scholarly journals Magnetic resonance imaging in lumbar gunshot wounds: an absolute contraindication?

2014 ◽  
Vol 37 (1) ◽  
pp. E13 ◽  
Author(s):  
Eduardo Martinez-del-Campo ◽  
Leonardo Rangel-Castilla ◽  
Hector Soriano-Baron ◽  
Nicholas Theodore
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Spinal Canal ◽  
English Language ◽  
Spinal Cord Injuries ◽  
Gunshot Wounds ◽  
Neurological Deficits ◽  
Neurological Improvement ◽  
Cord Injury

Object Performance of MR imaging in patients with gunshot wounds at or near the lumbar spinal canal is controversial. The authors reviewed the literature on the use of MR imaging in gunshot wounds to the spine. They discuss the results from in vitro and clinical studies, analyze the physical properties of common projectiles, and evaluate the safety and indications for MR imaging when metallic fragments are located near the spinal canal. Methods A review of the English-language literature was performed. Data from 25 articles were analyzed, including 5 in vitro studies of the interaction between 95 projectiles and the MR system's magnetic fields, and the clinical outcomes in 22 patients with metallic fragments at or near the spinal canal who underwent MR imaging. Results Properties of 95 civilian and military projectiles were analyzed at a magnet strength of 1, 1.5, 3, and 7 T. The most common projectiles were bullets with a core of lead, either with a copper jacket or unjacketed (73 [76.8%] of 95). Steel-containing (core or jacket) projectiles comprised 14.7%. No field interaction was evident in 78 (96.3%) of the 81 nonsteel projectiles. All steel projectiles showed at least positive deflection forces, longitudinal migration, or rotation. Heating of the projectiles was clinically insignificant. Image artifact was significant in all 9 steel bullets tested, but was not significant in 39 (88.6%) of the 44 nonsteel bullets tested. Overall, 22 patients with complete (82%) and incomplete (14%) spinal cord injury secondary to a projectile lodged inside the spinal canal underwent MR imaging. Discomfort and further physical or neurological deficits were not reported by any patient. Two patients with spinal cord injuries underwent MR imaging studies before surgical decompression and had subsequent, significant neurological improvement. Conclusions Metallic implants near or at the spinal canal are a relative contraindication for MR imaging. However, safe MR imaging might be feasible when a projectile's properties and a patient's individualized clinical presentation are considered.

Evaluation of in situ gelling chitosan-PEG copolymer for use in the spinal cord

2018 ◽  
Vol 33 (3) ◽  
pp. 435-446 ◽  
Author(s):  
Ashley E Mohrman ◽  
Mahmoud Farrag ◽  
Rachel K Grimm ◽  
Nic D Leipzig
Keyword(s):  
Spinal Cord ◽  
Polyethylene Glycol ◽  
Spinal Cord Injuries ◽  
Similar Response ◽  
Cellular Delivery ◽  
Thiolated Chitosan ◽  
Cord Injury ◽  
In Situ Gelling

The goal of the present work was to characterize a hydrogel material for localized spinal cord delivery. To address spinal cord injuries, an injectable in situ gelling system was tested utilizing a simple, effective, and rapid cross-linking method via Michael addition. Thiolated chitosan material and maleimide-terminated polyethylene glycol material were mixed to form a hydrogel and evaluated in vitro and in vivo. Three distinct thiolated chitosan precursors were made by varying reaction conditions; a modification of chitosan with Traut’s reagent (2-iminothiolane) displayed the most attractive hydrogel properties once mixed with polyethylene glycol. The final hydrogel chosen for animal testing had a swelling ratio (Q) of 57.5 ± 3.4 and elastic modulus of 378 ± 72 Pa. After confirming low cellular toxicity in vitro, the hydrogel was injected into the spinal cord of rats for 1 and 2 weeks to assess host reaction. The rats displayed no overt functional deficits due to injection following initial surgical recovery and throughout the 2-week period after for both the saline-injected sham group and hydrogel-injected group. The saline and hydrogel-injected animals both showed a similar response from ED1+ microglia and GFAP overexpression. No significant differences were found between saline-injected and hydrogel-injected groups for any of the measures studied, but there was a trend toward decreased affected area size from 1 to 2 weeks in both groups. Access to the central nervous system is limited by the blood–brain barrier for noninvasive therapies; further development of the current system for localized drug or cellular delivery has the potential to shape treatments of spinal cord injury.

