Central Cord Research Articles

Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013.

The causes and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency. Our goal is to describe demographics, incidence, cause, spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures. A retrospective review was carried out of the Nationwide Inpatient Sample. International Classification of Disease, Ninth Revision E-codes identified trauma cases from 2005 to 2013. Patients with cervical fracture were isolated. Demographics, incidence, cause, fracture levels, concurrent injuries, surgical procedures, and complications were analyzed. t tests elucidated significance for continuous variables and χ2 for categorical variables. Level of significance was P < 0.05. A total of 488,262 patients were isolated (age, 55.96 years; male, 60.0%; white, 77.5%). Incidence (2005, 4.1% vs. 2013, 5.4%), Charlson Comorbidity Index (2005, 0.6150 vs. 2013, 1.1178), and total charges (2005, $71,228.60 vs. 2013, $108,119.29) have increased since 2005, whereas length of stay decreased (2005, 9.22 vs. 2013, 7.86) (all P<0.05). The most common causes were motor vehicle accident (29.3%), falls (23.7%), and pedestrian accidents (15.7%). The most frequent fracture types were closed at C2 (32.0%) and C7 (20.9%). Concurrent injury rates have significantly increased since 2005 (2005, 62.3% vs. 2013, 67.6%). Common concurrent injuries included fractures to the rib/sternum/larynx/trachea (19.6%). Overall fusion rates have increased since 2005 (2005, 15.7% vs. 2013, 18.0%), whereas decompressions and halo insertion rates have decreased (all P < 0.05). SCIs have significantly decreased since 2005, except for upper cervical central cord syndrome. Complication rates have significantly increased since 2005 (2005, 31.6% vs. 2013, 36.2%). Common complications included anemia (7.7%), mortality (6.6%), and acute respiratory distress syndrome (6.6%). Incidence, complications, concurrent injuries, and fusions have increased since 2005. Length of stay, SCIs, decompressions, and halo insertions have decreased. Indicated trends should guide future research in management guidelines.

Chapter 2 - The cerebrospinal fluid and barriers – anatomic and physiologic considerations

The cerebrospinal fluid (CSF) space consists of the intracerebral ventricles, subarachnoid spaces of the spine and brain (e.g., cisterns and sulci), and the central spinal cord canal. The CSF protects the central nervous system (CNS) in different ways involving metabolic homeostasis, supply of nutrients, functioning as lymphatic system, and regulation of intracranial pressure. CSF is produced by the choroid plexus, brain interstitium, and meninges, and it circulates in a craniocaudal direction from ventricles to spinal subarachnoid space from where it is removed via craniocaudal lymphatic routes and the venous system. The CSF is renewed 3-5 times daily and its molecular constituents are mainly blood-derived (80%), while the remainder consists of brain-derived and intrathecally produced molecules (20%). The CSF space is separated from the vascular system by the blood-CSF barrier (BCB), whereas the blood-brain barrier (BBB), responsible for maintaining the homeostasis of the brain, is located between brain parenchyma and vascular system. Although both barriers have similar functions, they differ with regard to their morphologic and functional properties. Both barrier systems are permeable not only for small molecules, but also for macromolecules and circulating cells. The transport of molecules across the BBB and BCB is regulated by passive diffusion (e.g., albumin, immunoglobulins) and facilitated or active transport (e.g., glucose). The extracellular space volume, potassium buffering, CSF circulation, and interstitial fluid absorption are mainly regulated by aquaporin-4 channels, which are abundantly located at the blood-brain and brain-CSF interfaces. The composition of CSF shows a high dynamic range, and the levels of distinct proteins vary due to several influencing factors, such as site of production (brain or blood-derived), site of sampling (ventricular or lumbar), CSF flow rate (BCB function), diurnal fluctuations of CSF production rate, and finally, molecular size of blood-derived proteins (IgM vs. albumin) and circadian rhythm (glucose, prostaglandin D synthase). Alterations of lumbar CSF are mainly influenced by processes of the CNS located adjacent to the ventricular and spinal CSF space and less by pathologies in cortical areas remote from the ventricles.

