Posttraumatic Ligamentous Disruption of the Cervical Spine, an Easily Overlooked Diagnosis: Presentation of Three Cases

Neurosurgery ◽  
1990 ◽  
Vol 26 (4) ◽  
pp. 674-678 ◽  
Author(s):  
M. Fazl ◽  
J. LaFebvre ◽  
R. A. Willinsky ◽  
S. Gertzbein
Keyword(s):  
Cervical Spine ◽  
Motor Vehicle ◽  
Plain Film ◽  
Neurological Deficits ◽  
Magnetic Resonance Imaging Scan ◽  
Disc Space Narrowing ◽  
Disc Disease ◽  
Disc Space ◽  
Plain Films ◽  
Flexion And Extension

Abstract Three patients with hyperflexion sprain of the cervical spine secondary to motor vehicle accidents are discussed. One patient exhibited tetraplegia and the other two only had paresthesia of the upper and/or lower extremities at the scene of the accident. All patients were young with no evidence of degenerative disc disease or osteoarthritis. Diagnosis of hyperflexion sprain is suggested by transient or persistent neurological deficits, local tenderness, or plain film findings, which include interspinous fanning, localized kyphotic angulation, subluxation, or disc space narrowing. Review of our patients' records revealed that some of these findings were evident at their initial presentation. In patients who have no neurological deficits, controlled flexion and extension views after routine plain films may be diagnostic of an unstable cervical spine. If there is a persistent neurological deficit, a magnetic resonance imaging scan is the examination of choice. If there is no compression of the thecal sac or spinal cord, supervised flexion and extension views of cervical spine should be done. Definitive management of the unstable spine is operative fixation.

Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

2011 ◽  
Vol 16 (2) ◽  
pp. 8-9
Author(s):  
Marjorie Eskay-Auerbach
Keyword(s):  
Clinical Symptoms ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Disc Space Narrowing ◽  
Disc Disease ◽  
Disc Space ◽  
Radiographic Findings ◽  
Asymptomatic Patients

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

High Rotation Rate Behavior of Cervical Spine Segments in Flexion and Extension

2014 ◽  
Vol 136 (12) ◽  
Author(s):  
Jeffrey B. Barker ◽  
Duane S. Cronin ◽  
Naveen Chandrashekar
Keyword(s):  
Experimental Data ◽  
Cervical Spine ◽  
Rotation Rate ◽  
Motor Vehicle ◽  
Tissue Level ◽  
Fe Model ◽  
Rate Behavior ◽  
Numerical Finite Element ◽  
Development And Validation ◽  
Flexion And Extension

Numerical finite element (FE) models of the neck have been developed to simulate occupant response and predict injury during motor vehicle collisions. However, there is a paucity of data on the response of young cervical spine segments under dynamic loading in flexion and extension, which is essential for the development or validation of tissue-level FE models. This limitation was identified during the development and validation of the FE model used in this study. The purpose of this study was to measure the high rotation rate loading response of human cervical spine segments in flexion and extension, and to investigate a new tissue-level FE model of the cervical spine with the experimental data to address a limitation in available data. Four test samples at each segment level from C2–C3 to C7–T1 were dissected from eight donors and were tested to 10 deg of rotation at 1 and 500 deg/s in flexion and extension using a custom built test apparatus. There was strong evidence (p < 0.05) of increased stiffness at the higher rotation rate above 4 deg of rotation in flexion and at 8 deg and 10 deg of rotation in extension. Cross-correlation software, Cora, was used to evaluate the fit between the experimental data and model predictions. The average rating was 0.771, which is considered to demonstrate a good correlation to the experimental data.

Spinal Accessory Schwannoma Mimicking a Tumor of the Fourth Ventricle: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 510-514 ◽  
Author(s):  
Ryu Kurokawa ◽  
Masanao Tabuse ◽  
Kazunari Yoshida ◽  
Takeshi Kawase
Keyword(s):  
Fourth Ventricle ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Histopathological Examination ◽  
Neurological Deficits ◽  
Magnetic Resonance Imaging Scan ◽  
Surgical Specimen ◽  
Spinal Accessory ◽  
Computed Tomographic ◽  
Suboccipital Craniectomy

Abstract OBJECTIVE AND IMPORTANCE Spinal accessory schwannomas unassociated with neurofibromatosis are very rare, and only 30 cases have been reported in the literature. To our knowledge, this is the first report of a spinal accessory schwannoma mimicking a tumor of the fourth ventricle. CLINICAL PRESENTATION A 50-year-old man presented with neck pain after being involved in a motor vehicle accident. There were no neurological deficits, but a computed tomographic scan revealed a large hypodense mass with punctuate calcifications in the fourth ventricle. The tumor exhibited low intensity on the T1-weighted magnetic resonance imaging scan and high intensity on the T2-weighted scan, and it showed inhomogeneous contrast enhancement. INTERVENTION The tumor was totally removed by a bilateral suboccipital craniectomy and C1 laminectomy. Dissection of the surgical specimen revealed that the tumor had originated from the left spinal accessory nerve. Histopathological examination confirmed the diagnosis of schwannoma. The patient experienced transient postoperative cerebellar ataxia but recovered completely. CONCLUSION Intracisternal-type spinal accessory schwannomas sometimes mimic a tumor of the fourth ventricle. Total surgical resection can be achieved with good outcome.

