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The long-term efficacy and complications of implantable diaphragm pacer (IDP) in a child with cervical spinal cord injury (CSCI) in the Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center in September 2022 were retrospective analyzed.A male child had quadriplegia without an obvious cause at the age of 12 years, and he was then lived completely with the assistance of mechanical ventilation.At the age of 14 years, he could wean off the ventilator in unilateral diaphragmatic pacing mode.However, mechanical ventilation was re-given for months after 5 years due to pneumonia, and then the IDP was re-given with the self-felt decreased pacing effect.After hospitalization, the patient was examined with mild diaphragmatic atrophy, secondary flat chest, and mild scoliosis.After optimization of the transdiaphragmatic pacing threshold and rehabilitation, his respiratory function improved.IDP can be used in CSCI for long time, while flat chest and scoliosis that limited the expansion of the lungs should be considered.At the meantime, the increased abdominal spasm affected the abdominal compliance, leading to the decrease in the efficiency of the diaphragm.
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Abstract Cervical degenerative myelopathy (CDM) is a cervical spine condition resulting in clinical manifestations of spinal cord compression related to the chronic, non-traumatic, and progressive narrowing of the cervical spinal canal. Conventional magnetic resonance imaging (MRI) is the gold standard test to diagnose and assess the severity of CDM. However, the patient is in a neutral and static position during the MRI scan, which may devalue the dynamic factors of CDM, underestimating the risk of spinal cord injury related to cervical spine flexion and extension movements. Dynamic MRI is a promising technique to change this scenario. Therefore, the present review aims to answer the following question: "Is dynamic MRI of the cervical spine more accurate in diagnosing CDM than conventional MRI?". We will search for studies in the MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS, and SciELO databases. The search strategy will contain a combination of terms related to cervical myelopathy and magnetic resonance imaging. Two independent reviewers will select studies, extract data, and assess the risk of bias. The synthesis of results will be descriptive, considering the main findings of the studies about the outcomes of interest.
Resumo A mielopatia cervical degenerativa (MCD) é uma doença da coluna cervical com manifestações clínicas de compressão da medula espinal relacionadas ao estreitamento crônico, não traumático e progressivo do canal vertebral cervical. A ressonância magnética (RM) convencional é o exame padrão-ouro para o diagnóstico e a avaliação da gravidade da MCD. Contudo, o paciente encontra-se em posição neutra e estática durante a realização deste exame, o que pode desvalorizar os fatores dinâmicos da MCD, subestimando o risco de lesão medular relacionados aos movimentos de flexão e extensão da coluna cervical. A RM dinâmica é uma técnica promissora para modificar esse panorama. Portanto, a presente revisão tem o objetivo de responder a seguinte pergunta: "A RM dinâmica da coluna cervical é mais precisa no diagnóstico de MCD em comparação à RM convencional?" As buscas por estudos serão realizadas nas bases de dados MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS e SciELO. A estratégia de busca conterá combinação de termos relacionados à mielopatia cervical e à ressonância magnética. Dois avaliadores independentes irão realizar a seleção dos estudos, a extração dos dados e a avaliação dos riscos de viés. A síntese dos resultados será realizada de maneira descritiva, considerando os principais achados dos estudos relacionados aos desfechos de interesse.
Subject(s)
Humans , Spinal Cord Compression/diagnostic imaging , Spine/diagnostic imaging , Magnetic Resonance Imaging , Cervical Cord/pathologyABSTRACT
Las personas con lesiones de la médula espinal cervical tienen de dos a cinco veces más probabilidades de morir prematuramente, estas lesiones son una de las causas de muerte más frecuente en la población mundial independientemente de la religión, edad, raza, sexo, nacionalidad o clase social; las tasas de supervivencia más bajas, se encuentran en los países de ingresos bajos y medianos. En Guinea-Bissau, los pacientes desconocen su enfermedad y los beneficios de la actividad física para su tratamiento; por ello, se realizó un estudio con diez pacientes que asisten al área de Neuro-rehabilitación motora, Bissau, donde el objetivo fue: determinar el impacto de los ejercicios físicos en la rehabilitación de los pacientes con lesión medular cervical incompleta. Se utilizaron métodos de orden cualitativo (revisión documental) y cuantitativos (medición) y criterio de expertos que permitieron el estudio del objeto y la evaluación teórica y práctica de los ejercicios físicos, los que fueron validados por 17 expertos, entre los cuales el 95 % evaluaron los indicadores en adecuados y muy adecuados y se aplicó en la práctica a diez pacientes con resultados muy satisfactorios, lo que confirmó la pertinencia del estudio realizado. El 100 % de los participantes alcanzaron un nivel significativo en las actividades de la vida diaria, capacidades físicas y funcionales. Este estudio respondió a necesidades investigativas de la Universidad de Ciencias de la Cultura Física y el Deporte "Manuel Fajardo", de Cuba y al Centro de Neuro-Rehabilitación Físico Motor Sanca, de Guinea-Bissau.
