Complete Cord Injury Research Articles

Medical Supports for Return to Work after Complete Cervical Cord Injury

Medical Supports for Return to Work after Complete Cervical Cord Injury

Epidemiology of Complete Cervical Cord Injury in Japan

Epidemiology of Complete Cervical Cord Injury in Japan

Socio-demographic factors, clinico-radiological profile of patients with traumatic cervical spine injury in South India, and its association with short-term clinical outcome.

Spinal cord injury is a devastating condition to an individual and his/her family imposing an economic burden on the family, society, and the country. Finding out the demographic and morbidity profile of cervical spine injuries is essential for formulating means and ways for its prevention and treatment. This study aimed at assessing the clinico-radiological and socio-demographic profile of cervical spine injury patients and their association with short-term clinical outcomes. This was a prospective observational study that included 120 patients with cervical spine/cord injury. Social, demographic, clinical, and radiological parameters of the study participants were recorded. Improvement, worsening, and neurological stability at 2 weeks follow-ups were considered as a short-term outcome. The association of neurological outcomes with clinico-radiological profile and socio-demographic characteristics was analyzed to study the level of significance. The study found that nearly 81% of the study participants were involved in heavy physical activity, and 45% of the cases sustained cervical spine injury because of falls from height. About 37% and 55% of patients had complete and incomplete cord injury, respectively. Computerized tomography of the spine injury patients showed a fracture, subluxation, and locked facets. Magnetic resonance imaging showed disco-ligamentous injury and cord contusion in these patients. Nearly 29% of patients showed motor improvement, and around 4% of patients had a worsening of their neurological status after 2 weeks. Most of the people who sustain cervical spine injuries are involved in heavy physical work. Female gender, incomplete cord injury, and unilateral locked facet in subluxation are associated with good neurological outcomes. This study will form a preliminary base to build a larger database on spinal cord injury at the regional and national levels.

85. The neurology stability epidural compression assessment: a new score to establish the need for surgery in spinal metastases

85. The neurology stability epidural compression assessment: a new score to establish the need for surgery in spinal metastases

Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes.

To systematically review the literature on penetrating spinal cord injury (PSCI) and evaluate current management strategies, their impact on patient functional outcomes, and treatment complications. PubMed, Scopus, and Cochrane were searched based on the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines to include studies on penetrating spinal cord injury (PSCI). We included 10 articles comprising 1754 cases of PSCI. Mean age was 19.2 years (range, 16-70), and most patients were male (89.9%). Missile spinal cord injury (MSCI) was the most common type, affecting 1623 patients (92.6%), while non-missile spinal cord injury (NMSCI) accounted for only 131 cases (7.4%). Gunshots were the most common cause of MSCI, representing 87.2%, while knife stabs were the most common cause of NMSCI, representing 72.5%. A total of 425 patients (28.0%) underwent surgical intervention, and 1094 (72.0%) underwent conservative management. The conservative group had a higher rate of complete spine cord injury compared with the surgical group (61.5% vs. 49.2; p < 0.001). Although surgery yielded a higher score improvement rate compared with the conservative management (41.5% vs. 20.5%, p < 0.001), neither treatment strategy displayed superiority in improving neurological outcomes for neither complete SCIs (OR:0.7, 95% CI, 0.3-1.64; I2 = 44%, p = 0.13) nor for incomplete SCIs (OR:1.15, 95% CI, 0.64-2,06; I2 = 40%, p = 0.12). Surgical and conservative management strategies proved to be equally effective on PSCI, irrespective of injury severity. Therefore, tailored treatment strategies for each patient and careful surgical selection is advised.

