[Clinical Features and Treatment Strategy of Vertebral Artery Injury Associated with Cervical Spine Trauma].

OBJECTIVE: Vertebral artery injury(VAI)associated with cervical spine trauma has the potential to cause catastrophic vertebrobasilar stroke. However, there are no well-defined treatment recommendations for VAI. The purpose of this study was to identify an effective treatment strategy for VAI following cervical spine trauma. METHODS: Ninety-seven patients with blunt cervical spine trauma were treated at Hyogo Prefectural Kakogawa Medical Center between January 2013 and September 2017. Of these patients, 49 underwent computed tomographic angiography or magnetic resonance angiography for evaluation of the vertebral artery. Eighteen patients(36.7%)had a diagnosis of VAI. We retrospectively analyzed the clinical features, treatment, and outcomes in these 18 patients. RESULTS: Seven patients(38.9%)had bilateral VAI, 16(88.9%)had cervical dislocation, and 2(11.1%)had transverse process fractures extending into the transverse foramen. Surgical reduction was performed in 14 patients. Five patients with either bilateral or unilateral occlusion underwent parent artery occlusion before reduction. There were no complications after this procedure. Two patients with bilateral VAI had a stroke before treatment. There were no infarctions in the distribution of the vertebrobasilar artery after intervention. The perioperative stroke rate was relatively good, and almost all Glasgow Outcome Scale scores were related to the degree of spinal cord injury. CONCLUSIONS: Aggressive screening for VAI is important in patients with cervical spine trauma in order to ensure adequate treatment. Although the treatment strategy described here could yield good results, it may require modification according to the needs of the individual patient.

Synthesis and antiproliferative evaluation of 3,5-disubstituted 1,2,4-triazoles containing flurophenyl and trifluoromethanephenyl moieties.

An efficient 1,3-dipolar cycloaddition method was performed for the synthesis of a series of monofluoro- and trifluoromethane-3,5-disubstituted 1,2,4-triazoles. This efficient cycloaddition method was to react hydrazonoyl hydrochlorides with a series of aldehydes in the presence of NEt(3) as catalytic basic agent to provide the corresponding product in 28-94%. Their growth inhibitory results against cancer cells indicated that some of the fluorine- and trifluoromethane-containing compounds could effectively inhibit the growth of NCI-H226 and T-cell leukemia (Jurkat) cells. Among the compounds, trifluoromethane-containing 1,2,4-triazoles possessed the five-membered ring groups on the C-5 position of the triazolic ring, including cyclopentyl, 3-furyl, 3-thienyl, and 2-pyrrolyl, possessed the significant inhibitory activity for NCI-H226 cancer cells.

Synthesis and antiproliferative evaluation of N,N-disubstituted-N'-[1-aryl-1H-pyrazol-5-yl]-methnimidamides.

A series of N,N-disubstituted-N'-[1-aryl-1H-pyrazol-5-yl]-methnimidamides was synthesized by a newly developed microwave reaction and their antiproliferative activities were evaluated. Microwave irradiation of 5-amino-1,3-disubstituted pyrazoles with various amide solvents in the presence of POCl(3) provided the corresponding 2a-2k, 3a-3c, and 4a-4f in good to excellent yields. The obtained methnimidamides were tested against NCI-H661, NPC-TW01, and Jurkat cancer cell lines and the results indicated that compounds 2d and 2e were the most potent with IC(50) values in low micromolar range.

Proprioceptive recovery of patients with cervical myelopathy after surgical decompression.

STUDY DESIGN: A prospective observational study. OBJECTIVES: To determine whether proprioceptive deficit recovers after surgery and whether proprioceptive evaluation can predict functional outcome in cervical myelopathy patients. SUMMARY OF BACKGROUND DATA: Proprioceptive sensation plays an important role in smooth, coordinated movement of the limbs. Information about proprioception ascends through the dorsal columns in the spinal cord. In severe compressive myelopathy, proprioceptive ability would be reduced and could be improved after surgical decompression. However, there have been few studies concerning proprioceptive impairment in cervical myelopathy. MATERIALS AND METHODS: The study group included 26 cervical myelopathy patients who underwent posterior surgical decompression. Knee proprioception was assessed by joint position sense, which was evaluated by measuring the error angle when the subjects tried to reproduce the predetermined angle by extension and by flexion. Proprioceptive deficit in the study group was evaluated, compared with age-matched normal subjects. Postoperative recovery and correlation to functional status was analyzed in the study group. The Japanese Orthopedic Association (JOA) scores were used for functional evaluation. RESULTS: The error angles were significantly higher in the study group than those in the control group before surgery. All patients in the study group finally had improvement of the error angles by a year after surgery. The average of error angles in the study group was improved 2 weeks after surgery; however, no changes were observed later. There was significant correlation between the improvement rate of the error angles 2 weeks after surgery and that of the JOA scores 2 years after surgery. There were 9 patients who had worsened proprioception 2 weeks after surgery either by extension or by flexion, all of whom had poor functional outcome. CONCLUSIONS: Knee proprioception was impaired in cervical myelopathy and recovered after surgical posterior decompression. Proprioceptive improvement at 2 weeks correlates with the degree of improvement in JOA scores at 2 years after surgery.

An expanding cervical synovial cyst causing acute cervical radiculopathy.

Synovial cysts of the cervical spine occur infrequently in the spinal canal and are most often associated with degenerative facet joints. Despite the prevalence of degenerative spinal disease, symptomatic synovial cysts are extremely uncommon. We report a rare case that showed an exacerbation of a cervical radiculopathy due to an acute expansion of the synovial cyst. Magnetic resonance (MR) images originally revealed a small cystic extradural lesion when the patient presented with neck pain and slightly numbness in the right hand. The patient's complaints subsequently subsided after administration of pain killers. However, 2 weeks after this, the patient experienced a spontaneous, sudden, severe radiating pain into the right arm without any accompanying cervical injury. MR images showed that the cyst had become markedly increased in size in the intervening 4 weeks and compressed the spinal cord laterally. Because the arm pain was so severe and neurologic examinations revealed the paralysis of the C8 nerve root, the synovial cyst was excised surgically and a good clinical outcome achieved. Thus, even if symptoms are mild and the size of the synovial cyst is small, acute expansion of the cyst might be rarely observed and careful management, including surgical consideration, is needed.

Avulsion fracture of the posterior oblique ligament associated with acute tear of the medial collateral ligament.

The term posterior oblique ligament was proposed in 1973 but the specific anatomy of this region has been controversial. It has been concluded that the posterior oblique ligament is separated from the medial collateral ligament, each with distinctly different bony attachment points. In this article, we report a posterior oblique ligament avulsion fracture associated with a medial collateral ligament rupture.