scholarly journals Outcome of Delayed Surgery in Treatment of Acute Traumatic Central Cord Syndrome without Fracture or Instability: A Retrospective Study

2020 ◽  
Author(s):  
Binbin Wang ◽  
Yuemian Huang ◽  
Haozhi Yang ◽  
Xiaobao Zou ◽  
Ling Ni ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
Neurological Function ◽  
Cervical Disc ◽  
Long Term Outcome ◽  
Delayed Surgery ◽  
Neurological Improvement ◽  
Central Cord Syndrome

Abstract Background: The optimal surgical timing for acute traumatic central cord syndrome (ATCCS) without fracture or instability has not been established. The purpose of this study is to explore the outcome of delayed surgery in treatment of ATCCS and to investigate potential factors associated with postoperative neurological improvement. Methods: Patients who underwent delayed surgery for ATCCS with at least 2 year follow up time were retrospectively reviewed. Parameters including age, gender, traumatic mechanism, interval to operation, surgical procedures, and complications were collected. Magnetic resonance imaging was performed to determine levels of spinal cord signal change and concomitant pathology. American Spinal Injury Association (ASIA) classification and Japanese Orthopedic Association (JOA) scores were evaluated and compared at admission and the 2 year follow-up visit for neurologic function assessment. Correlations of neurological improvement and age, traumatic mechanism, interval to operation, surgical procedures, concomitant pathology, and preoperative neurological function were investigated by Spearman ’ s correlation test. Results: A total of 39 patients (M:F=28:11, mean age 52.2±10.4 yrs) were enrolled into this study. 21 cases were caused by falls followed by 16 by motor-vehicle accidents and 2 by sports. 19 patients presented with preexisting cervical disc herniation (CDH)，12 with spinal canal stenosis (SCS), 5 with OPLL, and 3 with a combined pathology of CDH and CS. 14 samples received ACDF procedure, 8 obtained ACCF, and 17 underwent posterior unilateral open-door laminoplasty. The mean interval from trauma to surgery was 20.8±3.7 days. All cases except three (ASIA B) showed improvement of ASIA grades with a mean improvement of 1.1±0.5 grades at 2-year follow-up. JOA scores significantly improved from 6.3±3.1 points at admission to 11.4±3.9 points at 2-year follow up. No difference of neurological improvement was found between different procedures groups. No correlation was showed between neurological improvement and age, concomitant pathology, traumatic mechanism, interval to operation, surgical procedures, or preoperative neurological function. Conclusions: Delayed surgery was a feasible and effective therapy for ATCCS without fracture or instability although long-term outcome and more details still need to be investigated.

scholarly journals Definitive single-stage posterior surgical correction of complete traumatic spondyloptosis at the thoracolumbar junction

2015 ◽  
Vol 22 (6) ◽  
pp. 653-657 ◽  
Author(s):  
Lee Sandquist ◽  
Alexander Paris ◽  
Daniel K. Fahim
Keyword(s):  
Motor Vehicle ◽  
Spinal Injury ◽  
Single Stage ◽  
Thoracolumbar Junction ◽  
Surgical Reconstruction ◽  
Rare Occurrence ◽  
Postoperative Therapy ◽  
Hand Control ◽  
Solid Fusion

Complete dislocation at the thoracolumbar junction is a rare occurrence, with only 4 previously reported cases in 3 separate series. Surgical procedures in the reported cases of spondyloptosis at the thoracolumbar junction have been described using instrumentation, reduction, decompression, and stabilization techniques. In this report the authors' patient presented with spondyloptosis at the thoracolumbar junction, resulting in a T-11 American Spinal Injury Association Grade A injury. The authors corrected the patient's thoracolumbar spondyloptosis with surgical reconstruction without the use of leveraged instrumented reduction. They describe a single-stage, posterior-only spinal realignment, reconstruction, and stabilization. Within months of beginning postoperative therapy, the patient enrolled and attended courses at a local college and regained personal independence by learning to drive a motor vehicle with a hand control. Two-year radiographic and clinical follow-up confirms solid fusion across the reconstruction.