131. Risk factors that decrease complete recovery in idiopathic scoliosis surgery associated neurological injuries

<h3>BACKGROUND CONTEXT</h3> Neurological injuries (NI) are devastating complications of idiopathic scoliosis (IS) surgeries. The risk factors for these injuries have been well studied in the literature. However, the prognosis and the factors that impact the prognosis of NIs have been poorly studied. <h3>PURPOSE</h3> The purpose of this study was to summarize the prognosis of the documented 8-year NIs associated with IS surgeries from the Scoliosis Research Society Morbidity and Mortality (SRS M&M) database. <h3>STUDY DESIGN/SETTING</h3> Retrospective study conducted querying the SRS M&M database between 2009 and 2017 for idiopathic scoliosis population who had perioperative neurological deficits from scoliosis surgery. <h3>PATIENT SAMPLE</h3> n= 418; males (n=93; 22.4%), females (n=322, 77.6%), 3 unknown. <h3>OUTCOME MEASURES</h3> To determine the risk factors that decrease the complete recovery of neurological injuries. <h3>Methods</h3> Analyses were made to compare the correlation between the extent of neurological recovery (complete, partial and no change) and time of event occurrence (intraoperative, acute postoperative (<24hrs) and delayed postoperative >24hrs), intraoperative neurophysiological monitoring (IONM) used (yes/no), intra- and postoperative hypotension (yes/no), type of neurological injury (cord, root or both), type of cord injury (complete or incomplete). Chi-square and ANOVA tests were used for analyses. <h3>Results</h3> Data showed: EOIS (n=30), adolescent IS (n=244) and adult IS (n=144); average estimated blood loss, 1.9L; and average follow-up: 180 days. Intraoperative neuromonitoring (IONM) was used in 351 (84%), intraoperative hypotension observed in 73 (18%), and postoperative hypotension observed in 32 (8%). The majority of the NIs were intraoperative 168 (40.2%); postoperative (<24hrs.) 159 (38%); delayed (> 24 hrs) 91 (21.8%). Incomplete cord injuries were 178 (47.7%), complete cord injuries 53 (14.2%), root injuries 142 (38.1%) and no information for 45 patients. Injury level noticed at: cervical=20 (4.8%); thoracic=181 (43.3%), lumbar=187 (44.7%), sacrum=5 (1.2%) and unknown in 25 (6.0%) patients. Complete recovery was noticed in 269 patients (64.4%), partial recovery in 125 patients (29.9%), no recovery in 24 patients (5.7%). Average follow-up length was no different among recovery types: complete=190 days; partial=174 days; and no change=174 days, p=0.35. Complete NI recovery rate was significantly lower for adult IS patients (n= 67, 46.5%) vs EOIS (n=24, 80%) and AIS (n=178, 73%), (p<0.001). There was a significant increase in no recovery NIs status rates for complete cord injuries (n=13, 24.5%) vs incomplete cord (n=4, 2.2%) and root injuries (n=4, 2.8%), p<0.001), IONM abnormalities decreased complete recovery rates for intraoperative NIs (n=4, 33% vs n=109, (76.8%), p=0.001. There was a trend toward lower complete recovery rates in patients who did not use IONM for intraoperative NIs (p=0.06). <h3>Conclusions</h3> Lower complete NI recovery rates were observed in adult IS patients. Complete cord injuries reduced NIs complete recovery rate. IONM signal abnormalities have a potential effect on intraoperative NI prognosis, but not on postoperative or delayed NI prognosis. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Ultrasound-driven piezoelectric current activates spinal cord neurocircuits and restores locomotion in rats with spinal cord injury

BackgroundNeuromodulation via electrical stimulation (ES) is a common technique to treat numerous brain and spinal cord related neurological conditions. In the present study, we examined the efficacy of piezoelectric stimulation (pES) by a custom miniature piezostimulator to activate the spinal cord neurocircuit in comparison with conventional epidural ES in rats.MethodsStimulation electrodes were implanted on L2 and S1 spinal cord and were connected to a head-plug for ES, and a piezostimulator for pES. EMG electrodes were implanted into hindlimb muscles. To generate piezoelectric current, an ultrasound beam was delivered by an external ultrasound probe. Motor evoked potentials (MEPs) were recorded during the piezoelectric stimulation and compared with the signals generated by the ES.ResultsOur results suggest that ultrasound intensity as low as 0.1 mW/cm2 could induce MEPs in the hindlimbs. No significant difference was found either in MEPs or in muscle recruitments for ES and pES. Similar to ES, pES induced by 22.5 mW/cm2 ultrasound restored locomotion in paralyzed rats with complete thoracic cord injury. Locomotion EMG signals indicated that pES works same as ES.ConclusionWe propose piezoelectric stimulation as a new avenue of neuromodulation with features overtaking conventional electrical stimulation to serve future bioelectronic medicine.83StwwHHYaD7oZ4SVru6w9Video abstract.

