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1.
World Neurosurg ; 133: e76-e83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521757

RESUMO

OBJECTIVE: Spine fractures, including associated spinal cord injury, account for 3%-6% of all skeletal fractures annually in the United States. Patients who undergo interhospital transfer after injury may have a greater likelihood of nonroutine disposition, longer hospital stay, and higher cost. We evaluated the effects of patient transfer on functional outcomes after spine trauma. METHODS: Patients were treated after acute traumatic spine injury at a rehabilitation hospital in 2011-2017. Compared patients were those directly admitted to the tertiary hospital or transferred from a community hospital. RESULTS: A total of 188 patients (mean age 46.1 ± 18.6 years, 77.1% men) were evaluated, including 130 (69.1%) directly admitted and 58 (30.9%) transferred patients. The most common levels of injury were at C5 (19.1%) and C6 (12.2%), and most injuries were American Spinal Injury Association injury severity score grade D (33.2%) or grade A (32.1%). No statistical difference in age, injury pattern, timing from injury to surgery, or rehabilitation length of stay was seen between admitted and transferred patients. A significant improvement in ambulation distances was seen at discharge for directly admitted compared with transferred patients (447.7 ± 724.9 vs. 159.9 ± 359.5 feet; P = 0.005). However, no significant difference primary outcomes, namely American Spinal Injury Association injury severity score distribution (P = 0.2) or Functional Independence Measures (Δ30.9 ± 15.9 vs. 30.1 ± 17.1; P = 0.7), were seen between admitted and transferred patients at time of rehabilitation discharge. CONCLUSIONS: Interhospital transfer status did not diminish time to rehabilitation after injury or reduce functional recovery, suggesting early surgical treatment in community settings may have merit prior to transfer.


Assuntos
Transferência de Pacientes , Traumatismos da Coluna Vertebral/reabilitação , Atividades Cotidianas , Adulto , Idoso , Continuidade da Assistência ao Paciente , Feminino , Hospitais Comunitários , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/cirurgia , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/cirurgia , Centros de Atenção Terciária , Centros de Traumatologia , Índices de Gravidade do Trauma , Resultado do Tratamento , Adulto Jovem
2.
World Neurosurg ; 132: 197-201, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31450001

RESUMO

BACKGROUND: Gunshot wounds are the most common etiology of penetrating spine injuries and have been increasing in incidence in civilian populations. Although these injuries typically result in severe neurologic deficits, operative intervention remains is controversial and is usually reserved for patients with neurologic deterioration, a persistent externalized cerebrospinal fluid fistula, mechanical instability, metallic toxicity, or a bullet location at high risk of migration. CASE DESCRIPTION: A previously asymptomatic patient who had sustained a gunshot wound to the cervical spine 20 years previously presented with new-onset progressive myelopathy and radiculopathy secondary to heterotopic ossification (HO) surrounding the retained bullet fragments near the left lateral masses of C5-T1. Computed tomography myelography demonstrated no cranial migration of contrast material past this region of the spine, suggesting severe spinal canal stenosis. Intraoperatively, bullet shrapnel and heterotopic bone fragments were found within the central canal causing compression of the spinal cord. Following decompression and stabilization, the patient had complete resolution of his symptoms and returned to his neurologic baseline. Although HO has been reported as a complication following through and through gunshot wounds, there is a paucity of literature discussing HO formation around retained bullet fragments in the spine. CONCLUSIONS: HO surrounding retained bullet fragments in the spine is a rare cause of progressive neurologic deterioration following gunshot wounds. Surgical excision of the shrapnel and heterotopic bone can lead to symptomatic relief, and therefore surgery should be considered as a treatment option in carefully selected patients.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/cirurgia , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/cirurgia , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/cirurgia , Adulto , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Humanos , Laminectomia , Masculino , Procedimentos Neurocirúrgicos/métodos , Radiculopatia/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
World Neurosurg ; 131: e586-e592, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31404692

