Sudden death caused by spinal cord injury associated with vertebral fractures and fetlock failure in a Thoroughbred racehorse

The most prevalent causes of death in racehorses are musculoskeletal injuries, causing ~83% of deaths within the racing industry in California and elsewhere. The vast majority of these injuries have preexisting lesions that predispose to fatal injury. A 4-y-old Thoroughbred colt suffered an acute suspensory apparatus failure, including biaxial proximal sesamoid bone fractures of the right front fetlock, causing loss of support of the fetlock joint and consequent fall with fractures of the cervical and sacral spine. Cervical fracture caused spinal cord damage that resulted in sudden death. A preexisting lesion in the medial proximal sesamoid bone likely predisposed to complete fracture of this bone and fetlock breakdown. Interestingly, a comparable osteopenic lesion was present in the intact medial proximal sesamoid bone of the left forelimb, which is consistent with bilateral repetitive overuse injury in racehorses. The morphologic features of the cervical and sacral spine fractures were compatible with acute injury; no evidence of preexisting lesions was seen. Most likely, these acute vertebral fractures occurred as a result of the horse falling. This case emphasizes the importance of performing a detailed autopsy in horses that suffer an appendicular musculoskeletal injury, particularly in fatal cases when the horse dies following a leg injury.

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CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i4.131 ◽

2019 ◽

Vol 1 (4) ◽

Author(s):

Yustinus Robby Budiman Gondowardojo ◽

Tjokorda Gde Bagus Mahadewa

Keyword(s):

Spinal Cord ◽

Left Lung ◽

Lumbar Vertebrae ◽

Compression Fracture ◽

High Mobility ◽

Early Mobilization ◽

Cord Injury ◽

Cardiothoracic Surgeon ◽

The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

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Massive Edema of the Lower Limbs in Patients after Spinal Cord Injury—One Picture, Different Diagnoses

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084219 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4219

Author(s):

Magdalena Mackiewicz-Milewska ◽

Małgorzata Cisowska-Adamiak ◽

Katarzyna Sakwińska ◽

Iwona Szymkuć-Bukowska ◽

Iwona Głowacka-Mrotek

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Heterotopic Ossification ◽

Lower Limb ◽

Bone Fractures ◽

Lower Limbs ◽

University Hospital ◽

Pain Sensation ◽

Vein Thrombosis ◽

Cord Injury

Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead to lower-limb edema and the associated diagnostic difficulties. We present four cases of patients with massive edemas of lower limbs at different times after SCI undergoing treatment in the Department of Rehabilitation, University Hospital in Bydgoszcz, Poland. All patients had a lack of pain sensation in the lower limbs and significantly elevated levels of D-dimer. In two cases, deep vein thrombosis (DVT) and intramuscular hematomas (IHs) were diagnosed. IHs were probably a consequence of antithrombotic treatments implemented due to the occurrence of DVT. Heterotopic ossification (HO) was diagnosed in a third case, and, in another patient, who was hospitalized for the longest period after injury, we found humeral bone fractures. Heterotopic ossification, intramuscular haematomas, and bone fractures of the lower limb can mimic DVT. Careful observation of the edema evolution is recommended, as the onset of new symptoms may indicate a different cause of edema from that initially established.

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COMPLICATIONS OF ACUTE TRAUMATIC SPINAL INJURIES IN SAINT PETERSBURG

Marine Medicine ◽

10.22328/2413-5747-2020-6-1-33-42 ◽

2020 ◽

Vol 6 (1) ◽

pp. 33-42

Author(s):

S. V. Lobzin ◽

L. M. Mirzaeva

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Vertebral Fractures ◽

Length Of Hospital Stay ◽

Respiratory Complications ◽

Traumatic Injuries ◽

Cord Injury

Almost every sailor during performing his job duties aboard receives injuries of varying severity, among which the most common are deck fractures, including compression vertebral fractures, as well as open and closed vertebral fractures with spinal cord injuries. Besides the recovery of disordered functions of the spinal cord, in cases of spinal cord injury, the fight against numerous neurological, infectious and somatic complications affecting the survival and quality of life of patients is still relevant.Objective: to study the incidence of complications of traumatic injuries of the spinal cord under initial hospitalization, their impact on the length of hospital stay, to identify and evaluate the role of risk factors in the development of complications.Materials and methods. A retrospective cohort study was conducted according to the archived case histories of patients hospitalized in neurosurgical hospitals in St. Petersburg. 311 cases of acute spinal cord injury in 2012–2016 were analyzed.Results: complications not directly related to spinal cord injury, such as bronchitis, pneumonia, bedsores, sepsis, thromboembolism, urinary tract infections, postoperative wound pyogenesis and others (damage to other organs and systems), were found in one third of patients (33,8%), in half of the cases there were multiple complications (2 or more), the most frequent — respiratory (23,5%) and pressure sores (10%). Complications significantly increased the length of hospital stay. The dependence of the frequency of complications on age, the level of spinal cord damage and the severity of the injury was revealed. Risk factors such as concomitant head injury and alcohol intoxication have been found. The revealed positive effect of corticosteroids on the regression of neurological deficit was not statistically confirmed. At the same time, there was a significant increase in the frequency of respiratory complications when using corticosteroids.Conclusion: Knowledge of the factors affecting the incidence of complications, optimization of their prevention and therapy will shorten the duration of hospitalization and improve the prognosis and quality of life of patients. The issue of use of corticosteroid therapy in the acute period of traumatic injuries of the spinal cord remains debatable. When choosing therapeutic tactics for managing patients with spinal trauma, it is necessary to take into account the risk of respiratory complications and carefully evaluate the ratio of benefits to harm.