Timing of surgery in traumatic spinal cord injury: a national, multidisciplinary survey

PurposeThe optimal surgical timeframe for neurological recovery in traumatic spinal cord injury (tSCI) still remains unknown. Recent guidelines have recommended performing surgery within 24 h for all patients with tSCI regardless of initial neurological deficit. It remains unclear whether patients with complete, incomplete tSCI, or traumatic central cord injury (TCCI) will experience the same degree of improvement after urgent surgical intervention. We investigated if the severity of initial neurological injury influenced surgeons on their decision-making of surgical timing in tSCI.MethodsWith a web-based survey, we investigated the current opinion in The Netherlands on timing of surgical decompression and stabilization, depending on the initial degree of neurological injury.ResultsSurgeons prefer to perform more urgent surgery for incomplete tSCI compared to complete tSCI. In addition, 43% of patients with complete tSCI are not preferably operated within the recommended 24 h. Even though TCCI is the most common form of incomplete tSCI, these patients are preferably managed less urgently than patients with other types of incomplete tSCI.ConclusionThe severity of initial neurological injury seems to play an important role in the urgency of surgical timing for tSCI. A substantial number of patients with complete tSCI are not preferably treated within the recommended surgical timeframe, while patients with incomplete tSCI are preferably operated far more urgent than recommended in the current guidelines.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

Spinal Cord Injury Paralysis: Synaptic Competitive-Learning and Rewiring Therapy Restores Locomotoricity

At this point in time there are only limited treatment options available for spinal cord injury (SCI) paralysis (e.g. implanted stimulation devices, stem cells). They are in clinical trials, complex, invasive, ill-affordable, and quality of outcome rather unpredictable. This author had presented two alternative treatment procedures based on over five decades of fundamental research on the functioning of the spinal cord motor system in 2009, 2013 and 2015. These are non-invasive, functional, and recovery predictable. The first one uses low-dose Botulinum toxin to select paralyzed limb muscles. The second consists of transient partial denervation of the muscles. They both operate on similar principles of synaptic competitive-learning (SCL) and rewiring. They focus on the spinal motoneuron, its synaptic connectivity, and spinal cord reflexes. They are (i) induce competition among neuromuscular synapses, (ii) modify the motoneurons’ soma sizes (Size principle) and thus their excitability-inhibitability, firing properties, (iii) resize the motor units of the paralyzed muscles, and (iv) reposition the synaptic memory weights impinging on the motoneurons. Animal model treated by the second procedure shows that even in complete cord injury, the residual networks of the isolated distal cord are capable of remarkable motor restoration (see videos). This paper now explains the precise mechanisms behind the restorative rewiring (SCL) therapy.

Active physiological conservative management in traumatic spinal cord injuries – an evidence-based approach

The management of the traumatic spinal cord injury remains controversial. Guttmann demonstrated that with simultaneous attention to all medical and non-medical effects of the spinal cord injury, a significant number of patients recovered motor and sensory functions to ambulate and the majority were pain-free following conservative management. Active physiological conservative management of the spinal injury requires simultaneous scrupulous care of the injured spine together with; the multisystem neurogenic effects of the spinal cord injury on the respiratory, cardiovascular, urinary, gastrointestinal, dermatological, sexual and reproductive functions; the management of the associated psychological effects of paralysis from the early hours or days of injury as well as; the physical rehabilitation and modification of the environment. To date, there is no evidence to suggest that the surgical decompression and/or stabilisation of the neurologically impaired spinal cord injury patient is advantageous. This article considers the debates and evidence of surgical management including the effects of timing of the surgical decompression. Also addressed are the factors influencing decisions on management, prognostic indicators of recovery and natural history of complete and incomplete cord injuries. Traumatic biomechanical instability of the spine, physiological instability of the spinal cord, traumatic spinal canal encroachment and traumatic cord compression are also discussed. Early mobilisation, indications for surgery at the RJAH and economic considerations of spinal cord injuries are presented. The ultimate goals of the active physiological conservative management are to ensure maximum neurological recovery and independence, a pain-free and flexible spine, safe and convenient functioning of the various systems of the body with minimal inconvenience to patients and the prevention of complications.

