Bullet retrieval from the cauda equina after penetrating spinal injury: A case report and review of the literature

Background: When gunshot injuries occur to the spine, bullet fragments may be retained within the spinal canal. Indications for bullet removal include incomplete spinal cord injury, progressive loss of neurologic function including injury to the cauda equina, and dural leaks with impending risk of meningitis. Case Description: Here, we present a 34-year-old male with a missile penetrating spinal injury to the cauda equina. In addition to the computed tomography scan demonstrating retention of a bullet in the left L1/2 disc space, the scan suggested likely dural injury. The patient underwent a decompression/instrumented fusion with retrieval of the retained bullet fragment. A laminectomy was performed from T12 to L3, and at L1 and L2, a large traumatic durotomy was identified and repaired. The patient, unfortunately, continued to have bilateral lower extremity plegia with neurogenic bladder/bowel dysfunction at 1-year follow-up. Conclusion: We discuss the operative management and provide an intraoperative video showing the bullet extraction and dural closure.

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Cauda Equina Syndrome Retention Type –Late Intervention Can also give Excellent Results

10.47363/jnrrr/2020(2)125 ◽

2020 ◽

pp. 1-4

Author(s):

Suhasish Roy ◽

◽

Siddhartha Mahapatra ◽

Keyword(s):

Disc Herniation ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Golden Rule ◽

Complete Recovery ◽

Neurological Status ◽

Bowel Dysfunction ◽

Caries Spine ◽

Bladder Bowel Dysfunction

Introduction: Cauda Equina Syndrome (CES) is an acute stenosis of lumbar spinal canal leading to compression of neural elements below the level of L1 mostly due to disc herniation but other causes exist. Intervention within 48 hours prevent permanent sensorimotor, sphincter and sexual disturbances. We reporttwelvecases of Cauda Equina Syndrome with complete sensorimotor deficit, bladder, bowel dysfunction intervened at least 1 month after initiation of symptoms with complete recovery of functions. Till date a few literature support is there to substantiate this evidence. Methods: 22 patients between 2011 to 2015, 18 male and 4 female, attended with complete or retention type of cauda equina syndrome. Of the 8 men, 5 had acute discherniations, 2 had caries spine, 1 had trauma. Of the 4 women,3 had acute disc herniation,1 had caries spine. 4 attended 35- 39 days, 4 between 45- 45 days,4 between 45- 60 days. They were urgently decompressed within 72 hours of attendance. 4 were lost in follow- up within 1 year. Rest were followed up3- 5 years. Results: 3 patients improved by 14 to 28 days, their neurological status improved from ASIA A to ASIA D, 4 patients by 30 to 90 days from ASIA A to ASIA E. 1 male patient improved from ASIA A to ASIA C in 3 years. All the above neurological status maintained. 2 men and 2 women were lost to follow up within 1 year when their improvement were by only one grade in ASIA impairment scale. 7 out of 8 patients had excellent results. Conclusion: Though early intervention is the golden rule, in late presentations of complete cauda equine syndrome, thorough decompression improves the neurological status of the patient

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Olfactory ensheathing cell transplantation for chronic spinal cord injury: A long-term follow-up study

Journal of Neurorestoratology ◽

10.26599/jnr.2021.9040008 ◽

2021 ◽

Vol 9 (2) ◽

pp. 94-105

Author(s):

Naifeng Kuang ◽

Xiaoyu Wang ◽

Yuexia Chen ◽

Guifeng Liu ◽

Fan’e Kong ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Autonomic Function ◽

Spinal Injury ◽

International Standards ◽

Olfactory Ensheathing Cell ◽

Cord Injury ◽

Long Term Follow Up

Spinal cord injury is a serious disabling condition. Transplantation of olfactory ensheathing cells (OECs) is one of the most promising treatments for spinal cord injury (SCI). Thirty-nine patients with chronic SCI received OEC transplantation and completed long-term follow-up, with a minimum follow-up of 7 years. We assessed sensorimotor function with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and autonomic nervous function by the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), and sympathetic skin responses (SSR). The scores of each group were significantly higher after OECs transplantation than before treatment. SSR latencies were shorter and response amplitudes increased after treatment. Long-term follow-up showed further improvement only in motor function and autonomic function compared with 3 months postoperatively. No complications occurred in any patient during long-term follow-up. The results indicate that the transplantation of OECs in spinal cord restored function without serious side effects.

