Effect of Matrix Rhythm Therapy Along With Conventional Physiotherapy Management in Quadriplegic Patient: A Case Study

A 26-year old Yemeni girl with a gunshot injury with cervical spine fracture at C6-C7 Level injury in June 2018 with complete loss of sensation in all the limbs, motor loss below C3 level with loss of saddle sensation and anal tone. The patient sustained spinal cord injury at C6-7 levels and edema extending upto C3 level, resulting in quadriplesgia.She was airlifted in medevac from yemen to Sultan Qaboos Hospital Salalah Oman in 28th June 2018.The patient underwent extensive Neuro surgical procedures for cervical fracture and spinal decompression.Additionally, the patient received education and counseling, nursing and nutritional intervention, and comprehensive physical therapy treatment including Matrix Rhythm therapy and other conventional Physiotherapy management.We conclude that Physiotherapy management with other medical disciplines are crucial in recovary of the patient and to improve quality of life.

Epidemiology of Traumatic Cervical Spinal Fractures in a General Western Population

Background: In Western countries, the typical cervical spine fracture (CS-Fx) patient has historically been a young male injured in a road traffic accident. Recent reports and daily clinical practice clearly indicate a change in the typical patient from a young male to an elderly male or female with comorbidities. This study aimed to establish contemporary population-based epidemiological data of traumatic CS-Fx for use in health care planning and injury prevention.Methods: This is a population-based clinical observational cohort study from the southeastern region of Norway with 3.0 million inhabitants. We included all patients diagnosed with a CS-Fx between 2015 and –2019. Information regarding demographics, preinjury comorbidities, trauma mechanisms, injury description, treatment, and level of hospital admittance is presented.Results: We registered 2153 patients with CS-Fx during a 5-years period, with an incidence of CS-Fx of 14.9/100,000 person-years. The median patient age was 62 years, 68% were males, 37% had a preinjury severe systemic disease, 16% were under the influence of ethanol, 53% had multiple trauma, and 12% had concomitant cervical spinal cord injury (incomplete in 85% and complete in 15%). The most common trauma mechanisms were falls (57%), followed by bicycle injuries (12%) and 4-wheel motorized vehicle accidents (10%). The most common upper CS-Fx was C2 odontoid Fx, while the most common subaxial Fx was facet joint Fx involving cervical level C6/C7. Treatment was external immobilization with a stiff neck collar alone in 65%, open surgical fixation in 26% (giving a 3.7/100,000 person-years surgery rate), and no stabilization in 9%. The overall 90-day mortality was 153/2153 (7.1%).Conclusions: This study provides an overview of the extend of the issue and patient complexity necessary for planning the health care management and injury prevention of CS-Fx. We suggest intensified fall preventive measures in the elderly, better public awareness of the risks of excessive ethanol use, and better road safety for bicyclists.

Abstract 1122‐000114: Blunt Traumatic Vertebral Artery Injury: Incidence, Treatment, and Outcomes

Introduction : Blunt cerebrovascular injury (BCVI) refers to any injury to the carotid or vertebral arteries sustained via blunt trauma. Computed tomographic angiography (CTA) has become a standard and widely available screening tool for BCVI, often allowing injuries to be detected on admission. Prior research has shown that BCVI is associated with subsequent stroke. Treatment protocols vary by institution, and the optimal treatment method for these injuries is not standardized. Methods : This research was approved by the IRB. All patients presenting to a level 1 trauma center from 2011 to 2018 were screened for inclusion using the Primordial Database imaging report search tool (San Mateo, CA). All included patients underwent CTA within 24 hours of presentation. Patients were excluded if they had penetrating injury, age <16 years, or concomitant carotid injury. Data was retrospectively collected. Injuries were graded according to the criteria of Biffl et al. Treatment and follow up imaging of BCVI was determined by the vascular neurosurgeon on call. Results : A total of 2819 patients underwent screening CTA, with 156 patients (5.5%) identified with isolated vertebral artery injuries. Sixteen patients (10%) had bilateral vertebral artery injuries, for a total of 172 injured vertebral arteries. There was a male predominance (n = 97, 62%). Ninety‐two patients (59%) had a cervical spine fracture at the level of injury. Three posterior circulation strokes were detected, all within 24 hours of admission, prior to starting any treatment. Treatment regimens included aspirin (n = 135 vessels), clopidigrel (n = 1), anticoagulation (n = 2), or no treatment (n = 18). Follow up imaging was available for 84 patients (98 arteries). Three patients had worsening Biffl grade on follow‐up CTA, and the remainder were stable or improved. The three worsened injuries were all grade 2 on initial presentation. Conclusions : In our patient population, isolated blunt vertebral artery injuries were treated with multiple regimens. The majority of patients in our group were treated with aspirin; no strokes were detected after the initiation of therapy, regardless of the treatment modality or the fate of the injured. Our study is not randomized and the treatment groups are not evenly distributed. Further investigation is required to address the optimal method and duration of treatment for blunt vertebral artery injury. However, our data suggest that aspirin alone may be sufficient therapy for isolated vertebral artery injuries.

