scholarly journals Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation

2018 ◽  
Vol 1 (1) ◽  
pp. 158-164 ◽  
Author(s):  
Dionne Telemacque ◽  
Fengzhao Zhu ◽  
Kaifang Chen ◽  
Lin Chen ◽  
Zhengwei Ren ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Control Group ◽  
Cord Injury ◽  
Prevention And Treatment ◽  
The Mean ◽  
Spinal Cord Decompression ◽  
Experimental Group

Introduction:We developed the method of cervical spinal cord decompression through durotomy followed by duroplasty and analyzed its efficacy.Purpose:To develop a tactic of decompression durotomy and duroplasty for the treatment of severe spinal cord injury(SCI) with extensive edema of the spinal cord and without intramedullary hematoma, and to demonstrate the effectiveness of this method.Methods:From October 2016 to January 2018, 17 decompression operations were performed in the cervical spine in patients with SCI. Decompression laminectomy was done without durotomy in the first group of patients. In the second group, duroplasty of the spinal cord was performed after decompression durotomy. A total of 17 patients, 16 males (94%) and 1 female (6%), were operated on (ages from 32 to 66 years). The patients were divided into two groups: a control group and an experimental group. We used the ASIA scale for assessing the patients. The mean follow up time is 12 months (8−24 months).Results:The first group, i.e., the control group consisted of 10 patients who underwent decompression laminectomy without durotomy. The second group, i.e., the experimental group consisted of 7 patients who underwent durotomy followed by duroplasty. In this group, the positive dynamics were observed in 6 patients. Out of 2 patients with ASIA grade “A”, one showed improvement to ASIA grade “C”, and one improved to ASIA “D”. Two patients with ASIA grade “B” showed recovery to ASIA “D”. Two patients with ASIA grade “C” improved to grade “D” while one patient showed no change from ASIA “C”. Durotomy and duroplasty was effective in the experimental group.Conclusion:The performance of durotomy and duroplasty is an efficient method for the full-scale decompression of the spinal cord and the prevention of edema. This method aims at decreasing intraspinal pressure, as well as preventing ischemia and apoptosis, which is possible for the prevention and treatment of the spinal cord compartment syndrome or spinal cord intramedullary hypertension.

scholarly journals Clinical Outcomes Using Modest Intravascular Hypothermia After Acute Cervical Spinal Cord Injury

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. 670-677 ◽  
Author(s):  
Allan D. Levi ◽  
Gizelda Casella ◽  
Barth A. Green ◽  
W. Dalton Dietrich ◽  
Steven Vanni ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Outcomes ◽  
Cervical Spinal Cord ◽  
Phase 1 ◽  
Medical Society ◽  
Control Group ◽  
Complication Rates ◽  
Cord Injury

Abstract BACKGROUND Although a number of neuroprotective strategies have been tested after spinal cord injury (SCI), no treatments have been established as a standard of care. OBJECTIVE We report the clinical outcomes at 1-year median follow-up, using endovascular hypothermia after SCI and a detailed analysis of the complications. METHODS We performed a retrospective analysis of American Spinal Injury Association and International Medical Society of Paraplegia Impairment Scale (AIS) scores and complications in 14 patients with SCI presenting with a complete cervical SCI (AIS A). All patients were treated with 48 hours of modest (33°C) intravascular hypothermia. The comparison group was composed of 14 age- and injury-matched subjects treated at the same institution. RESULTS Six of the 14 cooled patients (42.8%) were incomplete at final follow-up (50.2 [9.7] weeks). Three patients improved to AIS B, 2 patients improved to AIS C, and 1 patient improved to AIS D. Complications were predominantly respiratory and infectious in nature. However, in the control group, a similar number of complications was observed. Adverse events such as coagulopathy, deep venous thrombosis, and pulmonary embolism were not seen in the patients undergoing hypothermia. CONCLUSION This study is the first phase 1 clinical trial on the safety and outcome with the use of endovascular hypothermia in the treatment of acute cervical SCI. In this small cohort of patients with SCI, complication rates were similar to those of normothermic patients with an associated AIS A conversion rate of 42.8%.

scholarly journals An observation of the clinical efficacy of combining Riluzole with mannitol and hyperbaric oxygen in treating acute spinal cord injury