scholarly journals Treatment of posttraumatic syringomyelia: evidence from a systematic review

2020 ◽  
Vol 162 (10) ◽  
pp. 2541-2556
Author(s):  
Andrea Kleindienst ◽  
Francisco Marin Laut ◽  
Verena Roeckelein ◽  
Michael Buchfelder ◽  
Frank Dodoo-Schittko
Keyword(s):  
Spinal Cord ◽  
English Language ◽  
Spinal Cord Injuries ◽  
Case Reports ◽  
Treatment Options ◽  
Sensory Function ◽  
Time Interval ◽  
Eligibility Criteria ◽  
Cord Injury ◽  
Posttraumatic Syringomyelia

Abstract Background Following spinal cord injury (SCI), the routine use of magnetic resonance imaging (MRI) resulted in an incremental diagnosis of posttraumatic syringomyelia (PTS). However, facing four decades of preferred surgical treatment of PTS, no clear consensus on the recommended treatment exists. We review the literature on PTS regarding therapeutic strategies, outcomes, and complications. Methods We performed a systematic bibliographic search on (“spinal cord injuries” [Mesh] AND “syringomyelia” [Mesh]). English language literature published between 1980 and 2020 was gathered, and case reports and articles examining syrinx due to other causes were excluded. The type of study, interval injury to symptoms, severity and level of injury, therapeutic procedure, duration of follow-up, complications, and outcome were recorded. Results Forty-three observational studies including 1803 individuals met the eligibility criteria. The time interval from SCI to the diagnosis of PTS varied between 42 and 264 months. Eighty-nine percent of patients were treated surgically (n = 1605) with a complication rate of 26%. Symptoms improved in 43% of patients postoperatively and in 2% treated conservatively. Stable disease was documented in 50% of patients postoperatively and in 88% treated conservatively. The percentage of deterioration was similar (surgery 16%, 0.8% dead; conservative 10%). Detailed analysis of surgical outcome with regard to symptoms revealed that pain, motor, and sensory function could be improved in 43 to 55% of patients while motor function deteriorated in around 25%. The preferred methods of surgery were arachnoid lysis (48%) and syrinx drainage (31%). Conclusion Even diagnosing PTS early in its evolution with MRI, to date, no satisfactory standard treatment exists, and the present literature review shows similar outcomes, regardless of the treatment modality. Therefore, PTS remains a neurosurgical challenge. Additional research is required using appropriate study designs for improving treatment options.

Evaluation of clinical experience using cell-based therapies in patients with spinal cord injury: a systematic review

2012 ◽  
Vol 17 (Suppl1) ◽  
pp. 230-246 ◽  
Author(s):  
James S. Harrop ◽  
Robin Hashimoto ◽  
Dan Norvell ◽  
Annie Raich ◽  
Bizhan Aarabi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
English Language ◽  
Spinal Cord Injuries ◽  
Case Reports ◽  
A Priori ◽  
Level Of Evidence ◽  
Hematopoietic Stem ◽  
Cellular Therapies ◽  
Cord Injury ◽  
Current Utilization

Object Using a systematic approach, the authors evaluated the current utilization, safety, and effectiveness of cellular therapies for traumatic spinal cord injuries (SCIs) in humans. Methods A systematic search and critical review of the literature published through mid-January 2012 was performed. Articles included in the search were restricted to the English language, studies with at least 10 patients, and those analyzing cellular therapies for traumatic SCI. Citations were evaluated for relevance using a priori criteria, and those that met the inclusion criteria were critically reviewed. Each article was then designated a level of evidence that was developed by the Oxford Centre for Evidence-Based Medicine. Results The initial literature search identified 651 relevant articles, which decreased to 350 after excluding case reports and reviews. Evaluation of articles at the title/abstract level, and later at the full-text level, limited the final article set to 12 papers. The following cellular therapies employed in humans with SCI are reviewed: bone marrow mesenchymal and hematopoietic stem cells (8 studies), olfactory ensheathing cells (2 studies), Schwann cells (1 study), and fetal neurogenic tissue (1 study). Overall the quality of the literature was very low, with 3 Grade III levels of evidence and 9 Grade IV studies. Conclusions Several different cellular-mediated strategies for adult SCI have been reported to be relatively safe with varying degrees of neurological recovery. However, the literature is of low quality and there is a need for improved preclinical studies and prospective, controlled clinical trials.