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.

scholarly journals The Effect of Surgical Intervention for Delayed Cervical Central Cord Syndrome

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Yanan Liu ◽  
Zongyi Wang ◽  
Shaofeng Yang ◽  
Huilin Yang ◽  
Jun Zou
Keyword(s):  
Surgical Intervention ◽  
Spinal Injury ◽  
American Spinal Injury Association ◽  
Japanese Orthopedic Association ◽  
Sf 36 ◽  
Cord Injury ◽  
Central Cord Syndrome ◽  
Time Point ◽  
The Ideal

The authors retrospectively studied 11 patients with delayed cervical central cord syndrome (CCS) to investigate the efficacy of the surgical intervention on treatment for delayed CCS. The American Spinal Injury Association (ASIA) motor scores, Japanese Orthopedic Association (JOA) scores, SF-36 scores, and neurologic status were analyzed preoperatively and at each time point of postoperative follow-up. The results show that patients with reversible spinal cord injury caused by delayed central cord syndrome can recover significantly after surgical intervention. Therefore, we suggest that surgical intervention is still the ideal choice for delayed cervical central cord syndrome.

scholarly journals Correlation of magnetic resonance diffusion tensor imaging parameters with American Spinal Injury Association score for prognostication and long-term outcomes

2019 ◽  
Vol 46 (3) ◽  
pp. E2 ◽  
Author(s):  
Saman Shabani ◽  
Mayank Kaushal ◽  
Matthew Budde ◽  
Shekar N. Kurpad
Keyword(s):  
Correlation Analysis ◽  
Spinal Injury ◽  
Time Of Arrival ◽  
American Spinal Injury Association ◽  
Long Term Outcome ◽  
Imaging Parameters ◽  
Cord Injury ◽  
Asia Score

OBJECTIVEConventional MRI is routinely used to demonstrate the anatomical site of spinal cord injury (SCI). However, quantitative and qualitative imaging parameters have limited use in predicting neurological outcomes. Currently, there are no reliable neuroimaging biomarkers to predict short- and long-term outcome after SCI.METHODSA prospective cohort of 23 patients with SCI (19 with cervical SCI [CSCI] and 4 with thoracic SCI [TSCI]) treated between 2007 and 2014 was included in the study. The American Spinal Injury Association (ASIA) score was determined at the time of arrival and at 1-year follow-up. Only 15 patients (12 with CSCI and 3 with TSCI) had 1-year follow-up. Whole-cord fractional anisotropy (FA) was determined at C1–2, following which C1–2 was divided into upper, middle, and lower segments and the corresponding FA value at each of these segments was calculated. Correlation analysis was performed between FA and ASIA score at time of arrival and 1-year follow-up.RESULTSCorrelation analysis showed a positive but nonsignificant correlation (p = 0.095) between FA and ASIA score for all patients (CSCI and TCSI) at the time of arrival. Additional regression analysis consisting of only patients with CSCI showed a significant correlation (p = 0.008) between FA and ASIA score at time of arrival as well as at 1-year follow-up (p = 0.025). Furthermore, in case of patients with CSCI, a significant correlation between FA value at each of the segments (upper, middle, and lower) of C1–2 and ASIA score at time of arrival was found (p = 0.017, p = 0.015, and p = 0.002, respectively).CONCLUSIONSIn patients with CSCI, the measurement of diffusion anisotropy of the high cervical cord (C1–2) correlates significantly with injury severity and long-term follow-up. However, this correlation is not seen in patients with TSCI. Therefore, FA can be used as an imaging biomarker for evaluating neural injury and monitoring recovery in patients with CSCI.

scholarly journals Treatment of chronic subdural hematoma with atorvastatin combined with low-dose dexamethasone: phase II randomized proof-of-concept clinical trial

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Dong Wang ◽  
Chuang Gao ◽  
Xin Xu ◽  
Tao Chen ◽  
Ye Tian ◽  
...  
Keyword(s):  
Clinical Trial ◽  
T Cells ◽  
Subdural Hematoma ◽  
Controlled Trial ◽  
Chronic Subdural Hematoma ◽  
Complete Recovery ◽  
Neurological Function ◽  
Clinical Trial Registration ◽  
Neurological Improvement

