scholarly journals Civilian Gun Shot Wounds Associated With Spinal Injuries

2021 ◽  
pp. 219256822199180
Author(s):  
Laurence Ge ◽  
Ayodeji Jubril ◽  
Addisu Mesfin
Keyword(s):  
Clinical Improvement ◽  
Asian American ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Cauda Equina ◽  
Bladder Function ◽  
Neurological Deficits ◽  
Ambulatory Status ◽  
Shot Wounds

Study Design: Retrospective Objective: To evaluate functional outcomes and characteristics associated with gunshot wound (GSW) to the spine. Methods: Patients with GSW to the spine managed at a Level 1 Trauma Center from January 2003 to December 2017 were enrolled. Patient demographics, diagnoses, level of injury, American Spinal Injury Association (ASIA) score, ambulatory status at follow-up, bowel and bladder function, clinical improvement, and mortality were evaluated. Clinical improvement was defined as a progression in ambulatory status category at latest follow up. Results: 51 patients with GSW of the spine were identified. 48 (94.1%) were male and 3 (5.9%) were female, with a mean age of 27 years-old (range 15-56). 38 (74.5%) were Caucasian, 7 (13.7%) were African American, 1 (2.0%) Asian-American, and 5 (9.8%) were Other/Unknown. 46 (90.2%) patients had GSW related spinal fractures and 44 (86.3%) had neurological deficits. Among patients with neurologic deficits, 5 (9.8%) had Cauda Equina Syndrome, 1 (2%) had Brown-Sequard Syndrome, and 38 (74.5%) spinal cord injuries: ASIA A 26 (68.4%); ASIA B 3 (7.9%); ASIA C 7 (18.4%); ASIA D 2 (5.3%). At mean follow-up time of 4.2 years (SD 3.9), 27 (52.9%) patients were wheelchair bound, 11 (21.6%) were ambulating with assistance, and 13 (25.5%) had normal ambulation. ASIA grade (A or B) was significantly, P < 0.00001, associated with being wheelchair bound and having neurogenic bowel or bladder at follow-up. Conclusions: Most spinal GSW patients (70.6%) did not have any clinical improvement in ambulatory status and most injuries were ASIA A.

Gunshot Wounds to the Spine in Adolescents

Neurosurgery ◽  
2005 ◽  
Vol 57 (4) ◽  
pp. 748-752 ◽  
Author(s):  
Henry E. Aryan ◽  
Arun P. Amar ◽  
Burak M. Ozgur ◽  
Michael L. Levy
Keyword(s):  
Injury Severity ◽  
Spinal Injury ◽  
Gunshot Wounds ◽  
Dynamic Imaging ◽  
Neurological Deficits ◽  
Spinal Instability ◽  
Severity Of Injury ◽  
Bony Involvement ◽  
Cervical Injuries

ABSTRACT OBJECTIVE: The incidence of spinal instability after penetrating gunshot wounds to the spine in adolescents is unknown. We describe our experience over a 15-year period. METHODS: Hospital records were reviewed retrospectively. After injury and emergency care, patients were transferred to a rehabilitation facility. Examinations were completed using the American Spinal Injury Association and Frankel scales on admission, discharge, and 6 and 12 months after injury. Severity of injury was described by: 1) degree of neurological damage, 2) degree of preserved neurological function, and 3) presence of instability. RESULTS: Sixty patients were identified with a mean age 15.6 years (± 2.7 yr). Twelve patients had cervical, 31 thoracic, and 17 lumbosacral injuries. No operative treatments were used in their care. Thirty-four patients had complete neurological deficits. Mean acute hospitalization was 21.1 days (± 22.8 d), and mean rehabilitation stay was 86.3 days (± 48.9 d), for a total hospitalization of 107.4 days (± 65.9 d). At 1 year, 19 patients were ambulatory and 53 were autonomous. Despite the presence of bony involvement in all, no evidence of spinal instability was noted on follow-up dynamic imaging. Even in two patients with apparent two-column disruption, no instability was noted. At 1-year follow-up, significant (nonfunctional) improvement was noted in the neurological examination (P &lt; 0.0001). Improvements were most notable in those patients with cervical injuries, followed by thoracic and lumbar injuries. CONCLUSION: After penetrating gunshot wounds to the spine, patients at 1-year follow-up examinations have evidence of significant, but nonfunctional, improvement. No evidence of spinal instability was noted in this study, and no surgical intervention was required.

