Partial Cord Injury Research Articles

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.

Post-traumatic cervical spondyloptosis: A rare entity with multiple management options

Post-traumatic cervical spondyloptosis is a rare condition associated with high energy injuries, and to our knowledge only case reports are available. There are no universally accepted treatment paradigms for these cases and management is individualised according to the case and surgeon preference. We retrospectively analysed our management and clinical outcomes of this condition. From January 2007 to August 2014 we treated eight patients with cervical spondyloptosis at our institute. Only two patients had no neurological deficits; all the remaining patients had partial cord injury. Seven were treated surgically with preoperative traction followed by anterior cervical discectomy and fusion with fixation in three patients, and combined anterior and posterior fusion and fixation in four. Depending on the presence of anterior compression by a disc an anterior first or posterior first approach was advocated. All four combined anterior and posterior fusion and fixation patients needed to be turned more than once (540°). There was no neurological deterioration in any of the patients, as they either improved or remained stable neurologically. Post-traumatic cervical spondyloptosis is a challenging entity to manage. Surgery can be done safely with good clinical and radiological outcome and needs to be tailored to the individual patient.

The automatic bladder, excessive sweating and some other reflex conditions, in gross injuries of the spinal cord. By Henry Head, MD, FRS and George Riddoch, MD, Captain, Royal Army Medical Corps. (Officer in charge of the Empire Hospital, Vincent Square). Brain 1917; 40: 188-263.

‘The present War has afforded innumerable opportunities for investigating the phenomena due to gross injuries of the spinal cord …’. After working independently on the manifestations of total transverse section and the explanation for excess sweating as a sequel to spinal cord injury, respectively, Dr Head and Captain Riddoch (Figs 1 and 2) now realize that, in also studying the functional capacity of the automatic bladder, they are looking at different aspects of the same problem; and so they join forces. Based at the London Hospital and the Empire Hospital for Officers, they propose a physiological explanation for the clinical observations made by Dr Riddoch (see Brain 1917; 40: 264–402 and 2004; 129: 2150); and offer a general explanation for the remarkable behaviour of the distal end of the severed spinal cord. They acknowledge the invaluable work of the Cambridge school of physiology (John Langley, [Sir] Hugh Anderson and Thomas [TR] Elliot inter alia ) on the involuntary nervous system (summarized and reviewed in the same issue by Dr EG Fearnsides, Brain 1917; 40: 149–87). Fig. 1 Dr Henry Head (1861–1940). Fig. 2 Dr George Riddoch (1888–1847). Acute cord section results in urinary retention and, if complicated by infection and bed-sores, carries a high early mortality. After 2–3 weeks—sooner with partial cord injury and later when there is concomitant damage to the cauda equina—survivors usually develop automatic bladder emptying. Head and Riddoch aim to show that this partially restored function and other reflex activities to be discussed, depend on extra-vesical stimuli. First, in chronic but stable cases, they measure the capacity of the gently distended bladder and show that, in Case 1 studied at 158 days, small oscillations causing slight increases of pressure are seen immediately that increase in amplitude at volumes greater than 400 ml until complete reflex voiding occurs in three phases at …

Overcoming Inhibition in the Damaged Spinal Cord

Inhibition by several inhibitory molecules on oligodendrocytes, and by chondroitin sulphate proteoglycans and semaphorins in the glial scar discourages regeneration of axons in the injured spinal cord. This inhibition is compounded by the poor regenerative ability of most central nervous system (CNS) axons. Treatments that block some of these inhibitory mechanisms promote regeneration in animal models of cord injury. Plasticity is also reduced by some of the inhibitory molecules, and some of the treatments that promote regeneration also promote plasticity. This is probably a more achievable therapeutic target than axon regeneration, and an effective treatment would be of assistance to the majority of patients with partial cord injuries.