RESUMO

OBJECTIVE: Early decompression after acute spinal cord injury (SCI) is recommended. Acute care is crucial, but optimal management is unclear. The aim of this study was to investigate the role of preoperative magnetic resonance imaging (MRI) in addition to computed tomography (CT) in surgical decision making for acute cervical SCI. METHODS: All patients with cervical SCI between 2008 and 2016 who had preoperative CT and MRI (n = 63) at the Trauma Center Murnau, Germany, were included. We administered a survey to 10 experienced spine surgeons (5 neurosurgeons, 5 trauma surgeons) regarding the surgical management. First, the surgeons were shown clinical information and CT scans. Two months later, the survey was repeated with additional MRI. Corresponding percentages of change and agreement were obtained for each rater and survey item. Finally, results from both parts of the survey were compared with the definitive treatment option (i.e., real-world decision). RESULTS: MRI modified surgical timing in a median of 41% of patients (interquartile range 38%-56%). In almost every fifth patient (17%), no surgery would have been indicated with CT alone. The advocated surgical approach was changed in almost half of patients (median 48%, interquartile range 33%-49%). Surgically addressed levels were changed in a median of 57% of patients (interquartile range 56%-60%). MRI led to higher agreement with the real-world decision concerning addressed levels (median 35% vs. 73%), timing (median 51% vs. 57%), and approach (median 44% vs. 65%). CONCLUSIONS: Preoperative MRI influenced surgical decision making substantially in our cohort and has become a new standard for patients with cervical SCI in our institution if medically possible.


Assuntos
Tomada de Decisão Clínica , Descompressão Cirúrgica/métodos , Imagem por Ressonância Magnética , Neurocirurgiões , Procedimentos Neurocirúrgicos/métodos , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatologia , Vértebras Cervicais , Humanos , Período Pré-Operatório , Traumatismos da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Cirurgiões , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
4.
World Neurosurg ; 130: 84-88, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31284057

RESUMO

BACKGROUND: Hirayama disease (HD), characterized by insidiously progressive muscular atrophy of forearms and hands, is a self-limited cervical myelopathy that predominantly affects male adolescents, with female patients, especially middle-aged women, rarely affected. We present a rare case of HD with severe spinal cord injury in a 34-year-old woman. CASE DESCRIPTION: A 34-year-old woman presented with progressive weakness of both hands and forearms for a duration of 6 years and spastic gait for 1 year. The patient worked as a teacher and experienced long-term and repetitive neck flexion while writing at a desk, potentially causing cervical loading. Examination showed weakness and muscular atrophy of the bilateral upper limbs and pyramidal signs, including Hoffmann sign and hyperreflexia of the lower limbs. Radiologic studies revealed midcervical kyphosis and spinal cord compression by forward displacement of the dura mater with neck flexion. The clinical presentation and radiologic characteristics confirmed the diagnosis of HD. Anterior cervical corpectomy and fusion was performed owing to severe spinal cord injury, and the patient experienced satisfactory improvement. CONCLUSIONS: The present case clarified the potential involvement of cervical kyphosis and cervical loading-related exercise in the onset and progression of HD. Anterior cervical corpectomy and fusion could serve as a promising treatment of HD with severe spinal cord injury.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Índice de Gravidade de Doença , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico por imagem , Atrofias Musculares Espinais da Infância/complicações , Atrofias Musculares Espinais da Infância/diagnóstico por imagem , Adulto , Vértebras Cervicais/cirurgia , Feminino , Humanos , Traumatismos da Medula Espinal/cirurgia , Atrofias Musculares Espinais da Infância/cirurgia
5.
World Neurosurg ; 129: e343-e351, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132502

RESUMO

OBJECTIVE: Repair of spinal cord injury (SCI) using peripheral nerve graft (PNG) and acidic fibroblast growth factor (aFGF) has shown promising results in rats and a few human patients, but not in nonhuman primates. The aim of this study was to verify the effective use of PNG and aFGF for repairing incomplete SCI in nonhuman primates. METHODS: Six adult rhesus macaques received spinal cord hemisection at T8 level and were grouped into repair and control groups (n = 3 in each). Animals in the repair group underwent nerve repair with autologous PNG plus aFGF immediately after lesioning. The control group received exactly the same operation for lesioning but no treatment. Postoperative behavioral evaluations, electrophysiologic tests (including motor and somatosensory evoked potentials), and magnetic resonance imaging were performed and compared between the 2 groups as well as histologic examination of the spinal cord cephalic to, at, and caudal to the lesion site after sacrifice. RESULTS: Animals in the repair group had better motor function in the lower limbs at every observed time point and demonstrated more improvement on electrophysiologic examinations than the control group. The repair group had smaller areas of myelomalacia on magnetic resonance imaging around the lesion compared with the control group, suggesting diminished inflammatory responses with the repair strategy. CONCLUSIONS: PNG plus aFGF for SCI in nonhuman primates yielded improvements in clinical behavior, electrophysiologic tests, and magnetic resonance imaging. This study suggests that the repair strategy is feasible and effective for nonhuman primate SCI. Further investigations are warranted to corroborate its effectiveness for clinical application.