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Neurological prognosis after traumatic quadriplegia

Journal of Neurosurgery ◽

10.3171/jns.1979.50.5.0611 ◽

1979 ◽

Vol 50 (5) ◽

pp. 611-616 ◽

Cited By ~ 134

Author(s):

Frederick M. Maynard ◽

Glenn G. Reynolds ◽

Steven Fountain ◽

Conal Wilmot ◽

Richard Hamilton

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Head Injuries ◽

Gunshot Wounds ◽

Neurological Impairment ◽

Treatment Protocols ◽

Content Type ◽

Cord Injury

✓ Between January, 1974, and December, 1976, 123 patients with traumatic quadriplegia were admitted to the California Regional Spinal Cord Injury Care System. The spinal cord injury resulted from gunshot wounds in five, from a stab wound in one, from neck injuries with no bone damage seen on x-ray studies in 10, and from fracture dislocations of the cervical spine in 107. One-year follow-up information was available on 114 patients. Neurological impairment using the Frankel classification system was compared at 72 hours postinjury to the 1-year follow-up examination. Fifty of 62 patients with complete injury at 72 hours were unchanged at 1 year. Five of these 62 patients had developed motor useful function in the legs or became ambulatory by 1 year, but all had sustained serious head injuries at the time of their trauma making initial neurological assessment unreliable. Ten percent of all cases had combined head injury impairing consciousness. Among 103 cognitively intact patients, none with complete injury at 72 hours were walking at 1 year. Of patients with sensory incomplete function at 72 hours postinjury, 47% were walking at 1 year; 87% of patients with motor incomplete function at 72 hours postinjury were walking at 1 year. Spinal surgery during the first 4 weeks postinjury did not improve neurological recovery. A method of analyzing neurological and functional outcomes of spinal cord injury is presented in order to more accurately evaluate the results of future treatment protocols for acute spinal injury.

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Long-Term Follow-up of Patients with Spinal Cord Injury

Neurorehabilitation and Neural Repair ◽

10.1177/1545968305280210 ◽

2005 ◽

Vol 19 (4) ◽

pp. 332-337 ◽

Cited By ~ 8

Author(s):

Figen Yilmaz ◽

Fusun Sahin ◽

Semra Aktug ◽

Banu Kuran ◽

Adem Yilmaz

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Functional Independence Measure ◽

Functional Independence ◽

American Spinal Injury Association ◽

Cord Injury ◽

Long Term Follow Up

Objective. The aim of this study was to evaluate the motor, sensory, and functional recovery in patients with spinal cord injury (SCI). Methods. Forty-one patients with SCI participated in this study. Twenty patients were evaluated after discharge. Each patient was evaluated by the American Spinal Injury Association (ASIA) impairment scale and the Functional Independence Measure (FIM) at admission, before discharge, and at least at 6 months after discharge. Friedman, Dunn, and Mann-Whitney U tests were used for statistical analysis. Results. There were 17 male and 3 female patients. Seven patients had complete SCI, and 13 patients had incomplete SCI. The evaluation of motor, sensory, and FIM scores at admission showed significant improvement in all of the patients during the follow-up period (P < 0.0001). Five incompletely injured cases improved with regard to ASIA staging. Motor and FIM scores significantly increased at follow-up for converted and unconverted patients. All parameters increased at follow-up in patients who were complete and incomplete. Motor scores significantly increased at discharge and at follow-up. FIM scores also increased significantly at follow-up in incomplete patients. Conclusion. Motor, sensory, and FIM scores increased in patients with SCI after a follow-up period of 18 months. Improvement to a higher ASIA stage could be accomplished by 25% of the patients. Although both complete and incomplete patients recovered significantly at the follow-up period, only incompletely injured cases could convert to a higher ASIA stage.

