The Outcome of Cervical Spine Injury Associated with Traumatic Brain Injuries: Tertiary Care Hospital Study

Objective: Outcome of cervical spine injury associated with traumatic brain injuries. Materials & Methods: This study is a cross-sectional descriptive study that was performed at the Jinnah Post Graduate Medical Centre, Karachi. 158 total patients were included in the study, this study by non-probability consecutive sampling. The diagnosis was based primarily on a CT scan brain plain and an x-ray of the cervical spine of all the patients who were admitted to the ward. Results: Among 158, the age distribution of the patient was observed as 43(27%)patients presented as less than 20 years, 32(20%) were between the age of 21-30 years range, 28(18%) patients were ranged between 31-40 years, 16(10%) patients aged in a range of 41-50 years while 39(25%) were above 50 years. Head injury severity was observed at 47% as mild head injury, 32% as moderate injury and 21% had a severe head injury while cervical injury in association with traumatic brain injury was found in 10% of patients. Conclusion: The prevalence of cervical traumatic injury associated with moderate to severe head injury remained similar in the world overall with minute differences in the percentages that we have noticed in our study. The severity of the head injury is directly proportional to cervical injury.

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

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.

P.232 Motor Recovery after Early Surgical Decompression in Cervical ASIA A Spinal Cord Injury Patients

Background: Despite growing evidence for early surgical decompression for traumatic cervical spinal cord injury(tCSCI) patients, controversy surrounds the efficacy of early surgical decompression on patients with a complete (ASIA A) cervical injury. Methods: Patients with ASIA A cervical tCSCI were isolated from 4 prospective, multi-center datasets. Patients who had a Glasgow coma scale of less than 13, were over the age of 70 or under 16 were excluded. Significant gain was defined to include those that recovered more than two muscle groups (greater than 3/5 power) below their level of injury. Analysis of variance (ANOVA) was then done to compare significant gain over the 1 year follow-up period for patients with and without early decompressive surgery (<24hrs). Results: We identified 420 cervical ASIA A tCSCI patients. The mean number of muscle groups gained was 2.69 (SD 2.3.12) for those who had early surgery compared to 2.37 (SD 3.38) for those with late surgery. Of those patients who had early surgery 39.67% had a significant improvement vs. 28.76% of those who did not have early surgery (P = 0.030). Conclusions: For the first time, we have shown a clear therapeutic benefit of early surgical decompression within 24 hrs in ASIA A tCSCI patients.

Incomplete ossification of the atlas in cats: seven cases detected on computed tomography

Defects of the ventral arch of the atlas were detected on computed tomography in nine cats aged 3…12 months with signs of upper cervical injury including paina and ataxia. Seven cats have an ambulatory tetraparesis, and two cats have a nonambulatory tetraparesis. The bone defects were consistent with the normal location of the ventral arch growth areas of the atlas. In all observed cats, the pattern of ossification abnormalities was similar — the lateral portion of the arch was completely absent in seven cats on the left and in two cats on the right. The structure of the ventral tubercle was traceable in 8 of 9 cats. Also, in 8 of 9 cases an isolated bone fragment was observed lateral to the dens of the axis, the exact origin of which was not determined. This fragment was observed in 6 cases on the right, in two cases on the left, and only in two cases it corresponded to the side of the undeveloped arch. In 7 out of 9 cats, the dorsal arch was not fused; in 2 cats with complete fusion, the dorsal arch was deformed. An dens fracture was visualized in 3 cases, no hypoplasia of the dens was visualized, and one cat have atlantoaxial subluxation. Seven cats received conservative treatment and 2 cats received surgical treatment. Clinical improvement was observed in all cats. Disorder the ossification of the ventral arch of the atlas should be considered as the differential diagnosis in young cats with suspected atlanto-axial instability and trauma of the cervical spine. The authors were unable to find publications describing this atlas developmental abnormality in cats, so the authors believe that this is the first mention of incomplete ossification of the atlas in cats.

Diaphragm Pacing in Patients with Spinal Cord Injury: A European Experience

<b><i>Background:</i></b> Patients with high spinal cord injury (SCI) are unable to breathe on their own and require mechanical ventilation (MV). The long-term use of MV is associated with increased morbidity and mortality. In patients with intact phrenic nerve function, patients can be partially or completely removed from MV by directly stimulating the diaphragm motor points with a diaphragm pacing system (DPS). <b><i>Objectives:</i></b> We describe our multicenter European experience using DPS in SCI patients who required MV. <b><i>Methods:</i></b> We conducted a retrospective study of patients who were evaluated for the implantation of DPS. Patients evaluated for DPS who met the prospectively defined criteria of being at least 1 year of age, and having cervical injury resulting in a complete or partial dependency on MV were included. Patients who received DPS implants were followed for up to 1 year for device usage and safety. <b><i>Results:</i></b> Across 3 centers, 47 patients with high SCI were evaluated for DPS, and 34 were implanted. Twenty-one patients had 12 months of follow-up data with a median DPS use of 15 h/day (interquartile range 4, 24). Eight patients (38.1%) achieved complete MV weaning using DPS 24 h/day. Two DPS-related complications were surgical device revision and a wire eruption. No other major complications were associated with DPS use. <b><i>Conclusions:</i></b> Diaphragm pacing represents an attractive alternative stand-alone treatment or adjunctive therapy compared to MV in patients with high SCI. After a period of acclimation, the patients were able to reduce the daily use of MV, and many could be completely removed from MV.