SÍNTESE Pessoas com lesões da medula cervical têm duas a cinco vezes mais probabilidade de morrer prematuramente, essas lesões são uma das causas de morte mais freqüentes na população mundial, independentemente da religião, idade, raça, sexo, nacionalidade ou classe social; as mais baixas taxas de sobrevivência são encontradas em países de baixa e média renda. Na Guiné-Bissau, os pacientes desconhecem sua doença e os benefícios da atividade física para seu tratamento; portanto, foi realizado um estudo com dez pacientes que freqüentavam a área de neuro-reabilitação motora, Bissau, onde o objetivo era: determinar o impacto dos exercícios físicos na reabilitação de pacientes com lesão incompleta da medula cervical. Foram utilizados métodos qualitativos (revisão documental) e quantitativos (medição) e julgamento de especialistas para estudar o objeto e a avaliação teórica e prática dos exercícios físicos, que foram validados por 17 especialistas, 95% dos quais avaliaram os indicadores como adequados e muito adequados, e foram aplicados na prática a dez pacientes com resultados muito satisfatórios, confirmando a relevância do estudo realizado. 100% dos participantes atingiram um nível significativo nas atividades de vida diária, nas habilidades físicas e funcionais. Este estudo respondeu às necessidades de pesquisa da Universidade de Cultura Física e Ciências do Esporte "Manuel Fajardo", Cuba e do Centro de Reabilitação Neuro-Motora Sanca, Guiné-Bissau.
People with cervical spinal cord injuries are two to five times more likely to die prematurely, these injuries are one of the most frequent causes of death in the world population regardless of religion, age, race, sex, nationality or social class; the lowest survival rates are found in low- and middle-income countries. In Guinea-Bissau, patients are unaware of their illness and the benefits of physical activity for their treatment; for this reason, a study was carried out with ten patients who attend the area of Motor Neuro-rehabilitation, Bissau, where the objective was: to determine the impact of physical exercises on the rehabilitation of patients with incomplete cervical spinal cord injury. Qualitative (documentary review) and quantitative (measurement) and expert criteria methods were used, which allowed the study of the object and the theoretical and practical evaluation of the physical exercises, which were validated by 17 experts, among whom 95% they evaluated the indicators as adequate and very adequate and it was applied in practice to ten patients with very satisfactory results, which confirmed the relevance of the study carried out. 100% of the participants reached a significant level in activities of daily living, physical and functional capacities. This study responded to the research needs of the "Manuel Fajardo" University of Physical Culture and Sports Sciences, of Cuba and the Sanca Neuro - Physical Motor Rehabilitation Center, of Guinea-Bissau.
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Introduction：There are few detailed evaluations of upper extremity function in Japan, especially for cervical spinal cord injury (CSCI). The capabilities of upper extremity test (CUE-T) evaluates upper extremity function, is specialized for CSCI, and is internationally used；however, there are few reports from Japan. This study verified the reliability, validity, and responsiveness of the CUE-T in Japan.Methods：We determined the interrater reliability, internal consistency, weighted kappa coefficient, intraclass correlation coefficient, and Cronbach's α coefficient for acute and chronic CSCI. The correlation coefficient with other evaluations was calculated and validated. Furthermore, the evaluation was performed twice at regular intervals, and the correlation between the change in CUE-T and other evaluations and the sensitivity to change using the standardized response mean (SRM) were verified.Results：The weighted kappa coefficient was 0.61-1.00, intraclass correlation coefficient was ≥0.9, and Cronbach's α coefficient were ≥0.9. The CUE-T and other evaluation methods showed moderate to strong correlations. In addition, the amount of change between CUE-T and the other evaluations were significantly correlated, and the SRM was ≥0.8.Discussion：In Japan, the CUE-T has been suggested to have good reliability, validity, responsiveness, and interpretability as an evaluation of upper extremity function in patients with CSCI. We will continue to verify the interpretability of the CUE-T and consider its dissemination in Japan.