Spinal cord injury associated with cervical spinal canal stenosis: Outcomes and prognostic factors

ObjectivesTo specify outcomes and identify prognostic factors of neurologic and functional recovery in patients with an acute traumatic spinal cord injury (SCI) associated with cervical spinal canal stenosis (SCS), without spinal instability. MethodsA retrospective study was conducted using data from a Regional Department for SCI rehabilitation in France. A description of the population characteristics, clinical data and neurological and functional outcomes of all patients treated for acute SCI due to cervical trauma associated with SCS was performed. A statistical analysis provided insights into the prognostic factors associated with the outcomes. ResultsSixty-three patients (mean age 60.1 years) were hospitalized for traumatic SCI with SCS and without instability between January 2000 and December 2012. Falls were the most frequent cause of trauma (77.8%). At admission, most patients had an American Spinal Injury Association Impairment Scale (AIS) grade of C (43.3%) or D (41.7%) and the most frequent neurological levels of injury were C4 (35.7%) and C5 (28.6%). Clinical syndromes were frequently identified (78.6%), with the most frequent being the Brown-Sequard plus syndrome (BSPS) (30.9%), followed by central cord syndrome (CCS, 23.8%). Almost 80% of survivors returned to the community, 60% were able to walk and 75% recovered complete voluntary control of bladder function. Identified prognostic factors of favourable functional outcomes were higher AIS at admission, age under 60 years and presence of BSPS or CCS. ConclusionTraumatic SCI, associated with SCS results mostly in incomplete injuries, can cause various syndromes and is associated with favourable functional outcomes.

Neuronal Plasticity after Repetitive Transcranial Magnetic Stimulation in Patients with Central Cord Syndrome

To delineate the effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on the recovery of upper extremity in patients with central cord syndrome (CCS).

TH.O.17 - Whole-body rescue of Pompe disease with AAV liver delivery of engineered secretable GAA transgenes

Pompe disease is a severe neuromuscular disorder caused by mutations in the lysosomal enzyme acid a-glucosidase (GAA), which result in the pathological accumulation of glycogen in all tissues. Enzyme replacement therapy (ERT) is available for Pompe disease, however it has limited efficacy, high immunogenicity, and fails to correct nervous tissue and muscle groups refractory to cross-correction. Using bioinformatics analysis and protein engineering, we developed secretable GAA transgenes for enhanced cross-correction of Pompe disease via adeno-associated virus (AAV) vector liver gene transfer. Pompe mice were treated with AAV vectors optimized for hepatic expression of secretable GAA transgenes and followed for up to 10 months. Gene transfer resulted in dose- and time- dependent whole-body correction of biochemical and functional defects in muscle, central nervous system and spinal cord, with normalization of cardiac hypertrophy, muscle and respiratory function, and survival undistinguishable from wild-type littermates. In these experiments, secretable GAA transgenes showed superior therapeutic efficacy and markedly low immunogenicity compared with their native GAA counterpart. Scale-up to non-human primates, and modeling of GAA expression in primary hepatocytes using hepatotropic AAV vector serotypes, demonstrate the therapeutic potential of AAV vector-mediated liver expression of secretable GAA transgenes, supporting the feasibility of the approach in Pompe patients.

Usefulness of repetitive transcranial magnetic stimulation for the recovery of central cord syndrome

