Incomplete Cord Syndromes Research Articles

Asymmetric incomplete cord syndrome: A delayed and unusual presentation of traumatic sub-axial cervical disc prolapse

Isolated non-osseous cervical spine injuries are rare entities and most of the algorithms (NEXUS criteria and Canadian C- spine rules) focus on ruling out osseous injuries. Discoligamentous injuries require high index of suspicion and thorough clinical examination which may not be possible in emergency department due to other distracting injuries or lack of trained personnel in the centre. We present a case of 27 years old male with an unusual presentation of a combination of upper motor neuron and lower motor neuron lesions due to traumatic disc prolapse.

Incomplete Cord Syndromes: Clinical and Imaging Review.

The ability to localize the three spinal tracts (corticospinal tract, spinothalamic tract, and dorsal [posterior] columns) involved in incomplete spinal cord syndromes at cross-sectional imaging and knowledge of the classic clinical manifestations of the various syndromes enable optimized imaging evaluation and provide clinicians with information that aids in diagnosis and treatment. The requisite knowledge for localizing these tracts is outlined. The authors review the spinal cord anatomy, blood supply, and course of these tracts and describe the various associated syndromes: specifically, dorsal cord, ventral cord, central cord, Brown-Séquard, conus medullaris, and cauda equina syndromes. In addition, they describe the anatomic basis for the clinical manifestation of each syndrome and the relevant imaging features of the classic causes of these entities. Knowledge of the anatomy and clinical findings of the spinal cord is essential for examining and treating patients with cord abnormalities. ©RSNA, 2018.

A review of magnetic resonance imaging in spinal trauma.

One hundred and ninety-five magnetic resonance (MR) images (1.5 Tesla) of 167 patients with neurological impairment following spinal trauma were reviewed. Acute cord injury produces central haemorrhagic necrosis that extends transversely and longitudinally with time and increased injury severity. Oedoma is more homogeneous, extensive and dominant in minimal lesions. Magnetic resonance appearances correlate with neurological status and outcome. Patients with MR evidence of cord blood had severe clinical lesions and failed to show useful clinical improvement. Patients with homogeneous 'oedema' improved to useful function. Lesion signal inhomogeneity relates to a worse prognosis. The clinical level correlates closely with cord blood or signal in homogeneity but imprecisely with homogeneous oedema. Disc herniations require differentiation from epidural blood and venous engorgement, which are prominent with bone displacement. Magnetic resonance is recommended in incomplete cord syndromes and in cord injuries with no apparent fracture, particularly if clinically deteriorating. Chronic injury consists of cavitation, extensive gliosis, cord atrophy and leptomeningeal fibrosis. Progressive myelopathy may result from cystic or non-cystic intramedullary lesions. Cord cysts are common and cyst fluid signal should closely follow cerebrospinal fluid. Turbulent cyst fluid motion is commoner in larger cysts and may predict those cysts more prone to propagate. Progressive syrinxes show typical appearances, usually with transverse septa. Atrophy and propagating syrinxes usually take years to develop. Leptomeningeal cysts and spinal stenosis caused by bone displacement and accelerated adjacent disc disease may cause late deterioration. In progressive myelopathy following injury, surgically drainable cysts are clearly differentiable from cord gliosis and atrophy.

Spinal disorders at the cervicothoracic junction.

This study reviewed 36 retrospective patients who underwent surgeries for rare cervico-thoracic junctional problems. The authors review cervico-thoracic junctional disorders and study diagnostic methods, surgical approaches, surgical outcomes, and associated complications. The literature is sparse on cervico-thoracic junctional problems. This paper is the largest series to date on this subject. Thirty-six patients who underwent surgeries for spinal problems at the cervico-thoracic region (C7-T3) were reviewed. These included 18 patients with trauma, 15 patients with tumors, 2 patients with herniated discs, and one patient with postlaminectomy instability. There were 20 males and 16 females. The age ranged from 17 to 83 years with a mean of 43.5 years. Surgically, 21 patients had only posterior procedures, that included 12 wiring, 5 Luque rodding, 1 plate-screw fixation for postlaminectomy instability, 1 transpedicular biopsy, 1 foraminotomy for herniated C7-T1 disc, and 1 costotransversectomy for T2-T3 herniated disc. Neurologically, the majority of traumatic patients presented with neurologic deficits (10 complete and 4 incomplete, and 1 root injuries), and nontraumatic disorders were associated with 10 incomplete cord syndromes and 5 root dysfunctions. Follow-up average was 38 months based on 33 of 36 patients. There were three postoperative deaths (two sternotomies, one anterior C7 corpectomy). Neurologically, patients with complete cord injuries remained complete, whereas patients with incomplete or root deficits improved significantly. Complications included C6-C7 subluxation after C7-T2 fusion, pseudomeningocele, vocal cord paralysis, dysphagia, and Horner's syndrome. Other complications included wound infections, urinary tract infections, decubiti, deep vein thrombosis, pneumonia, and tumor recurrence. In treating patients with cervico-thoracic problems, one should do careful clinical and radiologic survey to avoid missed or delayed diagnoses, and the surgeon must be thoroughly familiar with anterior and posterior landmarks and associated vital structures and remember that the cervico-thoracic junction is an area of potential instability particularly after trauma or laminectomy. Complications of surgery at the cervico-thoracic junction are frequent, and meticulous surgical techniques and postoperative care are important in the prevention of these complications.

Semiological value of painful sensitivity of the testis in spinal cord injuries [proceedings

About 85 cases of spinal cord male injured patients; the authors bring their experience of the painful sensitivity of the testis by squeezing the gland. This sign has a semiological value about the topography and the level of complete and incomplete cord syndromes. It is of no value for the testicular fertility. The rehabilitation of neurological bladders must take this sign into account so as to appreciate the type of micturition.