No functional downgrading of elbow flexion or wrist extension strength was observed. CONCLUSIONS In patients with tetraplegia, finger flexion can be restored by nerve transfer. Nerve transfer using the nerve to the ECRB as the donor nerve produced better recovery of finger flexion in comparison with nerve transfer using the nerve to the brachialis or brachioradialis.

scholarly journals Multivariate Analysis of Acute Magnetic Resonance Imaging Predicts Neurological Improvements in Patients With Cervical Spinal Cord Injury After Early Surgical Decompression

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tomoo Inoue ◽  
Toshiki Endo ◽  
Shinsuke Suzuki ◽  
Hiroshi Uenohara ◽  
Teiji Tominaga
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Principal Component ◽  
Surgical Decompression ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury

Abstract INTRODUCTION Patients with cervical spinal cord injury (SCI) show different clinical outcomes. There is a significant association between the acute magnetic resonance (MR) imaging of cervical SCI and neurological recovery of cervical SCI. We speculated that principal component analysis (PCA), a dimension reduction procedure, would detect clinically predictive patterns in complex MR imaging and predict neurological improvements assessed by the American Spinal Injury Association Impairment Scale (AIS) and Japanese Orthopaedic Association (JOA) score. METHODS We performed a retrospective analysis of 50 patients with cervical SCI who underwent early surgical decompression less than 48 h after the trauma. We analyzed 7 types of MR imaging assessments: axial grade assessed by the Brain and Spinal Injury Center score (BASIC), longitudinal intramedurallry lesion length, spinal cord signal intensity on T1 and T2 weighted image, maximum canal compromise, maximum spinal cord compression, Subaxial Cervical Spine Injury Classification System. PCA was applied on these multivariate data to identify factors that contribute to recovery after cervical SCI following surgery. AIS conversion was evaluated at 6 mo. RESULTS Nonlinear principal component (PC) evaluation detected 2 features of MR imaging. PCA revealed PC 1 (40.6%) explaining the intramedullary signal abnormalities that were negatively associated with postoperative AIS conversion. PC2 (18.5%) suggested extrinsic morphological variables, but did not predict outcomes. The BASIC score revealed the significant overall predictive value for AIS conversion at six months (AUC 0.86). This result suggested that the intramedullary signal abnormalities reflect delayed neurological improvements even after early surgical decompressions in patients with cervical SCI. CONCLUSION PCA could be a useful data-mining tool to show the complex relationships between acute MR imaging findings in cervical SCI. This study emphasized the importance of multivariable intramedullary MR imaging as clinical outcome predictors.

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