Cervical Cord Injury Research Articles

Cervical Spinal Cord, Root, and Bony Spine Injuries

The aim of this study was to characterize cervical cord, root, and bony spine claims in the American Society of Anesthesiologists Closed Claims database to formulate hypotheses regarding mechanisms of injury. All general anesthesia claims (1970-2007) in the Closed Claims database were searched to identify cervical injuries. Three independent teams, each consisting of an anesthesiologist and neurosurgeon, used a standardized review form to extract data from claim summaries and judge probable contributors to injury. Cervical injury claims (n = 48; mean ± SD age 47 ± 15 yr; 73% male) comprised less than 1% of all general anesthesia claims. When compared with other general anesthesia claims (19%), cervical injury claims were more often permanent and disabling (69%; P < 0.001). In addition, cord injuries (n = 37) were more severe than root and/or bony spine injuries (n = 10; P < 0.001), typically resulting in quadriplegia. Although anatomic abnormalities (e.g., cervical stenosis) were often present, cord injuries usually occurred in the absence of traumatic injury (81%) or cervical spine instability (76%). Cord injury occurred with cervical spine (65%) and noncervical spine (35%) procedures. Twenty-four percent of cord injuries were associated with the sitting position. Probable contributors to cord injury included anatomic abnormalities (81%), direct surgical complications (24% [38%, cervical spine procedures]), preprocedural symptomatic cord injury (19%), intraoperative head/neck position (19%), and airway management (11%). Most cervical cord injuries occurred in the absence of traumatic injury, instability, and airway difficulties. Cervical spine procedures and/or sitting procedures appear to predominate. In the absence of instability, cervical spondylosis was the most common factor associated with cord injury.

Enteral nutrition in mechanically ventilated patients with cervical spinal cord injury

The aim of this study was to assess the adequacy of nutrition provision to mechanically ventilated patients in the acute phase after cervical cord injury. High spinal cord injury is associated with reduced gastric emptying due to excessive sympathetic activity from the isolated thoracolumbar cord [1], which is believed to compromise nasogastric delivery of nutrition and worsen clinical outcomes. However, the success of feeding early after high spinal cord injury has not been formally evaluated.

Enteral nutrition in cervical cord injury—A retrospective cohort study

Enteral nutrition in cervical cord injury—A retrospective cohort study

Body Adipose Content is Independently Associated With a Higher Risk of Organ Failure and Nosocomial Infection in the Nonobese Patient Postinjury

Obesity defined by a body mass index (BMI) >30 kg/m is associated with increased morbidity and mortality following trauma. Evidence suggests that obesity represents a state of chronic inflammation and that the adipose tissue content may affect the intensity and resolution of inflammatory response. We sought to avoid the confounding effects attributable to obesity and determine the association of BMI and outcomes following injury in nonobese patients. Data were obtained from a multicenter prospective cohort study evaluating outcomes in blunt-injured adults with hemorrhagic shock. Only patients with a BMI≥18.5 and<30 were analyzed. Those with isolated traumatic brain injury and cervical cord injury and those who survived<24 hours were excluded. Logistic regression was used to evaluate the effects of BMI on mortality, multiple organ failure (MOF, multiple organs dysfunction score [MODS]>5), and nosocomial infection (NI) after adjusting for differences in demographics, injury severity, early resuscitation needs, shock parameters, and comorbidities. Overall mortality, MOF, and NI rates for the study cohort (n=820) were 13%, 37%, and 46%, respectively. Median Injury Severity Score was 33 (interquartile range, 22-41). Median BMI for the study cohort was 25 (interquartile range, 23-27). As BMI increased, maximum organ dysfunction scores also significantly increased for cardiac, respiratory, and renal systems. Logistic regression revealed no significant association with mortality (odds ratio [OR]=0.95; 95% confidence interval [CI], 0.9-1.0); however, BMI was independently associated with a higher risk of MOF (OR=1.09; 95% CI, 1.02-1.06) and NI (OR=1.07; 95% CI, 1.01-1.13). For every single-point increase in BMI, the risk of MOF and NI increase by 9% and 7%, respectively. The risk of MOF and NI increases as BMI increases in the nonobese injured patient. These results suggest that body adipose content may be associated with the magnitude of or extent of the inflammatory response postinjury. Further studies are needed to elucidate the mechanism responsible for this association.