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Poster 229 Soft Tissue Sarcoma Affecting the Right Shoulder of a Man with Paraplegia from a Remote Traumatic Spinal Cord Injury: A Case Report

PM&R ◽

10.1016/j.pmrj.2015.06.267 ◽

2015 ◽

Vol 7 ◽

pp. S166-S167

Author(s):

Colin K. Franz ◽

Gayle R. Spill

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Case Report ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

The Right

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Analgesic effect of paired associative stimulation in a tetraplegic patient with severe drug-resistant neuropathic pain: a case report

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0012 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Selja Vaalto ◽

Anna-Lena Nyman ◽

Anastasia Shulga

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Motor Function ◽

Analgesic Effect ◽

Lower Limbs ◽

Drug Resistant ◽

Motor Rehabilitation ◽

Paired Associative Stimulation ◽

Cord Injury ◽

The Right

Abstract Objectives There is no effective evidence-based non-pharmacological treatment for severe neuropathic pain after spinal cord injury (SCI). Paired associative stimulation (PAS) has been used in motor rehabilitation of patients after SCI. In the SCI-PAS protocol for tetraplegic patients, peripheral and central nerve tracts are activated with subject-specific timing, such that ascending and descending signals appear simultaneously at the cervical level. The effect on motor rehabilitation is thought to arise via strengthening of cervical upper and lower motoneuron synapses. We have observed an analgesic effect of PAS on mild-to-moderate neuropathic pain in tetraplegic patients receiving PAS for motor rehabilitation. Here, we applied PAS to a patient with severe drug-resistant neuropathic pain. Methods The patient is a 50-year-old man who had a traumatic cervical SCI three years earlier. He has partial paresis in the upper limbs and completely plegic lower limbs. The most severe pain is located in the right upper limb and shoulder region. The pain has not responded to either pharmacological therapy or repetitive-TMS therapy targeted to either primary motor cortex or secondary somatosensory cortex. PAS was targeted to relieve pain in the right upper arm. Peripheral nerve stimulation targeted the median, ulnar, and radial nerves and was accompanied by TMS pulses to the motor representation area of abductor pollicis brevis, abductor digiti minimi, and extensor digitorum communis muscles, respectively. Results Hand motor function, especially finger abduction and extension, was already enhanced during the first therapy week. Pain decreased at the end of the second therapy week. Pain was milder especially in the evenings. Numerical rating scale scores (evening) decreased 44% and patient estimation of global impression of change was 1, subjectively indicating great benefit when compared to before therapy. Quality of sleep also improved. Conclusions The SCI-PAS protocol reduced neuropathic pain in our subject. The mechanism behind the analgesic effect may involve the modulation of nociceptive and sensory neuronal circuits at the spinal cord level. The possibility to use PAS as an adjunct treatment in drug-resistant post-SCI neuropathic pain warrants further investigation and sham-controlled studies. Patients with neuropathic pain due to SCI may benefit from PAS therapy in addition to PAS therapy-induced improvement in motor function.

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Botulinum toxin type A for the treatment of muscle contractures secondary to acute spinal cord injury in a young cat

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116920922648 ◽

2020 ◽

Vol 6 (1) ◽

pp. 205511692092264

Author(s):

Robert I McGeachan ◽

Tobias Schwarz ◽

Danièlle A Gunn-Moore ◽

Katia Marioni-Henry

Keyword(s):

