Post-traumatic Spinal Deformities Research Articles

A clinical case of transient diabetes insipidus with high spinal trauma

BACKGROUND: Diabetes insipidus is characterized by the kidneys inability to absorb water and concentrate urine, which is based on a defect in the synthesis or secretion of vasopressin and is manifested by severe thirst and excretion of large volumes of diluted urine. Data on diabetes insipidus in adults with isolated spinal injury are presented in single works of foreign authors, and no domestic and foreign publications have focused on diabetes insipidus in children. Available publications are descriptions and evaluations of the diseases clinical picture according to clinical and laboratory abnormalities and analyzed therapy in the postoperative period.
 CLINICAL CASE: This study presents a clinical case of transient diabetes insipidus in a 12-year-old patient with high-level spinal cord injury after shrapnel and explosive trauma. A detailed description of the clinical picture is provided.
 DISCUSSION: Polyuria, polydipsia, and low urine density were noted on day 14 after surgical correction and stabilization of post-traumatic spinal deformity with spinal cord rupture at the CVICVII level. The condition was considered a transient diabetes insipidus. Clinical and laboratory recovery was achieved on day 12 after surgery thanks to treatment by desmopressin.
 CONCLUSIONS: This clinical case presents that diabetes insipidus may develop in pediatric patients with isolated spinal injury. Given the insufficient understanding of the causes of this rare disease, differential diagnosis is necessary for pediatric patients with high-level spinal cord injuries associated with polyuria and low urine density. Moreover, treatment with desmopressin should be prescribed appropriately.

An Uncommon Case of Post-Traumatic Syringobulbia: A Case Report

Background and aim: Syringobulbia is a rare progressive neurological condition characterised by the presence of syrinx or an elongated fluid-filled cavity in the brainstem with multiple possible underlying aetiologies. However, to date, only a few cases of syringobulbia presenting as a late complication of post-traumatic syringomyelia (PTS) have been reported. Methods: We present a case of a 26-year-old morbidly obese gentleman with T4 AIS C incomplete spinal cord injury following T7 burst fracture 2 years prior requiring spinal instrumentation. He then experienced implant failure 1 year later, necessitating implant removal. Subsequently, he reported worsening back pain and neurology deterioration over his left upper and lower limb. In addition to that, pain and muscle spasms over the left upper limb extending up to the left side of his neck, face, and head warranted a repeat imaging of the brain and spinal cord. Magnetic resonance imaging (MRI) revealed syringobulbia predominantly affecting the left side of the medulla oblongata with extensive syringomyelia originating from the C1 to T12 vertebral level. Moreover, the old T7 fracture site remained malunited. Results: Despite a successful second spinal decompressive surgery and combined rehabilitation, there was no neurological recovery. However, the patient described significant improvement in pain and spasms. Conclusion: PTS complicated with syringobulbia, although rare, is one of the causes of the delayed-onset neurological deterioration in spinal cord injured patients. It might be a diagnostic dilemma as some cases exhibit atypical presentations and mimic the pre-existing neurological deficit. Syrinx formation due to alteration of subarachnoid cerebrospinal fluid (CSF) flow in post-traumatic spinal deformity might benefit from decompressive surgery, avoiding the need for intradural shunt placement, coupled with medication and physical therapy. Even though there was no neurological recovery, symptomatic alleviation of neuropathic pain and spasm improved quality of life.

