Traumatic Cervical Cord Injury Research Articles

Managing Tetraplegia with Blindness: Rehabilitation Approach

Background and aim: Spinal cord injury, especially tetraplegia, would severely disable an individual. The rare postoperative complication of cervical spine surgery, which caused bilateral blindness, would be catastrophic to a tetraplegic patient. Methods: A 60-year-old man sustained traumatic cervical cord injury (C2 AIS C) and underwent cervical decompression with dome laminoplasty of C3 – C6. He, unfortunately, developed bilateral central retinal artery occlusion, a rare postoperative complication leading to bilateral visual loss. Approximately 1-month post-injury, he was admitted to a rehabilitation ward with impairments of incomplete tetraplegia, non-perception of light in both eyes, orthostatic hypotension, neurogenic bladder, neurogenic bowel, neuropathic pain, multiple pressure injuries, and adjustment disorder with depressed mood. Results: Although the patient required caregiver assistance in most activities, functional improvement was observed by teaching him to incorporate other intact senses such as proprioception, stereognosis, and auditory sense. After 4 weeks of rehabilitation, the patient improved to C4 AIS D. His bed mobility required minimal assistance, transferred with the assistance of one person, was able to feed and groom with an assistive device. The rehabilitation process was complicated because the patient could not actively participate in therapy without assistance from his caregiver due to bilateral blindness and reduced sensation over all his limbs despite having adequate motor power for acquiring a certain level of independence in mobility and self-care. When vision loss presents together with sensory impairments, the impact of disability multiplies. Orientation and Mobility (O&M) training and sensory education were further strengthened with repeated verbal instructions to compensate for the loss of visual and sensory feedback to help the patient regain mobility and daily living skills. Three months post-rehabilitation, he was able to perform stand transfer with a walking frame under close supervision. Conclusion: Although total blindness with tetraplegia has severely disabled the patient, O&M strategies with remaining intact senses can be used to facilitate functional improvement.

Traumatic cervical spine injury: Clinical scenarios

This section of the symposium deals with different clinical situations related to the management of traumatic cervical spine cord injury (SCI) and its complications. These cases give an overview of the clinical dilemmas that test our decision-making abilities in dealing with patients with cervical SCI and its associated complications. The patients were managed in various centers across India with different infrastructures and facilities. They are managed by different experts in the field of spine surgery. This should help the reader in providing a wider perspective in the management of vertebral lesions of traumatic cervical SCI. This section also helps in understanding the newer advances in dealing with the dreaded complication of invasive long-term ventilation in a patient with cervical SCI. The spine clinic ends with comments by the authors on key takeaway points from each case scenario, and some literature supported recommendations for the management of traumatic cervical SCI.

Traumatic subaxial cervical spine injury - Improving initial evaluation through correlation of diffusion tensor imaging and subaxial cervical spine injury classification SLIC score.

Background: Traumatic injury to spine and spinal cord represents a devastating condition, with a huge risk for permanent severe disabilities. Predicting the long-term outcome in this type of trauma is a very difficult task being under the influence of a wide spectrum of biomechanical and pathophysiological factors. The advent of magnetic resonance imaging (MRI) structural evaluation of the spinal cord brought critical supplementary data in the initial evaluation of these cases. Although edema and hemorrhage proved to be valuable in predicting the outcome, there is a well-documented discrepancy between MRI findings and clinical status.Methods: We performed diffusion tensor imaging (DTI) MR in 22 symptomatic patients with traumatic cervical spine injuries (mean age 49.6 ± 16, range from 17 to 74 years, 20 males and 2 females). DTI parameters were computed in 15 patients. Regional apparent diffusion coefficient, fractional anisotropy (FA), and fiber length (FL) were calculated in the region of interest defined as the region of maximum structural MR alterations and in the normal cord (above or below the level of the injury). The values for normal and pathological cord were compared. The clinical deficit was assessed with ASIA and subaxial cervical spine injury classification (SLIC) scores. We looked at the correlation between the DTI measures and clinical scores.Results: There is a highly significant difference between normal and pathological spinal cord for all DTI properties measured. There is also a strong correlation between DTI measures and SLIC clinical score, especially for FA. Significant results were obtained for CDA and FL as well although with lesser statistical power.Conclusion: Our results suggest that DTI measures, especially FA, represent a strong indicator of the severity of the traumatic cervical cord injury. It correlates very well with SLCI score and can be used as an additional confirmation of the real degree of level lesioning and as a prognostic factor for the neurological outcome regardless of the choice of treatment.

