LOWER CERVICAL FRACTURE AND DISLOCATIONS

Objectives: The aim of our study is to determine the outcome of cervical pediclescrew fixation for fractures/dislocations of the cervical spine at our set up in Karachi, Pakistan.Study Design: A prospective case series. Period: 04 years duration from January 2013 toDecember 2016. Setting: Tertiary Care Centre in Karachi, Pakistan. Method: All the patientswho were included in the study signed a full informed consent. The inclusion criterion was allthe patients who cervical spine fracture/dislocation, presented to us within 24 hours of injuryand were operated at our set up. Data was collected in a predesigned proforma which includeda complete history and physical examination, age, gender, cause of injury, co morbidities, preoperativeradiological findings, past medical and surgical history. Serial X rays, MRI and CTscans were taken at 3, 6, 12 and 24 months post operatively for evaluation of stability, fusion andany complication such as deformity. The American Spinal Cord Injury Association impairmentscale was utilized in all the patients at follow ups to determine the sensory and motor functionimprovement post operatively. Data was analyzed using IBM SPSS for windows version 21.Results: The study population consisted of n= 40 patients of which n= 28 were male andn= 12 were female with a mean age of 45.2 years. The various types of injuries sustained bythe patients were as follows, n= 6 (15%) cases of cases had compression fractures (vertical),n=15 (37.5%) had flexion rotation injury and n=19 (47.5%) had flexion compression fracturesrespectively. While the division of bony injuries in the patient was as follows, n=5 (12.5%) hadcervical spinal burst fracture with dislocation, n= 15 (37.5%) patients had joint facet fracturewith dislocation bilaterally along with compression fracture of the vertebral body, n= 14 (35%)patients had facet joint fracture with dislocation bilaterally and n= 6 (15%) had unilateral fracturedislocation of joint facet. Complications such as injury to the vertebral artery, spinal cord, nerveroot were not observed in any of the patients in this series, all the patients achieved full bonyfusion at the 6 month follow up as observed on radiographic images. We also did not find anyincidence of screw penetration into the pedicle, similarly no incidence of screw breakage orloosening was observed. N=24 patients with incomplete injury of the spinal cord showedimprovements in their ASIA impairment scale, the patients n= 15 who had a complete spinalcord injury failed to show any improvement post operatively, but reported some decrease in painand numbness post operatively. Conclusion: For fractures/dislocations of the cervical spine thecervical pedicle screw is a reliable and effective method and provides good stability and bonyfusion. However the technique is dependent on surgeons experience and the extensive use ofpre-operative imaging to select the best insertion site of the screws as individualized for everypatient accordingly.

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Successful surgical repair and recovery in a 2-week-old infant after birth-related cervical fracture dislocation

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.7.peds17105 ◽

2018 ◽

Vol 21 (1) ◽

pp. 16-20

Author(s):

Sara Saleh ◽

Kyle I. Swanson ◽

Taryn Bragg

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spine ◽

Fracture Dislocation ◽

Interdisciplinary Management ◽

Cervical Fracture ◽

Spine Stabilization ◽

Cord Injury ◽

Spine Injuries

Cervical spine injuries are the most common spine injuries in the pediatric population. The authors present the youngest known patient who underwent cervical spine fusion to repair birth trauma–induced cervical fracture dislocation, resulting in spondyloptosis and spinal cord injury. A 2-week-old boy was found to have spondyloptosis and spinal cord injury after concerns arose from reduced movement of the extremities. The patient’s birth was complicated by undiagnosed abdominal dystocia, which led to cervical distraction injury. At 15 days of age, the boy underwent successful C-5 corpectomy, with anterior C4–6 and posterior C2–7 arthrodesis, using an autologous rib graft for a C-5 fracture dislocation. MRI performed 2 weeks postoperatively revealed significant improvement in the alignment of the spinal canal. The patient was discharged from the hospital in a custom Minerva brace and underwent close follow-up in addition to occupational therapy and physical therapy. At the latest follow-up 4.5 years later, the patient was able to walk and ride a tricycle by himself. The authors describe the patient’s surgery and the challenges faced in achieving successful repair and cervical spine stabilization in such a young patient. The authors suggest that significant neurological recovery after spinal cord injury in infants is possible with appropriate, timely, and interdisciplinary management.

