Abstract
Background: Since 1986 by the work of Goldsmith, we know that placing omental tissue on the injured spinal cord, we can provoke neurological improvement. Case report: A 4-year-old girl received a gunshot wound on August 2010., at the upper cervical cord, which was followed immediately by tetraplegia. Lose of respiratory ahttps://www.omicsonline.org/utomatism and she was connected to a fan. Preoperative MRI scans revealed a severe ischemic infarct at C2-C3. On July 2011, she received an omental transplantation. During surgery we found abundant scar tissue on the cervical cord between C2 and C3, small intramedullary cyst in the left side, reduction of blood vessels, and 70 percent of cervical cord hypotrophied. On this residual cervical cord a segment of omentum was placed. Two days after surgery, she began with respiratory automatism and voluntary movement of shoulders and right limbs. She could stand up and to walk with aid of orthopedic devices since 4 months after surgery. At present, 4 years after surgery, she(a 9-year-old girl) present partial control of sphincters and motor improvement by 40 percent. During the postoperative evolution she receive rehabilitation and electrical stimulation in the cervical cord. Conclusions: These results indicate that ischemic neurons and axons in the traumatized cervical cord can improve if is revascularized with omental tissue.
Highlights
Since 1986 by the work of Goldsmith, we know that placing omental tissue on the injured spinal cord, we can provoke neurological improvement.Case report: A 4-year-old girl received a gunshot wound on August 2010., at the upper cervical cord, which was followed immediately by tetraplegia
We report to a patient with severe sequelae in the upper cervical cord caused by a gunshot wound
During surgery we found: 1) leptomeningeal adhesions ; 2) abundant fibrosis in the posterior surface of the spinal cord between C2 and C3; 3) small intramedullary cyst in the left side of the cervical cord ;4) reduction of blood vessels, and 5) cervical cord was reduced to 70 percent and 3 cm of height
Summary
The sequelae of traumatized spinal cord is a challenging condition that only receives rehabilitation as treatment, in spite of previous neurosurgical experiences by means of omental transposition [1,2,3] or transplantation [4,5,6] on the affected zone. A magnetic resonance imaging (MRI) scans revealed a severe ischemic infarct in the cervical cord between C2 to C3 (Figure 1) Since her admission to the Instituto Nacional de Salud del Niño (Peru), she was connected to a ventilator. The examination showed a patient confined to bed, with tracheotomy and connected to an automatic fan She suffered severe pain in the neck, slight dysarthria and severe weak voice (she was heard at one meter). About 48 hours after surgery, she began with respiratory automatism, voice more intense and with voluntary movement of shoulders and neck Ten days later, she presented sensory in her hands and voluntary movement, ocasionally, in the right limbs. The voluntary movement of shoulders and neck improved by 70 percent and in less degree, in upper limbs and right leg. During whole postoperative evolution she has received rehabilitation, electrical stimulation in the cervical cord and she has been oriented to tolerate the respiration without ventilator
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