Cervical flexion myelopathy in a patient showing apparent long tract signs: A severe form of Hirayama disease

We describe an 18-year-old male with cervical flexion myelopathy with Hirayama disease-like features who showed apparent long tract signs. He first experienced insidious-onset hand muscle weakness and atrophy at the age of 15. Subsequently, he developed sensory disturbance in his lower limb. Neurological examination revealed atrophy and weakness in the right hand and forearm, pyramidal signs in the right lower extremity, and disturbance of superficial sensation in the lower left half of the body. Cervical magnetic resonance images and computed tomographic myelography revealed anterior displacement with compression of the cervical cord in flexion that was more apparent in the right side. The right side of the cervical cord showed severe atrophy. The mechanisms of myelopathy in our patient appeared to be same as that of “tight dural canal in flexion,” which has been reported to be the mechanism of juvenile muscular atrophy of the unilateral upper extremity (Hirayama disease). Patients with Hirayama disease generally show minimal sensory signs and no pyramidal signs. An autopsy case of Hirayama disease revealed confined necrosis of the cervical anterior horn without obvious changes in the white matter. Our patient's disease progression suggests that cervical flexion myelopathy patients with severe cervical cord compression in flexion may develop extensive cervical cord injury beyond the anterior horn.

A case of heterotopic ossification of the hip joint after 30 years in cervical cord injury

A case of heterotopic ossification of the hip joint after 30 years in cervical cord injury

2P2-E03 手指麻痺者用パワーグローブ : 頚椎損傷者の自立的生活と社会参加の支援を目的として(リハビリテーションロボティクス・メカトロニクス)

2P2-E03 手指麻痺者用パワーグローブ : 頚椎損傷者の自立的生活と社会参加の支援を目的として(リハビリテーションロボティクス・メカトロニクス)

A MPCDM-enabled Product Concept Design via User Involvement Approach

This article reports how designers manipulate a collaborative and reliable process, which is more directly in contact with users and is different from the traditional design approach for interpreting and satisfying users’ specific needs. The approach user involvement for product concept design is proposed, from a multi-professional design knowledge-handling viewpoint. It comprises three phases, namely, user needs elicitation and transformation, product definition diversification and design concept specification, which integrates the means end chain technique with systematic analysis and design technology to develop the multi-professional collaborative design model (MPCDM) for product concept design (PCD). Basically, this approach is a method of making design decisions via user involvement, that is, a strategy for transferring user preference into a specific product concept. A case study on designing an assistive eating device for patients with cervical cord injuries is used to illustrate the performance of the proposed prototype MPCDM-enabled PCD, which has demonstrated its effectiveness in user involvement issue and explained how designers are able to identify with a good degree of certainty attributes for creative product development, by collaboration with users via Internet.

Original article: Factors affecting long-term outcome in acute cervical cord injury

Several clinico-imageological factors affect the neurological outcome following cervical cord injury. Studying these factors is essential for predicting the outcome. Thirty-three patients with acute cervical cord injury who were treated at our institute from 2000–2003, were assessed by the American Spinal Injury Association (ASIA) scoring and magnetic resonance imaging (MRI) of cervical spine. MR patterns of cord injury and length of damage were evaluated by senior neuroradiologist. They were followed up with ASIA score at the end of one year. Four factors were analyzed for their possible influence on outcome namely age, initial neurological status, timing of surgery, MR findings. Patients were divided into groups based on the factor studied, and the improvement was compared amongst the groups. Chi Square analysis was done to study the statistical association. All patients with ASIA Grade ‘D’ improved whereas none improved in ASIA grade ‘A’. Patients with cord edema showed good recovery (52%) compared to patients with cord contusion (0%). Among the patients with cord edema, improvement was better in three or less than three segments (84.6%) compared to more than three segments (16.66%). There was no significant difference in improvements between age groups> 40 years (45%) and > 40 years (46.1%) (p>0.05). The difference in improvements between early surgery (60%) and delayed surgery (33.33%) was also not significant (p>0.05). The single most important factor, which determines the outcome, is the initial neurological status following injury. The age of the patient and the timing of surgery do not seem to influence the outcome. MRI pattern of cord edema with less than three segments has best prognosis for recovery.