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Introduction：There are few detailed evaluations of upper extremity function in Japan, especially for cervical spinal cord injury (CSCI). The capabilities of upper extremity test (CUE-T) evaluates upper extremity function, is specialized for CSCI, and is internationally used；however, there are few reports from Japan. This study verified the reliability, validity, and responsiveness of the CUE-T in Japan.Methods：We determined the interrater reliability, internal consistency, weighted kappa coefficient, intraclass correlation coefficient, and Cronbach's α coefficient for acute and chronic CSCI. The correlation coefficient with other evaluations was calculated and validated. Furthermore, the evaluation was performed twice at regular intervals, and the correlation between the change in CUE-T and other evaluations and the sensitivity to change using the standardized response mean (SRM) were verified.Results：The weighted kappa coefficient was 0.61-1.00, intraclass correlation coefficient was ≥0.9, and Cronbach's α coefficient were ≥0.9. The CUE-T and other evaluation methods showed moderate to strong correlations. In addition, the amount of change between CUE-T and the other evaluations were significantly correlated, and the SRM was ≥0.8.Discussion：In Japan, the CUE-T has been suggested to have good reliability, validity, responsiveness, and interpretability as an evaluation of upper extremity function in patients with CSCI. We will continue to verify the interpretability of the CUE-T and consider its dissemination in Japan.
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Cervical spinal cord injury can not only cause serious physical movement and sensory disorders but also lead to serious complications affecting the life safety and quality of life of patients.As the largest microecosystem in the human body,intestinal flora plays a very important role in maintaining host homeostasis and the occurrence and development of many diseases.In recent years,there has been increasing focus on the study of intestinal flora after spinal cord injury,leading to a growing recognition of the clinical value of intestinal flora in the treatment of spinal cord injury.Intestinal flora is not only related to the degree of spinal cord injury but also can provide therapeutic targets for neurogenic intestinal dysfunction after spinal cord injury.This paper discusses the mechanism of intestinal flora in the vagus nerve,hypothalamic-pituitary-adrenal axis,and metabolites after spinal cord injury.It explores the relationship between the occurrence and development of neurogenic intestinal dysfunction and changes in intestinal flora,offering valuable insights for the diagnosis and treatment of related diseases.
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Objective:To analyze the factors influencing dysphagia after an injury to the cervical spinal cord (CPCI) to provide a basis for clinical screening and intervention.Methods:A total of 110 CPCI patients with dysphagia were divided into a severe dysphagia group ( n=19), a mild dysphagia group ( n=35), and a control group ( n=56) according to their functional oral intake scale scores. Data on gender, age, level of injury, degree of damage, duration of injury, causes of injury, surgical mode, tracheotomy status, occurrence of pneumonia and pharynx swelling were collected. Univariate and multivariate logistic regressions were evaluated to identify factors affecting swallowing. Results:The regressions highlighted age, the severity of the spinal cord injury, tracheotomy status, and the occurrence of pneumonia and pharyngeal swelling during hospitalization as the best predictors of swallowing difficulties. Multifactoral logistic regression analysis revealed that undergoing tracheotomy and catching pneumonia during hospitalization were major risk factors for severe dysphagia.Conclusions:Tracheotomy and pneumonia during hospitalization are useful predictors of severe dysphagia after a cervical spinal cord injury.
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ObjectiveTo explore the application of Brain and Spinal Injury Center (BASIC) score in evaluation of traumatic cervical spinal cord injury. MethodsFrom January, 2015 to December, 2021, 175 patients with traumatic cervical spinal cord injury in Beijing Bo'ai Hospital were analyzed. Gender, age, cause of injury, injury mechanism and American Spinal Injury Association Impairment Scale (AIS) grade were collected. The sagittal and axial T2 weighted imaging (T2WI) of the patients were evaluated with BASIC score, single/multi-segment injury, and with/without intramedullary hemorrhage. According to the injury mechanism, the patients were divided into two groups: with fracture/fracture dislocation (n = 92) and without fracture and dislocation (n = 83). The baseline demographic indicators and T2WI evaluation indicators were compared between the two groups, and the relationship between AIS grade and BASIC score, intramedullary hemorrhage, single/multi-segment injury were investigated. ResultsThere were significant differences in gender, age and AIS grade, BASIC score, and the rates of inntramedullary hemorrhage and single segment injury of T2WI between two groups (t = -10.276, χ2 > 8.703, P < 0.01); however, no difference was found in the cause of injury (P > 0.05). The AIS grade was significantly correlated with the BASIC score (r = 0.790, P < 0.001). There was significant difference in AIS grade between intramedullary hemorrhage or not, and single/multi-segment injury (χ2 > 5.516, P < 0.05). ConclusionThe BASIC score of T2WI is a predictor of the severity of spinal cord injury after traumatic cervical spinal cord injury, and is different with the injury mechanisms.