scholarly journals Posterior Stabilization Without Neural Decompression in Osteoporotic Thoracolumbar Fractures With Dynamic Cord Compression Causing Incomplete Neurological Deficits

2020 ◽  
pp. 219256822095695
Author(s):  
Abhinandan Reddy Mallepally ◽  
Nandan Marathe ◽  
Gururaj Sangondimath ◽  
Kalidutta Das ◽  
Harvinder Singh Chhabra
Keyword(s):  
Spinal Injury ◽  
Compression Fracture ◽  
Osteoporotic Fractures ◽  
Neurological Impairment ◽  
Cord Compression ◽  
Fracture Site ◽  
Neurological Deficits ◽  
Neurological Improvement ◽  
Indirect Decompression

Study Design: Prospective cohort study. Objectives: Management of osteoporotic vertebral compression fracture (OVCF) remains an unsolved problem for a spine surgeon. We hypothesize that instability at the fracture site rather than neural compression is the main factor leading to a neurological deficit in patients with OVCF. Methods: In this study, the prospective data of patients with osteoporotic fractures with incomplete neurological deficits from January 2015 to December 2017 was analyzed in those who underwent posterior instrumented fusion without neural decompression. Results: A total of 61 patients received posterior indirect decompression via ligamentotaxis and stabilization only. Of these 17 patients had polymethylmethacrylate (PMMA) augmented screws and in 44 patients no PMMA augmentation was done. The mean preoperative kyphosis was 27.12° ± 9.63°, there was an improvement of 13.5° ± 6.87° in the immediate postoperative period and at the final follow-up, kyphosis was 13.7° ± 7.29° with a loss of correction by 2.85° ± 3.7°. The height restoration at the final follow-up was 45.4% ± 18.29%. In all patients, back pain was relieved, and neurological improvement was obtained by at least 1 American Spinal Injury Association Impairment Scale in all except 3 patients. Conclusion: We propose that neural decompression of the spinal cord is not always necessary for the treatment of neurological impairment in patients with osteoporotic vertebral collapse with dynamic mobility. Dynamic magnetic resonance imaging is a valuable tool to make an accurate diagnosis and determine precise surgical plan and improving the surgical strategy of OVCF.

Spinal cord concussion

1990 ◽  
Vol 72 (6) ◽  
pp. 894-900 ◽  
Author(s):  
Thomas J. Zwimpfer ◽  
Mark Bernstein
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Content Type ◽  
Young Males ◽  
Cord Injury ◽  
Sensory Disturbances ◽  
Fine Print

✓ The hallmark of concussion injuries of the nervous system is the rapid and complete resolution of neurological deficits. Cerebral concussion has been well studied, both clinically and experimentally. In comparison, spinal cord concussion (SCC) is poorly understood. The clinical and radiological features of 19 SCC injuries in the general population are presented. Spinal cord injuries were classified as concussions if they met three criteria: 1) spinal trauma immediately preceded the onset of neurological deficits; 2) neurological deficits were consistent with spinal cord involvement at the level of injury; and 3) complete neurological recovery occurred within 72 hours after injury. Most cases involved young males, injured during athletics or due to falls. Concussion occurred at the two most unstable spinal regions, 16 involving the cervical spinal and three the thoracolumbar junction. Fifteen cases presented with combined sensorimotor deficits, while four exhibited only sensory disturbances. Many patients showed signs of recovery with the first few hours after injury and most had completely recovered within 24 hours. Only one case involved an unstable spinal injury. There was no evidence of ligamentous instability, spinal stenosis, or canal encroachment in the remaining 18 cases. Two patients, both children, suffered recurrent SCC injuries. No delayed deterioration or permanent cord injuries occurred. Spinal abnormalities that would predispose the spinal cord to a compressive injury were present in only one of the 19 cases. This suggests that, as opposed to direct cord compression, SCC may be the result of an indirect cord injury. Possible mechanisms are discussed.