OBJECTIVEThe authors sought to test the hypothesis that adding dexamethasone (DXM) to atorvastatin (ATO) potentiates the effects of ATO on chronic subdural hematoma (CSDH).METHODSSixty patients with CSDH underwent 5 weeks of treatment with an additional 7-week follow-up. Patients were randomized to receive a 5-week regimen of ATO 20 mg daily or ATO 20 mg daily plus a DXM regimen (ATO+DXM). The 5-week DXM regimen was 2.25 mg daily for 2 consecutive weeks, followed by 0.75 mg twice daily for 2 weeks and 0.75 mg once daily for 1 week. The primary endpoint was hematoma reduction assessed by neuroimaging at baseline and at 5 weeks of follow-up. Secondary outcomes included neurological improvement assessed by using the Markwalder’s Grading Scale and Glasgow Coma Scale (MGS-GCS).RESULTSThe mean patient age was 66.6 years, and 25% of patients were women. The patients who were treated with ATO+DXM had more obvious hematoma reduction at the 5th week (between-groups difference 18.37 ml; 95% CI 8.17–28.57; p = 0.0005). This reduction started from the 2nd week (14.51 ml; 95% CI 4.31–24.71; p = 0.0056) of treatment and persisted until the 12th week (17.50 ml; 95% CI 7.30–27.70; p = 0.0009). Complete recovery of neurological function (MGS-GCS grade 0) at 5 weeks was achieved in 83.33% and 32.14% of patients in the ATO+DXM and ATO groups, respectively. At the 5th week, patients receiving ATO+DXM had significantly lower levels of T cells and higher levels of regulatory T cells and endothelial progenitor cells in their peripheral blood.CONCLUSIONSATO+DXM was more effective than ATO alone in reducing hematoma and improving neurological function in patients with CSDH. These results require further confirmation in a randomized placebo-controlled trial.Clinical trial registration no.: ChiCTR-IPR-14005573 (http://www.chictr.org.cn/index.aspx)

A rare case of atlantooccipital dissociation in the context of occipitalization of the atlas, with a 2-year follow-up

2013 ◽  
Vol 18 (2) ◽  
pp. 189-193 ◽  
Author(s):  
Navjot Chaudhary ◽  
Bill H. Wang ◽  
Kevin R. Gurr ◽  
Stewart I. Bailey ◽  
Christopher S. Bailey
Keyword(s):  
Rare Case ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
Bowel Function ◽  
Joint Mechanics ◽  
Vehicle Collision ◽  
The Right ◽  
Favorable Neurological Outcome ◽  
Atlantooccipital Dislocation

Atlantooccipital dislocation (AOD) is a rare and often fatal injury. In cases of survival, residual deficits are severe and often include cranial nerve palsy, quadriplegia, or respiratory issues. Occipitalization is defined as partial or complete congenital fusion of the occiput to the atlas and is exceptionally rare. The authors present a rare case of AOD superimposed on a congenital occipitalization of the atlas. This 39-year-old man had AOD following a motor vehicle collision. On examination, his overall motor score on the American Spinal Injury Association scale was 5/100, and his rectal tone was absent. Computed tomography demonstrated AOD in an area of occipitalization. Magnetic resonance imaging revealed ligamentous injury leading to C1–2 instability. Intervention included occipital cervical instrumentation fusion from the occiput to C-3. Six months postoperatively, imaging revealed fusion of the graft and consolidation of the fractured occipitalization. At the 2-year follow-up, the patient's strength was 3/5 for wrist extension and handgrip on the right side and full strength in the rest of the myotomes. Bladder and bowel function was also normalized. A high-velocity collision led to disruption of the atlantooccipital ligaments and fracture of the occipitalized lateral masses in this patient. Internal fixation and fusion led to good fusion postoperatively. Occipitalization probably led to abnormal joint mechanics at the C1-occiput junction, which might have altered the amount of force required to fracture the occipitalization and produce AOD. This difference may partially account for the favorable neurological outcome in the featured patient compared with traditional cases of AOD.