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Huan-xia Li ◽  
Jing Cui ◽  
Jing-shi Fan ◽  
Jian-zhou Tong
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Hyperbaric Oxygen ◽  
Clinical Efficacy ◽  
Acute Spinal Cord Injury ◽  
Sensory Function ◽  
Control Group ◽  
Thoracolumbar Fractures ◽  
Cord Injury ◽  
Experimental Group

Objective: To examine the clinical efficacy of combining Riluzole with mannitol and hyperbaric oxygen therapy in treating thoracolumbar vertebral fracture-induced acute spinal cord injury (ASCI). Methods: From June 2015 to May 2018, 80 patients with thoracolumbar fractures and ASCI who were treated at Baoding First Central Hospital were selected. All patients underwent posterior laminectomy and screw fixation, and they were randomly divided into two groups using a random number table method. The control group received conventional postoperative treatment, while the experimental group was treated with riluzole combined with mannitol and hyperbaric oxygen on the basis of conventional treatment. The recovery of nerve function which included motor function and sensory function, and the changes of serum IL-6, CRP, BDNF, BFGF and other factors before treatment and four weeks after treatment of the two groups of patients were observed and evaluated. Results: After treatment, the motor function scores and sensory function scores of the two groups of patients were improved compared with those before treatment (p<0.05). Compared with the control group, the experimental group improved significantly, and the difference was statistically significant (p<0.05). The levels of IL-6, BDNF and NFGF in the experimental group were significantly lower than those in the control group (p<0.05). Conclusions: For patients with thoracolumbar fractures and ASCI undergoing laminar decompression and fixation, the comprehensive treatment plan of riluzole combined with mannitol and hyperbaric oxygen has certain advantages. Compared with the conventional therapy, it may significantly improve the movement and sensory functions of patients, relieve the inflammatory response of spinal cord, and promote recovery from the injury. doi: https://doi.org/10.12669/pjms.37.2.3418 How to cite this:Li H, Cui J, Fan J, Tong J. An observation of the clinical efficacy of combining Riluzole with mannitol and hyperbaric oxygen in treating acute spinal cord injury. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3418 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals A demographic profile of cervical injury: an Indonesian single tertiary hospital study with 6 months to 1-year follow-up

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Lukas Widhiyanto ◽  
Aliefio Japamadisaw ◽  
Kukuh Dwiputra Hernugrahanto
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Traffic Accidents ◽  
Tertiary Hospital ◽  
First Year ◽  
Cervical Injury ◽  
Significant Difference ◽  
Cord Injury ◽  
The Mean

Abstract Background Spinal cord injury (SCI) can cause considerable morbidity and mortality. Until now there is no spinal cord injury profile in Indonesia. Therefore, this study aims to provide an overview of the spinal cord injury profile as well as to analyze the functional outcome at the sixth month and the first year. Results Most spinal cord injury cases were traumatic SCI (67.5%). Meanwhile, non-traumatic SCI was 32.5%. The mean age of patients who had traumatic SCI was 41.9 ± 17.4 years while non-traumatic SCI patients was 48.4 ± 13.7 with a significant difference (p < 0.05). Most cases occurred in men rather than women with significant differences based on the type of injury (p < 0.05). Traffic accidents were the most common cause of cervical injuries (47.1%). Surgery was the most common treatment modality in cervical injury cases (60.4%) with the posterior approach being the preferred approach in most operative measures (72.4%). Respiratory failure was the leading cause of death (48.9%). The mean LOS of patients with traumatic SCI was 28.8 ± 14.3 days while the mean LOS of non-traumatic SCI patients was 44.7 ± 28.7 with a significant difference (p < 0.05). There was significance difference between the initial outcome and after the sixth month to first year follow-up (p < 0.05). Conclusions This study demonstrated the epidemiology and characteristics of spinal cord injury which mostly had a good neurological outcome.

scholarly journals Model of spinal cord lateral hemi-excision at the lower thoracic level for the tasks of reconstructive and experimental neurosurgery

2021 ◽  
Vol 27 (3) ◽  
pp. 33-53
Author(s):  
Volodymyr V. Medvediev ◽  
Ibrahim M. Abdallah ◽  
Natalya G. Draguntsova ◽  
Sergiy I. Savosko ◽  
Viktoria V. Vaslovych ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Rank Order ◽  
Male Rats ◽  
Matched Pairs ◽  
Young Rats ◽  
Cord Injury ◽  
The Mean ◽  
Ashworth Scale