A Case of a Massive Retropharyngeal Hematoma Associated with Traumatic Cervical Cord Injury

Retropharyngeal hematomas are uncommon, but they may rarely cause occlusion of the upper airway and threaten life. Retropharyngeal hematomas often occur due to head or neck injury;they rarely occur due to iatrogenic causes such as insertion of a gastric tube or anticoagulant therapy. It has been found that patients receiving anticoagulant therapy are more likely to experience potentially severe retropharyngeal hematomas. We report the case of a patient with retropharyngeal hematoma with cervical cord damage. A 75-year-old man was transferred to our hospital after he sustained a fall and damaged his face. CT showed a massive retropharyngeal hematoma, but he did not complain of any breathing issues. Therefore, we selected conservative therapy. However, after approximately 4 hours, he suddenly complained of breathing problems and suffered from loss of consciousness. We performed intubation and provided sedation. After one week, his condition clearly improved and he was extubated.

Comparison of clinical treatment of traumatic cervical spinal cord injuries with acute respiratory failure treated by high-flow nasal cannula therapy and non-invasive positive pressure ventilation

Objective To compare the clinical efficacy of high-flow nasal cannula oxygen therapy (HFNC) with non-invasive positive pressure ventilation (NPPV) in patients with traumatic cervical spinal cord injury complicated with acute respiratory failure (ARF). Methods A prospective randomized controlled trial was performed in EICU of the First Affiliated Hospital of Zhengzhou University from May 2016 to January 2018. One hundred sixty-eight consecutive patients with traumatic cervical spinal cord injury complicated with ARF, who did not respond to conventional oxygen therapy, were assigned to the HFNC or NPPV treatment group sequenced by the random number table. The baseline clinical characteristics of randomized participants and respiratory frequency (RR), PaCO2, mean arterial pressure (MAP) at 1, 12, 24, 48 h after treatment were evaluated. Comfortable scale, tracheal intubation rate within 28 d, duration of mechanical ventilation, length of stay in ICU and mortality rate were compared as well. Results There was no significant differences in baseline clinical characteristics, such as sex, age. between the two groups (P>0.05). RR and PaCO2 were lower in the HFNC group at all time point. In addition, the HFNC group had significantly lower PaCO2 than the NPPV group at 24 and 48 h after treatment (P 0.05). Conclusions In addition to the superior efficacy in improving respiratory function and shortening length of stay in ICU, HFNC was well tolerated by patients with traumatic cervical spinal cord injury complicated with ARF, and could be recommended in clinical practice. Key words: Traumatic cervical spinal cord injury; High-flow nasal cannula oxygen therapy; Non-invasive positive pressure ventilation; Respiratory failure