scholarly journals Long-Term Follow-Up following Condylotomy in a Case of Traumatic Unilateral Anterosuperior Mandibular Condyle Dislocation

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Syed Nabil ◽  
Elavarasi Kuppusamy ◽  
Rifqah Nordin ◽  
Abdul Jabar Nazimi ◽  
Roszalina Ramli
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Present Report ◽  
Mandibular Condyle ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vehicle Accident ◽  
Long Term Follow Up

Anterosuperior temporomandibular joint dislocation is rare. Manual reduction of such dislocation is difficult especially when treatment is delayed. Therefore, it has an increased likelihood of needing surgical intervention to achieve reduction. The authors report a case of an anterosuperior temporomandibular dislocation in a 19-year-old male following a motor vehicle accident. Difficulties were encountered in reducing the dislocation necessitating surgically assisted reduction. The long-term outcome following management by condylotomy is reported. This present report also reviews the literature regarding the classification and management of this uncommon dislocation.

Long-Term Outcome of Surgical Management in Symptomatic Pediatric Vertebral Hemangiomas Presenting With Myelopathy

Neurosurgery ◽  
2020 ◽  
Author(s):  
Pankaj K Singh ◽  
Sarat P Chandra ◽  
Mohit Agrawal ◽  
Dattaraj Sawarkar ◽  
Rajender Kumar ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Spinal Injury ◽  
Lower Limbs ◽  
Vascular Lesions ◽  
Vertebral Hemangioma ◽  
Long Term Outcome ◽  
The Mean ◽  
Vertebral Hemangiomas

Abstract BACKGROUND Vertebral hemangiomas are benign, highly vascular lesions of the vertebra, rarely seen in the pediatric age group. OBJECTIVE To analyze the long-term (>3 yr) outcome of patients of pediatric vertebral hemangioma presenting with myelopathy and to describe our surgical strategy to treat such cases. METHODS All patients up to 18 yr of age with a symptomatic vertebral hemangioma treated at our hospital from May 2003 to August 2016, with at least 3-yr follow-up were included. Functional clinical outcomes were measured using American Spinal Injury Association (ASIA) score. RESULTS There were 7 male and 7 female patients. All hemangiomas were located in the thoracic spine with single-level involvement. Upper thoracic spine involvement was more common (12 cases: 85.71%) than lower thoracic spine involvement (2 cases: 14.29%). All patients had features of myelopathy. The mean age was 14.57 yr, ranging from 10 to 18 yr. The mean follow-up was 62.21 mo, ranging from 36 to 90 mo. All patients had improvement in motor strength of both lower limbs postoperatively. Local pain, which was present in 1 patient, resolved, and the bladder symptoms present in 5 patients also resolved. CONCLUSION Our experience in treating symptomatic pediatric vertebral hemangiomas, along with the long-term follow-up data, suggests that good postoperative results can be achieved with minimal complications in carefully selected patients.

scholarly journals Outcome in patients undergoing surgery for spinal injury in an Ethiopian hospital

2015 ◽  
Vol 23 (6) ◽  
pp. 772-779 ◽  
Author(s):  
Martin Andreas Lehre ◽  
Lars Magnus Eriksen ◽  
Abenezer Tirsit ◽  
Segni Bekele ◽  
Saba Petros ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
Addis Ababa ◽  
Cord Injury ◽  
Spine Injuries ◽  
Tract Infections

