Two spinal cord lesions in a patient with ankylosing spondylitis and cervical spine injury

Background. The main criteria for determining surgery strategy in patients with traumatic subaxial cervical injury are as follows: the type and degree of damage to the osteo-ligamentous structures of cervical spine that determines the level of instability; the value of spinal cord compression; the state of the sagittal profile. The aim of this study was to assess the degree of instability in different types of cervical spine injuries according to AOSpine Subaxial Cervical Spine Injury Classification System. Materials and methods. We performed a retrospective analysis of Х-ray, computed tomography and magnetic resonance imaging data of 168 patients with traumatic injury of subaxial cervical spine. All of them were hospitalized at the Department of Spinal Cord Pathology of the Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine 2008–2018. We assessed the degree of instability using the Cervical Spine Injury Severity Score and determined the type of damage according to the AOSpine Subaxial Cervical Spine Injury Classification System. Results. We found that the median rate of instability increases progressively with increasing severity of injury type. The widest range of instability values is observed in the compression damage: from 6 points (95% confidence interval (CI): 4.76–6.84) in A1 type to 11 points (95% CI: 9.48–11.81) in A4. For A2 and A3 types, we registered 7 (95% CI: 6.68–7.53) and 8 points (95% CI: 7.97–9.01), respectively. A smaller range of values characterizes flexion-extension injuries. The median progressively increases from B1 type — 13 points (95% CI: 12.4–13.92) to B3 type — 15.5 points (95% CI: 14.5–16.35). The value for B2 is intermediate and is 15 points (95% CI: 13.59–15.52). We registered maximum values in flexion-extension injuries — 18 points, for both B2 and B3 types. C type has the highest level of instability — 17 points (95% CI: 16.58–17.86) and a quite wide range of estimated values: from 13 to 20 points. Conclusions. The general trend is an increase in the level of instability in the range from A1 to C injury subtypes, but even A1 type in some cases are quite unstable and require surgery. In contrast to the classical views, type A injuries are often accompanied by da-mage to the facet joints, which must also be taken into account when determining the individual treatment.

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CERVICAL SPINE INJURY IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-197510000-00016 ◽

1975 ◽

Vol 15 (10) ◽

pp. 931-934 ◽

Cited By ~ 28

Author(s):

L. S. KEWALRAMANI ◽

M. S. ORTH ◽

ROBERT G. TAYLOR ◽

OTMAR W. ALBRAND

Keyword(s):

Cervical Spine ◽

Ankylosing Spondylitis ◽

Cervical Spine Injury ◽

Spine Injury

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CERVICAL GUNSHOT INJURY

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i3.6 ◽

2018 ◽

Vol 1 (3) ◽

Author(s):

Gede Andry Nicolas ◽

Heru Sutanto Koerniawan ◽

Tjokorda Gde Bagus Mahadewa

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spine ◽

Cervical Spine Injury ◽

Life Support ◽

Surgical Decompression ◽

Spine Injury ◽

Advanced Trauma Life Support ◽

Entire Body ◽

Cord Injury

The incident of cervical spine injury and cervical spinal cord injury is between 2.0% to 5.0%. The advanced trauma life support (ATLS) stated that a patient with multiple traumas should be assumed tohave cervical spine injury especially if the patient loses consciousness when present in the ER. It is stressed that cervical spine injury requires continuous immobilization of the patient’s entire body using a semirigid collar as well as a backboard with tape and straps before and during transfer to a defnitive care facility. The understanding of the mechanism of injury is the most important as the forces transferred are signifcantly diﬀerent causing diﬀerent injuries. A serial case reported by Walter and Adkins found that there was no signifcant diﬀerence between the patients that have a bullet removed from the neck and patients that have a bullet left in the cervical cord. In both cases, there was no improvement to the neurologic outcome. Kupcha recommends doing selective wound management and observation of retained intracanal bullet fragments in a patient with complete lesion. Surgical decompression after the injury is not recommended. We report a case of 14 year old boy who was treated at Sanglah Hospital referred froman out-of-island Type C Hospital with a spinal cord injury - American Spinal Injury Association A (SCI ASIA A) caused by a gunshot wound in the cervical. Surgical decompression and bullet removal was performedas well as fusion stabilization. He is then treated in the intensive care unit for 48 hours with a slight improvement in motoric of upper and lower extremities.

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(A121) Relation of Dopamine Dependent Hypotension with Outcome in Cervical Spine Injury Patients

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11001221 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s34-s34

Author(s):

A. T. D. Agarwal

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spine ◽

Cervical Spine Injury ◽

Recovery Period ◽

Trauma Centre ◽

Spine Injury ◽

Cervical Cord ◽

Cord Injury ◽

The Mean

BackgroundIt is believed that dopamine resistance sets in within 72–92 hours following therapy. However, in the authors' experience, spinal cord injury patients may require dopamine to maintain blood pressure over several weeks.ObjectivesThis study aims to: (1) assess the incidence and duration of of dopamine dependence in cervical cord injury patients; and (2) find the relation (if any) of dopamine dependent hypotension with outcome of spinal cord injured patients.MethodsThis was a prospective, observational study carried out over 2-month period in the neurosurgery intensive care unit (ICU) at JPN Apex Trauma Centre, AIIMS. All cervical spine injury patients who had hypotension during the hospital stay were included in the study. History, clinical findings, requirement of ionotropic support, management, and outcome were recorded for all enrolled subjects.ResultsDuring the study period 48 patients were admitted with cervical spine injury in the ICU. Of these, 26 patients (54%) had hypotension and were constituted the study group. Eleven patients had complete spinal cord injury (power 0/5) and 15 patients had incomplete spinal cord injury. Twenty-four patients were on ventilator support and two were on oxygen masks. The mean dose of dopamine which the patient receives during the treatment was 7.5 mcg/kg/min with the maximum and minimum doses of 20mcg/kg/min and 2 mcg/kg/min. The mean duration of dopamine support was 17 days (Range 6–48 days). Eight patients (31%) required intermittent dopamine support and 18 patients (70%) required continuous support. The in-hospital mortality was 61% (n = 16). Mortality was significantly lower in patients who received intermittent ionotropic support as compared to those who required continuous ionotropic support (p < 0.01).ConclusionThe patients with spinal cord injury are dependent on dopamine throughout their recovery period. The patients who required intermittent ionotropic support had significant better outcome compared to those who required continuous ionotropic support.

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