Acute Central Cervical Spinal Cord Research Articles

Clinical characteristics of acute central cervical spinal cord injury with only upper extremity involvement and with both upper and lower extremity involvement

Objective To compare and analyze the clinical characteristics of acute central cervical spinal cord injury with only upper extremity involvement and with both upper and lower extremity involvement. Methods A retrospective case control study was made on clinical data of 76 patients with acute central cervical spinal cord injury hospitalized from January 2010 to December 2013. Nerve injury involved was only upper extremity in 39 patients (upper extremity group), but both upper and lower extremities in 37 patients (upper-and lower-extremity group). In upper extremity group, there were 35 males and four females, age was 21-80 years [(52.5±13.4)years], injury resulted from traffic accidents in 24 patients, ground-level falls in eight, high-level falls in six and heavy-object hit in one, and level of injury was C3/4in 16 patients, C4/5in 14 and C5/6in nine. In upper- and lower-extremity group, there were 30 males and seven females, age was 36-78 years [(59.6±9.7)years], injury resulted from traffic accidents in 16 patients, ground-level falls in 11, high-level falls in seven and heavy-object hit in three, and level of injury was C3/4in nine patients, C4/5in 18 and C5/6in 10. Sagittal diameter of the cervical spinal canal, maximal canal compromise, maximal spinal cord compression, degenerating factors of the cervical spine and treatment protocols were determined. Upper extremity function was assessed with the American spinal injury association (ASIA) score. Results There were significant differences between upper extremity group and upper- and lower-extremity group in sagittal diameter of the cervical spinal canal [(7.5±1.5)mm ∶(6.8±1.2)mm], maximal canal compromise [(28.9±9.6)% ∶(34.9±10.6)%], ASIA score at admission[(31.6±11.8)points ∶(22.7±11.3)points)] and ASIA score at last follow-up [(46.2±4.2)points ∶(40.2±4.0)points](P 0.05). Lower prevalence of posterior osteophyte of the vertebral body was noted in upper extremity group than upper- and lower-extremity group (15% ∶51%) (P<0.01). Twenty patients (49%) in upper extremity group were surgically treated, while 31 patients (84%) in upper-and lower-extremity group (P<0.05). Conclusions Compared to acute central cervical spinal cord injury with both upper and lower extremity involvement, the injury with only upper extremity involvement is much common in younger patients and is characterized by lowered frequency of osteophyte, large buffer space, mild nerve damage, preferred non-operation treatment and good prognosis. Key words: Spinal cord injuries; Magnetic resonance imaging; Neurological status

A model of acute central cervical spinal cord injury syndrome combined with chronic injury in goats.

To develop a large animal model for acute central cervical spinal cord injury syndrome (ACCSCIS. Twenty-four adult male goats were randomized into four groups including group A with acute compression injury, group B with anterior chronic compression, group C as the test group that received anterior chronic compression by screw and acute compression by posterior balloon insertion, and group D as normal controls that received sham surgery. Neurological function (modified Tarlov motor function), CT, MRI, cortical somatosensory evoked potentials (CSEP), and pathological analysis were evaluated. The data were analyzed statistically. The motor function of the goats in group C was significantly lower than other groups. CSEP before spinal cord compression showed a stable pattern. Spinal cord compression resulted in a gradual decrement in the peak latency and significant increment in the peak amplitude. Cervical spinal canal occupying ratio was significantly lower in group C than the other groups. MRI revealed focal low signal in T1 weighted images and focal high signal in T2 weighted images in group C. Pathological analysis showed more severe lesions in the gray matter than that in the white matter in group C. The model well simulated the pathogenesis and resembled the clinical characteristics of ACCSCIS. This model seems to have the potential to contribute to the development of effective therapies for ACCSCIS.

Appraise operative outcome for acute central cervical spinal cord injuries without fracture and dislocation

To evaluate the surgical outcome for acute central cervical spinal cord injuries without fracture and dislocation. A retrospective study was performed on 52 patients with acute central cervical cord injuries without fracture and dislocation from 2000 to 2005. All of patients underwent cervical anterior or posterior decompression, fusion and inter fixation. Spinal function was evaluated by ASIA (American Spinal Injury Association) guidelines. Pre- and post-operation ASIA scores were analyzed using liner correlation and regression. The neurological function was recorded during followed-up. The average follow-up was 29 months (range, 12 to 42). After operation, the ASIA scores increased significantly (P<0.01). Finally, ASIA motor, pin pricking and light touching scores of the 41 patients were 91 +/- 7, 107 +/- 6 and 107 +/- 6 respectively. Decompression and inter fixation for injured segment can make a stable and broad space for spinal cord, promoting early neurological recovery and long-term improvement.

Clinical syndromes associated with disproportionate weakness of the upper versus the lower extremities after cervical spinal cord injury.

Patients with cervical spinal cord injuries who present with weakness or paralysis of the hands and arms with relative preservation of lower extremity strengths are often categorized as having two clinical syndromes, cruciate paralysis and acute central cervical spinal cord injury. The explanation for the pathophysiological findings of the dissociated strength in the upper versus the lower extremities has relied on the assumption that there is a localized injury within a somatotopically organized corticospinal tract. This article summarizes the evidence that there is no somatotopic organization within the corticospinal tract in the medulla or cervical spinal cord in primates. An alternative hypothesis for these two syndromes is presented and is based on evidence that has demonstrated that the corticospinal tract in primates is critical for hand function but not for locomotion. Other prevailing theories are reviewed. Thus, we propose that a syndrome consisting of relatively greater hand and arm weakness compared with leg weakness can occur after an injury to the corticospinal tracts in the medulla or the cervical cord. The proposed mechanism, based on the function of the corticospinal tract, unifies a spectrum of injuries of the lower medulla and cervical spinal cord, which produce similar clinical syndromes (cruciate paralysis and acute central cervical spinal cord injury).