Risk of early closed reduction in cervical spine subluxation injuries

1999 ◽  
Vol 90 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Gerald A. Grant ◽  
Sohail K. Mirza ◽  
Jens R. Chapman ◽  
H. Richard Winn ◽  
David W. Newell ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Mr Imaging ◽  
Disc Herniation ◽  
Closed Reduction ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Content Type ◽  
Fine Print

Object. The authors retrospectively reviewed 121 patients with traumatic cervical spine injuries to determine the risk of neurological deterioration following early closed reduction. Methods. After excluding minor fractures and injuries without subluxation, the medical records and imaging studies (computerized tomography and magnetic resonance [MR] images) of 82 patients with bilateral and unilateral locked facet dislocations, burst fractures, extension injuries, or miscellaneous cervical fractures with subluxation were reviewed. Disc injury was defined on MR imaging as the presence of herniation or disruption: a herniation was described as deforming the thecal sac or nerve roots, and a disruption was defined as a disc with high T2-weighted signal characteristics in a widened disc space. Fifty-eight percent of patients presented with complete or incomplete spinal cord injuries. Thirteen percent of patients presented with a cervical radiculopathy, 22% were intact, and 9% had only transient neurological deficits in the field. Early, rapid closed reduction, using serial plain radiographs or fluoroscopy and Gardner—Wells craniocervical traction, was achieved in 97.6% of patients. In two patients (2.4%) closed reduction failed and they underwent emergency open surgical reduction. The average time to achieve closed reduction was 2.1 ± 0.24 hours (standard error of the mean). The incidence of disc herniation and disruption in the 80 patients who underwent postreduction MR imaging was 22% and 24%, respectively. However, the presence of disc herniation or disruption did not affect the degree of neurological recovery, as measured by American Spinal Injury Association motor score and the Frankel scale following early closed reduction. Only one (1.3%) of 80 patients deteriorated, but that occurred more than 6 hours following closed reduction. Conclusions. Although disc herniation and disruption can occur following all types of traumatic cervical fracture subluxations, the incidence of neurological deterioration following closed reduction in these patients is rare. The authors recommend early closed reduction in patients presenting with significant motor deficits without prior MR imaging.

scholarly journals Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management

1999 ◽  
Vol 6 (1) ◽  
pp. E6 ◽  
Author(s):  
Fernando L. Vale ◽  
Jennifer Burns ◽  
Amie B. Jackson ◽  
Mark N. Hadley
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Cervical Spinal Cord ◽  
Bladder Function ◽  
Thoracic Spinal Cord ◽  
Arterial Blood ◽  
Thoracic Spinal ◽  
Cord Injury

The optimal management of acute spinal cord injuries remains to be defined. The authors prospectively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury. According to the Intensive Care Unit protocol, all patients were managed by Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated. Intravenous fluids, colloid, and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg. Surgery was performed for decompression and stabilization, and fusion in selected cases. Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessments and functional ability evaluations. Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association (ASIA) grade at the last follow-up review. Thirty percent regained the ability to walk and 20% had return of bladder function 1 year postinjury. Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade. Approximately 10% of the patients regained the ability to walk and had return of bladder function. As of the 12-month follow-up review, 92% of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status. Ninety-two percent regained the ability to walk and 88% regained bladder function. Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury. Eighty-eight percent were able to walk and 63% had return of bladder function. The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to, and/or distinct from, any potential benefit provided by surgery. Early and aggressive medical management (volume resuscitation and blood pressure augmentation) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma.

Return of normal urological and neurological function after revision surgery for spondyloptosis

2007 ◽  
Vol 6 (3) ◽  
pp. 272-275
Author(s):  
Sean M. Jones-Quaidoo ◽  
Travis Hunt ◽  
Christopher I. Shaffrey ◽  
Vincent Arlet
Keyword(s):  
Revision Surgery ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Bladder Function ◽  
Posterior Decompression ◽  
Index Procedure ◽  
Dome Osteotomy ◽  
Patient Reported ◽  
Grade 3

✓ The authors report on the return of neurological and urological function in an adolescent after revision surgery for spondyloptosis 5 years after the index procedure for high-grade spondylolisthesis. This 16-year-old girl with Grade 3 spondylolisthesis was initially treated with a posterolateral reduction and fusion. Following surgery, cauda equina syndrome symptoms developed and did not resolve despite subsequent surgical decompression. Five years later, because of worsening radicular pain, an inability to walk for significant distances, and no resolution of persistent bladder dysfunction, the patient presented with spondyloptosis. Posterior decompression, sacral dome osteotomy, and posterior reduction were performed and followed 3 days later with the placement of an anterior fibula autograft. Her bladder function recovered within 6 months, and at the 18-month follow up the patient reported a normal ability to ambulate.

Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases

2005 ◽  
Vol 3 (6) ◽  
pp. 450-458 ◽  
Author(s):  
Feyza Karagöz Güzey ◽  
Erhan Emel ◽  
N. Serdar Bas ◽  
Selim Hacisalihoglu ◽  
Hakan Seyithanoglu ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Posterior Instrumentation ◽  
Neurological Deficits ◽  
Easy Access ◽  
Tuberculous Spondylitis ◽  
Content Type ◽  
The Mean ◽  
Posterior Debridement ◽  
Fine Print

Object. Surgical treatment of thoracic and lumbar tuberculous spondylitis is controversial. An anterior approach is usually recommended. The aim of the present study was to assess the efficacy of posterior debridement and the placement of posterior instrumentation for the treatment of patients with thoracic and lumbar tuberculous spondylitis. Methods. Nineteen patients with thoracic and lumbar tuberculous spondylitis underwent single-stage posterior decompression and debridement as well as the placement of posterior interbody grafts if necessary, instrumentation and posterior or posterolateral grafts. No postoperative neurological deterioration was noted. One patient died of myocardial infarction on Day 10. The mean follow-up duration, excluding the one death, was 52.7 months (range 16–125 months). In a 70-year-old patient, a single pedicle screw broke after 3 months. All patients were in better neurological condition after surgery and at the last follow-up examination. Neurological deficits were present in only two patients at the last follow up (one American Spinal Injury Association Grade B and one Grade C deficit preoperatively). Three other patients suffered intermittent back or low-back pain. The mean angulation measured in 13 patients with kyphotic deformity was 18.2° (range 5–42°) preoperatively; this was reduced to 17.3° (range 0–42°) after surgery. There was a 2.8° loss of correction (range 2–5°) after 44.3 months (16–64 months). Kyphosis did not progress beyond 15 months in any patient. Conclusions A posterior approach in combination with internal fixation and posterior or posterolateral fusion (with or without placement of posterior interbody grafts) may be sufficient for the debridement of the infection and to allow spinal stabilization in patients with thoracic and lumbar tuberculous spondylitis. This procedure is associated with easy access to the spinal canal for neural decompression, prevention of loss of corrected vertebral alignment in the long term, and facilitation of early mobilization.

scholarly journals CyberKnife frameless single-fraction stereotactic radiosurgery for tumors of the sacrum

2003 ◽  
Vol 15 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Peter C. Gerszten ◽  
Cihat Ozhasoglu ◽  
Steven A. Burton ◽  
William C. Welch ◽  
William J. Vogel ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Cauda Equina ◽  
Surgical Techniques ◽  
Outpatient Setting ◽  
Neurological Deficits ◽  
Therapeutic Modality ◽  
Radiation Toxicity ◽  
Single Fraction

Object The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. The experience with radiosurgery for the treatment of spinal and sacral lesions is more limited. Sacral lesions should be amenable to radiosurgical treatment similar to that used for their intracranial counterparts. The authors evaluated a single-fraction radiosurgical technique performed using the CyberKnife Real-Time Image-Guided Radiosurgery System for the treatment of the sacral lesion. Methods The CyberKnife is a frameless radiosurgery system based on the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, which guides the therapy beam to the intended target without the need for frame-based fixation. All sacral lesions were located and tracked for radiation delivery relative to fiducial bone markers placed percutaneously. Eighteen patients were treated with single-fraction radiosurgery. Tumor histology included one benign and 17 malignant tumors. Dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Planning treatment volume was defined as the radiographically documented tumor volume with no margin. Tumor dose was maintained at 12 to 20 Gy to the 80% isodose line (mean 15 Gy). Tumor volume ranged from 23.6 to 187.4 ml (mean 90 ml). The volume of the cauda equina receiving greater than 8 Gy ranged from 0 to 1 ml (mean 0.1 ml). All patients underwent the procedure in an outpatient setting. No acute radiation toxicity or new neurological deficits occurred during the mean follow-up period of 6 months. Pain improved in all 13 patients who were symptomatic prior to treatment. No tumor progression has been documented on follow-up imaging. Conclusions Stereotactic radiosurgery was found to be feasible, safe, and effective for the treatment of both benign and malignant sacral lesions. The major potential benefits of radiosurgical ablation of sacral lesions are relatively short treatment time in an outpatient setting and minimal or no side effects. This new technique offers a new and important therapeutic modality for the primary treatment of a variety of sacral tumors or for lesions not amenable to open surgical techniques.