A novel approach toward pedicle screw placement in the thoracic spine

Purpose of study: Because of the smaller size of the thoracic pedicle, primarily in the coronal plane, most surgeons have opted to avoid the used of transpedicular screws in the thoracic spine. A new technique for placement of screws through thoracic pedicles with and without lateral wall violation is described.Methods used: From April 1992 through February 1999, 1,064 pedicle screws were placed within the thoracic spine of 137 patients. Primary diagnoses included scoliosis (59), fracture (41), kyphosis (16), tumor (12), pseudarthrosis (6), ankylosing spondylitis (2) and infection (1). Small posterior laminotomies were made at each level. A ball probe was used to identify the medial and inferior wall of the pedicle at each location. In general, 5-mm diameter screws of 30 to 35 mm in length were placed using a two-person technique. Screws were placed in a lateral to medial direction with the entry site being just lateral to the boundaries of the pedicle over the posterior laminar ridge. It was not unusual for the lateral wall of the pedicle to be violated. However, because of articulation of the rib to the transverse process, pedicle and vertebral body, the screws that were placed remained within the bony articulation without violating surrounding soft tissues. Through the laminotomies performed at each level, all walls of the pedicle with the exception of the lateral walls were directly inspected and ensured not to be violated by instrumentation. After placement of all screws, anteroposterior and lateral radiographs were taken to confirm appropriate placement and alignment.of findings: Mean follow-up was 64 months (range, 24 to 106 months). Construct failure included four misplaced screws, five loose screws, three broken rods and two loose nuts for a total implant complication rate of 1.3% (12 of 1,064). There were no vascular injuries or intrathoracic/pulmonary injuries. There was one transient thoracic radiculopathy with complete resolution, one transient posterior cord syndrome with subsequent resolution and retention of hardware and one transient partial cord injury after attempted reduction of complex scoliosis resulting from probable traction and vascular insult. With the exception of one transient thoracic radiculopathy, there were no identified neurologic deficits directly resulting from screw placement within the thoracic spine. The transient neurologic complication rate was 2.2% (3 of 137).Relationship between findings and existing knowledge: A new technique for placement of transpedicular screws through a posterior approach in the thoracic spine is described. It is a safe and reliable technique with low morbidity. Screws can be placed larger than the size of the width of the pedicle without neurologic or vascular injury while generally maintaining adequate purchase and construct stability.Overall significance of findings: Use of screws placed posteriorly in the thoracic spine is attractive in that improved segmental control can be obtained over that of the standard hook or wire construct.Disclosures: Device or drug: pedicle screws. Status: approved.Conflict of interest: No conflicts.

Spinal cord injury without radiographic abnormality in adults.

Spinal cord injury without fractures or bony malalignment on either plain radiographs or computed tomography (SCIWORA) is most commonly found in the paediatric age group. In recent years, magnetic resonance imaging (MRI) has been used to evaluate these patients. The present communication describes SCIWORA in 15 adult patients investigated by MRI. Of the 151 patients with spinal cord injury in 1 year, 15 adult patients had cervical SCIWORA. All patients were evaluated by MRI. The age ranged from 20 - 60 years. Eleven patients had partial cord injury, two had a complete cord syndrome while two had a central cord syndrome. MRI demonstrated an intervertebral disc prolapse in six patients, intramedullary haematoma/contusion in four and cord oedema in four patients. One patient had multiple disc prolapses and associated intramedullary haematoma. Patients with disc prolapse were operated upon and all showed neurological improvement. The rest of the patients were managed conservatively. There was mild improvement in patients with intramedullary haematomas while those with cord oedema alone showed moderate recovery. The pathogenesis of adult SCIWORA is possibly different from that in paediatric age group. Most of the patients with SCIWORA show some abnormality on MR imaging. MRI should therefore be done in all patients with spinal cord injury for diagnostic and prognostic purposes.

Magnetic resonance imaging in the evaluation of spinal cord injury without radiographic abnormality in children.

Seven children aged birth to 17 years with spinal cord injury without radiographic abnormality (SCIWORA) were studied with magnetic resonance imaging (MRI) between 3 hours and 16 days after the injury. There were six cervical cord injuries and one thoracic cord injury. The MRI findings were divided into two groups: extraneural and neural. The extraneural findings included one case of anterior longitudinal ligament disruption and anterior C6-C7 disc herniation associated with hyperextension; one case of posterior longitudinal ligament disruption and C2-C3 disc herniation associated with lateral flexion; and one case of C6-C7 disc abnormality consistent with increased water content occurring with hyperflexion. These ligament and disc injuries did not correlate with late instability. The neural MRI findings included one case of cord transection with rostral cord stump hemorrhage and one case of hemorrhage involving the majority of the cord's transverse diameter, both associated with permanent complete cord injuries; one case of hemorrhage involving a minor portion of the cord and of the brain stem's transverse diameter associated with a severe partial cord injury but subsequent incomplete improvement; one case of edema without hemorrhage associated with Brown-Séquard syndrome and subsequent incomplete improvement; and three cases of normal cord signal and outline. Two of the latter patients had mild cord injuries that recovered completely. In the third, a child with complete T12 sensorimotor paralysis at presentation, the normal MRI findings predicted the subsequent complete recovery. No extraaxial compressive lesion was demonstrated in these seven children.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical Neuroschisis and Meningocoele Manque in Type I (No Neck) Klippel-Feil Syndrome

A male child with type I (no neck) Klippel-Feil syndrome presented at birth with a transient and partial cord injury. Investigations failed to reveal spinal instability or foramen magnum compression. Subsequent deterioration led to investigations that demonstrated neuroschisis. A cervical meningocoele manque with cord tethering was found at exploration and untethering reversed the deficit. The surgical pathology of the cervical cord is described.

Trauma to the cervical spine

Ninety-one patients with cervical injuries treated at the Geisinger Medical Center Emergency Department were reviewed. Most injuries were bony injuries with no evidence of cord injury. Of the 43 cases with cord injury, 56% had partial cord injuries and 44% had complete cord injuries. Clinical presentations of these patients were reviewed. A basic outline of management is discussed.