Neurological Improvement Associated with Late Decompression of the Thoracolumbar Spinal Cord

Neurosurgery ◽  
1984 ◽  
Vol 14 (3) ◽  
pp. 302-307
Author(s):  
J. Maiman Dennis ◽  
J. Larson Sanford ◽  
C. Benzel Edward
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Canal ◽  
Spinal Instrumentation ◽  
Spinal Fixation ◽  
Neurological Improvement ◽  
Fixation Devices ◽  
Cord Injury ◽  
Spinal Fixation Devices ◽  
Premature Removal

Abstract We reviewed the cases of 20 patients admitted to our institution with thoracolumbar spinal cord injury who had previously undergone laminectomy and/or spinal instrumentation. Thirteen patients had a mass in the spinal canal, and 7 had kyphotic deformities. The lateral extracavitary approach to the spine and posterior stabilization when indicated were done in each. Seventeen patients obtained substantial neurological improvement. All 7 patients with kyphosis regained the ability to walk, as did all but 3 of the nonambulatory patients with a mass in the spinal canal. Morbidity was limited to pneumothorax and 1 case of late kyphosis associated with premature removal of the spinal fixation devices. Elective anterior approaches for reconstruction of the spinal canal with appropriate stabilization afford the best opportunity for neurological improvement in cases of thoracolumbar spinal cord injury.

Cervical Spine Trauma Management

2018 ◽  
Vol 1 (2) ◽  
pp. 14
Author(s):  
Rully Hanafi Dahlan ◽  
Sevline Estethia Ompusunggu ◽  
Farid Yudoyono
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Early Mobilization ◽  
Cord Compression ◽  
Spinal Injuries ◽  
Spine Injury ◽  
Spine Trauma ◽  
Neurological Improvement ◽  
Operative Care ◽  
Cord Injury

The incidence of spine injury following accidents are still very high in developing countries. Many problems occur after the accident including primary intervention on the scene, transportation to the public primary hospital, the referral system, and finally, the management at the central hospital.Cervical spinal cord injuries represent 20-33% of total spinal injuries with the prevalence of the subaxial levels. In patients with a preoperative neurological deficit due to spine trauma, in case of spinal cord compression or instability, surgery is often the treatment of choice to grant a chance of neurological recovery, early mobilization, and faster return to usual daily activities compared to the conservative treatment. In the past, many authors suggested a delayed surgical treatment to reduce postoperative complications rate, but recent studies have shown that an early decompression (<72 h) may facilitate a postoperative neurological improvement probably due to the prevention of the secondary mechanisms of damage in acute SCI.In the context of the advanced management of spinal injuries, the main points of the focused assessment, the important waypoints of a full classification of the skeletal and spinal cord injury, the principles of early prioritization and decision making, the outline of the surgical strategy including indications, timing, approaches, technique and post-operative care, and the outline principles of rehabilitation. The authors in this paper try to summarize and create a guideline of management, based on experience in a regional centre.

Spinal cord concussion

1990 ◽  
Vol 72 (6) ◽  
pp. 894-900 ◽  
Author(s):  
Thomas J. Zwimpfer ◽  
Mark Bernstein
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Content Type ◽  
Young Males ◽  
Cord Injury ◽  
Sensory Disturbances ◽  
Fine Print