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OBJECTIVE@#To compare the clinical effects of total laminectomy with lateral mass screw fixation and single open-door laminoplasty in the treatment of cervical spinal cord injury without fracture and dislocation.@*METHODS@#The clinical data of 75 patients with cervical spinal cord injury without fracture and dislocation treated from December 2014 to April 2020 were retrospectively analyzed, including 65 males and 10 females, aged from 33 to 83 years old with an average of (60.1±11.4) years. According to surgical method, the patients were divided into observation group (36 cases) and control group (39 cases). The observation group was treated with C3-C6 single open-door laminoplasty. In the control group, the C3-C6 whole lamina was opened by "uncovering", and the lateral mass screw was fixed and fused. The general conditions including operation time, intraoperative blood loss, hospital stay and complications such as axial pain, cerebrospinal fluid leakage, postoperative C5 nerve palsy were recorded. Visual analogue scale(VAS), Nurick pain scale, Japanese Orthopaedic Association(JOA) scores and American Spinal Injury Association(AISA) injury scale were used to evaluate the improvement of clinical symptoms and related functional recovery 12 months after operation.@*RESULTS@#There were no statistically significant differences in operation time, intraoperative blood loss and hospital stay between two groups(P>0.05). There were statistically significant differences in JOA, VAS, ASIA and Nurick scores of the all patients between 12 months after surgery and before surgery (P<0.05), and there was no significant difference between groups. There was significant difference in the incidence of C5 nerve root palsy and axial pain between two groups(P<0.05), but there was no significant difference in the complications of cerebrospinal fluid leakage between two groups (P>0.05).@*CONCLUSION@#Total laminectomy with lateral mass screw fixation and single open-door laminoplasty in treating cervical spinal cord injury without fracture and dislocation can obtain satisfactory results in restoring nerve function, alleviating pain and improving daily behavior, but single open-door laminoplasty has the advantages of less trauma and low incidence of complications.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Screws , Case-Control Studies , Cervical Cord/surgery , Cervical Vertebrae/surgery , Laminectomy/methods , Laminoplasty/methods , Retrospective Studies , Treatment OutcomeABSTRACT
Objective:To investigate the predictive value of diffusion tensor imaging (DTI) parameters in upper extremity motor function recovery after surgery in patients with acute cervical spinal cord injury (CSCI).Methods:Twenty-three patients with acute CSCI who received postoperative systemic rehabilitation therapy in Department of Neurosurgery, 900 th Hospital of Joint Logistics Team of People's Liberation Army from May 2019 to July 2021 were selected as an experimental group, and 22 healthy subjects (healthy control group) matched with age and gender were selected from Physical Examination Center of the same hospital at the same period. Routine MRI sequence and DTI scan of the cervical spinal cord, scale of American Association for Spinal Cord Injury (ASIA) and modified Barthe index (mBI) were performed in patients of the experimental group 1 d and 3 months after surgery. Routine MRI sequence and DTI scan of the cervical spinal cord were performed in healthy subjects after enrollment. The DTI parameters in different regions between the two groups were compared, and the differences in DTI parameters, ASIA scores and mBI in patients of the experimental group before and after surgery were compared. Correlations of preoperative DTI parameters with preoperative upper extremity motor ASIA scores and upper extremity motor recovery rate 3 months after surgery were analyzed by Pearson correlation analysis. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of preoperative fractional anisotropy (FA) in upper extremity motor function recovery in CSCI patients 3 months after surgery. Results:As compared with the healthy control group, the experimental group had significantly lower preoperative FA in the injury area and distal injury area, and statistically higher preoperative apparent diffusion coefficient (ADC, P<0.05). In patients of the experimental group, preoperative FA in the injury area was significantly lower and ADC in the injury area was significantly higher as compared with those in the distal injury area ( P<0.05); patients of the experimental group had significantly higher FA in these two regions, upper extremity motor ASIA scores and mBI, and significantly lower ADC 3 months after surgery as compared with those 1 d before surgery ( P<0.05). The preoperative FA in the injury area and distal injury area in CSCI patients were positively correlated with preoperative upper extremity motor ASIA scores and upper extremity motor recovery rate 3 months after surgery ( P<0.05). ROC curve results showed that the area under the curve (AUC) of preoperative FA in injury area in predicting upper extremity motor function recovery 3 months after surgery was 0.912 ( 95%CI: 0.783-1.000, P<0.001); that of preoperative FA in the distal injury area was 0.842 ( 95%CI: 0.682-1.000, P<0.001). Conclusion:DTI parameters FA and ADC are sensitive indicators for detecting CSCI; preoperative FA in the injury area and distal injury area can be used to predict the upper extremity motor function recovery, but the efficacy of the former is superior to that of the later.