Diffusion Tensor Imaging and Fiber Tractography of Patients with Cervical Spinal Cord Injury

To verify the usefulness of diffusion tensor imaging (DTI) and fiber tractography (FT) compared with routine magnetic resonance imaging (MRI) in patients with cervical spinal cord injury, and to clarify the relationship between motor and sensory impairments and DTI and FT parameters, we performed routine MRI and DTI on 10 patients with chronic cervical spinal cord injury and on 10 controls. Quantitative parameters of DTI, such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC), were calculated for each cervical cord level. FT parameters of imaginary crossing fiber numbers were also determined at the C3 level, from C3-C6, and from C3-C7, as well as each connection rate. All patients' clinical motor and sensory functions were examined using the International Standards for the Neurological Classification of Spinal Cord Injury (ISCSCI). FA values in the controls and patients were 0.76 ± 0.08 (mean ± standard deviation) and 0.58 ± 0.11, respectively, and ADC values in the controls and patients were 1.29 ± 0.75 × 10(-3) mm(2)/sec and 1.26 ± 0.66 × 10(-3) mm(2)/sec, respectively. In patients with cervical cord injury, abnormal cervical levels detected on routine MRI were not correlated with clinical findings and DTI parameters, but FA of DTI was correlated with motor function, as were imaginary crossing fiber numbers and connection rates of FT. Quantitative DTI and FT analyses were useful in the evaluation of patients with cervical spinal cord injury. The injured cervical spinal cord can be evaluated in more detail and more precisely using DTI and FT, for which findings are correlated with clinical findings such as neurological impairments.

Analysis of risk factors for early death following cervical injuries

Objective To discuss the complication risk factors for early death after cervical injuries and explore the indication for treatment. Methods A retrospective study was carried out on early death and complications in 419 patients with cervical injuries admitted into our hospital. We observed the relationship of all kinds of complications with cervical cord injury severity and the incidence rate of complications in all patients. Results The respiratory complication was the main cause of early death, accounting for 79.11%. There found complications including hypoalbuminemia ( 85.29% ), hypotension(50%) and hyponatremia ( 35.29% ) in the death patients. Conclusions The existence of complications, especially hypoalbuminemia, can aggravate the original dysfunction and is the risk factor for early death. The early treatment of the dangerous complications could prevent multiple organ failure and early death and provide sound condition for functional recovery. Key words: Spinal injuries; Cervical vertebrae; Complications; Cause of death

Improvement of nursing method of preventing pressure sore in the patients of cervical fracture combined with cervical cord injury

Objective To investigate the application effects of a new preventive and nursing method of pressure sore in the patients of cervical fracture combined with cervical cord injury. Methods A total of 72 patients of cervical fracture combined with cervical cord injury were divided into the experiment group (37 patients) and the control group (35 patients) according to hospitalization time. Patients in control group were adopted traditional method, while those in experiment group were adopted the new method. Results Compare with the control group, discomfort of pain, helpless, agrypnia and dysphoria was reduced significantly in the experiment group. The incidence of SpO2<90% in the experiment group was lower than that in control group,but the incidence of pressure sore showed no difference between the two groups. The satisfaction degree of nursing service in experiment group was significantly higher than that in control group. Conclusions The new preventive and nursing method is effective for the application on recovery of pressure sore in the patients with cervical fracture combined with cervical cord injury. Key words: Cervical fracture; Cervical cord injury; Pressure sore; Nursing

Acute traumatic cervical cord injury in patients with os odontoideum

We retrospectively reviewed acute cervical cord injury after minor trauma in 10 patients with os odontoideum. Their clinical history, neurological symptoms, radiological investigations, follow-up period, American Spinal Injury Association impairment classification and motor score were reviewed. Before their traumatic injury, three patients were asymptomatic and seven reported myelopathic symptoms, including four patients with neck pain, two patients with unsteadiness and one patient with dizziness. Falls were the most common cause of injury ( n = 6), followed by minor motor vehicle accidents ( n = 3) and assault ( n = 1). MRI and dynamic cervical lateral radiographs showed that all patients had atlantoaxial instability and cord compression. Most patients had spinal cord thinning and hyperintensity on T2-weighted MRI. Spinal cord compression was posterior ( n = 5), or both anterior and posterior ( n = 5). All patients underwent posterior rigid screw fixation and fusion, including atlantoaxial fusion ( n = 8) and occipitocervical fusion ( n = 2). We conclude that patients with asymptomatic or myelopathic atlantoaxial instability secondary to os odontoideum are at risk for acute spinal cord injury after minor traumatic injury. Fixation and fusion should be undertaken as prophylactic treatment for patients at risk of developing myelopathy and to avoid the neurological deterioration associated with acute traumatic cervical cord injury.