Anterior Spinal Stabilization and Fusion in Cervical Spinal Trauma

Objective: It was to find out the efficacy and benefits of anterior cervical spinal stabilization procedu-res in cases of cervical trauma.Material and Methods: It is a prospective study of 30 cases of Cervical Spinal Trauma in which anterior cervical spinal stabilization and fusion was performed. Study span is three years i.e from July 2005 to June 2008 with follow up period of one year and it was carried out in the Department of Neurosurgery, Quaid-e-Azam Medical College / Bahawal Victoria Hospital Bahawalpur.Results: 30 cases of cervical spinal trauma were included in the this study. Age range was 15 years to 40 years. Twenty three (23) were males and seven (7)) were females with male to female ratio of 3.2:1. Most common cause of cervical spinal injury was road traffic accidents and most common site of traumatic involvement was C5/C6 cervical spinal level. All the patients were belonging to poor and middle socio-economic class. Nine (9) patients sustained complete cervical cord injury and they were quadriplegic and remaining twenty one (21) patients were quadripretic as a result of partial cervical cord injury. All patients were assessed clinically and radiologically. Plain X-rays of cervical spine, AP and LAT. views, C-T scan and MRI of cervical spine were obtained to get information of injuries in detail. In almost all the cases, anterior two columns of spine were disrupted resulting in instability and cord compression. In all the cases cervical traction was applied to get alignment of the cervical column first and then anterior fixation and fusion was performed. All patients were mobilized early after surgery.Outcome: Nine (9) cases with complete cord injury did not improve neurologically after surgery. Eleven (11) patients with partial cord injury and power of G 3/5 before surgery improved to G 4+/5 after surgery and ten (10) patients with power G 2/5 before surgery improve to G 3/5 after surgery. All patients were out of bed early, to prevent the complications of being and ridden for long time.Conclusion: Anterior cervical spinal fixation and fusion is an excellent way of cervical spinal stabilization in cases of cervical trauma. Patients improve Neurologically with these procedures and they are mobilized early from the beds to prevent complications of being bed ridden for longer periods of time.

Effects of pulsed radiofrequency on spasticity in patients with spinal cord injury: a report of two cases.

Spasticity following spinal cord injury (SCI) results in functional deterioration and reduced quality of life. Herein, we report two SCI patients who presented with good response to pulsed radiofrequency (PRF) for the management of spasticity in the lower extremities. Patient 1 (a 47-year-old man) had complete thoracic cord injury and showed a phasic spasticity on the extensor of both knees (3–4 beats clonus per every 30 seconds) and tonic spasticity (Modified Ashworth Scale: 3) on both hip adductors. Patient 2 (a 64-year-old man) had incomplete cervical cord injury and showed a right ankle clonus (approximately 20 beats) when he walked. After the application of PRF to both L2 and L3 dorsal root ganglion (DRG) (patient 1) and right S1 DRG (patient 2) with 5 Hz and 5 ms pulsed width for 360 seconds at 45V under the C-arm guide, all spasticity disappeared or was reduced. Moreover, the effects of PRF were sustained for approximately 6 months with no side effects. We believe that PRF treatment can be useful for patients with spasticity after SCI.

Direct withdrawal of a knife lodged in the thoracic spinal canal in a patient with normal neurologic examination: is it safe?