Epidemiological analysis of traumatic cervical spinal cord injury

Objective To describe the epidemiological characteristics of cervical spine fracture combined with trauma cervical spinal cord injury (TCSCI) in Guangxi province. Methods A total of 385 patients met the inclusion criteria were enrolled for retrospective investigation. Detailed information included age, sex, marital status, occupation, date of admission, mechanisms of trauma, level of injury, ASIA grade, concomitant injuries, length of hospital stay, complications, and mortality. Results The ratio of Male/Female was 4.4:1. The average age of the patients was 47.9 years, and 88.8% of the patients were married. 72.9% of TCSCI occurred between the age of 35-64 years. Farmers accounted for the largest number of patients with TCSCIs, and 63% of patients with TCSCI were caused by falling. The damage was located at the C3-C5 level, accounting for 63.8%. More than half of the patients with CSCI had brain injury. The most common complication was respiratory infection (54.5%). Among the injury levels, the proportions of ASIA grade A, B, C, and D were 34.8%, 8.5%, 35.5%, and 21%, respectively. During the treatment, 58 patients required cardiopulmonary resuscitation, and 36 patients required mechanical ventilation. The average length of hospital stay was (26.5±21.6) d. Of the 375 patients discharged from the hospital, 51.2% patients had no improvement in the muscle strength. Conclusions Falling is the main cause of CSCI and men are more likely to be exposed to the injury. Patients with TCSCI have long treatment time and poor treatment results. Additionally, complications during the treatment should not be ignored. Key words: Trauma; Cervical spinal cord injury; Epidemiology; Single center; Retrospective analysis; Guangxi

Traumatic Cervical Cord Injury in the Neurosurgical Emergency : Treatment Consensus and Problems

Traumatic Cervical Cord Injury in the Neurosurgical Emergency : Treatment Consensus and Problems

Low virulence bacterial infections in cervical intervertebral discs: a prospective case series.

A prospective cross-sectional case series study. To investigate the prevalence of low virulence disc infection and its associations with characteristics of patients or discs in the cervical spine. Low virulence bacterial infections could be a possible cause of intervertebral disc degeneration and/or back pain. Controversies are continuing over whether these bacteria, predominantly Propionibacterium acnes (P. acnes), represent infection or contamination. However, the current studies mainly focus on the lumbar spine, with very limited data on the cervical spine. Thirty-two patients (20 men and 12 women) who underwent anterior cervical fusion for degenerative cervical spondylosis or traumatic cervical cord injury were enrolled. Radiological assessments included X-ray, CT, and MRI of the cervical spine. Endplate Modic changes, intervertebral range of motion, and disc herniation type were evaluated. Disc and muscle tissues were collected under strict sterile conditions. Samples were enriched in tryptone soy broth and subcultured under anaerobic conditions, followed by identification of the resulting colonies by the PCR method. Sixty-six intervertebral discs were excised from thirty-two patients. Positive disc cultures were noted in eight patients (25%) and in nine discs (13.6%). The muscle biopsy (control) cultures were negative in 28 patients and positive in 4 patients (12.5%); three of whom had a negative disc culture. Seven discs (10.6%) were positive for coagulase-negative Staphylococci (CNS) and two discs were positive for P. acnes (3.0%). A younger patient age and the extrusion or sequestration type of disc herniation, which represented a complete annulus fibrous failure, were associated with positive disc culture. Our data show that CNS is more prevalent than P. acnes in degenerative cervical discs. The infection route in cervical discs may be predominantly through an annulus fissure. Correlation between these infections and clinical symptoms is uncertain; therefore, their clinical significance needs to be investigated in the future. These slides can be retrieved under Electronic Supplementary Material.

The Need for Early Tracheostomy in Patients with Traumatic Cervical Cord Injury.

BackgroundIn patients who need sustained endotracheal intubation and mechanical ventilation due to respiratory failure after traumatic cervical spinal cord injury, tracheostomy can be performed to reduce the duration of mechanical ventilation and respiratory complications. The purpose of this study was to determine criteria and timing of tracheostomy in patients with severe traumatic cervical spinal cord injury accompanied by motor weakness.MethodsWe reviewed 22 patients who underwent tracheostomy (study group) and 27 patients who did not (control group) from January 2005 to March 2016. We assessed the American Spinal Injury Association (ASIA) impairment scale score and investigated accompanying thoracic injury, paradoxical respiration, postoperative endotracheal intubation and other clinical parameters. The study group was also subdivided into the early tracheostomy group and late tracheostomy group depending on whether the tracheostomy was performed within or later than 7 days after surgery.ResultsTwenty-two patients in the study group had a mean ASIA impairment scale score of 14.1 points, which was lower than the control group's 23.4 points. Paradoxical respiration was observed in 77% of the patients in the study group compared to 18% in the control group. Postoperative intubation was maintained in 68% in the study group; 32% underwent endotracheal intubation due to respiratory failure within 4 days after surgery and had a tracheostomy. In the control group, postoperative intubation was maintained in 22%, and all of them were weaned off intubation within 4 days after surgery. The duration of intensive care unit hospitalization was 11.4 days for the early tracheostomy group, which was shorter than the late tracheostomy group's 19.7 days.ConclusionsIn patients with severe traumatic cervical spinal cord injury, tracheostomy may be needed when the motor grade of the ASIA scale is low, above the C4 segment is injured, or paradoxical respiration occurs after injuries. In addition, if endotracheal extubation is not feasible within 4 days after surgery, an early tracheostomy should be considered.