OBJECT The objective of this study was to investigate epidemiology and outcome after surgical treatment for spinal injuries in Ethiopia. METHODS Medical records of patients who underwent surgery for spine injuries at Myungsung Christian Medical Center in Addis Ababa, Ethiopia, between January 2008 and September 2012 were reviewed retrospectively. Assessment of outcome and complications was determined from patient consultations and phone interviews. RESULTS A total of 146 patients were included (129 males, 17 females). Their mean age was 31.7 years (range 15–81 years). The leading cause of injury was motor vehicle accidents (54.1%), and this was followed by falls (26.7%). The most common injury sites were lumbar (41.1%) and cervical (34.2%) regions of the spine. In 21.2% of patients, no neurological deficit was present before surgery, 46.6% had incomplete spinal cord injury (American Spinal Injury Association [ASIA] Impairment Scale [AIS] Grade B-D), and 32.2% had complete spinal cord injury (AIS Grade A). Follow-up was hampered by suboptimal infrastructure, but information regarding outcome was successfully obtained for 110 patients (75.3%). At follow-up (mean 22.9 months; range 2–57 months), 25 patients (17.1%) were confirmed dead and 85 patients (58.2%) were alive; 49 patients (33.6%) underwent physical examination. At least 8 of the 47 patients (17.0%) with a complete injury and 29 of the 68 patients (42.6%) with an incomplete injury showed neurological improvement. The reported incidences of pressure wounds, recurrent urinary tract infections, pneumonia, and thromboembolic events were 22.5%, 13.5%, 5.6%, and 1.1%, respectively. CONCLUSIONS Patients showed surprisingly good recovery considering the limited resources. Surgical treatment for spine injuries in Ethiopia is considered beneficial.

Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial

2010 ◽  
Vol 13 (3) ◽  
pp. 308-318 ◽  
Author(s):  
J. Kenneth Burkus ◽  
Regis W. Haid ◽  
Vincent C. Traynelis ◽  
Praveen V. Mummaneni
Keyword(s):  
Clinical Outcomes ◽  
Surgical Procedures ◽  
Cervical Disc ◽  
Control Group ◽  
Segmental Motion ◽  
Disc Prosthesis ◽  
Treatment Groups ◽  
The Prestige

Object The purpose of this study was to determine long-term clinical outcomes in patients undergoing anterior cervical surgery in which a cervical disc prosthesis was used to treat single-level degenerative cervical disc disease. Methods In this prospective, nonblinded study, 541 patients at 32 investigational sites were randomly assigned to 1 of 2 treatment groups. The results of the investigational group, in which patients received the Prestige disc prosthesis, were compared with those of the control group, in which patients underwent an instrumented interbody fusion. Data were collected preoperatively, intraoperatively, and at 1.5, 3, 6, 12, 24, 36, and 60 months postoperatively. To date, 271 patients have completed 5 years of clinical follow-up (144 investigational and 127 control patients). Results Significant improvements in Neck Disability Index (NDI) scores, Physical Component Summary scores of the 36-Item Short-Form Health Survey, and neck and arm pain scores were achieved by 1.5 months in both groups and sustained at 5 years. The mean NDI improvements from preoperative scores were 35.4, 36.3, and 38.4 at 24, 36, and 60 months, respectively, in the investigational group. The corresponding mean NDI improvements were 33.9, 31.3, and 34.1 in the control group. The intergroup differences at both 36 and 60 months were significant (p = 0.008 and 0.022, respectively). The overall rates of maintenance or improvement in neurological status in the investigational group were 91.6%, 92.8%, and 95.0%, respectively, at 24, 36, and 60 months compared with 83.6%, 83.2%, and 88.9% in the control group (p = 0.006, 0.004, and 0.051, respectively). The implant effectively maintained angular motion, averaging more than 7.3° at 36 months and 6.5° at 60 months after surgery. No implant migration was observed up to 60 months. There were statistically significant differences between the investigational and control groups with regard to the rate of revision and supplemental fixation surgical procedures performed subsequent to the index procedure. Additional surgical procedures for adjacent-segment disease were observed in both treatment groups. Rates for surgery at adjacent levels trended lower in the investigational group (8 patients [11 surgeries]) compared with those in the control group (13 patients [16 surgeries]), but the differences were not statistically significant (p = 0.376). Some of the second surgeries involved both index and adjacent levels. Conclusions The Prestige disc maintains improved clinical outcomes and segmental motion after implantation at 5-year follow-up.

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