Purpose. To test the model of spinal cord lateral hemiexcision in young rats. Materials and methods. Animals ‒ male rats (age about 1 month, body weight about 50 g, inbred derivatives of the Wistar line); the number of experimental groups is: 1) lateral spinal cord hemisection at the level of segments about T12–T13 (Sect; n=11); 2) lateral spinal cord hemiexcision about 1 mm long at the similar level (Exc; n=8). Assessment of motor Function Index (FI) and the Spasticity Index (SI) of the paretic hindlimb was carried out using the Basso–Beattie–Bresnahan (BBB) scale and Ashworth scale, respectively, in our technical modifications. The non-inclusion criteria: the BBB score above 9 points of FI for the ipsilateral hindlimb in a week after injury ‒and / or BBB score less than or equal to 14 points of FI of the contralateral hindlimb during a long follow-up period (in general, 2 animals in the Sect group, 3 animals ‒ in the Exc group). Asymptotic differences in the timing of testing between subgroups and groups were revealed during the first three weeks of follow-up. Interpolation reproduction of individual values of FI and SI was used in exceptional cases. The total follow-up period was 5 months. Statistical analysis was performed using the Mann-Whitney U Test, Wilcoxon Matched Pairs Test, Spearman’s Rank Order Correlation. For pathomorphological study, the method of silver impregnation of the spinal cord longitudinal sections of the Exc group animals obtained in 5 months after the simulation of injury was used. Results. One week after injury, the FI in the Sect group was 5.9±1.1 according to BBB points, a statistically significant increase in the FI lasted for the first 3 weeks (p<0.05; Wilcoxon Matched Pairs Test), the FI maximum in the group was 10.1±1.1 BBB points, and the FI value at the end of the study was 9.5±1.0 BBB points. In the Exc group, 1 week after injury, the FI was 0.9±0.5 BBB points, during the next week it reached the actual maximum (1.9±0.7 BBB points), by the end of the 5th month it significantly decreased to 0.8±0.3 BBB points (p<0.05; Wilcoxon Matched Pairs Test). One week after injury, the SI value in the Sect group was 0.3±0.1 points according to Ashworth scale, in the Exc group ‒ 0.7±0.1 Ashworth points, a significant increase (p<0.05; Wilcoxon Matched Pairs Test) in SI in the Sect group was noted during the 2nd week and the 2nd month, in the Exc group ‒ during the 2nd and 6th week, as well as the 3rd and 5th month after injury. The SI final and maximal score for the Sect group was 0.8±0.2 Ashworth points, and for the Exc group ‒ 3.6±0.3 Ashworth points. For both groups, there was no correlation between the mean FI value and a significant positive correlation of the mean SI value with the value of the follow-up period (p<0.05; Spearman’s Rank Order Correlation), as well as the absence of correlation between the mean FI and SI values during the total follow-up period. A significant negative correlation (p<0.05; Spearman’s Rank Order Correlation) between individual FI and SI values was found after 1 and 4 weeks, 3 and 5 months after the injury for the Sect group, as well as after 5, 7, 8 weeks and after 3 and 4 months for the Exc group. At all periods of follow-up, the difference in both FI and SI mean values of both groups was significant (p<0.05; the Mann-Whitney U Test). Conclusions. The studied model of spinal cord injury in young rats is the means of choice for testing solid neural transplantation means for the spinal cord injury restorative treatment. The interpretation of data obtained using the BBB scale on models of lateral half spinal cord injury should be carried out with caution, and the methodology for verifying spasticity requires significant improvement. We recommend that the optimal timing for the FI and SI monitoring after lateral half spinal cord injury is 7 days, 14 days and in 1, 2, 3, 4, 5, 6, and 7 months.

scholarly journals Correlation of Oxidative and Antioxidative Processes in the Blood of Patients with Cervical Spinal Cord Injury

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Bartosz Woźniak ◽  
Alina Woźniak ◽  
Celestyna Mila-Kierzenkowska ◽  
Heliodor Adam Kasprzak
Keyword(s):  
Oxidative Stress ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Thiobarbituric Acid ◽  
Cervical Spinal Cord Injury ◽  
Decompression Surgery ◽  
Cord Injury ◽  
Spinal Cord Decompression ◽  
Mean Time