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Background Traumatic spinal cord injury (TSCI) is extremely costly to the global health system. Due to the significant frequency rate of traumatic cervical spinal cord injuries (TCSCI), the possible association between imaging findings and clinical outcome is not yet clear. In this study, we quantified maximum spinal cord compression and maximum cord swelling following TCSCI and determined the relevance of imaging findings to clinical outcome in patients. Materials and Methods This retrospective cohort comprises 20 patients with TCSCIs (C3-C7), classified as complete, incomplete, and no SCI, who were treated at the Poursina Hospital, Iran, from 2018 to 2020, and underwent spinal surgery. Patients with penetrating injuries and multiple trauma were excluded. Imaging findings revealing spinal cord compression, swelling, and canal stenosis, based on the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of patients from hospital admission (up to 48 hours after injury) and improvement of postoperative neurological symptoms (612 months) were evaluated. Results Cord compression (p » 0.05) and cord swelling (p » 0.02) were significantly related to predictive neurological outcomes in all cases. Evaluation with AIS at hospital admission and at 6 to 12 months postoperatively showed significant correlation with fracture type (p » 0.05) and the longitudinal length of the intramedullary lesion (IML); p » 0.01, respectively. Conclusion According to the results obtained in this study, it may be concluded that there is a significant association between cervical spinal cord compression and swelling, and clinical outcomes in patients with complete, incomplete, and no SCI.
Introdução A lesão traumática da medula espinal (LTME) é extremamente onerosa para o sistema de saúde global. Devido à significativa taxa de frequência de lesões traumáticas da medula espinal cervical (TCSCI), a possível associação entre achados de imagem e evolução clínica ainda não está clara. Neste estudo, quantificamos a compressão medular máxima e o edema medular máximo após TCSCI e determinamos a relevância dos achados de imagem para o resultado clínico dos pacientes. Materiais e métodos Esta coorte retrospectiva compreende 20 pacientes com TCSCIs (C3-C7), classificados como completos, incompletos e sem LME, que foram tratados no Hospital Poursina, Irã, de 2018 a 2020, e submetidos a cirurgia da coluna vertebral. Pacientes com lesões penetrantes e politraumatismos foram excluídos. Achados de imagem revelando compressão da medula espinhal, edema e estenose do canal, com base nos graus da American Spinal Injury Association (ASIA) Impairment Scale (AIS) de pacientes desde a admissão hospitalar (até 48 horas após a lesão) e melhora dos sintomas neurológicos pós-operatórios (6-12 meses) foram avaliados. Resultados A compressão do cordão (p = 0,05) e o edema do cordão (p = 0,02) foram significativamente relacionados aos desfechos neurológicos preditivos em todos os casos. A avaliação com AIS na admissão hospitalar com 6 a 12 meses de pós-operatório mostrou correlação significativa com o tipo de fratura (p = 0,05) e o comprimento longitudinal da lesão intramedular (IML); p = 0,01, respectivamente. Conclusão De acordo com os resultados obtidos neste estudo, pode-se concluir que existe uma associação significativa entre compressão e edema da medula espinal cervical e desfechos clínicos em pacientes com lesão medular completa, incompleta e sem lesão medular.
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Abstract Aim: This study aims to characterize the stress, recovery, mood, and motivation together with the training load of athletes with cervical spinal cord injury (CSCI) during a period of resumption of wheelchair rugby (WCR) training. Additionally, it aims to compare the psychological and load training aspects during a competitive preseason and determine the correlations between training load, mood, stress, and recovery. Methods: We evaluated variables such as mood (Brazilian Mood Scale, BRAMS), stress and recovery (Recovery-Stress Questionnaire for Athletes, RESTQ-Sport 76) and training load (Subjective Perception of Effort - SPE) of eight high-performance athletes of wheelchair rugby with CSCIs at three different times (E1 = returning from vacation, E2 = half of the preseason, and E3 = after 2 months of training) for 2 months at a monthly interval. We also evaluated motivation (Sport Motivation Scale) at E1 and E3. Results: Results indicated few changes during the competitive preseason in terms of stress, recovery, and mood. However, the training load decreased toward the end of this period. Furthermore, we found that physical complaints positively correlated with depression when resuming training. In the middle of the competitive preseason period, we also noted positive correlations between conflict/pressure and fatigue and between fatigue and energy loss. At the end of this period, the SPE and arbitrary units correlated positively with conflict/pressure. Conclusion: We found few changes during the competitive preseason in terms of stress, recovery, and mood but not motivation, which did not change during this period. On the other hand, the training load decreased at the end of the competitive preseason. Furthermore, we observed correlations between training load and psychological aspects at different times.