Clinical study of resiniferatoxin on neurogenic bladder

To understand the effect of resiniferatoxin on neurogenic bladder by intravesical filling. Twenty-four male spinal cord injury patients with an obviously low cystometric capacity, 2 incomplete cervical cord injury, 5 complete thoracic cord injury, 4 incomplete thoracic cord injury, 5 incomplete lumbar cord injury and 8 complete lumbar cord injury were examined. The age range was 24 - 58 years old and the course of disease 1 - 6 years. There were 0.0063 mg/4 ml RTX in each bottle, it was dissolved in 50 ml physiologic saline and was infused into bladder slowly, kept 30 min, then was discharged by intermittent catheterization (IC). During the process, the patients were requested to fill a micturition chart and conduct urodynamic examination before and after the infusion. We regulated that it was utility when the amount of increased maximal cystometric capacity (MCC) exceeded or was 100 ml, otherwise it was invalid. The urodynamic examination before intravesical filling and 1 week after intravesical filling showed that the average MCC were (210 ± 23) ml and (360 ± 30) ml respectively, the average bladder compliance were (17 ± 3) ml/cm H2O and (24 ± 5) ml/cm H2O, there were statistic difference between them (both P < 0.01). The overall effective rate was 62.5%. It lasted 1 - 4 months. Resiniferatoxin is effective to increase the cystometric capacity and booster the bladder compliance.

Efficacy of topical anesthesia with inhaled aerosolized lidocaine during tracheal intubation under guidance of fiberoptic bronchoscopy in cervical cord injury patients

Objective To evaluate the efficacy of topical anesthesia with inhaled aerosolized lidocaine during tracheal intubation under the guidance of fiberoptic bronchoscopy (FOB) in patients with cervical cord injury complicated with high paraplegia. Methods Sixty-four patients with cervical cord injury complicated with high paraplegia were randomly divided into 2 groups ( n = 32 each): group Ⅰ aerosol inhalation and group Ⅱ spray and cricothyroid membrane puncture. In group Ⅰ aerosolized 2% lidocaine was inhaled. In group Ⅱ after the pharynx and larynx was sprayed with 2% lidocaine, cricothyroid membrane puncture was performed and then 2% lidocaine 2 ml was injected. Midazolam 0.01 mg/kg and fentanyl 1 μg/kg were injected iv in both groups 15 min before tracheal intubation guided by FOB. During tracheal intubation guided by FOB, the intubation condition was assessed, and MAP, HR, ECG and SpO2 were monitored. Results The satisfactory rate of intubation condition and success rate of intubation under the guidance of FOB were significantly higher, and the incidences of arrhythmia and bad memory lower in group Ⅰ than in group Ⅱ ( P ＜ 0.05). Conclusion The topical anesthesia with inhaled aerosolized 2% lidocaine is helpful for improving the FOB-guided tracheal intubation condition, and can reduce the occurrence of adverse effects in patients with cervical cord injury complicated with high paraplegia. Key words: Lidocaine; Administration, inhalation; Anesthesia, intratracheal; Bronchoscopy; Intubafion, intratracheal; Trauma, nervous system; Paraplegia

Superior mesenteric artery syndrome in a tetraplegic patient, 11 years after a spinal cord injury: a case report

Case report. To report on the need to consider the possibility of the superior mesenteric artery syndrome (SMAS) even after a long time from the initial spinal cord injury. Ulsan, South Korea. A 41-year-old man with complete tetraplegia was evaluated for nausea and vomiting. He had a cervical cord injury 11 years previously and his body mass index was 18.6 on admission. The contrast-enhanced abdominal computed tomography (CT) showed intestinal obstruction at the third-portion of the duodenum. With frequent position change and intravenous electrolyte support, the symptoms resolved. There was no relapse of the symptoms with some lifestyle modifications. Patients with spinal cord injury may develop SMAS even long after their initial injury.