Stab wound injuries to the spinal cord are rare, although they commonly cause complete or incomplete neurological deficits. Normal neurological examination with a knife traversing the spinal canal is extremely rare. Here we report on a patient with a knife lodged in the thoracic spine with normal neurological examination and describe direct withdrawal of the knife with excellent results that have not been reported to date. A 50-year-old male patient was admitted to the emergency service because of his sustaining a stab wound to thoracic 3-4 level due to a knife traversing the spinal canal and still lodged in the vertebral bodies. His neurological examination was normal. The knife was withdrawn in the operating room under general anesthesia without bleeding or cerebrospinal fluid leakage. After withdrawal neurological examination was normal and control magnetic resonance imaging showed no abnormalities. Surgical exploration is suggested for spinal stab wounds if there is a retained body. Some authors recommend exploration even no foreign body is detected. Incomplete or complete cord injuries deserve surgical exploration, but in a patient with normal neurological examination direct withdrawal can be a safe option. Exploration of the wound surgically may have risks associated with enlarging the incision, muscle dissection, enlarging dural tear and bony removal, which may have long-term adverse effects. The operation team must be ready for urgent exploration. Cerebrospinal fluid leakage, excessive bleeding or any neurological deficit after removal must mandate surgical exploration. Long-term close follow-up of the patient has paramount importance for late complications such as infection and pseudomeningocele development.

Unknown Input Observer for Understanding Sitting Control of Persons with Spine Cord Injury

The present paper introduces a simple model to study sitting control for persons with complete thoracic spine cord injury. The system is obtained via Lagrangian techniques; this procedure leads to a nonlinear descriptor form, which can be written as a Takagi-Sugeno model. A first attempt to estimate the sitting control in disabled people is done via an unknown input observer. The conditions are expressed as linear matrix inequalities, which can be efficiently solved. Simulation results validate the proposed methodology as the observations are coherent with and without perturbations.

Effects of erythropoietin in improving function of spinal cord injury

Introduction: Acute Spinal Cord Injury (ASCI) is one of the most common and important disorders in the field of neurosurgery. Progress achieved in relation to the care provided to repair spinal cord injuries have been taken from ancient times to the present day. Recently Neuroprotective therapies have attracted a lot of staff to approach the patient. Research scientists have shown that there is a possibility of recovery after spinal cord injury. Many pharmacological agents, Erythropoietin, in this field are used to reduce secondary damage after the primary insult and try to preserve nerve tissue. The aim of this study was to investigate the effect of Erythropoietin on sensory and motor status of patients with acute spinal cord injury. Materials and Methods: In this clinical trial, 60 patients with acute spinal cord injury in the Frankel classification, the category A to C, and the selection of matched Frankel class into two groups A and B (each group consisted of 30 patients) was done. Group A underwent conventional treatment received methylprednisolone, were used erythropoietin and were compared after 4days,6-months intervals in terms of complete and incomplete cord injury status with group B (that underwent only conventional treatment such as methylprednisolone). Results: In our study of two groups there were 16 patients with complete spinal cord injury and 44 patients were had incomplete SCI. In the period of 4 days after the onset of the study, patients with complete SCI in case and control group did not recover. In Patients with incomplete spinal cord injury in case group 13 of 21 patients (62%) and 2 of 23 patients (9%) in the control group were cured. In the period of 6 months after the study, 2 of 8 patients (25%) in case group with complete cord had recovery. In the control group of patients with complete spinal cord injury didn't have any recovery. Also in incomplete SCI 12 of 19 patients (63%) in case group and 5 of 21 patients (23%) in the control group were cured. Conclusion: Based on the results obtained improvement in muscle strength and sensory classified according to Frankel in patients receiving erythropoietin in period between 4 days and 6 months can be seen that the difference significant with the control group (P<0.0001). So Frankel class B, C to C- D- E Frankel grade was reached after recovery. Keywords: Acute spinal cord injury; Classification Frankel; Erythropoietin; Methylprednisolone