scholarly journals Pneumorrhachis causing cauda equina syndrome: a case report and literature review

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Areez Shafqat ◽  
Hamzah M. F. Magableh ◽  
Shameel Shafqat ◽  
Syed Shafqat Ul Islam
Keyword(s):  
Cauda Equina ◽  
Neurological Symptoms ◽  
Neurological Deficits ◽  
Disc Disease ◽  
Surgical Interventions ◽  
Vacuum Phenomenon ◽  
Perineal Region ◽  
Magnetic Resonance Imaging Mri ◽  
Radicular Symptoms

Abstract Background Pneumorrhachis (PR) describes the rare presence of intraspinal air, mainly following traumatic or iatrogenic procedures. According to the localization of air in the spinal canal, PR has been classified into internal (subdural) and external (epidural). PR rarely manifests in neurological deficits and usually resolves spontaneously without recurrence, with air being passed directly into the bloodstream. Here, we report a case of external PR occurring spontaneously (without any underlying trauma or surgical interventions) manifesting as neurological deficits. This is an extremely rare finding with only a limited number of cases in the literature. Case presentation We report a case of spontaneous external PR manifesting as neurological symptoms in a 62-year-old male diabetic patient with chronic low backpain who developed numbness in his perineal region mainly on the left side. His medical history was normal, without trauma or surgical intervention. Magnetic resonance imaging (MRI) and computed tomography (CT) in the past 2 years demonstrated degenerative changes in the lumbar spine, including end plates and disc spaces, with intervertebral disc vacuum phenomenon (VP); the CT additionally showed intraspinal air in the epidural space at L5-S1 levels compressing the cauda equina. A diagnosis of spontaneous external PR was made. A follow-up MRI upon exacerbation of neurological deficits showed an increase in air locule size. Our patient was managed conservatively on a nonsteroidal anti-inflammatory agent (NSAID) and was advised for regular follow-ups. No aspiration or surgery has been performed to date. Conclusions Spontaneous external pneumorrhachis manifesting as neurological symptoms is extremely rare. Due to degenerative disc disease producing vacuum phenomenon, we propose that spontaneous PR secondary to intradiscal VP be considered as part of the differential for radicular symptoms, especially with increasing age. The most effective noninvasive investigation for the diagnosis of PR is CT. MRI is less beneficial in the case of PR as gas and calcifications are hard to distinguish, both being of low-intensity signals on all MR sequences.

scholarly journals Evaluation of Outcome of Timing of Surgical Intervention on Cauda Equina Syndrome

2021 ◽  
Vol 20 (1) ◽  
pp. 19-23
Author(s):  
Rajesh Pratap Shah ◽  
Bishnu Babu Thapa ◽  
Sushil Rana Magar ◽  
Ritesh Sinha ◽  
Pankaj Chand ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Tertiary Care ◽  
Cauda Equina ◽  
Timing Of Surgery ◽  
Bladder Function ◽  
Delayed Presentation ◽  
Inclusion Criteria ◽  
Permanent Disability ◽  
Number Of Patients

Introduction: Cauda equina syndrome (CES) is a rare clinical entity caused by compression of lumbar and sacral nerve roots resulting in various neurological dysfunctions. Early diagnosis of the syndrome and timely intervention is required to prevent permanent disability. Methods: This is a retrospective study conducted from January 2013 to December 2017 in a tertiary care centre in Kathmandu, Nepal. All the cases meeting the inclusion criteria were included in the study. Patients were operated using posterior open discectomy and the outcome was evaluated at  two weeks , one month, three months, six months and one year. Result: Total number of patients meeting the inclusion criteria was 10, two females and eight males with a mean age of 40.30 + 6.58 years. The mean time for onset of symptom to timing of surgery was 142 hrs. VAS for leg improved from 5.90 + 0 .738 to 0.70 + 0.483 and VAS for back pain improved from 3.20 + 1.476 to 0.5 + 0.572 post operatively. There was improvement in sensory and motor function in all the cases. Bowel and bladder function improved in all the cases postoperatively at the time of final follow up. Sexual function was impaired in six patients preoperatively but postoperatively four had improved and two patients had poor result at the time of final follow up. Conclusions: Timing of surgery may not be the most important determining factor for the outcome of the CES. Surgical decompression in delayed presentation have good clinical outcome in CES.

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