Assuntos
Fator 1 de Crescimento de Fibroblastos/uso terapêutico , Regeneração Nervosa/fisiologia , Transferência de Nervo/métodos , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/terapia , Animais , Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Macaca mulatta , Masculino , Modelos Animais , Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/cirurgia
6.
Top Spinal Cord Inj Rehabil ; 25(2): 186-193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31068749

RESUMO

Objective: To describe long-term neurological and functional outcomes for patients with penetrating spinal cord injury (PSCI) following surgical (SX) and nonsurgical (NSX) treatment. Methods: We identified all patients with PSCI in the Spinal Cord Injury Model Systems database from 1994-2015. Patients with PSCI were divided into surgical (SX) and nonsurgical (NSX) groups. Outcomes were measured using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Functional Independence Measure (FIM) motor scores. Outcomes were then analyzed separately for patients with complete and incomplete PSCI during acute hospitalization, SCI rehabilitation, and 1-year follow-up. Results: For patients with complete PSCI, acute hospital length of stay (LOS) was increased in the SX group (19 days vs 14 days; p < .0001) while median FIM motor scores were similar at 1-year follow-up (74 vs 75; p = .4). The percentage of patients with complete PSCI remained similar between groups at discharge from SCI rehabilitation (88% vs 88%; p = 0.5). For patients with incomplete PSCIs, acute hospital LOS was similar between groups (13 vs 11; p = .3) and no difference was observed in ASIA Impairment Scale improvement at discharge from rehabilitation (38% vs 37%; p = .9) or in FIM scores at 1 year (84 vs 85; p = .6). Conclusion: Surgery for patients with complete PSCI is associated with increased acute hospital LOS for complete PSCI and is not associated with improvement in neurological or functional outcomes in patients with either complete or incomplete PSCI.


Assuntos
Traumatismos da Medula Espinal/reabilitação , Ferimentos Penetrantes/reabilitação , Adulto , Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Prospectivos , Transtornos Psicomotores/etiologia , Transtornos Psicomotores/fisiopatologia , Transtornos Psicomotores/reabilitação , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/cirurgia , Resultado do Tratamento , Ferimentos Penetrantes/fisiopatologia , Ferimentos Penetrantes/cirurgia , Adulto Jovem
7.
World Neurosurg ; 128: 611-615.e1, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31078807

RESUMO

BACKGROUND: Tetraplegia caused by cervical spinal cord injury is devastating for patients and represents a significant public health problem in both developed and developing countries. Improved functional outcomes after nerve transfers are increasingly reported in the literature, but thus far, no options exist for injuries above the C5 level. CASE DESCRIPTION: We report the cases of 2 patients with C4 spinal cord injury, American Spinal Injury Association A, who underwent successful bilateral spinal accessory nerve transfers, on 1 side to the triceps nerve with long intervening sural graft and on the other side direct transfer to the motor fascicles of the middle trunk. Patients improved from Medical Research Council 0 to 4 on the side of the nerve graft and 0 to 2 or 3 on the side of the direct transfer. Both patients also underwent transfer of the greater auricular nerve to sensory fascicles of the middle trunk, and they experienced sensory recovery in the C6 distribution. Notably, both patients were far removed from the traditional window of nerve transfer surgery at 4 years and almost 11 years out from injury. CONCLUSIONS: We describe 2 successful cases of the first and to date only option for motor and sensory reinnervation in high cervical spinal cord injuries. These procedures provide a robust nerve transfer option capable of improving quality of life in tetraplegic patients. There may be a significant undertreated population of patients with cervical spinal cord injury patients in the United States who were previously considered outside the window for benefiting from nerve transfers but who would benefit from these techniques.


Assuntos
Nervo Acessório/transplante , Plexo Braquial/cirurgia , Transferência de Nervo/métodos , Quadriplegia/cirurgia , Traumatismos da Medula Espinal/cirurgia , Nervo Sural/transplante , Adolescente , Adulto , Plexo Cervical/cirurgia , Vértebras Cervicais , Humanos , Masculino , Quadriplegia/etiologia , Traumatismos da Medula Espinal/complicações
8.
Medicine (Baltimore) ; 98(19): e15531, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083201

RESUMO

RATIONALE: Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that causes venous infarction and intracerebral hemorrhage (ICH) with occlusion of cerebral veins, and its incidence is estimated to be 5 per 1 million people per year, accounting for 0.5% to 1.0% of all strokes. Despite advances in the recognition of CVT, the diagnosis and treatment may be difficult because of the diversity of underlying risk factors. A rare case of ICH due to CVT during surgery is described. PATIENT CONCERNS: A 69-year-old-man presented to our department with a history of paralyzed extremities after a backward fall and head trauma. The patient had a history of pharyngeal cancer treated with neck dissection and radiotherapy. Computed tomography (CT) images showed continuous ossification of the posterior longitudinal ligament (OPLL) at C2-5 levels and a fracture line at the caudal end plate of the C5 body. The diagnosis was traumatic cervical cord injury, so that posterior cervical decompression and fusion was performed. Immediately after surgery, the patient developed an epileptic seizure and the disturbance of consciousness persisted. MR venography and contrast CT images showed absence of flow from the superior sagittal sinus to the transverse sinus. DIAGNOSES: The diagnosis in this case was ICH due to CVT. INTERVENTIONS: The patient was treated with anticoagulation using unfractionated heparin. OUTCOMES: The patient ultimately made a complete recovery from CVT. LESSONS: Although risk factors for CVT are diverse, head and neck injury, patient's position during surgery, and postoperative radical neck dissection for pharyngeal cancer might have been the factors in this case. While the measures to prevent this disease are uncertain, early diagnosis and treatment are needed to avoid serious complications.


