The prognosis and recovery of major postoperative neurological deficits after corrective surgery for scoliosis

Aims The outcome following the development of neurological complications after corrective surgery for scoliosis varies from full recovery to a permanent deficit. This study aimed to assess the prognosis and recovery of major neurological deficits in these patients, and to determine the risk factors for non-recovery, at a minimum follow-up of two years. Methods A major neurological deficit was identified in 65 of 8,870 patients who underwent corrective surgery for scoliosis, including eight with complete paraplegia and 57 with incomplete paraplegia. There were 23 male and 42 female patients. Their mean age was 25.0 years (SD 16.3). The aetiology of the scoliosis was idiopathic (n = 6), congenital (n = 23), neuromuscular (n = 11), neurofibromatosis type 1 (n = 6), and others (n = 19). Neurological function was determined by the American Spinal Injury Association (ASIA) impairment scale at a mean follow-up of 45.4 months (SD 17.2). the patients were divided into those with recovery and those with no recovery according to the ASIA scale during follow-up. Results The incidence of major deficit was 0.73%. At six-month follow-up, 39 patients (60%) had complete recovery and ten (15.4%) had incomplete recovery; these percentages improved to 70.8% (46) and 16.9% (11) at follow-up of two years, respectively. Eight patients showed no recovery at the final follow-up. The cause of injury was mechanical in 39 patients and ischaemic in five. For 11 patients with misplaced implants and haematoma formation, nine had complete recovery. Fisher’s exact test showed a significant difference in the aetiology of the scoliosis (p = 0.007) and preoperative deficit (p = 0.016) between the recovery and non-recovery groups. A preoperative deficit was found to be significantly associated with non-recovery (odds ratio 8.5 (95% confidence interval 1.676 to 43.109); p = 0.010) in a multivariate regression model. Conclusion For patients with scoliosis who develop a major neurological deficit after corrective surgery, recovery (complete and incomplete) can be expected in 87.7%. The first three to six months is the time window for recovery. In patients with misplaced implants and haematoma formation, the prognosis is satisfactory with appropriate early intervention. Patients with a preoperative neurological deficit are at a significant risk of having a permanent deficit. Cite this article: Bone Joint J 2022;104-B(1):103–111.

Spontaneous Recovery of Penetrating Cervical Spinal Cord Injury with Physiotherapeutic Treatment: Case Report and Review of the Literature

Stab wounds to the cervical spine are less common than injuries from road accidents, sports injuries, and falls. The presence of vital, vascular, neural, respiratory, and digestive structures in the neck region mean that this kind of spinal injury is generally critical, and its management is a challenge. We report a unique case of a previously healthy 17-year-old adolescent admitted for quadriplegia secondary to a stab wound to the cervical spine at the C4C5 level. There was no surgical indication. The patient underwent physiotherapy. He showed spontaneous neurological improvement two weeks later and was able to sit on his own and to walk about three months of physical rehabilitation.

Spinal Cord Injuries in Emergency Medicine

Spinal cord injury is a serious medical disorder that frequently leads in significant morbidity and permanent impairment. Direct damage to the spinal cord or compression owing to broken vertebrae or masses such as epidural hematomas or abscesses are the most common causes of spinal cord injury. When examining a blunt trauma victim, medical professionals are taught to presume the patient has a spinal column damage unless it is proven otherwise. The early examination of a patient with a suspected cervical spinal injury in the emergency department (ED) is no different than that of any other trauma patient. The ABCs, or airway, breathing, and circulation, procedures are being taken into consideration. In acute spinal cord damage, hypotension can be hemorrhagic or neurogenic. Because of the high prevalence of concomitant injuries and vital sign confusion in acute spinal cord injury, a thorough search for hidden sources of bleeding is required. Surgical removal of bone fragments, foreign objects, herniated discs, or broken vertebrae that appear to be compressing the spine is frequently required. In order to avoid future discomfort or deformity, surgery may be required to stabilize the spine. In this review we’ll be looking at spinal cord injury, it’s diagnosis and treatment.

Unlike Brief Inhibition of Microglia Proliferation after Spinal Cord Injury, Long-Term Treatment Does Not Improve Motor Recovery

Microglia are major players in scar formation after an injury to the spinal cord. Microglia proliferation, differentiation, and survival are regulated by the colony-stimulating factor 1 (CSF1). Complete microglia elimination using CSF1 receptor (CSF1R) inhibitors worsens motor function recovery after spinal injury (SCI). Conversely, a 1-week oral treatment with GW2580, a CSF1R inhibitor that only inhibits microglia proliferation, promotes motor recovery. Here, we investigate whether prolonged GW2580 treatment further increases beneficial effects on locomotion after SCI. We thus assessed the effect of a 6-week GW2580 oral treatment after lateral hemisection of the spinal cord on functional recovery and its outcome on tissue and cellular responses in adult mice. Long-term depletion of microglia proliferation after SCI failed to improve motor recovery and had no effect on tissue reorganization, as revealed by ex vivo diffusion-weighted magnetic resonance imaging. Six weeks after SCI, GW2580 treatment decreased microglial reactivity and increased astrocytic reactivity. We thus demonstrate that increasing the duration of GW2580 treatment is not beneficial for motor recovery after SCI.

Management of Acute Traumatic Spinal Cord Injury: A Review of the Literature

Traumatic spinal cord injury (TSCI) is a debilitating disease that poses significant functional and economic burden on both the individual and societal levels. Prognosis is dependent on the extent of the spinal injury and the severity of neurological dysfunction. If not treated rapidly, patients with TSCI can suffer further secondary damage and experience escalating disability and complications. It is important to quickly assess the patient to identify the location and severity of injury to make a decision to pursue a surgical and/or conservative management. However, there are many conditions that factor into the management of TSCI patients, ranging from the initial presentation of the patient to long-term care for optimal recovery. Here, we provide a comprehensive review of the etiologies of spinal cord injury and the complications that may arise, and present an algorithm to aid in the management of TSCI.

Optimizing Backrest Geometry to Minimize Interfacial Pressure Concentrations in the Mid-To-Lumbar Region During Leg Press Resistance Training

The leg press is a resistance training (RT) exercise common to both weight- and powerlifting, where spine-related injuries remain prevalent. Here, the elevated loading has the potential to result in increased pressure on vertebral bodies and introduce the risk of spinal injury. This study therefore investigates back interfacial pressure under leg press loading conditions and offers design recommendations to minimize spatial pressure concentrations. A pressure mat was used to assess the back-backrest interfacial pressure distribution of 15 subjects executing RT leg-presses at 50% bodyweight, over 16 different back-support geometries. Real-time forces, knee angles, and pressures were captured. The resulting data show that more prominent (?2.1 cm) back-supports, positioned 19cm above the seat pan typically produced greater peak pressures (41.8±7.2 kPa). Conversely, less prominent supports (~0.7 cm) generally achieved lower peak pressures (with greater distribution). Our data suggest that the most prudent choice for fixed-shape backrests to best distribute interfacial pressure on leg-press devices is to incorporate shallow convex supports (~0.7 cm), and locate them away from P=19 cm. The result is surprising as this prominence location is a common ergonomic feature. If an adjustable backrest is considered, peak pressures may be reduced by up to 26±8% (9.7±3.1 kPa) compared to flat geometries.