Objectives Repetitive transcranial magnetic stimulation (rTMS) can modulate neuronal circuits and also enhance spinal cord plasticity. Our aim of this study was to delineate the effect of rTMS on the functional recovery of upper extremity in patients with incomplete spinal cord injury, especially central cord syndrome (CCS), and detect the changes of spinal cord tracts crossing the lesion by diffusion tensor imaging (DTI). Method Fourteen patients with CCS, which level of injury was between C4 to C6, were performed rTMS with high frequency (20Hz) over the unilateral motor cortex for 5 days as well as the conventional occupational therapy. The non-treated side of each subject was used as control. We assessed the neurological status using International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI), and functional status of upper extremities using the Jebsen hand function and O'conner finger dexterity tests twice; before treatment, and 1 month after treatment. DTI was performed on the injured cervical spinal cord, obtained fractional anisotrophy (FA), apparent diffusion coefficient (ADC) at each level, and calculate imaginary spinal cord tracts of each subject. Results The neurological status of the upper extremity motor score in the treated side using ISNCSCI was improved in all subjects otherwise only 10 of 14 subjects (71.4%) showed some improvements of non-treated side at 1 month after treatment. The functional status including the writing score of Jebsen hand function test were also significantly improved more in treated side in comparison with non-treated side at 1 month. The FA values and the number of imaginary spinal cord tracts of treated side at the injured level were also increased more than those of non-treated side in the same subjects. Any side effects such as seizure, severe headache, nausea or vision problem was not observed during rTMS treatment and follow-up period. Conclusions The high frequency rTMS was effective to improve the neurological and functional status of CCS patients and might increase the spinal cord plasticity without any serious side effects.

Translational Advances in the Management of Acute Spinal Cord Injury

Translational Advances in the Management of Acute Spinal Cord Injury

Sacral Neuromodulation for Fecal Incontinence: A Review of the Central Mechanisms of Action.

Fecal incontinence (FI) has a devastating effect on the quality of life and results in social isolation. Sacral neuromodulation (SNM) is proven to be an effective, minimal invasive treatment modality for FI. Despite the increasing application of SNM, the exact mechanisms of action remain unclear. The initial assumption of peripheral motor neurostimulation is not supported by increasing evidence, which report effects of SNM outside the pelvic floor. A new hypothesis states that afferent signals to the brain are essential for a successful therapy. This study aimed to review relevant studies on the central mechanism of SNM in FI. Clinical and experimental studies on the central mechanisms, both brain and spinal cord, of SNM for FI up to December 2015 were evaluated. In total, 8 studies were found describing original data on the central mechanism of SNM for FI. Four studies evaluated the central effects of SNM in a clinical setting and 4 studies evaluated the central effects of SNM in an experimental animal model. Results demonstrated a variety of (sub)cortical and spinal changes after induction of SNM. Review of literature demonstrated evidence for a central mechanism of action of SNM for FI. The corticoanal pathways, brainstem, and specific parts of the spinal cord are involved.

Timing of Decompression in Patients With Acute Spinal Cord Injury: A Systematic Review.

Study Design:Systematic review.Objective:To conduct a systematic review and synthesis of the literature to assess the comparative effectiveness, safety, and cost-effectiveness of early (≤24 hours) versus late decompression (>24 hours) in adults with acute spinal cord injury (SCI).Methods:A systematic search was conducted of Medline, EMBASE, the Cochrane Collaboration Library, and Google Scholar to identify studies published through November 6, 2014. Studies published in any language, in humans, and with an abstract were considered for inclusion. Included studies were critically appraised and the overall strength of evidence was determined using methods proposed by the Grading of Recommendation Assessment, Development and Evaluation working group.Results:The search yielded 449 potentially relevant citations. Sixteen additional primary studies were identified through other sources. Six studies met inclusion criteria. All but 2 studies were considered to have moderately high risk of bias. Across studies and injury levels, the impact of early surgical decompression (≤24 hours) on clinically important improvement in neurological status was variable. Isolated studies reported statistically significant and clinically important improvements at 6 months (cervical injury, low strength of evidence) and following discharge from inpatient rehabilitation (all levels, very low strength of evidence) but not at other time points; another study observed a statistically significant 6 point improvement in ASIA Impairment Scale (AIS) among patients with AIS B, C, or D, but not for those with AIS A (very low strength of evidence). In one study of acute central cord syndrome without instability, a clinically and statistically meaningful improvement in total motor scores was reported at 6 and 12 months in patients treated early (versus late). There were, however, no significant differences in AIS improvement between early and late surgical groups at 6- or 12-months (very low strength of evidence). One of 3 studies found a shorter length of hospital stay associated with early surgical decompression. Of 3 studies reporting on safety, no significant differences in rates of complications (including mortality, neurologic deterioration, pneumonia or pressure ulcers) were noted between early and late decompression groups.Conclusions:Results surrounding the efficacy of early versus late decompressive surgery, as well as the quality of evidence available, were variable depending on the level of SCI, timing of follow-up, and specific outcome considered. Existing evidence supports improved neurological recovery among cervical SCI patients undergoing early surgery; however, evidence regarding remaining SCI populations and clinical outcomes was inconsistent.

