TREATMENT OF THORACIC AND LUMBAR SPINE AND SPINAL CORD INJURY IN CHILDREN

Objective. To assess results of surgical treatment and to develop an optimal management regiment of patients with spine and spinal cord injury. Material and methods. Twenty patients, age 9 to 17 years, with complicated unstable spinal injuries were operated on. Out of them 13patients had severe Frankel grades A, B, C neurological disorders, 7 patients – grades D and Er. Seventeen patients had burst fractures, one – seat-belt injury, and two – fracture-dislocations. Surgery was performed in the first hours following the trauma in 9 patients, within two weeks – in 9, and after 15 days – in two. Burst fractures with grades A, B, C were treated by simultaneous posterior reposition and fixation of the injured segment, and anterior decompression and fusion. Grade D and Er was treated initially by indirect posterior reduction and fixation of the involved segment. If neurological disorders still remained decompression and body fusion were performed. Posterior-lateral decompression and instrumental fixation were performed in cases of seat-belt injuries. Fracture-dislocation was treated by decompression laminoplasty, spinal canal revision, followed by posterior reposition and fixation. Results. Two patients with burst fractures and grade A neurological disorders have shown a regression to the grade D. Dynamics of neurological restoration to grades B and C was observed in 4patients. The patient with grade B has not shown any regression. A positive dynamics with motor function improvement was observed in 4 patients with grade C. Seven patients (6 with burst fractures, 1 with seat-belt trauma) with grade D and Er were operated on within first hours and day after the trauma. First stage of surgical treatment provided elimination of neurological deficit in 5 cases. Two patients with grade D required the second stage. Regression of neurological deficit was not achieved in patients with fracture-dislocations. Conclusion. Surgical treatment of patients with complicated spine and spinal cord injury should be performed within first 6–8 hours after the trauma.

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THE INFLUENCE OF TIMING OF SURGICAL TREATMENT OF CHILDREN WITH SPINAL CORD INJURY ON THE DYNAMICS OF NEUROLOGICAL DISORDERS

Hirurgiâ pozvonočnika ◽

10.14531/ss2015.4.17-24 ◽

2015 ◽

pp. 17-24 ◽

Cited By ~ 1

Author(s):

Sergey Vissarionov ◽

◽

Sergey Belyanchikov ◽

Irina Solokhina ◽

Dmitry Kokushin ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Treatment ◽

Neurological Disorders ◽

Cord Injury

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Analysis of the influence of various factors on the course of neurological disorders in children with spinal cord injury

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors3412-21 ◽

2015 ◽

Vol 3 (4) ◽

pp. 12-21 ◽

Cited By ~ 1

Author(s):

Alexei Georgievich Baindurashvili ◽

Irina Yurievna Solokhina ◽

Dmitriy Nikolaevich Kokushin ◽

Sergei Mikhailovich Belyanchikov

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Thoracic Spine ◽

Neurological Deficit ◽

Neurological Disorders ◽

Spinal Canal ◽

Spinal Cord Injuries ◽

Clinical Manifestations ◽

Diagnostic Methods ◽

Cord Injury

Background. The study of the influence of various factors on the course of recovery of neurological disorders in children with spinal cord injuries is an important and relevant problem. The main causes of thoracic and lumbar injuries of the spine in children are road accidents and catatraumas. Anatomical and physiological features of the spine and spinal cord in children have a significant influence on the nature of spinal cord injury, clinical manifestations of the injury, and method of treatment. The degree of spinal canal deformity at the level of the damaged segment is directly proportional to the severity of the neurological disorder. The time between injury to when surgery is performed will strongly influence the nature and course of recovery of motor functions. Aim. To assess the influence of different factors in pediatric patients with complicated injuries of the spine at the thoracic and thoracolumbar levels on the recovery of neurological disorders. Materials and methods. The analysis of results of the surgical treatment of 36 children (24 boys and 12 girls) aged 3-17 years with damage to the spine and spinal cord in the thoracic spine and thoracolumbar junction, accompanied with neurological deficit in the form of central or peripheral paresis and paralysis, was performed. All patients underwent surgical intervention depending on the type and extent of damage. Clinical methods (i.e., detailed neurological examination) as well as X-ray, CT, and MRI were used as diagnostic methods. Results. The study revealed that the most severe damage concerning neurological disorders in children with spinal cord injury occurs in the thoracic spine. The extent of neurological changes depends not only on the level of damage to the spinal column but also on the magnitude of spinal canal stenosis. Surgery performed in the first hours of the injury leads to a more rapid and full recovery of the neurological deficit. Conclusion. Therefore, this study found that several factors influence the recovery of neurological disorders in children with spinal cord injury: timing of surgery, localization of the injury, spinal stenosis, the nature of lesions of the spinal cord, and the elements involved.

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“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

Vascular and Endovascular Surgery ◽

10.1177/15385744211002493 ◽

2021 ◽

pp. 153857442110024

Author(s):

Rozina Yasmin Choudhury ◽

Kamran Basharat ◽

Syeda Anum Zahra ◽

Tien Tran ◽

Lara Rimmer ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Treatment ◽

Literature Review ◽

Treatment Options ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Descending Aorta ◽

Cord Injury ◽

Aortic Pathologies

Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.