The effect of cervical spinal cord injury (CSCI) on oxidative stress parameters was assessed. The study was conducted in 42 patients with CSCI (studied group), 15 patients with cerebral concussion, without CSCI (Control II), and 30 healthy volunteers (Control I). Blood was taken from the basilic vein: before and seven days after the spinal cord decompression surgery (mean time from CSCI to surgery: 8 hours) in the studied group and once in the controls. Thiobarbituric acid reactive substances (TBARS) and conjugated dienes (CD) concentrations, and glutathione peroxidase (GPx), catalase (CAT), and creatine kinase (CK) activities before the surgery were higher in the studied group than in the controls. Reduced glutathione concentration was similar in all groups. Superoxide dismutase (SOD) in the studied group was 16% lower (P≤0.001) than in Control I. Lipid peroxidation products, and GPx and CAT activities in erythrocytes seven days after the surgery were lower (P≤0.001), while SOD was 25% higher (P≤0.001) than before the surgery. CK in blood plasma after the surgery was 34% lower (P≤0.001) than before it. CSCI is accompanied by oxidative stress. Surgical and pharmacological treatment helps to restore the oxidant-antioxidant balance.

scholarly journals Serial plasma DNA levels as predictors of outcome in patients with acute traumatic cervical spinal cord injury

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Hung-Chen Wang ◽  
Yu-Tsai Lin ◽  
Shih-Yuan Hsu ◽  
Nai-Wen Tsai ◽  
Yun-Ru Lai ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Japanese Orthopaedic Association ◽  
Cervical Spinal Cord Injury ◽  
Acute Injury ◽  
Control Group ◽  
Plasma Dna ◽  
Post Injury ◽  
Cord Injury

Abstract Background Acute traumatic cervical spinal cord injury (SCI) is a leading cause of disability in adolescents and young adults worldwide. Evidence from previous studies suggests that circulating cell-free DNA is associated with severity following acute injury. The present study determined whether plasma DNA levels in acute cervical SCI are predictive of outcome. Methods In present study, serial plasma nuclear DNA (nDNA) and mitochondrial DNA (mtDNA) levels were obtained from 44 patients with acute traumatic cervical SCI at five time points from day 1 to day 180 post-injury. Control blood samples were obtained from 66 volunteers. Results Data showed a significant increase in plasma nDNA and mtDNA concentrations at admission in SCI patients compared to the control group. Plasma nDNA levels at admission, but not plasma mtDNA levels, were significantly associated with the Japanese Orthopaedic Association (JOA) score and Injury Severity Score in patients with acute traumatic cervical SCI. In patients with non-excellent outcomes, plasma nDNA increased significantly at days 1, 14 and 30 post-injury. Furthermore, its level at day 14 was independently associated with outcome. Higher plasma nDNA levels at the chosen cutoff point (> 45.6 ng/ml) predicted poorer outcome with a sensitivity of 78.9% and a specificity of 78.4%. Conclusions These results indicate JOA score performance and plasma nDNA levels reflect the severity of spinal cord injury. Therefore, the plasma nDNA assays can be considered as potential neuropathological markers in patients with acute traumatic cervical SCI.

scholarly journals Sequential neurological improvements after conservative treatment in patients with complete motor paralysis caused by cervical spinal cord injury without bone and disc injury

2018 ◽  
Vol 29 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Eiji Mori ◽  
Takayoshi Ueta ◽  
Takeshi Maeda ◽  
Ryousuke Ideta ◽  
Itaru Yugué ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Conservative Treatment ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Neurological Improvement ◽  
Motor Paralysis ◽  
Cord Injury ◽  
Disc Injury

OBJECTIVEThis study investigated neurological improvements after conservative treatment in patients with complete motor paralysis caused by acute cervical spinal cord injury (SCI) without bone and disc injury.METHODSThis study was retrospective. The authors evaluated neurological outcomes after conservative treatment of 62 patients with complete motor paralysis caused by cervical SCI without bone and disc injury within 72 hours after trauma. The sequential changes in their American Spinal Injury Association Impairment Scale (AIS) grades were reviewed at follow-up 24–72 hours, 1 week, and 1, 3, and 6 months after treatment.RESULTSOf the 31 patients with a baseline AIS grade of A, 2 (6.5%) patients improved to grade B, 5 (16.1%) improved to grade C, and 2 (6.5%) improved to grade D by the 6-month follow-up. The 22 (71.0%) patients who remained at AIS grade A 1 month after injury showed no neurological improvement at the 6-month follow-up. Of the 31 patients with a baseline AIS grade of B, 12 (38.7%) patients showed at least a 1-grade improvement at the 1-month follow-up; 11 (35.5%) patients improved to grade C and 16 (51.6%) patients improved to grade D at the 6-month follow-up.CONCLUSIONSEven in patients with complete motor paralysis caused by cervical SCI without bone and disc injury within 72 hours after trauma, approximately 30% of the patients with an AIS grade of A and 85% of the patients with an AIS grade B improved neurologically after conservative treatment. It is very important to recognize the extent of neurological improvement possible with conservative treatment, even for severe complete motor paralysis.