Spinal Cord ◽

Botulinum Toxin ◽

Botulinum Toxin Type A ◽

Clinical Signs ◽

Type A ◽

Botulinum Toxin Type ◽

Subacute Stroke ◽

Thoracic Limb ◽

Cord Injury ◽

The Right

Case summary A 4-month-old male entire domestic shorthair cat presented for sudden onset of right thoracic monoparesis following a fall; within 18 h, the clinical signs progressed to non-ambulatory right hemiplegia with absent sensation in the distal right thoracic limb and left hemiparesis. MRI revealed changes consistent with a C6–C7 acute non-compressive nucleus pulposus extrusion with suspected secondary C5–C7 spinal cord haemorrhage. Rehabilitation exercises were started immediately after the diagnosis of acute spinal cord trauma. Sensation in the right thoracic limb improved and, with the help of a splint applied to that limb, the cat was ambulatory on all four limbs. Unfortunately, clinical signs started to progress over the course of 10 days. The cat developed progressive discomfort on manipulation of the right elbow and carpus, and a hyperflexion of the right carpus. Radiographs revealed no skeletal abnormalities. Muscle contractures were suspected. Under general anaesthesia the triceps and flexor muscles of the carpus and digits were injected with a total of 100 U of botulinum toxin type A (BTX-A). No complications were associated with the procedure and 24 h after the injection the carpal hyperflexion resolved. Relevance and novel information The use of BTX-A to treat muscle contractures in human medicine is an established and increasingly used technique. For example, in subacute stroke patients with a non-functional arm, BTX-A forearm injection appears to prevent disabling finger stiffness, likely by minimising the development of contractures. Here, we demonstrate that intramuscular BTX-A is an effective treatment for acquired muscle contractures in a cat.

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Metastatic Spine Disease

10.1093/med/9780190850036.003.0013 ◽

2018 ◽

Author(s):

Juan P. Cata

Keyword(s):

Spinal Cord ◽

Bone Fractures ◽

Multimodal Analgesia ◽

Cord Compression ◽

Medical Emergency ◽

Early Ambulation ◽

Decompressive Laminectomy ◽

Hematological Disorders ◽

Cord Injury ◽

Hospital Resources

Metastatic spinal cord compression (MSCC) is a medical emergency that requires early diagnosis and treatment. Medical management or surgery can be indicated depending on different factors including duration of the symptoms, patient comorbidities, and hospital resources. Patients scheduled for decompressive laminectomy due to MSCC may present to the operating room with pain, high requirements of opioids, hematological disorders, impending bone fractures, nausea and vomiting, and electrolytes disorders. Multimodal intraoperative monitoring is needed to minimize spinal cord injury. The immediate postoperative care of these patients is directed to accelerate recovery by providing multimodal analgesia, encouraging early ambulation, and optimizing their nutritional status.

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The management of fertility in spinal cord injury

10.1093/med/9780199659579.003.0100 ◽

2017 ◽

Author(s):

Mikkel Fode ◽

Jens Sønksen

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Semen Quality ◽

Sperm Quality ◽

Sperm Count ◽

Autonomic Nerve ◽

Sperm Retrieval ◽

Cord Injury ◽

The Right ◽

Spinal Cord Injured

While spinal cord injury (SCI) does not affect female fertility, the condition most often results in infertility in males due to anejaculation and reduced semen quality. Anejaculation is caused by disruption of the autonomic nerve fibres, which are normally responsible for the ejaculation. The reason for the poor sperm quality has not been firmly established. If spinal cord injured men cannot ejaculate by sexual intercourse or masturbation, ejaculation can be induced by either penile vibratory stimulation or electroejaculation. Only if these methods fail should surgical sperm retrieval be considered. The method of insemination depends largely on the total motile sperm count and patient preference. With the right treatment, it is possible for most SCI men to have children.

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Experimental spinal cord trauma: a review of mechanically induced spinal cord injury in rat models

Reviews in the Neurosciences ◽

10.1515/revneuro-2016-0050 ◽

2017 ◽

Vol 28 (1) ◽

pp. 15-20 ◽

Cited By ~ 9

Author(s):

Dauda Abdullahi ◽

Azlina Ahmad Annuar ◽

Masro Mohamad ◽

Izzuddin Aziz ◽

Junedah Sanusi

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cord Compression ◽

Acute Injury ◽

Optimal Timing ◽

Spinal Cord Trauma ◽

Rat Models ◽

Human Spinal Cord ◽

Cord Injury ◽

Transient Force

AbstractIt has been shown that animal spinal cord compression (using methods such as clips, balloons, spinal cord strapping, or calibrated forceps) mimics the persistent spinal canal occlusion that is common in human spinal cord injury (SCI). These methods can be used to investigate the effects of compression or to know the optimal timing of decompression (as duration of compression can affect the outcome of pathology) in acute SCI. Compression models involve prolonged cord compression and are distinct from contusion models, which apply only transient force to inflict an acute injury to the spinal cord. While the use of forceps to compress the spinal cord is a common choice due to it being inexpensive, it has not been critically assessed against the other methods to determine whether it is the best method to use. To date, there is no available review specifically focused on the current compression methods of inducing SCI in rats; thus, we performed a systematic and comprehensive publication search to identify studies on experimental spinalization in rat models, and this review discusses the advantages and limitations of each method.

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