Assuntos
Hemorragia Cerebral/etiologia , Vértebras Cervicais/cirurgia , Trombose Intracraniana/complicações , Complicações Intraoperatórias/etiologia , Traumatismos da Medula Espinal/cirurgia , Idoso , Descompressão Cirúrgica , Humanos , Masculino , Esvaziamento Cervical , Neoplasias Faríngeas/radioterapia , Neoplasias Faríngeas/cirurgia , Fusão Vertebral
9.
World Neurosurg ; 126: e1494-e1502, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30910750

RESUMO

OBJECTIVE: Spine trauma management in children varies from one team to another, and to date, no clear consensus has been reached. The goal of this study was to describe the epidemiology of spine trauma in children and evaluate the timing and techniques of surgery when it was required. METHODS: A retrospective review of all patients admitted to our pediatric trauma center for spine traumas that required surgical management, between 2005 and 2016, was performed. All patients were followed with clinical and radiologic examination to evaluate the quality of fusion and realignment. RESULTS: Seventy-three children, with a mean age of 14.1 years, were admitted. Spinal injuries were more common in the teenage group (14-18 years). The predominant etiology of spine injuries was motor vehicle collision (36%). The spinal level of injury varied according to the age group: young children presented more cervical traumas (P < 0.01), while teenagers presented more lumbar traumas. There were more fractures alone in the teenage group (P < 0.005), while there were more luxations alone in the school-age group (P < 0.05). Median timing for surgical intervention in patients with neurologic deficits was 1 day. Patients with posterior wall recession >5 mm underwent surgical management quicker than patients with no posterior wall recession (P < 0.03). At follow-up, out of the 37 patients with initial neurologic deficits, 14 had improved (38%). CONCLUSIONS: Diskoligament maturation is an essential concept in spine traumas in children, as well as in surgical management. Surgical procedures should be carried out as soon as possible when patients present with neurologic deficits. At the thoracolumbar junction, a 2-level up-and-down fixation is recommended.


Assuntos
Traumatismos da Coluna Vertebral/cirurgia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , Fixação Intramedular de Fraturas , Humanos , Lactente , Vértebras Lombares/lesões , Masculino , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/epidemiologia , Tempo para o Tratamento , Tomografia Computadorizada por Raios X
10.
World Neurosurg ; 127: e101-e107, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30851463

RESUMO

OBJECTIVES: Spine surgeons at a Level 1 Trauma Center have observed a high incidence of spine and spinal cord injuries owing to falls from tree stands. These injuries have been retrospectively reviewed in the context of the Thoracolumbar Injury Classification and Severity (TLICS) and the Subaxial Cervical Injury Classification and Severity (SLICS) classification systems to assess inter-user reliability and validity. We hypothesize that the inter-rater reliability will be similar between neuroradiology and neurosurgery raters and validity of the scoring system will be maintained at our institution. METHODS: The University of Wisconsin Hospital and Clinics' trauma database was reviewed for tree stand-related injuries from 1999 to 2013, with a focus on patients suffering from spine and spinal cord injuries. The TLICS and SLICS scores were then independently determined for these injuries by a neurosurgeon and a neuroradiologist. RESULTS: When cases were grouped by management recommendation (operative, equivocal, and nonoperative) reviewer agreement was 12/15 (80%) of SLICS and 38/52 (73%) of TLICS scores. Operative SLICS positive predictive value reached 100%, however, with a wide confidence interval. Conversely, the SLICS negative predictive value was poor at 54%-60%, with frequent operative treatment for patients assigned nonoperative scores. TLICS scores reached 77.8% and 93.3% positive predictive value per reviewer, whereas negative predictive values reached 93.9% and 89.2%, respectively. CONCLUSIONS: The TLICS and SLICS systems provide good-to-excellent inter-rater reliability. SLICS validity was poor, whereas TLICS was reasonable for nonoperative cases and moderate for operative cases. Systems such as the TLICS and the SLICS may be best applied in the educational setting to confirm the fracture morphology and presence or absence of ligamentous injury between surgeons and radiologists.