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Risk Factors for Poor Prognosis of Cervical Spinal Cord Injury with Subaxial Cervical Spine Fracture-Dislocation After Surgical Treatment: A CONSORT Study

Medical Science Monitor ◽

10.12659/msm.915700 ◽

2019 ◽

Vol 25 ◽

pp. 1970-1975 ◽

Cited By ~ 1

Author(s):

Bin-Hao Cao ◽

Zhi-Ming Wu ◽

Jian-Wei Liang

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spine ◽

Poor Prognosis ◽

Cervical Spinal Cord ◽

Fracture Dislocation ◽

Cervical Spine Fracture ◽

Subaxial Cervical Spine ◽

Cord Injury

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Atlantoaxial Instability in Individuals with Down’s Syndrome

Adapted Physical Activity Quarterly ◽

10.1123/apaq.1.3.194 ◽

1984 ◽

Vol 1 (3) ◽

pp. 194-196 ◽

Cited By ~ 9

Author(s):

Robert E. Cooke

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spine ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Atlantoaxial Instability ◽

X Rays ◽

Neurological Damage ◽

Cord Injury

Atlantoaxial Instability occurs in approximately 17% of all persons with Down’s syndrome. Such persons are susceptible to serious spinal cord injury if marked flexion of the neck occurs. Every person with Down’s syndrome should have cervical spine x-rays before performing in certain sports even though the frequency of sports-induced neurological damage is low.

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Complex clinical and therapeutic rehabilitation approach of a patient with complete AIS/Frankel A tetraplegia post cervical spinal cord injury after accidental fall off a trailer and multiple complications occurring during disease progression - case study

Balneo Research Journal ◽

10.12680/balneo.2019.302 ◽

2019 ◽

Vol 10 (Vol 10 No. 4) ◽

pp. 564-566

Author(s):

Irina ANGHEL ◽

Alexandra SPORICI ◽

Magdalena LAPADAT ◽

Gelu ONOSE

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Respiratory Distress ◽

Spinal Cord Injuries ◽

Wide Spectrum ◽

Burst Fracture ◽

Fracture Dislocation ◽

Cord Injury

Introduction: Spinal cord injury is a complex neurologic condition that embeds multiple complications, which are often debilitating for patients as the disease progresses. Materials and Methods: This paper presents a case of a 44-year-old patient with a longilin asthenic constitution and no previous medical history, who accidentally fell off a trailer resulting in burst fracture dislocation of C6/C7 associated with immediate loss and consciousness and onset of complete ASIA-A tetraplegia with C5 neurologic level. The patient received a complex nursing program, which included extensive debridement of the necrotic tissue, daily antiseptic wound dressing using Chloramine solution and silver sulfadiazine cream along with wide-spectrum antibiotic therapy with slow but favorable progression. During hospitalization the patient developed an episode of respiratory distress which responded favorably to Levocetirizine daily. Results: The complex neuro-muscular rehabilitation program along with the medical treatment and surgical debridement the patient received have improved of the clinical outcome with the shrinkage of the pressure point lesions, adequate respiratory function which permitted the mobilization of the patient with the wheelchair. Conclusions: Patients with spinal cord injuries are prone to a vast majority of complications including pressure sores complicated with necrotizing fasciitis and respiratory distress that could alter the quality of life. Proper monitoring and management of these kind of complications in the context of neuromuscular rehabilitation are necessary for the enhancement of the quality of life. Key words: spinal cord injury, tetraplegia, complications,

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Burning Hands Syndrome Revisited

Neurosurgery ◽

10.1227/00006123-198612000-00025 ◽

1986 ◽

Vol 19 (6) ◽

pp. 1038-1040 ◽

Cited By ~ 24

Author(s):

James E. Wilberger ◽

Adnan Abla ◽

Joseph C. Maroon

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Cervical Spine ◽

Cervical Spine Injury ◽

Fracture Dislocation ◽

Spine Injury ◽

Cervical Fracture ◽

Resonance Imaging ◽

Cord Injury ◽

Spine Abnormalities

Abstract The burning hands syndrome of spinal cord injury was first described in 1977. The syndrome is characterized by burning dysesthesias and paresthesias in the hands and may be associated with either cervical fracture/dislocation or no detectable cervical spine abnormalities. A case of burning hands syndrome without cervical spine injury is presented in which somatosensory evoked potentials and magnetic resonance imaging were used to delineate the pathophysiology of this syndrome.

