Recovery after traumatic thoracic- and lumbar spinal cord injury: the neurological level of injury matters.

STUDY DESIGN: Multicenter prospective cohort. OBJECTIVE: To discern neurological- and functional recovery in patients with a traumatic thoracic spinal cord injury (TSCI), conus medullaris syndrome (CMS), and cauda equina syndrome (CES). SETTING: Specialized spinal cord injury centers in Europe. METHOD: Lower extremity motor score (LEMS) and spinal cord independent measure (SCIM) scores from patients with traumatic TSCI, CMS, and CES were extracted from the EMSCI database. Scores from admittance and during rehabilitation at 1, 3, 6, and 12 months were compared. Linear mixed models were used to statistically analyse differences in outcome, which were corrected for the ASIA Impairment Scale (AIS) in the acute phase. RESULTS: Data from 1573 individuals were analysed. Except for the LEMS in patients with a CES AIS A, LEMS, and SCIM significantly improved over time for patients with a TSCI, CMS, and CES. Irrespectively of the AIS score, recovery in 12 months after trauma as measured by the LEMS showed a statistically significant difference between patients with a TSCI, CMS, and CES. Analysis of SCIM score showed no difference between patients with TSCI, CMS, or CES. CONCLUSION: Difference in recovery between patients with a traumatic paraplegia is based on neurological (motor) recovery. Regardless the ceiling effect in CES patients, patients with a mixed upper and lower motor neuron syndrome (CMS) showed a better recovery compared with patients with a upper motor neuron syndrome (TSCI). These findings enable stratifications of patients with paraplegia according to the level and severity of SCI.

Solitary bone plasmacytoma compression injury disguised as back pain: a case report.

Introduction: Low back pain is a leading disability worldwide; however, it is not often the result of a serious underlying condition such as a tumor. As a result, diagnosis of a serious underlying cause of low back pain may be delayed, such as in this case. Case presentation: We describe a case of a man presenting with low back pain, who was eventually diagnosed with solitary bone plasmacytoma (SBP) causing spinal cord compression from approximately T7-T9. The patient was classified as T8 ASIA C-Incomplete Paraplegia. He underwent an emergency T7-T9 open posterior laminectomy and resection of the epidural mass/tumor. Following an intensive course of rehabilitation treatment, the patient progressed to ASIA D. Discussion: Although SBP of the spine is rare, back or neck pain is a common initial presentation. This case is unique in that we provide a detailed description of both medical and rehabilitation diagnosis and treatment. We also suggest that persistent back pain warrants complete MRI spinal imaging to provide proper diagnosis and prompt treatment for cases with a serious underlying condition.

Perfil das pacientes indicadas à adaptação de órtese para estabilização vertebral / [Profile of patients indicated for orthosis adaptation for stabilization vertebral]

Introdução: A síndrome de compressão medular (SCM) é considerada emergência oncológica e necessita de uma abordagem imediata a fim de minimizar os danos à medula espinhal e preservar a função neuromotora. A adaptação de órtese é um dos recursos utilizados pela fisioterapia para estabilização da coluna vertebral e prevenção da perda de função e alívio da dor. O objetivo foi analisar o perfil dos pacientes com câncer de mama que adaptaram colete de estabilização. Materiais e métodos: Estudo de coorte retrospectivo. Foram incluídos pacientes com câncer de mama submetidos à adaptação de órtese para estabilização vertebral devido ao diagnóstico e/ou risco para o desenvolvimento de SCM por metástases ósseas, massa tumoral, lesão lítica ou fratura patológica no período de janeiro de 2013 a julho de 2016. Foram excluídos pacientes com diagnóstico de outro tipo de câncer primário associado, pacientes tratados fora da instituição ou pela falta de disponibilização dos prontuários físicos. Os dados sociodemográficos, clínicos e do tratamento oncológico realizado foram coletados dos prontuários físicos e eletrônicos. Resultados: Foram incluídas 191 pacientes. A média de idade foi de 52,32 ±31 anos, 35,8% foram classificadas como obesas e 74,8% apresentaram estadiamento avançado ao diagnóstico, 49,7% apresentaram dor como primeiro sintoma, seguido de paresia (23%). A metástase óssea esteve presente em todos os indivíduos que adaptaram órtese. Quanto à estabilização das órteses vertebrais: 46,7% adaptaram colete semi-rígido baixo, 31,9% o colete semi-rígido alto, 11,5% colar cervical e 9,9% colar + colete. 10,3% evoluíram com contra-indicação do uso da estabilização por piora do quadro álgico com a adaptação da órtese, dispneia.e distensão abdominal. Discussão: Estima-se que cerca de 5% a 14% dos pacientes oncológicos desenvolvem SCM. Em câncer de mama, o osso é um dos principais sítios de metástase, responsável por 15% dos casos de SCM. Os locais comumente acometidos em SCM são coluna torácica (70%), seguido da coluna lombar (20%) e região cervical (10%). A utilização de órteses de estabilização está indicada em pacientes com instabilidade da coluna vertebral que não são elegíveis para o tratamento cirúrgico. Poucos estudos abordam a utilização de órteses de estabilização e atuação da fisioterapia na reabilitação desses pacientes, portanto ausência de evidências claras, os profissionais de saúde e os pacientes precisam discutir asopções para decidir a conduta adequada para cada caso. Por se tratar de um estudo retrospectivo, existem algumas limitações como a presença de informações incompletas no prontuário físico e eletrônico, pequena amostra populacional. Conclusão: Foi observado que a órtese mais adaptada foi o colete semi-rígido baixo e que a dor e paresia foram os sintomas primários mais relatados.

Introduction: Spinal cord compression syndrome (SCM) is considered an oncologic emergency and requires an immediate approach in order to minimize damage to the spinal cord and preserve neuromotor function. Orthotic adaptation is one of the resources used by physiotherapy to stabilize the spine and prevent loss of function and pain relief. The objective was to analyze the profile of breast cancer patients who adapted stabilization vest. Materials and methods: Retrospective cohort study. We included patients with breast cancer submitted to orthosis adaptation for vertebral stabilization due to the diagnosis and / or risk for the development of SCM by bone metastases, tumor mass, lytic lesion or pathological fracture from January 2013 to July 2016. Patients diagnosed with other associated primary cancers, patients treated outside the institution, or lack of availability of physical records were excluded. The sociodemographic, clinical and oncological data were collected from physical and electronic records. Results: A total of 191 patients were included. The mean age was 52.32 ± 31 years, 35.8% were classified as obese and 74.8% presented advanced staging at diagnosis, 49,7% presented pain as the first symptom, followed by paresis (23%). Bone metastasis was present in all individuals who adapted bracing. Regarding the stabilization of vertebral orthoses: 46.7% adapted low semi-rigid vest, 31.9% high, 11.5% cervical collar and 9.9% collar + vest. 10.3% developed a contraindication to the use of stabilization because of the worsening of the pain with the adaptation of the orthosis, dyspnea, abdominal distension. Discussion: It is estimated that about 5% to 14% of cancer patients develop SCM. In breast cancer, bone is one of the major sites of metastasis, accounting for 15% of SCM cases. The sites commonly affected in SCM are thoracic spine (70%), followed by lumbar spine (20%) and cervical region (10%). The use of stabilization orthoses is indicated in patients with instability of the spine who are not eligible for surgical treatment. Few studies address the use of stabilization orthotics and physiotherapy in the rehabilitation of these patients, so there is no clear evidence, health professionals and patients need to discuss the options to decide the appropriate conduct for each case. Because it is a retrospective study, there are some limitations such as the presence of incomplete information in the physical and electronic records, a small population sample. Conclusion: It was observed that the most adapted bracing was the low semi-rigid vest and that pain and paresis were the primary symptoms most reported.

Aplicación de magnetoterapia y craneopuntura en un paciente con cuadriparesia / Use of magnetotherapy and craneopuncture in a patient with quadriparesis

Se presenta el caso clínico de un paciente con diagnóstico de cuadriparesia debido a una fractura vertebral cervical y compresión medular graves, producidas por una caída desde una altura de 2 metros. Según el examen físico, los estudios radiológicos y la aplicación de escalas neurológicas, presentaba pérdida total de la función motora, de la discriminación sensorial del dolor y de la temperatura por debajo del nivel de lesión. Debido a las secuelas de las lesiones traumáticas en el sistema nervioso central, se aplicó tratamiento bioenergético rehabilitador: magnetoterapia y craneopuntura, complementado con kinesioterapia y terapia ocupacional, y se obtuvo una mejoría de la fuerza, el tono muscular y la capacidad funcional, con coordinación de la marcha.

The case report of a patient with diagnosis of quadriparesis due to a cervical vertebral fracture and severe medullary compression, taking place due to a fall from a height of 2 meters is presented. According to the physical examination, the radiological studies and the use of neurological scales, he presented total loss of the motor function, of the sensorial discrimination of pain and of temperature under the lesion level. Due to the sequels of the traumatic lesions in the central nervous system, bioenergetic rehabilitative treatment was applied: magnetotherapy and craneopuncture, supplemented with kinesiotherapy and occupational therapy, and an improvement of the force, the muscle tone and the functional capacity, with coordination of walking was obtained.

Is there a role for postoperative physiotherapy in degenerative cervical myelopathy? A systematic review.

OBJECTIVE: To review peer-reviewed literature relating to postoperative physiotherapy for degenerative cervical myelopathy (DCM), to determine efficacy in improving clinical outcome and recovery. DATA SOURCES: MEDLINE, EMBASE, CENTRAL, PEDro, ISRCTN registry, WHO ICTRP and Clinicaltrials.gov . References and citations of relevant articles were searched. METHODS: A systematic search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42016039511) from the origins of the databases till 15 February 2018. Included were all studies investigating physiotherapy as an intervention after surgical treatment of DCM to determine effect on clinical outcome and recovery. Study quality was determined using the Grades of Recommendation, Assessment, Development and Evaluation guidelines. RESULTS: In all, 300 records were identified through tailored systematic searches, after removing duplicates. After screening, only one investigated postoperative rehabilitation using physiotherapy for DCM; however, this was retrospective with no controls. This study suggested that rehabilitation including physiotherapy improved postoperative recovery. There are currently two registered trials investigating the use of postoperative physiotherapy for DCM. CONCLUSIONS: The literature provides insufficient evidence to make any evidence-based recommendations regarding postoperative physiotherapy use in DCM.

Efectos de una técnica manual de tracción vertebral sobre el patrón de movimiento lumbo-pélvico y activación del erector espinal durante la flexo-extensión del tronco en pacientes con dolor lumbar / Effects of a manual spinal traction technique on lumbopelvic motion and erector spinae activation patterns during trunk flexion-extension in low back pain patients

Objetivo: Determinar el comportamiento del erector espinal y de los patrones de movimiento lumbo-pélvico durante el movimiento de flexo-extensión del tronco, tras la aplicación de una técnica manual de descompresión lumbo-sacra, en pacientes con dolor lumbar. Material y métodos: En el estudio participaron 10 sujetos con dolor lumbar inespecífico a los que se les realizaron registros electromiográficos de superficie de la actividad de la musculatura erectora espinal lumbar (L3 y L5, bilateral) y registros de la movilidad lumbo-pélvica durante la flexo-extensión de tronco. Estos registros se realizaron antes y después de la aplicación de la técnica. Resultados: Tras comparar los resultados obtenidos en los parámetros estudiados antes e inmediatamente después de la técnica manual, no se encontraron diferencias significativas ni en el comportamiento del erector espinal ni en el patrón de movimiento lumbo-pélvico. Conclusiones: Este estudio sugiere que la técnica manual de descompresión lumbo-sacra, por sí misma, no es suficiente para producir modificaciones de manera inmediata en los patrones de movimiento lumbo-pélvico y activación del erector espinal

Objective: To determine the behavior of the erector spinae and patterns lumbo-pelvic movement during flexion and extension movement of the trunk, following the application of a manual technique of lumbosacral decompression in patients with low back pain. Material and methods: 10 subjects with non-specific low back pain participated in the study. Surface electromyography recordings of the activity of the lumbar erector spinal muscles (L3 and L5, bilateral) and recordings of the lumbo-pelvic mobility were performed during trunk flexion and extension. These recordings were made before and after the application of the technique. Results: After comparing the results of the parameters studied before and immediately after the manual technique no significant differences in either the behavior of the erector spinae, or the pattern of lumbar-pelvic movement found. Conclusions: This study suggests that this manual technique of lumbosacral decompression, by itself, is not enough to produce immediate changes in patterns of lumbar-pelvic movement and activation of the erector spinae

Inpatient rehabilitation outcomes in patients with malignant spinal cord compression compared to other non-traumatic spinal cord injury: A population based study.

OBJECTIVE: To compare and describe demographic characteristics, clinical, and survival outcomes in patients admitted for inpatient rehabilitation following malignant spinal cord compression (MSCC) or other causes of non-traumatic spinal cord injury (NT-SCI). DESIGN: A retrospective cohort design was employed, using data retrieved from administrative databases. SETTING: Rehabilitation facilities or designated rehabilitation beds in Ontario, Canada, from April 2007 to March 2011. PARTICIPANTS: Patients with incident diagnoses of MSCC (N = 143) or NT-SCI (N = 1,274) admitted for inpatient rehabilitation. OUTCOME MEASURES: Demographic, impairment, functional outcome (as defined by the Functional Independence Measure (FIM)), discharge, healthcare utilization, survival, and tumor characteristics. RESULTS: There was a significant improvement in the FIM from admission to discharge (mean change 20.1 ± 14.3, <0.001) in the MSCC cohort. NT-SCI patients demonstrated a higher FIM efficiency (1.2 ± 1.7 vs. 0.8 ± 0.8, <0.001) and higher total (24.0 ± 14.4 vs. 20.1 ± 14.3, <0.001) FIM gains relative to MSCC cases. However, there were no differences between the MSCC and NT-SCI cohorts in length of stay (34.6 ± 30.3 vs. 37.5 ± 35.2, P = 0.8) or discharge FIM (100.7 ± 19.6 vs. 103.3 ± 18.1, P = 0.1). Three-month, 1-year, and 3-year survival rates in the MSCC and NT-SCI cohorts were 76.2% vs. 97.6%, 46.2% vs. 93.7%, and 27.3% vs. 86.7%, respectively. The majority (65.0%) of patients with MSCC was discharged home and met their rehabilitation goals (75.5%) at comparable rates to patients with NT-SCI (69.7 and 81.3%). CONCLUSION: Despite compromised survival, patients with MSCC make clinically significant functional gains and exhibit favorable discharge outcomes following inpatient rehabilitation. Current administrative data suggests the design and scope of inpatient rehabilitation services should reflect the unique survival-related prognostic factors in patients with MSCC.

An Intensive Locomotor Training Paradigm Improves Neuropathic Pain following Spinal Cord Compression Injury in Rats.

Spinal cord injury (SCI) is often associated with both locomotor deficits and sensory dysfunction, including debilitating neuropathic pain. Unfortunately, current conventional pharmacological, physiological, or psychological treatments provide only marginal relief for more than two-thirds of patients, highlighting the need for improved treatment options. Locomotor training is often prescribed as an adjunct therapy for peripheral neuropathic pain but is rarely used to treat central neuropathic pain. The goal of this study was to evaluate the potential anti-nociceptive benefits of intensive locomotor training (ILT) on neuropathic pain consequent to traumatic SCI. Using a rodent SCI model for central neuropathic pain, ILT was initiated either 5 d after injury prior to development of neuropathic pain symptoms (the "prevention" group) or delayed until pain symptoms fully developed (∼3 weeks post-injury, the "reversal" group). The training protocol consisted of 5 d/week of a ramping protocol that started with 11 m/min for 5 min and increased in speed (+1 m/min/week) and time (1-4 minutes/week) to a maximum of two 20-min sessions/d at 15 m/min by the fourth week of training. ILT prevented and reversed the development of heat hyperalgesia and cold allodynia, as well as reversed developed tactile allodynia, suggesting analgesic benefits not seen with moderate levels of locomotor training. Further, the analgesic benefits of ILT persisted for several weeks once training had been stopped. The unique ability of an ILT protocol to produce robust and sustained anti-nociceptive effects, as assessed by three distinct outcome measures for below-level SCI neuropathic pain, suggests that this adjunct therapeutic approach has great promise in a comprehensive treatment strategy for SCI pain.

Early diagnosis and treatment is crucial for neurological recovery after surgery for metastatic spinal cord compression in prostate cancer.

BACKGROUND: Spinal cord compression is an oncological and surgical emergency. Delays in referral and diagnosis may influence functional outcome. It is therefore important to identify patients who will regain or maintain the ability to walk after surgery. The aim of the present study was to examine current practice for referral and diagnosis of prostate cancer patients with spinal cord compression and to identify prognostic factors for neurological outcome after surgery. PATIENTS AND METHODS: The study includes 68 consecutive patients with prostate cancer who underwent surgery due to neurological compromise. Intervals from onset of neurological symptoms to referral, diagnosis, and treatment were analyzed in relation to functional outcome. The prognostic significance of preoperative clinical parameters on gait function one month after surgery was evaluated. RESULTS: Patients who were referred from local hospitals had longer delay to surgery than those who directly presented to the cancer center (p = 0.004). The rate of diagnosis with MRI increased through the week and peaked on Friday, with few patients being diagnosed during weekends. The ability to walk before surgery, hormone-naive prostate cancer, and/or shorter time from loss of ambulation were associated with more favorable neurological outcome. In patients with hormone-refractory disease who were unable to walk before surgery regaining ambulation was associated with: duration of paresis < 48 hours (p = 0.005), good preoperative performance status (p = 0.04), preoperative PSA serum level < 200 ng/ml (p = 0.03), and surgery with posterior decompression and stabilization (p = 0.03). CONCLUSION: Early diagnosis and rapid treatment of spinal cord compression in prostate cancer patients is crucial for neurological recovery. Raising awareness of the condition among patients at risk and among physicians is of outmost importance as well as improving local and regional guidelines for treatment.

[Functional results of surgery for cervical stenosis]. / Resultados funcionales de la cirugía del conducto cervical estrecho.

INTRODUCTION: Cervical stenosis refers to the narrowing of the spinal canal or the intervertebral foramina at different anatomic levels, secondary to pathologic processes of the vertebral elements. Surgical management is used when conservative management fails. The anterior and posterior approaches are the most frequently used ones, and the surgical options resulting from these approaches are: anterior cervical diskectomy plus fusion, anterior corporectomy plus fusion, laminoplasty, laminectomy and arthroplasty. MATERIAL AND METHOD: This is an ambispective study conducted in 195 patients with a diagnosis of cervical stenosis who required surgical treatment at our hospital from January 1995 to January 2007. The neck disability index questionnaire was applied, as well as the Nurick scale. Descriptive statistics was used with frequency and percentage measures. RESULTS: The review of the National Rehabilitation Institute electronic records from January 1st 1995 to December 31st 2007 showed that 195 patients underwent surgery for cervical stenosis. Females were predominant. The most affected age group was 46-55 years. The most frequently affected level was C5-C6. A significant improvement was seen in the neck disability index due to pain and the Nurick scale. CONCLUSION: According to world literature, mean age of patients with cervical stenosis is 57.2 years, and the most compromised levels were C4-C5 and C5-C6. Improvement was evident according to the neck disability index and the Nurick scale.

Inpatient rehabilitation of patients with cancer: efficacy and treatment considerations.

Although cancer can affect a great number of individuals and is the second leading cause of death in the United States, the number of individuals admitted to acute inpatient rehabilitation units with impairments primarily as the result of cancer diagnoses remains small. There is a lack of awareness among health care providers as to the functional loss that can be associated with cancer and the potential benefits of inpatient rehabilitation. Furthermore, financial pressures from third-party payors may dissuade the admission of patients with cancer for inpatient rehabilitation. This is a narrative review of the literature with respect to the efficacy and potential benefits of inpatient rehabilitation for patients with cancer. The findings of studies on the rehabilitation of general cancer populations are presented, with a focus on functional outcomes, medical complications and transfer rates, and common symptoms encountered during inpatient rehabilitation. Studies that focus on tumors involving the brain and spinal cord are separately analyzed. Functional outcomes by tumor location are reviewed with respect to tumor type, recurrence, and comparison with nontumor diagnoses. In addition, the effects of concomitant treatments on functional outcomes and possible correlations of survival with functional outcome are presented. Justification for admission of patients with cancer diagnoses to inpatient rehabilitation units, as well as implications for management of these patients during their rehabilitation stay, will be summarized.

Kinematic study of locomotor recovery after spinal cord clip compression injury in rats.

After spinal cord injury (SCI), precise assessment of motor recovery is essential to evaluate the outcome of new therapeutic approaches. Very little is known on the recovery of kinematic parameters after clinically-relevant severe compressive/contusive incomplete spinal cord lesions in experimental animal models. In the present study we evaluated the time-course of kinematic parameters during a 6-week period in rats walking on a treadmill after a severe thoracic clip compression SCI. The effect of daily treadmill training was also assessed. During the recovery period, a significant amount of spontaneous locomotor recovery occurred in 80% of the rats with a return of well-defined locomotor hindlimb pattern, regular plantar stepping, toe clearance and homologous hindlimb coupling. However, substantial residual abnormalities persisted up to 6 weeks after SCI including postural deficits, a bias of the hindlimb locomotor cycle toward the back of the animals with overextension at the swing/stance transition, loss of lateral balance and impairment of weight bearing. Although rats never recovered the antero-posterior (i.e. homolateral) coupling, different levels of decoupling between the fore and hindlimbs were measured. We also showed that treadmill training increased the swing duration variability during locomotion suggesting an activity-dependent compensatory mechanism of the motor control system. However, no effect of training was observed on the main locomotor parameters probably due to a ceiling effect of self-training in the cage. These findings constitute a kinematic baseline of locomotor recovery after clinically relevant SCI in rats and should be taken into account when evaluating various therapeutic strategies aimed at improving locomotor function.

Giant cell bone tumor of the thoracic spine presenting in late pregnancy.

BACKGROUND: We report a case of a large giant cell tumor of the thoracic spine presenting with spinal cord compression during pregnancy. CASE: A 24-year-old woman presented at term with lower back pain, bilateral lower extremity weakness, numbness, and bowel and bladder incontinence. Magnetic resonance imaging revealed a spinal soft tissue mass compressing the spinal cord. The patient delivered a healthy girl by cesarean then underwent a T8-T9 laminectomy, posterior spinal decompression, and instrument fusion. Two days later, she had a thoracotomy, corpectomy of the vertebral body, and anterior tumor debulking. Ultimately, the patient was discharged to inpatient rehabilitation with improved lower extremity strength and returned bowel and bladder function. CONCLUSION: Obstetricians should be vigilant regarding progressive neurologic symptoms during pregnancy.

Rehabilitation in neuro-oncology: a meta-analysis of published data and a mono-institutional experience.

BACKGROUND: Rehabilitation for cancer patients with central nervous system (CNS) involvement is rarely considered and data on its use are limited. The purpose of the present study is to collect all available published data on neuro-oncology rehabilitation and perform a meta-analysis where results were presented in a comparable manner. Moreover, the authors report results on cancer patients with neurological disabilities undergoing rehabilitation at their unit. STUDY DESIGN: A PubMed search was performed to identify studies regarding cancer patients with CNS involvement undergoing inpatient physical rehabilitation. Studies with a complete functional evaluation at admission and discharge were selected. As the most common evaluation scales were Functional Independence Measure (FIM) and Barthel Index (BI), only articles with complete FIM and/or BI data were selected for the meta-analysis. Moreover, 23 cancer patients suffering from diverse neurological disabilities underwent standard rehabilitation program between April 2005 and December 2007 at the San Raffaele Pisana Rehabilitation Center. Patient demographics and relevant clinical data were collected. Motricity Index, Trunk Control Test score, and BI were monitored during rehabilitation to assess patient progresses. BI results of patients in this study were included in the meta-analysis. RESULTS: The meta-analysis included results of a total of 994 patients. A statistically significant (P < .05) improvement of both BI and FIM scores was demonstrated after rehabilitation (standardized mean difference = 0.60 and 0.75, respectively). Functional status determined by either FIM or BI improved on average by 36%. CONCLUSION: Published data demonstrate that patients with brain tumors undergoing inpatient rehabilitation appear to make functional gains in line with those seen in similar patients with nonneoplastic conditions.

Conservative treatment with hyperbaric oxygen therapy for cervical spondylotic amyotrophy.

STUDY DESIGN: Small case series of patients with cervical spondylotic amyotrophy (CSA) managed by conservative treatment with hyperbaric oxygen (HBO) therapy. OBJECTIVE: To study the effects of conservative treatment with HBO therapy of CSA patients. SETTING: Department of Orthopaedic Surgery, Imakiire General Hospital, Kagoshima, Japan. METHODS: This study included 10 patients with CSA who underwent rehabilitation, including cervical traction and muscle exercise, for some period of time but did not respond well to it, and were then managed by additional HBO therapy for rehabilitation. Information was obtained on the duration of symptoms and strength of the most atrophic muscle, intramedullary high-signal-intensity changes on T2-weighted magnetic resonance imaging, presence of 'snake-eyes' appearance and the number of stenotic canal levels. RESULTS: The mean duration of symptoms before HBO treatment was 3.1 months. The axial T2-weighted magnetic resonance images of all 10 patients showed a 'snake-eyes' appearance. The mean number of stenotic canal levels was 0.3. There was marked improvement on manual muscle testing from a mean of 1.9 pretreatment to a mean of 4.4 at the last follow-up after HBO therapy. The outcomes of all 10 patients, whose results were classified as excellent or good, were considered clinically satisfactory. CONCLUSION: To our knowledge, conservative treatment with HBO therapy for CSA patients has not previously been described. It appears that HBO therapy might improve ischemic injury of the anterior horns in CSA patients with short duration of symptoms.