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus &gt;24 Hours) of Decompressive Surgery

Objective:To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome.Methods:A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as “we recommend,” whereas a weak recommendation is presented as “we suggest.”Results:Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation; (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery; and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: “We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome” and “We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level.” Quality of evidence for both recommendations was considered low.Conclusions:These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions.

Spinal Cord Injury-What Are the Controversies?

Traumatic spinal cord injuries have a tremendous impact on individuals, families, and society as a whole. Substantial heterogeneity in the patient population, their presentation and underlying pathophysiology has sparked debates along the care spectrum from initial assessment to definitive treatment. This article reviews spinal cord injury (SCI) management followed by a discussion of the salient controversies in the field. Current care practices modeled on the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint section guidelines are highlighted including key recommendations regarding immobilization, avoidance of hypotension, early International Standards for Neurological Classification of SCI examination and intensive care unit treatment. From a diagnostic perspective, the evolving roles of CT, MRI, and leading-edge microstructural MRI techniques are discussed with descriptions of the relevant clinical literature for each. Controversies in management relevant to clinicians including the timing of surgical decompression, methylprednisolone administration, blood pressure augmentation, intraoperative electrophysiological monitoring, and the role of surgery in central cord syndrome and pediatric SCI are also covered in detail. Finally, the article concludes with a reflection on clinical trial design tailored to the heterogeneous population of individuals with SCI.

Poster 297: Central Cord Syndrome in Third-Trimester Pregnancy: A Case Report

Poster 297: Central Cord Syndrome in Third-Trimester Pregnancy: A Case Report

Quantifying the structure of the chorionic vascular tree with central and eccentric cord insertion

Quantifying the structure of the chorionic vascular tree with central and eccentric cord insertion

Intermittent apnea elicits inactivity-induced phrenic motor facilitation via a retinoic acid- and protein synthesis-dependent pathway.

Respiratory motoneuron pools must provide rhythmic inspiratory drive that is robust and reliable, yet dynamic enough to respond to respiratory challenges. One form of plasticity that is hypothesized to contribute to motor output stability by sensing and responding to inadequate respiratory neural activity is inactivity-induced phrenic motor facilitation (iPMF), an increase in inspiratory output triggered by a reduction in phrenic synaptic inputs. Evidence suggests that mechanisms giving rise to iPMF differ depending on the pattern of reduced respiratory neural activity (i.e., neural apnea). A prolonged neural apnea elicits iPMF via a spinal TNF-α-induced increase in atypical PKC activity, but little is known regarding mechanisms that elicit iPMF following intermittent neural apnea. We tested the hypothesis that iPMF triggered by intermittent neural apnea requires retinoic acid and protein synthesis. Phrenic nerve activity was recorded in urethane-anesthetized and -ventilated rats treated intrathecally with an inhibitor of retinoic acid synthesis (4-diethlyaminobenzaldehyde, DEAB), a protein synthesis inhibitor (emetine), or vehicle (artificial cerebrospinal fluid) before intermittent (5 episodes, ~1.25 min each) or prolonged (30 min) neural apnea. Both DEAB and emetine abolished iPMF elicited by intermittent neural apnea but had no effect on iPMF elicited by a prolonged neural apnea. Thus different patterns of reduced respiratory neural activity elicit phenotypically similar iPMF via distinct spinal mechanisms. Understanding mechanisms that allow respiratory motoneurons to dynamically tune their output may have important implications in the context of respiratory control disorders that involve varied patterns of reduced respiratory neural activity, such as central sleep apnea and spinal cord injury.NEW & NOTEWORTHY We identify spinal retinoic acid and protein synthesis as critical components in the cellular cascade whereby repetitive reductions in respiratory neural activity elicit rebound increases in phrenic inspiratory activity.