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Humans , Spinal Cord Injuries/physiopathology , Exercise , Psychology, Sports , Para-Athletes , Stress, Physiological , Wit and Humor , MotivationABSTRACT
Introducción: los ependimomas son tumores cerebrales que surgen de células ependimarias, células de soporte en el cerebro y la médula espinal. Representan entre el 2 y el 3% de todos los tumores cerebrales primarios. Son el cuarto tumor cerebral más común en los niños, donde el 90% de los mismos se localizan en la fosa posterior. En adultos, el 60% de estos tumores se encuentran en la médula espinal pudiendo presentarse a cualquier nivel de ésta; el caso a continuación reporta un ependimoma cervical. Objetivo: reportar un caso de ependimoma medular de ubicación poco frecuente, con resección total, sin recidiva porterior a 2 años de seguimiento.Descripción del caso: se reporta el caso de un paciente adulto, 44 años, masculino, con un síndrome medular cervical completo, progresivo, provocado por un ependimoma cervical. Intervención: se realizó laminectomía de dos espacios [C7 a T1], apertura dural, mielotomía posterior logrando exéresis total de la lesión con durorrafia a sello de agua y posterior cierre por planos sin complicaciones, con seguimiento de 2 años de sobrevida. Conclusiones: la resección total macroscópica de este tipo de tumores es muy importante para poder evitar residiva. El ependimoma cervical puede recidivar, sobre todo cuando existen residuales de la lesión. El manejo oportuno depende de gran manera de que los pacientes acudan tempranamente a valoración especializada; la resección guiada con monitorización neurofisiológica transoperatoria provee mayor oportunidad a los pacientes a no presentar secuelas permanentes y permite asimismo, mejores resultados de la rehabilitación neurológica postoperatoria
Introduction: ependymomas are brain tumors that arise from ependymal cells, supporting cells in the brain and spinal cord. They represent between 2 and 3% of all primary brain tumors. They are the fourth most common brain tumor in children, where 90% of them are located in the posterior fossa. In adults, 60% of these tumors are found in the spinal cord and can occur at any level of the spinal cord; the case below reports a cervical ependymoma. Objective: to report a case of medullary ependymoma of rare location, with total resection, without recurrence after 2 years of follow-up. Case description: a 44-year-old male adult patient with a progressive, complete cervical spinal cord syndrome, caused by a cervical ependymoma, is reported.Intervention: two-space laminectomy [C7 to T1], dural opening and posterior myelotomy were performed, achieving total excision of the lesion with water-seal durorrhaphy and subsequent closure by planes without complications, with a 2-year survival follow-up. Conclusions: macroscopic total resection of this type of tumor is very important to avoid residual. Cervical ependymoma can recur, especially when there is residual lesion. Timely management depends to a great extent on the patients attending early for a specialized evaluation; guided resection with intraoperative neurophysiological monitoring provides a greater opportunity for patients to not present permanent sequelae and also allows better results of postoperative neurological rehabilitation.
Subject(s)
Male , Ependymoma , Spinal Cord , Brain Neoplasms , Cerebrum , Intraoperative Neurophysiological Monitoring , Neurophysiological Monitoring , Cervical Cord , Neurological RehabilitationABSTRACT
Objective The three-dimensional (3D) solid model of medulla oblongata-upper cervical spinal cord based on specimen pathological section data was established, and the stress and strain levels of medulla oblongata-upper cervical spinal cord under dentate process compression were obtained by finite element analysis, so as to provide references for clinical research. Methods Mimics was used to process the slice data, so as to establish the point cloud model. SolidWorks was used to locate, edit and optimize the point cloud model, so as to establish the 3D solid model. HyperMesh was used to establish the finite element model and ANSYS was used for finite element analysis. Results The medulla oblongata-upper cervical spinal cord model with clear boundary between gray matter and white matter and white matter fiber bundle was established. The stress and strain levels and stress-strain curves of white matter and gray matter under different compression degrees were obtained. Conclusions Combined with pathological sections of specimens and reverse engineering, the 3D medulla oblongata-upper cervical spinal cord model with clear morphology and structure of gray/white matter can be established. When the medulla oblongata-upper cervical spinal cord is compressed, the stress level of gray matter is lower than that of white matter, and about 20% of compression is the critical state of white matter. When the disease develops beyond the critical state, the biomechanical properties of white matter may fail, resulting in gray matter damage.