Assuntos
Vértebras Cervicais/lesões , Vértebras Lombares/lesões , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Índices de Gravidade do Trauma , Acidentes por Quedas/estatística & dados numéricos , Vértebras Cervicais/cirurgia , Tratamento Conservador , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Lesões do Pescoço/classificação , Variações Dependentes do Observador , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/terapia , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/cirurgia , Wisconsin/epidemiologia
11.
Medicine (Baltimore) ; 98(8): e14527, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813159

RESUMO

RATIONALE: Pregnancy after spinal cord injury, hip resection, leg amputation, and scoliosis is an uncommon event. Given the specific pathophysiological changes in this patient, an aesthetic management presented a particular challenge. The effects on the physiological changes associated with pregnancy, aesthetic methods, blood loss, autotransfusion from uterine contractions and thrombotic risk had to be considered. PATIENT CONCERNS: A 25-year-old female earthquake survivor was admitted at 36.4 weeks of pregnancy for preterm labor. She had suffered from a spinal cord injury and complex trauma and had subsequently undergone left hip resection, bilateral amputations, and multiple surgical procedures during the previous 6 years. Additionally, she had developed severe scoliosis due to her weight-bearing posture. DIAGNOSES: High amputation after earthquake injury; Scoliosis; Vulvar reconstruction; Intrauterine pregnancy (35.6 weeks) with a single live fetus with possible premature delivery. INTERVENTIONS: We administered general anesthesia during a cesarean section for the parturient woman. Both the central venous pressure and pleth variability index were used to continuously evaluate intraoperative fluid management and blood loss. OUTCOMES: Delivery and patient recovery were uneventful. LESSONS: Anesthetic management of a pregnant woman with a spinal injury, scoliosis, left total leg and right below-knee amputations, and left hip resection requires considerable attention. Advances in medical technology have provided clinicians with insights into managing patients with this condition.


Assuntos
Anestesia Geral/métodos , Cesárea/métodos , Trabalho de Parto Prematuro/terapia , Escoliose/cirurgia , Traumatismos da Medula Espinal/cirurgia , Adulto , Amputação , Anestésicos/administração & dosagem , Terremotos , Feminino , Articulação do Quadril/cirurgia , Humanos , Monitorização Intraoperatória/métodos , Traumatismo Múltiplo/cirurgia , Gravidez , Escoliose/complicações , Traumatismos da Medula Espinal/complicações , Sobreviventes
12.
Med Sci Monit ; 25: 1970-1975, 2019 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-30877267

RESUMO

BACKGROUND The objective of the study was to identify risk factors for poor prognosis of cervical spinal cord injury (SCI) with subaxial cervical fracture-dislocation after surgical treatment. MATERIAL AND METHODS A total of 60 cervical SCI patients with subaxial cervical fracture-dislocation were primarily included in the study from April 2013 to April 2018. All the enrolled subjects received surgical treatment. The enrolled patients with complete follow-up record were divided into 2 groups based on the neural function prognosis: a non-functional restoration group and a functional restoration group. Multivariate regression analysis was performed to identify independent risk factors for poor prognosis of SCI after surgical treatment. RESULTS Fifty-five subjects were included in this study, and the follow-up time ranged from 8.5 to 44.5 months. A total of 25 subjects were categorized into the non-functional restoration group and 30 subjects into the functional restoration group. According to the results of multivariate regression analysis, time from injury to operation (more than 3.8 days), subaxial cervical injury classification (SLIC, score more than 7.5), and maximum spinal cord compression (MSCC, more than 55.8%) are independent risk factors for poor prognosis of SCI after surgical treatment (p<0.05), with AUCs of 0.95 (time from injury to operation), 0.91 (SLIC score), and 0.96 (MSCC). CONCLUSIONS Time from injury to operation (more than 3.8 days), SLIC score (more than 7.5), and MSCC (more than 55.8%) are independent risk factors for poor prognosis of SCI with subaxial cervical fracture-dislocation after surgical treatment.


