Case Of Complete Paraplegia Research Articles

The outcome of surgical resection in complete paraplegia patient due to thoracic schwannoma

Spinal schwannoma is the most common benign intradural spinal tumor. However, studies regarding the neurological outcome of tumor resection in complete paraplegia patients are still lacking. The authors report a case of complete paraplegia due to primary intradural extramedullary low-grade schwannoma of the spinal cord. Surgery was performed 5 weeks after the paraplegia complaint first occurred. The patient did not regain motor nor sensory function in the 1-month follow-up but resolution of pain was achieved. The patient was able to perform daily activity more comfortably. In the event of complete paraplegia, surgery should still be offered promptly as it can still benefit the patient. Possible factors that could have influenced the prognosis in our study are discussed.

Intra thoracic extra pulmonary supra apical tuberculoma in Pott's disease: A case report and review of literatures

Background: Spinal tuberculosis is one of the commonest forms of skeletal tuberculosis in India. It accounts for about 50 % of osteo-articular tuberculosis. Spinal tuberculosis causes significant morbidity in Indian Population. Often patients present with Pott’s disease related paraplegia attended by "destruction of vertebral body, lamina, pedicle and spinous process with perivertebral abscess". Huge intra-thoracic extra-pulmonary extra-plural supra- apical tuberculoma due to extension of spinal tuberculosis is not reported yet. We describe here such a case of complete paraplegia with huge chest mass and its successful management. Case Description: A 20 years young male presented with upper thoracic Pott’s paraplegia showing involvement of D1-D3 vertebra with their left pedicle , part of lamina , costo-vertebral and costo-transverse joint with a huge intra thoracic extra-pulmonary supra apical granular tuberculoma mimicking apical tumor. The patient was managed by a posterior “T” shaped vertical midline approach with debridement and decompression of spinal cord and excision of intra thoracic supra apical tuberculoma extra-pleurally. He was administered ATT perioperatively. Postoperatively he followed up for 1 year and now able to walk, run and play normally as before. Conclusion: Pott’s spine may present with intra-thoracic extra-pleural mass which can be managed by posterior costo-transversectomy and laminectomy. So proper assessment of disease and early need full surgical intervention with anti tubercular therapy can control severe morbidity and disability.

Paraplegia after mastoidectomy under general anesthesia

We report a case of complete paraplegia after general anesthesia for a right tympanomastoidectomy without any apparent predisposing factors related to the surgical procedure or the anesthetic. The case raises the possibility that the combination of neck rotation and relative hypotension may precipitate paraplegia in patients with preexisting spinal chord pathology.

Comparison between anterior and posterior surgical treatments of thoracolumbar burst fractures

目的 评价前、后路手术治疗胸腰段爆裂骨折的效果及特点.方法 1999年9月～2004年11月,对43例平均年龄为30.4岁的胸腰椎爆裂骨折患者根据伤情选择手术方式,17例采用前路手术,26例采用后路手术.术前神经功能按Frankel分级评定:A级3例,B级12例,C级19例,D级9例.结果所有患者获平均36.7个月(8～51个月)随访.术后伤口均一期愈合,未出现神经损伤症状加重等严重并发症.除3例完全性截瘫患者神经功能无变化外,其余病例均获较明显改善,前、后路手术Frankel分级分别改善1.6、1.3级.结论前、后路手术各有其特点,前路手术减压更为充分,术后脊柱序列维持较好。

Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting.