✓ The hallmark of concussion injuries of the nervous system is the rapid and complete resolution of neurological deficits. Cerebral concussion has been well studied, both clinically and experimentally. In comparison, spinal cord concussion (SCC) is poorly understood. The clinical and radiological features of 19 SCC injuries in the general population are presented. Spinal cord injuries were classified as concussions if they met three criteria: 1) spinal trauma immediately preceded the onset of neurological deficits; 2) neurological deficits were consistent with spinal cord involvement at the level of injury; and 3) complete neurological recovery occurred within 72 hours after injury. Most cases involved young males, injured during athletics or due to falls. Concussion occurred at the two most unstable spinal regions, 16 involving the cervical spinal and three the thoracolumbar junction. Fifteen cases presented with combined sensorimotor deficits, while four exhibited only sensory disturbances. Many patients showed signs of recovery with the first few hours after injury and most had completely recovered within 24 hours. Only one case involved an unstable spinal injury. There was no evidence of ligamentous instability, spinal stenosis, or canal encroachment in the remaining 18 cases. Two patients, both children, suffered recurrent SCC injuries. No delayed deterioration or permanent cord injuries occurred. Spinal abnormalities that would predispose the spinal cord to a compressive injury were present in only one of the 19 cases. This suggests that, as opposed to direct cord compression, SCC may be the result of an indirect cord injury. Possible mechanisms are discussed.

Pulmonary Complications of Acute Spinal Cord Injuries

Neurosurgery ◽  
1987 ◽  
Vol 21 (2) ◽  
pp. 193-196 ◽  
Author(s):  
David H. Reines ◽  
Robert C. Harris
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Spinal Cord Injuries ◽  
Pulmonary Complications ◽  
Neurological Deficits ◽  
Respiratory Problems ◽  
Cord Injury ◽  
The Mean

Abstract The records of 123 consecutive patients admitted with spinal cord injury were examined for the presence of pulmonary complications. Forty-nine had tetraplegia and 23 had paraplegia; the remainder suffered a variety of neurological deficits. Multiple injuries were encountered in 36 patients. Fifty-three pulmonary complications were noted in 44 (35.7%) patients. The most common problems were atelectasis and pneumonia. There were 22 (18%) deaths. Fourteen deaths were related to pulmonary complications. The mean age of patients who died was 52 ± 13 (SE) compared to 28 ± 12 for survivors. A mean forced vital capacity (FVC) of 1127 ± 410 cc in patients suffering respiratory difficulties compared to a FVC of 1865 ± 85 cc in patients without complications (P &lt; 0.001). Oxygenation (PaO2 90 ± 19 torr) was normal in patients without respiratory problems and was abnormal in patients developing problems (PaO2 76 ± 30 torr; P &lt; 0.05). Twenty patients were treated with a rotating bed. The complication rate of patients on the bed was only 10%. In conclusion, respiratory problems remain a significant cause of morbidity and mortality in spinal cord injury. The forced vital capacity, blood oxygen tension, and age are predictors of pulmonary complications. The use of a multidisciplinary approach and a rotating bed may minimize these problems.

scholarly journals Rat Spinal Cord Injury Experimental Model

2016 ◽  
Vol 60 (2) ◽  
pp. 41-46 ◽  
Author(s):  
I. Šulla ◽  
V. Balik ◽  
J. Petrovičová ◽  
V. Almášiová ◽  
K. Holovská ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Basic Research ◽  
Experimental Models ◽  
Neurological Deficits ◽  
Survival Times ◽  
Cord Injury ◽  
Female Wistar Rats ◽  
Trauma Model

Abstract Spinal cord injuries (SCI) with their tragic consequences belong to the most serious pathological conditions. That is why they have stimulated basic research workers, as well as health care practitioners, to search for an effective treatment for decades. Animal experimental models have been essential in these efforts. We have jointly decided to test and standardize one of the spinal cord injury compression models in rats. Twentythree adult female Wistar rats weighing 250-320 g were utilized. Employing general anaesthesia along with a mixture of sevoflurane with O2, 2 rats (sham controls) had their vertebral arch of either Th8 or Th9 vertebra removed (laminectomy). The other 21 experimental rats with similar laminectomies were divided into 3 subgroups (n = 7) which received compression impact forces of 30, 40 or 50 g (subgroups-1, -2, and -3, respectively) applied on their exposed spinal medulla for 15 minutes. All rats were observed for 28 days after the experimental procedure and their motor functions were assessed by the Basso, Beattie, Bresnahan (BBB) test 6 hours, 7, 21 and 28 days after the simulated SCI. All 23 rats survived the surgical procedures. The control rats were without any neurological deficits. There were, in every experimental subgroup, 1 or 2 rats with extreme BBB scores. So the rats with the maximum and minimum BBB values were excluded. Then, the results acquired in the residual 5 rats in each group were averaged and statistically analysed by the Tukey multiple comparisons test. Statistically significant intersubgroup differences were found at all survival times equal to or longer than 7 post SCI days. The goal of the SCI experiment was to generate a reproducible and reliable, submaximal spinal cord trauma model. The statistical analyses demonstrated that this objective was best achieved in the subgroup-2 with the 40 g compression.