Surgical options for traumatic fractures of the thoracic and lumbar spine

Background context. Thoracolumbar fractures represent a large number of spine injuries in adults. Such fractures are a result of traumatic accidents with high-energy impacts, such as falls from height or following motor vehicle accidents, often resulting in some degree of neurological deficit. Purpose. To report a total of 20 cases of thoracolumbar fractures in young adults with various neurological manifestations. The majority had indications for transpedicular fixation. Study Design. Series of 20 cases and review of the literature. Patient Sample. A series of 20 patients with a history of falling from a height or after motor vehicle accidents (RTA) with complicated fractures at the level of the thoracolumbar vertebrae which present with neurological deficits. Methods. We report here on a total of 20 patients with a history of falls from height or following RTA. Patients presented to the hospital complaining of back and abdominal pain. Fractures at the thoracolumbar vertebral level were confirmed with imaging studies revealing post-traumatic spinal deformities. All cases were initially considered for conservative medical treatment. However, unstable complicated cases with bone fragment migration as well as spinal canal compression were deemed candidates for surgical intervention via posterior spinal fusion with transpedicular screw fixation. Written informed consent was gathered from all patients. Detailed history, clinical examination, as well as X-ray, computed tomography and magnetic resonance imaging of the dorsolumbar spine were obtained in all cases. Neurological status was assessed using the Frankel grading for spinal cord injury. Results. The patients tolerated the operations without complications and remained in stable postoperative condition. Conclusion. Surgical treatments via transpedicular fixation are extremely efficient for treating unstable and complicated thoracolumbar spinal fractures. Nevertheless, conservative medical treatment is still of high value and should be considered as the first treatment option, especially in stable cases. The patients who underwent surgery showed excellent outcomes and improvement of neurological deficits. The surgical procedure preferred in the present study was the posterior spinal fusion with pedicle screw fixation.

Post-traumatic deformities of the spine: relevance, problems, and revision surgery

Objective . To analyze tactical approaches and types of surgical interventions for post-traumatic deformity of the spine. Material and Methods . Study design: retrospective monocentric cohort study. The study included 116 patients: Group 1 consisted of 50 patients with primary post-traumatic deformities, and Group 2 of 66 patients with secondary deformities after previously performed decompression and stabilization surgery who were admitted for revision interventions. The average age of patients was 42.1 ± 11.6 years, the long-term follow-up period varied from 2 to 60 months (16.6 ± 10.2). Methods used in the study were clinical (neurological status, ASIA, VAS) one, evaluation of treatment results according to MacNub scale, radiography, CT, radiometry (local kyphosis according to Cobb, Surgimap Spine), MRI, and statistical methods. Results. The follow-up period of Group 1 patients was 31.3 ± 28.1 months, of Group 2 patients – 60.3 ± 48.1 months. Injuries were predominantly localized at the level of the thoracolumbar junction. In Group 2, more severe neurological disorders (ASIA) prevailed. All patients underwent primary or revision transpedicular fixation and Schwab vertebrotomy variants through posterior approach. The follow ing types of primary deformities according to Rajasekaran were observed: type IIA in 16 (32 %) patients, IIIA in 30 (45 %), and IIIB in 4 (6 %). Patients with secondary deformities had failure of posterior instrumental fixation (100 %), failure (56 %) or absence (73 %) of anterior fusion, and progression of deformity (100 %). In Group 1, local kyphosis was 32.0° ± 9.9° before treatment and 12.5° ± 8.8° after treatment, pain VAS score before treatment 76.6 ± 6.9, and after treatment 47.6 ± 8.8. In Group 2, local kyphosis was 31.8° and 10.1°, and pain score 80.6 and 48.4, respectively. Complications were registered in 10 % of cases. Treatment results were assessed as good/satisfactory in 32 (64 %)/18 (36 %) Group 1 patients, and in 38 (57 %)/28 (42 %) Group 2 patients, respectively. Conclusion. Classification options and tactical approaches for primary post-traumatic spinal deformities were defined; for secondary posttraumatic deformities there is no classification defining treatment tactics and criteria for assessing the parameters of local and global body balances. Joint multicenter studies are necessary for the adoption of consensual conclusions in the revision surgery of post-traumatic spinal deformities.

SURGICAL TREATMENT OF A PATIENT WITH MULTIPLE FRACTURES OF THE THORACIC AND LUMBAR VERTEBRAE ASSOCIATED WITH HAJDU – CHENEY SYNDROME

A clinical case of surgical and multimodal conservative treatment of an 11-year-old female patient with Hajdu – Cheney syndrome with multiple vertebral fractures in the thoracic and lumbar spine is presented. The main and significant manifestations of this syndrome are osteoporosis and acroosteolysis. After the injury, the child underwent correction of posttraumatic spinal deformity and stabilization of spinal motion segments by a placement of multi-anchor instrumentation through a posterior approach. The long-term postoperative period was characterized by the absence of bone block formation, development of distal junctional kyphosis and scoliotic deformity, which required additional surgical intervention in the amount of elongation of instrumentation and correction of the developed curvature. The paper describes in detail the clinical manifestations of the syndrome, the results of surgical treatment, and clinical and radiological characteristics.