Motion Analysis of the Cervical Spine

2004 ◽  
Vol 9 (5) ◽  
pp. 1-11
Author(s):  
Patrick R. Luers
Keyword(s):  
Cervical Spine ◽  
Intervertebral Disk ◽  
Radiographic Evaluation ◽  
Ligamentous Injury ◽  
Pattern Of Injury ◽  
Motion Segment ◽  
Single Pattern ◽  
Compensatory Motion ◽  
Loss Of Motion ◽  
Flexion And Extension

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, defines a motion segment as “two adjacent vertebrae, the intervertebral disk, the apophyseal or facet joints, and ligamentous structures between the vertebrae.” The range of motion from segment to segment varies, and loss of motion segment integrity is defined as “an anteroposterior motion of one vertebra over another that is greater than 3.5 mm in the cervical spine, greater than 2.5 mm in the thoracic spine, and greater than 4.5 mm in the lumbar spine.” Multiple etiologies are associated with increased motion in the cervical spine; some are physiologic or compensatory and others are pathologic. The standard radiographic evaluation of instability and ligamentous injury in the cervical spine consists of lateral flexion and extension x-ray views, but no single pattern of injury is identified in whiplash injuries. Fluoroscopy or cineradiographic techniques may be more sensitive than other methods for evaluating subtle abnormal motion in the cervical spine. The increased motion thus detected then must be evaluated to determine whether it represents normal physiologic motion, normal compensatory motion, motion related to underlying degenerative disk and/or facet disease, or increased motion related to ligamentous injury. Imaging studies should be performed and interpreted as instructed in the AMA Guides.

Operative management of traumatic cervical spine distraction and complete cord transection in a 3-year-old patient

2015 ◽  
Vol 15 (2) ◽  
pp. 214-219 ◽  
Author(s):  
Monica Salazar Davern ◽  
Sumeet Garg ◽  
Todd C. Hankinson
Keyword(s):  
Spinal Cord ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Cervical Spinal Cord ◽  
Young Patients ◽  
Operative Management ◽  
Neurological Deficits ◽  
Spinal Instability ◽  
Ethical Challenges ◽  
Vehicle Accident

This report describes the presentation and operative treatment of a 3-year-old boy who survived a motor vehicle accident that resulted in a C6–7 distraction injury, complete avulsion of the spinal cord, and gross spinal instability. Only 5%–10% of all spinal cord and vertebral column injuries occur in children. Survival after such an injury is exceptionally rare in very young patients and is associated with severe neurological deficits. The authors discuss the substantial ethical challenges involved in the care of a patient with this injury. To their knowledge, only two other cases of survival have been reported in pediatric patients following motor vehicle trauma resulting in complete injury to the lower cervical spinal cord.

scholarly journals Relationship between diffuse idiopathic skeletal hyperostosis and fragility vertebral fracture: a prospective study in older men

Rheumatology ◽  
2020 ◽  
Author(s):  
Anaïs Guiot ◽  
Charline Estublier ◽  
Marine Gaude ◽  
Pawel Szulc ◽  
Roland Chapurlat
Keyword(s):  
Vertebral Fracture ◽  
Fracture Risk ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Older Men ◽  
Fracture Prediction ◽  
Intervertebral Space ◽  
Disc Space Narrowing ◽  
Disc Space ◽  
Vertebral Fracture Risk ◽  
A Prospective Study

Abstract Objective To analyse the risk of incident vertebral and non-vertebral fracture in men with DISH. Methods In 782 men ages 50–85 years, DISH was diagnosed using Resnick’s criteria. In men followed prospectively for 7.5 years, a radiographic incident vertebral fracture was defined by a decrease of ≥20% or ≥4mm in any vertebral height vs baseline. Self-reported incident non-vertebral fractures were confirmed by medical records. Results Men with DISH had higher BMD at the lumbar spine (P &lt; 0.05), but not at other skeletal sites. After adjustment for confounders including disc space narrowing (DSN) and endplate irregularity, the risk of vertebral fracture was higher in men with DISH vs men without DISH [10/164 (6.1%) vs 16/597 (2.7%), P &lt; 0.05; odds ratio (OR) 2.89 (95% CI 1.15, 7.28), P &lt; 0.05]. DISH and low spine BMD were each associated with a higher vertebral fracture risk. The vertebral fracture risk was higher in men who had both DISH and severe DSN. DISH and endplate irregularities (EIs) were each associated with higher vertebral fracture risk. DISH, DSN and EIs define the intervertebral space dysfunction, which was associated with higher vertebral fracture risk [OR 3.99 (95% CI 1.45, 10.98), P &lt; 0.01]. Intervertebral space dysfunction improved the vertebral fracture prediction (ΔAUC = +0.111, P &lt; 0.05), mainly in men with higher spine BMD (&gt;0.9 g/cm2; ΔAUC = +0.189, P &lt; 0.001). DISH was not associated with the risk of non-vertebral fracture. Conclusion DISH is associated with higher vertebral fracture risk, independently of other risk factors. Assessment of the intervertebral space dysfunction components may improve the vertebral fracture prediction in older men.