Current status of pediatric home mechanical ventilation in Japan

The first nationwide survey of pediatric home mechanical ventilation (HMV) was conducted. From 35 out of 149 medical centers investigated, 49 cases of HVM were reported. The patients ranged in age from 1 to 20 years, and the causes of respiratory failure were neuromuscular diseases (51%), central hypoventilation (33%), respiratory disorders (10%) and cervical cord injury (6%). Since 1983 when 2 patients were discharged home on mechanical ventilation, more and more ventilator-dependent children have been sent home every year. However, home mechanical ventilation is not yet well recognized in Japan as an option for pediatric patients with chronic respiratory failure, and there are many problems to be solved. Firstly, very few, if any, hospitals have a designated home care team composed of physicians and other specialists. Secondly, the current health insurance system scarcely covers the cost of home ventilation. Thirdly, development of home use equipment, in particular, portable ventilators and monitors is imperative. There are 107 hospitalized patients in 56 institutions who are reportedly able to go home if a support system is established. A program for pediatric home mechanical ventilation should be urgently developed on a national basis.

Correlation between serous neuron specific enolase and acute spinal cord injury severity

Objective To explore the correlation between serous level of neuron specific enolase (NSE) and severity of acute spinal cord injury. Methods The NSE serous levels were determined by enzyme-labeled immunosorbent assay (ELISA) in 41 consecutive patients with acute spinal cord injury. There were 7 cases of cervical cord injury, 13 cases of thoracic cord injury and 21 cases of lumbar cord injury. They were 24 males and 17 females, aged 21 to 67 years (average, 43.8 years). The correlations between the NSE serous levels and the severities of acute spinal cord injury in all the patients were analyzed using the statistic software SPSS 13.0. The NSE serous level was compared with MRI and CT in evaluating the severity of acute spine cord injury. Results The NSE serous levels at the 1, 2, 3, 5, 7 days after the acute spinal cord injury were significantly correlated with the severities of acute spine cord injury (P<0.05). The correlations between the NSE serous level and the severity of spine cord injury were higher than those between the MRI index and the severity of spine cord injury at the 2 and 3 days after the injury. Conclusion As the NSE serous level may be positively correlated with the severity of acute spine cord injury, we can evaluate the severity of acute spine cord injury by determine the NSE serous level of the patient. Key words: Spinal cord injury; Serum; Phosphopyruvate hydratase; Enzyme-linked im-munosorbent assay

Development of a Mouthpiece Type Remote Controller for Disabled Persons

A variety of operation devices have been developed for severely disabled people such as those with cervical cord injuries and/or muscular dystrophies. Each device has its own merits and demerits respectively, but there is still a need to develop other types of operation devices. In this study, we have tried to develop a mouthpiece type remote controller to operate an electric powered wheelchair. This remote controller would be inserted into user's mouth and be operated by tongue. This remote controller has passive RFID transponders but no battery. To evaluate the performance of this system, the MCR (Maximum Communication Range) was measured. The results indicated that if users set the antenna beside their cheek, the remote controller would work well. For the preliminary study, the operativeness of this remote controller was suitable. With this system, we succeeded in an operating electric powered wheelchair on the market. These results suggested the possibility that this mouthpiece type remote controller system would be effective for severely disabled people.

Clinical Analysis of Spinal Cord Injury With or Without Cervical Ossification of the Posterior Longitudinal Ligament, Spondylosis, and Canal Stenosis in Elderly Head Injury Patients

Patients with degenerative diseases of the cervical spine, such as ossification of the posterior longitudinal ligament, spondylosis, and canal stenosis, sometimes present with acute spinal cord injury caused by minor trauma. However, the relative risk of cervical cord injury with these diseases is unknown. The clinical and radiological features of 94 elderly patients with head injury, 57 men and 37 women aged from 65 to 98 years (mean 76.6 years), were retrospectively analyzed to assess the association of spinal cord injury with degenerative cervical diseases. Degenerative cervical diseases were present in 25 patients, and spinal cord injury was more common in the patients with degenerative diseases (11/25 patients) than in the patients without such diseases (3/69 patients; relative risk = 10.2). The incidence of degenerative cervical diseases seems to be increasing in Japan because life expectancy has increased and the elderly are a rapidly growing part of the population. A fall while walking or cycling is a common mechanism of head injury and/or cervical cord injury in the elderly. To decrease the occurrence of cervical myelopathy, prevention by increasing social awareness and avoiding traffic accidents and falls is important.