Surgical treatment of a patient with posttraumatic syringomyelia associated with complex posttraumatic deformity of the spine

A clinical case of surgical treatment of a female patient with posttraumatic syringomyelia which led to tetraparesis and dissociated sensory loss in the trunk and upper and lower limbs is presented. Clinical manifestations of these spinal cord changes occurred 21 years after complicated fracture of the L1 vertebra associated with complex posttraumatic spinal deformity. Multistage surgical intervention made it possible to restore liquorodynamics, perform the necessary correction of severe kyphotic deformity of the spine, and reduce the risk of torso imbalance. As a result, the syrinx practically disappeared at all levels of the study.

A clinical case study of long-term injury of the thoracic and lumbar spine

Overestimation of the efficacy of conservative treatment of spine injuries children often leads to unsatisfactory long-term results. The effective correction of post-traumatic spinal column deformities occurs in patients who undergo the operation in the early post-traumatic period. While choosing treatment strategies for children, higher reparative opportunities, which provide early fracture consolidation, including those in faulty positions, should be considered. This study presents a case of surgical treatment for uncomplicated injury of the thoracic and lumbar spine, with long-term compression fragmental fracture of the L1 vertebra body in a 12-year-old child. Due to the long-standing character of the injury right thoraco-frenotomy was conducted with partial L1 vertebral body and resection of the adjacent discs, deformity correction of the thoracic and lumbar spine with a transpedicular system, and ventral spondylodesis with an autograft. This extensive intervention was justified by the peculiarities in the vertebral body damage and the post-traumatic segmental kyphotic deformity that resulted from delayed medical treatment. An anterior approach was chosen to achieve immobilization at the site of the damage before correction using the transpedicular system. Surgical correction of long-term spinal injuries in children, with the use of a combined approach, is usually laborious and traumatic. The prevention of rigid post-traumatic spine deformities with the help of timely diagnostics and appropriate treatment, including surgery, should be a priority to prevent such cases.

Operative Management of Post-tumor Spinal Deformity

Introduction The purpose of our research is evaluation of the outcome after surgery and health-related quality of life (HRQOL) parameters in patients with post-tumor spinal deformity. Material and Methods Retrospective clinical and radiographic data were collected for 33 patients (15 male and 18 female, average age of 61.4 years) with spinopelvic malalignments (SRS-Schwab sagittal modifiers: 2 grade and more) who underwent spinal deformity surgery. Patients were divided into two groups. The first group included 13 patients ( n = 12 after chemotherapy of plasmacytoma, n = 1 patient after radiotherapy of cervix uteri cancer metastasis) with confirmed spinal oncology diagnosis by biopsy. All patients have had oncology remission with a 3-year minimum follow-up. Spinal deformity was developed in the period between 1 and 6 years after conservative treatment. Repeated biopsy did not show tumor cells, this was evaluated as local control of tumor. Low scores of HRQOL and unsuccessful nonoperative approach were indications for surgical intervention. The second comparative group consisted of 20 patients with “de novo” degenerative or posttraumatic spinal deformity. The aim of surgical management was to achieve sagittal balance, using osteotomies and transpedicular instrumentalization. Groups were evaluated with HRQOL-scales including VAS, ODI, SF36 and SRS-24. Radiographical assessment included Cobb coronal angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS), sagittal vertical axis (SVA). Radiographical, HRQOL-parameters and complications were analyzed and compared between two groups. The comparisons were done by using independent sample Student t-test. A p-value of less than 0.05 was accepted as significant. Results Both groups showed a restoration of global spinal alignments without significant differences in TK, LL, PI, PT, SS, SVA parameters (p > 0.05). In addition, HRQOL-scores (VAS, ODI, SF36, SRS-24) of the patients were increased after operation. The HRQOL-scores after 2 years are slightly higher in the first group, but we did not get significant difference between groups (p > 0.05). The number of complications in the form of implant instability, proximal and distal junctional disorders was comparable (p > 0.05). However, general medical complications in the first group was significantly higher than in the second one ( p < 0.05). It is important that no patients had local recurrence or metastasis of tumor during follow-up in the first group. Conclusion Spinal tumor under local control is not contraindication for spinal deformity surgery. Realigning of the sagittal plane is paramount, especially because of the sagittal balance impact on quality of life.