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Current use and timing of spinal surgery for management of acute spinal cord injury in North America: results of a retrospective multicenter study

Neurosurgical FOCUS ◽

10.3171/foc.1999.6.1.5 ◽

1999 ◽

Vol 6 (1) ◽

pp. E4 ◽

Cited By ~ 1

Author(s):

Charles H. Tator ◽

Michael Fehlings ◽

Kevin Thorpe ◽

Wayne Taylor

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Randomized Controlled Trial ◽

Spinal Injury ◽

Controlled Trial ◽

Cauda Equina ◽

Timing Of Surgery ◽

Acute Spinal Cord Injury ◽

Randomized Controlled ◽

Cord Injury

A multicenter retrospective study was performed in 36 participating North American centers to examine the use and timing of surgery in the treatment of acute spinal cord injury (SCI). The study was conducted to obtain information required for the planning of a randomized controlled trial of early compared with late decompressive surgery. The records of all patients aged 16 to 75 years with acute SCI who were admitted to the 36 centers within 24 hours of injury over a 9-month period (August 1994 to April 1995) were examined to obtain data on admission variables, methods of diagnosis, use of traction, and surgical variables including type and timing of surgery. A total of 585 patients with acute SCI or cauda equina injury were admitted to these centers, although approximately half were ultimately excluded because they did not meet inclusion criteria. Common causes for exclusion were late admission, age, gunshot wound, and an absence of spinal cord compression demonstrated on imaging studies. Thus, only approximately 50% of acute SCI patients would be eligible for inclusion in a study of acute decompressive procedures. Although 100% of patient underwent computerized tomography (CT) scaning, only 54% underwent magnetic resonance imaging, and CT myelography was performed in only 6%. Complete neurological injuries (American Spinal Injury Association Grade A) were present in 57.8%. Traction was applied in only 47% of patients with cervical injuries, of which only 42% demonstrated successful decompression by traction. Neurological deterioration occurred in 8.1% of patients after traction. Surgery was performed in 65.4% of patients. The timing of surgery varied widely: less than 24 hours in 23.5% of patients; 25 to 48 hours in 15.8%; 48 to 96 hours in 19.0%; and 5 days or longer in 41.7% of patients. These data indicate that whereas surgery is commonly performed in patients with acute SCI, one-third of the cases are managed nonoperatively, and there is very little agreement on the optimum timing of surgical treatment. The results of this study confirm the need for a randomized controlled trial to determine the optimum timing of surgical decompressive procedures in patients with SCI.

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A new transpedicular lag-screw fixation for treatment of unstable Hangman’s fracture: a minimum 2-year follow-up study

10.21203/rs.3.rs-29091/v1 ◽

2020 ◽

Author(s):

Yijie Liu ◽

Yi Zhu ◽

Xuefeng Li ◽

Jie Chen ◽

Sen Yang ◽

...

Keyword(s):

Spinal Injury ◽

Screw Fixation ◽

Biomechanical Testing ◽

Biomechanical Properties ◽

Hangman’S Fracture ◽

Lag Screw ◽

Associated Lesions ◽

Cord Injury ◽

Hangman's Fracture

Abstract Background A new C2 transpedicular lag-screw designed by our team has been used in human cadaver spines for biomechanical testing, and the results showed that the biomechanical properties of the new C2 transpedicular lag-screw were better than ordinary screws. The objective of this study is to analyze the clinical efficacy and safety of the new C2 transpedicular lag-screw fixation for treatment of an unstable Hangman’s fracture. Methods From March 2013 to June 2017, 25 patients who had unstable Hangman’s fractures were operated on with a new C2 transpedicular lag-screw fixation. The patients included 18 males and 7 females whose ages ranged from 31–62 years (average 45.4 ± 9.3 years). The cause of the injury was a traffic accident in 17 patients and a fall from height in 8 patients. Other associated lesions included rupture of the spleen (1 patient) and rib fractures (2 patients). According to the Levine-Edwards classification, 17 patients were Type II and 8 patients were Type IIA, and according to the Frankel Neurological Performance scale, 8 cases and 17 cases were graded as spinal cord injury D and E, respectively. Of the cases, 23 cases received bilateral screw fixation and 2 cases had unilateral screw fixation because another pedicle was chipped. The whole procedure was accomplished with monitoring by“C”-arm fluoroscopy. Results The mean follow-up time was (36 ± 12) months and ranged from 24 to 60 months. No obvious symptomatic or radiologic postoperative complications were found during the follow-up period. 6 cases restored from D to E while 2 cases remained D according to American Spinal Injury Association (ASIA) grade. Osseous union was achieved in all cases, and the range of cervical motion recovered to normal level up to the last follow-up. Conclusions The primary clinical and radiographic efficacies of a new C2 transpedicular lag-screw fixation for treatment of an unstable Hangman’s fracture were satisfactory. This approach could be considered a simple, effective, reliable and economic surgical method for managing unstable Hangman’s fractures.