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OBJECTIVE@#To explore the influencing factors of the operative effect on cervical spinal cord injury without fracture or dislocation.@*METHODS@#The clinical data of 69 patients with cervical spinal cord injury without fracture or dislocation from November 2010 to November 2016 who received operation were retrospectively analyzed. There were 37 males and 32 females, aged from 32 to76 years with an average of (51.6±7.3) years. The clinical data of 12 factors were selected, including age, gender, ASIA grade of spine cord injury, the length of spine cord injury by MRI, Pavlov ratio, ossification of the posterior longitudinal ligament (OPLL), intervertebral disc herniation, type of spine cord injury by MRI, time from injury to operation, treatment of high-dose methylprednisolone, operation time, intraoperative bleeding volume. In order to screen the main influencing factors of above items to prognosis, the single factor and multiple factor Logistic regression analysis were used in the clinical data by SPSS 22.0 statistical software.@*RESULTS@#Univariate analysis results showed that the factors including ASIA grade of spine cord injury, the length of spine cord injury by MRI, Pavlov ratio, ossification of longitudinal ligament, intervertebral disc herniation, the type of spine cord injury by MRI were associated with prognosis (<0.05). Multi factor analysis of the selected factors indicated that the type of spine cord injury by MRI, the length of spine cord injury by MRI, Pavlov ratio, ASIA grade of spine cord injury were the main prognostic factors according to the influence intensity (<0.05).@*CONCLUSION@#The influencing factors of the operative effect on cervical spinal cord injury without fracture and dislocation were the type of spine cord injury by MRI, the length of spine cord injury by MRI, Pavlov ratio, ASIA grade of spine cord injury, and the foremost were the type and length of spine cord injury by MRI. Compared with other patients, preoperative MRI showed the patient with spinal cord injury type with bleeding and edema, or the length of spine cord injury larger than 45 mm may be less effective, therefore, it is necessary to thoroughly communicate with the patients and their kin before surgery.
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BACKGROUND: Cervical spondylotic myelopathy is one of the most serious types of cervical spondylosis. The histopathological study of cervical spondylotic myelopathy is not very clear, mainly because of the lack of ideal animal models. OBJECTIVE: To review the common methods of making cervical spondylotic myelopathy model, and analyze and evaluate the different methods of making the model, so as to promote the improvement and perfection of cervical spondylotic myelopathy animal models in the future. METHODS: The “cervical spondylotic myelopathy, cervical spinal compression, animal model” in Chinese and English, respectively were used as keywords. The first author retrieved the literature concerning construction methods of cervical spondylotic myelopathy animal model in CNKI, Wanfang, VIP, PubMed, Medline and Embase databases from 2000 to 2019, and all data were filtered for analysis and evaluation. RESULTS AND CONCLUSION: (1) There are many construction methods of cervical spondylotic myelopathy animal model at present, which can be divided into two types: dynamic modeling methods and static modeling methods, and their advantages and disadvantages coexist. (2) Screw compression is the most common construction method of cervical spondylotic myelopathy animal models, which has the advantages of strong controllability and short modeling cycle, but the damage to cervical spinal cord of animals is more serious and has a high fatality rate. The technology of expansion material compression method is difficult, but it has a high success rate and high reliability. It needs to be further improved and promoted. (3) At present, the construction methods of cervical spondylotic myelopathy animal model still have many disadvantages, and need to be improved on the basis of previous modeling by researchers, so as to realize good reproducibility, repeatable and scalable animal model making and provide a better clinical theoretical basis for cervical spondylotic myelopathy in the future.