Localized Bowel Distension in the Newborn: A Review of the Plain Film Analysis and Differential Diagnosis

PEDIATRICS ◽  
1984 ◽  
Vol 73 (2) ◽  
pp. 206-215
Author(s):  
J. Fred Johnson ◽  
Lawrence H. Robinson
Keyword(s):  
Differential Diagnosis ◽  
Plain Film ◽  
Left Colon ◽  
Lower Abdomen ◽  
Air Trapping ◽  
Bowel Distension ◽  
Distended Bowel ◽  
Plain Films ◽  
Small Bowel Atresia ◽  
Bowel Atresia

Neonatal abdominal plain films were prospectively analyzed over a 41-month period in order to generate a differential diagnosis for focal bowel distension during the first 6 weeks of life. A total of 31 examples of locally distended bowel were collected. The study discredits the concept that asymmetrically distended bowel in the newborn is usually caused by necrotizing enterocolitis (only 9/31 cases) and indicates that distended bowel in the lower abdomen or left upper quadrant is often caused by air trapping in normal but redundant rectosigmoid (11 cases) or in distal transverse colon (three cases). Five other pathologic conditions not normally specified in differential diagnoses of focally distended bowel included inguinal hernia (three cases), small bowel atresia (two cases), midgut volvulus (one case), Hirschsprung's disease (one case), and small left colon (one case). The study emphasizes the value of sequential supine and prone filming for distinguishing normal from pathologic dilated loops of bowel.

What is the onset mechanism of internal hernia after vertebral body fracture? A case of internal hernia secondary to traumatic vertebral fracture

2021 ◽  
Vol 14 (9) ◽  
pp. e241005
Author(s):  
Akiyo Matsumoto ◽  
Takahiko Akao ◽  
Hiroshi Matsumoto ◽  
Naoki Kobayashi ◽  
Makoto Kamiya
Keyword(s):  
Internal Hernia ◽  
Histopathological Examination ◽  
Lumbar Vertebra ◽  
The Body ◽  
Neurological Deficits ◽  
Disc Space ◽  
Ileal Loop ◽  
Body Fracture ◽  
Enhanced Ct

A 67-year-old man who had been pinned between a basket crane and a tree complained of severe pain in his lower back and a decreased appetite. Laparotomy after decompressing the gastrointestinal tract revealed incarceration of an ileal loop within a fractured third lumbar vertebra. The damaged bowel was resected, and an end-to-end anastomosis was performed. Once the patient’s condition had stabilised, posterior lumbar fixation was performed. There were no abdominal complications or lower limb neurological deficits during the follow-up period. Enhanced CT and MRI had been helpful in making the diagnoses. Histopathological examination revealed the aetiology of the traumatic incarceration: the intestine had been pinched as the disc space closed, and the body attempted to return to its original state by exerting countertraction.

Cervical Spine Fractures Sustained by Young Children in Forward-Facing Car Seats

PEDIATRICS ◽  
1989 ◽  
Vol 84 (2) ◽  
pp. 348-354
Author(s):  
Susan Fuchs ◽  
Martha J. Barthel ◽  
Ann Marie Flannery ◽  
Katherine K. Christoffel
Keyword(s):  
Cervical Spine ◽  
Young Children ◽  
Parent Education ◽  
Health Care Professionals ◽  
Motor Vehicle ◽  
Cervical Spine Injuries ◽  
Car Seats ◽  
Number Of Children ◽  
Car Safety ◽  
Safety Seat

Child passenger safety restraint laws have reduced the number of children killed or injured in motor vehicle accidents in the past few years. However, the increased used of child safety seats has brought with it an increase in the misuse of these devices. High cervical spine injuries sustained by five children less than 2 years of age while in forward-facing car seats are described. In the cases of three children, the car safety seat use was correct. Misuse of car seats and anatomic and biomechanical factors in the cervical spines of infants and young children appear to have contributed to the occurrence of these previously rare injuries. Like seat belts, car safety seats are now a factor in child passenger injury characteristics, and therefore, car safety seat design merits reevaluation. In light of this development, public and parent education by health care professionals concerning the correct use of car safety seats is necessary.

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