Neuromodulation for Refractory Failed Back Surgery Syndrome Patients

doi: 10.17691/stm2015.7.3.13 Received February 23, 2015I.N. Morozov, Md, dSc, Senior Researcher, Advisory and Rehabilitation department;А.I. Ushakov, Neurosurgeon, department of NeurosurgeryPrivolzhsky Federal Research Medical Center, Ministry of Health of the Russian Federation, 18 Verkhne-Volzhskaya naberezhnaya St., Nizhny Novgorod, 603155, Russian FederationThe aim of the investigation was to assess the capabilities of spinal cord stimulation, and compare it with conventional nonsurgical treatment in failed back syndrome.Materials and Methods. The study involved the patients with at least one anatomically successful lumber disc hernia excision, post-traumatic spinal deformity in their past history, the patients keeping suffering from neuropathic pain.Group 1 patients (n=45) in addition to traditional therapy underwent spinal cord stimulation. Group 2 control patients (n=35) were given medicines, therapeutic blocks, physiotherapy, and psychotherapy.Results. Epidural spinal cord stimulation in chronic pain syndrome treatment enables to improve significantly the patients, condition: it lowers pain level, increases the functionality and improves the quality of life.Conclusion. Being minimally invasive and highly safe, neuromodulation enables to achieve good treatment results in failed back syndrome.Key words: neuromodulation; spinal cord stimulation; SCS; failed back surgery syndrome; FBSS.For contacts: Morozov ivan Nicolaevich, e-mail: ivanmorozov@list.ru

Incidence and the risk factors of spinal deformity in adult patient after spinal cord injury: a single center cohort study.

A retrospective consecutive case series of adult spinal cord injuries (SCIs) patients. To assess the incidence and risk factors of spinal deformity in a large sample of patients with SCIs. Post-traumatic spinal deformities are well-recognized sequelae of SCIs. Despite the devastating complications for SCI patients with trunk imbalance, the incidence, clinical outcomes, and independent risk factors of scoliosis after SCI remain controversial. We assessed 214 consecutive adult compressive SCI patients who were hospitalized in our hospital. We compared patients who developed spinal deformities with those who did not. Univariate and multivariate analyses to determine the independent risk factors were performed. Age, gender, etiology, ASIA grade (American Spinal Injury Association) surgery, and other demographic data were analyzed to determine the risk factors for developing a spinal deformity. The average patient age was 58.3 years (20-86 years). The etiology was trauma (n = 158), ossification of ligament (n = 22), infectious (n = 17), and others. One hundred fifty-two patients had cervical spine involved, 62 had thoracic spine involved. 26 patients classified as ASIA A, 54 were ASIA B, 96 were ASIA C, and 42 were ASIA D 4. One hundred thirty-five patients had either decompression or decompression and fusion surgery. The incidence of spinal deformities was 21 % (44/214). The mean Cobb angle was 28.9 degrees (13-38°). ASIA grade and surgery predicted the occurrence of spinal deformity in both the univariate model (ASIA grade, OR: 1.59 [95 % CI: 1.04-2.44; P = 0.032]; Surgery, OR: 4.47 [95 % CI: 1.89-10.06; P = 0.0007]) and the multivariate model (ASIA grade, OR: 1.63 [95 % CI: 1.04-2.57; P = 0.033]; Surgery, OR: 4.59 [95 % CI: 1.91-11.04; P = 0.0006]), whereas surgery was the most important risk factor in the Cox model (HR: 3.50 [95 % CI: 1.56-7.88; P = 0.0025]). The SCI patients with high ASIA grades and those who had undergone surgery had a higher likelihood of developing a spinal deformity. Of these risk factors, surgery was the stronger risk factor.