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OBJECTIVE: To observe the effect of electroacupuncture (EA) on incisional pain and expression of tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10) and interleukin-4 (IL-4) of cervical dorsal part of spinal cord in rats with incisional neck pain, so as to explore its analgesic mechanisms. METHODS: Eighty-four male SD rats were randomly divided into normal control, model, EA-Futu(LI18) and EA-Zusanli(ST36)-Yanglingquan(GB34, EA-ST36-GB34) groups (n=21 in each group). The incisional neck pain model was established by making a longitudinal incision along the bilateral cervical thyroid regions and repeated mechanical separation stimulation. For rats of the EA groups, EA (2 Hz/100 Hz, 1 mA) was applied to bilateral LI18 or ST36-GB34 for 30 min/ time during the surgery, and 20 and 44 h after surgery, respectively. The thermal pain threshold (TPT) of the incisional region was detected. The immunoactivity of TNF-α and IL-10 of the dorsal portion of the cervical spinal cord (C2-C5) was detected by immunofluorescence, and the expression of TNF-α, IL-10, IL-4 and IL-4 receptor (IL-4R) mRNAs was determined by quantitative real-time PCR. RESULTS: Compared with the normal group, the TPT of the incisional area was significantly decreased at 4, 24 and 48 h after neck-incision (P<0.05), the levels of TNF-α mRNA, IL-10 mRNA and TNF-α IL-10 immunoactivity at 24 h were remarkably increased (P<0.05), and the expression of IL-4R mRNA was considerably decreased at 24 h in the model group (P<0.05). Following EA intervention, the TPT, and expression levels of IL-4 mRNA and IL-4R mRNA were significantly increased at 24 h after surgery in the EA-LI18 group relevant to the model group (P<0.05), while the expression level of TNF-α(coexpressed with microgliacytes) in the EA-LI18 group, and TNF-α mRNA expression at 24 h in both EA-LI18 and EA-ST36-GB34 groups, as well as the expression of IL-10 and IL-10 mRNA at 24 h in both EA-LI18 and EA-ST36-GB34 groups were significantly decreased (P<0.05). The effect of EA LI18 was significantly superior to that of EA ST36-GB34 in up-regulating TPT and expression of IL-4 mRNA and IL-4R mRNA at 24 h (P<0.05). CONCLUSION: EA of LI18 has an analgesic effect in incisional neck pain rats, which may be related to its effect in down-regulating the expression of TNF-α, IL-10 and promoting IL-4 /IL-4R signaling in dorsal portions of the cervical spinal cord. The analgesic effect of EA LI18 is better than that of EA ST36-GB34.
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Objective To study the effect of high-flow nasal cannula oxygen therapy (HFNC) in reduction in re-intubation rate, length of ICU stay and improvement of respiratory function in patients with high cervical spinal cord injury.Methods Single center retrospective study was carried out in our intensive care unit from September 2016 to March 2018. Post-operative patients ready for planned extubation with high cervical spinal cord injury were included. The length of ICU stay, re-intubation rate in case of respiratory failure, respiratory rate, pulse rate, MAP, SaO2, PaO2/FiO2, and PaCO2 of patients at 6, 24 and 72 h after extubation were compared between the HFNC and conventional oxygen therapy (COT) groups. Results During the study period, 38 patients were enrolled in the study. Of them, 16 patients were assigned in the HFNC group and 22patients in the COT group. Re-intubation rate was significantly different between the two groups (18.8％ vs 27.3％, P<0.05), but the length of ICU stay had no significant difference [(15.5±3.4) days vs (16.6±5.2) days]. The respiratory rate, pulse rate, SaO2 and PaO2/FiO2 at 6 h after extubation in the HFNC group were improved markedly than those in the COT group (P<0.05); and the PaCO2 and PaO2/FiO2 at 24 and 72 h after extubation in the HFNC group had much more improvement than those in the COT group (P<0.05). Conclusions Among individuals with post-operative high cervical spinal cord injury, high-flow oxygen therapy could reduce re-intubation rate, and PaCO2 level, and improve the respiratory function, but cannot reduce the length of ICU stay. High-flow oxygen therapy may offer advantages for patients with high cervical spinal cord injury.
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Objective@#To make a postural transfer belt for patients with cervical spinal cord injury, to reduce and prevent the corresponding nursing problems with traditional methods of transfer@*Methods@#44 patients with cervical spinal cord injury admitted to the ward from January to June 2017 were selected as the control group by traditional methods of postural metastasis, and 48 patients with cervical spinal cord injury admitted to the ward from July to December 2017 were selected as the observation group by using self-made transfer belt.@*Results@#Number of the skin injury caused by transfer in observation group was 0 cases, in control group was four cases, and there was significant difference (χ2=1.91, P=0.049). Falls occur due to metastasis: there were 0 cases in the observation group and five cases in the control group, there was significant difference (χ2=2.39, P=0.026). The number of caregivers in the observation group decreased on average (1.21±0.08), and the number of caregivers in the control group decreased on average (0.86±0.09). The differences between the two groups are statistically significant (t=2.905, P=0.005). The results of the investigation on the escorts in the observation group showed that 46 (95.8%) people believed that the transfer belt was convenient for patients. 47 people believed that the transfer belt was safer and more labor-saving to use, accounting for 97.9%, and 47 people believed that the transfer belt would continue to be used when they went home, who occupied 97.9%.@*Conclusion@#The self-made transfer belt is convenient for the caregivers to carry the patients with cervical spinal cord injury, which effectively prevents the occurrence of skin injury, falls and other nursing problems, and improves the quality and experience of the caregivers. This technology is worthwhile to spread.
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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.