Complications of Halo Vest Orthosis: A Narrative Study

Background and Aim: Perry and Nickel introduced the halo vest in 1959. It is the most common immobilization device for the unstable cervical spine. In the literature review, most articles review the beneficial effects of the halo vest, and a few report its complications. This study aims to evaluate the complications associated with halo orthosis. Methods and Materials/Patients: This is a narrative study about halo vest complications. To provide up-to-date information, we reviewed the articles written about halo complications. All relevant articles were retrieved from Google Scholar, Medline, PubMed, etc., using the keywords of “halo vest orthosis”, “unstable cervical spine fracture”, “halo vest complications”, “halo vest immobilization”, “pin-site-related complications”, and “vest-related complications”. Afterward, we reviewed and critically analyzed the articles. Results: At first, the halo vest was used for postoperative paralyzed poliomyelitis patients, and later, it was also used for traumatic injury of the cervical spine or postoperatively in cervical spine reconstructive surgery. Compared to other orthoses, the halo vest provides a more effective external fixation and maintains normal anatomic alignment of the cervical spine without impacting jaw motion and resulting in eating problems. However, it has many temporary complications. To prevent halo vest complications, experienced people should apply it, and the patients should be regularly followed up for early detection and treatment of complications. Conclusion: Our review is the starting point for the evaluation and investigation of halo vest complications. Because of the high incidence of pin loosening and infection, it is better to evaluate the design and application of halo pin. Since the initial design of the halo vest, only its superstructure has been redesigned without any significant change in other parts of it.

Upper Cervical Spine Fracture-Dislocation in Patients With Ankylosing Spondylitis: Application of Halo Vest Before and During Posterior Surgery

Background It is a challenge to reduce and immobilize the broken “bamboo spine”, especially for the upper cervical spine, in patients with ankylosing spondylitis (AS) before and during posterior surgery. Methods We retrospectively analyzed the case histories, operations, neurologic outcomes, follow-up data, and imaging records of 17 patients with AS and upper cervical spine fracture-dislocation who underwent surgical treatment in three clinical spine center from 2010 to 2019. A halo vest was used to reduce and immobilize fractured spinal column ends. The neurological injury was evaluated using the American Spinal Injury Association (ASIA) impairment scale score and Japanese Orthopaedic Association (JOA) score before and after operation. Complications and time of bone fusion were recorded. Results Fourteen patients achieved closed anatomical reduction after halo vest application. No displacement in fracture ends and loss of reduction occurred after prone position. No patient presented with secondary neurological deterioration. All patients was performed posterior surgery. The surgery improved the ASIA grade in all patients (P < 0.001). The mean JOA score also increased significantly at last follow-up compared to preoperation (14.5 ± 2.3 vs. 9.2 ± 2.4, P < 0.01). No severe complication and death occurred. All patients reached solid bony fusion at 12-month follow-up. Conclusions Use of a halo vest before and during the operation is safe and effective in patients with AS who develop upper cervical spine fracture-dislocation. This technique makes positioning, awake nasoendotracheal intubation, nursing, and the operation more convenient. It can also provide satisfactory reduction and rigid immobilization and prevent secondary neurologic deterioration. .