ДИАГНОСТИКА И ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ НЕБЛАГОПРИЯТНЫХ ПОСЛЕДСТВИЙ ПОЗВОНОЧНО-СПИННОМОЗГОВОЙ ТРАВМЫ

Objective. To analyze the content and results of specialized medical care delivered to patients with adverse consequences of spine and spinal cord injury. Material and Methods. The retrospective analysis included 307 patients treated for adverse consequences of the spine and spinal cord injury. Main reasons for low quality of life of patients and basic pathological conditions causing poor anatomical and functional results in them were studied. Results. Rational volume of surgery based on the clinical and X-ray data included decompression of the spinal cord and its roots, the spine release, correction of post-traumatic spinal deformities, anterior column reconstruction, and spinal fusion. Out of 257 patients with neurological disorders the regression was achieved in 156 (60.6 %) cases. Correction of posttraumatic deformity was 28.2° in the thoracic, 17.7° in the cervical, and 23.4° in the lumbar spine. Conclusion. Surgical treatment of the spine and spinal cord injury, even in its late period, is very effective and allows achieving partial or complete regression of neurological deficit and pain, permanent stabilization of the spine, correction of posttraumatic deformity, and significant improve in the function and quality of life of patients. Hir. Pozvonoc. 2014;(1):71-77.

Unique Features of Pediatric Spinal Cord Injury

Systematic review. The objective of this systematic review was to identify the unique features associated with pediatric spinal cord injury (SCI) with the intention of determining the most effective spinal stabilization methods and identifying the optimum treatment for post-traumatic spinal deformity in pediatric patients with a SCI. Spinal injuries occur in 1.99/100,000 children, 10% are under 15 years, 60% to 80% occur in the cervical spine, and 5.4% to 34% in the thoracolumbar spine. The most frequent incident of spinal injury (50%-56%) occurs during motor vehicle accidents. A systematic review of the English language literature explored articles published between 1950 and 2009. Electronic databases (Medline and Embase) and reference lists of key articles were searched to identify unique features of pediatric SCI based on 2 questions: (1) "What is the most effective means to achieve spinal stabilization in pediatric patients with a SCI?" and (2) "What is the most effective treatment of post-traumatic spinal deformities in pediatric patients with a SCI?" Three Spinal Trauma Study Group faculty members assessed the level of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria and disagreements were resolved by a modified Delphi consensus. No Level 1 or 2 evidence articles were discovered. Question 1 was addressed by 417 abstracts; from those 15 were selected for inclusion. This literature proved to be controversial, mostly focused on the adult population, pediatric series were retrospective, and most treatments were based on adult experience. The evidence supporting stabilization of the spine in the pediatric SCI population is very low for both the cervical and thoracic spinal regions. Question 2 was discussed in 517 abstracts; 8 relevant articles were selected. The principal key points, regarding the most effective treatment of post-traumatic spinal deformity in the pediatric SCI patients, suggest that the deformity should be prevented before the age of 10 to 12 years, younger SCI patients are unfavorable, nearly 100% of patients with SCI will develop a deformity, and brace treatment is generally recommended. Current evidence in support of brace use is very low. Despite the lack of well-designed prospective studies to establish the efficacy of instrumentation in these cases, there remains very low evidence that supports the use of instrumentation in unstable pediatric spines to prevent neurologic injury and maintain spinal alignment. The very low evidence of benefits from early bracing clearly outweighs the risks and complications associated with its use. Close monitoring should be initiated early so as to delay surgical correction as late as possible. There is very low evidence to support the use of surgery for the treatment of deformity triggered by a SCI. There may be evidence suggesting that the correction techniques used for neuromuscular deformities are useful for SCI patients. In conclusion, there is a strong recommendation for the use of instrumentation in the unstable pediatric spinal injured population, and there is a strong recommendation for traditional neuromuscular spinal deformity treatment techniques to be adopted as a treatment of progressive spinal deformities after a neurologic injury.