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356 An Unfortunate Case of Spinal Injury and Bladder Dysfunction During the Covid-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab259.287 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J Lane ◽

M Johnston ◽

M Davies

Keyword(s):

Emergency Services ◽

Spinal Injury ◽

Operative Management ◽

Dental Services ◽

Artificial Sphincter ◽

Urethral Catheterisation ◽

Cord Injury ◽

Surgical Speciality ◽

Functional Urology ◽

Learning Points

Abstract There is no doubt that COVID-19 has had a profound impact on every medical and surgical speciality. In the height of the pandemic many non-emergency services were shut down, including dental services, with unexpected consequences. We present a case which highlights the unexpected and indirect consequences of a national lockdown on a Urology patient and discuss learning points. A 54-year-old male, previously fit and well suffered with a small dental abscess, media outlets were reporting that dental surgeries were closed, and he therefore attempted to drain the abscess himself. The infection spread to his epidural space, causing compression via a collection at L2 and consequently spinal cord injury. This was managed with urgent lumbar decompression and antibiotics. A specialist functional urology team were involved after his transfer to the tertiary spinal unit 3 months after his first presentation. He was catheterised but suffered with recurrent catheter blockages. Video urodynamics demonstrated a stable bladder with a low-pressure leak point, managed with urethral catheterisation. A repeat video urodynamics demonstrated a loss of compliance and stress incontinence. Unclear as to whether he would regain function rehabilitation techniques are currently being attempted prior for definitive operative management with an artificial sphincter. This case highlights the indirect impact of COVID-19 on UK urology services, and this has not been widely reported.

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Depression, Social Support, and Coping Strategies in Individuals with Spinal Injury Depression with Spinal Injury Patients

Siriraj Medical Journal ◽

10.33192/smj.2021.67 ◽

2021 ◽

Vol 73 (8) ◽

pp. 518-525

Author(s):

Nopchanok Sukprasert ◽

Cholavech Chavasiri ◽

Srinual Chavasiri

Keyword(s):

Social Support ◽

Spinal Cord ◽

Coping Strategies ◽

Spinal Injury ◽

Depression Scale ◽

Negatively Associated ◽

The Social ◽

Cord Injury ◽

Prevalence Of Depression

Objective: To investigate the prevalence of and factors associated with depression, the social support received by, and the coping strategies used by spinal cord injury (SCI) patients.Materials and Methods: SCI patients who received follow-up evaluation at the Siriraj Hospital during 2016 to 2018. The instruments used included a general information, the Zung Self-Rating Depression Scale(Thai version), the Social Provisions Scale, and the Spinal Cord Lesion-Related Coping Strategies Questionnaire (Thai version).Results: Eighty-six SCI patients (age: 43.1±15.7 years, 66.3% male) were included, and 59.3% had some level of permanent impairment. The prevalence of depression was 55.8%. Depression was found to be negatively associated with all social support domains. Regarding coping, depression was shown to be negatively associated with the acceptance strategy, but positively associated with the social reliance strategy. Multivariate analysis by multiple logistic regression showed level of impairment (p=0.005), guidance provision (p=0.040), fighting spirit strategy (p=0.031), and the social reliance strategy (p=0.032) to be independently associated with depression.Conclusion: The prevalence of depression among SCI was 55.8%. The results revealed the types of social support received, and the coping strategies used by SCI patients after hospital discharge. These findings will improve follow-up care and patient quality of life.