Prospective observational research on the clinical profile and outcome analysis among a cohort of patients sustaining traumatic cervical spine and cord injury in a peripheral tertiary spine care centre in Nepal

Background: In developing nations like Nepal, spinal cord injury has multispectral consequences for both the patient and their family members. It has the tendency to cripple and handicap the patients, and burn out their caretakers, both physically and mentally. Furthermore, the centralization of health care with only a handful of dedicated rehabilitation centers throughout Nepal further places patients into disarray. This study was carried out as a pilot study to determine the modes of injury, age groups affected, clinical profiles and patterns of injury sustained, as well as the efficacy of managing a subset of patients, who have sustained cervical spine and cord injuries. Methods: This was a prospective cohort study comprising of 163 patients enrolled over a period of three years that were managed in the spine unit of College of Medical Sciences, Bharatpur, Nepal. Results: Road traffic accidents were implicated in 51% of these patients. 65% of them were in the age group of 30-39 years. Traumatic subluxation occurred in 73 patients with maximum involvement of the C4/5 region (28.76%). Good outcome was seen in patients with ASIA ‘C’ and ‘D’ with 55% of patients showed improvement from ‘C’ to ‘D’ and 95% of patients showed improvement from ‘D’ to ‘E’ at 1 year follow up. The overall mortality in the patients undergoing operative interventions was only 1.98%. Conclusions: The prevalence of cervical spine injuries in the outreach area is still significant. The outcome of managing these patients, even in the context of a resource limited setup in a spine unit outside the capital city of a developing nation, can be as equally as effective and efficient compared to the outcome from a well-equipped and dedicated spine unit elsewhere.

Prospective observational research on the clinical profile and outcome analysis among a cohort of patients sustaining traumatic cervical spine and cord injury in a peripheral tertiary spine care centre in Nepal.

Background: In developing nations like Nepal, spinal cord injury has multispectral consequences for both the patient and their family members. It has the tendency to cripple and handicap the patients, and burn out their caretakers, both physically and mentally. Furthermore, the centralization of health care with only a handful of dedicated rehabilitation centers throughout Nepal further places patients into disarray. This study was carried out as a pilot study to determine the modes of injury, age groups affected, clinical profiles and patterns of injury sustained, as well as the efficacy of managing a subset of patients, who have sustained cervical spine and cord injuries. Methods: This was a prospective cohort study comprising of 163 patients enrolled over a period of three years that were managed in the spine unit of College of Medical Sciences, Bharatpur, Nepal. Results: Road traffic accidents were implicated in 51% of these patients. 65% of them were in the age group of 30-39 years. Traumatic subluxation occurred in 73 patients with maximum involvement of the C4/5 region (28.76%). Good outcome was seen in patients with ASIA 'C' and 'D' with 55% of patients showed improvement from 'C' to 'D' and 95% of patients showed improvement from 'D' to 'E' at 1 year follow up. The overall mortality in the patients undergoing operative interventions was only 1.98%. Conclusions: The prevalence of cervical spine injuries in the outreach area is still significant. The outcome of managing these patients, even in the context of a resource limited setup in a spine unit outside the capital city of a developing nation, can be as equally as effective and efficient compared to the outcome from a well-equipped and dedicated spine unit elsewhere.