Demographic and injury characteristics of spinal cord injury in 275 children

Objective To study the demographic and injury characteristics of pediatric spinal cord injury(SCI) in children less than 14 years old in order to provide the guide for its prevention and treatment. Methods A retrospective study was performed and a total of 275 cases of children (less than 14 years old) with SCI were identified in China Rehabilitation Research Center(CRRC) from January 1989 to December 2014.The clinical information including gender, age, causes of injury, date of injury and injury condition were analyzed. Results Among 275 cases(male 111 cases, female 164 cases), 48.0% of the cases were 4.0-7.0 years old (132/275 cases), including 93 female cases (70.5%, 93/132 cases). Transport activities(74 cases, 26.9%), non traumatic causes(72 cases, 26.2%), sports and leisure activities (70 cases, 25.5%) were the main causes of SCI.Significant difference was observed in a number of patients in sports between 2003-2014 group (28.0%, 65/232 cases) and 1987-2002 group(11.6%, 5/43 cases)(χ2=5.135, P=0.023). The largest gender gap among kids was doing sports (7 male cases, 63 female cases), and the chief reason for children aged 4.0 to 7.0 years was also sports (48.2%, 55/114 cases). Patients suffered with SCI without radiologic abnormality (SCIWORA), in greater number (69.5%, 141/203 cases), and 121 (85.8%, 121/141 cases) patients were thoracic cord injury without radiologic abnormality(TCIWORA). Sports was the main cause of injury (64.1%, 50/78 cases) for 4.0 to 7.0 years old children (64.5%, 78/121cases) who were the greatest number of patients with TCIWORA.The earliest case of sports occurred in 1995, which happened nationwide each year since 2001.Spine hyperextension (90.0%, 63/70 cases) was the most common in sports, which caused 62 patients with SCIWORA (98.4%, 62/63 cases) including 47 children with complete thoracic cord injury (75.8%, 47/62 cases), and it often occurred in summer and autumn. Conclusions Sports injury was the most common cause of SCI children in CRRC nearly 12 years.The incidence of this damage was growing up and the girl(4-7 years old) because of spine hyperextension in sports(bend down in dancing practice) was the largest proportion of children with SCI.This severe damage which often resulted in complete thoracic cord injury should arouse more attention in clinic.The main crowd protection was the children who exercised back bend.This results provided important clues to develop related etiologic study and pointed out that it was needed to collect more information to investigate its injury mechanism. Key words: Spinal cord injury; Spinal cord injury without radiologic abnormality; Retrospective analysis; Child

Local cooling for traumatic spinal cord injury: outcomes in 20 patients and review of the literature

In this prospective study, the authors offered protocol-selected patients a combination of parenteral steroids, decompression surgery, and localized cooling to preserve viable spinal cord tissue and enhance functional recovery. After acquiring informed consent, the authors offered this regimen with localized deep cord cooling (dural temperature 6°C) to 20 patients with a neurologically complete spinal cord injury to begin within 8 hours of injury. After decompression, the cord was locally cooled through the intact dura using a suspended extradural saddle at the site of injury for up to 4 hours, during which time spinal fusion was performed. Sensation and motor function were evaluated directly after the injury and again over a year later. The patients were evaluated using the 2011 amendment to the American Spinal Injury Association (ASIA) Impairment Scale. Eighty percent of the 20 patients (12 with cervical and 4 thoracic injuries) with an initial neurologically complete cord injury had some recovery of sensory or motor function. All patients initially had ASIA Grade A impairment. Of 14 patients with quadriplegia, 5 remained ASIA Grade A, 5 improved to ASIA Grade B, 3 to ASIA Grade C, and 1 to ASIA Grade D. The remaining 6 patients had suffered a thoracic spinal cord injury, and of these 2 remained ASIA Grade A, 1 recovered to ASIA Grade B, 2 to ASIA Grade C, and 1 ASIA Grade D. All considered, of 20 patients, 35% remained ASIA Grade A, 30% improved to ASIA Grade B, and 25% to ASIA Grade C. Impairment in 2 (10%) of 20 patients improved to ASIA Grade D. The mean improvement in neurological level of injury in all patients was 1.05, the mean improvement in motor level was 1.7, and the mean improvement in sensory level was 2.8. Two patients recovered the ability to walk, 2 could extend their legs, 5 could sense bladder fullness, and 3 had partial ability to void voluntarily. Four males recovered subnormal ability to have voluntary erection sufficient for limited sexual activity. The authors present here results of 20 patients with neurologically complete spinal cord injury treated with a combination of surgical decompression, glucocorticoid administration, and regional hypothermia. These patients experienced a better recovery than might have been expected had traditional forms of treatment been used. The benefit of steroid treatment for cord injury has been debated in the last decade, but the authors feel that research into the effects of cord cooling should be expanded. Given that the optimal neuroprotective temperature after acute trauma has not yet been defined, and may well be below that which is considered safely approachable through systemic cooling, methods that allow for the early attainment of such a temperature locally should be further explored. The results are encouraging enough to suggest the undertaking of controlled clinical trials of treatment using localized spinal cord cooling, where such treatment can be instituted within hours following injury.