Recurrent Neurological Deterioration after Conservative Treatment for Acute Traumatic Central Cord Syndrome without Bony Injury: Seventeen Operative Case Reports.

The mechanisms of late recurrent neurological deterioration after conservative treatment for acute traumatic central cord syndrome (ATCCS) remain unclear. Seventeen operative cases sustaining late recurrent neurological deterioration after conservative treatment for ATCCS were reviewed to investigate the mechanisms. The assessment of neurological status was based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Gender, age, cause of injury, results of image, conservative treatment and operative data, and neurological status at different time points were recorded. The mean age of 17 patients was 43.8 ± 2.3 years old, and the causes of the cervical injury were 14 vehicle accidents and 3 falls. The neurological deficits of 17 patients on admission were not serious, and patients recovered quickly after conservative treatment. No fractures or dislocation were found in any patient's radiographs or CT scan images. All 17 patients performed first MRI test in 4 days and there was a slight or mild compression on the spinal cord in 16 patients. Eight patients had a second MRI scan ∼6 weeks later, which showed that there was aggravated compression on the spinal cord in six patients. All patients underwent an anterior approach to cervical decompression and internal fixation operation. During the operation, there were loose discs found in all 17 patients, obvious ruptures of disks found in 3 patients, obvious ruptures of anterior longitudinal ligaments (ALLs) found in 8 patients, and obvious ruptures of posterior longitudinal ligaments (PLLs) found in 7 patients. There was serious adhesion between PLLs and cervical disks in 12 patients. In five patients, partial ossification of PLLs was detected. All patients had a good neurological outcome at 6 month follow-up. Ruptures of ALLs, PLLs, and discs resulting in cervical instability and secondary compression on the spinal cord were important causes for recurrent neurological deterioration after conservative treatment for ATCCS. With timely spinal decompression after recurrent neurological deterioration, patients could achieve a good neurological outcome.

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

Abstracts from The 35th Annual National Neurotrauma Symposium July 7-12, 2017 Snowbird, Utah.

Abstracts from The 35th Annual National Neurotrauma Symposium July 7-12, 2017 Snowbird, Utah.

The impact of spine stability on cervical spinal cord injury with respect to demographics, management, and outcome: a prospective cohort from a national spinal cord injury registry

Background ContextEmergent surgery for patients with a traumatic spinal cord injury (SCI) is seen as the gold standard in acute management. However, optimal treatment for those with the clinical diagnosis of central cord syndrome (CCS) is less clear, and classic definitions of CCS do not identify a unique population of patients. PurposeThe study aimed to test the authors' hypothesis that spine stability can identify a unique group of patients with regard to demographics, management, and outcomes, which classic CCS definitions do not. Study Design/SettingThis is a prospective observational study. Patient SampleThe sample included participants with cervical SCI included in a prospective Canadian registry. Outcome MeasuresThe outcome measures were initial hospitalization length of stay, change in total motor score from admission to discharge, and in-hospital mortality. MethodsPatients with cervical SCI from a prospective Canadian SCI registry were grouped into stable and unstable spine cohorts. Bivariate analyses were used to identify differences in demographic, injury, management, and outcomes. Multivariate analysis was used to better understand the impact of spine stability on motor score improvement. No conflicts of interest were identified. ResultsCompared with those with an unstable spine, patients with cervical SCI and a stable spine were older (58.8 vs. 44.1 years, p<.0001), more likely male (86.4% vs. 76.1%, p=.0059), and have more medical comorbidities. Patients with stable spine cervical SCI were more likely to have sustained their injury by a fall (67.4% vs. 34.9%, p<.0001), and have high cervical (C1–C4; 58.5% vs. 43.3%, p=.0009) and less severe neurologic injuries (ASIA Impairment Scale C or D; 81.3% vs. 47.5%, p<.0001). Those with stable spine injuries were less likely to have surgery (67.6% vs. 92.6%, p<.0001), had shorter in-hospital lengths of stay (median 84.0 vs. 100.5 days, p=.0062), and higher total motor score change (20.7 vs. 19.4 points, p=.0014). Multivariate modeling revealed that neurologic severity of injury and spine stability were significantly related to motor score improvement; patients with stable spine injuries had more motor score improvement. ConclusionsWe propose that classification of stable cervical SCI is more clinically relevant than classic CCS classification as this group was found to be unique with regard to demographics, neurologic injury, management, and outcome, whereas classic CCS classifications do not . This classification can be used to assess optimal management in patients where it is less clear if and when surgery should be performed.