Epidemiology of traumatic cervical spinal cord injury in ICU

Objective To investigate the epidemiological characteristics of traumatic cervical spinal cord injury (TCSCI) in ICU. Method The data of patients with TCSCI admitted from October 2010 to March 2016 in the intensive care unit were retrospectively studied. The general epidemiological data included: gender, age, marital status, occupation, cause of injury, injury severity, injured segment (ASIA grade), and complications were collected. Results There were 109 patients identified to have TCSCI with mean age of 53.72 ± 14.86 years (25.69% patients in the range of 60-69 years old). The male to female ratio was 9: 1, and the most were married. The majority of individuals were retired (30.27%), and the main causes of injury were traffic accidents and tumble. The C5 segment of the spine was the most vulnerable to be injured, and then the C4 segment was the nest in turn. There were up to 30.28% patients suffered from multiple injuries, and 26.61% patients also had a craniocerebral injury. Bedsore and respiratory system complications were the two leading complications, and 83 patients suffered from at least one system dysfunction with respiratory dysfunction accounted for 98.79% and circulatory dysfunction accounted for 65.06%. Fifty-one patients presented more than two system dysfunctions (46.79%). Twenty patients (18.35%) died. Conclusion Patients with TCSCI in ICU presented specially characteristic features. Traffic accidents were the main cause of TCSCI, and fall accidents were one of the main causes in the elderly. The mortality of TCSCI was high, especially in males. The complication rate was relatively high and the most common complications were water and electrolyte disturbance and respiratory dysfunction. Multiple organ dysfunction incidences might be associated with the ASIA grades. Key words: Spinal cord injury; Traumatic cervical spinal cord injury; Epidemiology; ASIA; Vehicle accident; Complications; Multiple organ dysfunction; Mortality

Recovery patterns of spinal cord injury after traumatic cervical cord injury in a developing country

Background: Traumatic cervical cord injury (CCI) management requires extended acute care and lifelong chronic care. Aims: The present study was aimed to find out that after traumatic CCI, if neurological recovery takes place, how early it starts, how long it continues, and after how many weeks we can safely prognosticate that no more recovery will take place. Materials and Methods: Different epidemiological factors, radiological evidence of trauma, types of injury, cause, mechanism of injury, and level were recorded. The patients were examined every week to record any neurological recovery, either as per Frankel's or ASIA grading. These recordings were done till 6 weeks of admission. Cervical fractures were usually treated by continuous skull traction either by Crutchfield tong traction or by head halter traction giving adequate weight according to the level of vertebral fracture. At the end of 2 years, we followed the recovery pattern in 126 CCI patients. Results: 20.00% of patients showed signs of recovery and 56.36% patients did not show any sign of recovery in complete lesion. 69.01% of patients showed sign of recovery and 25.35% patients did not show any sign of recovery in incomplete lesion. 53.84% of patients showed the first sign of neurological recovery within 1 st week, 32.30% in 2 nd week, 9.23% in 3 rd week, and 4.61% in 4 th week. In upper cervical spine lesion, 22.22% of patients showed first sign of neurological recovery within 1 st week, 55.55% in 2 nd week, 16.11% in 3 rd week, and 5.55% in 4 th week. In lower cervical spine lesion, 65.95% of patients showed the first sign of neurological recovery within 1 st week, 23.40% in 2 nd week, 8.51% in 3 rd week, and 2.12% in 4 th week. Conclusions: In traumatic CCI, patients' level of lesion, type of injury, and nature of injury may be helpful in the early prediction of recovery pattern of patients and careful monitoring of these patients may reduce the social burden in developing countries and reduce morbidity and mortality of these patients.

Clinical Outcome in Patients with Early versus Delayed Decompression in Cervical Spine Trauma.