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Traumatic Spinal Cord Injury: Long-Term Motor, Sensory, and Urinary Outcomes

Asian Spine Journal ◽

10.4184/asj.2017.11.3.412 ◽

2017 ◽

Vol 11 (3) ◽

pp. 412-418 ◽

Cited By ~ 7

Author(s):

Rouzbeh Motiei-Langroudi ◽

Homa Sadeghian

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Treatment Protocol ◽

Spinal Column ◽

Surgical Approaches ◽

Trauma Mechanism ◽

Cord Injury

<sec><title>Study Design</title>Retrospective study.</sec><sec><title>Purpose</title>To evaluate how motor, sensory, and urinary outcomes of spinal cord injury (SCI) patients were influenced in the long term.</sec><sec><title>Overview of Literature</title>SCI is a potentially disabling and devastating neurological outcome that can occur because of spinal column fractures. Most studies have not evaluated or have failed to show the influence of different surgical approaches and other parameters on neurological recovery.</sec><sec><title>Methods</title>A thorough history regarding sensory, motor, and urinary complaints was taken from 103 patients with SCI due to vertebral fracture; patients were followed by a thorough neurological examination. Subsequently, all medical records of patients, including neurological state after trauma, trauma mechanism, treatment protocol, surgical protocol, and imaging findings, were evaluated.</sec><sec><title>Results</title>Of the 103 patients, 73.8% were survivors of a major earthquake and 26.2% were victims of vehicle accidents; 92.2% patients were surgically treated, while 7.8% underwent conservative management. The mean follow-up duration was 10.3 years. In follow-up visits, 67.0%, 12.6%, 13.6%, and 6.8% patients showed no, partial, substantial, and complete motor improvement, respectively; 68.0%, 26.2%, and 5.8% showed no, mild, and substantial sensory improvement, respectively; and 73.8%, 17.5%, and 8.7% showed no, substantial, and complete urinary improvement, respectively. Logistic regression analysis showed that sex, age at injury time, follow-up duration, trauma mechanism, and stem cell therapy had no effect on motor, sensory, and urinary improvement. Higher initial scores on the American Spinal Injury Association (ASIA) classification, lumbar fracture level, and performance of laminectomy improved motor outcome; higher initial ASIA scores improved urinary and sensory outcomes.</sec><sec><title>Conclusions</title>The initial ASIA score is the most important factor for prognosticating motor, sensory, and urinary improvement in SCI patients. Lumbar (L3–L5) and thoracic (T1–T10) fractures have the best and worst prognosis, respectively, in terms of motor recovery. Laminectomy during surgery improves motor function.</sec>

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Аcute transverse myelitis and Guillain – Barre overlap syndrome in a patient with СOVID-19

Russian neurological Journal ◽

10.30629/2658-7947-2021-26-6-43-51 ◽

2022 ◽

Vol 26 (6) ◽

pp. 43-51

Author(s):

E. A. Ruina ◽

V. N. Grigoryeva ◽

A. A. Lesnikova ◽

K. M. Beliakov

Keyword(s):

Spinal Cord ◽

Transverse Myelitis ◽

Bowel Dysfunction ◽

Intravenous Immunoglobulins ◽

Sensory Loss ◽

Focal Lesion ◽

High Dose ◽

Bladder Bowel Dysfunction ◽

Guillain Barré

We report a case of transverse myelitis and Guillain–Barre syndrome (GBS) overlap in the 42-year-old patient with moderate course of Coronavirus disease 2019 (СOVID-19). Nasopharyngeal SARS-CoV 2 RT-PCR was positive. Severe neck pain developed in this patient on the 5-th day of СOVID-19. A few hours later weakness in the feet arised and then spread to the thighs and arms. Quadriparesis, arefl exia in all limbs, sensory loss below the level of T4 and bladder/bowel dysfunction were present. Pyramidal signs were negative. There was no increase of COVID-19 severity at the time of neurological signs development. Magnetic resonance imaging of the spinal cord showed the focal lesion in the C2-T1 segments, which was consistent with the features of longitudinally extensive transverse myelitis. Along with the myelitis, acute motor axonal polyneuropathy was diagnosed. This diagnosis of GBS was supported by ascending weakness with arefl exia, albumin-cytological dissociation in cerebrospinal fl uid and the data of neuroelectrophysiological examination. We proposed that both myelitis and GBS had disimmune nature associated with COVID-19. The other possible causes of damage to the spinal cord and peripheral nervous system were excluded.Immunotherapy with high dose of intravenous immunoglobulins was administered. Steroids also were used taking into account the myelitis. At the follow up in 4 months the motor functions were found to be improved nonsignifi cantly, the patient was still severe disabled.

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