scholarly journals MR imaging of penetrating spinal trauma

2003 ◽  
Vol 7 (3) ◽  
pp. 25-29
Author(s):  
Peter Corr ◽  
Hoosen Lakhi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mr Imaging ◽  
Clinical Signs ◽  
Artery Occlusion ◽  
Spinal Trauma ◽  
Mr Studies ◽  
Neurological Deficits ◽  
Cord Injury ◽  
Shot Wounds

Objective: To determine the utility of MR imaging in the assessment of spinal cord injury following penetrating spinal trauma.Methods: We retrospectively reviewed the case notes and MR studies of patients referred to our MR facility over a 2-year period with neurological deficits following penetrating spinal injuries. All MR studies were performed on the same MR scanner with identical protocols. We reviewed the MR studies blinded to the clinical data and MR reports. We recorded the presence of: spinal cord transection, cord contusion, haematomyelia, extramedullary haematoma and vascula injury.Results: 20 patients (17 males, 3 females) with a mean age of 28 years were studied. Causes of injury were knife wounds in 17 patients and gun shot wounds in 3 patients. Site of injury was: cervical in 14, thoracic 4, lumbar in 2. Neurological deficits were: Brown-Séquard syndrome in 8, paraparesis in 7, quadraparesis in 2, hemiplegia 2, unconscious 1. MR findings were: partial cord transection in 9 patients, cord oedema/contusion in 5, haematomyelia in 2, myelomalacia in 2, and disk herniation in 1. One patient with cord transection sustained verterbral artery occlusion. Only 4 patients with Brown-Séquardsyndrome had partial cord transection, the other 5 had cord contusions.Conclusions: MR accurately demonstrates spinal cord injury in patients with penetrating spinal trauma, however the clinical signs detected do not always correlate with the MR findings.

scholarly journals A Sensitive and Fast Fiber Bragg Grating-Based Investigation of the Biomechanical Dynamics of In Vitro Spinal Cord Injuries

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1671
Author(s):  
Satyendra Kumar Mishra ◽  
Jean-Marc Mac-Thiong ◽  
Éric Wagnac ◽  
Yvan Petit ◽  
Bora Ung
Keyword(s):  
Spinal Cord ◽  
Fiber Bragg Grating ◽  
Real Time ◽  
Soft Tissues ◽  
Spinal Cord Injuries ◽  
Bragg Grating ◽  
Transverse Compression ◽  
Spatiotemporal Resolution ◽  
Cord Injury

To better understand the real-time biomechanics of soft tissues under sudden mechanical loads such as traumatic spinal cord injury (SCI), it is important to improve in vitro models. During a traumatic SCI, the spinal cord suffers high-velocity compression. The evaluation of spinal canal occlusion with a sensor is required in order to investigate the degree of spinal compression and the fast biomechanical processes involved. Unfortunately, available techniques suffer with drawbacks such as the inability to measure transverse compression and impractically large response times. In this work, an optical pressure sensing scheme based on a fiber Bragg grating and a narrow-band filter was designed to detect and demonstrate the transverse compression inside a spinal cord surrogate in real-time. The response time of the proposed scheme was 20 microseconds; a five orders of magnitude enhancement over comparable schemes that depend on costly and slower optical spectral analyzers. We further showed that this improvement in speed comes with a negligible loss in sensitivity. This study is another step towards better understanding the complex biomechanics involved during a traumatic SCI, using a method capable of probing the related internal strains with high-spatiotemporal resolution.

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