Study DesignProspective observational study.PurposeTo assess the clinical outcome after early versus late decompression for traumatic cervical cord injury.Overview of LiteratureTraumatic spinal cord injury is common globally with the most tragic outcomes in the cervical spine. Although recent studies have shown that early decompression results in more favourable outcome, its authority is yet to be established.MethodsStudy on 98 patients with a traumatic cervical cord injury was conducted over a period of 5 years. The patients who were operated on within 24 hours of the onset of the primary injury (n=34) were classified as the early group, and those who were operated on after 24 hours of the onset of the injury (n=64) were categorized as the late group. The outcome of both the groups was assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at the 6-month follow-up.ResultsThe patients in the early group were operated on at a mean time of 18.4 hours (range, 13-24 hours) while patients were operated on at a mean time of 52.7 hours (range, 31-124 hours) in the late group. At the 6-month follow-up, 7 (23.3%) in the early group and 5 (8.7%) in the late group showed >2 grade improvement in the AIS.ConclusionsThe results of patients undergoing decompression within 24 hours of the injury are better than those who are operated on later. An attempt should be made to decompress the traumatic cervical spine early in all possible cases.

RETRACTED: <i>A rare presentation of silent gastric perforation in quadriplegic patient</i>

Traumatic cervical spinal cord lesions are highly susceptibility to produce life threatening complications like respiratory failure, cardiac failure and gastrointestinal complications. We are presenting a case of traumatic cervical cord injury with quadriplegia, presented with chief complaints of constipation with abdominal distention and altered sensorium. After detailed examination and history, patient diagnosed as case of post traumatic cervical spine with incidental finding of gastric perforation and managed surgically in emergency.

One-Year Evolution of Ulnar Somatosensory Potentials after Trauma in 365 Tetraplegic Patients: Early Prediction of Potential Upper Limb Function

Early prediction of hand function is crucial for efficient rehabilitation of cervical spinal cord injury (cSCI). This study investigated correlations between ulnar somatosensory evoked potentials (ulnar SSEPs) and functional outcome of hand function following acute traumatic cervical cord injury. Neurological assessment of sensory scores and hand function were compared with five ulnar SSEP categories of similar persistence and quality in 365 patients throughout the first year after cSCI. Of the 365 patients, 218 (68%) exhibited ulnar SSEP potentials at any one stage during the year, and in 147 patients (40.3%) ulnar SSEPs were obtainable at every assessment stage. While ulnar SSEP latency and amplitude assessments remained largely unchanged over time in the majority of patients, hand function improved remarkably during the first year following cSCI. One year outcome of hand function was predetermined by ulnar SSEP category due to distinct differences in the ulnar SSEP parameters. Additionally, an early prognostic group allocation by ulnar SSEP criteria at the first assessment stage within 4 weeks after spinal trauma allowed reliable prediction of hand function outcome after 1 year. We conclude that early assessment of ulnar SSEP as a non-invasive and objective neurophysiological test is a valuable marker of prospective hand function and independence 1 year after cSCI. This could be most relevant for planning neurorehabilitation, and in prospective clinical SCI trials.

Clinical analysis of hyponatremia after different extent of traumatic cervical spinal cord injury

Objective To analyze the incidence and possible etiological factors of hyponatremia after acute cervical spinal cord injury (CSCI),and evaluate the effect of severity of CSCI,age,sex and injured segment on hyponatremia.Methods From June 2005 to March 2011,a series of patients with CSCI caused by cervical vertebras trauma were treated in our department.Except patients combined with craniocerebral injury or chronic diseases,other patients were divided into three groups:complete CSCI group,incomplete CSCI group and no neurological disorder group.Concentration of natrium in blood in all patients was analyzed respectively.Results All 102 patients (83 males,19 females) were selected with an average of 45.6years old.There were 23 patients with complete CSCI,60 with incomplete CSCI and 19 with no neurological disorder.Hyponatremia was found in 15 patients in complete CSCI group,23 patients in incomplete CSCI group and 1 patient in no neurological disorder group.The incidence of hyponatremia was significantly different between three groups,among which the complete CSCI group had the highest incidence.Multiple linear regression analysis showed hyponatremia was obviously correlated with the injury degree of spinal cord,but not correlated with the age,sex and injury segment of the patients.Conclusion Hyponatremia is a common complication in patients suffered from CSCI.Although the balance of natrium in blood is very complicated and influenced by many factors,autonomic nerve system and neuroendocrine system dysfunction,and hemodynamic changes after CSCI may play a key role in happening of electrolytical abnormality. Key words: Cervical vertebrae; Spinal cord injuries; Hyponatremia; Autonomic nervous system

Correlation of MR Diffusion Tensor Imaging Parameters with ASIA Motor Scores in Hemorrhagic and Nonhemorrhagic Acute Spinal Cord Injury

This study investigated correlations between American Spinal Injury Association (ASIA) clinical injury motor scores in patients with traumatic cervical cord injury and magnetic resonance (MR) diffusion tensor imaging (DTI) parameters. Conventional imaging and DTI were performed to evaluate 25 patients (age, 39.7±13.9 years; 4 women, 21 men) with blunt spinal cord injury and 11 volunteers (age, 31.5±10.7 years; 3 women, 8 men). Cord contusions were hemorrhagic (HC) in 13 and non-hemorrhagic (NHC) in 12 patients. The spinal cord was divided into three regions to account for spatial and pathological variation in DTI parameters. Comparisons of regional and injury site mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity ( λ(⊥)), and longitudinal diffusivity ( λ(‖)) were made with control subjects. ASIA motor scores were correlated with DTI using linear regression analysis. HC and NHC patients showed significant reduction (p<0.001) in MD and λ(‖) in all three regions. At the injury site, significant decreases in FA and λ(‖) were seen for both injury groups (p<0.001). λ(⊥) values were significantly increased only for patients with NHC (p<0.05). Significant reduction in FA and λ(‖) (p<0.0001) was observed at the whole cord level between the injured (NH and NHC) and control groups. Within the NHC group, strong correlations were observed between ASIA motor scores and average MD, FA, λ(⊥), and λ(‖) at the injury site. However, no correlation was observed within the HC group between any of the DTI parameters and ASIA motor scores. DTI parameters reflect the severity of spinal cord injury and correlate well with ASIA motor scores in patients with NHC.

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.

Does Ossification of the Posterior Longitudinal Ligament Affect the Neurological Outcome After Traumatic Cervical Cord Injury?

Retrospective outcome measurement study. The purpose of this study is to assess whether ossification of the posterior longitudinal ligament (OPLL) affects neurologic outcomes in patients with acute cervical spinal cord injury (SCI). There have so far been few reports examining the relationship between OPLL and SCI and there is controversy regarding the deteriorating effects of OPLL-induced canal stenosis on neurologic outcomes. To obtain a relatively uniform background, patients nonsurgically treated for an acute C3-C4 level SCI without any fractures or dislocations of the spinal column were selected, resulting in 129 patients. There were 110 men and 19 women (mean age was 61.1 years), having various neurologic conditions on admission (American Spinal Injury Association [ASIA] impairment scale A, 43; B, 16; C, 58; D, 12). The follow-up period was the duration of their hospital stay and ranged from 50 to 603 days (mean, 233 days). The presence of OPLL, the cause of injury, the degree of canal stenosis (both static and dynamic), and the neurologic outcomes in motor function, including improvement rate, were assessed. Of the 129 patients investigated in this study, OPLL was identified at the site of the injury in 13 patients (10.1%). In this OPLL+ group, the static and dynamic canal diameters at C3 and C4 were significantly smaller than those of the remaining 116 patients (OPLL- group). However, no significant difference was observed between the 2 groups in terms of ASIA motor score both at the time of administration and discharge, and the mean improvement rate in ASIA motor score was 55.5 +/- 9.0% in OPLL+ group, while it was 43.1 +/- 2.8% in the OPLL-group. Furthermore, no significant correlation was observed between the static/dynamic canal diameters and neurologic outcome in all 129 patients. No evidence was found for OPLL to have any effect on the initial neurologic status or recovery in motor function after traumatic cervical cord injury, suggesting that the neurologic outcome is not significantly dependent on canal space.