Paraplegia associated with spinal hydatid cyst: a case report.

STUDY DESIGN: Case report. OBJECTIVES: To report a case with paraplegia caused by spinal hydatid cyst. SUMMARY OF BACKGROUND DATA: Hydatid cyst is a disease caused by larval Echinococcus granulosus tapeworm. Spinal hydatid cyst rarely leads to severe neurologic problems. METHODS: A 34-year-old male patient was referred to our outpatient clinic due to back and low back pain, progressive weakness and numbness in both lower extremities, and a prediagnosis of lumbar disc hernia. He had spastic paraplegia, and thorax magnetic resonance imaging revealed a lobulated cystic lesion with extradural intraspinal localization. RESULTS: After surgery and following 2 months of rehabilitation program, the patient showed a dramatic clinical improvement. CONCLUSION: By this case, it is emphasized that spinal hydatid cyst should come to mind in the differential diagnosis of spinal cord compression, and the importance of prevention, early diagnosis, and treatment is highlighted because of high mortality and morbidity.

Clinical significance of intramedullary Gd-DTPA enhancement in cervical myelopathy.

STUDY DESIGN: Prospective multicenter study. OBJECTIVE: To clarify the significance of intramedullary Gd-DTPA enhancement in cervical myelopathy, the prevalence, morphologic features, clinical relevance and postoperative change were investigated. SETTING: Four hospitals in Japan. METHODS: A total of 683 patients with cervical myelopathy who underwent decompressive surgery were consecutively examined. T1, 2 and Gd-DTPA-enhanced MRI were taken before surgery. Fifty consecutive cases without intramedullary enhancement were allocated in the non-enhancement group. The following variables were investigated: prevalence of the enhancement, the morphologic feature, the relationship between the enhancement and T2 high-intensity areas, the change of the Japanese Orthopedic Association (JOA) score for cervical myelopathy and the change of the enhancement after surgery. RESULTS: Intramedullary enhancement was observed in 50 cases (7.3%). The enhancements were observed between the most severely compressed disc and the cranial half of the lower vertebral body. On axial images, they were observed at the posterior or posterolateral periphery of the spinal cord. Enhancement areas were observed within T2 high-intensity areas and smaller than them. The preoperative JOA score was 9.8+/-2.8 points in the enhancement group and 9.8+/-3.3 points in the non-enhancement group (NS). The postoperative JOA score was 12.7+/-2.9 points in the enhancement group and 14.2+/-2.4 in the non-enhancement group (P=0.006). Intramedullary enhancement disappeared in 60% of the patients 1 year after surgery. CONCLUSION: Intramedullary enhancement indicated not the severity of preoperative symptoms, but a sign of a worse prognosis.

Patients' constructions of disability in metastatic spinal cord compression.

Metastatic spinal cord compression (MSCC) is characterised by poor prognosis and serious physical disability. Patients have complex rehabilitation needs, but the evidence on rehabilitation is sparse. This study aimed to ascertain the constructions placed upon disability by patients with MSCC. The method consisted of a series of nine process-tracing, longitudinal case studies, involving 58 interviews with 9 patients, 6 carers and 29 staff in one National Health Service region. A context-mechanism-outcome configuration was adopted as a conceptual basis for data collection, together with a constant comparative method of data analysis. Patients' orientation to disability incorporated two apparently inconsistent attitudes. Patients acknowledged that their situation had changed and that their future plans would need to accommodate altered circumstances. However, they also resisted the idea of themselves as disabled, wanting to retain an image of themselves as resourceful and resilient. Patients used a number of strategies to reconcile the tension between these two positions. The illusions incorporated into the 'failure to acknowledge' pole of this orientation are self-protective and, like other positive illusions, have psychological benefits. Providing effective and acceptable support to patients living with disability relies on professional responses that are able to sustain patients' sense of their own competence.