Servikal dar kanal hastalarında radyolojik travma bulgusu olmaksızın servikal omurilik yaralanması: Ardışık 15 olgunun değerlendirilmesi

Objective: Cervical spinal canal stenosis is a well-known risk factor for spinal cord injury. In some patients, spinal cord injury is the first symptom of spinal stenosis. Therefore, some authors recommend preventive decompression of the spinal canal in asymptomatic patients with spinal stenosis. In this study, we aimed to determine the outcome of patients with spinal cord injury associated with cervical spinal canal stenosis and the rate of previously asymptomatic patients. Material and Methods: Data of 15 consecutive patients were evaluated. Improvement of neurological deficits during follow-up was accepted as good outcome and mortality and unchanging neurological deficits were accepted as worse outcome. Results: All patients were male, aged between 44 and 85 years. High-energy traumas caused injury in 7 of the cases and low-energy traumas in the others. Nine cases had central cord injury and 6 had other types of traumas. Only 2 patients had been diagnosed with minor symptoms associated with cervical canal stenosis before trauma, while the other patients had been asymptomatic. One patient did not consent to undergo an operation and two others could not be operated because of their general status; the latter 2 patients died. The other 12 patients were decompressed 0 to 40 days after trauma. Two other patients with severe transverse-type cord injury also died postoperatively. The other patients were followed for 1 to 48 months (22.7±17.7 months). In 2 patients, neurological deficits had not improved on last follow-up. Deficits had completely or partly improved in the other patients, including the one who had not accepted the operation. Central cord injury had a significantly better prognosis than other types (p=0.0019). Age, cervical canal diameter, and motor and sensory scores of the American Spinal Injury Association scale, type of trauma, and level of spinal cord injury were not significantly different in the patients with good and worse prognosis. Conclusion: The rate of asymptomatic patients before trauma was very high in patients with spinal cord injury associated with cervical spinal canal stenosis. Therefore, the treatment decision must be carefully assessed in asymptomatic cervical spinal stenosis patients. Catastrophic consequences of spinal trauma may be seen in patients with cervical spinal canal stenosis even in asymptomatic patients. Central cord syndrome had a good prognosis in these patients. Other types of injuries such as transverse and motor types had a worse outcome.

Evaluation of the impact of vasa previa on feto-placental hormonal synthesis and fetal growth

IntroductionA vasa previa (VP) refers to aberrant chorionic vessels which can either connect the chorionic plate to a velamentous cord (type I) or a succenturiate or accessory lobe to the main placental mass (type II). MethodsWe performed retrospective cohort study of 32 singleton pregnancies diagnosed with VP. The levels of maternal serum alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and unconjugated estriol (uE3) were measured at 15–18 weeks as part of the triple test screening for Trisomy 21. The data were subdivided according to the type of VP and compared with those of a control group with central cord insertion and no succenturiate or accessory placental lobe. ResultsTwenty one (65.6%) parturient women presented with VP type I and 11 (34.4%) with VP type II. The mean birthweight and placental weight was significantly higher in pregnancies with VP type II than in pregnancies with VP with VP type I (3037.3±400.9 gr vs 2493.5±491.6 gr; p=0.004 and 511.0±47.2 gr vs 367.1±64.3 gr; p<0.0001; respectively). The mean hCG level in VP type II was significantly (p<0.001) higher than those with type I (2.38MoM vs 1.17MoM) and compared to controls (2.38MoM vs 0.99MoM). ConclusionsThere is no obvious impact on both placental and fetal growth in VP type II. By contrast, VP type I is associated with slower feto-placental growth secondary to impaired development and biological functions of the placenta during the first half of pregnancy.