Anticipated Prognosis of Ambulation in Patients with Acute Central Cervical Spinal Cord Injury

Anticipated Prognosis of Ambulation in Patients with Acute Central Cervical Spinal Cord Injury

上肢型急性中心性頚髄損傷の臨床的検討

Acute central cervical spinal cord injury (ACCSCI), as defined by Schneider is characterized by disproportionately more motor impairment of the upper rather than the lower extremities, bladder dysfunction, and varying degrees of sensory loss below the level of the lesion. 22 patients with ACCSCI (upper limbs type) after traumatic cervical cord injury are presented. We used a new quantitative estimation scale of both sensory and motor function. 21 patients who were treated conservatively had a good prognosis for neurologic and functional improvement. Younger age group made a quick and good recovery of both sensory and motor function when compared with older age group. A 56-year-old man with OPLL who developed delayed neurological dysfunction after good recovery underwent an anterior decompression and anterior fusion.

Vascular insufficiency of the cervical cord due to hyperextension of the spine

A patient with acute transverse myelopathy after minor trauma due to hyperextension of the neck is reported. The pattern of neurologic deficit favors the diagnosis of acute central cervical spinal cord syndrome. The proposed causative mechanism is temporary vascular insufficiency of the spinal cord. The architecture of vascular supply of the spinal cord and specific cerebrospinal fluid abnormalities in this patient are compatible with the diagnosis. The differential diagnosis of traumatic vascular spinal cord lesions is discussed.

Hyperextension dislocation of the cervical spine.

The purpose of this report is to describe hyperextension dislocation of the cervical spine and to illustrate its often subtle radiographic features. An analysis of the lateral cervical spine radiographs in 20 patients with hyperextension dislocation of the cervical spine revealed the combination of diffuse prevertebral soft-tissue widening together with normally aligned cervical vertebrae in all patients with this injury. In six (30%) of 20 patients, this combination of findings was the only radiographic sign. The precise level of dislocation was indicated by a thin, transversely oriented avulsion fracture fragment arising from the anterior aspect of the inferior end-plate of the dislocated vertebra in 13 (65%) of 20 patients, by a vacuum defect in the intervertebral disk subjacent to the dislocated vertebra in three (15%), by a widened intervertebral disk space in three (15%), and by comminuted fracture of the spinous process in one (5%). Clinically, all 20 patients had facial trauma and all had some manifestation of the acute central cervical spinal cord syndrome.

Surgical Result of Acute Central Cervical Spinal Cord Injury

Surgical Result of Acute Central Cervical Spinal Cord Injury

Acute central cervical spinal cord syndrome

Two cases of the acute central cervical spinal cord syndrome are presented. A 63-year-old diabetic hypertensive man manifested the syndrome as a result of atraumatic ischemia of the cord. A 32-year-old health man developed it after sustaining a hyperextension injury in a baseball game. The pathogenesis and pathophysiology of this entity are reviewed. Knowledge of this entity is of major importance in the analysis and management of head and neck trauma, as well as in the recognition and management of atraumatic neurologic dysfunction due to ischemia, hemorrhage, or thrombosis.

Acute Central Cervical Spinal Cord Syndrome Treated by Acupuncture and Electrical Stimulation (AES)

Twelve cases of acute central cervical spinal cord syndrome were treated by acupuncture and electrical stimulation. The paraesthesia, as well as movements of the hand and upper extremities, were greatly improved immediately after each treatment.

Acute central cervical spinal cord syndrome--aetiology, age incidence and relationship to the orthopaedic injury.

A series of 99 cases of acute central cervical spinal cord syndrome is reviewed. This represents 25% of all acute cervical spinal cord injuries (excluding stabs and gunshots), admitted to the Spinal Cord Injury Centre, Conradie Hospital during an 8-year period (November 1963 to December 1971). Aetiology, age incidence and relationship to injury is discussed.

CENTRAL ACUTE TRAUMATIC SYNDROME OF THE CERVICAL SPINAL CORD

São relatados dois casos de síndrome traumática central aguda da medula cervical, sendo comentados os aspectos clínicos e fisiopatogênicos e ressaltado o valor prático do seu conhecimento.

Vertebral artery insufficiency in acute and chronic spinal trauma, with special reference to the syndrome of acute central cervical spinal cord injury.

OR many years surgeons have been puzzled by the fact that some patients with injuries of the cervical spine have sustained severe neurological deficit without alteration in the alignment of the bony spine. This neurological disability frequently has followed a definite pattern which was described several years ago as the acute central cervical spinal cord injury syndrome. It was thought that this syndrome resulted from a certain type of cervical cord contusion. However, careful neurological evaluation of subsequent eases has suggested that this syndrome also may be caused by a second mechanism, namely, one of partial or relative insu:fieieney of the vertebral artery to the cervical spinal cord. In this paper 4 cases are presented to demonstrate the mechanisms involved and to support the evolution of these concepts. CONTUSION In 1948 Taylor and Blackwood -s discussed

The syndrome of acute central cervical spinal cord injury.

The syndrome of acute central cervical spinal cord injury.

The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine.

The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine.