Improving the staging of neck injuries using a new index, the Neck Functional Holistic Analysis Score: Clustering approach to determine degrees of impairment.

BACKGROUND: Traumatic cervical spine injuries are amongst the traffic injuries that can cause most harm to a person. Classifying subtypes of clinical presentations has been a method used in other pathologies to diagnose more efficiently and to address the appropriate treatment and the prognosis. The management of patients suffering from cervical injuries could be improved by classifying the severity of the impairment. This will allow clinicians to propose better treatment modalities according to the severity of the injury. MATERIALS AND METHODS: The present study is a retrospective cohort study performed with the clinical data from 772 patients stored at Fisi-(ON) Health Group. All the patients treated for cervical spine injuries are evaluated using the EBI-5® system, which is based on inertial measurement unit (IMU) technology. The normalized range of motion of each patient was incorporated into a single index, the Neck Functional Holistic Analysis Score (NFHAS). RESULTS: Clustering analysis of the patients according to their NFHAS resulted in five groups. The Kruskal-Wallis H test showed that there were statistically relevant differences in the ROM values and NFHAS of the patients depending on the cluster they were assigned to: FE X2(4) = 551.59, p = 0.0005; LB ROM X2(4) = 484.58, p = 0.0005; RT ROM X2(4) = 557.14, p = 0.0005; NFHAS X2(4) = 737.41, p = 0.0005. Effect size with ηp2 for the comparison of groups were: FE = 0.76, LB = 0.68, RT = 0.76 and NFHAS = 0.96. CONCLUSION: The NFHAS is directly correlated to the available ROM of the patient. The NFHAS serves as a good tool for the classification of cervical injury patients. The degree of impairment shown by the cervical injury can now be staged correctly using this new classification.

Intracranial hypotension induced by cervical spine chiropractic manipulation.

STUDY DESIGN: Case report. OBJECTIVES: We report a case of intracranial hypotension ensuing after a spinal chiropractic manipulation leading to cerebrospinal fluid (CSF) isodense effusion in the upper cervical and thoracic spine. SUMMARY OF BACKGROUND DATA: The etiology of intracranial hypotension is not fully understood, but CSF leakage from spinal meningeal diverticula or dural tears may be involved. METHODS: A 36-year-old woman presented with neck and both shoulder pain 4 days earlier. She undertook a spinal chiropractic manipulation. After this maneuver, she complained of a throbbing headache with nausea and vomiting. Her headache worsened, and lying down gave the only measure of limited relief. In CSF study, it showed dry tapping. Brain MRI showed pachymeningeal gadolinum enhancement. Thoracic spine MRI showed CSF leakage. After admission to the hospital, she was treated by hydration and pain control over several days. However, her headache did not improve. RESULTS: She was treated by epidural blood patch. Afterwards, her headache was improved. This is the first case of spontaneous intracranial hypotension in which spinal chiropractic manipulation coincided with the development of symptoms and in which a CSF collection in the upper cervical and thoracic spine was demonstrated radiographically in Korea. CONCLUSIONS: From this case, we can understand the etiology of intracranial hypotension and consider the complication of chiropractic manipulation.

Transcutaneous functional electrical stimulation for grasping in subjects with cervical spinal cord injury.

STUDY DESIGN: Case series. OBJECTIVES: To evaluate the benefit, shortcomings and acceptance of a new transcutaneous functional electrical stimulation (FES) technology aimed at improving the grasp function in tetraplegic subjects in acute and postacute rehabilitation. SETTING: Spinal cord injury (SCI) centre, university hospital. METHODS: : Subjects (N=11) with complete or incomplete SCI at C4/5-C7 who started FES 1-67 months after their accident were included. Hand function tests, analysis of video recordings and of written documentation of FES sessions, status of muscle strength, and follow-up query were used as outcome measures. RESULTS: Nine subjects used FES as a neuroprosthesis. Eight demonstrated improved grasp function and performance in activities of daily living. In one subject, no benefit from FES was observed. Two other subjects showed improvements in muscle strength and facilitation of active movement with FES. Four subjects successfully integrated FES as neuroprosthesis in everyday life within the rehabilitation centre. Three received the system for home use. The most relevant reasons for stopping the FES application were: (i) improvement of voluntary grasp function, (ii) physical and psychological problems, (iii) no available stimulator for home use, and (iv) insufficient assistance for electrode placement at home. Shortcomings related to the transcutaneous surface technology (eg pain or coactivation of neighbouring muscles) could usually be reduced, or did not limit the efficiency or acceptance of FES. Individually designed digital or analogue control devices were preferred. CONCLUSION: Tetraplegic subjects in acute and postacute rehabilitation can profit from a new transcutaneous FES system with respect to functional use and independence. It can be implemented in the rehabilitation programme for muscle strengthening and facilitation of voluntary activity. For a successful application of FES, there is a need for individual electrode placement, stimulation programmes, and FES control devices.

Uneventful upper cervical manipulation in the presence of a damaged vertebral artery.

OBJECTIVE: To discuss a case in which a patient with a previously injured vertebral artery underwent manipulation in the upper cervical spine without alteration of her symptom pattern. The literature concerning the relative safety of specific upper cervical manipulative techniques is reviewed. CLINICAL FEATURES: A 42-year-old woman had a 3-week history of unilateral suboccipital pain that she related to a sudden twisting of her head and neck that occurred while she was putting sheets of drywall on top of her car. Subsequent examination by a neurologist 2 weeks later was unremarkable, and a tension-type headache was diagnosed. Approximately 10 days later (3 weeks after injury), a single high-velocity upper-cervical manipulation (incorporating slight rotation and full lateral flexion) was performed with no change in her symptom pattern. Two weeks after that, the patient had development of a lateral medullary syndrome (also known as Wallenberg syndrome) after she briefly extended and rotated her upper cervical spine while painting a ceiling. INTERVENTION AND OUTCOME: The patient was treated with anticoagulant therapy, and the lateral medullary infarct healed without incident. The spinocerebellar and subtle motor symptoms also resolved, but the ipsilateral suboccipital headache and the loss of temperature sensation associated with the spinothalamic tract lesion were still present 9 months later. CONCLUSION: This case report demonstrates that vigorous manipulation of the upper cervical spine is possible without injuring an already damaged vertebral artery. It is suggested that the line of drive used during the single manipulation, almost pure lateral flexion with slight rotation, was responsible for the apparent innocuous response. Guidelines for the evaluation and management of vertebral artery dissection are reviewed. Because it is currently impossible to identify patients at risk of having a dissected vertebral artery with standard in-office examination procedures, rotational manipulation of the upper cervical spine should be abandoned by all practitioners, and schools should remove such techniques from their curriculums.