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Management of fracture-dislocation of the lower cervical spine with the cervical pedicle screw system

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2010.92.5.406 ◽

2010 ◽

Vol 92 (5) ◽

pp. 406-410 ◽

Cited By ~ 7

Author(s):

Feng Zhou ◽

Jun Zou ◽

Minfeng Gan ◽

Ruofu Zhu ◽

Huilin Yang

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spine ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Fracture Dislocation ◽

Cervical Pedicle Screw ◽

Cord Injury ◽

Cervical Pedicle

INTRODUCTION Usually, cervical pedicle screw fixation has been considered too risky for neurovascular structures. The purpose of this study was to investigate the method and efficacy of the cervical pedicle screw system for fracture-dislocation of the cervical spine because of its rigid fixation. PATIENTS AND METHODS A prospective study was conducted involving 48 patients with cervical spine fracture-dislocation who underwent cervical pedicle screw fixation surgery between January 2003 and January 2007. All patients had various degrees of cord injury, and they were classified according to the American Spinal Cord Injury Association (ASIA) Impairment Scale: 18 cases were grade A, 15 grade B, 10 grade C, and 5 grade D. RESULTS Six months after the operation, all patients had achieved solid bony fusion and stable fixation of the related segments. Thirty patients with incomplete spinal cord injury improved their ASIA Impairment Scale classification by 1 to 2 grades after the operation. Eighteen patients with complete spinal cord injury had no improvement in neural function. However, nerve root symptoms such as pain and numbness were alleviated to some extent. CONCLUSIONS The cervical pedicle screw system is an effective and reliable method for the restoration of cervical stability. Sufficient pre-operative imaging studies of the pedicles and strict screw insertion technique should be emphasised.

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In-hospital mortality in people with complete acute traumatic spinal cord injury at a tertiary care center in India—a retrospective analysis

Spinal Cord ◽

10.1038/s41393-021-00657-x ◽

2021 ◽

Author(s):

Harvinder Singh Chhabra ◽

Rajesh Sharawat ◽

Gayatri Vishwakarma

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Hospital Mortality ◽

Retrospective Analysis ◽

Care Center ◽

Tertiary Care ◽

Traumatic Spinal Cord Injury ◽

Tertiary Care Center ◽

Cord Injury

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Operative Treatment of Severe Cervical Spine Injuries Sustained in Youth Sports: Experience from a Pediatric Level 1 Trauma Center over a 16-Year Period

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00085 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0008

Author(s):

Bram P Verhofste ◽

Daniel J Hedequist ◽

Craig M Birch ◽

Emily S Rademacher ◽

Michael P Glotzbecker ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Trauma Center ◽

Youth Sports ◽

Axial Loading ◽

Permanent Disability ◽

Cervical Spine Injuries ◽

Cord Injury ◽

Spine Injuries ◽

Level 1

Background: Sports-related cervical spine injuries (CSI) are devastating traumas with the potential for permanent disability. There is a paucity of literature on operative CSI sustained in youth athletes. Hypothesis/Purpose: The aims of this study aims were to review injury characteristics, surgical treatment, and outcomes of severe pediatric CSI encountered in youth sports. Methods: We reviewed children less than 18 years old with operative sports-related CSI at a pediatric Level 1 pediatric trauma center between 2004−2019. All cases underwent modern cervical spine instrumentation and fusion. SCI were stratified according to the American Spinal Injury Association Impairment Scale (ASIA). Clinical, radiographic, and surgical characteristics were compared between groups of patients with and without spinal cord injury (SCI). Results: Three thousand two hundred and thirty-one children (mean, 11.3y±4.6y) were evaluated for CSI at our institution during the 16-year period. The majority of traumas resulted from sports/recreational activities and were seen in 1365 cases (42.3%). Of these, 171/1365 patients (12.5%) were admitted and 29/1365 patients (2.1%) required surgical intervention (mean age, 14.5y±2.88y; range, 6.4y–17.8y). Sports included: eight football (28%), seven wrestling (24%), five gymnastics (17%), four diving (14%), two trampoline (7%), one hockey (3%), one snowboarding (3%), and one biking injury (3%). Mechanisms were 19 hyperflexion (65%), eight axial loading (28%), and two hyperextension injuries (7%). The majority of operative CSI were fractures (79%) and/or subaxial defects (72%). Seven patients (30%) sustained SCI and three patients (10%) spinal cord contusion or myelomalacia without neurologic deficits. The risk of SCI increased with age (15.8y vs. 14.4y; p=0.03) and axial loading mechanism (71% vs. 14%; p=0.003). Postoperatively, two SCI patients (29%) improved 1 ASIA Grade and one (14%) improved 2 ASIA Grades. Increased complications developed in SCI than patients without SCI (mean, 2.0 vs 0.1 complications; p=0.02). Clinical and radiographic fusion occurred in 24/26 patients (92%) with adequate follow-up (median, 32 months). Ten patients returned to their previous activity and nine to sports with a lower level of activity. Conclusion: The overall incidence of sports-related operative CSI is low. Age- and gender discrepancies exist, with male adolescent athletes most commonly requiring surgery. Hyperflexion injuries had a good prognosis; however, older males with axial loading CSI sustained in contact sports were at greatest risk of SCI, complications, and permanent disability. [Figure: see text][Table: see text][Table: see text]

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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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