Management of Posttraumatic Kyphosis After Thoracolumbar Injuries

Spinal trauma is relatively common, and each year approximately 10,000 to 17,000 people in the United States will sustain a spinal cord injury, and approximately 150,000 to 160,000 will fracture their spinal column. Posttraumatic spinal deformity is a common potential complication of spinal injury and poses as the greatest challenge in spinal surgery. Successful treatment of posttraumatic spinal deformity is dependent on careful patient selection and appropriate surgical intervention. Surgery should be considered in the presence of significant or increasing deformity, increasing back and/or leg pain, “breakdown” at levels above or below the deformity, pseudarthrosis or malunion, and increasing neurological deficit. The goals of surgery should be to decompress the neural elements if neurological claudication or neurological deficit is present and to recreate normal sagittal contours and sagittal and coronal balance and to optimize the chances for successful fusion. These goals can be achieved through an all-anterior, all-posterior, or a combined anterior and/or posterior approach, assuming that close attention is paid to using the appropriate bone-grafting techniques, selecting technically sound segmental instrumentation, and providing appropriate biomechanical environment for maintenance of correction and successful fusion.

外傷後脊椎変形を伴った高度肥満患者へのバクロフェン髄腔内投与治療の工夫

外傷後脊椎変形を伴った高度肥満患者へのバクロフェン髄腔内投与治療の工夫

Pedicle subtraction osteotomy in the treatment of chronic, posttraumatic kyphotic deformity

Thoracolumbar fractures, treated operatively or nonoperatively, may cause painful kyphotic deformities over time. A pedicle subtraction osteotomy (PSO) is a single-stage posterior procedure designed to correct sagittal plane deformity. Although it was initially used to treat nontraumatic conditions, a PSO can be highly effective in chronic, posttraumatic fractures of the lumbar spine. In this report the authors review details obtained in the treatment of three patients with severe, posttraumatic spinal deformities. They describe the surgical technique used to correct the sagittal malalignments. All three patients were middle aged, and good bone mineral density had been demonstrated in each case preoperatively. After PSO, a mean 51 degrees improvement in sagittal alignment was achieved and maintained until a solid arthrodesis was documented in each case. Substantial improvements in pain relief and functional outcome were observed. A detailed, procedure-specific literature review was undertaken. A PSO is a valuable tool to add to the armamentarium of neurosurgeons who treat patients suffering from painful posttraumatic deformity following fractures of the upper lumbar spine.

Post-traumatic spinal deformity.

There are approximately 50,000 fractures to the bony spinal column each year in the United States. The vast majority of unstable spinal injuries are recognized early and managed appropriately. Rarely, the initial treatment may have been inadequate, or in less obvious injuries, less aggressive immobilization techniques may have been chosen. This along with continued exposure to physiologic stresses may lead to a gradual post-traumatic deformity that may further impede the functional as well as emotional status of these often already compromised patients. The management of post-traumatic deformity can be extremely challenging. A post-traumatic kyphotic deformity may occur in the cervical, thoracic, thoracolumbar, or lumbar spine, and once appropriate imaging studies are obtained, careful surgical considerations must be undertaken. Surgical intervention is considered if the kyphotic deformity is progressive over time or there is new onset or progression of a neurologic deficit. Surgical procedures include either a posterior or anterior only approach or any variation of a combined anterior or posterior procedure. In most cases a posterior only fusion is often insufficient for optimal correction and stabilization. Although the majority of patients developing a post-traumatic deformity usually occur after spinal column trauma initially treated nonoperatively, several miscellaneous causes of post-traumatic deformity may occur after surgery. These include nonunion, implant failure, Charcot spine, and technical error. The overall outcome after the surgical management of post-traumatic deformity has been satisfactory with better outcomes in the patients treated earlier as opposed to later. Operative complications include the increased risk of neurologic injury because of the draping of the neural elements over the anterior vertebral elements, any pre-existing spinal cord injury, and possible scarring with cord tethering. Trauma to the spinal cord and column is a devastating injury that may be fraught with many complications including post-traumatic deformity. Certainly, the best treatment is prevention with close follow-up and early intervention when needed. Once present, the treatment of post-traumatic deformity follows basic biomechanical principles consisting of re-establishing the integrity of the compromised spinal columns so that spinal stability can be restored.