A retrospective clinical study was performed. To study clinical and radiologic late results after posterior stabilization of thoracolumbar fractures with internal fixator and interbody fusion via transpedicular bone grafting. The posterior approach, using an internal fixator, is a standard procedure for stabilizing the injured thoracolumbar spine. Transpedicular bone grafting was invented by Daniaux in 1986 for achieving an interbody fusion. Pedicle screw fixation with additional transpedicular fusion has remained controversial because of inconsistent reports and a lack of late results. Between January 1989 and July 1992, 76 patients with thoracolumbar fractures were operatively treated, and after a mean of more than 3 years, 56 of 62 patients (90%) still alive who had their implants removed were examined. According to the Magerl classification, 33 patients sustained Type A, 13 Type B, and 10 Type C fractures. Three patients with incomplete paraplegia returned to normal. In one case of complete paraplegia, no change occurred. The mean operative time was 3 hours. In this study, two complications (3.6%) were observed: one iatrogenic vertebral arch fracture without consequences and one deep infection. Compared with the preoperative status, follow-up examinations demonstrated permanent physical and social sequelae: The percentage of individuals able to do physical labor was reduced by half (22 to 11 patients), whereas the share of unemployed or retired patients doubled (4 to 8 patients). At the time of follow-up examination, only 21 of 42 patients continued in sports. The assessment of reported problems and functional outcome with the Hannover spine score reflected a significant difference between the status before injury (96.6/100 points) and at the time of follow-up evaluation (71. 4/100 points) (P < 0.001).The radiographic assessment in the lateral plane (Cobb technique) demonstrated a significant (P < 0.001) mean restoration from an initial angle of -15.6 degrees (kyphosis) to +0. 4 degrees (lordosis). Serial postoperative radiographic follow-up assessment showed progressive loss of correction. At follow-up examination, a mean difference from the postoperative angle of 10.1 degrees was found (P < 0.001). Compared with the preoperative deformity, a mean improvement of 6.1 degrees (average, -9.7 degrees ) at follow-up examination was noted. The addition of transpedicular cancellous bone grafting did not decrease the loss of correction. Computed tomography scans after implant removal were performed in nine cases: Only three of nine patients showed evidence of intervertebral fusion. No correlation could be found between the Magerl classification and radiographic outcome. However, the preoperative wedge angle of the vertebral body correlated significantly with the postoperative loss of reduction. Because of the disappointing results from this study, the authors cannot recommend the additional transpedicular cancellous bone grafting as an interbody fusion technique after posterior stabilization in cases of complete or incomplete burst injury to the vertebral body.

4-Aminopyridine in Chronic Spinal Cord Injury: A Controlled, Double-Blind, Crossover Study in Eight Patients

The potassium channel blocking drug 4-aminopyridine (4-AP) was administered to eight patients with chronic spinal cord injury, in a therapeutic trial based on the ability of the drug to restore conduction of impulses in demyelinated nerve fibers. The study was performed using a randomized, double-blind, crossover design, so that each patient received the drug and a vehicle placebo on different occasions, separated by 2 weeks. Drug and placebo were delivered by infusion over 2 h. An escalating total dose from 18.0 to 33.5 mg was used over the course of the study. Subjects were evaluated neurologically before and after the infusion. Two subjects returned for a second trial after 4 months and were examined daily for 3 to 4 days following drug infusion. Side effects were consistent with previous reports. Administration of the drug was associated with significant temporary neurologic improvement in five of six patients with incomplete spinal cord injury. No effect was detected in two cases of complete paraplegia and one of two severe incomplete cases (Frankel class B). Improvements in neurologic status following drug administration included increased motor control and sensory ability below the injury, and reduction in chronic pain and spasticity. The effects persisted up to 48 h after infusion of the drug, and patients largely returned to preinfusion status by 3 days. Compared with the more rapid elimination of the drug, these prolonged neurologic effects appear to involve a secondary response and are probably not a direct expression of potassium channel blockade.

Effects of applied electric fields on clinical cases of complete paraplegia in dogs

A clinical trial of applied, slowly oscillating, weak electric fields was performed in dogs with naturally occurring spinal cord injuries due to intervertebral disc herniation. Criteria for admission to the study were: complete paraplegia, defined by neurological examination and electrophysiological testing; intact segmental reflexes; radiologic and myelographic evidence of spinal cord compression due to disc herniation and a focal lesion, without appreciable rostrocaudal spread of necrosis; weight less than 16 kg; onset of paralysis less than 1 month before surgery. The injured cord was exposed by laminectomy, and decompressed by aspiration of disc material. Active (n = 13) or sham (n = 11) stimulators were implanted subcutaneously, with platinum/iridium electrodes sutured to muscle several millimeters above the cord surface, at either end of the laminectomy site. Active stimulators delivered 200 μA of direct current, switching polarity every 15 min, for 3, 6, or 15 weeks. Neurological and electrophysiological examinations were repeated approximately 6 weeks and 6 months after implantation. Few complications were noted. None were attributable to current application. The group of dogs with active stimulators showed greater improvement in function than the group with sham implants, with a trend towards greater recovery in all neurological measures, and evoked potentials. The combined neurological score derived from these separate tests was significantly different from controls at 6 weeks and 6 months (P < 0.05). Application of slowly oscillating electric fields thus appears to be beneficial in the treatment of paraplegia in dogs.