Pediatric spinal injury: review of 61 deaths

1992 ◽  
Vol 77 (5) ◽  
pp. 705-708 ◽  
Author(s):  
Mark G. Hamilton ◽  
S. Terence Myles
Keyword(s):  
Spinal Cord ◽  
Spinal Injury ◽  
Pediatric Population ◽  
Spinal Column ◽  
Cervical Cord ◽  
Maximum Score ◽  
Content Type ◽  
Cord Injury ◽  
High Cervical ◽  
Spinal Cord Injured

✓ Injury to the spinal column and spinal cord occurs relatively infrequently in the pediatric population. The authors present a unique review of 61 pediatric deaths associated with spinal injury. This group represented 28% of the total pediatric spine-injured population and 45% of the total pediatric spinal cord-injured group studied. The ratio of pediatric to adult spinal injury mortality was 2.5:1. Of the 61 children, 54 (89%) died at the accident scene. Thirty patients underwent a complete autopsy, 19 of whom had an Abbreviated Injury Scale Grade 6 injury (maximum score, untreatable). Spinal cord injury was found to be the cause of death in only eight children and was associated with injury to the high cervical cord and cardiorespiratory arrest. These children typically sustained severe multiple trauma. In this population, there appears to be little room for improved outcome through changes in treatment strategy.

Acute cervical cord injury without fracture or dislocation of the spinal column

2000 ◽  
Vol 93 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Izumi Koyanagi ◽  
Yoshinobu Iwasaki ◽  
Kazutoshi Hida ◽  
Minoru Akino ◽  
Hiroyuki Imamura ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Spinal Canal ◽  
Spinal Column ◽  
Cord Compression ◽  
Cervical Cord ◽  
Content Type ◽  
Cord Injury ◽  
Cervical Cord Injury ◽  
Fine Print

Object. It is known that the spinal cord can sustain traumatic injury without associated injury of the spinal column in some conditions, such as a flexible spinal column or preexisting narrowed spinal canal. The purpose of this study was to characterize the clinical features and to understand the mechanisms in cases of acute cervical cord injury in which fracture or dislocation of the cervical spine has not occurred. Methods. Eighty-nine patients who sustained an acute cervical cord injury were treated in our hospitals between 1990 and 1998. In 42 patients (47%) no bone injuries of the cervical spine were demonstrated, and this group was retrospectively analyzed. There were 35 men and seven women, aged 19 to 81 years (mean 58.9 years). The initial neurological examination indicated complete injury in five patients, whereas incomplete injury was demonstrated in 37. In the majority of the patients (90%) the authors found degenerative changes of the cervical spine such as spondylosis (22 cases) or ossification of the posterior longitudinal ligament (16 cases). The mean sagittal diameter of the cervical spinal canal, as measured on computerized tomography scans, was significantly narrower than that obtained in the control patients. Magnetic resonance (MR) imaging revealed spinal cord compression in 93% and paravertebral soft-tissue injuries in 58% of the patients. Conclusions. Degenerative changes of the cervical spine and developmental narrowing of the spinal canal are important preexisting factors. In the acute stage MR imaging is useful to understand the level and mechanisms of spinal cord injury. The fact that a significant number of the patients were found to have spinal cord compression despite the absence of bone injuries of the spinal column indicates that future investigations into surgical treatment of this type of injury are necessary.

scholarly journals Arrow-Shot Injury to Pediatric Spinal Cord

2021 ◽  
Author(s):  
Vijayveer Singh ◽  
Sharad Thanvi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Pediatric Population ◽  
Cervical Region ◽  
Cervical Cord ◽  
Cord Injury ◽  
Dural Suturing ◽  
Stab Injuries ◽  
Early Surgical Intervention

AbstractPenetrating spinal cord injuries (PSCI) in cervical region are extremely rare in pediatric population. Most injuries in pediatric population are accidental due to gunshot or a stab injury with a sharp or pointed object. Gun shots may result into a severe wound which is usually fatal and may result in death, quadriplegia, or serious long-term disability. Stab injuries are less severe and may result in neurological sequalae. In this paper, an unusual case of pediatric arrow shot partial cervical cord injury is reported which was managed by aggressive neurosurgical management. The arrow lodged in the cervical cord was very near to the vertebral artery leading to parapariesis which recovered well without any complications. Diagnostic imaging at admission included radiographs, computed tomography (CT), and CT angiography of the cervical region. The patient underwent early surgical intervention with removal of foreign body from the cord and subsequent dural suturing.

Deterioration following spinal cord injury

1987 ◽  
Vol 66 (3) ◽  
pp. 400-404 ◽  
Author(s):  
Lawrence F. Marshall ◽  
Sharen Knowlton ◽  
Steven R. Garfin ◽  
Melville R. Klauber ◽  
Howard M. Eisenberg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Cord ◽  
Skeletal Traction ◽  
Systemic Complications ◽  
Content Type ◽  
Management Procedures ◽  
Cord Injury ◽  
Specific Management ◽  
Fine Print

✓ The results are presented of a prospective study of the course of 283 spinal cord-injured patients who were consecutively admitted to five trauma centers participating in the Comprehensive Central Nervous System Injury Centers' program of the National Institutes of Health. Of the 283 patients, 14 deteriorated neurologically during acute hospital management. In 12 of the 14, the decline in neurological function could be associated with a specific management event, and in nine of these 12 the injury involved the cervical cord. Nine of the 14 patients who deteriorated had cervical injuries, three had thoracic cord injuries, and two had thoracolumbar junction injuries. Management intervention was identified as the cause of deterioration in four of 134 patients undergoing operative intervention, in three of 60 with skeletal traction application, in two of 68 with halo vest application, in two of 56 undergoing Stryker frame rotation, and in one of 57 undergoing rotobed rotation. Early surgery on the cervical spine when cord injury is present appears hazardous, since each of the three patients with a cervical cord injury who deteriorated was operated on within the first 5 days. No such deterioration was observed following surgery performed from the 6th day on. In two other patients, deterioration did not appear to be related to management but was a direct product of the underlying disease or of systemic complications. Deterioration following hospitalization for spinal cord injury is relatively uncommon — 4.9% in this large series. In most instances, decline in function could be attributed to specific management procedures. These changes must not be interpreted as representing failure to provide optimal care but rather should be seen as the inevitable product of an attempt to manage patients with spinal cord and column injuries, many of which are clearly unstable.

Neurological prognosis after traumatic quadriplegia

1979 ◽  
Vol 50 (5) ◽  
pp. 611-616 ◽  
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.

Progressive post-traumatic syringomyelia: a clinical case

2019 ◽  
Vol 21 (4) ◽  
pp. 81-88
Author(s):  
F. A. Bushkov ◽  
M. A. Bzhylyanskiy ◽  
A. Yu. Kordonskiy
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Informed Consent ◽  
Conflict Of Interest ◽  
Clinical Case ◽  
Spinal Injury ◽  
Spinal Column ◽  
Cord Injury ◽  
Post Traumatic ◽  
The Right

The objective of the present article is to describe a rare clinical case of progressive post-traumatic cervical syringomyelia after spinal cord injury with fracture of proximal metaepiphysis of the right humerus. The patient had a progressive neurological loss after spinal cord injury.Materials and methods. The patient underwent surgical treatment: decompression and stabilization of spinal column, surgical technique of spinal cord detethering, cyst shunting.Results. In the postoperative period the patient had increased spasticity in the lower extremities, increased weakness in the muscles of the upper extremities, aggravation of orthostatic hypotension, and inability to flex the first and the fifth fingers of the right hand. Magnetic resonance imaging of the cervical spine revealed progression of syringomyelia.Conclusion. This case demonstrates differentiation between cervical myelopathy and plexus paresis in a patient with combination spinal injury and reveals the mechanisms underlying late progression of neurological deficit.Conflict of interest. The authors declare no conflict of interest.Informed consent. The patient gave written informed consent to the publication of his data.

Pediatric spinal injury: the very young

1988 ◽  
Vol 68 (1) ◽  
pp. 25-30 ◽  
Author(s):  
John R. Ruge ◽  
Grant P. Sinson ◽  
David G. McLone ◽  
Leonard J. Cerullo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Causative Factor ◽  
Important Variable ◽  
Neurological Injury ◽  
Content Type ◽  
Significant Difference ◽  
Cord Injury

✓ Maturity of the spine and spine-supporting structures is an important variable distinguishing spinal cord injuries in children from those in adults. Cinical data are presented from 71 children aged 12 years or younger who constituted 2.7% of 2598 spinal cord-injured patients admitted to the authors' institutions from June, 1972, to June, 1986. The 47 children with traumatic spinal cord injury averaged 6.9 years of age and included 20 girls (43%). The etiology of the pediatric injuries differed from that of adult injuries in that falls were the most common causative factor (38%) followed by automobile-related injuries (20%). Ten children (21.3%) had spinal cord injury without radiographic abnormality (SCIWORA), whereas 27 (57%) had evidence of neurological injury. Complete neurological injury was seen in 19% of all traumatic pediatric spinal cord injuries and in 40% of those with SCIWORA. The most frequent level of spinal injury was C-2 (27%, 15 cases) followed by T-10 (13%, seven cases). Upon statistical examination of the data, a subpopulation of children aged 3 years or younger emerged. These very young children had a significant difference in level of injury, requirement for surgical stability, and sex distribution compared to 4- to 12-year-old children.

Neuroprotective effects of GYKI 52466 on experimental spinal cord injury in rats

2003 ◽  
Vol 98 (3) ◽  
pp. 275-281 ◽  
Author(s):  
Ahmet Çolak ◽  
Osman Soy ◽  
Hafize Uzun ◽  
Özcan Aslan ◽  
Seref Barut ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuroprotective Effects ◽  
Content Type ◽  
Gyki 52466 ◽  
Cord Injury ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Spinal Cord Injured ◽  
Fine Print

Object. The toxic effects of glutamate in the central nervous system are well known. This neurotoxicity occurs through metabotropic and ionotropic receptors, the latter group composed of N-methyl-d-aspartate, α-amino-3-hydroxy-5-methylisoxazole-4-proprionic acid (AMPA), and kainate receptors. The authors investigated the neuroprotective effects of GYKI 52466, a 2,3-benzodiazepine that is a selective and potent AMPA receptor antagonist, in a rat spinal cord trauma model. Methods. Sixty Wistar albino rats were studied in three groups of 20 animals each: sham-operated controls (Group 1); spinal cord—injured rats (Group 2); and spinal cord—injured plus GYKI 52466—treated rats (Group 3). In Groups 2 and 3, spinal cord injury (SCI) was induced at the thoracic level by applying an aneurysm clip to the cord for 1 minute. One minute after the clip was removed, the rats in Group 3 received an intraperitoneal injection of 15 mg/kg GYKI 52466. Responses to injury and treatment were evaluated based on biochemical parameters (lipid peroxidation and adenosine 5′-triphosphate [ATP] levels in tissue), and on light and transmission electron microscopy findings in cord tissue collected at different times post-SCI. Five rats from each group underwent assessment of functional recovery at 1, 3, and 5 days after SCI; evaluation was performed using the inclined-plane technique and Tarlov motor grading scale. The mean lipid peroxidation levels in Groups 1 and 2 were 21.73 ± 4.35 and 35.53 ± 2.99 nmol/g of wet tissue, respectively. The level in Group 3 was 27.98 ± 3.93 nmol/g of wet tissue, which was significantly lower than that in Group 2 (p < 0.01). The mean ATP levels in Groups 1 and 2 were 166.21 ± 25.57 and 41.72 ± 12.28 nmol/g of wet tissue, respectively. The ATP level in Group 3 was 85.82 ± 13.92 nmol/g of wet tissue, which was significantly higher than that in Group 2 (p < 0.01). Light microscopic examination of Group 2 tissues showed hemorrhage, necrosis, polymorphonuclear leukocyte infiltration, and vascular thrombi. In contrast, the examination of Group 3 tissues showed limited hemorrhage and no necrosis or vascular thrombi. The most prominent findings in Group 2 were hemorrhage and necrosis, whereas the most prominent findings in Group 3 were focal hemorrhage and leukocyte infiltration. Electron microscopy demonstrated that GYKI 52466 protected the neurons, myelin, axons, and intracellular organelles. The mean inclined-plane angles in Groups 1, 2, and 3 were 65°, 40 to 45°, and 55°, respectively. Motor scale results in all groups showed a similar trend. Conclusions. The findings in this rat model suggest that GYKI 52466 may provide significant therapeutic protection from secondary damage after acute SCI. This agent may be a viable alternative treatment for SCI.

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

2017 ◽  
Vol 11 (3) ◽  
pp. 412-418 ◽  
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><p>Retrospective study.</p></sec><sec><title>Purpose</title><p>To evaluate how motor, sensory, and urinary outcomes of spinal cord injury (SCI) patients were influenced in the long term.</p></sec><sec><title>Overview of Literature</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec>

Pediatric spinal injury: review of 174 hospital admissions

1992 ◽  
Vol 77 (5) ◽  
pp. 700-704 ◽  
Author(s):  
Mark G. Hamilton ◽  
S. Terence Mylks
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Hospital Admissions ◽  
Spinal Injury ◽  
Neurological Injury ◽  
Cervical Cord ◽  
Mature Adult ◽  
Younger Patients ◽  
Cord Injury ◽  
Radiological Abnormality

✓ Injury to the spinal column and spinal cord occurs relatively infrequently in the pediatric population. A review of 174 pediatric patients is presented, representing 5.4% of all patients admitted with spinal injury, Spinal cord injury was present in 45% of patients. A distinct injury profile, explained by anatomical and biomechanical features, distinguishes the young patient with an immature spine from older adolescents with a more mature, adult-like spine. The younger patients, while less likely to have spinal injury, had a higher incidence of neurological injury, in addition to a higher frequency of both spinal cord injury without radiological abnormality and upper cervical cord injury. In addition, younger patients with spinal cord injury and no radiological abnormality were more likely to have complete or severe cord injury. Prognosis was determined by the severity of spinal cord injury. Patients with complete cord injuries showed little improvement, while patients with incomplete injuries generally fared much better, with 74% showing significant improvement and 59% experiencing a complete recovery of neurological functions. There were six deaths, but none was attributed solely to spinal injury. The authors conclude that outcome is quite good after pediatric spinal cord injury that does not produce a physiologically complete cord deficit.

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.

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