Treatment of posttraumatic syringomyelia with extradural decompressive surgery

The authors review the management of five patients with posttraumatic syringomyelia (PTS) associated with an uncorrected spinal deformity. Patients with evidence of progressive neurological deterioration underwent ventral spinal decompressive surgery. The mean patient age at the time of injury was 39 years, and the time between injury and the diagnosis of PTS ranged from 2 to 22 years. Mechanisms of injury consisted of fracture/subluxations in three patients and burst fractures in two. All patients experienced delayed neurological deterioration consistent with PTS. Magnetic resonance imaging revealed ventral deformities, and the spinal canal stenosis ranged from 20 to 50% (mean 39%). All patients underwent ventral epidural spinal decompressive surgery to correct the bone deformity and restore the spinal canal. The mean follow-up period was 38 months. The decompressive intervention was initially successful in treating the neurological deterioration in all patients. Symptoms resolved completely in four patients, and the other experienced neurological improvement. Postoperative magnetic resonance imaging revealed a reduction in the size of syrinx cavity in the patients whose symptoms resolved and no change in the remaining patient. Two patients required a subsequent second-stage posterior intradural exploration and duraplasty for recurrence of symptoms and/or syrinx. Posttraumatic spinal deformity may cause spinal canal stenosis and alter subarachnoid cerebrospinal fluid (CSF) flow in certain patients. Ventral epidural spinal decompressive surgery may result in neurological improvement and a reduction of the syrinx cavity, avoiding the need for placement of a shunt or other intradural procedures. However, some patients will also require reconstruction of the posterior subarachnoid space with duraplasty if the ventral decompressive procedure achieves only partial restoration of the subarachnoid CSF flow.

Pediatric spinal cord and vertebral column injury.

Between January 1, 1970, and December 31, 1988, 179 children (birth to age 16) were treated for spinal cord and/or vertebral column injury by the Neurosurgical Service at the University of Iowa Hospitals and Clinics. Pediatric injuries accounted for 9% of all spinal trauma seen during this period. The mean age was 10.2 years. Sixty-two children were between birth and 8 years of age and 117 were between ages 9 and 16. The cause, distribution, type of injury, and severity of neurological injury varied with age. Neurological outcome was dependent on the severity of the initial neurological injury. Children with complete or severe incomplete myelopathy uniformly remained with severe neurological dysfunction; children with mild to moderate injuries recovered normal or nearly normal neurological function. Surgical versus nonoperative management had no bearing on neurological outcome. Twelve percent of the children with severe spinal cord injuries developed posttraumatic spinal deformity. We conclude that spinal injury patterns differ between preadolescent and older children. Most injuries can be successfully managed with nonoperative therapy. Prognosis is primarily correlated with the severity of the initial neurological insult. Finally, children with severe spinal cord injury must have close, long-term follow-up to monitor the development of posttraumatic spinal deformity.

Clinical Study of Chronic Cases after Thoracic and Lumbar Spinal Injuries with Associated Neurologic Defecit

The purpose of this clinical study was to determine deformities and synptoms of the thoracic and lumbar spine produced by fractures and dislocations.After reviewing 78 patients with neurologic defecits related to spinal fracture dislocations of the thoracic and lumbar spine, we found that neurologic defecits were severe on having unstable spinal injuries.Kyphotic deformties or lateral deformities were remarkable in the patients having slice fractures. Posttraumatic spinal deformities may cause back pain and damaged spinal cord may evoke phantom pain in the palaplegic legs.From these results we found that treatment of the spinal injury with neurologic defecit was most beneficial in restoring spinal alignment using our operative procedure.