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Contusion, dislocation, and distraction: primary hemorrhage and membrane permeability in distinct mechanisms of spinal cord injury

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.3.255 ◽

2007 ◽

Vol 6 (3) ◽

pp. 255-266 ◽

Cited By ~ 85

Author(s):

Anthony M. Choo ◽

Jie Liu ◽

Clarrie K. Lam ◽

Marcel Dvorak ◽

Wolfram Tetzlaff ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

White Matter ◽

Animal Models ◽

Membrane Permeability ◽

High Speed ◽

Test System ◽

Fracture Dislocation ◽

Sprague Dawley ◽

Cord Injury

Object In experimental models of spinal cord injury (SCI) researchers have typically focused on contusion and transection injuries. Clinically, however, other injury mechanisms such as fracture–dislocation and distraction also frequently occur. The objective of the present study was to compare the primary damage in three clinically relevant animal models of SCI. Methods Contusion, fracture–dislocation, and flexion–distraction animal models of SCI were developed. To visualize traumatic increases in cellular membrane permeability, fluorescein–dextran was infused into the cerebrospi-nal fluid prior to injury. High-speed injuries (approaching 100 cm/second) were produced in the cervical spine of deeply anesthetized Sprague–Dawley rats (28 SCI and eight sham treated) with a novel multimechanism SCI test system. The animals were killed immediately thereafter so that the authors could characterize the primary injury in the gray and white matter. Sections stained with H & E showed that contusion and dislocation injuries resulted in similar central damage to the gray matter vasculature whereas no overt hemorrhage was detected following distraction. Contusion resulted in membrane disruption of neuronal somata and axons localized within 1 mm of the lesion epicenter. In contrast, membrane compromise in the dislocation and distraction models was observed to extend rostrally up to 5 mm, particularly in the ventral and lateral white matter tracts. Conclusions Given the pivotal nature of hemorrhagic necrosis and plasma membrane compromise in the initiation of downstream SCI pathomechanisms, the aforementioned differences suggest the presence of mechanism-specific injury regions, which may alter future clinical treatment paradigms.

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Subacute posttraumatic ascending myelopathy in a 15-year-old boy

Journal of Neurosurgery Spine ◽

10.3171/2014.5.spine13754 ◽

2014 ◽

Vol 21 (3) ◽

pp. 454-457 ◽

Cited By ~ 9

Author(s):

Timothy J. Kovanda ◽

Eric M. Horn

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Rare Event ◽

Fracture Dislocation ◽

Secondary Injury ◽

Spinal Cord Trauma ◽

Rare Occurrence ◽

Time Period ◽

Cord Injury ◽

Complete Spinal Cord Injury

Secondary injury following initial spinal cord trauma is uncommon and frequently attributed to mismanagement of an unprotected cord in the acute time period after injury. Subacute posttraumatic ascending myelopathy (SPAM) is a rare occurrence in the days to weeks following an initial spinal cord injury that is unrelated to manipulation of an unprotected cord and involves 4 or more vertebral levels above the original injury. The authors present a case of SPAM occurring in a 15-year-old boy who sustained a T3–4 fracture-dislocation resulting in a complete spinal cord injury, and they highlight the imaging findings and optimum treatment for this rare event.

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THORACOLUMBAR SPINAL ARTHRODESIS - EPIDEMIOLOGY AND COSTS

Coluna/Columna ◽

10.1590/s1808-185120171601162774 ◽

2017 ◽

Vol 16 (1) ◽

pp. 52-55

Author(s):

TOBIAS LUDWIG DO NASCIMENTO ◽

LUIZ PEDRO WILLIMANN ROGÉRIO ◽

MARCELO MARTINS DOS REIS ◽

LEANDRO PELEGRINI DE ALMEIDA ◽

GUILHERME FINGER ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neurological Deficit ◽

Traffic Accidents ◽

Thoracolumbar Spine ◽

Hospital Costs ◽

Spine Fracture ◽

Female Ratio ◽

Cord Injury ◽

Fall From Height

ABSTRACT Objective: To describe the epidemiology of patients with thoracolumbar spine fracture submitted to surgery at Hospital Cristo Redentor and the related costs. Methods: Prospective epidemiological study between July 2014 and August 2015 of patients with thoracolumbar spine fracture with indication of surgery. The variables analyzed were sex, age, cost of hospitalization, fractured levels, levels of arthrodesis, surgical site infection, UTI or BCP, spinal cord injury, etiology, length of stay, procedure time, and visual analog scale (VAS) . Results: Thirty-two patients were evaluated in the study period, with a mean age of 38.68 years. Male-female ratio was 4:1 and the most frequent causes were fall from height (46.87%) and traffic accidents (46.87%). The thoracolumbar transition was the most affected (40.62%), with L1 vertebra involved in 23.8% of the time. Neurological deficit was present in 40.62% of patients. Hospital stay had a median of 14 days and patients with neurological deficit were hospitalized for a longer period (p<0.001), with an increase in hospital costs (p= 0.015). The average cost of hospitalization was U$2,874.80. The presence of BCP increased the cost of hospitalization, and patients with spinal cord injury had more BCP (p= 0.014) . Conclusion: Public policies with an emphasis on reducing traffic accidents and falls can help reduce the incidence of these injuries and studies focusing on hospital costs and rehabilitation need to be conducted in Brazil to determinate the burden of spinal trauma and spinal cord injury.

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