Assuntos
Traumatismos da Medula Espinal/mortalidade , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Adulto , Medula Cervical/lesões , Vértebras Cervicais/cirurgia , China , Feminino , Fraturas Ósseas , Humanos , Luxações Articulares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Coluna Vertebral , Resultado do Tratamento
13.
World Neurosurg ; 126: e288-e294, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30822587

RESUMO

BACKGROUND: Spinal cord injury (SCI) may result in neuromotor, sensory, and autonomic function damages. Edema because of spinal cord trauma can reach serious dimensions. The aim of this study was to histologically evaluate the effects of duraplasty on neural tissues. METHODS: Twenty-eight Wistar rats were randomly divided into 4 experimental groups: group 1 received laminectomy without SCI (sham); group 2 received laminectomy and SCI with the weight drop method; group 3 received laminectomy, SCI, and duraplasty within the first 6-8 hours of SCI; and group 4 received laminectomy, SCI, and duraplasty after 24 hours of SCI. The neurologic functions of the rats were tested periodically. All animals were euthanized 28 days after the surgery. Histopathologic and immunohistochemical evaluations were performed, and Kruskal-Wallis tests were used for statistical comparison of data between the groups. RESULTS: There was no significant difference in the Tarlov examination scores from different time points between the groups. The number of neurons stained with nuclear factor kappa beta was higher in group 3 than groups 1 and 4. The number of neurons stained with terminal deoxynucleotidyl transferase dUTP nick-end labeling was higher in group 2 than group 3. CONCLUSIONS: Decompressive laminectomy is a procedure frequently used in spinal trauma surgery. However, it is often unclear whether the decompression is fully adequate. Our results will aid the development of further studies regarding the reliability of duraplasty in the treatment of SCI.


Assuntos
Dura-Máter/cirurgia , Procedimentos Neurocirúrgicos/métodos , Traumatismos da Medula Espinal/cirurgia , Animais , Descompressão Cirúrgica/métodos , Imuno-Histoquímica , Laminectomia , Exame Neurológico , Ratos , Ratos Wistar , Recuperação de Função Fisiológica , Resultado do Tratamento
14.
Med Sci Monit ; 25: 1164-1168, 2019 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-30753178

RESUMO

BACKGROUND The aim of this study was to evaluate 2 methods to treat patients with thoracic lumbar spine fracture with merging spinal cord injury, including complications of surgery and the influence of inflammatory factors. MATERIAL AND METHODS Eighty patients were randomly divided into an anterior decompression group (study group) or a posterior decompression group (control group) to observe perioperative complications, evaluate preoperative and postoperative nerve function, and evaluate the 6-month injured vertebral height and Cobb angle of the vertebral bodies. The expression level of TGF-ß2 on day 1, day 7, day 15, and day 30 after treatment was detected by enzyme-linked immunosorbent assay (ELISA). RESULTS The nerve function sensation score, the height of the vertebral body, and the recovery of Cobb angle were better for the anterior decompression group than the posterior decompression group and the effect was significant (P<0.05). The complication rate for the posterior decompression group was lower than the anterior decompression group. The level of TGF-ß2 in the anterior decompression group was higher than in the posterior decompression group for the same times: after day 1, day 7, day 15, and day 30 after treatment (P<0.05). CONCLUSIONS Patients who had thoracic lumbar spine fracture with merging spinal cord injury and who had anterior fixation achieved a good fixation effect; their neurologic and vertebral injury recovery was better. However, this relatively complex and traumatic surgery must consider the clinical manifestations and fractures of the patients and select the appropriate surgical approach.


Assuntos
Descompressão Cirúrgica/métodos , Fraturas da Coluna Vertebral/terapia , Adulto , Parafusos Ósseos , China , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Período Pós-Operatório , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas
15.
Mymensingh Med J ; 28(1): 182-192, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30755568

RESUMO

Spine injuries, a common component in Polytrauma are usually affects the young people and is a major cause of morbidity and poses a significant health care expenditure and considerable threats to survival and quality of life. We retrospectively assess the demographics, incidence, mode of trauma, associated spine injuries, complications, neurological improvement and mortality. Records of total 1695 admitted patients, spinal injuries were 262 patients. Among them 30(11.45%) patients were associated with Polytrauma victims. Eleven patients (36.67%) were admitted through Ortho emergency dept, 14(46.67%) patients through Intensive care unit (ICU), 5(16.66%) patients through other department (CVS, Urology). Most (56%) of the patients were young in the age range of 16 to 40 years. Cervical spines were most commonly (44%) affected followed by lumbar (31%), thoracic (13%), thoraco-lumbar (9%) and Cervico-thoracic (3%) spines. Road traffic accident was the common cause (80%). Twelve patients (40%) had problems at various steps of management and maximum problems occur in step III. Nineteen patients (63.33%) management needs co-ordination between various specialties. Significant number of patients (76.67%) required operative treatment (p<0.05) and 13.33% were managed conservatively. Mortality rate (10%) was insignificant (p>0.05%). Of these patients, 73.33% had shown neurological improvement of at least one ASIA grade. The treatment of spinal injury in polytrauma patient should follow the principle of Advanced Trauma Life Support (ATLS). Once life and limb-threatening injuries have been identified and addressed, suspected spinal cord injury patients should be immobilized as early as possible to reduced the secondary injury, improve motor and sensory function as well as reduced the extend of permanent paralysis.


Assuntos
Traumatismo Múltiplo/cirurgia , Traumatismos da Medula Espinal/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Adolescente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Traumatismo Múltiplo/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
16.
Neurol India ; 67(Supplement): S106-S114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30688243

RESUMO

Peripheral nerve injuries are extremely devastating, and their management is exceedingly complex. Microsurgical repair is the mainstay of treatment and this includes direct nerve repair, nerve grafts, nerve tubes and nerve transfers. Today, nerve transfers are being widely performed due to an increased understanding of cortical plasticity, motor re-education and perioperative rehabilitation, and they are now known to produce excellent functional outcomes. This manuscript reviews the current strategies for nerve repair, including comments on outcomes, with special emphasis on existing nerve transfer techniques.


Assuntos
Procedimentos Neurocirúrgicos/tendências , Traumatismos dos Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/tendências , Humanos , Microcirurgia/tendências , Transferência de Nervo/métodos , Transferência de Nervo/tendências , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/cirurgia , Resultado do Tratamento
17.
Turk Neurosurg ; 29(4): 506-512, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30649823

RESUMO

AIM: To understand the differences between operative versus conservative treatment in terms of the outcome measured according to the American Spinal Injury Association (ASIA) impairment scale (AIS) in patients with gunshot acquired spinal cord injuries. MATERIAL AND METHODS: A total of 168 patients were included in this retrospective study. The AIS score was recorded for all survivors who provided consent after emergence from spinal shock. Demographic information and level of injury were also recorded. Patients were categorized according to the management approach, and the outcome was measured at the 6-month follow-up, using the AIS score. Univariate statistics were used for data analysis. RESULTS: Most patients were male (91.6%), with a mean age of 26 ± 4.2 years. A majority of patients (73.2%) had incomplete spinal cord injuries. Among the complete spinal injuries, most involved the thoracic spine (84%). Overall, the thoracic spine was involved in half of the cases (51%). Twenty-six (15.4%) patients underwent surgery. The distribution of AIS score differed between the operative and non-operative groups. In both groups, the AIS score on follow-up differed significantly from admission AIS score (p < 0.001). However, no significant differences were found between groups on the AIS score at follow-up (p > 0.05). CONCLUSION: None of the management approaches showed superior neurological recovery. Therefore, we conclude that outcome improvement in young patients depends on appropriate selection of surgical candidates.


Assuntos
Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/terapia , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/terapia , Adolescente , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Tratamento Conservador/métodos , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Sacro/lesões , Traumatismos da Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Resultado do Tratamento , Ferimentos por Arma de Fogo/cirurgia , Adulto Jovem
18.
Ann Anat ; 222: 139-145, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30599238

RESUMO

Severe spinal cord injuries cause permanent neurological deficits and are still considered as inaccessible to efficient therapy. Injured spinal cord axons are unable to spontaneously regenerate. Re-establishing functional activity especially in the lower limbs by reinnervation of the caudal infra-lesional territories might represent an effective therapeutic strategy. Numerous surgical neurotizations have been developed to bridge the spinal cord lesion site and connect the intact supra-lesional portions of the spinal cord to peripheral nerves (spinal nerves, intercostal nerves) and muscles. The major disadvantage of these techniques is the increased hypersensitivity, spasticity and pathologic pain in the spinal cord injured patients, which occur due to the vigorous sprouting of injured afferent sensory fibers after reconstructive surgery. Using micro-surgical instruments and an operation microscope we performed detailed anatomical preparation of the vertebral canal and its content in five human cadavers. Our observations allow us to put forward the possibility to develop a more precise surgical approach, the so called "ventral root bypass" that avoids lesion of the dorsal roots and eliminates sensitivity complications. The proposed kind of neurotization has been neither used, nor put forward. The general opinion is that radix ventralis and radix dorsalis unite to form the spinal nerve inside the dural sac. This assumption is not accurate, because both radices leave the dural sac separately. This neglected anatomical feature allows a reliable intravertebral exposure of the dura-mater ensheathed ventral roots and their damage-preventing end-to-side neurorrhaphy by interpositional nerve grafts.


Assuntos
Paralisia/cirurgia , Traumatismos da Medula Espinal/cirurgia , Raízes Nervosas Espinhais/anatomia & histologia , Raízes Nervosas Espinhais/cirurgia , Cadáver , Dura-Máter/anatomia & histologia , Humanos , Microcirurgia/instrumentação , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/cirurgia , Regeneração Nervosa , Procedimentos Neurocirúrgicos , Nervos Periféricos/anatomia & histologia , Nervos Periféricos/cirurgia , Canal Vertebral/anatomia & histologia , Medula Espinal/anatomia & histologia , Medula Espinal/cirurgia , Coluna Vertebral/anatomia & histologia
19.
Neurocrit Care ; 30(2): 421-428, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30328047

RESUMO

BACKGROUND/OBJECTIVES: We recently developed techniques to monitor intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP) from the injury site to compute the optimum SCPP (SCPPopt) in patients with acute traumatic spinal cord injury (TSCI). We hypothesized that ISP and SCPPopt can be predicted using clinical factors instead of ISP monitoring. METHODS: Sixty-four TSCI patients, grades A-C (American spinal injuries association Impairment Scale, AIS), were analyzed. For 24 h after surgery, we monitored ISP and SCPP and computed SCPPopt (SCPP that optimizes pressure reactivity). We studied how well 28 factors correlate with mean ISP or SCPPopt including 7 patient-related, 3 injury-related, 6 management-related, and 12 preoperative MRI-related factors. RESULTS: All patients underwent surgery to restore normal spinal alignment within 72 h of injury. Fifty-one percentage had U-shaped sPRx versus SCPP curves, thus allowing SCPPopt to be computed. Thirteen percentage, all AIS grade A or B, had no U-shaped sPRx versus SCPP curves. Thirty-six percentage (22/64) had U-shaped sPRx versus SCPP curves, but the SCPP did not reach the minimum of the curve, and thus, an exact SCPPopt could not be calculated. In total 5/28 factors were associated with lower ISP: older age, excess alcohol consumption, nonconus medullaris injury, expansion duroplasty, and less intraoperative bleeding. In a multivariate logistic regression model, these 5 factors predicted ISP as normal or high with 73% accuracy. Only 2/28 factors correlated with lower SCPPopt: higher mean ISP and conus medullaris injury. In an ordinal multivariate logistic regression model, these 2 factors predicted SCPPopt as low, medium-low, medium-high, or high with only 42% accuracy. No MRI factors correlated with ISP or SCPPopt. CONCLUSIONS: Elevated ISP can be predicted by clinical factors. Modifiable factors that may lower ISP are: reducing surgical bleeding and performing expansion duroplasty. No factors accurately predict SCPPopt; thus, invasive monitoring remains the only way to estimate SCPPopt.


Assuntos
Circulação Sanguínea/fisiologia , Pressão do Líquido Cefalorraquidiano/fisiologia , Monitorização Neurofisiológica/métodos , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia , Medula Espinal/irrigação sanguínea , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/cirurgia , Adulto Jovem
20.
World Neurosurg ; 122: e754-e758, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30391609

RESUMO

OBJECTIVE: We sought to compare timing of intervention for patients with spinal cord injury (SCI) requiring surgical procedures during weekend versus weekday admissions. METHODS: The National Inpatient Sample database from 2012 to 2014 was queried to identify patients with SCI who underwent surgical treatment (decompression with or without stabilization) as an emergent/urgent procedure. Timing of intervention, inpatient morbidity, and inpatient mortality were compared between patients admitted during the weekend versus a weekday. Multiple logistic regression analyses were also performed. RESULTS: A total of 9390 patients were identified (mean age 55 years, 73.2% male) from the database, with 34.1% admitted during the weekend and 65.9% during a weekday. The average day of intervention for the entire cohort was 2.8 (SD 3.9, interquartile range 1-4); day 2.7 (standard deviation [SD] 4.0) versus day 2.8 ([SD] 3.9) for patients admitted in a weekend versus weekday (P = 0.418). After controlling for patient age, sex, and injury severity score on multiple logistic regression analysis, weekend admission was not significantly associated with early intervention (odds ratio [OR] 0.99; 95% confidence interval [CI], 0.82-1.21; P = 0.993), complication occurrence (OR 1.09; 95% CI, 0.86-1.38; P = 0.476), or inpatient mortality (OR 0.83; 95% CI, 0.44-1.56; P = 0.563). Patients with complete/American Spinal Injury Association A injuries were more likely to undergo early intervention (OR 2.09; 95% CI, 1.31-3.31; P = 0.002). CONCLUSION: In this national study, patients with SCI who were admitted during the weekend received surgical intervention as early as patients admitted during a weekday. Furthermore, no differences in complication or mortality rates between groups were found.


Assuntos
Procedimentos Neurocirúrgicos/tendências , Admissão do Paciente/tendências , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/cirurgia , Tempo para o Tratamento/tendências , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/normas , Admissão do Paciente/normas , Estudos Retrospectivos , Traumatismos da Medula Espinal/diagnóstico , Fatores de Tempo , Tempo para o Tratamento/normas
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