Evaluation of the short-term outcome of anterior approach surgery of the dorsal and lumbar spine

ObjectiveThe aim of this study is to evaluate the short-term outcome of anterior decompression and fusion surgery of the dorsal and lumbar spine, in cases of traumatic and pathologic vertebral fractures, in terms of stability and function.BackgroundSurgical treatment of dorsal and lumbar spine fractures aims to achieve bony union and restore spinal anatomy. An anterior approach is recommended for repair of anterior bone loss and to release medullary compression.Materials and methodsSelection criteria included traumatic and pathologic lesions causing vertebral body comminution, kyphotic angulation, or intractable pain. Exclusion criteria included patients with complete cord injury, osteoporosis, or less than 3 months life expectancy. Seven patients (group A) underwent the solo anterior approach surgery, whereas the other seven patients (group B) underwent initial posterior decompression and instrumented fusion, followed by anterior surgery. Operative and postoperative events were noted. Patients were followed up clinically and radiologically for 6 months.ResultsSeven patients showed improved ASIA grade postoperatively. The mean improvement in the ASIA grade was 0.6 in group A and 1.0 in group B. Seven patients regained bladder control, whereas two remained catheter dependent (one from each group). The pain visual analog scale range was 3-9 preoperatively and 0-5 postoperatively. The mean postoperative improvement in segmental kyphosis was 2.42° in group A and 1.85° in group B. After 6 months, 28.57% of patients in group A had grade-5 bone fusion, 42.86% had grade-4 fusion, 7.14% had grade-3, and 7.14% had grade-2 fusion, whereas 42.86% of patients in group B had grade-5 bone fusion and 57.14% had grade-4 fusion. No instability was detected in the dynamic radiographic films of all patients. Only one case had metallic device malposition because of trauma. Postoperative complications included chest infection (four cases), wound infection (two cases), urinary tract infection (one case), retroperitoneal hematoma (one case), and sympathetic dysfunction (one case).ConclusionThe anterior approach for dorsal and lumbar fractures enables direct, under-vision satisfactory decompression of the neural tissue, facilitating improvement in the neurological functions of the patients. It also helps to correct the instability of the fractured vertebral column by both internal metallic fixation for temporary stability and bone grafting with a high percentage of bony fusion to achieve permanent stability.

Open pathological dislocation of the hip secondary to trochanteric decubitus ulcer

This is a case report of a 30-year-old male hand digging manual borehole driller who became quadriplegic as a result of a complete cervical cord injury at the level of C5. He subsequently developed a trochanteric decubitus ulcer through which the head of the femur dislocated; a rare and unusual complication which has not been previously described in adult quadriplegics.

Comparison of Arm-Trunk Movement between Complete Paraplegic and Able- Bodied Subjects during Circle Drawing

Abstract Study design : This study was a cross sectional, controlled trial. Objectives: To examine the performance of repetitive circle drawing on dynamic sitting balance between subject with spinal cord injury (SCI) and age-matched able-bodied (AB) adults. Summary of background data : Previous studies showed that the dynamic sitting balance is impaired in SCI. However, the arm-trunk coordinated movement for different directions in seated SCI has not been examined yet. Methods: Twelve subjects with complete T7-T12 thoracic cord injury (mean age: 36.3 ± 3.0 years) and 12 age- matched AB adults were recruited. Subjects performed 10 repetitive circle drawing at seated position. The three- dimensional motion system (Vicon) was used to measure shoulder, trunk and pelvic angles at sitting position. Results : The SCI group displayed an arm-trunk movement with a significantly larger shoulder adduction/ abduction angle (p<0.001), but less trunk flexion/extension, pelvic anterior/posteriortilt and pelvic rotation angles than AB controls (p<0.05, p<0.001, and p<0.001, respectively). Conclusions: The small circle drawing is feasible to detect the compensatory movement of shoulder for the impairment of trunk and pelvic control in thoracic SCI. Furthermore, the assistance and guidance of trunk and pelvic movements is important for the arm-trunk coordinated movement in thoracic SCI.