scholarly journals Cervical Spine AIS 6 – untreatable but survivable

2020 ◽  
Author(s):  
Oliver Kamp ◽  
O. Jansen ◽  
R. Lefering ◽  
M. Aach ◽  
C. Waydhas ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mortality Rate ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Control Group ◽  
Multi Centre Study ◽  
Actual Mortality ◽  
Cord Injury ◽  
Trauma Scores

Abstract Background Trauma is a significant cause of death and impairment. The Abbreviated Injury Scale (AIS) differentiates the severity of trauma and is the basis for different trauma scores and prediction models. An AIS of 6 is described as currently untreatable or unsurvivable. While the majority of patients do not survive such injuries, there are several patients with a cervical spinal cord injury and an AIS of 6 that could be discharged from hospital despite the prognosis of trauma scores. For this reason, we evaluated these findings in a larger control group. Methods In a retrospective, multi-centre study, we used the data recorded in the TraumaRegister DGU® (TR-DGU) to select patients with a severe cervical spinal cord injury and an AIS of 3 to 6 between 2002 to 2015. We compared the estimated mortality rate according to the Revised Injury Severity Classification II (RISC II) score against the actual mortality rate for this group. Results Six hundred and twelve patients (0.6%) sustained a severe cervical spinal cord injury with an AIS of 6. The mean age was 57.8 ± 21.8 years and 441 (72.3%) were male. 580 (98.6%) suffered a blunt trauma, 301 patients were injured in a car accident and 29 through attempted suicide. Out of the 612 patients, 391 (63.9%) died from their injury and 170 during the first 24 hours. The group had a predicted mortality rate of 81.4%, but we observed an actual mortality rate of 63.9%. Conclusions An AIS of 6 with a complete cord syndrome above C3 as documented in the TR-DGU is survivable if patients get to the hospital alive, at which point they show a survival rate of more than 35%. Compared to the mortality predictive model of the RISC II score, they survived much more often than expected.

scholarly journals The Risk of Acute Spinal Cord Injury After Minor Trauma in Patients With Preexisting Cervical Stenosis

Neurosurgery ◽  
2015 ◽  
Vol 77 (4) ◽  
pp. 561-565 ◽  
Author(s):  
Victor Chang ◽  
Benjamin M. Ellingson ◽  
Noriko Salamon ◽  
Langston T. Holly
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Vehicle ◽  
Traumatic Event ◽  
Minor Trauma ◽  
Cervical Stenosis ◽  
Canal Diameter ◽  
Cord Injury ◽  
The Mean

Abstract BACKGROUND: Cervical stenosis patients are commonly advised to undergo surgery due to the risk of spinal cord injury (SCI) after a traumatic event. However, the actual risk of SCI in this scenario is unknown. OBJECTIVE: To evaluate the risk of SCI after minor trauma in a cohort of prospectively followed cervical stenosis patients. METHODS: Clinical and radiographical analysis was performed in 55 nonoperatively treated patients evaluated between 2009 and 2014. Each patient was asked standardized questions including: 1) whether a previous physician recommended neck surgery, 2) whether a physician indicated that they would become paralyzed after a traumatic event, and 3) whether they experienced a traumatic event during the follow-up period. RESULTS: The mean age was 65, with a mean modified Japanese Orthopedic Association score of 16.6. The mean canal diameter was 6.1 mm. Nineteen patients (35%) had evidence of intramedullary T2 signal abnormality. Thirty-one patients (56%) were previously recommended for surgery. Twenty-six patients (47%) were told that they would be paralyzed after a motor vehicle accident or fall unless surgery was performed. Ten patients (18%) experienced a traumatic event during the follow-up, with none sustaining an SCI. CONCLUSION: Asymptomatic and mildly symptomatic cervical stenosis patients are commonly recommended to undergo surgery due to risk of paralysis after a traumatic event. SCI was not observed after minor trauma in our cohort of prospectively followed patients. It seems that occurrence of SCI in this patient population after minor trauma is likely smaller than many physicians surmise, yet will require future prospective study in a large cohort of patients.

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