ABSTRACT
Spinal cord injury without radiographic abnormality (SCIWORA) is a rare phenomenon, but with advances in imaging and improvements in magnetic resonance imaging more cases are being identified. Even more uncommon is the finding of spinal cord avulsion as a type of SCIWORA with only single case reports in the literature. We present the case reports of 2 patients both experiencing spinal cord avulsion as a type of SCIWORA, secondary to improper lap-belt restraint during a motor vehicle accident.
Subject(s)
Seat Belts/adverse effects , Spinal Cord Injuries/etiology , Accidents, Traffic , Bradycardia/etiology , Cervical Vertebrae , Child Restraint Systems , Child, Preschool , Contusions/etiology , Diagnostic Errors , False Negative Reactions , Fecal Incontinence/etiology , Femoral Fractures/diagnosis , Humans , Hypesthesia/etiology , Hypotension/etiology , Intensive Care Units, Pediatric , Longitudinal Ligaments/injuries , Magnetic Resonance Imaging , Male , Paraplegia/etiology , Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/diagnostic imaging , Thoracic Vertebrae , Tomography, X-Ray Computed , Urinary Incontinence/etiologyABSTRACT
OBJECT: The authors conducted a biomechanical study in which they compared the uses of the Rogers interspinous and the Lovely-Carl tension band wiring techniques for internal fixation of the cervical spine. METHOD: An extensive biomechanical evaluation (stiffness in positive and negative rotations around the x, y, and z axes; range of motion in flexion-extension, bilateral axial rotation, and bilateral bending; and neutral zone in flexion-extension, bilateral axial rotation, and lateral bending to the right and to the left) was performed in two groups of intact calf cervical spines. After these initial tests, all specimens were subjected to a distractive flexion Stage 3 ligamentous lesion. Group 1 specimens then underwent surgical fixation by the Rogers technique, and Group 2 specimens underwent surgery by using the Lovely-Carl technique. After fixation, specimens were again submitted to the same biomechanical evaluation. The percentage increase or decrease between the pre- and postoperative parameters was calculated. These values were considered quantitative indicators of the efficacy of the techniques, and the efficacy of the two techniques was compared. CONCLUSIONS: Analysis of the findings demonstrated that in the spines treated with the Lovely-Carl technique less restriction of movement was produced without affecting stiffness, compared with those treated with the Rogers technique, thus making the Lovely-Carl technique clinically less useful.
Subject(s)
Bone Wires , Cervical Vertebrae/surgery , Internal Fixators , Animals , Biomechanical Phenomena , Cattle , Cervical Vertebrae/injuries , Cervical Vertebrae/physiopathology , Elasticity , Evaluation Studies as Topic , Follow-Up Studies , Intervertebral Disc/injuries , Intervertebral Disc/physiopathology , Intervertebral Disc/surgery , Longitudinal Ligaments/injuries , Longitudinal Ligaments/physiopathology , Longitudinal Ligaments/surgery , Pliability , Range of Motion, Articular/physiology , Rotation , Statistics, NonparametricABSTRACT
The clinical, radiological and operative findings in 10 consecutive patients with cervical spine trauma presenting with locked facets (bilaterally in nine patients) are reported. The treatment was cervical traction until reduction of the locked facets was achieved, followed by anterior surgical decompression and ostheosynthesis. Intervertebral disc herniation was present in nine of the patients, and ruptured calcified posterior longitudinal ligament was present in the remaining patient. Four patients improved after treatment (none of these had clinically complete tetraplegia preoperatively), and three patients died. Associated soft tissue injuries producing spinal cord compression after reduction of cervical locked facets were verified in all of the patients of this series, suggesting that systematic surgical exploration should be done in this category of patients.